Impact of a randomized school-based intervention program on blood pressure levels

Matos, Raiani Spalenza; Siqueira, Jordana Herzog; Cunha, Diana Barbosa; Molina, Maria del Carmen Bisi

doi:10.1590/1806-93042020000400004

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 20 (4) • Oct-Dec 2020 • https://doi.org/10.1590/1806-93042020000400004 copy

Impact of a randomized school-based intervention program on blood pressure levels

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to evaluate the impact of a health program performed in a school setting on the blood pressure levels of schoolchildren in the public school system in Vitória/ES-Brazil.

Methods:

a randomized community trial was performed with 237 schoolchildren (6 to 12 years) from two public schools, randomly defined as the intervention and control school. Participants of the intervention group attended 11 education sessions over 4 months (July to October 2014). To test for differences between groups, the chi-square (categorical variables), and the paired t test or Wilcoxon (continuous variables) was used. The rate of variation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) throughout the follow-up, according to allocation group, was evaluated using linear generalized models for time-repeated measures.

Results:

there was a reduction in the means of SBP (0.5 mmHg) and DBP (0.6 mmHg) in the intervention group and an increase in the control group, with a significant difference in the BP variation between groups over the follow-up period (p<0.05).

Conclusion:

a low-cost and easily implemented intervention may be one of the factors associated with the lowest blood pressure levels in the group studied, and reproduction in a school environment is feasible.

Key words:
Clinical trial; Arterial pressure; Child; Adolescent.

Intervention components	Objectives	Methodology
1) Food preferences and relation with nutrition	To know the schoolchildren's eating habits and understand the nutrition process	Recording with words or drawings the foods they like, do not like, and are good for health
2) Identification of points of sale of food near the school and the children's homes	To know points of sale in the children's and the school's neighborhood	Observation of the school and the children's residence neighborhood, and recording what was observed
3) Diversity of fruits and vegetables and the benefits of five colors (red, orange, green, purple, and white)	To present and show the importance - by means of interactive games - of the benefits of colorful foods	Dynamic games with riddles relating to fruits and vegetables
4) Food labeling and TV advertising	To excite curiosity about reading labels and warn about food ads, as well as develop critical thinking	Reading food labels and showing advertisements as well as test tubes with amounts of salt, sugar, and fat as contained in the food consumed by children
5) Active play	To encourage the practice of physical activities and show that not much room or resources are needed to exercise	Series of playing (hopscotch, elastic, running with balloons) and recalling of parents' games during the chat groups
6) Reviewing the benefits of the five colors of fruits and vegetables	To re-emphasize the benefits of regular consumption of fruits and vegetables through an analysis of their nutrients based on the food's colors	Dynamic game of filling in posters with the names of fruits and vegetables with each of the five colors
7) Fruit tasting	To show the diversity of fruits and encourage regular eating	Blind tasting and guess dynamics in which the children tasted fruits that they usually eat and other exotic fruits
8) Assessment of the interventions	To observe the changes/ effects of the workshops	Recording, with words or drawings, the food preferences, the changes after the workshops, and the foods they intend to try
9) Identification of colleagues for playing and physical activities	To collect reports of affection and engaging in physical activity outside the school	Division of groups for running activities and questions about affection
10) Identification of places for physical activity	To know the places near the children's homes which were identified as potential places for playing	Division of groups for tracing the places available for playing and physical activities close to their homes
11) Education actions review	To recall and assimilate the education actions review contents	Chat panels and delivery of educational material to be read with the family

Variables	Intervention School		Control School		p
Variables	n	%	n	%	p
Sex					0.862
Male	66	44.3	40	45.5
Female	83	55.7	48	54.5
Age (years)					0.342
6 and 7	39	26.2	24	27.3
8 and 9	58	38.9	41	46.6
≥ 10	52	34.9	23	26.1
Race/Ethnicity					<0.001
White	62	41.6	14	15.9
Black	41	27.5	32	36.4
Brown	46	30.9	42	47.7
Socioeconomic class^ One child from the control school did not have data for food quality, socioeconomic class, physical activity, or screen time; BMI= Body Mass Index.					<0.001
A and B	66	44.3	13	14.9
C	67	45.0	64	73.6
D and E	16	10.7	10	11.5
School year					0.561
2nd	36	24.2	23	26.1
3rd	36	24.2	22	25.0
4th	26	17.4	20	22.7
5th	51	34.2	23	26.1
Blood pressure					0.445^* * Wilcoxon Test;
Normal	144	96.6	84	95.5
Borderline and Elevated	5	3.4	4	4.5
Food quality^ One child from the control school did not have data for food quality, socioeconomic class, physical activity, or screen time; BMI= Body Mass Index.					0.110
Low quality	42	28.2	36	41.4
Intermediate quality	37	24.8	19	21.8
Good quality	70	47.0	32	36.8
Physical activity^ One child from the control school did not have data for food quality, socioeconomic class, physical activity, or screen time; BMI= Body Mass Index.					0.701
≥ 300 minutes/week	129	86.6	73	83.9
< 300 minutes/week	20	13.4	14	16.1
Screen time^ One child from the control school did not have data for food quality, socioeconomic class, physical activity, or screen time; BMI= Body Mass Index.					0.857
≤ 120 minutes/day	24	16.1	15	17.2
> 120 minutes/day	125	83.9	72	82.8
BMI/Age (kg/m²)	18.6	3.8	17.5	3.3	0.065

	Intervention School		p	Control School		p
	Initial Evaluation	Final Evaluation		Initial Evaluation	Final Evaluation
	X̅ ± SD (Median)	X̅ ± SD (Median)		X̅ ± SD (Median)	X̅ ± SD (Median)
Weight (kg)	35.7 ± 11.5 (33.2)	38.3 ± 12.5 (35.6)	< 0.001^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;	32.2 ± 9.6 (29.7)	34.4 ± 10.4 (31.1)	< 0.001^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;
Height(cm)	137 ± 11 (137)	140 ± 12 (139)	< 0.001	135 ± 10 (135)	138 ± 10 (137)	< 0.001
BMI/Age (kg/m²)	18.6 ± 3.8 (17.4)	19.1 ± 4 (17.9)	< 0.001^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;	17.5 ± 3.3 (16.3)	17.8 ± 3.4 (16.8)	< 0.001^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;
SBP (mmHg)	99.4 ± 8.3 (99)	98.9 ± 7.8 (99)	0.345	100.6 ± 7.0 (100)	102.4 ± 7.1 (102)	0.052
DBP (mmHg)	60.5 ± 7.3 (60)	59.9 ± 5.6 (60)	0.320^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;	60.3 ± 6.2 (59.5)	62.5 ± 6.1 (62)	0.002^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;
Screen time (min/day)^ The data for one child from control school do not include food quality, socioeconomic class, physical activity, or screen time; SCD = School Child Diet Index.	295 ± 154 (300)	261 ± 152 (240)	0.010^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;	284 ± 155 (270)	263 ± 150 (270)	0.083
Physical activity (min/week)^ The data for one child from control school do not include food quality, socioeconomic class, physical activity, or screen time; SCD = School Child Diet Index.	1.076 ± 699 (950)	1.159 ± 756 (990)	0.129^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;	1.120 ± 717 (1.010)	1.235 ± 819 (1.130)	0.034
SCD index^ The data for one child from control school do not include food quality, socioeconomic class, physical activity, or screen time; SCD = School Child Diet Index.	5.3 ± 3.6 (5)	5.4 ± 3.5 (5)	0.377^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;	4.4 ± 3.2 (4)	5.4 ± 3.29 (5)	0.001^* * Wilcoxon test; BMI= Body Mass Index; SBP= Systolic blood pressure; DBP= Diastolic blood pressure;

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