Pediatric Weight Management

PWM: School-based Interventions (2011)


Beets MW, Beighle A, Erwin HE, Huberty JL. After-school program impact on physical activity and fitness: A meta-analysis. Am J Prev Med. 2009 Jun; 36(6): 527-537.

PubMed ID: 19362799
Study Design:
Meta-analysis or Systematic Review
M - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To examine after-school programs targeting youth physical activity.

Inclusion Criteria:
  • Related to an after-school intervention
  • Sample population: Children or adolescents (aged 18 or less years)
  • The setting of the intervention: A school (public or private)
  • To promote physical activity by intervention
  • Outcome measures of physical activity and physical fitness were reported
  • Physical fitness was included as an outcome based on a number of studies indicating that the use of increased physical activity can promote changes in constructs related to physical activity (e.g., bone mineral density, cardiovascular fitness, blood lipids and body composition)
  • Studies could have been either quasi-experimental (using pre- and post-tests with no control and no randomization) or RCT.
Exclusion Criteria:
  • Non-English publications
  • Studies were descriptive in purpose
  • Included an after-school component as one of several arms of an intervention and did not report findings
  • Separating the impact of attending an after-school program
  • Conducted in a non-school setting (e.g., local health clubs)
  • An overview of study design without quantitative outcomes.
Description of Study Protocol:
  • Sources (databases) searched: PubMed, ScienceDirect and EBSCOhost
  • Search dates (beginning and end): 1980 and February 2008
  • Key question(s): What is the effectiveness of after-school programs in increasing physical activity?
  • Four key elements for the search strategy:
    • School-based setting (primary or secondary)
    • After-school program
    • Physical activity behavior
    • Study design (intervention, quasi or controlled).
Data Collection Summary:
  • Population: Children or adolescents (aged 18 years or less)
  • Intervention(s) or exposure: After-school programs in increasing physical activity
  • Outcomes: Physical activity, physical fitness, body composition, blood lipids, psychosocial constructs and sedentary activities
  • Setting: School (public or private)
  • Method of analysis: Narrative summary and quantitative summary.
Description of Actual Data Sample:
  • Number of studies identified: 797
  • Number of studies reviewed: 34
  • Number of studies included: 13 articles (11 studies)
  • Number of studies included in meta-analysis:
    • Physical activity: Six studies
    • Physical fitness: Six studies
    • Body composition: 10 studies
    • Lipids: Three studies
    • Psychosocial
      • Physical activity: Three studies
      • Bodyweight concerns: Three studies
      • General: Two studies:
      • Sedentary activity: Four studies.
Summary of Results:
  • Question 1: What is the effectiveness of after-school programs in increasing physical activity?
  • Quantity of studies: 11 studies
  • Design(s) of studies included for this question: Study design (intervention, quasi or controlled)
  • Conclusion or key outcome: From the six domains (physical activity, physical fitness, body composition, lipids, psychosocial, sedentary activity), positive effect sizes were demonstrated for:
    • Physical activity [0.44 (95% CI: 0.28 to 0.60)]
    • Physical fitness [0.16 (95% CI: 0.01 to 0.30)]
    • Body composition [0.07 (95% CI: 0.03 to 0.12)] and blood lipids [0.20 (95% CI: 0.06 to 0.33)].
Author Conclusion:

The limited evidence suggests that after-school programs that include a physical activity component can be effective in improving physical activity levels, physical fitness, body composition and blood lipid profiles of children and young adolescents. 

Funding Source:
Other: not reported
Reviewer Comments:
  • Because the studies are heterogeneous, we cannot determine the specific component of a successful after-school program
  • No information on attendance rates and process evaluations
  • Studies with control group or pilot studies are included. 
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes