Research Quarterly for Exercise and Sport

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The Effects of a Family Fitness Program on the

Physical Activity and Nutrition Behaviors of Third-
Grade Children

Chris A. Hopper , Kathy D. Munoz , Mary B. Gruber & Kim P. Nguyen

To cite this article: Chris A. Hopper , Kathy D. Munoz , Mary B. Gruber & Kim P. Nguyen (2005)
The Effects of a Family Fitness Program on the Physical Activity and Nutrition Behaviors
of Third-Grade Children, Research Quarterly for Exercise and Sport, 76:2, 130-139, DOI:
10.1080/02701367.2005.10599275

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 Epidemiology
Hopper, Munoz, Gruber, and Nguyen

Research Quarterly for Exercise and Sport

©2005 by the American Alliance for Health,
Physical Education, Recreation and Dance
Vol. 76, No. 2, pp. 130–139

The Effects of a Family Fitness Program on the Physical

Activity and Nutrition Behaviors of Third-Grade Children
Chris A. Hopper, Kathy D. Munoz, Mary B. Gruber, and Kim P. Nguyen

This study examined the efficacy of a school-based exercise and nutrition program with a parent component. Third-grade
children (N = 238) from six elementary schools participated in the study, with three schools randomly assigned to a program
group and the other three schools to a control group. The program group received a health-related fitness school-based
program and a home program that required parents and children to complete activities and earn points for nutrition and
exercise activities. The control group received their traditional physical education and nutrition education program.
Univariate analysis of variance on pre- and posttest scores were completed on the following variables: height, weight, body
mass index, skinfold, blood cholesterol, mile run, exercise and nutrition knowledge, calories, protein, carbohydrates, total fat,
saturated fat, dietary cholesterol, fiber, sodium, percentage of calories from carbohydrates, and percentage of calories from fat.
At pretest, the treatment and control groups did not significantly differ on the measures using schools as the unit of analysis.
Girls scored significantly higher than boys on skinfold and pretest knowledge. At posttest, the treatment group scored
significantly higher than the control group on exercise and nutrition knowledge and significantly lower than the control
group on total fat intake, using schools as the unit of analysis. There was no improvement in physiological measures,
including blood cholesterol. The study demonstrated that schools can adjust curriculum to meet some health needs of
students and achieve modest changes in exercise and nutrition knowledge and diet. The family component of the program
provided a practical approach to improving physical activity and nutrition behaviors for elementary school teachers who
teach many participants in a crowded curriculum.

Key words: cardiovascular disease, exercise, healthy age group should be beneficial to improving heart health
lifestyle, parent-child relationships in the adult population. Despite considerable public at-
tention to health issues, there is evidence that the risk

T he purpose of this study was to determine if a

school-based cardiovascular health promotion
program with a family participation component would
improve specific physical fitness and nutrition behav-
iors. Cardiovascular disease (CVD) is the leading cause
of death in the United States (Anderson, 2002). Because
the development of heart disease has been proposed to
begin in childhood (Berenson et al., 1998; Harrell et al.,
1998), interventions aimed at reducing risk factors in this
Chris A. Hopper and Kathy D. Munoz are with the Department of
Health and Physical Education at Humboldt State University.
Mary B. Gruber is with the Department of Psychology at
Humboldt State University. Kim P. Nguyen is with the Depart-
ment of Exercise and Sport Science at Oregon State University.
factor status in adolescents is worsening rather than im-
proving, as evidenced by a rise in body mass index over
a 10-year period from 1986 to 1996 (Luepker, Jacobs,
Prineas, & Sinaiko, 1999).
An ideal setting for childhood interventions pro-
moting heart healthy lifestyle changes is the school site.
Promoting physical fitness through increased physical
activity has become a national public health objective.
Physical education is identified as an important vehicle
for this objective (Sallis & McKenzie, 1991). Health
education is already an integral part of the elementary
education curriculum, federally funded food service
programs provide breakfast and lunch to school
children, and state-mandated physical education
courses are presently in place (U.S. Department of
Health and Human Services, 1993). These factors

130 RQES: June 2005

Hopper.pmd 130 11/20/2006, 2:36 PM


enable interventions, aimed at improving heart health,
to be feasible and realistic to achieve.
Research has identified numerous factors that
appear to increase the risk of heart disease. Included
in the list are factors such as obesity, elevated blood
lipids, inactivity, hypertension, smoking, and family
history. Children and adolescents have reportedly high
blood cholesterol levels (Donker et al., 1993; Garcia &
Moodie, 1989; Kelder et al., 2002; Webber et al., 1991)
that remain high into adulthood. Lauer, Lee, and Clark
(1988) reported that serum cholesterol levels from
children ages 2–3 years track well into adulthood and
that hypercholesterolemic children are likely to be-
come hypercholesterolemic adults, with a high risk of
developing CVD prematurely. This information is im-
portant when attempting to reduce the incidence of
CVD. It is generally recognized that the higher the lev-
els of serum cholesterol, the greater the risk for car-
diovascular disease. Accordingly, when serum choles-
terol levels are reduced, the risk of CVD is also reduced
(Kwiterovich, 1986). Thus, any attempt to reduce se-
rum cholesterol levels would be beneficial. Serum cho-
lesterol levels have been positively correlated with di-
etary intake of total and saturated fat (Donker et al.,
1993; Garcia & Moodie, 1989; Weidenback-Wilson &
Lewis, 1992). Unfortunately, researchers have also re-
ported that children ingest a high dietary intake of
total fat and saturated fatty acids (Cresenta, Farris,
Croft, Frank, & Berenson, 1988; Nader et al., 1999).
In the opinion of many authors, the process of
atherosclerosis may begin developing during child-
hood (American Heart Association, 1986; Berenson,
1986; Berenson et al., 1998; DISC Collaborative
Research Group, 1993; Donker et al., 1993; Garcia &
Moodie, 1989; Muhonen, Burns, Nelson, & Lauer,
1994). Their opinions are based partly on evidence of
advanced heart disease reported in 20–22-year-old
soldiers who were killed in the Korean and Vietnam
wars (Enos, Holmes, & Boyer, 1953; McNamara, Molot,
& Stremple, 1971) and the multi-institutional autopsy
study of 2,876 participants ages 15–34 years (Strong et
al., 1999). Thus, it would appear, that the process of
CVD begins early in life and is possibly related to
obesity, high serum cholesterol levels, and a diet high
in total and saturated fat. Therefore, reducing the
intake of foods high in fat and cholesterol early in
childhood may delay or reduce the risk of CVD later
in life. While it is well documented that exercise and
nutrition habits develop during childhood and are
somewhat resistant to change (Connor et al., l986),
past research has shown encouraging signs that nutri-
tion education promotes significant improvements in
behavior as well as knowledge and attitudes regarding
dietary intake (Green, McIntosh, & Wilson, 1991;
Kelder et al., 2002).
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Hopper.pmd 131
Hopper, Munoz, Gruber, and Nguyen
Knowledge in children, related to cardiovascular
health, was also enhanced in within-school and after-
school programs in cardiovascular health (Connor et al.,
1986; Harrell, McMurray, Gansky, Bangdiwala, &
Bradley, 1999; Luepker et al., 1996; Perry et al., 1988;
Petchers, Hirsch, & Bloch, l988). A few researchers have
reported other benefits of within-school cardiovascular
health programs beyond knowledge, including improve-
ment in children’s food choices (Coates, Jeffery, &
Slinkard, l981; Nader et al., 1999; Simons-Morton, Par-
cel, Baranowski, Forthofer, & O’Hara, 1991). Other
researchers have reported changes in cardiovascular
heath risk factors, such as increased exercise, heart-
healthy snacking (Killen & Robinson, l989), small
reductions in diastolic blood pressure (Harrell et al.,
1999; Walter, Hoffman, Connelly, Barrett, & Kost,
l986) and blood cholesterol (Harrell et al., 1999;
Walter, Hoffman, Vaughan, & Wynder, l988), and reduc-
tion in self-reported daily energy intake from fat
(Luepker et al., 1996) following school interventions.
While nutrition education appears to improve knowl-
edge and some eating behaviors, the data also reveal that
alterations in behavior are generally smaller than
cognitive improvements.
Although educating the child is the ultimate goal
of any health promotion program, the family is
the immediate source and primary context for health
information and education. Sallis and Nader (1990)
indicated that the family is a powerful influence on
promoting health behaviors. Parents serve important
health-related roles for their children, as models of
appropriate behavior, as gatekeepers to opportunities
and barriers, and as a major source of reinforcement
in most children’s lives (Perry et al., 1988). Thus,
changes in diet are unlikely to occur without family
support, especially because of the more practical
aspects of food purchasing and preparation. If long
lasting changes are to be achieved, family attitudes and
habits are most likely to promote these changes. Many
health educators also believe attitudes and behaviors
regarding diet are learned and nurtured in the home
(U.S. Department of Health and Human Services,
1991; White, Taylor, & Moss, 1992). The effectiveness
of school-based programs may be improved by includ-
ing parents in efforts to decrease cardiovascular disease
risk factors (Sallis & McKenzie, 1991).
Social learning theory (Bandura, 1977), which em-
phasizes modeling, rehearsal, practice, goal-setting, cue-
ing, and reinforcement of desirable behaviors by signifi-
cant others, including family members, has been incor-
porated into programs in various ways to improve
children’s fitness. Training parents in behavioral man-
agement techniques has been effective in helping over-
weight children maintain improved weight status (Israel,
Stolmaker, & Andrian, 1985) and low-fitness children in-
131
11/20/2006, 2:36 PM
 Hopper, Munoz, Gruber, and Nguyen
crease their physical activity levels and fitness scores
(Taggart, Taggart, & Siedentop, 1986). Behavioral coun-
seling of family groups in evening and weekend sessions
has also been effective in producing heart healthy dietary
changes in children and their family (Nader et al., 1983;
Nicklas, Johnson, Arbeit, Franklin, & Berenson, 1988).
In a weight loss program involving behavioral therapy
sessions for children and their parents, obese children
showed greater weight reduction and maintenance in a
condition targeting both children and their parents
rather than in one targeting only children or no one in
particular (Epstein, Wing, Koeske, & Valoski, 1987). In
two studies working directly with parents and children
(Nader et al., 1983, 1989), families showed improved
blood pressure, dietary behaviors, and health knowledge.
Programs that work directly with parents and
family groups are complicated and expensive to conduct,
often with high dropout rates. In designing this
type of intervention, several factors need to be consid-
ered. For example, many parents indicate a reluctance
to attend a series of evening or weekend sessions
(Crockett, Perry, & Pirie, 1989: Perry et al., 1988; Hollis,
1984). In the Oregon Family Heart Project (Hollis,
1984), randomly selected families were recruited to
participate at monthly evening sessions in a long-term
gradual process of health behavior change. Unfortu-
nately, high dropout rates and nonattendance were
reported. Perry et al. (1988) indicated parents preferred
to receive educational information through (in order
of preference) behavioral tip sheets, worksheets, and
homework from school that required parent involvement
to informational brochures, phone calls, and parent
education nights. Perry et al. (1988), in the Minnesota
Home Team Project, reported an improvement in
dropout rates and that 71% of all parents completed
the Home Team program when these participation
preferences were taken into consideration.
This study disseminated health information to
children and their parents through a 20-week school-
based program in nutrition and exercise entitled
“Family Fitness.” Because behavior is developed,
changed, and maintained through the interplay of
personal, social, and environmental factors, this
research study used these components by addressing
both school and family life. The study offered
incentives for adopting a heart-healthy lifestyle and
cognitive and behavioral skills to enable families to
change behavior. The curriculum and guided home
activities provided specific practice in using skills to
strengthen perceived competence and a problem-solv-
ing approach to help with specific skills for resisting
influences to return to old habits. The aim was to
assist families to initiate a process of modifying
behaviors that are considered risk factors for cardio-
vascular disease.
132
Hopper.pmd 132
Method
Participants
Six elementary schools in Humboldt County,
California, a predominantly rural area, agreed to partici-
pate. The schools were randomly assigned to program
and control groups. Of the participating schools, 15 class-
rooms were represented, with 9 program classrooms and
6 control classrooms. Our of 381 students, a total of 238
participated in the study (117 girls, 49%; and 121 boys,
51%). Of these, 142 (60%) were in the program group,
and 96 (40%) were in the control group.
Most of the students were Caucasian (83%), with
Native American (5%), Asian (5%), Hispanic (5%), and
African American (2%) students also represented. Chi-
square analysis demonstrated that the proportion of
boys versus girls did not differ significantly between
the program and control groups. However, a significant
difference in ethnic grouping was observed between
participation groups, X2 (1) = 10.41, p < .001. These re-
sults indicated that the program group had a higher
proportion of non-Caucasian students (n = 33, 23.2%)
than the control group (n = 7, 7%). The children’s mean
age was 102.82 months, with a standard deviation of 7.60
months. There was no significant difference in ages
between the different groups.
Procedure
This study evaluated a 20-week intervention, with
10 weeks in the fall semester and 10 weeks during the
spring, involving teachers, parents, and third-grade
students from six elementary schools (3 intervention
schools with 9 third-grade classrooms, and 3 control
schools with 6 third-grade classrooms). The classroom
teachers selected to administer the program had pre-
viously participated in a 10-hr training (1 hr per week)
designed to prepare them to implement the classroom
lessons. Teachers also received ongoing assistance from
the researchers throughout the school year in deliver-
ing the program.
At the beginning of the intervention in the fall,
pretests were conducted on each child, in both the
treatment and control groups, to assess the following:
height, weight, and computation of body mass index
(BMI) from height and weight measurements, skinfold
caliper measurements for body fat analysis, blood
cholesterol, time to run 1 mile, exercise and nutrition
knowledge, and 24-hr dietary recalls. Posttests on the
same measures were given in late spring, 8 months
after the pretest, and follow-up testing on selected mea-
sures occurred 1 year after the posttests.
At the beginning of the intervention, all parents
of the children in the program group were invited to
RQES: June 2005
11/20/2006, 2:36 PM

attend an orientation held at each school site that
included an opportunity to participate in selected tests
(height, weight, skinfold, blood cholesterol, and
dietary recall) and receive an overview of the program.
A total of 100 parents voluntarily attended. Parents
received a written invitation to attend the orientation
and also a follow-up home telephone call reminding
them of the event. Parents were asked to complete a
medical history and consent-to-participate form. For
those who were non-English speaking or limited in
English, interpreters were available in Spanish,
Hmong, and Laotian. Interpreters fluent in each
language translated all written materials from English
into Spanish, Hmong, and Laotian for parents. Parents
received the results of both their tests and their
children’s. From this information, participating fami-
lies were asked to set activity goals to provide direction
and motivation for behavior change. The family fitness
scorecard was presented, and parents received direc-
tions on how points could be earned for physical
activities and how to complete the physical activity log.
Classroom teachers instructed children how to com-
plete the scorecards for families whose parents were
unable to attend the orientation.
In the control condition, children received no ad-
ditional instruction in nutrition and physical education
beyond that provided in their regular school curriculum.
At the conclusion of the study, all curriculum materials,
as well as home packet information, were provided to the
teachers and parents in the control group.
Physical education instruction for three 30-min
lessons per week emphasized the physical activity and
fitness objectives specified in Healthy People 2000 (1993).
The specific lessons were taken from the curriculum
guide by Hopper, Munoz, and Fisher (1997). Teachers
were trained to deliver specific lessons from this guide,
with emphasis on increasing levels of physical activity for
all students during physical education lessons and teach-
ing concepts related to cardiovascular health. Lessons
included a variety of cooperative activities and games with
20 min of aerobic activity in each. Children received sug-
gestions on how to participate in such activities as
walking and bicycling with parents.
Nutrition education occurred in the classroom
and was scheduled as part of the curriculum for two
30-min lessons per week. Classes emphasized the
impact of nutrition on heart health, reading labels, and
other consumer tips. The classroom teacher taught the
format, which was written and designed by the research
team and included hands-on activities, games, group
discussion, and role-playing designed to encourage the
use of healthy foods. Food choices were designated as
“everyday” (low in fat and cholesterol, high in fiber)
and “sometimes” (typically higher in fat) foods, thus,
attempting to remove guilt and promote healthy eat-
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Hopper.pmd 133
Hopper, Munoz, Gruber, and Nguyen
ing habits. Children were also taught how to discuss
nutritional topics at home with their parents and how
to improve eating habits within the family.
The intervention included a home program that
requested parents and children to complete activities
and earn points for exercise and nutrition activities.
Each Monday, children took home a packet contain-
ing information and exercise and nutrition activities
to complete during the week. They returned the
completed packet the following Monday. The instruc-
tions in the packets were printed in either English,
Spanish, Hmong, or Laotian to provide a clear and
concise understanding for each participant. The
school-based lessons paralleled the information taken
home, and children were encouraged to share the
knowledge learned in class with their parents. The
family teams received weekly points for completing
exercise and nutrition activities. Parents and children
earned physical activity points, one point per minute
of activity, in self-selected physical exercise/activity. A
goal of 100 points per week was the target for each fam-
ily fitness team. Children and parents received points
for their individual exercise, but 50 of the 100-point
weekly goal was designated for parents and children
participating together in selected physical activities.
They received examples of physical activities appropri-
ate for parents and children together.
Nutrition activities included using heart-healthy reci-
pes, setting nutritional goals, and distinguishing between
everyday and sometimes foods. The research team re-
corded points were recorded every week and posted
them in the classrooms. Each student and participating
family members received a t-shirt after completing the
pretest session, and children were rewarded with stick-
ers every time they returned their scorecard on Mondays.
Instrumentation
Physical Measures. Anthropometric measures were
taken at pre- and posttest. The scores for height were
recorded in centimeters and weight in kilograms. Each
person’s BMI was calculated as weight divided by
squared height. Skinfold sites, measured in millime-
ters, for girls and boys, were taken at the triceps and
calf. Lange (Cambridge Scientific Industries, Cam-
bridge, MD) calipers were used for all skinfold mea-
surements. The researcher completed the skinfold
measurements for all individuals in the pre- and
posttest. All children completed a 1-mile run and were
timed in seconds. They completed a practice run prior
to the test, and children in both groups were coached
with identical instructions on pacing techniques.
Blood Cholesterol. Blood cholesterol (mg/dL) for chil-
dren was assessed using a Reflotron (Boehringer Man-
heim Diagnostics, Indianapolis, IN). Prior research
133
11/20/2006, 2:36 PM
 Hopper, Munoz, Gruber, and Nguyen
(Statland, 1990) reported use of the Reflotron dry chem-
istry analyzer as a valid and reliable method of determin-
ing cholesterol. Reflotron cholesterol values obtained
from this instrument provided an error range of + or -
5%, which is in agreement with the ranges presented in
the literature (Selmer, Foss, & Lund-Larsen, 1990;
Statland, 1990). Test-retest reliability over a 9-month
period was .74 based on 87 control children in this study.
Exercise and Nutrition Knowledge. An exercise and
nutrition knowledge questionnaire composed of
25 questions related to cardiovascular health was
developed specifically for this study to assess the
children’s knowledge at pre- and posttest. Children
completed this multiple-choice test in the classroom. To
reduce error due to students’ different reading readiness
levels, all classroom teachers read each question in
class when administering the test. The questionnaire was
similar to the one used in a previous study (Hopper,
Gruber, Munoz, & Herb, 1992), with minor changes to
improve clarity. The test-retest reliability on the exercise
and nutrition knowledge test in the prior study was .65
based on control group pre- and posttest scores. Inter-
nal reliability was .65 based on all children at pretest.
Twenty-Four-Hr Dietary Recalls. Trained interviewers
conducted the dietary recalls at pre- and posttest,
using the technique developed by Frank, Berenson,
Schilling, and Moore (1977), for a random sample of
146 children, to obtain estimates of food intake. This
method was used because of the difficulty in obtain-
ing written food records from young children. Data
were collected on 1 week day and 1 weekend day, for a
total of 2 days’ intake. A 2-day average for each period
was then analyzed using the Food Processor II com-
puter program (Hands, 1989), which has been used
in many published articles (Howat 1999; Johnson-
Down, 1997; Lewis & Baker, 1994). The program
calculated each child’s daily intake of kilocalories;
grams of protein, carbohydrate, fiber, total fat, and
saturated fat; and milligrams of cholesterol and
sodium. In addition, the percentage of total calories
from carbohydrate and fat was determined.
Parent Participation. A weekly score card, which
parents completed and signed, and indicating the
accomplishment of weekly assignments, measured the
amount of family participation. The research team
recorded the family’s points earned each week. The
base number of points for families was 2,000 for the
entire program. Families were encouraged to do more
than the minimum, and the median number of family
points was 3,117 in a positively skewed distribution.
Data Analysis
The research design was a pretest-posttest design
with treatment and control groups measured on 17
134
Hopper.pmd 134
variables: height (cm), weight (kg), BMI (kg/m2), sum
of skinfolds (mm), blood cholesterol (mg/dL), mile
run (s), exercise and nutrition knowledge, kilocalories,
protein (g), carbohydrate (g), fiber (g), total fat (g),
saturated fat (g), dietary cholesterol (mg), sodium
(mg), percentage of calories from fat, and percentage
of calories from carbohydrate. The independent
variable was the treatment that included the program
and control conditions. The two groups were com-
pared using the school as the unit of analysis, because
the unit of randomization was the school. Children in
the program and control groups were not independent
of each other, and the school was selected as the unit
of analysis following the guidelines presented by
Silverman and Solmon (1998). To determine whether
there was a significant difference between the program
and control groups, school means on all the measures
were compared.
The dependent variables were continuous, with at
least an interval scale of measurement. Measures on
each variable were obtained at pre- and posttest for each
child and participating parents. All children who were
present at both pre- and posttesting were included in
the analysis. Any missing values for these children
were handled by deletion case-wise within analyses.
Accordingly, if an individual was missing a score on a
particular variable, the individual was included in
all analyses that did not involve that variable but
were deleted from all analyses in which the variable
was included.
Data were analyzed using the Statistical Package for
the Social Sciences computer program. The criterion
for statistical significance was set at the .05 alpha level.
Correlations among each of the measured variables
were explored. The correlations between pre- and
posttest measures in the control group were used to
check the test-retest reliability of each variable.
Results
Using Pearson product-moment correlations, test-
retest reliabilities were calculated from pre- and
posttest scores for all measures on the responses by
children in the control group (see Table 1). Of the 17
coefficients calculated, 14 had significant test-retest
reliabilities at the p < .05 alpha level or stronger.
Fitness Measures
Children were tested at pre- and posttest on the
physical measures of height, weight, BMI, sum
of skinfolds, and blood cholesterol and on the perfor-
mance measures of 1-mile run times and fitness and
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11/20/2006, 2:36 PM
 Hopper, Munoz, Gruber, and Nguyen

nutrition knowledge. Children’s age in months, Dietary Intake

gender, and ethnicity were examined at pretest in A randomly selected subset of children completed
relation to all variables. Girls scored significantly two 24-hr dietary recalls at pre- and posttest. Dietary
higher at pretest on skinfold sum (M = 27.44, SD = 1.06) intake of kilocalories, protein (g), carbohydrate (g),
than boys (M = 24.09, SD = 11.36), F(1, 220) = 4.91, fiber (g), total fat (g), saturated fat (g), dietary cho-
p < .05, η2 = .02. The girls also scored higher on fitness lesterol (mg), sodium (mg), and the percentage of
knowledge (M = 12.18, SD = 3.13) than the boys calories from carbohydrate and fat were analyzed.
(M = 11.35, SD = 3.07), F(1, 218) = 3.92, p < .05, The nutrition measures were analyzed using schools
η2 = .02. Pearson product-moment correlation coeffi- as the unit of analysis. The pre- and posttest dietary
cients showed significant relationships between intake means for schools are presented in Table 2.
age and height, r(223) = .32, p < .001, age and weight, When the means for the three program schools were
r(223) = .32, p < .001, and age and BMI, r(223) = .19, compared with the means for the three control schools,
p < .01, indicating that older children were taller, no significant differences were found between the
weighed more, and had higher BMI scores at pretest. schools at pretest. At posttest, however, the program
The fitness measures were analyzed using schools scored significantly lower (M = 57.05, SD = 4.21)
schools as the unit of analysis. The pre- and posttest than the control schools (M = 64.68, SD = 0.87) on
fitness means for schools are presented in Table 2. mean total fat intake, F(1, 4) = 9.41, p < .05, η2 = .70.
When the means for the three program schools were
compared with those for the three control schools, no
significant differences were found between the schools
at pretest or at follow-up. At posttest, however, the Discussion
program schools scored significantly higher
(M = 15.41, SD = 1.10) than the control schools The analysis for posttest scores revealed that the
(M = 13.43, SD =0.55) on mean knowledge scores, F(1, program group schools scored significantly higher than
4) = 7.85, p < .05, η2 = .66. It should be noted, however, the control schools on knowledge. Improvement in
that the degrees of freedom for the school mean com- knowledge as a result of program participation has been
parisons were low (1, 4). a significant outcome in other studies (Connor et al,
1986; Harrell et al., 1998; Hopper et al., 1992; Perry et
al., 1988). Increased knowledge may be considered one
of the first steps in bringing about behavioral changes.
However, the difference in knowledge did not persist in
Table 1. Test-retest reliabilities for fitness and nutrition variables follow-up testing 1 year later. This result is not consistent
in control children with follow-up results showing maintenance of dietary
knowledge reported by Nader et al. (1999).
Variable Coefficient (r) While there was significant but temporary im-
provement in knowledge, there was no significant im-
Height .99*** provement in physiological variables. The groups did
Weight .98*** not differ at posttest or follow-up in weight, BMI,
Body mass index .96*** skinfold sum, or 1-mile run. The only encouraging
Skinfold .93*** physiological result in this study was that the control
Blood cholesterol .74*** schools showed greater nonsignficant increases in
Mile run .57***
skinfold and BMI than the program schools. Physical
Knowledge .37***
Kilocalories .26* activity and fitness improvements as measured by
Protein .37** traditional assessments are resistant to change. These
Carbohydrate .38** results were similar to those reported for the Child-
Total fat .12 hood Adolescent Trial for Cardiovascular Health
Saturated fat .09 (CATCH) study that found no significant differences
Dietary cholesterol .21 between conditions for weight, BMI, skinfolds, run
Fiber .28** time, or blood cholesterol, either at posttest (Luepker
Sodium .29* et al., 1996) or at a 3-year follow-up (Nader et al., 1999).
% Calories from carbohydrate .31**
The CATCH study was much larger than the current
% Calories from fat .25*
one, with 5,106 third-grade students. In the CATCH
*p < .05. study no significant differences between conditions
**p < .01. were found for weight, BMI, skinfolds, run time (9
***p < .001. min), and blood cholesterol. Nader et al. (1999) com-

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 Hopper, Munoz, Gruber, and Nguyen

pleted a 3-year follow-up study on the participants in
the CATCH study and found no significant differences
between control and intervention students in eighth
grade for BMI, blood pressure, serum lipids, and
cholesterol levels. The CATCH study, however, dem-
onstrated increases in observed physical activity for the
intervention students.
There were some encouraging results in the dietary
intake category. The program group showed a signifi-
cantly lower intake of total fat at posttest than the con-
trol group. Similar studies (Gortmaker et al., 1999;
Luepker et al., 1996) found that total and saturated fat
consumption was reduced after a school-based interven-
tion but that physical activity variables were more resis-
tant to change. In the CATCH study, self-reported daily
fat intake among students in the intervention schools was
significantly reduced compared to students in the con-
trol schools (Luepker et al., 1996).
At posttest, the program schools showed a nonsig-
nificant higher percentage of calories from carbohy-
drates and a lower percentage of calories from fat rela-
tive to the control schools. These outcomes, although
nonsignificant, support the effectiveness of the
program’s nutrition education component. At posttest,
the observed value of percentage of calories from fat
in the program group was 31.58%, slightly higher than
the 30% target recommended by the American Heart
Association. Percentage of calories from carbohydrates
was 53.87%, but still slightly below the target of 55%.
This outcome also suggests that classroom teachers
who are not specialists can deliver an effective curricu-
lum with specific training.
The lack of change in blood cholesterol levels and
other physiological factors, although disappointing, is
not surprising. In the Harrell et al. (1998) study sig-
nificant reductions in blood cholesterol levels were
achieved with third- and fourth-grade children in the
intervention groups. However, in the Harrell study a
prerequisite of participation for each child in the
intervention group was the possession of two cardio-
vascular risk factors. In their case, improvement of the
cholesterol score may have been easier to achieve. The
current study included all children, regardless of their
pretest cholesterol status.
This study was based on the premise that improve-
ments in children’s health behaviors would produce fa-
vorable changes in physical measures and blood
cholesterol. However, this assumption may be influenced
by developmental processes. The children in this study
were in an important period of growth and development,
as they were approaching the onset of puberty. The ef-
fect of diet and exercise changes may be confounded by
developmental changes, which include increases in
weight, BMI, and skinfold measures (Vizmanos & Marti-
Henneberg, 2000). A program of this type may help
moderate the amount of increase in the children’s body
fat during this growth period.
Previous research (Epstein, Wing, Koeske, &
Valeski, 1987; Israel, Stolmaker, & Andrian, 1985)
indicated that family involvement has helped children

TTable
able 2. Pretest and posttest fitness and dietary means for control group and program group schools

Variable Control Program

Pretest Posttest Pretest Posttest

Height (cm) 131.95 135.56 130.95 135.34

Weight (kg) 31.11 34.28 30.87 33.60
Body mass index (kg/m2) 17.69 18.44 17.83 18.15
Skinfold sum (mm) 26.69 28.00 26.29 27.42
Blood cholesterol (mg/dL) 150.53 156.27 153.70 164.87
Mile run time (s) 775.04 722.64 785.96 722.56
Knowledge 12.36 13.43 11.61 15.41*
Kilocalories 1,698.34 1,686.25 1,657.13 1,586.15
Protein (gm) 64.40 62.28 65.33 57.79
Carbohydrate (gm) 222.14 222.10 221.72 217.42
Fiber (gm) 12.45 13.74 12.86 12.07
Total fat (gm) 64.50 64.68 59.67 57.05*
Saturated fat (gm) 23.86 23.39 22.18 21.17
Dietary cholesterol (mg) 194.94 186.22 219.35 168.08
Sodium (mg) 2,744.82 2,797.74 2,550.30 2,404.36
% Calories from carbohydrates 52.15 51.64 53.32 53.87
% Calories from fat 33.17 33.74 31.12 31.58

*Significantly different from control group at p < .05.

136 RQES: June 2005

Hopper.pmd 136 11/20/2006, 2:36 PM


make significant changes in diet and physical activity.
However, these approaches have used fairly intensive
methods with direct behavioral counseling of indi-
vidual families. The above studies incorporated key
components of social learning theory, with parents
modeling specific behaviors and including goal setting
in behavior-change strategies. The intensity of these
procedures may have contributed to the development
of desirable exercise and nutrition behaviors. In the
current study, there was limited direct contact with
parents, with children supporting their parents’ par-
ticipation in the family fitness program. The finding
of a significant reduction in total fat intake in the
program group is encouraging and indicates that
behavior change is possible with a less intrusive ap-
proach than individual counseling.
Given that most teachers have limited time and
resources to contribute to this curriculum area,
the issue of feasibility is important. Although more
substantial modifications in health habits and changes
in physiological risk factors could occur if family
involvement were greater, this task may not be a high
priority for teachers, given the emphasis on basic
academic standards. In this study, the classroom
teacher was responsible for delivering the physical edu-
cation and health curriculum, and specialists in these
curriculum areas are not required by state regulations.
In situations without specialists, the classroom teacher
is often overburdened with various curriculum man-
dates, and a reasonable and realistic approach for
teachers is required if any progress is to be made in
health habits. Further research on different strategies
to secure parent participation seems warranted, espe-
cially given the limited amount of time a teacher can
devote to fitness and nutrition issues in a crowded
elementary school curriculum.
There are many practical issues to be resolved to
implement a program that effectively includes family
participation. This study was limited by moderate
participation rates of parents in the home program.
Children’s participation rates were relatively high, even
with inclusion of the blood cholesterol test. Methods
used to improve home participation in program
activities included sending home information about
the program, calling parents, recruiting parent
volunteers to encourage others to participate, and pro-
viding incentives such as door prizes. The study was also
limited by the amount of school time devoted to the
program. Teachers considered 30 min of instructional
time per day feasible due to other curriculum needs.
Therefore, to increase physical activity and nutrition
education opportunities, a family component was
added to the intervention.
The program was implemented in a rural area with
modest resources and staff development. However, the
RQES: June 2005
Hopper.pmd 137
Hopper, Munoz, Gruber, and Nguyen
program demonstrated that schools can adjust the
curriculum to meet some health needs of students and
their parents. Some significant changes occurred in
increased knowledge and reduction of total dietary fat
intake. Further research involving the entire school
population and over several years, with support from
physical education and health education specialist
teachers, may demonstrate long-term cardiovascular
health benefits. It is likely that consistent programs
emphasizing physical fitness and nutrition education
are necessary throughout the grades to solidify
behavioral changes.
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Authors’ Notes
Support for this study was provided by the National
Heart, Lung and Blood Institute, R15 HL 42626-01A4.
Please address all correspondence concerning this
article to Chris Hopper, Department of Health and
Physical Education, Humboldt State University, Arcata,
CA 95521.
E-mail: cah3@humboldt.edu
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