Project Energize: whole-region primary school nutrition and physical activity programme; evaluation of body size and fitness 5 years after the randomised controlled trial.

Project Energize, a region-wide whole-school nutrition and physical activity programme, commenced as a randomised controlled trial (RCT) in the period 2004-6 in 124 schools in Waikato, New Zealand. In 2007, sixty-two control schools were engaged in the programme, and by 2011, all but two of the 235 schools in the region were engaged. Energizers (trained nutrition and physical activity specialists) work with eight to twelve schools each to achieve the goals of the programme, which are based on healthier eating and enhanced physical activity. In 2011, indices of obesity and physical fitness of 2474 younger (7·58 (sd 0·57) years) and 2330 older (10·30 (sd 0·51) years) children attending 193 of the 235 primary schools were compared with historical measurements. After adjusting for age, sex, ethnicity, socio-economic status (SES) and school cluster effects, the combined prevalence of obesity and overweight among younger and older children in 2011 was lower by 31 and 15 %, respectively, than that among 'unEnergized' children in the 2004 to 2006 RCT. Similarly, BMI was lower by 3·0 % (95 % CI - 5·8, - 1·3) and 2·4 % (95 % CI - 4·3, - 0·5). Physical fitness (time taken to complete a 550 m run) was significantly higher in the Energized children (13·7 and 11·3 %, respectively) than in a group of similarly aged children from another region. These effects were observed for boys and girls, both indigenous Maori and non-Maori children, and across SES. The long-term regional commitment to the Energize programme in schools may potentially lead to a secular reduction in the prevalence of overweight and obesity and gains in physical fitness, which may reduce the risk of developing obesity and type 2 diabetes.

Baseline measures for a school-based obesity control programme: Project Energize: differences by ethnicity, rurality, age and school socio-economic status.

AIM: School-based interventions to tackle the rise in childhood overweight and obesity remain inconclusive and are often limited in their application to diverse populations. To inform and measure the effect of the implementation of a primary school-based longitudinal randomised controlled nutrition and activity intervention, Project Energize, baseline measures of body size and blood pressure were required. METHODS: This cross-sectional study stratified by age, sex, ethnicity, rurality and school socio-economic-status (school-SES) measured body mass index (BMI), percentage body fat (%BF), waist and resting blood pressure from 2752 5- and 10-year-old children (62% European, 31% Maori) representative of the Waikato region of New Zealand. RESULT: Waikato children have a high prevalence of overweight and obesity that is linked with hypertension. Cardiovascular risk factors including raised blood pressure and hypertension, waist and arm circumference and percentage body fat (%BF) were more prevalent in 10-year-olds, lower school-SES and to some extent, urban living. In European children, BMI and waist circumference were similarly predictive of %BF, but for Maori children, waist circumference predicted %BF better than BMI. CONCLUSIONS: A variety of stratified, baseline measurements is important when designing school-based interventions. In particular, waist circumference measures may be a more accurate predictor of %BF than BMI when determining measurement protocols that consider different ethnic groups and environments among children. The effect of targeted improvements of the school physical activity and nutrition environment on the rate of increase of weight, fatness and blood pressure in children should be examined.

A school-based obesity control programme: Project Energize. Two-year outcomes.

Through-school nutrition and physical activity interventions are designed to help reduce excess weight gain and risk of chronic disease. From 2004 to 2006, Project Energize was delivered in the Waikato Region of New Zealand as a longitudinal randomised controlled study of 124 schools (year 1-6), stratified by rurality and social deprivation, and randomly assigned to intervention or control. Children (686 boys and 662 girls) aged 5 (1926) and 10 (1426) years (692 interventions and 660 controls) had height, weight, body fat (by bioimpedance) and resting blood pressure (BP) measured at baseline and 2 years later. Each intervention school was assigned an 'Energizer'; a trained physical activity and nutrition change agent, who worked with the school to achieve goals based on healthier eating and quality physical activity. After adjustment for baseline measures, rurality and social deprivation, the intervention was associated with a reduced accumulation of body fat in younger children and a reduced rate of rise in systolic BP in older children. There was some evidence that the pattern of change within an age group varied with rurality, ethnicity and sex. We conclude that the introduction of an 'Energizer led' through-school programme may be associated with health benefits over 2 years, but the trajectory of this change needs to be measured over a longer period. Attention should also be paid to the differing response by ethnicity, sex, age group and the effect of rurality and social deprivation.

Vitamin D status of Year 3 children and supplementation through schools with fortified milk.

OBJECTIVE: To evaluate levels of vitamin D3 and HDL-cholesterol (HDL-C), and the ratio of HDL-C to LDL-cholesterol (LDL-C), in schoolchildren receiving vitamin-D-fortified, fat-depleted, high-Ca milk in schools. DESIGN: Cross-sectional study of previously randomised schools receiving supplemental milk, compared with a matched control group. SETTING: Low-decile Year 1-6 schools in the Waikato region of New Zealand. SUBJECTS: Year 3 children from either milk schools or control schools, consenting to blood sampling. RESULTS: For eighty-nine children receiving supplementary daily milk, vitamin D3 levels were significantly higher than in eighty-three control children matched for age, sex, body composition and ethnicity (mean (sd): 49.6 (15.8) v. 43.8 (14.7) nmol/l, P = 0.011), as were HDL-C levels (mean (sd): 1.47 (0.35) v. 1.35 (0.29) mmol/l, P = 0.024) and HDL-C:LDL-C (median: 0.79 v. 0.71, P = 0.026). LDL-C levels were similar in both groups (mean (sd): 2.07 (0.55) v. 2.16 (0.60) mmol/l, P = 0.31). Of control children, 32/83 (20.2 %) of the milk group (Pearson's chi2 = 7.00, P = 0.008). Mean 25-hydroxyvitamin D (vitamin D3) levels in the milk group were still below the lower end of the recommended normal range (60 nmol/l). CONCLUSIONS: Vitamin D3 levels are low in low-decile Year 3 children in midwinter. Levels are improved with vitamin-D-fortified milk but still below the recommended range. HDL-C and HDL-C:LDL-C levels are improved in the milk-supplemented group. This supports the supply of vitamin-D-fortified, fat-reduced milk to schools.

Lifetime cost effectiveness of a through-school nutrition and physical programme: Project Energize.

Project Energize, a multicomponent through-school physical activity and nutrition programme, is delivered to all primary school children in the Waikato region. The programme aim is to improve the overall health and reduce the rate of weight gain of all Waikato primary school children. An existing economic model was used to extrapolate the programme effects, initial costs, lifetime health treatment cost structures, quality-adjusted-life-years gained and increased life expectancy to the general and Maori child population of New Zealand. In March 2011, a sample of 2474 younger (7.58 ± 0.57 years, mean ± SD) and 2330 older (10.30 ± 0.51 years) children (36% Maori) attending Energize schools had body mass index measured and compared using mixed effect modelling with unEnergized comparison children from 2004 and 2006 from the same region. In 2011 the median body mass index reduction compared with the comparison younger children was -0.504 (90% CI -0.435 to -0.663) kg/m(2) and in the older children -0.551 (-0.456 to -0.789) kg/m(2). In 2010 there were 42,067 children attending Energize schools and in the same year NZ$1,891,175 was spent to deliver the programme; a cost of $44.96/child/year. Compared to the comparison children the increment in cost/quality-adjusted-life-year gained was $30,438 for the younger and $24,690 for the older children, and lower for Maori (younger $28,241, older $22,151) and for the middle socioeconomic status schools ($23,211, $17,891). Project Energize would improve quality and length of life and when compared with other obesity prevention programmes previously assessed with this model, it would be relatively cost-effective from the health treatment payer's perspective.

Improvement of fundamental movement skills through support and mentorship of class room teachers.

Project Energize, a multicomponent through-school programme aims to improve the overall health and reducing weight gain of Waikato primary school children by increasing their physical activity and encouraging healthy eating. The aim of this report is to describe the efficacy of one intervention that provided classroom teachers with tools for improving fundamental movement skill (FMS) proficiency in years 0-8 school children. In 2008 the Test of Gross Motor Development (TGMD) was used to measure the FMS proficiency of children from 11 schools and 41 classes; before (n = 701) and after (n = 598) the teacher support was provided. Children were identified only by class years. At baseline less than half of the children exhibited proficiency in kicking (21%), throwing (31%) and striking (40%) while most children were able to run (84.6%) and slide (78.0%). All skills were substantially improved (P < 0.001) after the intervention with the biggest changes in kicking, throwing and striking; 49.8%, 63.5% and 76.3% proficient. At baseline children in years 0-3 from higher decile schools performed better than lower decile schools and after intervention this gap was reduced or removed. After receiving tailored FMS physical education classes led by the teacher, younger children were more competent than the older children were at baseline. The large, positive effects of the intervention have implications for long term physical activity participation and fitness with subsequent health benefits. The school-based FMS teacher support intervention by Team Energize is an effective way to improve outcomes for children.

Use of pedometers to identify less active children and time spent in moderate to vigorous physical activity in the school setting.

OBJECTIVES: To examine in the context of a school day whether a pedometer, compared to an accelerometer, was an effective tool to identify children with low physical activity levels. Additionally, to characterise within the school day, patterns of variation in level and timing of activity of the most active and least active children. DESIGN: Observational study to compare two methods (accelerometer and pedometer) of identifying less active children and intensity of activity. METHOD: During school hours, for three consecutive days, children (n=47, aged 8-11 years) in two classes wore an accelerometer and sealed pedometer. Accelerometers were programmed to record at 15s epochs and the number of pedometer steps taken were recorded at the end of each school day. Patterns of activity by total accelerometer counts, and with cutoffs applied, were examined against time and the number of steps taken. RESULTS: Based on the accelerometer (>1500 counts/min), the majority (68%) of children spent more than 60 min in moderate to vigorous physical activity (MVPA) during the school day. Overall, time spent in MVPA was three times greater during break times compared to classroom time, with no apparent differences by class/age or gender. Total accelerometer counts and pedometer steps were correlated (r=0.60). One minute of MVPA was equivalent to 45 (95% CI 20 to 70) pedometer steps. CONCLUSION: The pedometer, a practical, relatively inexpensive tool, is suitable for the identification of less active children and has some utility to assess the relative intensity of activities in the context of a school day.

Increasing activity and improving nutrition through a schools-based programme: Project Energize. 1. Design, programme, randomisation and evaluation methodology.

Project Energize is a through-school nutrition and activity programme that is being evaluated in a 2-year, cluster-randomised, longitudinal study. The present paper describes the background of the programme and study, the programme development and delivery, the study methodology including randomisation, measurement and analysis tools and techniques, and the mix of the study population. The programme is being delivered to sixty-two primary schools with sixty-two control schools, each limb containing about 11,000 students. The children in the evaluation cohort are 5 or 10 years old at enrolment; the randomisation protocol has achieved post-consent enrolment of 3,000 evaluation participants, who are comparable by age, sex and school decile. End-point measures include body composition and associated physical characteristics, fitness, home and school environment and practice.