Quasiexperimental changes in PA, smoking, BMI, BP, lipids, and glucose 3 yrs. (cohort)
(I) Whole of community (30–67 yrs.) (C) Age-matched sample from neighbouring community
I: 57.2% C: 55.7% I: 47.7 yrs. (10.3) C: 48.0 yrs. (9.4) Mean years of education (SD): I: 11.6 yrs. (3.8) C: 12.2 yrs. (3.8)
(I) One district n = 6,700 (All 30–67 yrs. invited) (C) One neighbouring district Response rate: 48% Baseline: (I) n = 1497 (C) n = 1453 Lost to follow-up: (I) 41% (C) 40% No randomisation
(I) District selected as disadvantaged, with a high population of low-income, multiethnic residents (C) Neighbouring district selected due to demographic similarities
3-year intervention (same as follow-up) Individual: PA, diet, and smoking (a) Individual counselling: offered during biannual fitness tests and as per protocol for high-risk groups Environmental: PA (a) Awareness campaign: mass media, local meetings, pamphlets, and reminders to use stairs not lifts (b) Organised activities (free): walking groups, indoor activities, and tailored activities for students enrolled in language school (c) Infrastructure: improved safety of pavements and trails, including street lighting and labelling of walking trails (d) Worksite: encouragement of PA for staff employed at the local community organisation
Proportion with net increase in BMI (difference of proportion with increase and proportion with decrease) (I) 14.2% (C) 28.9%
Lupton et al. [45] (Norway) “Health inequalities in Finnmark programme-health and well-being project”
Quasiexperimental changes in PA, diet, smoking, BMI, BP, and cholesterol 6 yrs. (cohort)
(I) Whole of community (20–62 yrs.) (C) similar communities
I: 48.9% C: 49.8% Male: I: 47.7 yrs. (NA) C: 48.6 yrs. (NA) Female: I:47.5 yrs. (NA) C:47.9 yrs. (NA) Mean years of education (SD): Male I: 8.7 (NA) C: 8.5 (NA) Female I: 8.6 (NA) C: 8.4 (NA)
(I) One municipality n = 2500 (All 40–62 yrs. invited and 15% random sample of 20–39 yrs. invited) (C) Three municipalities n = 5000 (all 40–62 yrs. invited and 15% random sample of 20–39 yrs. invited) Response rate: NA Baseline: (I) n = 364 (C) n = 960 Lost to follow-up: (I) 39% (C) 30% No randomisation
(I) Municipality selected based on high CVD mortality in Finnmark county (C) Selected due to similarities in age, ethnicity, and main industry (fishing)
3-year intervention (shorter than follow-up) Individual: PA, diet, and smoking (a) Cholesterol screening: in food stores, provision of healthy recipes, and menus (b) Individual counselling: in primary care for persons at high risk identified though project’s baseline screening Environmental: PA, diet, and smoking (a) awareness campaign: newspaper, radio, and TV (b) organised activities (tailored to specific groups or whole community, run by sports club or community originations): aerobics, physical training, badminton, swimming training, community dances, hiking tours, cooking classes, and health fair (c) Infrastructure: improved cycling paths and ski trails (d) Policy: smoke-free institutions and health care centers (e) Worksite: reestablishment of staff sporting association (sporting competitions) and provision of healthy vacuumed packed meals to fishermen (f) Supporting material: project manual
Mean BMI change Males (I) 1.50 (NA) (C) 1.1 (NA)
Females (I) 1.9 (NA) (C) 1.4 (NA)
Kumpusalo et al. [42] Kumpusalo et al. [65]a (Finland) “Finnish healthy village study” -A pilot study
Quasiexperimental changes in PA, diet, smoking, alcohol, BMI, BP, and lipids 3 yrs. (cohort + cross-sectional samples)
(I) Whole of community (20–64 yrs.) (C) Similar communities
I: 46.0% C: 46.4% 20–34 yrs. n = 245 35–49 yrs. n = 250 50–64 yrs. n = 298 NA by intervention Mean years of education (SD): NA Education level: (Highd: 3%) NA by intervention
(I) Four villages (C) Two villages n = 220–490 Response rate: 80% Baseline: (I) n = 450 (C) n = 343 Lost to follow-up: (I) 11% (C) 21% No randomisation
Villages selected due to similar characteristics of rural villages associated with population, age, trades and services (I) Health profile available for two villages out of four (C) Health profile available for the two villages
3-year intervention (same as follow-up) Tailored components to each community Individual: PA (a) Walking tests (part of walking campaign) Environmental: diet, PA, and smoking (a) Awareness campaign: newspaper, radio, project booklet (b) Organised activities: (i) village seminars 1/month (e.g., diet, social support, and medicine), (ii) Study groups, sports groups, and courses e.g., healthy cooking, quitting smoking (iii) Walking campaigns 2/yr
Mean BMI before-after (I) 26.6 (4.7) versus 27.0 (4.7)
(I) 26.1 (4.1) versus 26.4 (4.2)
(C) 26.5 (4.1) versus 27.1 (4.0)
(C) 26.9 (4.3) versus 27.4 (4.4)
Test for comparisons between (I) and (C): NA
Isacsson et al. [37] (Sweden) “Halsan I Olofstrom” (HIO)
Pre- and post-intervention (No control group) changes in smoking, BMI, BP, cholesterol, and glucose 4 yrs. (cohort + cross-sectional samples)
(I) Whole of community (30–64 yrs. and children)
49.2% Male: 47.5 yrs. (9.6) Female: 47.5 yrs. (9.2) Mean years of education (SD): NA
One municipality n = 15,000 (All 30–64 invited and 30–64 who visited the health centre) Response rate: Survey 1: 79% Survey 2: 70% Survey 3: 74% Baseline: Survey 1: (1989) n = 347 Survey 2: (1991) n = 312 Survey 3: (1993) n = 325
Municipality selected based on high CVD mortality
5-year intervention (longer than follow-up) Individual: diet, PA, smoking and alcohol (a) Health screening for visitors to the health center, by invitation and at community activities. Pamphlets provided (b) Individual counselling in primary care for persons at high risk. Environmental: diet, PA, smoking, and alcohol (a) Capacity building in the community: school food service, teachers, health professionals, businesses, sporting clubs, worksites, restaurant employees, volunteers from NGO’s (b) Awareness campaign: newspaper, radio, pamphlets, recipes, and project magazines delivered to households (c) Organised activities: Lectures by key persons in community and local area meetings promoting a healthy lifestyle and participation in local PA program to individuals and community groups (d) Food stores and restaurants: discount campaign for low fat, high fibre foods, and complementary recipes distributed (e) School: health education provided to school canteen managers and teachers One school received a health education program for children 7–13 yrs. and individual screening with GP (f) Worksites: larger worksites distributed health information and recipes to employees. Managers and union members were offered some health education
Mean BMI for every cross-sectional survey Males 1989: 25.9 (0.23) 1991: 26.3 (0.26) 1993: 26.4 (0.27)
Pre- and postintervention (no control group) changes in BMI, BP, and cholesterol 8 yrs. (cohort + cross-sectional samples)
(I) Whole of community (30 and 35 yrs.)
51.8% 30 yrs. n = 872 35 yrs. n = 1,637 Mean years of education (SD): NA
One county n = 272,215 (All 30 and 35 yrs. invited) Response rate: Year 1: NA Year 2: 72% Year 3: 63% Year 4: 67% Year 5: 55% Year 6: 52% Year 7: 60% Year 8: 58% Baseline: Year 1: n = 2509 Year 2: n = 3227 Year 3: n = 2878 Year 4: n = 2493 Year 5: n = 1884 Year 6: n = 1538 Year 7: n = 1545 Year 8: n = 1527
County selected based on high CVD mortality
8-year intervention (same as follow-up) Individual: diet, PA, smoking, alcohol, and stress (a) Health screening at health centers for those aged 30 and 35 yrs (b) Individual counselling provided to all screened participants. High-risk participants provided with additional support (individually or in groups) Environmental: diet and healthy lifestyle (a) Awareness campaign: radio and project newsletter (b) Food stores: education for staff and diploma program for stores meeting criteria for the promotion of healthy food
Mean BMI before-after for age groups 30 and 35 years Males Age 30 1989–1990: 24.8 (3.2) 1995–1996: 25.0 (3.2)
Age 35 1989–1990: 24.8 (3.0) 1995–1996: 25.7 (3.4)
Females Age 30 1989–1990: 23.3 (3.5) 1995–1996: 24.3 (4.4)
Age 35 1989–1990: 23.6 (3.7) 1995–1996: 24.7 (4.1)
Weinehall et al. [56] Brannstrom et al. [57]a (Sweden) “Norjso”
Quasiexperimental changes in smoking, BMI, BP, and cholesterol 4 yrs. (cohort + cross-sectional samples)
(I) Whole of community (30, 40, 50 and 60 yrs.) (C) Monica randomly selected, age-stratified reference population from same region Northern Sweden (25–64 yrs.)
(I) One municipality n = 5,500 (All 30, 40, 50, 60 yrs. invited) (C) One region n = 510,000 (n = 2,000 inhabitants 25–64 yrs. randomly selected) Response rate: (I) 1985: 96% (I) 1986: 96% (I) 1987: 96% (I) 1988: 96% (I) 1989: 94% (I) 1990: 91% (I) 1991: 88% (I) 1992: 81% (C)1986: 81% (C)1990: 79% Baseline: (I) 1985: n = 271 (I) 1986: n = 260 (I) 1987: n = 258 (I) 1988: n = 251 (I) 1989: n = 232 (I) 1990: n = 227 (I) 1991: n = 205 (I) 1992: n = 189 (C) 1986: n = 1625 (C) 1990: n = 1583 (The sample from 1986 was followed-up in 1988 and 1991) Lost to follow-up: 36% No randomisation
Municipality selected due to high CVD incidence and mortality
4-year intervention (same as follow-up) Individual: diet and healthy lifestyle (a) Health screening at health centers for age groups 30, 40, 50, and 60 yrs. annually (b) Individual counselling provided to all screened participants. High-risk participants provided with additional support Environmental: diet, PA, alcohol, and psychosocial factors (a) Awareness campaign: newspapers, radio, and TV (b) Organised activities: Educational and health promotion activities provided by existing community and sporting associations. Alternative methods using drama, music, and informal gatherings were encouraged (c) Food stores: food labelling system introduced
Mean BMI for every cross-sectional survey for (I) and (C) groups Males (I) 1985: 25.6 (NA) (I) 1986: 25.5 (NA) (I) 1987: 25.3 (NA) (I) 1988: 24.8 (NA) (I) 1989: 26.3 (NA) (I) 1990: 26.5 (NA) (I) 1991: 25.7 (NA) (I) 1992: 26.2 (NA)
Mean BMI before-after Males (I) 25.4 (NA) versus 25.3 (NA) versus 25.1 (NA)
Females (I) 25.0 (NA) versus 25.0 (NA) versus 25.1 (NA)
Schuit et al. [52] (The Netherlands) “Hartslag Limburg” (Heartbeat Limburg)
Quasiexperimental Changes in smoking, BMI, BP, lipids, and glucose 5 yrs. (cohort)
(I) Whole of community (20–59 yrs.) (C) Community originated from the same monitoring study as the intervention community
I: 49.6% C: 54.0% Male: I: 50.6 yrs. (9.8) C: 52.2 yrs. (9.9) Female: I: 50.6 yrs. (9.7) C: 51.3 yrs. (10.4) Mean years of education (SD): NA Low SES: Male: I: 45% C: 43% Female: I: 61% C: 61%
(I) One province n = 13,184 (n = 4,500 adult inhabitants randomly selected) (C) Same monitoring study (All 1,115 invited from ongoing cohort) Response rate: 80% Baseline: (I) n = 3,000 (C) n = 895 Lost to follow-up: (I) 19% (C) 15% No randomisation
Province selected as a demonstration project and from previous national monitoring studies
5-year Intervention (same as follow-up) 790 components implemented: PA, diet, and smoking: Individual: diet (a) Computer-tailored nutrition education Environmental: PA, diet, and smoking (a) Awareness campaign: radio, newspaper, TV, and pamphlets (b) Organised activities: establishment of walking/cycling clubs and associated campaign, stop-smoking campaign (c) Food stores: supermarket tours, food labelling (d) Policy: smoke-free areas
Mean BMI change Males (I) 0.37 (NA) (C) 0.71 (NA)
Females (I) 0.38 (NA) (C) 0.63 (NA)
Worksite-based
Engbers et al. [34] (The Netherlands) “Food steps”
Quasiexperimental, Changes in PA, diet, alcohol, smoking, BMI, BP, and lipids 1 yr. (cohort)
(I) Office workers from a governmental company with BMI > 23 kg/m2 (C) Office workers from a governmental company with BMI > 23 kg/m2
I: 37.4% C: 41.7% I: 45.3 yrs. (9.6) C: 45.5 yrs. (8.7) Mean years of education (SD): NA Education level: Highd I: 69.9% C: 63.9%
(I) One company located in one building (employees with BMI > 23 kg/m2 invited) (C) One company (different company) located in one building (employees with BMI > 23 kg/m2 invited) Response rate: 12% Baseline: (I) n = 257 (C) n = 283 Lost to follow-up: (I) 8% (C) 6% No randomisation
Worksites selected based on comparability of working environments
1-year Intervention (same as follow-up) Environmental: diet and PA (a) Awareness campaign: prompts (staircases and on elevator doors) to motivate and encourage stair use. Pamphlets promoting healthy lifestyles available in canteen (b) Canteen and vending machines: nutritional information provided at point of sale
Mean BMI change (I) −0.3 (1.2)
(C) −0.2 (1.0)
Test for comparisons between (I) and (C): NA
Kwak et al. [43] (The Netherlands) “NHF-NRG-in balance-project”
Quasiexperimental changes in body composition 2 yrs. (cohort)
(I) Blue collar and white collar workers employed by local government, hospital, factories, energy company, and university (<40 yrs.) (C) Blue collar and white collar workers (<40 yrs.) with a similar SES matched for similar SES
I: 50.7% C: 48.2% I: 38.9 yrs. (8.2) C: 35.0 yrs. (7.4) Mean years of education (SD): NA Education level: Highd I: 49.6% C: 51.6%
(I) Six worksites (Worksites that have accepted to be in the (I) group only, all employees <40 yrs. invited) (C) Six worksites (All employees <40 yrs. invited) Out of all 128 randomly selected worksites from the same region Response rate: NA Baseline: (I) n = 365 (C) n = 188 Lost to follow-up: (I) 30% (C) 23% No randomisation
Worksites matched for SES selected based on size (100 employees +) and staff access to a canteen
1-year intervention (shorter than follow-up) Individual: diet and PA (a) Professional monitoring of body composition (b) “In-balance-box” (pedometer, measuring tape, “calorie guide,” food, and exercise diary) (c) Computer-tailored advice. Environmental: diet and PA Free choice of interventions by worksite including: (a) Awareness campaign: promotional material to encourage stair-use, lunch-walking, and cycling or an information wall about energy balance (b) Organised activities: health workshops (c) Canteen: healthy choices
Quasiexperimental changes in PA, diet, smoking, BMI, BP, lipids and stress 1½ yrs. (cohort)
(I) Professional drivers, 86% blue collar workers (C) Professional drivers, 92% blue collar workers
No females I: 42.9 yrs. (9.9) C: 43.4 yrs. (10.6) Mean years of education (SD): NA
(I) Drivers within 50 km from one town (51 drivers invited) (C) Drivers within 50 km from another town (51 drivers invited) Response rate: 95% Baseline: (I) n = 49 (C) n = 48 Lost to follow-up: (I) 16% (C) 2% No randomisation
Participants selected from previous participation in a CVD screening program of professional drivers The 102 invited drivers did not differ compared to the other 260 drivers of the previous screening programme
1-year intervention (shorter than follow-up) Individual: diet, PA, smoking, and stress (a) Health and nutrition screening for all participants (b) Counselling for all participants led by a healthcare consultant and Dietitian. Pamphlets and free activities provided about a healthy lifestyle at the individual and group level Environmental: diet and PA (c) Organised activities: practical education sessions for drivers and their families. e.g., an exercise session and cooking classes (healthy lunch boxes)
Mean BMI before-after (I) 24.4 (NA) versus 24.9 (NA)
Quasiexperimental (pilot study) changes in diet and BMI 4 months (cohort)
(I) 10th grade students (15 yrs.) from a secondary school (C) 10th grade students (15 yrs.) from the same school
I: 42.3% C: 50.0% No mean ageb Mean years of education (SD): NA
(I) One school, one class n = 26 (C) Same school, one class n = 28 (Intervention school randomly selected among 2 schools) Response rate: 100% Baseline: (I) n = 26 (C) n = 28 Lost to follow-up: (I) NA (C) NA No randomisation
School selected due to request from teachers concerned about antisocial behaviour and poor attendance
4-month intervention (same as follow-up) Environmental: diet (a) Food provision: free healthy breakfast served to students each school day
Median (range) BMI before and after Males (I) 22.6 (17.8–33.6) versus 21.8 (17.6–33.9)
(C) 21.7 (17.0–29.4) versus 22.4 (18.6–29.2)
Females (I) 21.8 (16.9–27.3) versus 22.1 (17.5–28.1)
Quasiexperimental (pilot study) changes in diet and BMI 4 months (cohort)
(I) 9th grade students from a secondary school (C) 9th grade students from secondary schools in the same region
NA No mean age Mean years of education (SD): NA
(I) One school n = 64 (C) Two schools n = 120 (Intervention school randomly selected among 3 schools) Response rate: 82% Baseline: (I) n = 61 (C) n = 95 Lost to follow-up: (I) 9% (C) 4% No randomisation
Schools selected as their syllabus for the 9th grade included lunch preparation in the home economics class, provided 3 times per week
4-month intervention (same as follow-up) Environmental: diet (a) Food provision: free healthy school lunch served to students (prepared by students and served in classroom)
Mean BMI before-after Males (I) 20.7 (3.1) versus 21.3 (3.3)
(C) 20.8 (2.9) versus 21.2 (3.1)
Females (I) 20.5 (3.5) versus 20.7 (3.4)
(C) 20.2 (2.8) versus 20.5 (2.5)
Bere et al. 2014 [26] (Norway) “Norwegian school fruit program for free”
Cluster randomised changes in diet and BMI 8 yrs. (cohort)
(I) 6th and 7th grade children (10–12 yrs.) from schools from one county (C) 6th and 7th grade children (10–12 yrs.) from schools in the same and an alternative county
I: 49% C: 50% 11.8 yrs. (NA) NA by intervention Parents with a high education: I: 48% C: 39%
(I) Nine schools n = NA (C) Twenty-nine schools n = NA (38 elementary schools, randomly selected from two counties) Response rate: NA Baseline: (I) n = 585 (C) n = 1365 Lost to follow-up: (I) 81% (C) 85% Randomisation
(I) Schools selected from one county participating in the “fruit and vegetables make the marks project” (FVMM) (C) Schools selected from 2 counties participating in the same project
1-year intervention (shorter than follow-up) Environmental: diet (a) Food provision: free fruit for students at school (one piece of extra fruit per day)
Mean BMI (95% CI) (I) NA versus 20.5 (19.9, 21.1) versus 22.7 (22.0, 23.4) (C) NA versus 20.7 (20.2, 21.3) versus 23.2 (22.6, 23.8)
Grydeland et al. [35] (Norway) “Health in adolescents (HEIA) study”
Cluster Randomised changes in body composition 20-months (cohort)
(I) 6th grade children (11 yrs.) from schools in the largest towns/ municipalities of 7 counties (C) 6th grade children (11 yrs.) from schools from the same region
I: 50% C: 48% No mean age Parents with an education >16 yrs. I: 36.3% C: 31.1%
(I) Twelve schools n = 784 (C) Twenty-five schools n = 1381 (Out of all 177 schools invited, 37 schools accepted) Response rate: 73% Baseline: (I) n = 566 (C) n = 1014 Lost to follow-up: (I) 7% (C) 9% Randomisation
Schools selected from large municipalities located in 7 counties from the same region with greater than 40 students in 6th grade
20-month intervention (same as follow-up) Individual: diet and PA (a) Computer-tailored individual advice Environmental: diet and PA (a) Curriculum: e.g., Lessons on diet and PA (1/month), breaks for PA and fruit and vegetable snacks (1/week), and active transport campaigns (b) Teachers: training for PE teachers to increase active involvement and enjoyments of students in PE. Toolbox for teachers: Student workbooks, sports equipment, pedometers, practical nutrition activities, and box of sports equipment provided for children to access during breaks (c) Parents: pamphlets on healthy lifestyle (monthly) School-wide: annual meetings for staff and parent committee to encourage active participation and support of project, and positive environmental changes within the school grounds
Mean BMI change (95% CI) Males (I) NA versus 18.6 (18.5; 19.3) (C) NA versus 18.5 (18.4; 18.6)
Females (I) NA versus 19.0 (18.8; 19.3) (C) NA versus 19.2 (19.1; 19.3) ;
Resaland et al. [51] (Norway) “The sogndal school-intervention study”
Quasiexperimental changes in BMI, BP, lipids, and glucose 2 yrs. (cohort)
(I) 4th grade children (9 yrs.) from a school in a municipality (C) 4th grade children (9 yrs.) from a school from another municipality with similar SES
I: 49.6% C: 52.7% No mean age Mean years of education (SD) NA
(I) One school n = 125 (C) One school n = 134 Response rate: 99% Baseline: (I) n = 125 (C) n = 131 Lost to follow-up: (I) 26% (C) 37% No Randomisation
Schools selected from municipalities located within the same region, 105 km apart and had a similar SES, similar size, and similar number of children
2-year intervention (same as follow-up) Environmental: PA (a) Curriculum: 60 minutes of PA per day of the school week (includes 90 minutes per week of standard school-based PE)
Mean BMI change (I) 0.8 (0.1) (C) 0.9 (0.1)
Bugge et al. [27] (Denmark) “Copenhagen school child intervention study” (CoScIS)
Quasiexperimental Changes in PA, BMI, BP, lipids, and glucose 7 yrs. (cohort)
(I) 1st-3rd grade children (6-7 yrs.) from schools from one local authority (suburb) (C) 1st-3rd grade children (6-7 yrs.) from schools from another local authority with similar SES
I: 45.6% C: 50.3% Male: I: 6.8 yrs. (0.4) C: 6.8 yrs. (0.3) Female: I: 6.7 yrs. (0.4) C: 6.6 yrs. (0.4) Mean years of education (SD): NA
(I) Ten schools n = NA (C) Eight school n = NA Response rate: 69% Baseline: (I) n = 408 (C) n = 286 Lost to follow-up: (I) 36% (C) 37% No Randomisation
(I) Schools selected due to an interest by one of the local authorities, in measuring the effect of recently upgraded PA opportunities for young school children (C) Schools selected due to similar SES
3-year intervention (shorter than follow-up) Environmental: PA and diet (a) Curriculum: 180 minutes of PE per week (includes 90 minutes per week of standard school-based PA). Theoretical lessons on PA and healthy eating (b) Teachers: training for PE teachers in use of specialised didactic tools to motivate children to participate and enjoy PA (c) Infrastructure: upgrade of school sports and playing facilities
Mean BMI change Baseline to T1 (I) 1.31 (1.23) (C) 1.15 (1.20)
Quasiexperimental changes in body composition 2 yrs. (cohort)
(I) 2nd–4th grade children (8–13 yrs.) from schools within one municipality (C) 2nd–4th grade children (8–13 yrs.) from schools within the same municipality with similar SES
NA
(I) Six schools n = 773 (C) Four schools n = 734 (Out of all 19 invited for (I) and out of all 6 invited for (C)) Response rate: 80% Baseline: (I) 402 (C) 315 Lost to follow-up: (I) 8.2% (C) 8.0% No randomisation
(I) Schools selected based on an initiative by a community to increase PE lessons in local primary schools for improved health of students (C) Schools matched by SES, school size, and rural/urban area
2-year intervention (same as follow-up) Environmental: PA (a) Curriculum: minimum of 4.5 hours of PE per week (includes 90 minutes per week of standard school-based PE) (b) Teachers: training of PE teachers to plan and facilitate age-related PA for children
Mean BMI before-after (I) 16.7 (2.2) versus 17.7 (2.5) (C) 16.8 (2.1) versus 17.9 (2.6)
Puska et al. [50] (Finland) “The North Karelia youth project”
Quasiexperimental changes in diet, smoking, BMI, BP, cholesterol, health knowledge, attitude, and emotional problems 2 yrs. (cohort)
(II)d 7th grade students (13 yrs.) from schools from one county (CI)d 7th grade students (13 yrs.) from schools from the same county (C) 7th grade students (13 yrs.) from schools from another county
II: 44.8% CI: 47.6% C: 51.8% No mean age Mean years of education (SD): NA
(II) Two schools n = 338 (CI) Two schools n = 318 (C) Two schools n = 310 (One of the two major schools from the county capital randomly selected and one of the schools of major rural centers randomly selected.) Response rate: 99% Baseline: (II) n = 335 (CI) n = 315 (C) n = 309 Lost to follow-up: (II) 12% (CI) 10% (C) 11% Randomisation
(II) (CI) The Intervention county (North Karelia) was selected as it was the setting of an established ‘whole of community’ intervention, of which this school-based intervention was a component (C) County selected as it was located in the same regional area as the (I) county
2-year intervention (same as follow-up) Part of a whole of community intervention (II) Intensive intervention in 2 schools implemented by the project team Individual: diet, PA, and smoking (a) Health screening: by school nurse 1-2/yr.) Counselling: a health passport was used to guide lifestyle counselling for the children by the school nurse. Additional in-home consultations provided by a nutritionist for those children at high risk of CVD Environmental: diet, PA, and smoking (a) Awareness campaign: to promote lifestyle changes (mass media, project magazine, posters, and pamphlets) (b) Curriculum: antismoking (10 × 45 minutes sessions over 2 yrs., led by trained older peer leaders) and diet (education sessions about healthy eating) (c) Teachers: active participation in project encouraged (d) Parents: education sessions promoting a healthy lifestyle (e) Canteen: nutritional changes to the lunch provided to include less total and saturated fat, higher proportion of polyunsaturated fat, more fibre, and less sodium (CI) County-wide Intervention in remainder of North Karelia (i) Recommendations and training regarding the interventions applied in the (II) schools was given to the (CI) schools. Implementation of these initiatives by the schools was encouraged
Mean BMI change Males (II) 1.4 (1.3) (CI) 1.3 (1.3) (C) 1.5 (1.0)
Females (II) 1.4 (1.2) (CI) 1.2 (1.4) (C) 1.4 (1.2)
Cluster Randomised changes in body composition and cardiorespiratory fitness 2 yrs. (cohort)
(I) 2nd grade children (7 yrs.) from schools from the same city (C) 2nd grade children (7 yrs.) from schools from the same city
I: 50.8% C: 60.1% No mean age Mothers with a university degree: I: 52.1% C: 62.9% Fathers with a university degree: I: 43.9% C: 46.2%
(I) Three schools n = 151 (C) Three schools n = 170 (One school from each pair was randomised to (I) and the other to (C)) Response rate: 83% Baseline: (I) n = 128 (C) n = 138 Lost to follow-up: (I) 20% (C) 41% Randomisation
(I) Schools in this region were selected based on a national concern of a decline in aerobic fitness of children and adolescents (C) Schools matched for school size and grades
2-year intervention (same as follow-up) Environmental: PA and diet (a) Curriculum: increase of PA at school through playful learning and participation of teachers together with students in activities e.g., outdoor teaching, excursions, promotion of active transport, one additional PE lesson per week to represent 3 × 40 minute sessions per week. (includes 2 × 40 minute sessions per week of standard school-based PE). Nutrition education lessons to improve awareness, knowledge, self-efficacy, taste and preference surrounding healthy eating with the aim of increasing fruit and vegetable intake at school and home (b) Teachers: training of general teachers to improve their health promoting skills at bimonthly meetings with research team. Education Toolbox provided (books, DVD’s, and sporting and play equipment for indoor and outdoor use) (c) Parents: achieving positive parental influence towards healthy eating an aim of the intervention
Mean BMI before-after (I) 16.0 (1.8) versus 17.4 (2.2) (C) 16.7 (2.1) versus 17.5 (2.7)
Elinder et al. [33] Elinder et al. [66]a (Sweden) “Stockholm county implementation programme- SCIP”
Quasiexperimental changes in PA, diet, BMI, and self-esteem 2 yrs. (cohort)
(I) 2nd, 4th, and 7th grade children and students (6–16 yrs.) from schools in a municipality (C) 2nd, 4th, and 7th grade children and students (6–16 yrs.) from schools from the same municipality
Grade 2: 49.2% Grade 4: 52.3% Grade 7: 47.6% Grade 2: Male: 8.8 yrs. (0.02) Female: 8.7 yrs. (0.03) Grade 4: Male: 10.8 yrs. (0.02) Female: 10.8 yrs. (0.03) Grade 7: Male: 13.9 yrs. (0.03) Female: 13.9 yrs. (0.03) NA by intervention Parents with a high education (>12 years at follow-up): Grade 2: Male: 65.5% Female: 69.6% Grade 4: Male: 62.0% Female: 65.0% Grade 7: Male: 60.2% Female: 56.1%
(I) Nine schools n = 764 (C) Nine schools n = 595 (Self-selection to (I) or (C) group out of all the 18 invited) Response rate: 60% Baseline: (I) n = 482 (C) n = 331 Lost to follow-up: (I) 6% (C) 13% No Randomisation
(I) Schools located in a middle-class municipality were selected for the study due to a request by representatives from the municipality (C) Schools from the same municipality who did not accept to participate in the intervention (Project part of the Stockholm County Overweight and Obesity Action plan)
2-year intervention (same as follow-up) Environmental: diet, PA, and mental health (a) Awareness campaign: newsletters, pamphlets (a) Teachers: 4 training sessions in health promotion, diet, PA, and mental health. Education toolbox provided (including written health education material) (b) Parents: minimum of 1 meeting with parents conducted by the school and research team where the project was presented and pamphlets on health information provided (c) School-wide: each school, in collaboration with a multidisciplinary health team, through a series of workshops developed a tailored action plan with 4 themes (health practices, PA, mental health, and diet) Example of implemented strategies from a combination of various schools: curriculum: outdoor activities, activities on body image, and encouragement of students to prepare healthy snacks Teachers: training skills associated with empathy Parents: encouraged to provide a healthy breakfast and initiate active transport e.g., walking school bus Infrastructure: improvement to playground Policy development/guidelines: implementation of school guidelines to reduce sweets served at festivities
Cluster randomised changes in PA, diet, and BMI 4 yrs. (cohort)
(I) Children (6–10 yrs.) from schools in one county area (C) Children (6–10 yrs.) from schools, from the same county area
49% NA by intervention I: 7.4 yrs. (1.3) C: 7.5 yrs. (1.3) Parents with an education higher than upper secondary school: I: 23–46% C: 26–46%
(I) Five schools n = NA (C) Five schools n = NA (Out of 387 invited schools, 170 schools accepted and 10 schools were selected) Response rate: 90–100% Baseline: (I) n = 1670 (C) n = 1465 Lost to follow-up: 89% Randomisation
Selected schools had a population of students from families of middle and working class
4-year intervention (same as follow-up) School and after School care Environmental: diet and PA (a) Awareness campaign: newsletter for parents and school staff biannually (b) Curriculum: 30 min extra PA per day by general teachers (c) Parents: encouraged not to provide students with unhealthy food and drinks at school or for school outings (d) Canteen: improvements made to the standard free school lunch menu to include less fat, sugar, and more fibre with the promotion of fruit and vegetables (e) Policy implementation/guidelines (i) Restricted of access to and time spent playing computer games to 30 min per school day (ii) Reduced use of sweetened foods at birthday parties and excursions
NA
Nyberg et al. [49] (Sweden) “The healthy school start study”
Cluster randomised changes in PA, diet, BMI, health behaviours, and parental self-efficacy 1 yr. (cohort)
(I) Children (6 yrs.) and their parents from preschools in a municipality (C) Children (6 yrs.) and their parents from preschools within the same municipality
I: 47.3% C: 50.9% No mean age Parents with a low education: I: 33% C: 40%
(I) Seven preschool classes n = NA (C) Seven preschool classes n = NA N total = 338 (Out of all 15 eligible schools in the area, 8 schools accepted and included 14 preschool classes) Response rate: 72% Baseline: (I) n = 129 (C) n = 112 Lost to follow-up: (I) 2% (C) 0% Randomisation
Schools selected from a municipality with low to medium SES due to the higher prevalence of obesity in lower SES communities in Sweden
6-month intervention (shorter than follow-up) Environmental: diet and PA (a) Curriculum: 30-minute healthy lifestyle education sessions, held 7–10 times/intervention period. Toolbox of activities provided (teacher manual and student workbooks) (b) Teachers: 2-hour training provided for classroom activities (c) Parents: pamphlets provided (healthy eating, PA, screen time, and sleep), motivational interviews (2 × 45 minute sessions), active participation encouraged with children’s healthy lifestyle homework
NA
De Henauw et al. [31] Hense et al. [67]a Ahrens et al. 2011 [68]a (Sweden) “IDEFICS” “The Identification and prevention of dietary- and lifestyle-induced health Effects in children and infants approach”
Quasiexperimental changes in diet, body composition, well being, screen time, and sleep 2 yrs. (cohort)
(I) Children (2–9.9 yrs.) from kindergartens and primary schools from one region (C) Children (2–9.9 yrs.) from kindergartens, preschools, and schools (grades 1 and 2) from a region with similar SES
48.8% NA by intervention 5.7 yrs. (0.05) NA by intervention Parents with a high education: 67.2% NA by intervention
All the schools in the region were invited Number of randomisation units NA N total = 2759 Response rate: 66% Baseline: (I) n = 902 (C) n = 907 Lost to follow-up: 18.2% No randomisation
(I) Community selected as one of eight European countries as part of the IDEFICS cross-cultural childhood obesity and prevention study (C) Community selected based on similar size and SES
2-year intervention (same as follow-up) Environmental: diet, PA, stress, and sleep (a) Awareness campaign: local media to promote a healthy lifestyle in the community (b) Curriculum: increased opportunities for PA and provision of healthy lifestyle education (c) Parents: encouraged to support a healthy lifestyle for their children (d) Infrastructure (community): liaison with local authorities to improve e.g., outdoor play and cycling opportunities, access to water fountains (e) School-wide: improvement to the school food environment (f) Supporting materials: toolbox detailing implementation of intervention components focused on diet, PA, stress-coping capacity, and sleep quality
Mean BMI-z score before-after Males (I) 0.070 versus 0.138 (C) −0.127 versus −0.021
Females (I) 0.007 versus 0.104 (C) −0.093 versus −0.017
Quasiexperimental Changes in PA and BMI 3 yrs. (cohort)
(I) Children (6–9 yrs.) from a school from a rural location (C) Children (6–9 yrs.) from a school from a rural location with similar SES
I: 39.7% C: 48.6% Mean age (SD): NA Mean years of education (SD): NA
(I) One school n = NA (C) One school n = NA N total = 132 Response rate: 100% Baseline: (I) n = 58 (C) n = 74 Lost to follow-up: 8% No randomisation
Schools selected based on similarities of rural location, size, appearance, structure, and SES of the children
3-year intervention (same as follow-up) Environmental: PA (a) Curriculum: increase in PE time to include one 40-minute lesson per day–4 days per week (includes standard school-based PE of one lesson/week (6–9 yrs.) and two lessons/week (10–12 yrs.) +60 minutes of outdoor activities with classroom teacher once per week Obese children offered one extra lesson per week
Quasiexperimental changes in PA and body composition (I) 1 yr. (C) 2 yrs. (cohort)
(I) 1st and 2nd grade girls (7–9 yrs.) from a school from a middle-class area in a municipality (C) 1st and 2nd grade girls (7–9 yrs.) from neighbouring schools with similar SES
I: 100% C: 100% I: 7.7 yrs. (0.6) C: 7.9 yrs. (0.6) Mean years of education (SD): NA
(I) One school n = 61 (C) Three schools n = NA Response rate: (I) 90% (C) NA Baseline: (I) n = 55 (C) n = 64 Lost to follow-up: (I) 4% (C) 22% No randomisation
(I) School selected that did not have a high level of PA in the curriculum (C) Schools selected from neighbouring area with similar SES
1-year intervention (same as follow-up) Environmental: PA (a) Curriculum: One 40-minute lesson of PE per school day (200 min/week, includes standard school-based PE of 60 minutes PE/week)
Busch et al. [28] (The Netherlands) “The utrecht healthy school program (UHS)”
Quasiexperimental Changes in PA, diet, alcohol, drug use, smoking, BMI, sedentary time, sexual behaviours, and bullying 2 yrs. (cohort + cross-sectional samples)
(I) Students from high schools from suburbs of middle-large cities (C) Students from high schools, from suburbs of middle-large cities
NA
(I) Two schools n = 1400 (C) Two schools n = 1400 Response rate: 80% Baseline: 2011: n = 1716 2012: n = 1692 2013: n = 2393 Lost to follow-up: 65% No randomisation
(I) Schools selected to implement the Utrecht Health School (UHS) program (C) Schools selected from suburbs of middle-large cities as for the (I) group
2-year intervention (same as follow-up) Environmental: diet, PA, and smoking Priorities of (I) school A: increased PA, reduced sedentary time, healthy weight, nutrition, preventing, and reducing smoking Priorities of (I) school B: nutrition and PA Strategies implemented via capacity building through a tailored whole-school approach: (a) Capacity building: integration of local health authority e.g., professional support and provision of a Health Promoting Schools (HPS) coordinator (b) Curriculum: development of personal skills in health education. Health promoting schools goals guided the curriculum(c) Teachers: some unstructured competency training in health education provided (d) Parents: active involvement of parents to promote a healthy lifestyle (e) Canteen: healthy options provided (f) Policy: e.g., no smoking on school grounds Note: strategies implemented in a higher degree in (I) school A than (I) school B
School A Baseline versus T1 Baseline versus T2 School B Baseline versus T1
Baseline versus T2
Busch et al. [29] (The Netherlands) “The utrecht healthy school (UHS) program”-Pilot
Pre- and Postintervention historical control group (pilot study for Busch et al.) [28] Changes in PA, diet, alcohol, drug use, smoking, BMI, sedentary time, sexual behaviours and bullying 3 yrs. (cross-sectional samples)
(I) 4th grade students (15–16 yrs.) from a secondary school (C) 4th grade students (15–16 yrs.) from the same school, enrolled 3 years earlier
I: 47% C: 54% Mean age (SD): NA Mean years of education (SD): NA
(I) One school n = 199 (C) Same school n = 220 (The (C) group came from 4th grade students in 2007) (3 yrs. before the 4th grade students in 2010) Response rate: (I) 60% (C) 100% Baseline: (I) n = 136 (C) n = 220
(I) School selected to implement the Utrecht Health School (UHS) program in 4th graders in 2010 (C) Students selected who were 4th graders in 2007 at the same school
3-year intervention (same as follow-up) Environmental: diet, PA, alcohol, smoking, drug use, sexual behaviour, bullying, sedentary activity, and excessive gaming/internet use 1st year priorities: nutrition, reducing alcohol, smoking, sedentary behaviours, and bullying 2nd year approach: PA, sexual behaviours, and reducing drug use Strategies implemented via a capacity-building through a tailored whole-school approach: (a) Capacity building: integration of local health authority e.g., professional support (b) Curriculum: innovative and interactive methods to develop personal skills e.g., handling peer pressure, with special teaching modules using peer education. Health Promoting Schools goals guided curriculum for each priority area (c) Teachers: in-service training by health professionals (d) Parents: active involvement of parents to promote a healthy lifestyle (e) Canteen: healthy options provided (f) Policy: no smoking, alcohol or drugs. Bullying-zero tolerance (g) Supporting materials: healthy school website created by the school
NA
de Greeff et al. [30] (The Netherlands) Part of the project “Fit en vaardig op school” (fit and academically proficient at school; F&V)”
Cluster randomised changes in BMI and fitness 22-weeks (cohort)
(I) 2nd or 3rd grade children (7–8 yrs.) from schools in one region (C) 2nd or 3rd grade children (7–8 yrs.) from schools from the same region
I: 55.2% C: 59.0% I: 8.0 yrs. (0.7) C: 8.2 yrs. (0.8) Mean years of education (SD): NA
(I) Six 2nd grade and six 3rd grade classes n = NA (C) Six 2nd grade and six 3rd grade classes n = NA N total = 388 (Out of 12 schools 2nd or 3rd grade class was randomised as (I) or (C) for each of the 12 schools) Response rate: 97% Baseline: (I) n = 181 (C) n = 195 Lost to follow-up: NA Randomisation
Schools were selected as they were part of the project “Fit en Vaardig op school,” a randomised trial with the aim to improve academic performance
22-week intervention (same as follow-up) Environmental: PA (a) Curriculum: integration of physically active academic lessons of 30 minute lessons, 3 times per week implemented by trained substitutes teachers
Mean BMI before-after 2nd grade (I) 16.4 (NA) versus 16.7 (NA)
(C) 16.4 (NA) versus 16.6 (NA)
3rd grade (I) 17.0 (NA) versus 17.2 (NA)
(C) 17.0 (NA) versus 17.6 (NA)
Test for comparisons between (I) and (C): NA
Kocken et al. [41] (The Netherlands) “Extra fit!” (EF!)
Cluster randomised changes in PA, diet, BMI, sedentary behaviour, and behavioural determinants 2 yrs. (cohort)
(I) 4th–6th grade children (9–11 yrs.) from schools (C) 4th–6th grade children (9–11 yrs.) from schools
I: 52.0% C: 51.3% I: 9.2 yrs. (0.6) C: 9.1 yrs. (0.6) Mean years of education (SD): NA
(I) Twenty-three schools n = NA (C) Twenty-two schools n = NA (Out of 500 schools from the same country, 65 were randomised, 20 dropped-out after randomisation. For every pair of school, one was randomised to (I) and the other to (C).) Response rate: NA Baseline: (I) n = 615 (C) n = 497 Lost to follow-up: (I) 40% (17 schools) (C) 5% (21 schools) Randomisation
(I) Children aged 9–11 yrs. were selected due to their ability to participate in the study questionnaires and the restricted budget for the study (C) Schools matched, based on similar SES and urbanization
2-year intervention (same as follow-up) Environmental: diet and PA (a) Curriculum: practical and interactive theoretical education program promoting behavioural changes towards a healthy diet and PA. Children participated in an average of 7.6 hours of lessons over 16-weeks per school year compared to control schools with an average of 3.3 hours. Schools could offer extra PA lessons at their discretion (b) Teachers: professional support provided to teachers by local health professionals and sports service (c) Parents: encouraged to promote a healthy lifestyle and participate with homework activities. Extra optional activity: “Extra fit-day” for parents and children
Mean BMI z-score before-after (I) 0.6 (0.2) versus 0.6 (1.2) versus 0.6 (1.1) (C) 0.6 (1.1) versus 0.5 (1.2) versus 0.6 (1.2)
de Meij et al. [32] (The Netherlands) “JUMP-in study”
Quasiexperimental Changes in PA, BMI, sports participation, and fitness 20-months (cohort)
(I) 3rd–8th grade children (6–12 yrs.) from schools in 2 city districts (C) 3rd–8th grade children (6–12 yrs.) from comparable schools in geographically separated city districts
I: 51.2% C: 48.1% Male: I: 8.6 yrs. (1.9) C: 8.6 yrs. (1.8) Female: I: 8.5 yrs. (1.9) C: 8.5 yrs. (1.8) Mean years of education (SD): NA
(I) Nine schools n = NA (C) Ten schools n = NA Response rate: 100% Baseline: (I) n = 1378 (C) n = 1451 Lost to follow-up: (I) 20% (C) 13% No randomisation
Schools were selected from socially and economic deprived areas which met the criteria of a certified PE teacher, high enrolment of students with a low SES, and access by school to a gymnasium
2-year intervention (same as follow-up) Individual: PA (a) Health screening for children-annually: “pupil follow-up system.” (b) Additional tailored activities for overweight children: “club extra” Environmental: PA (a) Curriculum: regular PA breaks in class time “The class moves.” In class activity workbook promoting PA, associated skills, and health benefits (b) Parents: workbook “this is your way to move” with activities for children and parents. Parental information services about sports activities, meetings, and courses (c) School-wide: different sporting activities offered to children to try on a daily basis in collaboration with local sports clubs “School sports clubs.”
Mean BMI before-after (I) 18.2 (3.4) versus 18.7 (3.6) versus 19.1 (3.7) (C) 18.1 (3.4) versus 18.4 (3.5) versus 18.8 (3.7)
Jansen et al. [38] (The Netherlands) “Lekker fit!” (enjoy being fit!)
Cluster randomised changes in BMI and fitness 2 yrs. (cohort)
(I) 3rd–8th grade children (6–12 yrs.) from schools from an inner-city area (C) 3rd–8th grade children (6–12 yrs.) from schools from the same inner-city area
Grades 3–5 I: 50.5% C: 51.0% Grades 6–8 I: 52.8% C: 49.0% Grades 3–5 I: 7.7 yrs. (1.0) C: 7.8 yrs. (1.0) Grades 6–8 I:10.8 yrs. (1.0) C:10.8 yrs. (1.0) Mean years of education (SD): NA
(I) Ten schools n = 1271 (C) Ten schools n = 1499 (Out of 27 schools that volunteered to participate, 26 were paired (one did not match) and randomised to (I) or (C)) Response rate: 95% Baseline: (I) n = 1240 (C) n = 1382 Lost to follow-up: (I) 7% (C) 8% Randomisation
Primary schools were selected as located in deprived inner-city neighbourhoods, with low SES, and a high proportion of immigrant children
2-year intervention (same as follow-up) Individual: diet and PA (a) Eurofit test with scorecard at commencement and conclusion of school year (b) Individual counselling by school nurse as required Environmental: diet and PA (a) Curriculum: 3xPE sessions per week (includes 2 PE sessions per week of standard school-based PE) Educational program on healthy lifestyle, diet, and PA (b) Parents: annual information meeting about local sporting clubs (c) Community: optional extra sport and play activities outside school hours in collaboration with local sporting clubs
Mean BMI before-after Grades 3–5 (I) 17.1 (2.8) versus 17.5 (3.0) (C) 17.1 (2.8) versus 17.6 (3.1)
Grades 6–8 (I) 19.6 (4.0) versus 20.4 (4.2) (C) 19.1 (3.8) versus 19.8 (4.1)
Singh et al. [53] (The Netherlands) “Dutch obesity intervention in teenagers (DOiT)”
Cluster randomised changes in PA, diet and body composition 20-months (cohort)
(I) 1st grade students (12–14 yrs.) from schools (C) 1st grade students (12–14 yrs.) from schools
I: 53.2% C: 46.6% Males I: 12.8 yrs. (0.5) C: 12.9 yrs. (0.5) Females I: 12.6 yrs. (0.5) C: 12.7 yrs. (0.5) Mean years of education (SD): NA
(I) Ten schools n = NA (C) Eight schools n = NA Response rate: 84% Baseline: (I) n = 632 (C) n = 476 Lost to follow-up: 21% Randomisation
NA
8-month intervention (shorter than follow-up) Environmental: PA and diet (a) Curriculum: adaptation of the school curriculum to include 11 lessons in biology and PE promoting healthy lifestyle. School encouraged to include more PE classes (b) Canteen: school encouraged to make healthy changes
Mean BMI before-after Males Baseline to T1 (I) 18.2 (2.6) versus 18.6 (2.8) (C) 19.0 (2.9) versus 19.4 (2.9)
Baseline to T2 (I) 18.2 (2.6) versus 19.1 (3.0) (C) 19.0 (2.9) versus 19.8 (3.0)
Baseline to T3 (I) 18.2 (2.6) versus 19.4 (2.9) (C) 19.0 (2.9) versus 20.0 (2.7)
Females Baseline to T1 (I) 19.0 (3.0) versus 19.5 (3.1) (C) 19.5 (3.4) versus 20.0 (3.5)
Baseline to T2 (I) 19.0 (3.0) versus 19.9 (3.2) (C) 19.5 (3.4) versus 20.3 (3.4)
Baseline to T3 (I) 19.0 (3.0) versus 20.2 (2.9) (C) 19.5 (3.4) versus 20.9 (3.6)
Naul et al. [48] (The Netherlands) “Healthy children in sound communities” (HCSC/gkgk)--a Dutch-German community-based network project.”
Quasiexperimental changes in BMI and fitness 1 yr. (cohort)
(I) Children (6–10 yrs.) from Dutch schools (C) Children (6–10 yrs.) from German schools located in the same Dutch-German border region
Gender: NA I: 6.96 yrs. (0.56) C: 7.24 yrs. (0.24) Mean years of education (SD): NA
(I) Thirteen schools n = NA (C) Six schools n = NA Response rate: NA Baseline: n = 744 Lost to follow-up: 25% No randomisation
Schools were selected from a sample of 39 primary schools that had implemented an intervention in their school
1st year (4-year intervention) Environmental: PA and diet (a) Curriculum: 3 hours/week of tailored PE, one hour of cross-curricular education per week with a focus on health, and nutrition, healthy-active school breaks (b) Teachers: training (health, PE, and nutrition) Toolbox (project homepage): lesson plans for PE (c) Parents: events for children and their parents e.g., cooking classes (d) School-wide: active commuting to school-walking school bus (e) Community: one-hour extra PA, facilitated by sport clubs, offered 2 afternoons/week. Training for coaches. (f) Supporting materials: project homepage
Mean BMI before-after (I) 16.3 (NA) versus 16.6 (NA) (C)16.5 (NA) versus 16.7 (NA) (p = significant for heavy overweight and obese children, NA)
SD: standard deviation; SES: socioeconomic status; PA: physical activity; BMI: body mass index; BP: blood pressure; yrs.: years; yr.: year; I: intervention; C: control; n: number; NA: not available; CVD: cardiovascular disease; NS: non-significant; NGO: non-governmental organizations; MONICA: multinational monitoring of trends and determinants in Cardiovascular disease; PE: physical education; II: intense direct intervention; CI: county-wide intervention; IDEFICS: the identification and prevention of dietary- and lifestyle-induced health Effects in children and infants approach. aAdditional references (e.g., design article) for further information on baseline data and design. bDoes not apply for mean age when all children are at the same grade (same age). cMean years of education or SES for schools where we refer to the years of education of the parents and not of the children or adolescents. dHigh refers to high education as defined as university education [34, 42, 43, 65], or 13 years or more of education [56, 57].eData presented only for BMI changes and not obesity prevalence changes. Data are presented by gender and intervention only if total data by intervention group are not available.
