"11 for Health" in Pakistan - Effects on Physical Fitness, Health Knowledge and Well-being of 8-14-year-old Schoolchildren

Primary outcomes

1. Resting Heart Rate

   Time frame: before and at the end of the 11-week intervention

   Resting heart rate (RHR) was measured four times using a portable liquid crystal display (LCD) finger-type pulse oximeter. Prior to RHR measurement, participants were required to rest in a seated position for 15-20 minutes. Four measurements were taken for each participant, with at least 2-minute intervals between readings.

   Unit of Measurement: Beats per minute (bpm)

2. Systolic Blood Pressure and Diastolic Blood Pressure

   Time frame: before and at the end of the 11-week intervention

   Trained staff measured blood pressure using an aneroid sphygmomanometer. The first and fifth Korotkoff sounds were recorded as systolic (SBP) and diastolic (DBP) pressure. Participants rested seated for 15-20 minutes beforehand. Four readings were taken at intervals of at least two minutes.

   Unit of Measurement: Millimeters of Mercury (mmHg)

3. Body Mass Index (BMI)

   Time frame: before and at the end of the 11-week intervention

   Weight and Height were combined to report BMI in kg/m^2. Height was measured to the nearest 0.1 cm using a yardstick. Weight was recorded with a 0.1 kg precision using a portable calibrated scale. These measurements were conducted with participants barefoot and wearing light clothing.

   Unit of Measurement: BMI in kg/m^2

4. Waist Circumference

   Time frame: before and at the end of the 11-week intervention

   Waist circumference (WC) was assessed at the midpoint between the lowest rib and the superior border of the iliac crest at the end of normal expiration, using a non-stretch measuring tape held parallel to the floor.

   Unit of Measurement: centimetre (cm) for the waist circumference

5. Postural Balance

   Time frame: before and at the end of the 11-week intervention

   Postural balance was assessed using the Stork balance stand test. Participants placed their hands on hips, positioned one foot against the supporting leg's knee, and raised the supporting heel to balance on the ball of the foot. Timing began at heel lift and stopped if hands moved, the foot shifted, knee contact broke, or the heel touched down.

   Unit of Measurement: seconds (s)

6. Jump Performance

   Time frame: before and at the end of the 11-week intervention

   Jump performance was assessed by standing long jump test. Each student performed two barefoot jumps. Starting with toes behind a line, feet parallel and shoulder-width apart, they squatted to 90° knee flexion with hands on hips. After two seconds, they jumped forward, keeping hands on hips.

   Unit of Measurement: Distance from line to heel was measured to the nearest centimetre (cm).

7. Agility

   Time frame: before and at the end of the 11-week intervention

   The Arrow-head agility test is used to measure agility. Participants sprint from a start line to a middle cone, turn right around a side cone, circle the farthest cone, and return. Knocking over a cone requires a restart. Two attempts were made after one trial. The shorter time of the two attempts was recorded.

   Unit of Measurement: Seconds (s) - Time to complete the test

8. 30-metre Sprint

   Time frame: before and at the end of the 11-week intervention

   The participants performed two 30-metre sprints at their maximal speed with 2-3 minutes of rest between attempts. Three timers with stopwatches stood 6 metres perpendicular to the finish line. They started timing at the student's first movement and stopped when the upper body crossed the finish line.

   Unit of Measurement: The average time in seconds (s) given by testers.

9. Cardiovascular Performance

   Time frame: before and at the end of the 11-week intervention

   Cardiovascular performance was evaluated with the Yo-Yo intermittent recovery level 1 children's test. The test took place outdoors at all schools. It consisted of repeated 16-metre shuttle runs with progressively increasing speed. Between runs, participants had a 10 second active recovery by jogging around a cone set 4 metres behind the start line. A prerecorded beep regulated the pace. Missing the beep twice terminated the test.

   Unit of Measurement: Total running distance in metres (m)

10. Health Knowledge

    Time frame: before and at the end of the 11-week intervention

    A 34-item Urdu version health knowledge questionnaire assessed children's understanding of ten health topics related to the "11 for Health" programme before and after the intervention. Items used either a true/false/don't know format or multiple choice with four options. Correct answers received a score of 2, while incorrect or don't know responses scored 1.

    Unit of Measurement: Mean percentage and standard deviation of correct responses were calculated for each health message based on all individual answers.

11. Well-being

    Time frame: before and at the end of the 11-week intervention

    An Urdu version of the adapted KIDSCREEN-27 questionnaire was used to measure well-being of the partcipants. The 20 items covered four dimensions: physical well-being, psychological well-being, peers and social support, and school environment. Items used a five-point Likert scale ranging from "never" to "always" or "not at all" to "extremely". The subscale scores are converted to a standardized scale where the average is around 50 and the standard deviation is about 10. Higher scores reflected better well-being.