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

"11 for Health" in Pakistan - Effects of a School-Based Football Intervention Programme on Cardiorespiratory Health, Physical Fitness, Health Knowledge and Well-being of 8-14-year-old Schoolchildren

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.

In developing countries like Pakistan, limited funding, infrastructure, and policy support pose challenges for promoting structured physical activity among school-aged children. These gaps result in low physical activity levels, with consequences extending beyond individual health to national healthcare systems and societal well-being.

Despite growing interest in improving physical education in Pakistan, current initiatives remain fragmented and under-researched. Introducing a structured, football-based physical and health education model such as "11 for Health" into this context offers an opportunity to test a scalable and contextually relevant approach.

The "11 for Health" programme is designed to deliver health education through physical activity using football drills and small-sided games. The intervention comprises 90 minutes of football-related activities per week, integrated with the delivery of ten health messages addressing communicable and non-communicable diseases (NCDs). Each health message is thematically linked to a specific football skill (Fuller et al. 2017). Since its in inception in South Africa in 2009, the "11 for Health" programme has been implemented across multiple regions, including Africa, South America, Oceania, Europe, and Southeast Asia, and a growing body of literature has analysed its effects on physical fitness, health knowledge, well-being, and cognitive outcomes. Its documented effectiveness in a range of international settings suggests potential for positive impact in Pakistan as well.

This study examined the "11 for Health" programme within the public school system and evaluated its effects on multiple aspects of health and well-being. These findings could help determine the programme's adaptability, thereby contributing critical insights into sustainable strategies for promoting health and physical fitness among Pakistani schoolchildren.

Inclusion Criteria:

• 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

Exclusion Criteria:

• 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.