Findings From The Active For Life Year 5 (AFLY5

Findings From The Active For Life Year 5 (AFLY5) School-based Cluster
Randomised Controlled Trial To Increase Physical Activity, Reduce Sedentary
Behaviour and Increase Fruit and Vegetable Consumption
Ruth Kipping, Laura Howe, Russell Jago,
Rona Campbell, Sian Wells, Catherine Chittleborough,
Julie Mytton, Sian Noble, Tim Peters,
Chief Investigator: Debbie Lawlor
www.decipher.uk.net
Aim
• To investigate the effectiveness of a school-based
intervention to increase physical activity, reduce sedentary
behaviour, and increase fruit and vegetable consumption
in children.
• To present the effectiveness outcomes at end of Year 5
www.decipher.uk.net
Background: obesity prevention research
www.decipher.uk.net
Background
• School based interventions to encourage healthy lifestyles
• Systematic reviews of randomised controlled trials
•
Increasing physical activity, reducing sedentary behaviour, and
increasing fruit and vegetable consumption
• Poor quality of many of the trials
•
Results may exaggerate the truth
www.decipher.uk.net
Kipping RR, Payne C, Lawlor DA. Randomised controlled trial adapting US school
obesity prevention to England. Arch Dis Child. 2008 Jun;93(6):469-73.
www.decipher.uk.net
•
•
•
•
•
Based on US programme ‘Eat Well & Keep Moving’
Key focus
•
Balanced diet (‘eatwell plate’)
•
Increasing activity (≥ 60 mins/day)
•
Reducing screen viewing time (≤ 2 hours/day)
16 lessons & 10 homeworks
Newsletter inserts & leaflets for parents
Training day compulsory for all Y5 teachers
•
All materials, lesson plans etc provided
•
Nutrition & Physical Activity experts
www.decipher.uk.net
Methods
• Cluster RCT
• Setting:
• 60 primary schools, Bristol & North Somerset
• Population: 2221 pupils
• Recruited in Y4 (age 8-9)
• Measurements at 3 time points
• Baseline Y4/5
• FU1 end of Y5
• FU2 end of Y6
www.decipher.uk.net
Outcomes
 1° Outcomes



Activity (mean minutes of MVPA per day, measured by accelerometers)
Sedentary behaviour (mean minutes per day)
Fruit & vegetable consumption (servings per day)
 2° Outcomes





Screen viewing (self report screen time)
Consumption of snacks, high fat food, high energy drinks (servings per
day)
BMI
Waist circumference
Odds overweight/obese
www.decipher.uk.net
Active for Life Year 5: cluster RCT
60 schools recruited (2221 children)
Baseline measurements
Randomisation
Intervention n=30
Follow-up 1 measurements
End of Year 5
Follow-up 2 measurements
End of Year 6
Control schools offered intervention
www.decipher.uk.net
Process evaluation and
economic evaluation
Control n=30
Intention to treat analysis end of Year 5:
primary outcomes
Primary outcomes
Main comparison between two groups
(intervention vs control)
Number
Difference in means
(95% CI)
p value
Time spent in MVPA
(min/day)
1252
-1.35 (-5.29 to 2.59)
0.50
Time spend in sedentary
time (min/day)
1252
-0.11 (-9.71 to 9.49)
0.98
Servings of fruit and veg
(number/day)
2121
0.08 (01-12 to 0.28)
0.42
www.decipher.uk.net
Intention to treat analysis end of Year 5:
secondary outcomes screen and anthropometric
Secondary outcomes
Main comparison between two groups
(intervention vs control)
Number
Difference in means
(95% CI)
p value
Time spent screen viewing
(mins/day weekday)
2121
-15.56 (-33.56 to 2.45)
0.09
Time spent screen viewing
(mins/day Saturday)
2121
-20.86 (-37.30 to -4.42)
0.01
BMI (z score)
1825
-0.02 (-0.08 to 0.03)
0.41
Waist circumference
(z score)
1981
-0.12 (-0.23 to -0.01)
0.03
www.decipher.uk.net
Intention to treat analysis end of Year 5:
secondary outcomes diet
Secondary outcomes
Main comparison between two groups
(intervention vs control)
Number
Difference in means
(95% CI)
p value
Servings of high energy drinks 2121
(number/day)
-0.26 (-0.43 to -0.10)
0.002
Servings of high fat foods
(number/day)
2121
-0.10 (-0.24 to 0.03)
0.13
Servings of snacks
(number/day)
2121
-0.22 (0.38 to -0.05)
0.01
www.decipher.uk.net
Intention to treat analysis end of Year 5:
secondary outcomes overweight/obesity
Secondary outcomes
Main comparison between two groups
(intervention vs control)
Number
Odds ratio (95% CI)
p value
Overweight or obese
1825
0.89 (0.61 to 1.31)
0.56
Centrally
overweight/obese
1981
0.72 (0.50 to 1.04)
0.08
Kipping RR, Howe LD, Jago R, Campbell R, Wells S, Chittleborough CR, Mytton J, Noble SM, Peters TJ, Lawlor DA. Effect of
intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in
children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial. BMJ. 2014 May 27;348:g3256. doi:
10.1136/bmj.g3256.
www.decipher.uk.net
Conclusions
• Large cluster randomised controlled trial found no
evidence that a school based intervention was effective in
increasing physical activity or decreasing sedentary
behaviour assessed using accelerometers
• The intervention also had no effect on child reported fruit
and vegetable consumption
• More intense behavioural interventions with school
children or more upstream societal, family, and school
environmental and cultural change may be required
www.decipher.uk.net
Reflection on MRC framework
for developing complex interventions
www.decipher.uk.net
Acknowledgements
•
Public Health colleagues and organisations in South Gloucestershire, North
Somerset and Bristol
•
Participants in schools – teachers, children and parents
•
AFLY5 research team
•
National Institute of Health Research funding
•
The work was undertaken with the support of The Centre for the Development and Evaluation of
Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health
Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation,
Cancer Research UK, Economic and Social Research Council, Medical Research Council, the
Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research
Collaboration, is gratefully acknowledged.
www.decipher.uk.net