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Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial

BMJ 2011; 343 doi: (Published 13 October 2011) Cite this as: BMJ 2011;343:d6195
  1. J J Puder, assistant professor1,
  2. P Marques-Vidal, assistant professor2,
  3. C Schindler, statistician3,
  4. L Zahner, assistant professor4,
  5. I Niederer, research assistant4,
  6. F Bürgi, research assistant4,
  7. V Ebenegger, research assistant5,
  8. A Nydegger, senior lecturer6,
  9. S Kriemler, assistant professor3
  1. 1Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
  2. 2Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne
  3. 3Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4002 Basel
  4. 4Institute of Exercise and Health Sciences, University of Basel, Birsstrasse 320b, 4052 Basel
  5. 5Institute of Sport Sciences, University of Lausanne, Bâtiments administratifs de Vidy, Route de Chavannes 33, 1015 Lausanne
  6. 6Department of Paediatric Gastroenterology and Nutrition, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne
  1. Correspondence to: J J Puder jardena.puder{at}
  • Accepted 7 September 2011


Objective To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children.

Design Cluster randomised controlled single blinded trial (Ballabeina study) over one school year; randomisation was performed after stratification for linguistic region.

Setting 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerland.

Participants 652 of the 727 preschool children had informed consent and were present for baseline measures (mean age 5.1 years (SD 0.7), 72% migrants of multicultural origins). No children withdrew, but 26 moved away.

Intervention The multidimensional culturally tailored lifestyle intervention included a physical activity programme, lessons on nutrition, media use (use of television and computers), and sleep and adaptation of the built environment of the preschool class. It lasted from August 2008 to June 2009.

Main outcome measures Primary outcomes were aerobic fitness (20 m shuttle run test) and body mass index (BMI). Secondary outcomes included motor agility, balance, percentage body fat, waist circumference, physical activity, eating habits, media use, sleep, psychological health, and cognitive abilities.

Results Compared with controls, children in the intervention group had an increase in aerobic fitness at the end of the intervention (adjusted mean difference: 0.32 stages (95% confidence interval 0.07 to 0.57; P=0.01) but no difference in BMI (−0.07 kg/m2, −0.19 to 0.06; P=0.31). Relative to controls, children in the intervention group had beneficial effects in motor agility (−0.54 s, −0.90 to −0.17; P=0.004), percentage body fat (−1.1%, −2.0 to −0.2; P=0.02), and waist circumference (−1.0 cm, −1.6 to −0.4; P=0.001). There were also significant benefits in the intervention group in reported physical activity, media use, and eating habits, but not in the remaining secondary outcomes.

Conclusions A multidimensional intervention increased aerobic fitness and reduced body fat but not BMI in predominantly migrant preschool children.

Trial registration Clinical Trials NCT00674544.


  • We thank Rolf Gaillard, Nelly Pitteloud, Sergio Fanconi, and Fabien Ohl, who helped to make this study possible. We specially thank all the children, their parents, the school teachers, and the respective school health services.

  • Contributors: JJP and SK designed the study. JJP was the principal investigator and is guarantor. All authors established the methods and questionnaires. IN, FB, VE, and JJP were the main coordinators of the study. IN, FB, VE, LZ, AN, PM-V, and JJP conducted the study. CS and PM-V gave statistical and epidemiological support. JJP wrote the article with the support of SK, PM-V, FB, and IN. JJP obtained the funding, with the assistance of SK and LZ. All authors provided comments on the drafts and have read and approved the final version.

  • Funding: The study was mainly supported by the Swiss National Science Foundation (grant No 3200B0-116837) and Health Promotion Switzerland (project No 2104). Additional funding was obtained from a research award for interdisciplinary research from the University of Lausanne, a Takeda research award, the Wyeth Foundation for the Health of Children and Adolescents, the Freie Akademische Gesellschaft, and an unrestricted educational grant from Nestlé. The funding sources had no role in the study design, data collection, analysis, interpretation of data, in the writing of the report, and in the decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by ethical committees of the cantons involved in the study, and written informed consent was given by a parent or legal representative of each child.

  • Data sharing: Data about unadjusted changes and their standard deviations are available from the corresponding author.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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