The associations between individual and environmental
variables are summarised in Table 4. This table only presents
data for the aspects of school health promotion that had
an impact on one or more health indicators in participants.
Thus, schoolchildren whose teachers had received training on nutrition in recent years showed higher levels of physical activity (P = .010), a greater degree of compliance with
the Mediterranean diet (P = .020) and fewer daily hours of
screen time (P = .016) compared to peers whose teachers
had not received such training. Meanwhile, schoolchildren
attending schools with written or unwritten policies aiming at increasing the consumption of fruits and vegetables
reported a higher compliance with Mediterranean dietary
patterns (P = .017) and fewer hours of screen time per day
(P = .023). Lastly, when it came to the physical environment,
it is worth noting that students whose schools had sports
facilities within the school grounds or in the vicinity showed
higher levels of physical activity than students that did not
have access to such facilities (P = .023). this percentage dropped significantly for recess and lunch
breaks. When asked about the factors that influence physical activity in students, school administrators underscored
the involvement of parents and students and the improvement of facilities, equipment and activities. In terms of
parental and student involvement, a recent health promotion project implemented in 12 schools in the north east of
Spain achieved positive results by formulating their strategies based on the opinions of parents and schoolchildren
through committees that met regularly.22 As for the second
factor, previous studies have found higher levels of physical
activity in schools that had facilities, policies, and opportunities available for the improvement of these levels. Thus,
boys that attended schools that scored high on these areas
engaged in physical activity during school hours 53% more
than their peers in lower-scoring schools, while in the case
of girls the percentage of physical activity during spare time
rose to 62%. As for the levels of physical activity, we observed
higher values in boys, consistent with previous evidence for
schoolchildren of similar ages (P < .001).24 The differences
between the sexes were particularly marked for the overall weekly activity and for activity at specific times of day,
such as recess. While some authors advocate the promotion of physical activity during recess,25 these differences
had been observed in the past, with a larger percentage
of boys engaging in vigorous physical activity and a lower
percentage engaging in sedentary activities (P < .001 in both
cases).26 However, previous studies have described similar
benefits for both sexes, despite the lower levels of activity
reported by girls,27 which may suggest the need to adjust
physical activity recommendations based on sex.
While recent studies have associated neighbourhood features (access to parks, presence of fast food restaurants. . .)
with the body composition of its inhabitants,28,29 the literature is not consistent when it comes to the effects of
the school environment, although there is evidence that it
influences the habits of students.6 In this regard, previous
studies show that interventions that combined educational
and environmental elements were more effective.30 This
fact was demonstrated in a nationwide study conducted in
Spain in which the physical activity of schoolchildren was
directly correlated to the promotion policies of the schools
they attended, so that 47.4% of students in schools with high
levels of promotion met the recommendations for physical
activity, while only 33.1% of students did in schools with low
health promotion levels.31
In our study, students whose schools had multi-sport
game courts reported higher levels of physical activity than
students who did not have access to such facilities. The association between conducive environments and the practise
of physical activity have been studied in the past. Access
to playgrounds after school hours was associated with the
total amount of physical activity in adolescents in the United
States (P = .016).32 Similarly, moderate or vigorous physical
activity was also influenced by the school physical environment in Canadian children (P < .005).33 However, none of
these studies found an association with body composition,
which is consistent with a recent review that did not find
conclusive results concerning the availability/adequacy of
the multi-sport game courts and the body mass index of the
schoolchildren.