Evaluation of school-based interventions including homework to promote healthy lifestyles: a systematic review with meta-analysis

Aim: It is important to promote healthy lifestyles in youth through initiatives in school, which is a preferred setting to implement health-related interventions also targeted at families to be more effective. This study aimed to synthesise school-based interventions including homework and extracurricular activities for the promotion of healthy lifestyles, especially healthy nutrition and physical activity, in children and adolescents. Methods: This systematic review was conducted according to the PRISMA guidelines. Quality assessment was performed using the Cochrane Tool for Quality Assessment for randomized and non-randomized control trials, while the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines were used for observational studies. Results: From the 1356 studies identified, eight were included. Across studies, a significant effect was found in increasing fruit and vegetable consumption and reducing snack and sugar intake, while no effect was found for moderate to vigorous physical activity (MVPA) unless for light PA (LPA) and step counts. The results of BMI and waist circumference are still unclear after performing a meta-analysis of three studies. Conclusion: School-based interventions including homework and extracurricular activities were shown to improve nutritional behaviour, step counts, and LPA. Despite some statistically significant results, the effects of BMI and waist circumference are still unclear. Further studies are needed to demonstrate that these intervention s can represent an effective strategy for obesity prevention.