# The need for tailoring school-based physical activity interventions: preliminary insights into body weight and cross-country differences from the DELICIOUS project

## TL;DR

A school-based physical activity program had mixed effects on children's health across five Mediterranean countries, with body weight and location influencing outcomes.

## Contribution

The study reveals how physical activity interventions yield varying results by country and weight status, emphasizing the need for tailored approaches.

## Key findings

- Children with obesity in Egypt and Spain showed significant BMI reductions after the intervention.
- Physical performance improvements were most consistent in children with overweight, especially in Egypt.
- Children with obesity had the lowest responsiveness to the program across most countries.

## Abstract

Although school-based physical activity (PA) programs are recognized for enhancing children’s health-related fitness (HRF), limited evidence exists on how responsiveness varies by country and body weight status. Within the framework of the DELICIOUS project, this study analyzed cross-country variations in anthropometric and health-related fitness (HRF) changes among children with normal weight, overweight, and obesity who participated in a standardized school-based PA intervention.

Over 900 children aged 8–14 years from Egypt, Lebanon, Italy, Portugal, and Spain participated in a standardized six-month PA-program. Anthropometric measures (weight, height, and BMI) and physical fitness components (sprint, jump, strength, endurance, and coordination) were assessed before and after the intervention. Intervention effects were analyzed using repeated measures and factorial ANOVA models to examine interactions between time, country, and body weight category.

The intervention showed the greatest anthropometric effectiveness in Egypt and Spain, where children with overweight and obesity experienced weight stabilization and BMI reductions, significant among groups with obesity (−4% in Egypt; −2% in Spain). In contrast, Lebanon and Italy exhibited slight but significant increases in BMI among participants with normal and overweight. Regarding physical performance, the intervention led to significant improvements across countries, particularly in coordination and cardiovascular endurance. The most comprehensive gains were observed among children with overweight, with Egypt showing improvements across all fitness outcomes, and Lebanon and Portugal improving in all except sprint. Among normal-weight, participants in Lebanon, Egypt, and Portugal improved in 4 to 5 out of 6 fitness tests, whereas those in Spain and Italy improved in only 2 to 3. Children with obesity exhibited the lowest responsiveness overall, with Egypt, Italy, Spain, and Portugal showing improvements in only 1 to 2 outcomes.

The standardized PA intervention yielded promising, yet heterogeneous HRF changes among Mediterranean children, differing by country and weight status. These findings highlight the importance of adapting school-based PA programs to local sociocultural contexts and individual profiles. In particular, vulnerable groups such as children with obesity may require tailored, multicomponent interventions that extend beyond standardized PA to include nutritional education, psychological support, and culturally adapted strategies to optimize outcomes and promote sustained engagement.