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Obesity-related conditions impose a considerable and growing burden on low- and middle-income countries, including South Africa. We aimed to assess the effect of twice a 10-week multidimensional, school-based physical activity intervention on children's health in Port Elizabeth, South Africa. A cluster-randomised controlled trial was implemented from February 2015 to May 2016 in grade 4 classes in eight disadvantaged primary schools. Interventions consisted of physical education lessons, moving-to-music classes, in-class activity breaks and school infrastructure enhancement to promote physical activity. Primary outcomes included cardiorespiratory fitness, body mass index (BMI) and skinfold thickness. Explanatory variables were socioeconomic status, self-reported physical activity, stunting, anaemia and parasite infections. Complete data were available from 746 children. A significantly lower increase in the mean BMI Z-score (estimate of difference in mean change: -0.17; 95% confidence interval (CI): -0.24 to -0.09; p < 0.001) and reduced increase in the mean skinfold thickness (difference in mean change: -1.06; 95% CI: -1.83 to -0.29; p = 0.007) was observed in intervention schools. No significant group difference occurred in the mean change of cardiorespiratory fitness (p > 0.05). These findings show that a multidimensional, school-based physical activity intervention can reduce the increase in specific cardiovascular risk factors. However, a longer and more intensive intervention might be necessary to improve cardiorespiratory fitness.

Original publication




Journal article


International journal of environmental research and public health

Publication Date





Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland.


Humans, Obesity, Body Mass Index, Exercise, Social Class, Physical Education and Training, Schools, Physical Fitness, Child, Vulnerable Populations, South Africa, Female, Male