Childhood obesity is an important predictor of adult obesity leading to significant long-term health consequences (7). Rising levels of overweight and obesity are reducing life expectancy and quality of life and contributing to more type 2 diabetes in children (5,6,8). To prevent obesity, it is important to focus on children and their maintenance of healthy weight as an effective public health approach. Many trials that have an obesity focus have demonstrated small negligible improvements in dietary behavior after the intervention (3,11). Outside of the home, schools and child-care services are key places for programming (1,8,10,13). The amount of obesity-focused interventions for adolescents and their frequency of mixed results or little benefit suggest that future interventions may be better suited if they simply strive to get children to be physically active after school and improve their knowledge, attitudes, and behaviors related to activity and diet (9,12,14). Specifically, rather than having children “exercise,” we wished to have the children want to “play.” We wanted the children to learn through being active whether it was on the field, in the gym, or in the classroom, and thus, Fit Club was designed.
The purpose of our 10-week program, Fit Club, was to provide elementary schoolchildren ages 5 to 12 years old and their parents structured nutrition education and tasting, gardening education, and physical activity and to improve their knowledge, attitudes, and behaviors. This program was done at four Y (historically known as the YMCA) sites and included 67 children (44 children in grades kindergarten through 3 (K to 3) and 23 children in grades 4 through 6), whereas two additional Y sites completed the pretest and posttest only so we could compare results between Fit Club recipients and nonrecipients. We had 75 children at the control sites, 48 of whom were in grades K to 3 and 27 in grades 4 to 6.
A team composed of two registered dietitians, a fitness specialist, an epidemiologist, and public health students created and delivered the program at four after-school sites located in impoverished areas, as identified through the U.S. Census. Before the program began, all children completed a physical activity pretest adapted from the YMCA Youth Fitness Test (4). 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 to 2) completed a timed 0.5-mile run, whereas those in grades 3 through 6 completed a timed 1-mile run.
Our research team administered an oral survey preprogram and postprogram to the K to 2 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. Before Fit Club was implemented, the surveys were pilot tested at a local elementary school to determine internal validity and reliability from pretest to posttest.
Once per week, there was an interactive nutrition lesson. Parents were invited to sessions to facilitate interaction with their children. We encouraged the parents who attended, which ranged anywhere from 15% to 40%, to try the foods and beverages with their child or children present and assist them with the nutrition education activities. Parents were able to share advice with other parents in attendance while the children worked together and answered questions related to the topic of the day. This also provided time for both the parent and child to discover the benefits of consuming such products, which we hoped would improve the nutritional value of what was purchased when shopping for groceries. Of the 67 children who made up our first-day attendance at all implementation sites combined, 59 (88%) attended all sessions, including the posttesting session. The most common reported reason for children being unable to attend was school absence caused by illness.
Each nutrition 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. The children sat at tables or desks and wrote their journal entries after their daily nutrition or physical activity session had concluded. Because some of the children were just learning to write, it was not required for them to writecomplete sentences. Children would often draw picturesorwrite individual words to describe their thoughts and feelings.
Fruit and vegetable tasting was frequently provided to introduce the children to products that some reportedly had never consumed before or recognized in their natural state. The children were always asked before the lessons if they had ever eaten or drank the products. Fruits tasted included mango, kiwi, varieties of pears and apples, pineapple, grapes, cantaloupe, oranges, strawberries, blueberries, raspberries, and blackberries. Vegetables tasted included broccoli, varieties of peppers, tomatoes, onions, cauliflower, carrots, celery, corn, spinach, green beans, radishes, and sweet potatoes. They also tried varieties of milk (e.g., skim, 1%, 2%, and soy), tortilla chips, and black bean salsa.
The children engaged in physical activity during Fit Club, also once per week. Each activity session was led by a public health professional and Master of Public Health students — allof whom had received training from a certified personal trainer— our fitness specialist — in preparation for Fit Club. Y personnel were present at all physical activity and nutrition sessions and helped in program implementation and child supervision. The children completed 5 minutes of warming up, followed by 30 minutes of physical activity, and 5 more minutes of cooling down. The activities consisted of walking and a mix of assorted games that rotated among soccer, basketball, jump roping, tag, dodge ball, and relay races.
The physical activity emphasized warming up before play, constant movement, and fun. The combination of fun activities allowed the children to enjoy playing with each other while distracting them from our intention of getting them to exercise. Our educators, who were trained by a certified personal trainer, instructed children on how to warm up before being active and why this was important to helping them be active, flexible, and as safe as possible from injury. The emphasis was on helping them have fun and not getting hurt. Furthermore, we never mentioned the term “exercise” during our sessions. From informal chats with the children and site staff before Fit Club was introduced, we discovered that “exercise” tends to be viewed as “work” to the children. However, if you call exercise an “activity” or “game,” you can grab their attention and provide them the motivation to move and have fun.
We also combined technology with the physical activity by providing all the children with their own pedometer. Many of the children were interested in the buttons and changing numbers on the pedometer and wanted to know how they worked. This served as a catalyst for their activity levels. These days, any amount of technology that can be added, be it interactive gaming systems or step and mileage logs that can be kept on a computer or phone, will definitely interest children and help them see that being active is exciting and entertaining (2). 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, wiffleball bats and balls, kickballs, soccer balls, footballs, Frisbees, and hula hoops — all of which could be used with their pedometers. This provided the children further incentive and opportunity to play and be active after the completion of Fit Club. For the sites that served as our “controls,” we provided basketballs, soccer balls, kickballs, and jump ropes for the children as a token of our appreciation for helping us determine the effectiveness 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. We recommend you shop around for a reasonably priced pedometer and one that can easily attach to shoelaces. 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 U.S. Department of Agriculture. Gardening can be done throughout the year, particularly with grow lights, plant food, and adequate indoor temperature during the fall and winter seasons. Some Y facilities are now purchasing hydroponic equipment to help with gardening efforts year-round. This may be an additional idea to use in a program you design. Gardening promotes activity and increases the likelihood that children will eat what they grow. If they can see the process from seed to food, they can appreciate the time and effort it took to create the food and learn how to prepare it once it can be harvested. The journals allow children to enhance their writing skills and express themselves creatively regarding their experiences in the program. This further simulates a school-based environment and allows the physical activity and gardening to become an additional physical activity after school.
Many of the children were enthusiastic 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 ranged from 11 seconds to 50 seconds, whereas the average reach improved between 0.03 and 0.46 inches, depending on the Y site. Although this may not seem to be a “large” improvement, it is an improvement during a 10-week program that can only benefit the children in the future. Not all children improved their run time or their reach distance, and only a few regressed. As expected, the children at the control sites did not improve their run time or their reach distance.
The mean steps and mileage for all children at the Fit Club sites were 7,063 steps and 3.0 miles. Many children, from the kindergarteners to the sixth graders, actually took more than 10,000 total steps during Fit Club and traveled more than 6 miles during the program. Many of the children were very excited to show their pedometers after the session and tell us how many steps they took while being physically active. Some seemed to compete with each other for the highest step count. This was fine with everyone associated with the program because it simply increased their activity level and motivation to move even more than before. We would have liked to implement Fit Club 3 or 4 days per week to include at least one more day of physical activity as additional benefit for the children. However, there were many competing priorities for the children, including homework, extracurricular activities, and family obligations. After-school programs must always be cognizant of the numerous commitments of schools, children, and their families and be able to adjust to the needs and desires of those involved.
Although we were unable to significantly increase children’s self-reported fruit, vegetable, and grain intake, there was a reduction in their reported daily fast food, soda, and candy intake. This result likely reflects changes in both the parent and child in food and beverage choices. We cannot conclude that there was no increase in consumption of healthy products but rather no statistical proof of this result. The reduction in these snack and drive-thru items is a definite improvement to their diet outside of the school setting. 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. Many children at the program sites reported on their surveys that they liked to play games and help with gardening, grocery shopping, and cooking.
Children at the control sites did not change their appreciation for these activities, and their intake of healthy and unhealthy products remained similar. Parental involvement is an absolute necessity for any program. Parents were able to see the enjoyment and excitement on their children’s faces, and we feel that this certainly helped the parents and children make healthier choices and thus decrease their intake of some of those unhealthy foods and beverages.
The Fit Club program provided children with additional physical activity after school. This activity seems to have played a role in improving the fitness level of many children and reduced intake of unhealthy products, including candy and soda. We hope that our findings may provide further incentive for parents to make time with their children and improve their overall health and well-being. Our approach of involving children and their families, the after-school site, area schools from which the children attend, and a local university may be an ideal prototype for program development in the future. Many of our objectives were either met or partially met at some intervention sites. Having control sites to compare Fit Club with was ideal for determining program impact.
CONDENSED VERSION & BOTTOM LINE
The Fit Club program was a nutrition education and physical activity program. It used a combination of interactive nutrition lessons including education, preparation, and tasting, along with walking and multiple games to get elementary-aged children more active after school. Using simple equipment such as pedometers, jump ropes, and balls, many children were able to improve their posttest run time after the 10-week program. Furthermore, there were reported decreases in consumption of candy and soda after the completion of Fit Club. Getting children excited about nutrition and physical activity can have a real benefit to their overall health and well-being.
1. Burrows T, Warren JM, Collins CE. Impact of a child obesity intervention on dietary intake and behaviors. Int J Pediatr Obes. 2010; 5: 43–50.
2. Christison A, Khan HA. Exergaming for health: a community-based pediatric weight management program using active video gaming. Clin Pediatrics. 2012; 51 (4): 382–88.
3. Collins C, McCoy P, Neve M, Stokes B, Warren J. Measuring effectiveness of dietetic interventions in child obesity: a systematic review of randomized trials. Arch Pediatr Adolesc Med. 2006; 160: 906–22.
4. Franks BD. The YMCA Youth Fitness Test. In: Franks B., editor. YMCA Youth Fitness Manual. Champaign (IL): Human Kinetics Publishers, Inc.; 1989.
5. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children
, adolescents, and adults, 1999–2002. JAMA. 2004; 291: 2847–50.
6. Honisett S, Woolcock S, Porter C, Hughes I. Developing an award program for children
’s settings to support healthy eating and physical activity
and reduce the risk of overweight and obesity. BMC Public Health. 2009; 345: 1–11
7. Kamath CC, Vickers KS, Ehrlich A, et al
. Clinical review: behavioral interventions to prevent childhood obesity — a systematic review and meta-analyses of randomized trials. J Clin Endocrinol Metab. 2008; 93 (12): 4606–15.
8. Lobstein T, Baur LA, Uauy R. Obesity in children
and young people: a crisis in public health. Obes Rev. 2004; 5 (S1): 4–104.
9. Oude Luttikhuis H, Baur L, Jansen H, et al
. Interventions for treating obesity in children
. Cochrane Database Syst Rev. 2009; 1: CD001872
10. Stone E, McKenzie TL, Welk GJ, Booth ML. Effects of physical activity
interventions in youth: review and synthesis. Am J Prev Med. 2001; 21: 101–109.
11. Sung-Chan P, Sung YW, Zhao X, Brownson RC. Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obes Rev. 2012; 14: 265–278.
12. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and interventions for childhood overweight: a summary of evidence for the U.S. Preventive Services Task Force. Pediatrics. 2005; 116: e125–44.
13. Wilson DK, Evans AE, Williams J, Mixon G, Sirard JR, Pate R. A preliminary test of a student-centered intervention on increasing physical activity
in underserved adolescents. Ann Behav Med. 2005; 30: 119–24.
14. Yee SL, Williams-Piehota P, Sorensen A, Roussel A, Hersey J, Hamre R. The nutrition
and physical activity
program to prevent obesity and other chronic diseases: monitoring progress in funded states. Prev Chronic Dis. 2006; 3: 1–6.
Keywords:© 2013 American College of Sports Medicine.
Nutrition; Education; Activity; Games; Children