4. Discussion
Obesity, obesity
OBESITY, OBESITY, CHILDHOOD OBESITY
Obesity in the pediatric population is a serious public health problem, and in southern Europe, there is the highest percentage of overweight or obese children [This is the first study evaluating the effects of a school-based physical activity intervention, performed in the form of some active breaks of a total duration of 10 min a day, introduced during curricular lessons, together with a 10 min physical activity intervention during the daily school recess period, on obesity prevention, fitness, psychological health, and cognitive performance in Italian school children.In the intervention group, the school-based physical activity intervention produced the following main consequences: (i) changes in body mass index, in waist circumference, and waist-to-height ratio; (ii) lower relative body fat mass; (iii) better performances in physical fitness; (iv) significant differences in cognitive performance; and (v) enhancement of psychological well-being in the intervention group compared with the control group. Given the conflicting results in the literature regarding physical activity interventions in schools, one of the objectives of this study was to examine the effects of a 6-month obesity prevention and physical activity promotion program in children.Our results show that the intervention program used here, despite individual variability, produced a decrement in both the mean BMI value and the waistline value in the healthy children of the intervention group compared to the control group. A high percentage of body fat is coupled with cardiovascular risk factors in both children and adolescents [The intervention also significantly decreased the WHR in the intervention group. Several studies have reported that the WHR is a very helpful predictor of cardiovascular risk in adults [These findings can mainly be explained by the increase in energy expenditure, as no significant changes in calorie intake were identified during the 6-month period.Albeit physical-activity-based interventions varying substantially between their intervention approaches, most of them have been demonstrated to have a positive impact on young people [The main task of a program for the prevention of childhood obesity is not only to reduce body weight or BMI but, above all, to improve body composition and, consequently, improve motor coordination and physical fitness [The reasons for the improvements in cognitive performance related to exercise are not yet fully understood but there is no doubt that cognitive enhancement is based on different levels of change [It is worth remembering that the association between increased physical activity and mental well-being demonstrated here is coincident with several previous literature reports [Although other unmeasured factors may have contributed to the observed effects (this may be a limitation of the study), the results established that increased physical activity positively contributed to the physical and mental well-being of the participating children, suggesting that physical activity represents a modifiable means to protect well-being by promoting resilience under different conditions. We have to consider that this study was conducted on children aged 8 to 10 years for whom pubertal stages were not measured and the results probably cannot be transferred to the general population of school children with different ages; furthermore, of the participants in this study, we did not assess habitual physical activity. Another limitation could be the sample size and the loss of follow-up data which could compromise the generalizability of the results, because the recruited participants were representative of a target population with considerable individual variability. For example, the influences of socio-economic conditions were not evaluated in the present study. In addition, future studies that take into account variables such as the study time or rest, as well as nutrition or the use of new technologies, which could affect associations, would be recommended. Additionally, only specific physical fitness dimensions have been assessed. Yet another potential limitation of this study is the difficulty of controlling for variations in daily physical activities that were performed by the study participants outside of school hours. However, greater attention was paid by the respective coaches of all of those children who regularly played sports. Future research, therefore, should consider an assessment of different dimensions of fitness (e.g., cardiorespiratory fitness, muscular fitness, and motor-cognitive fitness), which could provide a more comprehensive insight into the relationships between physical fitness, cognitive functioning, and psychological well-being.