Healthy cardiovascular habits taught to children early on though school-based programmes can keep their lifestyle choices in check and prevent the risk of heart disease. Unhealthy lifestyle habits such as a nutritionally poor diet, sedentary lifestyle, and smoking, all contribute to cardiovascular disease risk; previous studies also point to a relationship between poor cardiovascular health in childhood and poor cardiometabolic health in adults.

However, a multilevel and multicomponent school-based programme involving 50 schools across Spain and the US, saw how early education in children with regards to their cardiovascular health ensured lasting lifestyle improvements.

According to the 10-year results of the SI! Program (Salud Integral — Comprehensive Health), a significant increase in knowledge, attitudes, and healthy lifestlye habits were apparent in more than 3,800 young children after the implementation of a four-month health promotion programme. Children who received more than 75% of the programme were found to have a significant change from baseline in overall knowledge, attitudes, and habits, compared to children who received less than 50% of the same programme.

“Most preschool interventions focus solely on physical activity and diet. The SI! Program breaks down cardiovascular health into four components. Through the first two components, children are learning how a well-balanced diet and physically active life are directly connected to a healthy heart. Next, they learn about emotion management, which seeks to instill behaviour mechanisms against substance abuse – mainly smoking – and dietary decisions later in life. Finally, the children are taught about how the human body works and how it is affected by behaviour and lifestyle,” said Dr. Gloria Santos-Beneit, scientific coordinator of the SHE-la Caixa Foundation, Spain.

The programme itself incorporated assessment tools suited to the maturation of the children, while questionnaires included simple pictures and were modified to the sociocultural contexts of each country.]

For example, to accommodate the learning styles of preschool-aged children, the SI! Program used a heart-shaped mascot named “Cardio” to teach about recommended healthy behaviours, along with the Sesame Street character Dr. Ruster, a Muppet based on the principal investigator of the programme, to introduce and convey messages and activities. Other materials include video segments and printed materials (a colorful storybook, an interactive board game, flash cards and a teacher’s guide).

The activities and messages used were tailored by country, keeping in mind cultural health beliefs or practices related to food, facilities allocated for physical activity, transportation methods to school, meals provided in school, popular songs or stories, and local everyday rituals and celebrations.

“The school environment is a great area to introduce lifestyle interventions, because children are spending so much of their time there,” said Dr. Rodrigo Fernández-Jiménez, group leader of the cardiovascular health and imaging lab at Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain. “There are specific times in a child’s life when improvements can be made to enhance long-term cardiovascular health status. Our review, and previous studies, suggest that 4-5 years of age is the most favourable time to start a school-based intervention focused on healthy habits.”

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