Discussion
OBESE, DISORDERS
The main findings of this study are that the Our first aim was to study the immediate effect of a health-enhancing physical education intervention on cardiometabolic indicators in children at risk of NCDs compared to their healthy peers.Although mixed results have been reported for school-based programs targeting PA, our findings are in line with those of a recent umbrella review (In fact, the positive results found on school MVPA were on children with low initial levels of PA, as well as in girls independent of their activity status. These findings differ from that of a pooled analysis that detected a positive effect on PA for already active children, but not for inactive children or girls (Conflicting results exist about the potential of interventions to modify cardiometabolic risk markers. In our study, the intervention did not affect BMI levels in neither normal weight or overweight learners. However, it lowered MAP for children with and without pre-existing elevated BP. Furthermore, a significant improvement in glucose and lipid levels was only observed among children with no glycemic or lipidemic disorders, respectively. Poor cardiovascular health in children is oftentimes associated with unhealthy habits. Changing at-risk behaviors through lifestyle interventions has proven challenging. For example, limited results in BMI reduction among severely obese children and sustainability issues have been described (The second aim of the study was to assess the long-term development of risk factors in especially vulnerable children. In general, the cardiometabolic risk profile of at-risk children worsened over time. However, results must be interpreted in the context of the COVID-19 pandemic, as South Africa employed one of the strictest lockdown measures globally. The 2 year follow-up assessments took place after children re-entered schools and while operating at 50% capacity.A decline in total MVPA of over 11 min/day, although not statistically significant, was observed from October 2019 to October 2021. This reduction is higher than the 8 min/day reported for a population of school-aged English children between Summer 2018 and Autumn 2021 in the United Kingdom, which would be broadly equivalent to the expected natural decline observed with age (Indeed, a deterioration of children’s health during the COVID-19 pandemic has been reported by other authors, although evidence is limited and heterogeneous. In our study we found a significant increase in MAP at follow-up, and small, non-significant changes in HbA1c and TC to HDL ratio. Our observations are in line with one study that found significant changes in HbA1c and lipid levels among dyslipidemic children (Finally, we aimed to evaluate whether the effects observed in at-risk children post-intervention could be maintained over time. In line with previous research, we could not detect any outcome differences between the intervention and control groups at the 2 year follow-up (