"11 for Health" in Pakistan - Effects on Physical Fitness, Health Knowledge and Well-being of 8-14-year-old Schoolchildren

NCT07542574 | Completed

• 1 other identifier: Reg. No. HPESS 007
• Study Type: interventional
• Target: 254
• Locations: 1 country
• Sites: 1

Brief Summary

This study examined the effects of a school-based football intervention, the "11 for Health" (11fH) programme, on cardiorespiratory health, musculoskeletal fitness, health knowledge and well-being among Pakistani school children. The main questions it aimed to answer were:

• Does the programme enhance Pakistani schoolchildren's cardiorespiratory health and physical fitness, including blood pressure, resting heart rate, aerobic capacity, horizontal jumping ability, agility, 30-m sprint, postural balance, BMI and waist circumference?
• Does it improve their health knowledge and well-being? Researchers compared students who participated in the "11 for Health" intervention to those who continued their regular school curriculum. 254 fifth- and sixth-grade students (126 boys, 128 girls) from five schools in Islamabad participated in this study, allocated to an 11-week intervention group, a 5-week intervention group, and a control group. Researchers tested all groups before and after the intervention. Cardiorespiratory health and physical fitness were assessed with standardized tests. Health knowledge and well-being were measured with validated Urdu questionnaires.

Conditions

Physical Fitness; Health Knowledge; Cardiovascular Health; Well-being

Keywords

11 for Health; Physical Fitness; Cardiorespiratory Health; Health Knowledge; Well-being; Physical Education; Physical Activity

Outcome Measures

Primary Outcomes (11)

• Resting Heart Rate

  Resting heart rate (RHR) was measured four times using a portable liquid crystal display (LCD) finger-type pulse oximeter. Prior to RHR measurement, participants were required to rest in a seated position for 15-20 minutes. Four measurements were taken for each participant, with at least 2-minute intervals between readings. Unit of Measurement: Beats per minute (bpm)

  before and at the end of the 11-week intervention

• Systolic Blood Pressure and Diastolic Blood Pressure

  Trained staff measured blood pressure using an aneroid sphygmomanometer. The first and fifth Korotkoff sounds were recorded as systolic (SBP) and diastolic (DBP) pressure. Participants rested seated for 15-20 minutes beforehand. Four readings were taken at intervals of at least two minutes. Unit of Measurement: Millimeters of Mercury (mmHg)

  before and at the end of the 11-week intervention

• Body Mass Index (BMI)

  Weight and Height were combined to report BMI in kg/m\^2. Height was measured to the nearest 0.1 cm using a yardstick. Weight was recorded with a 0.1 kg precision using a portable calibrated scale. These measurements were conducted with participants barefoot and wearing light clothing. Unit of Measurement: BMI in kg/m\^2

  before and at the end of the 11-week intervention

• Waist Circumference

  Waist circumference (WC) was assessed at the midpoint between the lowest rib and the superior border of the iliac crest at the end of normal expiration, using a non-stretch measuring tape held parallel to the floor. Unit of Measurement: centimetre (cm) for the waist circumference

  before and at the end of the 11-week intervention

• Postural Balance

  Postural balance was assessed using the Stork balance stand test. Participants placed their hands on hips, positioned one foot against the supporting leg's knee, and raised the supporting heel to balance on the ball of the foot. Timing began at heel lift and stopped if hands moved, the foot shifted, knee contact broke, or the heel touched down. Unit of Measurement: seconds (s)

  before and at the end of the 11-week intervention

• Jump Performance

  Jump performance was assessed by standing long jump test. Each student performed two barefoot jumps. Starting with toes behind a line, feet parallel and shoulder-width apart, they squatted to 90° knee flexion with hands on hips. After two seconds, they jumped forward, keeping hands on hips. Unit of Measurement: Distance from line to heel was measured to the nearest centimetre (cm).

  before and at the end of the 11-week intervention

• Agility

  The Arrow-head agility test is used to measure agility. Participants sprint from a start line to a middle cone, turn right around a side cone, circle the farthest cone, and return. Knocking over a cone requires a restart. Two attempts were made after one trial. The shorter time of the two attempts was recorded. Unit of Measurement: Seconds (s) - Time to complete the test

  before and at the end of the 11-week intervention

• 30-metre Sprint

  The participants performed two 30-metre sprints at their maximal speed with 2-3 minutes of rest between attempts. Three timers with stopwatches stood 6 metres perpendicular to the finish line. They started timing at the student's first movement and stopped when the upper body crossed the finish line. Unit of Measurement: The average time in seconds (s) given by testers.

  before and at the end of the 11-week intervention

• Cardiovascular Performance

  Cardiovascular performance was evaluated with the Yo-Yo intermittent recovery level 1 children's test. The test took place outdoors at all schools. It consisted of repeated 16-metre shuttle runs with progressively increasing speed. Between runs, participants had a 10 second active recovery by jogging around a cone set 4 metres behind the start line. A prerecorded beep regulated the pace. Missing the beep twice terminated the test. Unit of Measurement: Total running distance in metres (m)

  before and at the end of the 11-week intervention

• Health Knowledge

  A 34-item Urdu version health knowledge questionnaire assessed children's understanding of ten health topics related to the "11 for Health" programme before and after the intervention. Items used either a true/false/don't know format or multiple choice with four options. Correct answers received a score of 2, while incorrect or don't know responses scored 1. Unit of Measurement: Mean percentage and standard deviation of correct responses were calculated for each health message based on all individual answers.

  before and at the end of the 11-week intervention

• Well-being

  An Urdu version of the adapted KIDSCREEN-27 questionnaire was used to measure well-being of the partcipants. The 20 items covered four dimensions: physical well-being, psychological well-being, peers and social support, and school environment. Items used a five-point Likert scale ranging from "never" to "always" or "not at all" to "extremely". The subscale scores are converted to a standardized scale where the average is around 50 and the standard deviation is about 10. Higher scores reflected better well-being.

  before and at the end of the 11-week intervention

Study Arms (3)

11-week Intervention Group

EXPERIMENTAL

The 11-week Intervention Group participated in the complete "11 for Health" program for 11 weeks.

Other: "11 for Health" Intervention Programme

5-week Intervention Group

EXPERIMENTAL

The 5-week Intervention Group completed the last 5-week intervention program after returning school (the new semester began).

Other: "11 for Health" Intervention Programme

Control Group

NO INTERVENTION

The control group continued with their regular daily life and school activities.

Interventions

"11 for Health" Intervention Programme OTHER

The "11 for Health" intervention consisted of two 45-minute sessions per week for 11 weeks, including a "Play Football" session that focused on developing specific football skills, and a "Play Fair" session that delivered health education through football-related activities, replacing traditional chalkboard instruction. Small-sided games (3v3, 4v4) were included in every session as the main physical stimulus.

11-week Intervention Group; 5-week Intervention Group

Eligibility Criteria

• Age: 8 Years - 14 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Enrollment in Grade 5 or Grade 6 in the participating schools during the 2023 to 2024 academic year
• Provision of written informed consent from parents or guardians together with assent from the students

You may not qualify if:

• Inability to provide consent or assent and medical conditions that prevented participation in football or other moderate-to-vigorous physical activities. Examples included severe mobility limitations, serious cardiovascular disease, or severe asthma.

Sponsors & Collaborators

• Farman Ullah: lead
• University of Southern Denmark: collaborator

Study Sites (1)

Khursheed Hockey Ground, F-10/1, Islamabad

Islamabad, Pakistan

Location

Related Publications (6)

• Moller TK, Larsen MN, Pfeffer K, Frydenlund SE, Ntoumanis N, Krustrup P. The effects of a combined physical activity and health education program on health knowledge and well-being of socially vulnerable children. Scand J Med Sci Sports. 2024 Apr;34(4):e14606. doi: 10.1111/sms.14606.

  PMID: 38545956 BACKGROUND

• Madsen M, Elbe AM, Madsen EE, Ermidis G, Ryom K, Wikman JM, Rasmussen Lind R, Larsen MN, Krustrup P. The "11 for Health in Denmark" intervention in 10- to 12-year-old Danish girls and boys and its effects on well-being-A large-scale cluster RCT. Scand J Med Sci Sports. 2020 Sep;30(9):1787-1795. doi: 10.1111/sms.13704. Epub 2020 May 27.

  PMID: 32353906 BACKGROUND

• Fuller CW, Orntoft C, Larsen MN, Elbe AM, Ottesen L, Junge A, Dvorak J, Krustrup P. 'FIFA 11 for Health' for Europe. 1: effect on health knowledge and well-being of 10- to 12-year-old Danish school children. Br J Sports Med. 2017 Oct;51(20):1483-1488. doi: 10.1136/bjsports-2016-096123. Epub 2016 Apr 29.

  PMID: 27130925 BACKGROUND

• Li Z, Krustrup P, Randers MB, Xu B, Yang W, Huang Z, Mao L. "11 for Health" in China - Effects on physical fitness in 9-11-year-old schoolchildren. Eur J Sport Sci. 2023 Dec;23(12):2291-2298. doi: 10.1080/17461391.2023.2227139. Epub 2023 Jul 1.

  PMID: 37338107 BACKGROUND

• Skoradal MB, Purkhus E, Steinholm H, Olsen MH, Orntoft C, Larsen MN, Dvorak J, Mohr M, Krustrup P. "FIFA 11 for Health" for Europe in the Faroe Islands: Effects on health markers and physical fitness in 10- to 12-year-old schoolchildren. Scand J Med Sci Sports. 2018 Aug;28 Suppl 1:8-17. doi: 10.1111/sms.13209. Epub 2018 Jun 8.

  PMID: 29882318 BACKGROUND

• Orntoft C, Fuller CW, Larsen MN, Bangsbo J, Dvorak J, Krustrup P. 'FIFA 11 for Health' for Europe. II: effect on health markers and physical fitness in Danish schoolchildren aged 10-12 years. Br J Sports Med. 2016 Nov;50(22):1394-1399. doi: 10.1136/bjsports-2016-096124. Epub 2016 Apr 29.

  PMID: 27130927 BACKGROUND

Related Links

• This website provides the detailed information of the "11 for Health" program implementation in Pakistan. The implementation process was recorded in the form of photos, videos, newsletters, etc.

MeSH Terms

Conditions

Motor Activity

Condition Hierarchy (Ancestors)

Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Ph.D. Candidate

Study Record Dates

• First Submitted: April 12, 2026
• First Posted: April 21, 2026
• Study Start: May 13, 2024
• Primary Completion: December 20, 2024
• Study Completion: December 20, 2024
• Last Updated: April 21, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, ICF
• Time Frame: Beginning 1 year after publication with no end date.

Locations

PA (1)