The negative consequences of sedentary behavior and obesity have been well documented, yet almost one third of American children remain overweight or obese. As technology evolves and provides children more opportunities to talk, text, or play video games with friends, the amount of time left in the day for children to be active decreases. Some community-based initiatives have been shown to help children lose weight and prevent them from gaining weight, but most have failed to demonstrate long-term community-wide reductions in childhood obesity rates (1). Obesity prevention experts recommend a comprehensive approach, involving schools, parks, health departments, community programs, families, and health care practitioners (2,3). The purpose of our 10-week program, Fit Club, was to provide elementary school children ages 5 to 12 years and their parents structured nutrition education and tasting, gardening education, and physical activity and to improve their knowledge, attitudes, and behaviors regarding these topics.
A team composed of two registered dietitians, a fitness specialist, an epidemiologist, and public health students created and delivered the program at two after-school sites located in impoverished, urban areas. Before the program began, all children completed a physical activity pretest adapted from the Young Men’s Christian Association Youth Fitness Test. The test was modified to include only the flexibility and cardiorespiratory components, the distance run and sit-and-reach test. The children in kindergarten through second grade (K-2) completed a timed, half-mile run, whereas those in grades 3 through 6 completed a timed, 1-mile run. We did not have two separate sites to serve as controls, rather we compared pretest and posttest performance by attendance rate to see if better attendance was correlated with greater improvement. This design also allowed those who attended the least, which included students who never attended one of the classes but only the pretest and posttest, to serve as controls.
Our research team administered an oral survey preprogram and postprogram to the kindergarten to second grade children covering nutrition, gardening, and physical activity behaviors and attitudes. The older children completed the same survey in written form. The questions were at an appropriate reading level and asked for responses including yes/no, a number (e.g., number of glasses of water they drink each day), or a feeling (e.g., happy or sad) regarding games, healthy foods, gardening, and physical activity. Once per week, there was an interactive nutrition lesson. Parents were invited to sessions to facilitate interaction with their children. Each session was led by a registered dietitian and trained study personnel to ensure internal consistency. The topics covered included Food Pyramid, Vary Your Veggies, Focus on Fruits, Make Half Your Grains Whole, Get Your Calcium Rich Foods, Go Lean with Protein, Portion Distortion and Label Reading, Purchasing and Preparing Healthy Meals at Home, Keeping Foods Safe and Hand Washing, and Finding a Balance between Food and Physical Activity. Each child had his or her own personalized binder complete with handouts for each lesson, pencils, and notebook paper that served as a journal for the children to record their activities, thoughts, and feelings during the program.
Fruit and vegetable tasting was frequently provided to introduce the children to products that some had never consumed before or recognized in their natural state. They also tried varieties of white milk, tortilla chips, and black bean salsa.
Once per week, the children completed 5 minutes of stretching followed by 30 minutes of physical activity, and five more minutes of cool-down stretching. The activities consisted of a mix of assorted games (e.g., tag and relay races) and walking that encouraged constant movement.
The physical activity content emphasized stretching before play, constant movement, and fun. Our educators instructed children on how to stretch before being active and why the stretching was important to improved performance, flexibility, and reducing the risk of injury. We also combined technology with the physical activity by providing all the children with their own pedometer. The buttons and changing numbers on the pedometer fascinated the children and served as a catalyst for their activity levels. We kept a log of their steps and miles after each session and kept a running total at each site so the children and their parents could follow their progress. We provided prizes to all children for their participation and their overall performance during and at the end of the program. These prizes included jump ropes, waffle ball bats and balls, kickballs, soccer balls, footballs, Frisbees, and hula hoops. This provided the children further incentive and opportunity to play and be active after the completion of Fit Club.
It is possible to implement an after-school program, such as Fit Club, without a great deal of financial resources. Pedometers are an inexpensive and effective method for tracking steps and mileage. Each child was able to keep his or her pedometer and binder after program completion. The nutrition sessions can be adapted from numerous organizations - ours were adapted primarily from the United States Department of Agriculture. Gardening is something that can be done year round with pots and plants indoors during colder months and outdoors in planters or gardens during warmer months. Gardening promotes activity and increases the likelihood that children will eat what they grow. The journals provide a great way for the children to practice their writing skills and express themselves on paper about their experiences in the program. This further simulates a school-based environment and allows the physical activity and gardening to become an additional physical education class held after school.
The children expressed enthusiasm with the program and were able to associate physical activity with walking, games, and play - normal activities that they can do anytime. The average run time improvement was 41 seconds among the kindergarten to second grade children, and 1 minute and 53 seconds for the third to sixth grade children who attended at least 95% of the program. The mean steps and mileage for the kindergarten through second grade children were 9,611 steps and 3.66 miles, and for the third to sixth grade children, the means were 11,555 steps and 5.61 miles.
Although we were unable to significantly increase children’s fruit, vegetable, and grain intake, there was a reduction in daily fast food, soda, and candy intake. Children reported their overall enjoyment of Fit Club to the site staff and our research team and repeatedly stated how much they enjoyed trying fruits, vegetables, grains, and dairy products.
We accept that more studies like this one are needed to confirm these local findings because they may not be reflective of state and national trends. However, given the benefits derived from improving knowledge, attitudes, and behaviors regarding nutrition, gardening, and physical activity, future programs similar to this one have the potential to help children and their families.
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