Project Energize

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https://hdl.handle.net/10292/14400

Energize, collectively Project Energize (PE) and Under 5 Energize (U5E), is a nutrition and physical activity programme/”way of doing” that has been delivered in Waikato primary schools since 2004 and early childhood centres since 2013. By 2020 over 80,000 children in New Zealand were receiving the Energize programme.

Two innovative measures of the impact of Energize are the time taken for primary-schoolchildren to run 550m and reduction in visible dental decay in 4-year-old children. The first is an audit of a quality control measure undertaken within schools and the second uses the national Before School Check (B4SC) dataset.

In 2015 PE children ran faster than children in 2011. In particular in 2015, boys and Māori boys were faster, as were 7, 8 and 9 year old children. Children attending decile 1, 2, 4 and 6 schools were also faster in 2015. No groups of children in 2015 were slower than in 2011. Between 2013 and 2017 Waikato B4SC data analysis showed that between 2015 and 2017 visible dental decay was more likely in children who were Māori (3.17x), living in high deprivation (1.66x) and male (1.10x) but less likely if attending an U5E-ECC (0.79x). The alternative measures of impact, i.e. decreases or maintenance in time to run and visible dental decay provide construct validity for the effectiveness of Energize and investment in the programme. In addition, the national health survey reports that in 2019 childhood overweight has decreased in the Waikato region in all and Māori children.

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    Cardiorespiratory Effects of Project Energize: A Whole-of Region Primary School Nutrition and Physical Activity Programme in New Zealand in 2011 and 2015
    (BioMed Central, 2020) Cairncross, C; Obolonkin, V; Coppinger, T; Rush, E
    Background: Since 2004, Sport Waikato has delivered Project Energize, a through-school nutrition and physical activity program to primary schools in the Waikato. As part of the program's continued assessment and quality control, the programme was evaluated in 2011 and 2015. This paper's aim was to compare the cardiorespiratory fitness (time to run 550 m (T550)) levels of children participating in Project Energize in 2011 and 2015. Methods: In the 2011 evaluation of Project Energize, gender specific- T550-for-age Z scores (T550AZ) were derived from the T550 of 4832 Waikato children (2527 girls; 2305 boys; 36% Māori) aged between 6 and 12 years. In 2015, T550 was measured for 4798 (2361 girls; 2437 boys; 32% Māori) children, representative of age, gender and school socioeconomic status (SES). The T550AZ for every child in the 2015 study and 2011 evaluation were derived and differences in T550 between 2015 and 2011 by gender, SES and age were determined using independent t-tests. Multiple regression analysis predicted T550 Z score and run time, using year of measurement, gender, ethnicity, age and school SES. Results: With and without adjustment, children in 2015 ran 550 m faster than in 2011 (adjusted Z score 0.06, time 11 s). Specifically, girls ran at a similar speed in 2015 as 2011 but boys were faster than in 2011 (Z score comparison P < 0.001, mean difference 0.18 95%CI 0.12, 0.25). Regression analysis showed time taken to run 550 m was 11 s less in 2015 compared with 2011. Boys ran it 13 s faster than girls (Z score 0.07) and for each 1 year age increase, children were 8 s slower (Z score 0.006). For each 10% decrease in SES, children were 3 s slower (Z score 0.004) and Māori children were 5 s slower than Non-Māori children (Z score 0.15). Conclusions: The findings from this study support the continuation of the delivery of Project Energize in the Waikato region of New Zealand, as cardiorespiratory fitness scores in 2015, compared to 2011, were improved, particularly for lower SES schools and for Māori children. Ethnically diverse populations, schools with higher deprivation and girls, continue to warrant further attention to help achieve equity.
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    Increasing Activity and Improving Nutrition Through a Schools-based Programme: Project Energize. 1. Design, Programme, Randomisation and Evaluation Methodology
    (Cambridge University Press, 2008) Graham, D; Appleton, S; Rush, E; McLennan, S; Reed, P; Simmons, D
    Project Energize is a through-school nutrition and activity programme that is being evaluated in a 2-year, cluster-randomised, longitudinal study. The present paper describes the background of the programme and study, the programme development and delivery, the study methodology including randomisation, measurement and analysis tools and techniques, and the mix of the study population. The programme is being delivered to sixty-two primary schools with sixty-two control schools, each limb containing about 11,000 students. The children in the evaluation cohort are 5 or 10 years old at enrolment; the randomisation protocol has achieved post-consent enrolment of 3,000 evaluation participants, who are comparable by age, sex and school decile. End-point measures include body composition and associated physical characteristics, fitness, home and school environment and practice.
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    Project Energize: Intervention Development and 10 Years of Progress in Preventing Childhood Obesity
    (BioMed Central Ltd., 2016) Rush, E; Cairncross, C; Williams, MH; Tseng, M; Coppinger, T; McLennan, S; Latimer, K
    Prevention of childhood obesity is a global priority. The school setting offers access to large numbers of children and the ability to provide supportive environments for quality physical activity and nutrition. This article describes Project Energize, a through-school physical activity and nutrition programme that celebrated its 10-year anniversary in 2015 so that it might serve as a model for similar practices, initiatives and policies elsewhere. The programme was envisaged and financed by the Waikato District Health Board of New Zealand in 2004 and delivered by Sport Waikato to 124 primary schools as a randomised controlled trial from 2005 to 2006. The programme has since expanded to include all 242 primary schools in the Waikato region and 70 schools in other regions, including 53,000 children. Ongoing evaluation and development of Project Energize has shown it to be sustainable (ongoing for >10 years), both effective (lower obesity, higher physical fitness) and cost effective (one health related cost quality adjusted life year between $18,000 and $30,000) and efficient ($45/child/year) as a childhood 'health' programme. The programme's unique community-based approach is inclusive of all children, serving a population that is 42 % Ma¯ori, the indigenous people of New Zealand. While the original nine healthy eating and seven quality physical activity goals have not changed, the delivery and assessment processes has been refined and the health service adapted over the 10 years of the programme existence, as well as adapted over time to other settings including early childhood education and schools in Cork in Ireland. Evaluation and research associated with the programme delivery and outcomes are ongoing. The dissemination of findings to politicians and collaboration with other service providers are both regarded as priorities.
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    Project Energize: Whole-region Primary School Nutrition and Physical Activity Programme; Evaluation of Body Size and Fitness 5 Years After the Randomised Controlled Trial
    (Cambridge University Press, 2014) Rush, E; McLennan, S; Obolonkin, V; Vandal, AC; Hamlin, M; Simmons, D; Graham, D
    Project Energize, a region-wide whole-school nutrition and physical activity programme, commenced as a randomised controlled trial (RCT) in the period 2004-6 in 124 schools in Waikato, New Zealand. In 2007, sixty-two control schools were engaged in the programme, and by 2011, all but two of the 235 schools in the region were engaged. Energizers (trained nutrition and physical activity specialists) work with eight to twelve schools each to achieve the goals of the programme, which are based on healthier eating and enhanced physical activity. In 2011, indices of obesity and physical fitness of 2474 younger (7·58 (sd 0·57) years) and 2330 older (10·30 (sd 0·51) years) children attending 193 of the 235 primary schools were compared with historical measurements. After adjusting for age, sex, ethnicity, socio-economic status (SES) and school cluster effects, the combined prevalence of obesity and overweight among younger and older children in 2011 was lower by 31 and 15 %, respectively, than that among 'unEnergized' children in the 2004 to 2006 RCT. Similarly, BMI was lower by 3·0 % (95 % CI - 5·8, - 1·3) and 2·4 % (95 % CI - 4·3, - 0·5). Physical fitness (time taken to complete a 550 m run) was significantly higher in the Energized children (13·7 and 11·3 %, respectively) than in a group of similarly aged children from another region. These effects were observed for boys and girls, both indigenous Māori and non-Māori children, and across SES. The long-term regional commitment to the Energize programme in schools may potentially lead to a secular reduction in the prevalence of overweight and obesity and gains in physical fitness, which may reduce the risk of developing obesity and type 2 diabetes.
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    A School-based Obesity Control Programme: Project Energize. Two-year Outcomes
    (Cambridge University Press, 2012) Rush, E; Reed, P; McLennan, S; Coppinger, T; Simmons, D; Graham, D
    Through-school nutrition and physical activity interventions are designed to help reduce excess weight gain and risk of chronic disease. From 2004 to 2006, Project Energize was delivered in the Waikato Region of New Zealand as a longitudinal randomised controlled study of 124 schools (year 1-6), stratified by rurality and social deprivation, and randomly assigned to intervention or control. Children (686 boys and 662 girls) aged 5 (1926) and 10 (1426) years (692 interventions and 660 controls) had height, weight, body fat (by bioimpedance) and resting blood pressure (BP) measured at baseline and 2 years later. Each intervention school was assigned an 'Energizer'; a trained physical activity and nutrition change agent, who worked with the school to achieve goals based on healthier eating and quality physical activity. After adjustment for baseline measures, rurality and social deprivation, the intervention was associated with a reduced accumulation of body fat in younger children and a reduced rate of rise in systolic BP in older children. There was some evidence that the pattern of change within an age group varied with rurality, ethnicity and sex. We conclude that the introduction of an 'Energizer led' through-school programme may be associated with health benefits over 2 years, but the trajectory of this change needs to be measured over a longer period. Attention should also be paid to the differing response by ethnicity, sex, age group and the effect of rurality and social deprivation.
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    Under 5 Energize: Tracking Progress of a Preschool Nutrition and Physical Activity Programme With Regional Measures of Body Size and Dental Health at Age of Four Years
    (MDPI, 2017-05-01) Rush, E; Obolonkin, V; Young, L; Kirk, M; Tseng, M
    To reduce weight gain and encourage healthy eating including reduced sugar intake, Under 5 Energize (U5E) was introduced to 121 early-childhood-centres in the Waikato region of New Zealand in July 2013. Using anonymized data collected from January 2013 to September 2016 through free physical assessments of all 4-year-olds provided by the NZ Ministry of Health, the prevalence of obesity and dental decay children measured in the Waikato region was examined. Data were divided into four periods representing pre-implementation and 3 years of gradual implementation. Obesity was defined according to International Obesity Task Force criteria. Of 18,774 Waikato children included in the analysis, 32% were indigenous Māori, and 32% attended an U5E centre. Pre-implementation prevalences of obesity (4%) and visible dental decay (11%) of children attending and not-attending U5E centres were not different. While obesity prevalence did not change significantly over time, prevalence of dental decay decreased among children at U5E (trend p = 0.003) but not non-U5E (trend p = 0.14) centres, such that prevalences were significantly different between children at U5E vs. non-U5E centres at Year 3 (p = 0.02). The U5E intervention is a small but arguably effective part of the wider system approach that is required to improve children’s future health.
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    Vitamin D Status of Year 3 Children and Supplementation Through Schools With Fortified Milk
    (Cambridge University Press, 2009) Graham, D; Kira, G; Conaglen, J; McLennan, S; Rush, E
    Objective: To evaluate levels of vitamin D3 and HDL-cholesterol (HDL-C), and the ratio of HDL-C to LDL-cholesterol (LDL-C), in schoolchildren receiving vitamin-D-fortified, fat-depleted, high-Ca milk in schools. Design: Cross-sectional study of previously randomised schools receiving supplemental milk, compared with a matched control group. Setting: Low-decile Year 1-6 schools in the Waikato region of New Zealand. Subjects: Year 3 children from either milk schools or control schools, consenting to blood sampling. Results: For eighty-nine children receiving supplementary daily milk, vitamin D3 levels were significantly higher than in eighty-three control children matched for age, sex, body composition and ethnicity (mean (sd): 49.6 (15.8) v. 43.8 (14.7) nmol/l, P = 0.011), as were HDL-C levels (mean (sd): 1.47 (0.35) v. 1.35 (0.29) mmol/l, P = 0.024) and HDL-C:LDL-C (median: 0.79 v. 0.71, P = 0.026). LDL-C levels were similar in both groups (mean (sd): 2.07 (0.55) v. 2.16 (0.60) mmol/l, P = 0.31). Of control children, 32/83 (20.2 %) of the milk group (Pearson's chi2 = 7.00, P = 0.008). Mean 25-hydroxyvitamin D (vitamin D3) levels in the milk group were still below the lower end of the recommended normal range (60 nmol/l). Conclusions: Vitamin D3 levels are low in low-decile Year 3 children in midwinter. Levels are improved with vitamin-D-fortified milk but still below the recommended range. HDL-C and HDL-C:LDL-C levels are improved in the milk-supplemented group. This supports the supply of vitamin-D-fortified, fat-reduced milk to schools.
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