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Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children a
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J. Jarani , A. Grøntved , F. Muca , A. Spahi , D. Qefalia , K. Ushtelenca , A. Kasa , D. h
Caporossi & M. C. Gallotta a
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Sports University of Tirana, Tirana, Albania
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Department of Sports Science and Clinical Biomechanics, Research Center of Childhood Health, University of Southern Denmark, Odense, Denmark c
Tirana International School, Tirana, Albania
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Department of Movement and Health, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania e
Sport Centre for Children, Tirana, Albania
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Department of Social Sciences and Education, Faculty of Movement Sciences, Sports University of Tirana, Tirana, Albania g
Department of Physical Activity, Recreation and Tourism, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania h
Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy Published online: 09 Apr 2015.
To cite this article: J. Jarani, A. Grøntved, F. Muca, A. Spahi, D. Qefalia, K. Ushtelenca, A. Kasa, D. Caporossi & M. C. Gallotta (2015): Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children, Journal of Sports Sciences, DOI: 10.1080/02640414.2015.1031161 To link to this article: http://dx.doi.org/10.1080/02640414.2015.1031161
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Journal of Sports Sciences, 2015 http://dx.doi.org/10.1080/02640414.2015.1031161
Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children J. JARANI1, A. GRØNTVED2, F. MUCA3, A. SPAHI4, D. QEFALIA5, K. USHTELENCA6, A. KASA7, D. CAPOROSSI8 & M. C. GALLOTTA8
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Sports University of Tirana, Tirana, Albania, 2Department of Sports Science and Clinical Biomechanics, Research Center of Childhood Health, University of Southern Denmark, Odense, Denmark, 3Tirana International School, Tirana, Albania, 4 Department of Movement and Health, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania, 5Sport Centre for Children, Tirana, Albania, 6Department of Social Sciences and Education, Faculty of Movement Sciences, Sports University of Tirana, Tirana, Albania, 7Department of Physical Activity, Recreation and Tourism, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania and 8Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy (Accepted 15 March 2015)
Abstract This study aims to evaluate the effectiveness of two school-based physical education (PE) programmes (exercise-based and games-based) compared with traditional PE, on health- and skill-related physical fitness components in children in Tirana, Albania. Participants were 378 first-grade (6.8 years) and 389 fourth-grade (9.8 years) children attending four randomly selected schools in Tirana. Twenty-four school classes within these schools were randomly selected (stratified by school and school grade) to participate as exercise group (EG), games group (GG) and control group (CG). Both EG and GG intervention programmes were taught by professional PE teachers using station/circuit teaching framework while CG referred to traditional PE school lessons by a general teacher. All programmes ran in parallel and lasted 5 months, having the same frequency (twice weekly) and duration (45 min). Heart rate (HR) monitoring showed that intensity during PE lessons was significantly higher in the intervention groups compared with control (P < 0.001). Both PE exercise- and games programmes significantly improved several health- and skill-related fitness indicators compared with traditional PE lessons (e.g. gross motor skill summary score: 9.4 (95% CI 7.9; 10.9) for exercise vs. control and 6.5 (95% CI 5.1; 8.1) for games vs. control, cardiorespiratory fitness: 2.0 ml O2 · min−1 · kg−1 (95% CI 1.5; 2.4) for exercise vs. control and 1.4 ml O2 · min−1 · kg−1 (95% CI 1.0; 1.8) for games vs. control). Furthermore, compared to games-based PE, exercise-based PE showed more positive changes in some gross motor coordination skills outcomes, coordination skills outcomes and cardiorespiratory fitness. The results from this study show that exercise- and games-based PE represents a useful strategy for improving health- and skill-related physical fitness in Albanian elementary school children. In addition, the study shows that exercise-based PE was more effective than games-based PE in improving gross motor function and cardiorespiratory fitness. Keywords: physical fitness components, coordination skills, cardiorespiratory fitness, physical activity, physical education programme
Introduction Promotion of physical activity and physical fitness in children is an important public health goal for governments, health authorities and other local public health stakeholders. The school environment plays a crucial role in providing opportunities for children to engage in physical activity (Gallotta, Marchetti, Baldari, Guidetti, & Pesce, 2009) and it serves as an ideal setting for school-based PA intervention (Kriemler et al., 2011). In Western countries, over 95% of children are enrolled in schools (Lee,
Burgeson, Fulton, & Spain, 2007), and physical education (PE) must be considered as a powerful and valuable setting for structured interventions affecting health outcomes including physical fitness among the majority of children in entire populations (Sallis, 2004). Studies have shown the effectiveness of daily PE lessons on physical fitness indicators (Ridgers, Stratton, & Fairclough, 2006) and cardiorespiratory fitness (Resaland, Andersen, Mamen, & Anderssen, 2011) in children. However, currently there is no strong evidence to guide the optimal approach for
Correspondence: Juel Jarani, Sports University of Tirana, Muhamet Gjollesha, Tirane, Albania. E-mail: [email protected] © 2015 Taylor & Francis
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PE in the school setting (Bonvin et al., 2013; Kriemler et al., 2011). The current challenges to achieve high-quality PE include competing curriculum demands (Dobbins, De Corby, Robeson, Husson, & Tirilis, 2009), reduced costs problem, low support in the provision of resources by local and central government bodies (DeCorby, Halas, Dixon, Wintrup, & Janzen, 2005) and priority given to academic subjects versus those practical (Sallis & Glanz, 2009). The low quality of PE classes can impair the effectiveness of PE for promoting physical activity and fitness in children (Van Sluijs, Mc Minn, & Mand Griffin, 2008), and further scientific examinations of strategies for optimal benefits of PE intervention are warranted. In particular, more attention should be paid on strategies focusing on the quantity and quality of PE classes (Sallis et al., 2012; Veugelers & Fitzgerald, 2005; Wang, Pereira, & Mota, 2005). PE should provide encouragement to increase PA and promote activity and exercises that aim to improve a broad range of physical fitness parameters including both health- (e.g. cardiovascular fitness, flexibility and body composition) and skill-related (e.g. agility, balance, power, speed and coordination) physical fitness. The aim of this study was to examine the effectiveness of two new PE programmes on skill- and health-related fitness among elementary school children aged 7 and 10 years in Tirana, Albania, without changing the traditional frequency and duration of the current PE in Albanian schools. Another aim of the study was to compare two PE programme approaches to improve children’s physical fitness: one with the emphasis on exercises and the other on games using station circuit teaching framework during PE lessons.
Methods Participants This study is part of the “ABC 5 on 5” (All Basic Coordination 5 on 5) project supported by the Albanian Ministry of Education and Science that, together with the Institutional Review Board of the University, approved this investigation. During the selection phase, all 56 elementary schools in Tirana that were not engaged in any physical activity programme/intervention were eligible to participate in the study. From these schools, 50 fulfilled our additional inclusion criteria, that is, availability of a gym, the space more than 180 m and a typical indoor air investigation which included observation of conditions in the area of gym and comfort parameters like humidity and temperature. A two-stage sampling cluster design was used during sample selection phase. First, four schools were randomly selected by a random-number table from the pool of 50 elementary schools. Second, stratified by school and age group (first and fourth grades), 24 classes from the four schools were randomly selected to the intervention groups (exercise-based PE intervention group (EG), games-based PE intervention group (GG) and control PE traditional group (CG)). Eight school classes (261 participants) were randomly assigned to an exercise-based PE programme (EG), eight classes (251 participants) were randomly assigned to a games-based PE programme (GG) and eight classes (255 participants) were assigned to a traditional PE programme (CG). A total of 767 children nested in these 24 classes were involved in this study, 378 first-grade (mean age 6.8 years) and 389 fourth-grade children (mean age 9.8 years) (Table I). All programmes lasted
Table I. Baseline characteristics of study participants by intervention group (control/exercise/games). Control (traditional PE) N Sex (% boys) Age (years) Height (m) Weight (kg) BMI (kg · m−2) Body fat (%) VO2max (ml O2 · min−1 · kg−1) 10 × 5 m shuttle run (s) Standing long jump (cm) Sit and reach (cm) Physical activity (score) Balance during backward gait (score) Side movements on plate (score) Jump on one leg (score) Lateral side jump (score) Gross motor summary score KTK (score)
248 56 8.3 1.3 31.2 17.8 19.2 41.5 25.4 104.2 24.8 2.4 88.9 52.0 97.5 96.3 78.8
(1.6) (0.1) (9.4) (3.4) (8.3) (4.9) (2.5) (19.6) (6.9) (0.6) (12.6) (6.0) (13.4) (15.0) (10.8)
Exercise-based PE 261 50.2 8.4 1.3 30.8 17.4 18.3 40.7 25.3 103.8 25.1 2.4 88.8 52.1 97.5 92.8 77.7
Note: Data are means (s) or percentage. P-values are global differences between groups.
(1.6) (0.1) (8.6) (3.2) (7.8) (4.7) (2.3) (18.6) (6.5) (0.6) (13.5) (5.3) (13.4) (14.9) (11.1)
Games-based PE 251 51.4 8.3 1.3 31.3 17.9 19.4 41.1 25.2 103.0 25.4 2.3 88.4 52.6 96.3 94.5 77.9
(1.6) (0.1) (9.5) (3.3) (7.7) (4.8) (2.2) (18.1) (6.5) (0.6) (13.0) (6.0) (14.1) (14.5) (11.5)
P-value
0.36 0.91 0.63 0.80 0.30 0.27 0.17 0.73 0.78 0.64 0.18 0.91 0.40 0.52 0.03 0.50
Exercise training for children’s fitness 56 primary schools asessed for eligibility
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6 schools not eligible
50 primary schools invited
4 schools randomly selected
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24 classes randomized (stratified by school and age group) n = 767 children in total n = 378 (6.8 years); n = 389 (9.8 years)
8 classes 261 children allocated to exercise-based PE intervention group
8 classes 251 children allocated to games-based PE intervention group
8 classes 255 children allocated to control PE traditional group
90% had data on baseline and follow-up measures of physical fitness indicators
90% had data on baseline and follow-up measures of physical fitness indicators
88% had data on baseline and follow-up measures of physical fitness indicators
80% had data on baseline and follow-up measures of BMI
81% had data on baseline and follow-up measures of BMI
74% had data on baseline and follow-up measures of BMI
97% had data on baseline and follow-up measures on gross motor skills and coordination abilities
97% had data on baseline and follow-up measures on gross motor skills and coordination abilities
94% had data on baseline and follow-up measures on on gross motor skills and coordination abilities
Figure 1. Flow chart of progress of schools, classes and children during the study.
5 months, with same duration (45 min/lesson) and frequency (two lessons/week). Seven children (three boys and four girls) did not finish the intervention programme as they moved to other schools. The flow of participants during the study is shown in Figure 1. Informed consent forms were obtained from both parents and children prior inclusion in the study. Description of the interventions The objectives of the intervention programmes, which were based on the “ABC 5 on 5” PE programme, were to develop physical fitness and movement skills by emphasising on overall development of the children’s fundamental motor skills and physical capacities (health and physical fitness oriented). The EG intervention programme emphasised PA exercises (e.g. gait exercises to improve speed), while the GG intervention programme was focused on fun games (e.g. tag games to improve speed). Compared with traditional PE, we assumed that children would be more dedicated to this type of PE and would provide improvements in physical fitness measures during the 5-month period. PE specialist teachers instructed each type of PE (EG and GG). PE lessons of both intervention groups
were organised to allow maximum participation of children using the station/circuit teaching framework to provide opportunities for continuous practice on different exercise or games at the same time. Both intervention PE programmes (EG and GG) were structured in four different modules: movement awareness, object/manipulative skills, rhythm, tumbling/gymnastics for the first grade and throwing/ catching, rhythm, fitness, tumbling/gymnastics for the fourth grade, respectively. The EG-based PE structures station/circuit activities were orientated on the individual school child, whereas the GGbased PE focused on involving more than three or four children in a game organised to address each of the four modules. Adherence to the protocol (threshold defined as missing out on a maximum of four lessons during the 5-month period) was completed by 93% of participating children.
First-grade intervention Movement awareness module. It included basics of movement (locomotor skills, steps/stops, twists/ turns, body awareness and spatial relationships) introduced and practised through a variety of situations and activities.
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Object/manipulative skills module. It included skill development, activities and games that emphasise throwing, catching, kicking and striking skills. Rhythm module. It used a variety of rhythmic activities including singing games, movements and folk dances to develop the child’s sense of rhythm. More advanced locomotor skills such as leaping, jumping, hopping, sliding and galloping were emphasised. Tumbling/gymnastics module. It included skills that could be performed with a variety of equipment, playground equipment or objects that increased the child’s strength, endurance, flexibility, body awareness and self-confidence.
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Fourth-grade intervention Throwing/catching module. Drills and activities introduced and practised to develop throwing/catching skills. The focus was on developing comfort and skill with throwing and catching activities in such a way that allowed everyone to participate and succeed. Rhythm module. Activities and dances that emphasised the use of movement to create and respond to rhythm are practised. Folk dance, square dance, line dance or other forms of dance were introduced. Rope jumping and other rhythmic exercises were also practised. Fitness module. A variety of exercises and activities with the aim of developing and maintaining physical fitness were introduced. Tumbling/gymnastics module. Tumbling or more advanced levels of gymnastics were practised aiming on skills, activities and games that develop fitness components. The CG continued to follow the traditional PE school curriculum given by their classroom teachers using traditional PE programmes including mainly typical sports. EG, GG and CG programmes were equivalent in structure and total duration (45 min). All PE lessons started with 10 min of warm-up, followed with 30 min of core phase physical activities, and ended with 5 min of cool-down and stretching. The intensity of two PE lessons for each type of intervention was monitored among all participants by recording HR using a Suunto® HR monitor M2 (Performance Watch; Vantaa, Finland). The intensity was monitored during the entire PE lesson on each unit of the PE curriculum during two consecutive PE lessons (in total = 4 weeks monitoring for four unit). The
HR measurements of the PE lesson were carried out by the primary school class teachers. The main equipment used for the intervention (EG and GG) were “five to five pieces” (ropes, balls, circles, beam bags and tennis balls) mentioned at the title of the project “All Basic Coordination 5 on 5”. These equipment were delivered by the scientific project team to the PE teachers. Physical fitness and coordination assessments Pre- and post-intervention tests assessed children gross motor coordination (Kiphard & Schilling, 1974), coordinative skills (Hirtz et al., 1985), physical fitness (Andersen, Andersen, Andersen, & Anderssen, 2008; Eurofit., 1993; The Cooper Institute, 2007) and physical activity (The Physical Activity Questionnaire for Children (PAQ-C)) level (Table II). All data were collected at the same time of day (morning), and the children were tested in the same order in both occasions. During the first phase, all children were familiarised with the tests prior to data collection, minimising any learning effects and actual improvements. The same research team collected all the data. During the pilot phase (prior to pre-test phase) among 174 children (a randomly selected subgroup consisting of four first-grade classes and four fourthgrade classes in two randomly selected schools), we carried out test–retest measurements for each physical fitness and coordination assessments used in the study. Gross motor coordination. To assess gross motor coordination, we used Body Coordination Test for Children (Körperkoordinationstest für Kinder (KTK)) (Kiphard & Schilling, 1974) using a final score (motor quotient (MQ)). It consists of four subtests where each value of a subtest is converted in a MQ score. All four values are summed and converted into a final score. Coordinative skills. To assess coordinative skills, we used four tests that were selected from a test battery for field evaluation. The test battery was validated by Hirtz et al. (1985) through administration to a large and representative sample of school-aged children. Orientation shuttle run test. An orientation shuttle run test was carried out to assess lower limb response orientation ability. In this test, the child runs three times towards a goal marker as quickly as possible from start marker towards one of five numbered goal markers located behind him/her. The goal markers are 3 m apart from the child and 1.5 m apart from another on a hypothetical circumference arc. The sequence of goal markings to be reached is not
Skinfolds measurement
Anthropometrics
Aerobic fitness Speed Power Physical activity
Coordination abilities
Balancing backwards Transference of platforms Lateral jumping Jumping on one leg Orientation shuttle run Hanging target throw test Low jump Backwards ball throw Intermittent shuttle run Shuttle run: 10 × 5 m Standing long jump Questionnaire (PAQ-C)
Test
KTK (Body Coordination Test for Children)
Dimension
Points Points s Points cm Points ml O2 · min−1 · kg−1 s cm Points
Kiphard and Schilling (2007) Kiphard and Schilling (2007) Hirtz et al. (1985) Hirtz et al. (1985) Hirtz et al. (1985) Hirtz et al. (1985) Andersen et al. (2008) Eurofit (1993) Eurofit (1993) Crocker, Bailey, Faulkner, Kowalski, and McGrath (1997) Slaughter et al. (1988) Body fat%
Points Points
Unit
Kiphard and Schilling (2007) Kiphard and Schilling (2007)
Reference
83
85 85 82 84 84 77
85 85 85 85
85 85
N
0.1 (0.6)
−0.9 (2.2) 1.4 (5.0) 0.03 (1.8) −0.2 (1.1) −3.6 (6.6) −0.3 (0.4)
3.4 11.1 3.5 2.0 9.3 0.6 −1.1; 1.3
−5.2; −8.3; −3.4; −2.3; −16.6; −1.1;
−14.1; −7.4; −5.6; −2.5;
−0.5 0.2 −0.9 1.6
13.0 7.8 3.7 5.7
−13.5; 12.1 −6.7; 7.8
−0.7 (6.5) 0.5 (3.7) (6.9) (3.9) (2.4) (2.1)
95% Limits of agreement
Mean difference (s)
First-grade children
89
89 88 88 89 87 81
89 89 89 89
89 89
N
Table II. Test–retest limit of agreement analysis for health- and skill-related physical fitness outcomes in the study by age group.
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(1.7) (2.9) (1.8) (0.9) (6.0) (0.4)
(5.1) (4.7) (2.1) (1.6)
−0.1 (0.7)
−0.9 0.5 0.2 −0.1 −2.2 −0.2
−0.8 −2.0 −0.6 1.4
0.3 (6.1) −1.4 (2.8)
Mean difference (s)
2.5 6.2 3.7 1.6 9.6 0.5
9.2 7.1 3.5) 4.7
−1.5; 1.2
−4.2; −5.3; −3.3; −1.9; −13.9; −1.0;
−10.8; −11.1; −4.7; −1.8;
−11.5; 12.2 −6.8; 4.1
95% Limits of agreement
Fourth-grade children
Exercise training for children’s fitness 5
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known previously. The next marking number is announced when the child returns to the start ball and touched it for the next run to begin without pausing. The test score is seconds used to accomplish the task.
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Hanging target throw. Hanging target throw test was used to assess upper limb response orientation ability. The instructor is in front of the child, 3 m apart, and lifts a hoop of 80 cm diameter hanging from a 60-cmlong rope to the horizontal axis. The instructor lets it go down for the child who tried to throw a tennis ball through the swinging hoop during its back swing. The child performs five consecutive trials. Two, one or zero points are, respectively, assigned if the ball passed through, touched or passed outside the hoop. The test score is the computed mean score. Low jump test. The low jump test was used to assess lower limb kinaesthetic discrimination ability. The child jumps with the legs together from a plinth to a ground marking at a set distance (1 m). The child is instructed to land with the heels on the marking. The test is performed twice and the distance of each heel from the marking is measured in centimetre for each trial. Distance values are collapsed across heels and trials to obtain a mean value as test score. Backwards ball throw. A backwards ball throw test was used to assess upper limb kinaesthetic discrimination ability. The aim is to hit a ground target located 250 cm behind the performer. The child performs a onehand overhead throw backwards with a tennis ball. The child is instructed to hit a ground target located behind him/her. After a training throw, the child performs five consecutive trials. Five points are assigned for each target hit. Scores of 4, 3, 2, 1 and 0 are assigned with increasing distance of the contact point of the ball from the target and the sum of scores is computed as test score.
Physical fitness measures Cardiorespiratory fitness. Intermittent shuttle run (IRT) test (Andersen test) was used to estimate maximal oxygen uptake (Andersen et al., 2008) with a reliability coefficient (r = 0.84). Children had to run as fast as they could in order to cover the longest possible distance during the 10 min test run, and this distance was the test result. To estimate child’s VO2max, we used the equation: VO2max = 18.38 + (0.03301 × distance) – (5.92 × sex) [(boys = 0; girls = 1)] (Andersen et al., 2008).
Speed. Shuttle run 10 × 5 m test (Eurofit, 1993) was used to assess speed and agility of the lower limbs. Power. Standing long jump (SLJ) test (Eurofit, 1993) was used to measure the explosive leg power. The measurement is taken from take-off line to the nearest point of contact on the landing (back of the heels). Flexibility. The sit and reach (SR) test was used to assess the hamstring muscles flexibility (The Cooper Institute, 2007). Participants were instructed to reach as far as possible with one leg straight while sitting at a sit-and-reach box (while keeping the legs straight, bends forward as far as possible). Physical activity level. The PAQ-C was used as a means for children to self-report their own levels of physical activity over the past seven days. Convergent validity for this instrument has previously been established through comparisons with other measures of physical activity, specifically an aerobic step test and a questionnaire related to perceptions of athletic competence (Janz, Lutuchy, Wenthe, & Levy, 2008). Health-related fitness components. Body height and body mass were measured using a Health O Meter 402 KL professional physician beam scale. Skin fold thickness measurement (carried out by a trained researcher) were used for the estimation of children body fat percentage. All skin folds were taken three times by the same examiner (specialist) to ensure consistency in the results with the average of the three values used as a final value. Triceps and subscapular thickness were measured to the nearest 0.1 mm using a caliper on the right side of the body (Harpenden Skinfold Caliper; Baty International RH15 9LR, England). To predict per cent body fat, the equation described by Slaughter et al. (1988) was used. Statistical analysis Test–retest limit of agreement analysis of each physical fitness outcome measurement was conducted (by age group) by calculating mean difference and 95% limits of agreement between first and second outcome measurement (Bland & Altman, 1986; Nevill & Arkinson, 1997). Bland–Altman plots were constructed to explore possible heteroscedasticity. Differences in the distribution of baseline characteristics by intervention group were tested via analysis of variance for continuous outcomes and a χ2 test for dichotomous outcomes. Linear random effect models with change from baseline to follow-up as outcome (for each physical fitness outcome) were carried out to evaluate differences between the three intervention groups
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Exercise training for children’s fitness using intention to treat. These models were adjusted for baseline levels of respective outcomes, sex, age group and with school and school class treated as random effects. We calculated Bonferroni corrected Pvalues for each pairwise comparison of interventions. We also pre-specified to examine possible age groupand sex-specific-dependent effects of the intervention by testing the age group (or sex)-by-intervention interaction for each physical fitness outcome with all main effects included in the model. To explore the possibility that lost to follow-up and missing values due to other reasons caused selection bias, we carried out sensitivity analyses by comparing estimates of effects in the complete case analyses with the full sample with missing values being imputed. In these analyses, missing values were imputed using a multivariate chained equation imputation approach (“mi impute chained” in STATA) including information on all background variables and the respective baseline and change in outcome variables (estimates were obtained based on 30 imputed data sets). All analyses were carried out using the software STATA (version 12.1; Stata Statistical Software: Release 12. StataCorp LP, College Station, TX, USA) with α = 0.05. Results More than 92% of the total sample had available data on baseline and follow-up measures of physical fitness indicators. There were no differences in proportions of missing data (due to loss to follow-up or missing data) by intervention group (EG, GG, CG) (P = 0.51). For body mass index (BMI), 79% of the total allocated sample had available measures at baseline and follow-up, and there was no difference in proportions of missing data (due to loss to
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follow-up or missing data) by intervention group (EG, GG, CG) (P = 0.28). There were no differences in age, sex or physical fitness indicators at baseline between the intervention groups, except for lateral side jump where the EG had significantly lower mean score compared with the CG (Table I). Raw study outcomes at baseline and follow-up by age group are presented in Table III. Reliability of physical fitness measures The results from the test–retest limits of agreement analysis of the outcomes measure of gross motor skills, coordination skills, cardiorespiratory fitness, anthropometry, speed and power are provided in Table II. We observed no clear evidence of heteroscedasticity for any outcome measures based on visual inspection of Bland–Altman plots. Furthermore, limits of agreement for each outcome were comparable across age group. HR monitoring Mean HR values during PE classes of both EG and GG were significantly higher than the CG (Table IV). Compared with the CG, no significant differences were observed for peak HR values in either the EG or the GG. Furthermore, boys had significantly higher HR values in each intervention group regardless of age group (P < 0.05). Gross motor coordination and coordinative skills Compared with traditional PE (CG), the EG-based PE had significantly greater effect on all gross motor skills and coordination ability measures except for the low jump test (Table V). Furthermore, the
Table III. Raw study outcome results at baseline and post-intervention stratified by age group. Baseline
Height (cm) Weight (kg) BMI (kg · m−2) Body fat (%) VO2max (ml O2 · min−1 · kg−1) 10 × 5 m shuttle run (s) Standing long jump (cm) Sit and reach (cm) Physical activity (score) Balance during backward gait (score) Side movements on plate (score) Jump on one leg (score) Lateral side jump (score) Gross motor summary score KTK (score) Note: Data are means (s).
Post-intervention
First grade
Fourth grade
First grade
Fourth grade
1.23 (0.05) 25.5 (5.5) 16.8 (2.6) 16.8 (7.1) 39.7 (4.6) 26.4 (2.0) 92.0 (11.7) 26.6 (6.2) 2.3 (0.6) 89.6 (12.8) 56.1 (4.7) 100.3 (12.4) 94.8 (13.2) 80.7 (10.2)
1.40 (0.06) 36.5 (8.7) 18.6 (3.6) 21.1 (8.1) 42.4 (4.6) 24.3 (2.2) 115.1 (17.3) 23.7 (6.8) 2.5 (0.6) 87.8 (13.2) 48.5 (4.0) 93.9 (14.0) 94.3 (16.3) 75.6 (11.5)
1.24 (0.05) 25.6 (5.5) 16.5 (2.7) 16.4 (7.0) 41.4 (4.6) 24.5 (2.3) 103.3 (11.9) 27.4 (6.2) 2.5 (0.6) 97.8 (14.1) 62.8 (6.1) 108.3 (12.6) 122.2 (15.0) 97.0 (12.0)
1.41 (0.06) 37.3 (8.7) 18.7 (3.5) 20.8 (8.1) 44.4 (4.9) 22.5 (2.8) 127.0 (18.2) 24.6 (6.6) 2.7 (0.6) 95.0 (12.7) 54.6 (6.2) 96.8 (11.9) 115.8 (16.0) 87.6 (11.5)
Mean (s) Peak (s) Mean (s) Peak (s) Mean (s) Peak (s)
162.1 198 160.2 200.4 150.3 201.1
(8.8) (4.7) (10.4) (8.5) (14.1) (8.4)
0.004 0.226 0.015 0.811
P-value 167.2* (7.6) 201.3* (4.3) 165.3* (9.9) 203.7* (8.2) 155.4* (13.5) 204.2 * (7.9)
Boys 0.004 0.003 0.001 0.124
P-value 157 194.7 155.1 197.1 145.2 198
(8.9) (5.4) (10.5) (9.2) (14.8) (7.8)
Girls 0.001 0.121 0.001 0.837
P-value 0.006 0.362 0.013 0.269
P-value 161.1* (16.2) 197.2* (8.9) 157.2* (16.4) 197.6* (7.9) 138.4 * (16.4) 192.4* (14)
Boys 0.001 0.124 0.001 0.121
P-value
Fourth grade
153.9 193.8 153.8 195.2 137.2 190.7
(19) (9.9) (16.5) (7.9) (17.1) (15.2)
Girls
1.0 −1.1 2.8 −0.5
Coordination abilities Hanging target throw test (points) Orientation shuttle run test (s) Backward ball throw test (points) Low jump (cm) 0.5; −1.5; 2.1; −2.0;
4.0; 2.9; 3.2; 12.3; 7.9; 1.4 −0.7 3.5 1.0
7.1 5.6 5.4 17.0 10.9
95% CI
Journal of Sports Sciences Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rjsp20
Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children a
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J. Jarani , A. Grøntved , F. Muca , A. Spahi , D. Qefalia , K. Ushtelenca , A. Kasa , D. h
Caporossi & M. C. Gallotta a
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Sports University of Tirana, Tirana, Albania
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Department of Sports Science and Clinical Biomechanics, Research Center of Childhood Health, University of Southern Denmark, Odense, Denmark c
Tirana International School, Tirana, Albania
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Department of Movement and Health, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania e
Sport Centre for Children, Tirana, Albania
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Department of Social Sciences and Education, Faculty of Movement Sciences, Sports University of Tirana, Tirana, Albania g
Department of Physical Activity, Recreation and Tourism, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania h
Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy Published online: 09 Apr 2015.
To cite this article: J. Jarani, A. Grøntved, F. Muca, A. Spahi, D. Qefalia, K. Ushtelenca, A. Kasa, D. Caporossi & M. C. Gallotta (2015): Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children, Journal of Sports Sciences, DOI: 10.1080/02640414.2015.1031161 To link to this article: http://dx.doi.org/10.1080/02640414.2015.1031161
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Journal of Sports Sciences, 2015 http://dx.doi.org/10.1080/02640414.2015.1031161
Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children J. JARANI1, A. GRØNTVED2, F. MUCA3, A. SPAHI4, D. QEFALIA5, K. USHTELENCA6, A. KASA7, D. CAPOROSSI8 & M. C. GALLOTTA8
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Sports University of Tirana, Tirana, Albania, 2Department of Sports Science and Clinical Biomechanics, Research Center of Childhood Health, University of Southern Denmark, Odense, Denmark, 3Tirana International School, Tirana, Albania, 4 Department of Movement and Health, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania, 5Sport Centre for Children, Tirana, Albania, 6Department of Social Sciences and Education, Faculty of Movement Sciences, Sports University of Tirana, Tirana, Albania, 7Department of Physical Activity, Recreation and Tourism, Faculty of Physical Activity and Recreation, Sports University of Tirana, Tirana, Albania and 8Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy (Accepted 15 March 2015)
Abstract This study aims to evaluate the effectiveness of two school-based physical education (PE) programmes (exercise-based and games-based) compared with traditional PE, on health- and skill-related physical fitness components in children in Tirana, Albania. Participants were 378 first-grade (6.8 years) and 389 fourth-grade (9.8 years) children attending four randomly selected schools in Tirana. Twenty-four school classes within these schools were randomly selected (stratified by school and school grade) to participate as exercise group (EG), games group (GG) and control group (CG). Both EG and GG intervention programmes were taught by professional PE teachers using station/circuit teaching framework while CG referred to traditional PE school lessons by a general teacher. All programmes ran in parallel and lasted 5 months, having the same frequency (twice weekly) and duration (45 min). Heart rate (HR) monitoring showed that intensity during PE lessons was significantly higher in the intervention groups compared with control (P < 0.001). Both PE exercise- and games programmes significantly improved several health- and skill-related fitness indicators compared with traditional PE lessons (e.g. gross motor skill summary score: 9.4 (95% CI 7.9; 10.9) for exercise vs. control and 6.5 (95% CI 5.1; 8.1) for games vs. control, cardiorespiratory fitness: 2.0 ml O2 · min−1 · kg−1 (95% CI 1.5; 2.4) for exercise vs. control and 1.4 ml O2 · min−1 · kg−1 (95% CI 1.0; 1.8) for games vs. control). Furthermore, compared to games-based PE, exercise-based PE showed more positive changes in some gross motor coordination skills outcomes, coordination skills outcomes and cardiorespiratory fitness. The results from this study show that exercise- and games-based PE represents a useful strategy for improving health- and skill-related physical fitness in Albanian elementary school children. In addition, the study shows that exercise-based PE was more effective than games-based PE in improving gross motor function and cardiorespiratory fitness. Keywords: physical fitness components, coordination skills, cardiorespiratory fitness, physical activity, physical education programme
Introduction Promotion of physical activity and physical fitness in children is an important public health goal for governments, health authorities and other local public health stakeholders. The school environment plays a crucial role in providing opportunities for children to engage in physical activity (Gallotta, Marchetti, Baldari, Guidetti, & Pesce, 2009) and it serves as an ideal setting for school-based PA intervention (Kriemler et al., 2011). In Western countries, over 95% of children are enrolled in schools (Lee,
Burgeson, Fulton, & Spain, 2007), and physical education (PE) must be considered as a powerful and valuable setting for structured interventions affecting health outcomes including physical fitness among the majority of children in entire populations (Sallis, 2004). Studies have shown the effectiveness of daily PE lessons on physical fitness indicators (Ridgers, Stratton, & Fairclough, 2006) and cardiorespiratory fitness (Resaland, Andersen, Mamen, & Anderssen, 2011) in children. However, currently there is no strong evidence to guide the optimal approach for
Correspondence: Juel Jarani, Sports University of Tirana, Muhamet Gjollesha, Tirane, Albania. E-mail: [email protected] © 2015 Taylor & Francis
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PE in the school setting (Bonvin et al., 2013; Kriemler et al., 2011). The current challenges to achieve high-quality PE include competing curriculum demands (Dobbins, De Corby, Robeson, Husson, & Tirilis, 2009), reduced costs problem, low support in the provision of resources by local and central government bodies (DeCorby, Halas, Dixon, Wintrup, & Janzen, 2005) and priority given to academic subjects versus those practical (Sallis & Glanz, 2009). The low quality of PE classes can impair the effectiveness of PE for promoting physical activity and fitness in children (Van Sluijs, Mc Minn, & Mand Griffin, 2008), and further scientific examinations of strategies for optimal benefits of PE intervention are warranted. In particular, more attention should be paid on strategies focusing on the quantity and quality of PE classes (Sallis et al., 2012; Veugelers & Fitzgerald, 2005; Wang, Pereira, & Mota, 2005). PE should provide encouragement to increase PA and promote activity and exercises that aim to improve a broad range of physical fitness parameters including both health- (e.g. cardiovascular fitness, flexibility and body composition) and skill-related (e.g. agility, balance, power, speed and coordination) physical fitness. The aim of this study was to examine the effectiveness of two new PE programmes on skill- and health-related fitness among elementary school children aged 7 and 10 years in Tirana, Albania, without changing the traditional frequency and duration of the current PE in Albanian schools. Another aim of the study was to compare two PE programme approaches to improve children’s physical fitness: one with the emphasis on exercises and the other on games using station circuit teaching framework during PE lessons.
Methods Participants This study is part of the “ABC 5 on 5” (All Basic Coordination 5 on 5) project supported by the Albanian Ministry of Education and Science that, together with the Institutional Review Board of the University, approved this investigation. During the selection phase, all 56 elementary schools in Tirana that were not engaged in any physical activity programme/intervention were eligible to participate in the study. From these schools, 50 fulfilled our additional inclusion criteria, that is, availability of a gym, the space more than 180 m and a typical indoor air investigation which included observation of conditions in the area of gym and comfort parameters like humidity and temperature. A two-stage sampling cluster design was used during sample selection phase. First, four schools were randomly selected by a random-number table from the pool of 50 elementary schools. Second, stratified by school and age group (first and fourth grades), 24 classes from the four schools were randomly selected to the intervention groups (exercise-based PE intervention group (EG), games-based PE intervention group (GG) and control PE traditional group (CG)). Eight school classes (261 participants) were randomly assigned to an exercise-based PE programme (EG), eight classes (251 participants) were randomly assigned to a games-based PE programme (GG) and eight classes (255 participants) were assigned to a traditional PE programme (CG). A total of 767 children nested in these 24 classes were involved in this study, 378 first-grade (mean age 6.8 years) and 389 fourth-grade children (mean age 9.8 years) (Table I). All programmes lasted
Table I. Baseline characteristics of study participants by intervention group (control/exercise/games). Control (traditional PE) N Sex (% boys) Age (years) Height (m) Weight (kg) BMI (kg · m−2) Body fat (%) VO2max (ml O2 · min−1 · kg−1) 10 × 5 m shuttle run (s) Standing long jump (cm) Sit and reach (cm) Physical activity (score) Balance during backward gait (score) Side movements on plate (score) Jump on one leg (score) Lateral side jump (score) Gross motor summary score KTK (score)
248 56 8.3 1.3 31.2 17.8 19.2 41.5 25.4 104.2 24.8 2.4 88.9 52.0 97.5 96.3 78.8
(1.6) (0.1) (9.4) (3.4) (8.3) (4.9) (2.5) (19.6) (6.9) (0.6) (12.6) (6.0) (13.4) (15.0) (10.8)
Exercise-based PE 261 50.2 8.4 1.3 30.8 17.4 18.3 40.7 25.3 103.8 25.1 2.4 88.8 52.1 97.5 92.8 77.7
Note: Data are means (s) or percentage. P-values are global differences between groups.
(1.6) (0.1) (8.6) (3.2) (7.8) (4.7) (2.3) (18.6) (6.5) (0.6) (13.5) (5.3) (13.4) (14.9) (11.1)
Games-based PE 251 51.4 8.3 1.3 31.3 17.9 19.4 41.1 25.2 103.0 25.4 2.3 88.4 52.6 96.3 94.5 77.9
(1.6) (0.1) (9.5) (3.3) (7.7) (4.8) (2.2) (18.1) (6.5) (0.6) (13.0) (6.0) (14.1) (14.5) (11.5)
P-value
0.36 0.91 0.63 0.80 0.30 0.27 0.17 0.73 0.78 0.64 0.18 0.91 0.40 0.52 0.03 0.50
Exercise training for children’s fitness 56 primary schools asessed for eligibility
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6 schools not eligible
50 primary schools invited
4 schools randomly selected
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24 classes randomized (stratified by school and age group) n = 767 children in total n = 378 (6.8 years); n = 389 (9.8 years)
8 classes 261 children allocated to exercise-based PE intervention group
8 classes 251 children allocated to games-based PE intervention group
8 classes 255 children allocated to control PE traditional group
90% had data on baseline and follow-up measures of physical fitness indicators
90% had data on baseline and follow-up measures of physical fitness indicators
88% had data on baseline and follow-up measures of physical fitness indicators
80% had data on baseline and follow-up measures of BMI
81% had data on baseline and follow-up measures of BMI
74% had data on baseline and follow-up measures of BMI
97% had data on baseline and follow-up measures on gross motor skills and coordination abilities
97% had data on baseline and follow-up measures on gross motor skills and coordination abilities
94% had data on baseline and follow-up measures on on gross motor skills and coordination abilities
Figure 1. Flow chart of progress of schools, classes and children during the study.
5 months, with same duration (45 min/lesson) and frequency (two lessons/week). Seven children (three boys and four girls) did not finish the intervention programme as they moved to other schools. The flow of participants during the study is shown in Figure 1. Informed consent forms were obtained from both parents and children prior inclusion in the study. Description of the interventions The objectives of the intervention programmes, which were based on the “ABC 5 on 5” PE programme, were to develop physical fitness and movement skills by emphasising on overall development of the children’s fundamental motor skills and physical capacities (health and physical fitness oriented). The EG intervention programme emphasised PA exercises (e.g. gait exercises to improve speed), while the GG intervention programme was focused on fun games (e.g. tag games to improve speed). Compared with traditional PE, we assumed that children would be more dedicated to this type of PE and would provide improvements in physical fitness measures during the 5-month period. PE specialist teachers instructed each type of PE (EG and GG). PE lessons of both intervention groups
were organised to allow maximum participation of children using the station/circuit teaching framework to provide opportunities for continuous practice on different exercise or games at the same time. Both intervention PE programmes (EG and GG) were structured in four different modules: movement awareness, object/manipulative skills, rhythm, tumbling/gymnastics for the first grade and throwing/ catching, rhythm, fitness, tumbling/gymnastics for the fourth grade, respectively. The EG-based PE structures station/circuit activities were orientated on the individual school child, whereas the GGbased PE focused on involving more than three or four children in a game organised to address each of the four modules. Adherence to the protocol (threshold defined as missing out on a maximum of four lessons during the 5-month period) was completed by 93% of participating children.
First-grade intervention Movement awareness module. It included basics of movement (locomotor skills, steps/stops, twists/ turns, body awareness and spatial relationships) introduced and practised through a variety of situations and activities.
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Object/manipulative skills module. It included skill development, activities and games that emphasise throwing, catching, kicking and striking skills. Rhythm module. It used a variety of rhythmic activities including singing games, movements and folk dances to develop the child’s sense of rhythm. More advanced locomotor skills such as leaping, jumping, hopping, sliding and galloping were emphasised. Tumbling/gymnastics module. It included skills that could be performed with a variety of equipment, playground equipment or objects that increased the child’s strength, endurance, flexibility, body awareness and self-confidence.
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Fourth-grade intervention Throwing/catching module. Drills and activities introduced and practised to develop throwing/catching skills. The focus was on developing comfort and skill with throwing and catching activities in such a way that allowed everyone to participate and succeed. Rhythm module. Activities and dances that emphasised the use of movement to create and respond to rhythm are practised. Folk dance, square dance, line dance or other forms of dance were introduced. Rope jumping and other rhythmic exercises were also practised. Fitness module. A variety of exercises and activities with the aim of developing and maintaining physical fitness were introduced. Tumbling/gymnastics module. Tumbling or more advanced levels of gymnastics were practised aiming on skills, activities and games that develop fitness components. The CG continued to follow the traditional PE school curriculum given by their classroom teachers using traditional PE programmes including mainly typical sports. EG, GG and CG programmes were equivalent in structure and total duration (45 min). All PE lessons started with 10 min of warm-up, followed with 30 min of core phase physical activities, and ended with 5 min of cool-down and stretching. The intensity of two PE lessons for each type of intervention was monitored among all participants by recording HR using a Suunto® HR monitor M2 (Performance Watch; Vantaa, Finland). The intensity was monitored during the entire PE lesson on each unit of the PE curriculum during two consecutive PE lessons (in total = 4 weeks monitoring for four unit). The
HR measurements of the PE lesson were carried out by the primary school class teachers. The main equipment used for the intervention (EG and GG) were “five to five pieces” (ropes, balls, circles, beam bags and tennis balls) mentioned at the title of the project “All Basic Coordination 5 on 5”. These equipment were delivered by the scientific project team to the PE teachers. Physical fitness and coordination assessments Pre- and post-intervention tests assessed children gross motor coordination (Kiphard & Schilling, 1974), coordinative skills (Hirtz et al., 1985), physical fitness (Andersen, Andersen, Andersen, & Anderssen, 2008; Eurofit., 1993; The Cooper Institute, 2007) and physical activity (The Physical Activity Questionnaire for Children (PAQ-C)) level (Table II). All data were collected at the same time of day (morning), and the children were tested in the same order in both occasions. During the first phase, all children were familiarised with the tests prior to data collection, minimising any learning effects and actual improvements. The same research team collected all the data. During the pilot phase (prior to pre-test phase) among 174 children (a randomly selected subgroup consisting of four first-grade classes and four fourthgrade classes in two randomly selected schools), we carried out test–retest measurements for each physical fitness and coordination assessments used in the study. Gross motor coordination. To assess gross motor coordination, we used Body Coordination Test for Children (Körperkoordinationstest für Kinder (KTK)) (Kiphard & Schilling, 1974) using a final score (motor quotient (MQ)). It consists of four subtests where each value of a subtest is converted in a MQ score. All four values are summed and converted into a final score. Coordinative skills. To assess coordinative skills, we used four tests that were selected from a test battery for field evaluation. The test battery was validated by Hirtz et al. (1985) through administration to a large and representative sample of school-aged children. Orientation shuttle run test. An orientation shuttle run test was carried out to assess lower limb response orientation ability. In this test, the child runs three times towards a goal marker as quickly as possible from start marker towards one of five numbered goal markers located behind him/her. The goal markers are 3 m apart from the child and 1.5 m apart from another on a hypothetical circumference arc. The sequence of goal markings to be reached is not
Skinfolds measurement
Anthropometrics
Aerobic fitness Speed Power Physical activity
Coordination abilities
Balancing backwards Transference of platforms Lateral jumping Jumping on one leg Orientation shuttle run Hanging target throw test Low jump Backwards ball throw Intermittent shuttle run Shuttle run: 10 × 5 m Standing long jump Questionnaire (PAQ-C)
Test
KTK (Body Coordination Test for Children)
Dimension
Points Points s Points cm Points ml O2 · min−1 · kg−1 s cm Points
Kiphard and Schilling (2007) Kiphard and Schilling (2007) Hirtz et al. (1985) Hirtz et al. (1985) Hirtz et al. (1985) Hirtz et al. (1985) Andersen et al. (2008) Eurofit (1993) Eurofit (1993) Crocker, Bailey, Faulkner, Kowalski, and McGrath (1997) Slaughter et al. (1988) Body fat%
Points Points
Unit
Kiphard and Schilling (2007) Kiphard and Schilling (2007)
Reference
83
85 85 82 84 84 77
85 85 85 85
85 85
N
0.1 (0.6)
−0.9 (2.2) 1.4 (5.0) 0.03 (1.8) −0.2 (1.1) −3.6 (6.6) −0.3 (0.4)
3.4 11.1 3.5 2.0 9.3 0.6 −1.1; 1.3
−5.2; −8.3; −3.4; −2.3; −16.6; −1.1;
−14.1; −7.4; −5.6; −2.5;
−0.5 0.2 −0.9 1.6
13.0 7.8 3.7 5.7
−13.5; 12.1 −6.7; 7.8
−0.7 (6.5) 0.5 (3.7) (6.9) (3.9) (2.4) (2.1)
95% Limits of agreement
Mean difference (s)
First-grade children
89
89 88 88 89 87 81
89 89 89 89
89 89
N
Table II. Test–retest limit of agreement analysis for health- and skill-related physical fitness outcomes in the study by age group.
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(1.7) (2.9) (1.8) (0.9) (6.0) (0.4)
(5.1) (4.7) (2.1) (1.6)
−0.1 (0.7)
−0.9 0.5 0.2 −0.1 −2.2 −0.2
−0.8 −2.0 −0.6 1.4
0.3 (6.1) −1.4 (2.8)
Mean difference (s)
2.5 6.2 3.7 1.6 9.6 0.5
9.2 7.1 3.5) 4.7
−1.5; 1.2
−4.2; −5.3; −3.3; −1.9; −13.9; −1.0;
−10.8; −11.1; −4.7; −1.8;
−11.5; 12.2 −6.8; 4.1
95% Limits of agreement
Fourth-grade children
Exercise training for children’s fitness 5
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known previously. The next marking number is announced when the child returns to the start ball and touched it for the next run to begin without pausing. The test score is seconds used to accomplish the task.
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Hanging target throw. Hanging target throw test was used to assess upper limb response orientation ability. The instructor is in front of the child, 3 m apart, and lifts a hoop of 80 cm diameter hanging from a 60-cmlong rope to the horizontal axis. The instructor lets it go down for the child who tried to throw a tennis ball through the swinging hoop during its back swing. The child performs five consecutive trials. Two, one or zero points are, respectively, assigned if the ball passed through, touched or passed outside the hoop. The test score is the computed mean score. Low jump test. The low jump test was used to assess lower limb kinaesthetic discrimination ability. The child jumps with the legs together from a plinth to a ground marking at a set distance (1 m). The child is instructed to land with the heels on the marking. The test is performed twice and the distance of each heel from the marking is measured in centimetre for each trial. Distance values are collapsed across heels and trials to obtain a mean value as test score. Backwards ball throw. A backwards ball throw test was used to assess upper limb kinaesthetic discrimination ability. The aim is to hit a ground target located 250 cm behind the performer. The child performs a onehand overhead throw backwards with a tennis ball. The child is instructed to hit a ground target located behind him/her. After a training throw, the child performs five consecutive trials. Five points are assigned for each target hit. Scores of 4, 3, 2, 1 and 0 are assigned with increasing distance of the contact point of the ball from the target and the sum of scores is computed as test score.
Physical fitness measures Cardiorespiratory fitness. Intermittent shuttle run (IRT) test (Andersen test) was used to estimate maximal oxygen uptake (Andersen et al., 2008) with a reliability coefficient (r = 0.84). Children had to run as fast as they could in order to cover the longest possible distance during the 10 min test run, and this distance was the test result. To estimate child’s VO2max, we used the equation: VO2max = 18.38 + (0.03301 × distance) – (5.92 × sex) [(boys = 0; girls = 1)] (Andersen et al., 2008).
Speed. Shuttle run 10 × 5 m test (Eurofit, 1993) was used to assess speed and agility of the lower limbs. Power. Standing long jump (SLJ) test (Eurofit, 1993) was used to measure the explosive leg power. The measurement is taken from take-off line to the nearest point of contact on the landing (back of the heels). Flexibility. The sit and reach (SR) test was used to assess the hamstring muscles flexibility (The Cooper Institute, 2007). Participants were instructed to reach as far as possible with one leg straight while sitting at a sit-and-reach box (while keeping the legs straight, bends forward as far as possible). Physical activity level. The PAQ-C was used as a means for children to self-report their own levels of physical activity over the past seven days. Convergent validity for this instrument has previously been established through comparisons with other measures of physical activity, specifically an aerobic step test and a questionnaire related to perceptions of athletic competence (Janz, Lutuchy, Wenthe, & Levy, 2008). Health-related fitness components. Body height and body mass were measured using a Health O Meter 402 KL professional physician beam scale. Skin fold thickness measurement (carried out by a trained researcher) were used for the estimation of children body fat percentage. All skin folds were taken three times by the same examiner (specialist) to ensure consistency in the results with the average of the three values used as a final value. Triceps and subscapular thickness were measured to the nearest 0.1 mm using a caliper on the right side of the body (Harpenden Skinfold Caliper; Baty International RH15 9LR, England). To predict per cent body fat, the equation described by Slaughter et al. (1988) was used. Statistical analysis Test–retest limit of agreement analysis of each physical fitness outcome measurement was conducted (by age group) by calculating mean difference and 95% limits of agreement between first and second outcome measurement (Bland & Altman, 1986; Nevill & Arkinson, 1997). Bland–Altman plots were constructed to explore possible heteroscedasticity. Differences in the distribution of baseline characteristics by intervention group were tested via analysis of variance for continuous outcomes and a χ2 test for dichotomous outcomes. Linear random effect models with change from baseline to follow-up as outcome (for each physical fitness outcome) were carried out to evaluate differences between the three intervention groups
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Exercise training for children’s fitness using intention to treat. These models were adjusted for baseline levels of respective outcomes, sex, age group and with school and school class treated as random effects. We calculated Bonferroni corrected Pvalues for each pairwise comparison of interventions. We also pre-specified to examine possible age groupand sex-specific-dependent effects of the intervention by testing the age group (or sex)-by-intervention interaction for each physical fitness outcome with all main effects included in the model. To explore the possibility that lost to follow-up and missing values due to other reasons caused selection bias, we carried out sensitivity analyses by comparing estimates of effects in the complete case analyses with the full sample with missing values being imputed. In these analyses, missing values were imputed using a multivariate chained equation imputation approach (“mi impute chained” in STATA) including information on all background variables and the respective baseline and change in outcome variables (estimates were obtained based on 30 imputed data sets). All analyses were carried out using the software STATA (version 12.1; Stata Statistical Software: Release 12. StataCorp LP, College Station, TX, USA) with α = 0.05. Results More than 92% of the total sample had available data on baseline and follow-up measures of physical fitness indicators. There were no differences in proportions of missing data (due to loss to follow-up or missing data) by intervention group (EG, GG, CG) (P = 0.51). For body mass index (BMI), 79% of the total allocated sample had available measures at baseline and follow-up, and there was no difference in proportions of missing data (due to loss to
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follow-up or missing data) by intervention group (EG, GG, CG) (P = 0.28). There were no differences in age, sex or physical fitness indicators at baseline between the intervention groups, except for lateral side jump where the EG had significantly lower mean score compared with the CG (Table I). Raw study outcomes at baseline and follow-up by age group are presented in Table III. Reliability of physical fitness measures The results from the test–retest limits of agreement analysis of the outcomes measure of gross motor skills, coordination skills, cardiorespiratory fitness, anthropometry, speed and power are provided in Table II. We observed no clear evidence of heteroscedasticity for any outcome measures based on visual inspection of Bland–Altman plots. Furthermore, limits of agreement for each outcome were comparable across age group. HR monitoring Mean HR values during PE classes of both EG and GG were significantly higher than the CG (Table IV). Compared with the CG, no significant differences were observed for peak HR values in either the EG or the GG. Furthermore, boys had significantly higher HR values in each intervention group regardless of age group (P < 0.05). Gross motor coordination and coordinative skills Compared with traditional PE (CG), the EG-based PE had significantly greater effect on all gross motor skills and coordination ability measures except for the low jump test (Table V). Furthermore, the
Table III. Raw study outcome results at baseline and post-intervention stratified by age group. Baseline
Height (cm) Weight (kg) BMI (kg · m−2) Body fat (%) VO2max (ml O2 · min−1 · kg−1) 10 × 5 m shuttle run (s) Standing long jump (cm) Sit and reach (cm) Physical activity (score) Balance during backward gait (score) Side movements on plate (score) Jump on one leg (score) Lateral side jump (score) Gross motor summary score KTK (score) Note: Data are means (s).
Post-intervention
First grade
Fourth grade
First grade
Fourth grade
1.23 (0.05) 25.5 (5.5) 16.8 (2.6) 16.8 (7.1) 39.7 (4.6) 26.4 (2.0) 92.0 (11.7) 26.6 (6.2) 2.3 (0.6) 89.6 (12.8) 56.1 (4.7) 100.3 (12.4) 94.8 (13.2) 80.7 (10.2)
1.40 (0.06) 36.5 (8.7) 18.6 (3.6) 21.1 (8.1) 42.4 (4.6) 24.3 (2.2) 115.1 (17.3) 23.7 (6.8) 2.5 (0.6) 87.8 (13.2) 48.5 (4.0) 93.9 (14.0) 94.3 (16.3) 75.6 (11.5)
1.24 (0.05) 25.6 (5.5) 16.5 (2.7) 16.4 (7.0) 41.4 (4.6) 24.5 (2.3) 103.3 (11.9) 27.4 (6.2) 2.5 (0.6) 97.8 (14.1) 62.8 (6.1) 108.3 (12.6) 122.2 (15.0) 97.0 (12.0)
1.41 (0.06) 37.3 (8.7) 18.7 (3.5) 20.8 (8.1) 44.4 (4.9) 22.5 (2.8) 127.0 (18.2) 24.6 (6.6) 2.7 (0.6) 95.0 (12.7) 54.6 (6.2) 96.8 (11.9) 115.8 (16.0) 87.6 (11.5)
Mean (s) Peak (s) Mean (s) Peak (s) Mean (s) Peak (s)
162.1 198 160.2 200.4 150.3 201.1
(8.8) (4.7) (10.4) (8.5) (14.1) (8.4)
0.004 0.226 0.015 0.811
P-value 167.2* (7.6) 201.3* (4.3) 165.3* (9.9) 203.7* (8.2) 155.4* (13.5) 204.2 * (7.9)
Boys 0.004 0.003 0.001 0.124
P-value 157 194.7 155.1 197.1 145.2 198
(8.9) (5.4) (10.5) (9.2) (14.8) (7.8)
Girls 0.001 0.121 0.001 0.837
P-value 0.006 0.362 0.013 0.269
P-value 161.1* (16.2) 197.2* (8.9) 157.2* (16.4) 197.6* (7.9) 138.4 * (16.4) 192.4* (14)
Boys 0.001 0.124 0.001 0.121
P-value
Fourth grade
153.9 193.8 153.8 195.2 137.2 190.7
(19) (9.9) (16.5) (7.9) (17.1) (15.2)
Girls
1.0 −1.1 2.8 −0.5
Coordination abilities Hanging target throw test (points) Orientation shuttle run test (s) Backward ball throw test (points) Low jump (cm) 0.5; −1.5; 2.1; −2.0;
4.0; 2.9; 3.2; 12.3; 7.9; 1.4 −0.7 3.5 1.0
7.1 5.6 5.4 17.0 10.9
95% CI
