Health Promotion in Primary Schools- Evaluation of Side-Effects on Cognitive and Academic Performance in a Randomized Trial

Abstract

Background: School-based lifestyle interventions are a cost-effective way to prevent pediatric overweight. The program “Join the Healthy Boat” focuses on physical activity, healthy diet and screen media use in German primary school children, implemented by regular classroom teachers including teaching units, physical activity exercises, and work with parents. Objective of the study was to measure potential side-effects on children’s cognitive and academic performance. Methods: The program was evaluated in a RCT design, measurements took place before and after one year of intervention. Stratification of randomization was carried out for number of classes and grade level. Participants were 1st and 2nd graders of primary schools. Intervention and assessment took place on site at school; questionnaires were issued. N=442 children performed a computer based test battery measuring inhibitory control, cognitive flexibility and sustained attention. Academic achievement was assessed via parental questionnaire. Results: Multiple regression analyses controlling for age, gender and parental education and Mann-Whitney-Utests revealed no significant differences between intervention and control group in cognitive changes or academic development from baseline to follow up. In Cognitive Flexibility, however, the number of children who improved was higher in the intervention group. Conclusion: Taking time from the regular school curriculum for health promotion had no negative impacts on children’s cognitive or academic development. To obtain more positive effects a longer period of time and a more intense intervention are presumably necessary. The findings are in line with a recent review indicating no negative effects of school health programs. Eventually there is a positive impact of physical activity interventions on specific cognitive functions but findings regarding academic outcomes are still inconclusive. Weak evidence is reported for nutrition services.