Thuyvi Luong and Jean Munnerlyn

Research Proposal

HSC 6735

Background and Aims

The United States has one of the highest rates of childhood obesity in the entire world. Despite

considerable attention, research, resource investment, and effort, childhood obesity remains one

of the most prominent public health issues in the US. Although overall obesity rates seem to

have stabilized, the prevalence of childhood obesity is still alarmingly high (Wendel, 2016). In

their longitudinal analysis of national data, Ogden et al. found that 16.9% of children aged 2 to

19 years were obese in 2012, and another 14.9% were overweight (Wendel, 2016). Children who

are obese have a greater chance of developing type 2 diabetes, hypertension, cardiovascular

disease, and some cancers. According to Wendel, they could be more likely to encounter low-

self esteem, depression, anxiety, and become victims of bullying. Along with those factors what

Wendel described, he also stated that childhood obesity, if not controlled, can translate to

adulthood obesity.

The cause of childhood obesity is multifaceted and varies from child to child. But at the

most basic level, obesity can be caused by sedentary behavior, such as sitting (Clemes, 2015) and

energy imbalances (Wendel, 2016). Reducing sedentary behaviors in young people is pertinent

for the primary and secondary prevention of diseases that result from excessive engagement in

these behaviors. The grade school classrooms in the US have high volumes of sedentary

behavior. Due to the classroom sedentary behavior, there are interventions to target reductions in

classroom sitting among children. Evidence suggests that the use of sit-to-stand desks in
elementary schools is effective in increasing energy expenditure. Some studies have also shown

bike-desks are successful in lowering BMI levels in high school students (Torbeyns, 2017).

However, few studies have done attempted to show the effectiveness of bike-desks in elementary

to middle school age students. The overall goal of this research proposal is to assess the most

successful methods of non-traditional classroom obesity prevention and to identify the gaps of

knowledge. The specific aims of this project are:

Aim 1: To identify the successful methods of non-traditional physical activity in grade school

classroom settings and describe how each method operates.

Aim 2: To determine whether non-traditional obesity prevention methods alone are significantly

effective in reducing childhood obesity.

Significance

The obesity epidemic in the United States among those in grade school is growing.

According to the Centers for Disease Control and Prevention (CDC), the prevalence of childhood

obesity was, on average, 17% from 2011 and 2014. While the CDC says the prevalence has

recently been stable, intervention programs can be improved. Many current obesity prevention

programs in place can be refined to focus more on in-class physical exercise rather than solely

learning about nutrition education and healthy habits. Most students attend school for eight hours

a day. The majority of those hours are spent stationary at their desks. Various studies show that

sitting for the majority of the day can lead to unhealthy habits and obesity.

Identifying and determining the successful methods of non-traditional physical activity in

grade-school classroom settings will allow us to provide the next step of determining how to

improve obesity prevention plans. The goal is to prevent obesity in students during the grade

school years. Many grade schools have traditional ways of teaching, which includes sitting in the
classroom most of the day, and many of them only get traditional physical education once or

twice a week (Burgermaster, 2017) . Non-traditional classroom exercises can be a solution to

tackling childhood obesity. Examples of these methods include standing desks, bike desks, and

general exercises incorporated into lessons during classroom time. Studies that try to look over

many different prevention plans at once wind up only have less than ten studies they look at

(Wang, 2015).

Along with eating healthy, exercise is one of the best ways to help prevent obesity and

keep a healthy weight, which means leading a less sedentary life (Akindutire, 2017) Most

prevention programs at the grade school level highlight healthy eating but lack focusing on

physical exercise. Increased sedentary behavior is associated with an elevated risk of diabetes,

cardiovascular disease e increased risks along with obesity (Wilmot et al., 2012). Meanwhile,

physical activity has been associated to overall increased cognitive performance, brain

functioning and academic performance (Torbeyns 2017), which is critical in a classroom setting.

There are also studies that show differences in brain activation between those who are more

physically active as opposed to those who are less active (Torbeyns 2017). This allows us to see

that there is a need here to see if incorporating non-traditional methods of physical fitness into

the classroom setting.

In classroom settings, we have seen certain types of non-traditional methods have the

potential to help students increase their physical fitness, while not interfering with their academic

performance (Torbeyns 2017). While these stand-alone studies are important, one of the main

issues of these studies is the small sample sizes, which normally focus on one specific classroom

or one specific grade in a primary school. These studies are also only looking at one method of

non-traditional exercise in classroom and do not compare themselves to others methods.

 This research study will aim provide more scientific knowledge along with improving

technical methods of non-traditional exercise methods for grade schools. Understanding the

effectiveness of non-traditional methods in schools will allow us to modify obesity prevention

programs to contain more exercise. We can also identify more beneficial methods to help

children lose weight. Since prevention programs are generally more on the on the educational

side, rather than holistically incorporating physical fitness into them, we will be able to see if

integrating them into the classroom have a long term effect on their BMI over a period of time.

This research aims to increase students' ability to understand how exercise and changing simple

habits will allow them to leave healthier lives and how to apply it to their everyday lives.

If we see there is a positive association of the proposed aims, we hope to see more

effective preventative methods that integrate more non-traditional methods. Allowing children to

participate in non-traditional exercise in prevention programs will allow the children to see the

effect of their health, which will hopefully inspire the children themselves. More movement and

exercise during the normal school day will show similar results as during the prevention

programs, and this will hopefully be more overall more effective for students who are are at risk

for childhood obesity.

Innovation

Our research aims to shift current research on non-traditional classroom obesity prevention

programs by proposing to incorporate more stationary bikes in the classrooms of middle school

(grades 6-8) and high schools (grades 9-12) and more stand-sit desks in elementary schools

(grades K-5). Out of all the studies we analyzed, the most successful one is from Tobeyn, 2017,

Bike Desks in the Classroom: Energy Expenditure, Physical Health, Cognitive Performance,

Brain Functioning, and Academic Performance. This is based on the overall BMI decrease of
students, success with teachers, and the likelihood of interference of student’s behaviors. This

study concluded that the implementation of bike desks in the classroom were a highly effective

means of reducing in-class sedentary time and improving adolescent’s physical health. Along

with that, teachers had an overall positive experience with the bikes, and it did not interfere with

adolescents’ academic performance.

Some of the research articles we reviewed used stand-sit desks (Wendel, 2016, Clemes,

2015). These studies were successful in that they had significant effects on student’s BMI

percentiles. But the issue with these studies is that measuring BMI can be a challenging task,

especially when young children are growing at fast rates over the course of studies. We suggest

refining this method of data collection by examining changes in BMI percentile over time. This

is one way of balancing the issue of BMI collection. The growth of charts can account for

anticipated increases in height and weight of children.

To conclude, for the purpose to reducing childhood obesity through non-traditional

classroom physical exercise, we suggest studying the use of bike-related exercises. There are few

studies on the impact of stationary bikes in classrooms, but the couple that have been done are

widely successful. For methodology, we suggest measuring BMI over the course of time and

analyzing the growth of charts.

Approach

Our research proposal aims to identify successful methods of non-traditional physical

activity in grade school classroom settings and to describe how each method operates and aims

to determine whether non-traditional obesity prevention methods alone are significantly effective

in reducing childhood obesity. Both aims will done through a systematic review of literature and

an analysis of data at the end. The objective will be to synthesize existing knowledge on non-
traditional obesity prevention methods, and to see if bike desks should be studied in elementary

schools. Bike desks in middle and high schools was in the past, but little to no research was

studied in elementary schools. We hope to draw a conclusion from all the literature to determine

the most effective obesity prevention method.

The study population is students from kindergarten to 12th grade. These students will be

from schools in the United States in public or private schools. The wide inclusion criteria will

aim to include as many elementary school students as possible. Our hypothesis is that students

using non-traditional desks will have lower BMI at the end of the study than those with

traditional desks. The independent variable is the use of non-traditional classroom obesity

prevention methods, such as sit-stand desks and bike desks. The dependent variable is the change

in BMI over the course of the study.

Our hypothesis for this study is a combination of both of aims. Our aims are to identify

and then determine if non-traditional obesity prevention programs can reduce obesity in children

across the US. We theorize most types of non-traditional physical activity will have a statistically

significant effect on reducing childhood obesity. Our study aims to understand just how well this

can change the tides of rising childhood obesity through different practices then they are used to.

The data collected for the study through various databases. Databases that we will use for

the study are the most common are NHANES, CINHAL and MEDLINE. Search criterias for the

prevention methods will include “non-traditional prevention”, “seat-bikes”, and “stand desks”,

“exercise in classrooms”. For the population we are looking at, we will use search criteria of

“Children”, “grades-school” and “k-12”. After finding studies for each specific prevention

method we are looking at, and calculate BMI before and after all of the studies and see if there is

a negative relationship between BMI before and after. If there is the relationship we are looking
for, then we will say that it is successful. We will also look at studies that mix traditional and

non-traditional prevention methods, and calculate those BMI’s and look for if there is a

statistically significant linear relationship between the BMI change.

When analyzing, we have to be aware of potential problems, alternative strategies, and

benchmarks for success, along with the statistical methods that are used for this study. We are

going to look at the correlation between the BMI of the students in the prevention program from

when they started and when they finished the program, and if there is a negative relationship

between the BMI from at the start, and at the end, then the program was successful. We are

going to look at studies that have traditional and non-traditional types of prevention and analyze

them separately from the studies with only non-traditional types within the study. If we see a

negative trend with those studies, then we will assume that there is a potential for the non-

traditional prevention to work.

There are a few problems that could arise with this kind of study. The main issue is that

there could be incorrect and missing data. We are depending on other studies for our data, so we

have to trust that data is correct and has minimum room for error.. A way for us to avoid the

problem is to find data from studies that has been peer reviewed and are from a reputable source.

One concerning issue that may arise from this study is that there may not be enough data on

either one specific non-traditional physical activity, or all of them in general. Not finding enough

data would force us to drop that specific method from our study. We would have to claim that

the data was insufficient, even if there were studies that had findings pertinent to that one

specific method of prevention.

Those alternative strategies for this proposal is one of our potential problem if we cannot

find enough data for all of the methods, is to look in other databases for data, or start looking at
creating a study that would allow us to test the non-traditional methods in real time, and collect

our own data. While there are other databases with health literature, we chose those three

because they are the most robust, but we would have to start looking at others if we found that

there was not enough data in an of the databases for any of the methods that we are trying to

examine. The last resort if none of the databases have enough data, is that we would have to

conclude that our study material was insufficient and start the project over, and start working on

collecting our own data to see if it would work in a small population - instead if it was working

over a wide range of areas.

We will view this study as successful in the following ways - 1) If at least have of the

non-traditional methods of prevention we are looking are successful in showing a negative trend

in BMI, and 2) If those that have been mixed with traditional methods have also been successful

in showing that same negative trend. The first benchmark will prove that the majority of these

methods are effective and will help us look at how to start implementing them to students to start

helping with obesity prevention in classrooms. If the second benchmark is successful, then we

will be able to see that mixed methods are important for helping prevent childhood obesity, and

both should be implemented together if we want to start reducing this issue.

Bibliography

Akindutire, I. O., & Olanipekun, J. A. (2017). Sedentary Life-Style as Inhibition to Good Quality
of Life and Longevity. Journal Of Education And Practice, 8(13), 39-43.

Burgermaster, M., Koroly, J., Contento, I., Koch, P., & Gray, H. L. (2017). A Mixed-Methods
Comparison of Classroom Context During Food, Health & Choices, a Childhood Obesity
Prevention Intervention. Journal Of School Health, 87(11), 811-822.
doi:10.1111/josh.12556

Clemes, Stacy A., et al. “Reducing Children's Classroom Sitting Time Using Sit-to-Stand Desks:
Findings from Pilot Studies in UK and Australian Primary Schools | Journal of Public
Health | Oxford Academic.” OUP Academic, Oxford University Press, 17 Oct. 2016,
 academic.oup.com/jpubhealth/article-abstract/38/3/526/2239809/Reducing-children-s-
classroom-sitting-time-using.

Gutilla, M. J., Davidson, A. J., Daley, M. F., Anderson, G. B., Marshall, J. A., & Magzamen, S.
(2017). Data for Community Health Assessment in Rural Colorado. Journal of Public
Health Management and Practice, 23. doi:10.1097/phh.0000000000000589

Howard-Drake, E. J., & Halliday, V. (2016). Exploring primary school headteachers'

perspectives on the barriers and facilitators of preventing childhood obesity. Journal Of
Public Health, 38(1), 44-52. doi:10.1093/PubMed/fdv021

Mccrady-Spitzer, Shelly K., et al. “Low-Cost and Scalable Classroom Equipment to Promote
Physical Activity and Improve Education.” Journal of Physical Activity and Health, vol.
12, no. 9, 2015, pp. 1259–1263., doi:10.1123/jpah.2014-0159.

Neelon, Sara E. Benjamin, et al. “Preventing Obesity in Infants and Toddlers in Child Care:
Results from a Pilot Randomized Controlled Trial.” Maternal and Child Health Journal,
vol. 18, no. 5, 2013, pp. 1246–1257., doi:10.1007/s10995-013-1359-x.

Torbeyns, Tine, et al. “Bike Desks in the Classroom: Energy Expenditure, Physical Health,
Cognitive Performance, Brain Functioning, and Academic Performance.” Journal of
Physical Activity and Health, vol. 14, no. 6, 2017, pp. 429–439., doi:10.1123/jpah.2016-
0224.
Wang, Y., Cai, L., Wu, Y., Wilson, R. F., Weston, C., Fawole, O., … Segal, J. (2015). What
childhood obesity prevention programmes work? A systematic review and meta-analysis.
Obesity Reviews : An Official Journal of the International Association for the Study of
Obesity, 16(7), 547–565. http://doi.org/10.1111/obr.12277

Wendel, Monica L., et al. “Stand-Biased Versus Seated Classrooms and Childhood Obesity: A
Randomized Experiment in Texas.” American Journal of Public Health, vol. 106, no. 10,
2016, pp. 1849–1854., doi:10.2105/ajph.2016.303323.