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Longitudinal analysis of cardiovascular disease risk profile in neighbourhood poverty subgroups: 5-year results from an afterschool fitness programme in the USA
  1. Emily M D’Agostino1,
  2. Hersila H Patel1,
  3. Eric Hansen1,
  4. M Sunil Mathew2,
  5. Maria Nardi1,
  6. Sarah E Messiah2,3
  1. 1 Health and Fitness Division, Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, Florida, USA
  2. 2 Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
  3. 3 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Emily M D’Agostino, Health and Fitness Division, Miami-Dade Department of Parks, Recreation and Open Spaces, Miami, Florida 33128, USA; emily.dagostino{at}


Background The WHO calls for affordable population-based prevention strategies for reducing the global burden of cardiovascular disease (CVD) on morbidity and mortality; however, effective, sustainable and accessible community-based approaches for CVD prevention in at-risk youth have yet to be identified. We examined the effects of implementing a daily park-based afterschool fitness programme on youth CVD risk profiles over 5 years and across area poverty subgroups.

Methods The study included 2264 youth (mean age 9.4 years, 54% male, 50% Hispanic, 47% non-Hispanic black, 70% high/very high area poverty) in Miami, Florida, USA. We used three-level repeated measures mixed models to determine the longitudinal effects of programme participation on modifiable CVD outcomes (2010–2016).

Results Duration of programme participation was significantly associated with CVD risk profile improvements, including body mass index (BMI) z-score, diastolic/systolic blood pressure, skinfold thicknesses, waist–hip ratio, sit-ups, push-ups, Progressive Aerobic Cardiovascular Endurance Run (PACER) score, 400 m run time, probability of developing systolic/diastolic hypertension and overweight/obesity in high/very high poverty neighbourhoods (P<0.001). Diastolic blood pressure decreased 3.4 percentile points (95% CI −5.85 to −0.85), 8.1 percentile points (95% CI –11.98 to −4.26), 6.1 percentile points (95% CI −11.49 to −0.66), 7.6 percentile points (95% CI −15.33 to –0.15) and 11.4 percentile points (95% CI −25.32 to 2.61) for 1–5 years, respectively, in high/very high poverty areas. In contrast, significant improvements were found only for PACER score and waist–hip ratio in low/mid poverty areas.

Conclusion This analysis presents compelling evidence demonstrating that park-based afterschool programmes can successfully maintain or improve at-risk youth CVD profiles over multiple years.

  • cardiovascular disease
  • child health
  • physical activity
  • health inequalities
  • poverty

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  • Contributors For this manuscript, EMD designed and implemented the study, conducted the analysis and prepared all sections of the text. HHP prepared results for publication and reviewed all sections of the text. EH developed and supervised the data collection protocols. MSM developed data collection protocols and managed the dataset. MN reviewed all sections of the text. SEM supervised all aspects of the study design, implementation, analysis and manuscript preparation.

  • Competing interests None declared.

  • Ethics approval The study was approved by the University of Miami Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All of the individual participant data are stored deidentified in a database housed and managed at University of Miami Miller School of Medicine. Provisions for maintaining participant privacy include assigning all participants a unique identifier, no names or personal identifying information on data sheets (unique identifiers only) and uploading all participant data to a database according to their unique identifier (ie, personal identifying information is not uploaded to the database).