Examination of the association between a child’s health behavior and access to healthy living at home and their HR, BMI

, flexibility and strength measures in 2nd and 3rd graders
Stephanie Birkenstock, Adam Engel, Katie Lorenzi, Josh Merrick, Kalina Myszkowski, Grace Price, Julie Waldie, Ira Gorman School of Physical Therapy, Regis University, Denver, CO
INTRODUCTION
 Over the past 20 years, the prevalence of children who  are overweight has become an epidemic, increasing  by 50% in the United States.1, 2  This trend has proven  to put children, with increased Body Mass Index (BMI),  at serious risk for developing negative or adverse  health implications across the lifespan including: type  II diabetes, numerous cardiovascular complications,  and early mortality rates. The three major levels that  we believe contribute to this epidemic are the  individual factors, the physical environment (i.e.,  school and home) and the social/cultural environment.   This said, it has been noted that increased physical  activity cannot only reduce children’s BMI, but reduce  the numerous corollary health conditions associated  with high BMI.  It is further evident that performance  gains in the areas of strength, power, speed,  endurance, coordination, and agility have been  associated with increased physical activity in children. 

METHODS
Subjects: 
Subjects included second and third grade students at  The Odyssey School, a DPS charter school that uses  dynamic expeditionary learning to foster each child's  unique potential and spirit of adventure.   A total of 54  students (32 males) from two separate classes,  participated in this study.

RESULTS

DISCUSSION
• Cohort of overall healthy 2nd and 3rd graders with only 3  subjects falling into the at risk or overweight category  • Percent BMI decreased significantly but can be attributed  to maturation of the subjects • Pre/post-test analysis of the subject’s attitudes  demonstrated a statistically significant positive trend  towards increased physical activity and better eating habits

  
Pre-Test

EDUCATIONAL PIECE Heart Health Education Nutritional Reflection Importance of Physical Activity Pro-section of human, cow and sheep hearts/lungs

 
PreTest Survey

Shuttle run HR/HT/WT Curl up Shoulder Flex Sit and Reach Vertical Jump

PostTest
Shuttle run HR/HT/WT Curl up Shoulder Flex Sit and reach Vertical Jump

* Indicates p <.05

• Small sample size and skewed distribution of the outcome  variables prevented the finding of significant regression  models

PostTest Survey

CLINICAL RELEVANCE
•Physical therapists have a role in health education  within the community •Beginning health and wellness education at a young  age could have beneficial effects on subjects’ attitudes  towards a healthy lifestyle •Future studies should consider… • Larger sample size, different age groups, more  diverse SES, longer period for follow-up, and/or  more active intervention • Analysis of covariates as stated above and  control for other possible confounders • Clustering of tests to more effectively determine  fitness level of subjects

October 2007

April 2008

Procedures:
• We worked in collaboration with the faculty  at Odyssey  to enrich the student’s learning experience on various  health-related topics • Distributed initial survey that was completed at home  with parents included validated questions regarding  physical activity levels, attitudes about health, nutrition,  and environment

Purpose:
To examine the association between a child’s health  behavior and access to healthy living at home and their  HR, BMI, flexibility, and strength measures.  Additionally,   to determine if an educational-based intervention for  second and third graders would result in improved  attitudes towards exercise, physiological measures, and  physical performance.  As a result, we hope to further  identify appropriate interventions for battling the epidemic  of childhood overweight as well as contribute to the  evidence detailing the effectiveness of school-based  intervention programs.

• Performance tests and measures administered to the  children including:  shuttle run, vertical jump, curl-up, sit  and reach, push ups, and shoulder flexion • Educational segments included: • Small group discussions about nutrition and  physical activity • Pro-section observation of human, cow and sheep  hearts and lungs • Instruction on self monitoring HR • Data analysis conducted: • Descriptive statistics to define demographics   • Paired t-test to determine if significant differences  pre- post-test existed • Linear Regression models to determine if certain  behaviors or attitudes predicted the various  outcome variables
8 7 6 5 4 3 2 1 0
>5 5--10 11--20 21-30

Percentile BMI

31-40

41-50

51-60

61-70

71-80

81-84

>85

Percentile BMI

Post Test D ata Reg ression Analysis with r Values Percent BMI S huttle Run Curl Ups Vertical Jum p Perform ance Measures 0 3 .1 1 0 5* .4 4 0 2* .3 8 0 1* .3 1 Nutrition Multim edia Usage Health Attitudes *significant to p< 5 .0 0 7 .0 0 9 .1 3 0 8 .0 8 0 7 .0 7 0 1 .0 6 0 9* .1 7 0 2 .1 7 0 0 .1 7 0 4 .1 4 0 6 .1 9 0 7 .0 9 0 3 .1 7

2

Acknowledgements :
We would like to thank the 2nd and 3rd graders of Mr. Andy and Ms. Kathi’s  classes, Amy Hammerich, PT, DPT, and Ira Gorman, PT, MSPH.

References :
• • Snethen JA, Broome ME. Weight, exercise, and health: children's perceptions. Clin Nurs Res. May 2007;16(2):138-152. Center for disease control and prevention: BMI. May 2007; http://www.cdc.gov/nccdphp/dnpa/bmi/childrens_BMI/about_childrens_BMI.htm. Accessed July 15, 2007.