Cardiovascular Health, Health Knowledge, Physical Fitness, Well-being
Conditions
Keywords
11 for Health, Physical Fitness, Cardiorespiratory Health, Health Knowledge, Well-being, Physical Education, Physical Activity
Brief summary
This study examined the effects of a school-based football intervention, the "11 for Health" (11fH) programme, on cardiorespiratory health, musculoskeletal fitness, health knowledge and well-being among Pakistani school children. The main questions it aimed to answer were: * Does the programme enhance Pakistani schoolchildren's cardiorespiratory health and physical fitness, including blood pressure, resting heart rate, aerobic capacity, horizontal jumping ability, agility, 30-m sprint, postural balance, BMI and waist circumference? * Does it improve their health knowledge and well-being? Researchers compared students who participated in the "11 for Health" intervention to those who continued their regular school curriculum. 254 fifth- and sixth-grade students (126 boys, 128 girls) from five schools in Islamabad participated in this study, allocated to an 11-week intervention group, a 5-week intervention group, and a control group. Researchers tested all groups before and after the intervention. Cardiorespiratory health and physical fitness were assessed with standardized tests. Health knowledge and well-being were measured with validated Urdu questionnaires.
Detailed description
In developing countries like Pakistan, limited funding, infrastructure, and policy support pose challenges for promoting structured physical activity among school-aged children. These gaps result in low physical activity levels, with consequences extending beyond individual health to national healthcare systems and societal well-being. Despite growing interest in improving physical education in Pakistan, current initiatives remain fragmented and under-researched. Introducing a structured, football-based physical and health education model such as "11 for Health" into this context offers an opportunity to test a scalable and contextually relevant approach. The "11 for Health" programme is designed to deliver health education through physical activity using football drills and small-sided games. The intervention comprises 90 minutes of football-related activities per week, integrated with the delivery of ten health messages addressing communicable and non-communicable diseases (NCDs). Each health message is thematically linked to a specific football skill (Fuller et al. 2017). Since its in inception in South Africa in 2009, the "11 for Health" programme has been implemented across multiple regions, including Africa, South America, Oceania, Europe, and Southeast Asia, and a growing body of literature has analysed its effects on physical fitness, health knowledge, well-being, and cognitive outcomes. Its documented effectiveness in a range of international settings suggests potential for positive impact in Pakistan as well. This study examined the "11 for Health" programme within the public school system and evaluated its effects on multiple aspects of health and well-being. These findings could help determine the programme's adaptability, thereby contributing critical insights into sustainable strategies for promoting health and physical fitness among Pakistani schoolchildren.
Interventions
OTHER"11 for Health" Intervention Programme
The "11 for Health" intervention consisted of two 45-minute sessions per week for 11 weeks, including a "Play Football" session that focused on developing specific football skills, and a "Play Fair" session that delivered health education through football-related activities, replacing traditional chalkboard instruction. Small-sided games (3v3, 4v4) were included in every session as the main physical stimulus.
Sponsors
Farman Ullah
University of Southern Denmark
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
8 Years to 14 Years
Healthy volunteers
Yes
Inclusion criteria
* Enrollment in Grade 5 or Grade 6 in the participating schools during the 2023 to 2024 academic year * Provision of written informed consent from parents or guardians together with assent from the students
Exclusion criteria
* Inability to provide consent or assent and medical conditions that prevented participation in football or other moderate-to-vigorous physical activities. Examples included severe mobility limitations, serious cardiovascular disease, or severe asthma.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Resting Heart Rate | before and at the end of the 11-week intervention | Resting heart rate (RHR) was measured four times using a portable liquid crystal display (LCD) finger-type pulse oximeter. Prior to RHR measurement, participants were required to rest in a seated position for 15-20 minutes. Four measurements were taken for each participant, with at least 2-minute intervals between readings. Unit of Measurement: Beats per minute (bpm) |
| Systolic Blood Pressure and Diastolic Blood Pressure | before and at the end of the 11-week intervention | Trained staff measured blood pressure using an aneroid sphygmomanometer. The first and fifth Korotkoff sounds were recorded as systolic (SBP) and diastolic (DBP) pressure. Participants rested seated for 15-20 minutes beforehand. Four readings were taken at intervals of at least two minutes. Unit of Measurement: Millimeters of Mercury (mmHg) |
| Body Mass Index (BMI) | before and at the end of the 11-week intervention | Weight and Height were combined to report BMI in kg/m\^2. Height was measured to the nearest 0.1 cm using a yardstick. Weight was recorded with a 0.1 kg precision using a portable calibrated scale. These measurements were conducted with participants barefoot and wearing light clothing. Unit of Measurement: BMI in kg/m\^2 |
| Waist Circumference | before and at the end of the 11-week intervention | Waist circumference (WC) was assessed at the midpoint between the lowest rib and the superior border of the iliac crest at the end of normal expiration, using a non-stretch measuring tape held parallel to the floor. Unit of Measurement: centimetre (cm) for the waist circumference |
| Postural Balance | before and at the end of the 11-week intervention | Postural balance was assessed using the Stork balance stand test. Participants placed their hands on hips, positioned one foot against the supporting leg's knee, and raised the supporting heel to balance on the ball of the foot. Timing began at heel lift and stopped if hands moved, the foot shifted, knee contact broke, or the heel touched down. Unit of Measurement: seconds (s) |
| Jump Performance | before and at the end of the 11-week intervention | Jump performance was assessed by standing long jump test. Each student performed two barefoot jumps. Starting with toes behind a line, feet parallel and shoulder-width apart, they squatted to 90° knee flexion with hands on hips. After two seconds, they jumped forward, keeping hands on hips. Unit of Measurement: Distance from line to heel was measured to the nearest centimetre (cm). |
| Agility | before and at the end of the 11-week intervention | The Arrow-head agility test is used to measure agility. Participants sprint from a start line to a middle cone, turn right around a side cone, circle the farthest cone, and return. Knocking over a cone requires a restart. Two attempts were made after one trial. The shorter time of the two attempts was recorded. Unit of Measurement: Seconds (s) - Time to complete the test |
| 30-metre Sprint | before and at the end of the 11-week intervention | The participants performed two 30-metre sprints at their maximal speed with 2-3 minutes of rest between attempts. Three timers with stopwatches stood 6 metres perpendicular to the finish line. They started timing at the student's first movement and stopped when the upper body crossed the finish line. Unit of Measurement: The average time in seconds (s) given by testers. |
| Cardiovascular Performance | before and at the end of the 11-week intervention | Cardiovascular performance was evaluated with the Yo-Yo intermittent recovery level 1 children's test. The test took place outdoors at all schools. It consisted of repeated 16-metre shuttle runs with progressively increasing speed. Between runs, participants had a 10 second active recovery by jogging around a cone set 4 metres behind the start line. A prerecorded beep regulated the pace. Missing the beep twice terminated the test. Unit of Measurement: Total running distance in metres (m) |
| Health Knowledge | before and at the end of the 11-week intervention | A 34-item Urdu version health knowledge questionnaire assessed children's understanding of ten health topics related to the "11 for Health" programme before and after the intervention. Items used either a true/false/don't know format or multiple choice with four options. Correct answers received a score of 2, while incorrect or don't know responses scored 1. Unit of Measurement: Mean percentage and standard deviation of correct responses were calculated for each health message based on all individual answers. |
| Well-being | before and at the end of the 11-week intervention | An Urdu version of the adapted KIDSCREEN-27 questionnaire was used to measure well-being of the partcipants. The 20 items covered four dimensions: physical well-being, psychological well-being, peers and social support, and school environment. Items used a five-point Likert scale ranging from "never" to "always" or "not at all" to "extremely". The subscale scores are converted to a standardized scale where the average is around 50 and the standard deviation is about 10. Higher scores reflected better well-being. |
Countries
Pakistan
Outcome results
None listed