041 - Preliminary Effectiveness of After School Programs (ASPs) on Blood Pressure, Body Mass Index, Percent Body Fat and Pulse Wave Velocity in Overweight Children

Publication Number: 41.6147

Megan S. McFarland, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Bridget Armstrong, University of South Carolina, Columbia, SC, United States; Michal T. Smith, University of South Carolina, West Columbia, SC, United States; Hannah Parker, University of South Carolina, Columbia, SC, United States; Abbi Lane, University of Michigan, Ann Arbor, MI, United States; Michael Beets, University of South Carolina, Columbia, SC, United States; Lauren Von Klinggraeff, Augusta University, Augusta, GA, United States; Sudha Garimella, University of South Carolina School of Medicine Greenville, Greenville, SC, United States

Background: ASPs are useful tools for providing structure and exercise options for children and may reduce risk for obesogenic behaviors and hypertension. Pulse wave velocity (PWV) is considered the gold standard for assessment of central arterial stiffness in children. PWV can be a valuable tool in hypertension risk prediction.

Objective: To determine effectiveness of afterschool programs on improving blood pressure, body mass index, percent body fat and pulse wave velocity in overweight children.

Design/Methods: 7,265 children ages 8-12 were identified via an electronic health record query within a large regional healthcare system database with BMI ≥ 85th percentile and/or blood pressure (BP) ≥90th percentile at 1+ clinic visits. 2,239 of these children lived in zip codes with eligible school-to-ASP infrastructure in place. A random subsample of 1,787 families were invited to participate via recruitment flyers mailed to their homes. Enrolled participants (n=12) were provided 17 weeks of afterschool care at their local ASP. Anthropometric measures were recorded prior to starting, and at the end of the ASP program. Measures included BMI z-score, percent body fat (BF%) (using bioelectrical impedance) brachial automated blood pressures, and Pulse Wave Velocity (PWV) .

Results: Average age of participants was 10.28 yrs (SD 1.15), 58% Female, 50% identified as White. The average within-person change in zBMI was -0.039 (SD = 0.14) Cohen's D = -0.28. The average decrease in BF% was -0.65% (SD 2.8) Cohen’s D = -.23. Change in PWV was small and heterogeneous, with half of the sample showing increases and half decreases. The average change in Systolic BP was -5.9(SD=17.4) Cohen's D = -0.30. with Diastolic BP change at-9.6(SD=14) Cohen's D = -0.67.

Conclusion(s): Small to medium effects indicate a preliminary signal of effectiveness for providing free ASP prescriptions on BP and zBMI. A larger sample size is needed to determine effectiveness of exercise prescriptions on PWV change. It is possible to modify cardiovascular risk in overweight/obese children using after school programs. Improving access to ASPs should be considered as part of therapeutic lifestyle changes for overweight/obese children.

Mean Central Systolic and Diastolic Blood Pressure Before and After Lifestyle Intervention
Mean Central Systolic and Diastolic Blood Pressure Before and After Lifestyle Intervention .pdfColumn chart demonstrating the decrease in mean central systolic and diastolic blood pressure pre- and post-intervention. Mean systolic central blood pressure decreased from 110.7273 to 105.4545 mmHg. Mean diastolic central blood pressure decreased from 75.6363 to 66.0000 mmHg.

Mean zBMI Before and After Lifestyle Intervention
Mean zBMI Before and After Lifestyle Intervention.pdfColumn chart demonstrating the decrease in mean zBMI before and after lifestyle intervention, from 1.783 to 1.743.

Mean Central Systolic and Diastolic Blood Pressure Before and After Lifestyle Intervention
Mean Central Systolic and Diastolic Blood Pressure Before and After Lifestyle Intervention .pdfColumn chart demonstrating the decrease in mean central systolic and diastolic blood pressure pre- and post-intervention. Mean systolic central blood pressure decreased from 110.7273 to 105.4545 mmHg. Mean diastolic central blood pressure decreased from 75.6363 to 66.0000 mmHg.

Mean zBMI Before and After Lifestyle Intervention
Mean zBMI Before and After Lifestyle Intervention.pdfColumn chart demonstrating the decrease in mean zBMI before and after lifestyle intervention, from 1.783 to 1.743.