School Health Education Program in Pakistan(SHEPP) ; Impact on Lifestyle and Cardio-

1.1.Interventions to reduce childhood obesity School based programs have also been introduced as interventions to assess the impact on blood pressure ant weight. In effectiveness trial done by Yin et al on the impact of 8 months after school physical activity programme demonstrated a reduction in percentage body fat, but no effect on blood pressure.(52) Schools have been unable to provide sufficient time and resources for students to meet all the objectives of standard physical education, the concept of "health-related PE".(13)Traditionally, the role of schools in providing and promoting physical activity has been during the school day (eg, PE, recess) and/or on the school campus immediately after school. Trial of Activity for Adolescent Girls (TAAG) is a large-scale randomized trial involving 36 schools at 6 study sites across the United States and sponsored by the National Heart, Lung, and Blood Institute. This large-scale study is examining the effects of a school-community linked intervention on overall physical activity in middle school girls.(53)

Physical activity and behavior of change theory The effectiveness of physical activity interventions would benefit from a better understanding of this behavior. (54) Theory of planned behavior has demonstrated usefulness in studies of health-related behavior.(55) Only children's intention and self-identity as a result of their cognition is related to participation in physical activity to some extent(56). This suggests that educational strategies aimed at increasing children's motivation remainan important strategy to promote physical activity. Physical activity interventions have been done focusing on designing interventions to overcome cultural, socioeconomic barriers in performing physical activity based on psychosocial cognitive theory.(57)

A number of carefully designed studies incorporating health-related PE concepts and physical activity in PE classes have been conducted. Dietary or physical activity behavior produce a significant and clinically meaningful reduction in body mass index status of children and adolescents in preventing obesity (58, 59) Alternatively behavioral prevention and situational prevention elements have been combined to increase physical activity, decrease the consumption of sugar-sweetened beverages, and decrease time spent with screen media(60).

Studies reporting positive outcomes implemented physical activity sessions that lasted at least 30 min d(-1)?. Several studies showed that children are most active in the first 10-15 min. The existence or installation of playground markings or fixed play equipment had no effect, whereas the presence or addition of portable play equipment was positively correlated with moderate-to-vigorous physical activity.

Role of Parents and Teachers One of the interventions in promoting healthy lifestyle in children is focusing on children, parents and teachers simultaneously by introducing learning sessions and materials for healthy lifestyle.(32, 61)Teacher training may be a key element for successful interventions. To overcome time constraints, a suggested solution is to integrate physical activity into daily routines and other areas of the preschool curriculum.(62)Additionally parental barriers are associated with the time that children spend in both active and sedentary pursuits.(63) Knowledge about risk factors for obesity and myocardial infarction is suboptimal in Pakistani adults(64).Only 42% adult students had a good level of knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction in Karachi.(65)Health education on physical activity and healthy diet using multiple level intervention is essential to be given at schools.