Health effects of children's summer holiday programs: a systematic review and meta-analysis.
Child health
Health equity
Holidays
Obesity
Physical activity
Journal
The international journal of behavioral nutrition and physical activity
ISSN: 1479-5868
Titre abrégé: Int J Behav Nutr Phys Act
Pays: England
ID NLM: 101217089
Informations de publication
Date de publication:
18 Oct 2024
18 Oct 2024
Historique:
received:
02
05
2024
accepted:
13
09
2024
medline:
19
10
2024
pubmed:
19
10
2024
entrez:
18
10
2024
Statut:
epublish
Résumé
Unfavourable changes occur in children's health behaviours and outcomes during the summer holidays. This systematic review aimed to determine the effectiveness of summer holiday programs in mitigating these changes. Six databases (MEDLINE, JBI, PsychINFO, Embase, ERIC and Scopus) were systematically searched for experimental controlled studies that investigated programs of at least 5 days' duration conducted exclusively during the summer holiday period on school-aged children (5-18 years). Primary outcomes were moderate-vigorous physical activity and energy intake. Secondary outcomes were sedentary behavior, diet quality, adiposity, and cardiorespiratory fitness. Risk of Bias was assessed using the PEDro tool. Effect sizes were calculated using random-effects meta-analysis with narrative synthesis of effects by student or program characteristics. Ten studies (two randomised controlled trials, and eight non-randomised controlled trials) involving 1,446 participants were included. Summer programs had a significant moderate effect on reducing sedentary behaviour (g= -0.59, 95%CI= -1.16, -0.03) and significant small effects on improving moderate-to-vigorous physical activity (g = 0.35, 95%CI = 0.02, 0.67) and adiposity (g= -0.25, 95% CI = -0.39, -0.10). No significant change was detected for cardiorespiratory fitness (g = 0.43, 95%CI= -0.32, 1.17), energy intake (g= -0.06, 95% CI -2.33, 2.22), or diet quality (g = 0.20, 95%CI= -0.43, 0.83). Summer program effectiveness did not appear to differ by child sociodemographic or program characteristics. Concerns regarding bias and high heterogeneity impacted results. Summer programs show potential in promoting healthier movement behaviours in children and supporting healthy body weight during the summer months. Although evidence from the included studies has limitations, these programs produced small to moderate effect sizes and present promising health intervention opportunities for children. Future research with more rigorous study designs and comprehensive reporting is needed to confirm these findings and better understand the impact of summer programs on children's health. CRD42023409795.
Sections du résumé
BACKGROUND
BACKGROUND
Unfavourable changes occur in children's health behaviours and outcomes during the summer holidays. This systematic review aimed to determine the effectiveness of summer holiday programs in mitigating these changes.
METHODS
METHODS
Six databases (MEDLINE, JBI, PsychINFO, Embase, ERIC and Scopus) were systematically searched for experimental controlled studies that investigated programs of at least 5 days' duration conducted exclusively during the summer holiday period on school-aged children (5-18 years). Primary outcomes were moderate-vigorous physical activity and energy intake. Secondary outcomes were sedentary behavior, diet quality, adiposity, and cardiorespiratory fitness. Risk of Bias was assessed using the PEDro tool. Effect sizes were calculated using random-effects meta-analysis with narrative synthesis of effects by student or program characteristics.
RESULTS
RESULTS
Ten studies (two randomised controlled trials, and eight non-randomised controlled trials) involving 1,446 participants were included. Summer programs had a significant moderate effect on reducing sedentary behaviour (g= -0.59, 95%CI= -1.16, -0.03) and significant small effects on improving moderate-to-vigorous physical activity (g = 0.35, 95%CI = 0.02, 0.67) and adiposity (g= -0.25, 95% CI = -0.39, -0.10). No significant change was detected for cardiorespiratory fitness (g = 0.43, 95%CI= -0.32, 1.17), energy intake (g= -0.06, 95% CI -2.33, 2.22), or diet quality (g = 0.20, 95%CI= -0.43, 0.83). Summer program effectiveness did not appear to differ by child sociodemographic or program characteristics. Concerns regarding bias and high heterogeneity impacted results.
CONCLUSIONS
CONCLUSIONS
Summer programs show potential in promoting healthier movement behaviours in children and supporting healthy body weight during the summer months. Although evidence from the included studies has limitations, these programs produced small to moderate effect sizes and present promising health intervention opportunities for children. Future research with more rigorous study designs and comprehensive reporting is needed to confirm these findings and better understand the impact of summer programs on children's health.
PROSPERO REGISTRATION
UNASSIGNED
CRD42023409795.
Identifiants
pubmed: 39425115
doi: 10.1186/s12966-024-01658-8
pii: 10.1186/s12966-024-01658-8
doi:
Types de publication
Systematic Review
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
119Informations de copyright
© 2024. The Author(s).
Références
Weaver RG, Beets MW, Brazendale K, Brusseau TA. Summer Weight Gain and Fitness loss: causes and potential solutions. Am J Lifestyle Med. 2019;13(2):116–28.
pubmed: 30800015
doi: 10.1177/1559827617750576
Olds T, Maher C, Dumuid D. Life on holidays: differences in activity composition between school and holiday periods in Australian children. BMC Public Health. 2019;19(Suppl 2):450.
pubmed: 31159768
pmcid: 6546614
doi: 10.1186/s12889-019-6765-6
Weaver RG, Armstrong B, Hunt E, Beets MW, Brazendale K, Dugger R et al. The impact of summer vacation on children’s obesogenic behaviors and body mass index: a natural experiment. Int J Behav Nutr Phys Activity. 2020;17(1):1–14.
Zosel K, Monroe C, Hunt E, Laflamme C, Brazendale K, Weaver RG. Examining adolescents’ obesogenic behaviors on structured days: a systematic review and meta-analysis. Int J Obes. 2022;46(3):466–75.
doi: 10.1038/s41366-021-01040-9
Grimes CA, Riddell LJ, Nowson CA. Nutrient and core and non-core food intake of Australian schoolchildren differs on school days compared to non-school days. Appetite. 2014;83:104–11.
pubmed: 25110037
doi: 10.1016/j.appet.2014.08.006
Brazendale K, Beets MW, Armstrong B, Weaver RG, Hunt ET, Pate RR, et al. Children’s moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis. Int J Behav Nutr Phys Act. 2021;18(1):28.
pubmed: 33568183
pmcid: 7877033
doi: 10.1186/s12966-021-01095-x
Watson A, Maher C, Golley R, Dumuid D, Manson A, Tomkinson G et al. Children’s activity and diet behaviours in the summer holidays versus school year. Pediatr Obes. 2023;8(7):e13029.
Baranowski T, O’Connor T, Johnston C, Hughes S, Moreno J, Chen T-A, et al. School year versus summer differences in child weight gain: a narrative review. Child Obes. 2014;10(1):18–24.
pubmed: 24367922
pmcid: 3922244
doi: 10.1089/chi.2013.0116
von Hippel PT, Powell B, Downey DB, Rowland NJ. Changes in children’s body Mass Index during the School Year and during summer vacation. Am J Public Health. 2007;97:696–702.
pubmed: 17329660
pmcid: 1829359
doi: 10.2105/AJPH.2005.080754
Singh AS, Mulder C, Twisk JW, Van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88.
pubmed: 18331423
doi: 10.1111/j.1467-789X.2008.00475.x
Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clinic proceedings. 2017;92(2):251–65.
Morgan K, Melendez-Torres G, Bond A, Hawkins J, Hewitt G, Murphy S, et al. Socio-Economic inequalities in adolescent summer Holiday experiences, and Mental Wellbeing on Return to School: analysis of the School Health Research Network/Health Behaviour in School-Aged Children Survey in Wales. Int J Environ Res Public Health. 2019;16(7):1107.
pubmed: 30925676
pmcid: 6480971
doi: 10.3390/ijerph16071107
Brazendale K, Beets MW, Weaver R, Pate RR, Turner-McGrievy GM, Kaczynski AT et al. Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act. 2017;14:1–14.
Olds T, Dumuid D, Eglitis E, Golley R, Fraysse F, Miatke A, et al. Changes in fitness and fatness in Australian schoolchildren during the summer holidays: fitness lost, fatness regained? A cohort study. BMC Public Health. 2023;23(1):1–11.
doi: 10.1186/s12889-023-17009-4
Eglitis E, Miatke A, Virgara R, Machell A, Olds T, Richardson M, et al. Children’s Health, Wellbeing and Academic outcomes over the summer holidays: a scoping review. Children. 2024;11(3):287.
pubmed: 38539322
pmcid: 10969660
doi: 10.3390/children11030287
Stewart H, Watson N, Campbell M. The cost of school holidays for children from low income families. Childhood. 2018;25(4):516–29.
pubmed: 30473595
pmcid: 6210572
doi: 10.1177/0907568218779130
Tanskey LA, Goldberg J, Chui K, Must A, Sacheck J. The state of the summer: a review of child Summer Weight Gain and efforts to prevent it. Curr Obes Rep. 2018;7(2):112–21.
pubmed: 29644576
pmcid: 6857933
doi: 10.1007/s13679-018-0305-z
Tassitano RM, Weaver RG, Tenorio MCM, Brazendale K, Beets MW. Physical activity and sedentary time of youth in structured settings: a systematic review and meta-analysis. Int J Behavavioural Nutr Phys Activity. 2020;17(1):160.
doi: 10.1186/s12966-020-01054-y
Hopkins L, Holloman C, Melnyk BM, Fristad MA, Goodway JD, Kennel J, et al. Participation in structured programming may prevent unhealthy weight gain during the summer in school-aged children from low-income neighbourhoods: feasibility, fidelity and preliminary efficacy findings from the Camp NERF study. Public Health Nutr. 2019;22(6):1100–12.
pubmed: 30604663
pmcid: 10260664
doi: 10.1017/S1368980018003403
Morgan K, McConnon L, Van Godwin J, Hawkins J, Bond A, Fletcher A. Use of the school setting during the summer holidays: mixed-methods evaluation of Food and Fun Clubs in Wales. J Sch Health. 2019;89(10):829–38.
pubmed: 31353475
pmcid: 6771694
doi: 10.1111/josh.12824
American Camp Association. Timeline North Martinsville, IN: American Camp Association; (n.d.) [ http://www.acacamp.org/anniversary/timeline/
Van Slyck AA. Summer camps. Encyclopedia of children and Childhood in History and Society. Encyclopedia.com; 2019.
Larose D, Chih-Shing Chen M, Panahi S, Yessis J, Tremblay A, Drapeau V. Interventions to promote healthy lifestyle behaviors in children and adolescents in summer day camps: a scoping review. BMC Public Health. 2023;23(1):773.
pubmed: 37101170
pmcid: 10134537
doi: 10.1186/s12889-023-15521-1
Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.4: Cochrane; updated August 2023.
Eglitis E, Maher C, Virgara R, Watson A, Olds T, Richardson M et al. Health effects of children’s summer holiday programs: protocol for a systematic review. PROSPERO: International prospective register of systematic reviews [Internet]. 2023. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023409795
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021;372. https://www.bmj.com/content/372/bmj.n71.short
Eglitis E, Singh B, Olds T, Virgara R, Machell A, Richardson M et al. Health effects of children’s summer holiday programs (searchRxiv.2023.00381). CABI International, Effect of summer holiday programs on children’s mental health and wellbeing (MEDLINE). 2023. https://doi.org/10.1079/searchRxiv.2023.00381
Oude Wolcherink MJ, Pouwels XGLV, van Dijk SHB, Doggen CJM, Koffijberg H. Can artificial intelligence separate the wheat from the chaff in systematic reviews of health economic articles? Expert Rev PharmacoEcon Outcomes Res. 2023;23(9):1049–56.
pubmed: 37573521
doi: 10.1080/14737167.2023.2234639
Van De Schoot R, De Bruin J, Schram R, Zahedi P, De Boer J, Weijdema F, et al. An open source machine learning framework for efficient and transparent systematic reviews. Nat Mach Intell. 2021;3(2):125–33.
doi: 10.1038/s42256-020-00287-7
The PEDro Partnership. PEDro Scale1999. https://pedro.org.au/english/resources/pedro-scale/
Moseley AM, Pinheiro MB. Research note: evaluating risk of bias in randomised controlled trials. J Physiotherapy. 2022;68(2):148–50.
doi: 10.1016/j.jphys.2022.02.003
Cashin AG, McAuley JH. Clinimetrics: Physiotherapy evidence database (PEDro) scale. J Physiother. 2020;66(1):59.
pubmed: 31521549
doi: 10.1016/j.jphys.2019.08.005
Evans EW, Wing RR, Pierre DF, Howie WC, Brinker M, Jelalian E. Testing the effect of summer camp on excess summer weight gain in youth from low-income households: a randomized controlled trial. BMC Public Health. 2020;20(1):1–10.
von Klinggraeff L, Dugger R, Brazendale K, Hunt ET, Moore JB, Turner-McGrievy G, et al. Healthy summer learners: an explanatory mixed methods study and process evaluation. Eval Program Plan. 2022;92:102070.
doi: 10.1016/j.evalprogplan.2022.102070
Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, et al. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med. 2017;51(21):1545–54.
pubmed: 27208067
doi: 10.1136/bjsports-2016-095987
R Core Team. R: a language and environment for statistical computing. Austria: R Foundation for Statistical Computing. Vienna; 2018.
Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with {R}: a practical tutorial. Evid Based Ment Health. 2019;22:153–60.
pubmed: 31563865
pmcid: 10231495
doi: 10.1136/ebmental-2019-300117
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1–48.
doi: 10.18637/jss.v036.i03
Harrer M, Cuijpers P, Furukawa T, Daniel DE. dmetar: Companion R Package For The Guide ‘Doing Meta-Analysis in R’. 2019.
Wilson DB. Practical Meta-Analysis Effect Size Calculator [Online calculator].n.d. https://campbellcollaboration.org/research-resources/effect-size-calculator.html
Harrer M, Cuijpers P, Furukawa TA, Ebert DD. Doing Meta-Analysis With R: A Hands-On Guide. 1st ed. Boca Raton, FL and London: Chapman & Hall/CRC Press; 2021 2021.
Cohen J. Statistical power analysis for the behavioral sciences. Routledge; 2013.
Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002. https://doi.org/10.1136/bmj.d4002
Park K-S, Lee M-G. Effects of summer school participation and psychosocial outcomes on changes in body composition and physical fitness during summer break. J Exerc Nutr Biochem. 2015;19(2):81–90.
doi: 10.5717/jenb.2015.15052005
OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. 2011; http://www.cebm.net/index.aspx?o=5653
Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B et al. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009; 2009. Accessed 25th January, 2023 from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009
Meucci M, Cook C, Curry CD, Guidetti L, Baldari C, Collier SR. Effects of supervised exercise program on metabolic function in overweight adolescents. World J Pediatr. 2013;9(4):307–11.
pubmed: 24235064
doi: 10.1007/s12519-013-0440-2
Evans EW, Bond DS, Pierre DF, Howie WC, Wing RR, Jelalian E. Promoting health and activity in the summer trial: implementation and outcomes of a pilot study. Prev Med Rep. 2018;10:87–92.
pubmed: 29868357
pmcid: 5984214
doi: 10.1016/j.pmedr.2018.02.008
Gately P, Cooke C, Barth JH, Bewick BM, Radley D, Hill AJ. Children’s residential weight-loss programs can work: a prospective cohort study of short-term outcomes for overweight and obese children. Pediatrics. 2005;116(1):73–7.
pubmed: 15995034
doi: 10.1542/peds.2004-0397
Matsui M, Togashi K. The effectiveness of physical activity promotion program during summer vacation. Japanese J Phys Fit Sports Med. 2019;68(2):145–52.
Dugger R, Brazendale K, Hunt ET, Moore JB, Turner-McGrievy G, Vogler K, et al. The impact of summer programming on the obesogenic behaviors of children: behavioral outcomes from a quasi-experimental pilot trial. Pilot Feasibility Stud. 2020;6(1):1–15.
doi: 10.1186/s40814-020-00617-x
Hazar K. Investigation of the Effect of regular Exercise on some motoric features in children in the 7–12 Age Group. J Educ Learn. 2019;8(3):81–8.
doi: 10.5539/jel.v8n3p81
D’Haese S, Van Dyck D, De Bourdeaudhuij I, Deforche B, Cardon G. Organizing Play streets during school vacations can increase physical activity and decrease sedentary time in children. Int. 2015;12:14.
D’Haese S, Van Dyck D, De Bourdeaudhuij I, Deforche B, Cardon G. Organizing Play streets during school vacations can increase physical activity and decrease sedentary time in children. Int J Behav Nutr Phys Activity. 2015;12(1):1–9.
doi: 10.1186/s12966-015-0171-y
Ekelund U, Luan Ja, Sherar LB, Esliger DW, Griew P, Cooper A, et al. Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA. 2012;307(7):704–12.
pubmed: 22337681
pmcid: 3793121
doi: 10.1001/jama.2012.156
Van Sluijs EM, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ. 2007;335(7622):703.
pubmed: 17884863
pmcid: 2001088
doi: 10.1136/bmj.39320.843947.BE
McPherson RS, Hoelscher DM, Alexander M, Scanlon KS, Serdula MK. Dietary assessment methods among school-aged children: validity and reliability. Prev Med. 2000;31(2):S11–33.
doi: 10.1006/pmed.2000.0631
Chambers T, Segal A, Sassi F. Interventions using behavioural insights to influence children’s diet-related outcomes: a systematic review. Obes Rev. 2021;22(2):e13152.
pubmed: 33462932
doi: 10.1111/obr.13152
Andueza N, Navas-Carretero S, Cuervo M. Effectiveness of nutritional strategies on improving the quality of diet of children from 6 to 12 years old: a systematic review. Nutrients. 2022;14(2):372.
pubmed: 35057552
pmcid: 8781853
doi: 10.3390/nu14020372
Katz DL, O’Connell M, Njike VY, Yeh M-C, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes. 2008;32(12):1780–9.
doi: 10.1038/ijo.2008.158
Parikh T, Stratton G. Influence of intensity of physical activity on Adiposity and Cardiorespiratory Fitness in 5–18 Year Olds. Sports Med. 2011;41(6):477–88.
pubmed: 21615189
doi: 10.2165/11588750-000000000-00000
Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput J-P, Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6):S197–239. (Suppl. 3)).
pubmed: 27306431
doi: 10.1139/apnm-2015-0663
Wu J, Yang Y, Yu H, Li L, Chen Y, Sun Y. Comparative effectiveness of school-based exercise interventions on physical fitness in children and adolescents: a systematic review and network meta-analysis. Front Public Health. 2023;11:1194779.
pubmed: 37342273
pmcid: 10278967
doi: 10.3389/fpubh.2023.1194779
Kriemler S, Meyer U, Martin E, van Sluijs EM, Andersen LB, Martin BW. Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. 2011;45(11):923–930.
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;36(6):527–37.
pubmed: 19362799
doi: 10.1016/j.amepre.2009.01.033
Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Reviews. 2021;9. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007651.pub3/full
Metcalf B, Henley W, Wilkin T. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54). BMJ. 2012;345:e5888. https://doi.org/10.1136/bmj.e5888
Hartwig TB, Sanders T, Vasconcellos D, Noetel M, Parker PD, Lubans DR, et al. School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials. Br J Sports Med. 2021;55(13):721–9.
doi: 10.1136/bjsports-2020-102740
Pozuelo-Carrascosa DP, García-Hermoso A, Álvarez-Bueno C, Sánchez-López M, Martinez-Vizcaino V. Effectiveness of school-based physical activity programmes on cardiorespiratory fitness in children: a meta-analysis of randomised controlled trials. Br J Sports Med. 2018;52(19):1234–40.
pubmed: 29074475
doi: 10.1136/bjsports-2017-097600
Eddolls WTB, McNarry MA, Stratton G, Winn CON, Mackintosh KA. High-intensity interval training interventions in children and adolescents: a systematic review. Sports Med. 2017;47(11):2363–74.
pubmed: 28643209
pmcid: 5633633
doi: 10.1007/s40279-017-0753-8
Tanaka C, Reilly JJ, Tanaka M, Tanaka S. Changes in Weight, sedentary Behaviour and physical activity during the School year and summer vacation. Int J Environ Res Public Health. 2018;15(5):915.
pubmed: 29734685
pmcid: 5981954
doi: 10.3390/ijerph15050915
Volmut T, Pišot R, Planinšec J, Šimunič B. Physical activity drops during summer holidays for 6- to 9-Year-old children. Front Public Health. 2021;8:631141.
National Academies of Sciences Engineering and Medicine. Shaping summertime experiences: opportunities to promote healthy development and well-being for children and youth. Washington, DC: National Academies; 2019. p. 0309496578. Report No.