CONTEXT: The effects of school-based physical activity (PA) programs on different cardiometabolic risk factors and the most appropriate features of PA programs to achieve maximum effectiveness are unclear. OBJECTIVE: To provide a comprehensive synthesis of the effectiveness of school-based PA interventions on cardiometabolic risk factors in children. DATA SOURCES: We identified studies from database inception to February 22, 2018. STUDY SELECTION: We selected studies that were focused on examining the effect of school-based PA interventions on cardiometabolic risk factors in children. DATA EXTRACTION: Random-effects models were used to calculate the pooled effect size (ES) for the included cardiometabolic risk factors (waist circumference (WC), triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure and diastolic blood pressure (DBP), and fasting insulin and glucose). RESULTS: Nineteen randomized controlled trials (which included 11 988 children aged 3 to 12 years) were included in the meta-analysis. School-based PA programs were associated with a significant small improvement in WC (ES -0.14; 95% confidence interval (CI) -0.22 to -0.07; p < 0.001), DBP (ES -0.21; 95% CI -0.42 to -0.01; p = 0.040), and fasting insulin (ES -0.12; 95% CI -0.20 to -0.04; p = 0.003). LIMITATIONS: Authors of few studies described the implementation conditions of their interventions in detail, and compliance rates were lacking in most studies. In addition, results by sex were provided in a small number of studies. CONCLUSIONS: School-based PA interventions improve some cardiometabolic risk factors in children, such as WC, DBP, and fasting insulin.
Reproduced with permission from Pediatrics. Copyright by the American Academy of Pediatrics.

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