Implementation of the project “Health Steps – education and learning as a determinant of a healthy and open society” as an example of a holistic approach to a healthy lifestyle for children and young people

The unique project “Health Steps – education and learning as a determinant of a healthy and open society” was implemented as part of the “Social Responsibility of Science” programme funded by the Ministry of Education and Science. This innovative initiative was led by the Medical University of Silesia in Katowice (SUM), the Regional In-Service Teacher Training Centre “Metisˮ and the Iskierka Foundation. The project aimed to increase the responsibility of teachers and legal guardians of healthy children and to instil in each group the awareness that taking care of physical health, mental health, and proper nutrition significantly impacts the quality of life. The project identifies eight broad tasks to enhance knowledge, practical skills, and social competencies in three thematic areas: physioprophylaxis, diet prevention, as well as mental health and oncology prevention. As part of physio prophylaxis, educational films on correct posture were realised, preventive posture examinations were conducted among children, and training workshops on ergonomics and adopting correct body positions while learning and playing were held. During the stage related to diet prevention, screening tests for overweight and obesity were carried out, including anthropometric tests, i.e. measurement of body height, body weight and body composition analysis among children. Eating behaviour and attitudes towards nutrition among children and their parents were studied, and a dietary intervention combined with nutrition education was implemented. Workshops conducted for teachers on the educational method of drama and supervision were aimed at enhancing educators’ competence in using these methods in health education. Extending care to children and adolescents is justified because their lifestyle habits depend on the environment in which they are raised (parents, teachers, peers). Informed participation in such projects allows them to take conscious control of their health in collaboration with an interdisciplinary team of professionals.


A B S T R A C T
The unique project "Health Stepseducation and learning as a determinant of a healthy and open society" was implemented as part of the "Social Responsibility of Science" programme funded by the Ministry of Education and Science.This innovative initiative was led by the Medical University of Silesia in Katowice (SUM), the Regional In-Service Teacher Training Centre "Metisˮ and the Iskierka Foundation.The project aimed to increase the responsibility of teachers and legal guardians of healthy children and to instil in each group the awareness that taking care of physical health, mental health, and proper nutrition significantly impacts the quality of life.The project identifies eight broad tasks to enhance knowledge, practical skills, and social competencies in three thematic areas: physioprophylaxis, diet prevention, as well as mental health and oncology prevention.As part of physio prophylaxis, educational films on correct posture were realised, preventive posture examinations were conducted among children, and training workshops on ergonomics and adopting correct body positions while learning and playing were held.During the stage related to diet prevention, screening tests for overweight and obesity were carried out, including anthropometric tests, i.e. measurement of body height, body weight and body composition analysis among children.Eating behaviour and attitudes towards nutrition among children and their parents were studied, and a dietary intervention combined with nutrition education was implemented.Workshops conducted for teachers on the educational method of drama and supervision were aimed at enhancing educators' competence in using these methods in health education.Extending care to children and adolescents is justified because their lifestyle habits depend on the environment in which they are raised (parents, teachers, peers).Informed participation in such projects allows them to take conscious control of their health in collaboration with an interdisciplinary team of professionals.

K E Y W O R D S
education, ergonomics, postural defects, overweight and obesity, drama, physioprophylaxis, diet prevention

Fizjoprofilaktyka w zakresie wykrywania nieprawidłowości w obrębie postawy ciała
Fizjoprofilaktyka została wprowadzona jako nowa definicja w 2019 r. [6], obejmując zasięgiem populację zdrowych, zdrowych w grupie ryzyka czy wreszcie osoby chore na różnych etapach leczenia.Biorąc pod uwagę nieprawidłowości w obrębie postawy ciała, należy szczególnie zwrócić uwagę na zachowania ergonomiczne, poziom aktywności fizycznej i czas ekranowy.Edukacja w tym zakresie odbywa się poprzez zwiększanie świadomości dotyczącej przyjmowania prawidłowych pozycji siedzących, choć zostały one uznane za najbardziej szkodliwą pozycję ludzkiego ciała [7], a także ich modyfikacji w trakcie nauki i zabawy.Kolejnym ważnym tematem jest aktywność analysis among children.In addition, dietary behaviour and attitudes towards nutrition were studied among children and their parents and a dietary intervention combined with nutrition education was implemented.Workshops conducted for teachers on the educational method of drama and supervision were aimed at enhancing educators' competence in using these methods in health education.As part of the project, measures were taken to popularise medical and health sciences and to translate scientific knowledge into everyday life.This included increasing the responsibility of teachers and legal guardians of children for the health and protection of children and instilling in children and young people and their families the awareness that caring for mental health and good nutrition significantly impact quality of life.The project also aimed to educate young people about social equality and diversity equity and to improve their mental health.The results of these two-year activities will be presented at a scientific and training conference dedicated to various medical and health sciences specialists and primary school teachers.Increasing the visibility of such programmes was based on guides prepared by specialists on the topics discussed.The effectiveness of interdisciplinary programmes will be able to be assessed over the next few years.However, it can already be clearly emphasised that any initiative that creates health awareness in the broader sense is an added value.Projects such as the one described in this paper should become the basis for creating systemic solutions to the critical problems that passivity of movement and steadily increasing body weight in children and adolescents have become.

Physioprophylaxis for the detection of postural abnormalities
Physioprophylaxis was introduced as a new definition in 2019 [6], covering the healthy population, the healthy at-risk population or, last but not least, the sick population at different stages of treatment.Considering postural abnormalities, special attention should be paid to ergonomic behaviour, physical activity levels, and screen time.Education in this area is done by raising awareness of the importance of adopting correct sitting positions, although they have been recognised as the most harmful position of the human body [7], as well as their modifications during learning and play.Another critical topic is regular and systematic physical activity, according to the recommendations of the World Health Organization (WHO) [8].Such topics have been addressed in the project in the form of prepared scenarios, followed by seven videos, including three for children (How to sit healthily?physio-preventiverecommendations, Move as much as possible?it is easy to say!, Get moving!), three for teachers (How to take care of the fizyczna, regularna i systematyczna, zgodnie z zaleceniami Światowej Organizacji Zdrowia (Word Health Organization -WHO) [8].Temat został podjęty w projekcie pod postacią scenariuszy, a następnie siedmiu filmów, w tym trzech dla dzieci (Jak zdrowo siedzieć?zaleceniafizjoprofilaktyczne, Ruszaj się jak najwięcej?-łatwo powiedzieć!, Rusz się!), trzech dla nauczycieli (Jak zadbać o kręgosłup i sprawność fizyczną uczniów przed monitorem?, Jak zadbać o kręgosłup w trakcie nauki?, WF onlinezalecenia fizjoprofilaktyczne) oraz jednego dedykowanego rodzicom/prawnym opiekunom (Jak zadbać o kręgosłup i sprawność fizyczną mojego dziecka?; ryc.1).
by Wysocka et al.A quality of body posture in early school-aged children after a pandemic and selected lifestyle componentspreliminary report, which is part of this special issue.
In the final stage, a practical workshop on the topics discussed above was held for parents and legal guardians, consistent with this thematic block.
Employees of the Department of Physiotherapy, Faculty of Health Sciences in Katowice SUM carried out these physioprophylaxis-related steps.It was planned to test the quality of posture in 1,000 primary school pupils (children aged 7-9) from the Silesian metropolis and to educate their parents/legal guardians (approximately 400 adults) during 20 meetings.
The authors expect that the measures taken will be effective primarily in terms of reducing time spent in sedentary positions, inappropriate sitting positions, or electronic device use in favour of increasing leisure--time physical activity.

Diet prevention as a method of preventing overweight and obesity in adolescents
Diet prevention, including nutritional education at every stage of life, aims at shaping the motivation to adopt health-promoting behaviour, the ability to interpret and critically evaluate information from various sources, especially the media and advertising, healthy eating behaviours which promote healthy development, health and well-being, signals associated with the satisfaction of nutritional needs (feelings of hunger and satiety, thirst, weight loss, weight gain, gastrointestinal complaints), and the ability to respond to these signals in an age--appropriate manner, consumer skills (read labels, e.g."best before" date, energy value, nutrient content, food additives including colours, preservatives, thickeners, flavour enhancers and sweeteners), and good organisation of work during preparation, serving and consumption [9,10].Food education is a fundamental right of every child, guaranteed by the "Convention on the Rights of the Child".Its presence in daily life should be a permanent element to enable the acquisition of knowledge about themselves and the world around them [11].
In the section on dietoprophylaxis, the primary activity was to identify the prevalence of nutritional status abnormalities, particularly overweight and obesity among adolescents and the study of dietary behaviour and attitudes towards food among children and adolescents and their parents.This stage was carried out by the staff of the Department of Human Nutrition, Faculty of Public Health in Bytom SUM.
parents by describing in an educational folder the consequences of poor self-perception, eating disorders among adolescents and how to have a conversation with an adolescent about eating disorders [20,21,22].
In the diet prevention stage, a nutritional intervention was implemented, and a nutritional education programme was implemented.Participants were pupils selected in the previously described screening study, whose results indicated excessive body weight.
The criterion for diagnosing excessive body weight was determined using BMI centile grids -OLA and OLAF [23] and the percentage of body fat based on the recommendations of the body composition analyser manufacturer, taking into account the age and sex of the children studied [24].

Mental health and cancer preventiondrama workshop
In health education methodology, specialists strongly emphasise the need to use active methods as much more effective in health education [25].In the spirit of these recommendations, it was decided to use the method of drama as a distinctive, popular pedagogical method.It has its roots as a method in British school theatre, which became a way for drama pioneer B. Way as a way to bring it into the classroom and educational setting [26].The fundamental difference between theatre activities and drama is that there is no audience in drama.The acting out of fictional stories, improvisation and bodywork are used to experience and understand the experience in group relationship situations.The narrative and dramaturgical process of drama is integrated with its reflective dimension, as the educator leading the process at different points in the process can pause, cut the drama activities to reflect, analyse outside the role, then return and experience the benefits of drama in the safe fiction that is the foundation of drama [27].
The project developed four drama scenarios the trained teachers implemented in their schools with young people.The first scenario dealt with obesity prevention, sensitivity to the situation of people struggling with eating disorders and body acceptance.
The backbone of this drama was a diary of a teenage girl and her relationship problems with her own body under the influence of online influencers.The script was consulted with M. Bąk-Sosnowska, PhD, DSc, a specialist in the field of eating disorder therapy.
The second scenario was about education for a healthy spine.It was based on a true story shared for the project by the Polish artist Magda Kopaniszyn, who wore an orthopaedic corset throughout her childhood and adolescence.The third scenario dealt with mental health and the prevention of depression among young people.It was created in cooperation with the Iskierka Foundation, based on a book published by the foundation by a girl who is a ward of the foundation.This scenario opened up a new perspective in Polish pedagogy, focusing on cancer prevention among teenagers.
As part of the supervision, teachers implementing the scenarios mentioned above in schools could analyse their experiences of the activities carried out (Figures 7 and 8).
Another pedagogically important element of the project was the previously mentioned production of physioprophylaxis films.Pupils and teachers from the schools where the project was carried out were active co-creators of this task.As part of the filmmaking workshops led by professionals, the students and teachers, in collaboration with the physiotherapists, recorded seven educational films awaiting their premiere at an upcoming conference to summarise the entire project.Therefore, the young people's artistic and creative work, as an additional benefit of the project, has become a pedagogical tool for even deeper health promotion.

CO NC LU SI O N S
Education in line with the Action Research paradigm plays a vital role in preventing various diseases, including diseases of civilisation.It allows for conscious participation in changing habits or building new ones based on evidence-based knowledge and the experience of specialists.It seemed essential to the authors of the project to take care of a group of children and adolescents whose lifestyle habits depend on the environment in which they are raised (parents, teachers, peers), and conscious participation in such projects allows them to take conscious control of their health [28].It should be emphasised that this is one way of investing in the future of a healthy society.Ważnym pedagogicznie elementem projektu była również wspomniana wcześniej realizacja filmów z zakresu fizjoprofilaktyki.Aktywnymi współtwórcami tego zadania byli uczniowie i nauczyciele szkół, w których realizowano projekt.W ramach warsztatów filmowych prowadzonych przez profesjonalistów uczniowie i nauczyciele we współpracy z fizjoterapeutami nagrali siedem filmów edukacyjnych, które czekają na premierę podczas zbliżającej się konferencji, podsumowującej cały projekt.Zatem artystyczna i kreatywna praca młodzieży jako dodatkowa korzyść projektu stała się pedagogicznym narzędziem jeszcze głębszej promocji zdrowia.

Practical implications
Prevention projects in which interdisciplinary teams work together are essential in introducing appropriate behavioural patterns.In addition, the education of children and young people and their parents/legal guardians and teachers in the broader sense perpetuates newly established patterns and habits.
Providing nutritional education and consultation with a dietician contributes to a better knowledge of proper nutrition among young people.Workshops on preparing healthy meals help implement knowledge into everyday eating behaviour.The project "Health Steps" not only contributed to the popularisation of science and knowledge among project participants but also expanded the cooperation of SUM with primary school principals and created new ideas aimed at promoting a healthy lifestyle.
INT RO D UCT IO N The originator of the project "Health Stepseducation and learning as a determinant of a healthy and open society" (hereinafter "Health Steps") was Oskar Kowalski, MD, PhD, Professor of SUM -Vice-Rector for Post-Degree Studies and Promotion, who invited employees of the Department of Physiotherapy, the Department of Social Sciences and Humanities of the Faculty of Health Sciences in Katowice, and the Department of Dietetics of the Faculty of Public Health in Bytom will participate.The project was implemented with the cooperation of the Regional In-Service Teacher Training Centre "Metisˮ in Katowice and the Iskierka Foundation.At the same time, employees of the Department of Post-Degree Studies of the Medical University of Silesia in Katowice coordinated the entire project and administrative support.

Ryc. 2 .Fig. 2 .Ryc. 3 . 3 .
e. physical activity level, screen time and sedentary time.The pilot study results are presented in the article a b Strona tytułowa poradników z zakresu fizjoprofilaktyki nieprawidłowości w obrębie postawy ciała -poradnik dla uczniów (a) i dla nauczycieli (b).Title page of the physioprophylaxis of postural abnormalities -a guide for students (a) and teachers (b). a b Zalecenia fizjoprofilaktyczne zawarte w poradniku dla uczniów (a) i dla nauczycieli (b).Fig. Physioprophylactic recommendations in the guide for students (a) and teachers (b).
due standards for this study.In the study, body composition was assessed by bioelectrical impedance analysis (BIA), and the research instrument was a TANITA MC-780 S MA body composition analyser (Tanita Corporation, Tokyo, Japan).The equipment used in the study is approved for medical use and meets NAWI CLASS III standards for scales used in medical measurements.The analyser is EU-certified CE0122 and meets the requirements of the MDD 93/42/EEC medical devices directive.The parameters assessed during this study were body weight, height, age, body mass index (BMI), basal metabolism (BMR), total body water (TBW), mineralised bone mass, percentage body fat (FM), and muscle mass (MM).The study also analysed segmental body fat and muscle mass by body segment: right and left arm, right and left leg, and body.

Ryc. 4 . 4 .
surveyed and their willingness to participate in the educational programme.A lecture on proper nutrition and individual meetings with nutritionists was scheduled during the nutritional education.During these meetings, nutritional interventions were set, including the development of nutritional goals and working on changing the eating habits of children and the whole family.As part of the nutrition counselling provided by the dieticians, each child received a prepared workbook and individual nutrition education aimed at providing substantive support on proper nutrition.a b Zalecenia dietoprofilaktyczne zawarte w poradniku dla uczniów (a) i dla rodziców (b).Fig. Dietary prophylactic recommendations in the guide for students (a) and parents (b).

Fig. 5 .Ryc. 6 . 6 .
Examples of healthy lunch box suggestions used in nutrition education workshops.Przykładowe propozycje zdrowych lunch boxów do szkoły dla dzieci i młodzieży.Fig. Examples of healthy lunch box suggestions for school for children and young people.