After-and in-school fitness and nutrition programs for elementary students.

Rearick, Matt ; Creasy, John ; Mumaw, Elizabeth 等

INTRODUCTION:

In the face of statewide budget cuts in education and the likely changes for physical education as a content area taught in public schools, it is important now more than ever that we as a community explore alternatives to traditional health and wellness educational models. This does not suggest we forego offering and/or emphasizing physical education as a core topic in the schools; nevertheless change is upon us and we must consider how to preserve this important area of every child's education.

This paper outlines a series of successful, alternative health and wellness interventions carried out at the elementary level between 2006 and 2008. The primary motivation for the project was to determine what supplemental wellness experiences are good for kids, staff, and faculty and what can be done with limited fiscal means. Methods in this paper are described in such a way that any school or school district might adopt parts of or the entire program. Our hope is that this project provides the seeds for other programs of its kind in the state of Virginia. We also trust that those individuals and schools already employing much of this in their own schools will come forth and assist in this conversation so Virginia can continue to offer top-notch health and wellness programs in the schools.

Purpose of Project:

The Lewis and Clark Trail Project was designed and implemented in a school system in Pennsylvania between 2006 and 2008 to increase awareness and understanding of the importance of fitness and nutrition to a healthy lifestyle. The primary goal of the project was to weave a series of fitness and nutrition activities into the everyday life of the school. To do this, the theme of walking the Lewis and Clark Trail was used as the project and curricular linchpin. For example, individual classrooms competed to see who could walk the trail the fastest (maps were posted throughout the school and progress reports tallied in the multi-purpose room each week). In addition, the Lewis and Clark Trail served as a relevant historical, geographic, mathematical and language arts topic for everyday coursework. Thus, the project supported the fitness and nutrition needs of the school and its' children as well as provided the opportunity for integrative, contextualized learning.

TARGET AUDIENCE:

Over two academic years approximately 630 students (prepubescent children, grades 3-6) as well as teachers and administrators participated in a series of initiatives as part of the Lewis & Clark project. Participants took part in a school-wide walking program and an after-school wellness club (called "Trailblazers"). Students' also experienced new foods through modified snack and lunch options instituted district wide by the Food Service's Program and within each classroom as part of a fruit and vegetable taste testing segment, similar in spirit to the Take 10! Program (www.take10.net).

SCOPE OF THE PROGRAM:

The school-wide walking initiative required participants (students, teachers, administrators and staff) to wear a pedometer for the entire school week and record the number of steps taken each day. The goal was for a significant number of participants to achieve 10,000 steps a day on average. A secondary goal was to impact the everyday culture of the school by making fitness a priority for everyone, not just for students.

The after-school wellness club incorporated a variety of nontraditional fitness activities based on the successful Sports, Play, and Active, Recreation for Kids (SPARK) after-school program (www.sparkpe.org) as well as healthy snack options; students also assessed their nutrition intake by using the food pyramid (www.pyramid.gov). Finally, Food Services introduced district-wide menu changes (particularly related to ala carte options) and instituted class-wide taste tests of fruits and vegetables one time each semester.

Several important findings from this program included i) significant improvement in student attitude toward physical activity (as assessed by the C-PAAS, Children's Physical Activity Attitude and Self-Efficacy survey); ii) 100% of students improving on 1 or more SPARK fitness tests as part of the after-school program; iii) over 50% (n = 200) of elementary students reaching 10,000 steps per day on average; iv) stabilization or decrease in the average BMI across all students grades 3--6; v) over 80 students and 12 teachers involved in the after-school program (= 60 days per school year) and vi) over 60% of participants in the after-school program improving food choices (as tracked by the food pyramid).

The Lewis and Clark Trail Project was funded through a local health foundation's competitive grant program. All program components were approved by the School Board of the participating District.

PROGRAM DESIGN:

The Lewis and Clark Trail Project consisted of several fitness and nutrition initiatives rolled into one. The school--wide walking portion was designed around the earlier work of Veugelers and Fitzgerald (2005) and is further supported by the Coordinated School Health approach to Childhood obesity (Schetzina et. al., 2009), which specifically outlines the "America on the Move" approach. Here small changes in activity, monitored by tracking steps through pedometer use, are emphasized. The desire is to institute small, incremental changes in behavior over time where lifelong habits are created and attitude toward physical activity is influenced in positive ways.

The after-school wellness club was modeled after the successful SPARK program, where the emphasis is on creating changes in students' environment and behavior (http://www.sparkpe.org/). Fun environments are developed that foster healthy eating, use non-traditional activities and focus on consistent practice of wellness, with a particular emphasis on individual achievement over group competition known as "Personal Best".

The nutrition component of the Lewis and Clark Project took on several forms and was modeled after the earlier work of Wardle and colleagues (2003) and is further supported by the recent Smart Bodies (Tuuri et. al., 2009) program. The Smart Bodies wellness program encourages the experience of tasting new, different and healthy foods. The rationale is the more opportunities children have watching others eat fruits and vegetables, as well as trying new foods themselves, the higher the probability they will develop healthy eating habits. The Lewis and Clark Project also introduced district wide changes in Food Services by instituting the NutriKids software program (http://www.nutrikids.com) and the Lunchbox, Point-of-Sale system ( ).

Special Considerations:

After two years of programming which included both formative and summative assessment, several issues are clear.

1). Teacher buy-in and participation is the key to success in the school-wide walking and after-school programs. Everything starts with the teachers and trickles down to the students. We found these programs work best in an elementary school setting where teachers and students are together for most of the day.

2.) All assessment processes should be put in place prior to the beginning of the project and teachers should be trained in how to collect the number of steps taken per student per day. We found this works best when one teacher or administrator is in charge and they facilitate the data collection process among all other teachers. This individual also acts as impromptu motivator and formative assessor; thus problems can be identified and solved quickly.

3.) We observed very specific outcome differences across pro grams; therefore it is likely each had its' own specific influence on student attitude and behavior. Nevertheless, we suggest a school only adopt one program to start (e.g. taste testing in the classrooms or the after-school program). As these programs become a part of the school's wellness culture additional programs can be added, particularly more comprehensive ones like the school-wide walking which is more challenging to implement.

Facility and Equipment Needs

a.) The in-school walking program requires all participants (students, b.) teachers, administrators and staff) to have a pedometer for use during the school week. It requires one individual to oversee data collection from all classrooms at the end of each week.

b.) The after-school program requires the use of a gymnasium or multi-purpose space, transportation [for various out-of-school activities (e.g., roller skating)] and 3--4 staff members to facilitate activities and the healthy snack during this period. Generally the after-school program runs three days per week over ten weeks in the fall and spring, respectively.

c.) The nutrition components for the in-school and after-school program involve a staff person capable of facilitating the purchase of vegetable and fruit trays for in-school taste tests (one to two times per year) and the purchase of snacks for after-school program (e.g., granola bars or grapes).

Assessment

It is our recommendation that one individual serve as the overall evaluator for the program. If this is not feasible (fiscally or practically) then one individual from the school, preferably with some experience in data collection, should be recruited. It is important to use formative assessment to track the program's progress and make needed changes quickly instead of waiting for the program to complete a full yearly cycle. This is more efficient and cost worthy. The Lewis and Clark Project instituted an array of qualitative and quantitative assessment tools to track the program's progress over time.

For the in-school walking program, students tracked steps taken each day. Generally this was reported and recorded on a tally sheet at the beginning of each school day. All these values were placed in an excel file for tracking. We have also tried another model which only uses pedometers during the school-day; they are handed out and collected within the same day. Both are equally challenging and rewarding methods and both meet our goal of impacting number of steps, awareness of fitness needs and overall attitude in elementary students.

For the after-school program, students took part in fitness testing (muscle endurance: sit-ups and push-ups, and cardiorespiratory endurance: loops) once every two weeks. This data was tracked on individual score cards. Values from score cards were placed in an excel file for tracking. Also, attendance, daily activities and snack options were tracked at each meeting. One time each semester (fall and spring) students self-assessed their own eating habits using the food pyramid (http://www.pyramid.gov/). They would track food consumed for a typical day and then set goals for the week. The following week they would track consumption again and look for positive changes in eating habits. Teachers would assist students in looking for positive changes and often would make recommendations for how they could improve even more.

Overall fitness and attitude were assessed by an outside team of college students majoring in health and wellness. This assessment model could easily be done in-house (e.g., with the school's wellness teacher(s) and support faculty); however if access to a college setting exists, using college students (and appropriate faculty) has been effective for the Lewis and Clark project outlined in this manuscript. The outside assessment team conducted its' assessment one time in the fall and one time in the spring, as close to the beginning and end of the school year as possible (based on the college academic schedule). Assessment included using a relatively random sample of 3rd--6th grade students (n =50 per grade level). Testing occurred over two days of normally scheduled physical education and wellness classes. Elementary students were subjected to a series of fitness assessments including: resting heart rate, height, weight, body mass index (BMI), Percent Body Fat via Bioelectrical Impendence (Raustorp et. al., 2006; Wells & Fewtrell, 2006) and submaximal VO2 step test (Frances & Feinstein, 1991). Students also took a student knowledge survey (SuperFit Kids Knowledge Test; Serpas-Mott et. al., 1991) and attitude and self-efficacy survey (C-PAAS, Children's Physical Activity Attitude and Self-Efficacy Survey; Maina, 2002).

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NOTE:

We encourage interested schools to seek external funding to support their own fitness and nutrition program. All the programs within the Lewis and Clark Project were supported by a regional health foundation. This health foundation was particularly keen on our overarching project model as well as our assessment and evaluation plan.

REFERENCES:

Frances, K. & Feinstein, R. (1991). A simple height-specific and rate-specific step test for Children. Southern Medical Journal, 84(2), 169-174.

Mania, J. (2002). Effects of an eight week fitness curriculum on the fitness knowledge, fitness test scores, attitude and self-efficacy towards physical activity of fifth grade children. Unpublished Doctoral Dissertation, Florida State University.

Raustorp, A., Mattsson, E., Svensson, K., & Stahle, A. (2006). Physical Activity, body composition and physical self-esteem: a 3--year follow-up study among adolescents in Sweden. Scandinavian Journal of Medicine and Science in Sport, 16(4), 258-66.

Schetzina, K.E., Dalton, W.T., Lowe, E.F., Azzazy, N., Von-Werssowetz, K.M., Givens, C., Pfortmiller, D.T., & Stern, H.P. (2009). A coordinated school health approach to obesity prevention among appalachian youth: The winning with wellness pilot project. Family and Community Health, 32(3), 271 - 285.

Serpas-Mott, D., Virgilio, S.J., Warren, B.L., & Berenson, G.S. (1991). Effectiveness of a personalized fitness module on knowledge, attitude, and cardiovascular endurance of fifth-grade students: "Heart Smart". Perceptual and Motor Skills, 73, 847-858.

Tuuri, G., Zanovec, M., Silverman, L., Geaghan, J., Solmon, M., Holston, D., Guarino, A., Roy, H., & Murphy, E. (2009). "Smart Bodies" school wellness program increased children's knowledge of healthy nutrition practices and self-efficacy to consume fruit and vegetables. Appetite, 52, 445-451.

Veugelers, P.J. & Fitzgerald, A.L. (2005). Effectiveness of school programs in preventing childhood obesity: a multi-level comparison. American Journal of Public Health, 95, 432-435.

Wardle, J., Herrara, M-L., Cooke, L. & Gibson, E.L. (2003). Modifying children's food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable. European Journal of Clinical Nutrition, 57, 341-348. 2003.

Wells, J.C. & Fewtrell, M.S. (2006). Measuring Body Composition. Archives of Disease in Childhood, 91(7), 612-7.

Matt Rearick, Ph.D., John Creasy, Ph.D., Elizabeth Mumaw, Roanoke College; Jack B. Johnson, Ph.D., CSCS, Virginia Military Institute