Testosterone effects on functional amygdala lateralization: A study in adolescent transgender boys and cisgender boys and girls

The influence of testosterone on the development of human brain lateralization has been subject of debate for a long time, partly because studies investigating this are necessarily mostly correlational. In the present study we used a quasi-experimental approach by assessing functional brain lateralization in trans boys (female sex assigned at birth, diagnosed with Gender Dysphoria, n = 21) before and after testosterone treatment, and compared these results to the functional lateralization of age-matched control groups of cisgender boys (n = 20) and girls (n = 21) around 16 years of age. The lateralization index of the amygdala was determined with functional magnetic resonance imaging (fMRI) during an emotional face matching task with angry and fearful faces, as the literature indicates that boys show more activation in the right amygdala than girls during the perception of emotional faces. As expected, the lateralization index in trans boys shifted towards the right amygdala after testosterone treatment, and the cumulative dose of testosterone treatment correlated significantly with amygdala lateralization after treatment. However, we did not find any significant group differences in lateralization and endogenous testosterone concentrations predicted rightward amygdala lateralization only in the cis boys, but not in cis girls or trans boys. These inconsistencies may be due to sex differences in sensitivity to testosterone or its metabolites, which would be a worthwhile course for future studies.

Exploring the Feasibility and Effectiveness of a Childcare PhysicaL ActivitY (PLAY) Policy: Rationale and Protocol for a Pilot, Cluster-Randomized Controlled Trial

Background: Young children are prone to low levels of physical activity in childcare. This environment, inclusive of equipment, policies, and staff, has been identified as influencing young children's activity behaviours. To date, no study has examined the feasibility and effectiveness of such policies in Canadian childcare centres, while the provision of physical activity policies in other countries has shown some promise for improving the activity levels of young children. As such, the primary objective of the Childcare PhysicaL ActivitY (PLAY) Policy study is to examine the feasibility of an evidence-based, stakeholder-informed, written physical activity and sedentary time policy for centre-based childcare (i.e., at the institutional level). The secondary objectives are to examine the impact of policy implementation on the physical activity levels and sedentary time of young children, subsequent environmental changes in childcare centres, and childcare providers' self-efficacy to implement a physical activity policy. This study will examine both policy implementation and individual (behavioural) outcomes. Methods/Design: The Childcare PLAY Policy study, a pilot, cluster-randomized controlled trial, involves the random allocation of childcare centres to either the experimental (n = 4) or control (n = 4) group. Childcare centres in the experimental group will adopt a written physical activity policy for eight weeks (at which time they will be asked to stop enforcing the policy). Physical activity levels and sedentary time in childcare will be assessed via ActiGraph™ accelerometers with measurements at baseline (i.e., week 0), mid-intervention (i.e., week 4), immediately post-intervention (i.e., week 9), and at six-month follow-up. Policy implementation and feasibility will be assessed using surveys and interviews with childcare staff. The Environment and Policy Assessment and Observation Self-Report tool will capture potential changes to the childcare setting. Finally, childcare providers' self-efficacy will be captured via a study-specific questionnaire. A nested evaluation of the impact of policy implementation on young children's physical activity levels will be completed. A linear mixed effects models will be used to assess intervention effects on the primary and secondary outcomes. Descriptive statistics and thematic analysis will be employed to assess the feasibility of policy implementation. Discussion: The Childcare PLAY Policy study aims to address the low levels of physical activity and high sedentary time observed in childcare centres by providing direction to childcare staff via a written set of evidence-informed standards to encourage young children's activity and reduce sedentary time. The findings of this work will highlight specific aspects of the policy that worked and will inform modifications that may be needed to enhance scalability. Policy-based approaches to increasing physical activity affordances in childcare may inform future regulations and programming within this environment.

Exploring the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education candidates

BACKGROUND

Early childhood educators greatly influence young children's physical activity and screen-viewing behaviours in childcare. However, educators have requested additional training in physical activity programming, and one logical place to provide this education is during their pre-service schooling. This study explored the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education (ECE) candidates across Canada, to determine their confidence and ability to facilitate physical activity opportunities and limit screen-viewing among young children in childcare.

METHODS

Key program personnel at 61 (of 110) Canadian colleges/universities offering an ECE program agreed to participate in this cross-sectional study. An online survey (112 items; 9 domains), developed by experts using the Tailored Design Method, was administered via Qualtrics© to a sample of 1292 ECE candidates. Descriptive statistics, Mann-Whitney U-tests, and chi-square tests were used to report participant demographics and physical activity and screen-viewing-related knowledge (i.e., of physical activity and screen-viewing concepts), training (i.e., physical activity and screen-viewing courses/content received), and self-efficacy (i.e., to facilitate physical activity and limit screen-viewing in childcare) of candidates.

RESULTS

ECE candidates exhibited the least amount of knowledge regarding the impact of screen-viewing on physiological outcomes (i.e., blood pressure) in young children. Further, only 32.2 and 26.7% of candidates reported completing physical activity or screen-viewing courses during their post-secondary training, respectively. Candidates who completed one or more physical activity or screen-viewing courses exhibited significantly greater (p <.05) self-efficacy than those without such training related to ensuring children were engaging in adequate moderate-to-vigorous physical activity (MVPA). Confidence to limit screen time did not differ. Candidates reporting meeting national physical activity recommendations (i.e., 150+ minutes of MVPA/week) exhibited significantly greater (p <.05) physical activity-related self-efficacy than those not meeting these guidelines.

CONCLUSIONS

Findings from this work highlight both the need for and the potential of supplementary physical activity and screen-viewing content in post-secondary ECE programs to benefit candidates' knowledge and self-efficacy in these areas. Introducing this content at the post-secondary level will ensure that all early childhood educators are appropriately trained regarding physical activity and screen-viewing before entering a childcare-based profession, where they can positively influence young children's health behaviours.

The Implementation and Feasibility of the Supporting Physical Activity in the Childcare Environment (SPACE) Intervention: A Process Evaluation

This study describes the process evaluation of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention, consisting of educator physical activity training, provision of portable play equipment, and a modified outdoor schedule (i.e., 4 × 30-minute periods). Educators ( N = 49) from 11 childcare centers in London, Ontario, Canada, delivered the 8-week intervention to 200 preschoolers ( M_age = 3.38 years). Workshop attendance was documented while adherence to the outdoor schedule and number and timing of outdoor sessions offered (i.e., dose) were recorded in a daily log. Questionnaire-based program evaluation ( n = 41) and in-person group interviews ( n = 7) were completed postintervention to assess educator perspectives on the barriers and facilitators to implementation (i.e., context), the feasibility and perceived effectiveness of the intervention, educator and preschooler enjoyment, communication among researchers and childcare personnel, and the future implementation of the intervention. Descriptive statistics were calculated, and responses to open-ended questions were inductively coded. Educator workshop attendance was 96%, and 88% of classrooms adhered to the four daily outdoor periods. Educators delivered 90% of the scheduled outdoor sessions, and 87% of these met the 30-minute criteria. Educators expressed that the increase in number of transitions made the outdoor playtimes challenging to implement, yet rated the feasibility of the training and equipment as high. Educators perceived the intervention to be both enjoyable and effective at increasing preschoolers' physical activity. They indicated effective communication and revealed that they intended to continue to use their physical activity knowledge and to offer the play equipment once the intervention had concluded. These findings demonstrate that the SPACE intervention is viable in center-based childcare.

Environmental Scan of Breastfeeding Resources in Canadian NICUs

We conducted an environmental scan using a mixed methods approach to determine the types and frequencies of breastfeeding resources available to mothers of infants in Canadian NICUs. Through interviews with key informants from 29 Level 3 NICUs, we identified six categories of resources: breastfeeding-friendly layout, breastfeeding support personnel, breastfeeding education for mothers, breast pump-related resources, coordination of postdischarge breastfeeding support, and breastfeeding-related policies. Findings from this national study indicate that a wide range of breastfeeding resources were reportedly available in Canadian Level 3 NICUs. NICU professionals are encouraged to connect with other units across Canada to facilitate the exchange of breastfeeding resources and best practices.

Preschoolers' health-related quality of life following the implementation of a childcare physical activity intervention

Being active offers many physical and emotional benefits contributing to a higher health-related quality of life (HRQoL); however, this relationship remains unexplored among preschoolers (aged 2.5-5 years). This study examined the impact of the Supporting Physical Activity in the Childcare Environment (SPACE), which was an intervention implemented using a cluster randomized controlled trial on preschoolers' HRQoL. Childcare centres were randomly allocated to the experimental (n = 11) or control (n = 11) conditions, and preschoolers' HRQoL was measured using the parent-report Pediatric Quality of Life Inventory 4.0 (3 subscales: physical, psychosocial, and total HRQoL) at baseline, post-intervention (i.e., week 8), and 6- and 12-month follow-up. A linear mixed-effects model was used to determine if preschoolers in the experimental condition displayed an increased HRQoL post-intervention and at follow-up compared with preschoolers in the control condition. Preschoolers (n = 234) with HRQoL data at baseline and one additional time-point were retained for analyses. Body mass index was not found to impact significantly on the intervention, and no statistically significant interaction effects were found for any of the 3 HRQoL variables. In conclusion, the SPACE intervention had no impact on preschoolers' HRQoL. Given the scarcity of research in this population, additional exploration is necessary to better understand the potential impact of physical activity participation on preschoolers' HRQoL.

Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers' physical activity levels and sedentary time: a single-blind cluster randomized controlled trial

BACKGROUND

Physical activity levels among preschoolers in childcare are low and sedentary time high. The Supporting Physical Activity in the Childcare Environment (SPACE) intervention had three components: 1. portable play equipment; 2. staff training; and, 3. modified outdoor playtime (i.e., shorter, more frequent periods). This study aimed to examine the effectiveness of the SPACE intervention on preschoolers' physical activity levels and sedentary time during childcare hours (compared to standard care).

METHODS

Via a single-blind cluster randomized controlled trial, 338 preschoolers (39.86 ± 7.33 months; 52% boys) from 22 centre-based childcare facilities (11 experimental, 11 control) were enrolled. Preschoolers wore an Actical™ accelerometer for 5 days during childcare hours at baseline, post-intervention, and 6- and 12-month follow-up, and were included in the analyses if they had a minimum of two valid days (5 h each day) at baseline and one additional time point. Intervention effectiveness was tested using a linear mixed effects model for each of the four outcome variables (i.e., sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and total physical activity [TPA]). Fixed effects were further evaluated with t-tests, for which degrees of freedom were estimated using a Satterthwaite approximation.

RESULTS

One hundred and ninety-five preschoolers were retained for analyses. The intervention did not significantly impact LPA. MVPA was significantly greater among children in the experimental group when comparing post-intervention to pre-intervention, t(318) = 3.50, p = .0005, but no intervention effects were evident at 6- or 12-month follow-up. TPA was significantly greater for children in the intervention group at post-intervention when compared to pre-intervention, t(321) = 2.70, p = .007, with no intervention effects evident at later time periods. Finally, sedentary time was significantly lower among preschoolers in the experimental group when comparing post-intervention to pre-intervention, t(322) = 2.63, p = .009, with no significant effects at follow-up.

CONCLUSIONS

The SPACE intervention was effective at increasing MVPA and TPA among preschoolers, while simultaneously decreasing sedentary time. The ability of the SPACE intervention to target higher intensity activity is promising, as MVPA levels have been documented to be low in centre-based childcare. The changes in physical activity were not sustained long term (6- or 12-month follow-up).

TRIAL REGISTRATION

ISRCTN70604107 (October 8, 2014).

The Physical Activity-Related Barriers and Facilitators Perceived by Men Living in Rural Communities

Men, especially those living in rural areas, experience chronic disease at higher rates than the general population. Physical activity is a well-established protective factor against many chronic diseases; however, only a small fraction of men are meeting national guidelines for physical activity. The purpose of this study was to examine the perceived physical activity-related barriers and facilitators experienced by men living in rural areas in Canada. Participants completed a paper-and-pencil or online survey and asked to select personally relevant physical activity-related barriers and facilitators from a list of 9 and 10 choices, respectively. A total of 149 men completed the survey (50.3% between the ages of 18 and 55 years; 43.0% older than 55 years). Participants were predominantly from rural areas and smaller communities. Overall, the response options "I'm too tired," "I don't have enough time," and "I think I get enough exercise as work" were the three most frequently cited barriers to regular physical activity. The response options "Personal motivation to be healthy," "I enjoy it," and "Support from family and/or friends" were the three most often cited facilitators to physical activity. Results are similar to those shown in other populations. Results can be used to inform the development of policies and programs that aim to increase the physical activity levels of men living in rural areas and small communities.

Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis

To conduct a systematic review and meta-analysis on the effects of electrical stimulation therapy (EST) on healing pressure ulcers in individuals with spinal cord injury (SCI). CINAHL, The Cochrane Library, PubMed, SCOPUS, EMBASE, Nursing & Allied Health and Dissertation & Theses databases were searched for relevant English language articles from the date of inception to 31 January 2014. Separate searches were conducted in Google Scholar and academic journals specialised in wound care. Two reviewers independently assessed study eligibility. Studies were included if EST was used to treat pressure ulcers in individuals with SCI. A total of 599 articles were screened, and 15 studies met the inclusion criteria. A meta-analysis with five studies demonstrated that EST significantly decreased the ulcer size by 1·32%/day [95% confidence interval (CI): 0·58-2·05, P < 0·001] compared to standard wound care (SWC) or sham EST. Another meta-analysis conducted with four studies showed that EST increased the risk of wound healing by 1·55 times compared with standard wound care or sham EST (95% CI: 1·12 to 2·15, P < 0·0001). Because of the wide array of outcome measures across studies, a single meta-analysis could not be conducted. EST appears to be an effective adjunctive therapy to accelerate and increase pressure ulcer closure in individuals with SCI.

Comparing physical activity and sedentary time among overweight and nonoverweight preschoolers enrolled in early learning programs: a cross-sectional study

Establishing appropriate physical activity and sedentary behaviours during early childhood is important to ensure children accrue the many associated health benefits. While physical activity levels have been reported as low within early learning programs, little research has explored the physical activity and sedentary time of Canadian preschoolers classified as overweight within these facilities. The purpose of this study was to compare objectively measured physical activity and sedentary time among preschoolers classified as overweight and nonoverweight in early learning programs. Direct assessment of physical activity and sedentary time of 216 preschool-aged children was collected via Actical accelerometers during early learning hours, while body mass index percentile was calculated based on preschoolers’ objectively measured height and weight. Results of three 3-way ANOVAs suggest that rates of moderate to vigorous physical activity, total physical activity, and sedentary time (p > 0.05) did not significantly differ based on weight status, sex, and type of early learning facility. This study is one of few that has examined differences in overweight and nonoverweight preschoolers’ sedentary time, and adds to the limited research exploring physical activity levels among overweight and nonoverweight preschoolers during early learning hours. Given the high rates of sedentary time reported, programming within early learning facilities is necessary to support preschoolers, regardless of weight status, to achieve increased physical activity levels and decreased sedentary time.

Member Diversity and Cohesion and Performance in Walking Groups

The purpose of the study was to examine the relationship of group member diversity in task-related attributes (i.e., self-efficacy, level of previous physical activity, and personal goals) and task-unrelated attributes (i.e., ethnicity and gender) to task cohesiveness and task performance in walking groups ( N varied from 1,324 to 1,392 groups for the analyses). For the task-related attributes, diversity in level of previous physical activity was significantly related to both task cohesion and group performance—as diversity increased, cohesion and performance decreased. For the task-unrelated attributes, diversity in gender was related to task cohesion—as diversity increased, cohesion decreased. Gender diversity was unrelated to group performance. The results are discussed in terms of their implications for the dynamics of task-oriented groups.

Cohesion as Shared Beliefs in Exercise Classes

The purpose of the study was to determine if perceptions of cohesion in exercise classes demonstrated sufficiently high consensus and between-group variance to support a conclusion that exercise classes are groups. Participants (N = 1,700) in 130classes were tested on either the Group Environment Questionnaire (GEQ) or the Physical Activity Group Environment Questionnaire (PAGEQ). Results showed that exercise classes satisfied the statistical criteria necessary to support a conclusion that they are true groups; that is, they exhibited acceptable levels of consensus about cohesion within classes and acceptable differences in cohesion between classes. In addition, index-of-agreement values were significantly greater for participants completing the PAGEQ than for participants completing the GEQ. Finally, consensus was greatest when participants evaluated how the exercise class satisfied their own personal task needs (i.e., individual attractions to the group-task), and second greatest when participants evaluated the collective unity around the task objectives (i.e., group integration-task).

Barriers to Recruiting Men Into Chronic Disease Prevention and Management Programs in Rural Areas

Chronic disease is becoming increasingly prevalent in Canada. Many of these diseases could be prevented by adoption of healthy lifestyle habits including physical activity and healthy eating. Men, especially those in rural areas, are disproportionately affected by chronic disease. However, men are often underrepresented in community-based chronic disease prevention and management (CDPM) programs, including those that focus on physical activity and/or healthy eating. The purpose of this study was to explore the experiences and perceptions of program delivery staff regarding the challenges in recruitment and participation of men in physical activity and healthy eating programs in rural communities, and suggestions for improvement. Semistructured interviews were conducted by telephone with 10 CDPM program delivery staff from rural communities in Southwest Ontario, Canada. Time and travel constraints, relying on spouses, and lack of male program leaders were cited as barriers that contributed to low participation levels by men in CDPM programs. Hiring qualified male instructors and engaging spouses were offered as strategies to increase men’s participation. The results of this study highlight many of the current issues faced by rural health organizations when offering CDPM programming to men. Health care organizations and program delivery staff can use the recommendations in this report to improve male participation levels.

Supporting Physical Activity in the Childcare Environment (SPACE): rationale and study protocol for a cluster randomized controlled trial

BACKGROUND

Young children are prone to low levels of physical activity in childcare. Researchers have identified that preschoolers tend to be more active outdoors than indoors, with higher activity levels occurring during the first 10 minutes of outdoor playtime. Additionally, interventions incorporating either staff training or the inclusion of play equipment have been effective at increasing children's activity in this setting. As such, the overarching objective of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention is to improve the physical activity levels of preschoolers during childcare hours, utilizing a combination of the above components. The purpose of this manuscript is to provide a detailed account of the protocol, innovative methods, and evaluation plans used in the implementation of the SPACE study; in an effort to support the development of further research in this field.

METHODS/DESIGN

The SPACE study, a cluster randomized controlled trial, involves 22 childcare centres randomly allocated to either the experimental (n = 11) or the control (n = 11) group. Childcare centres receiving the intervention will adopt an 8-week physical activity intervention with the following components: 1. shorter, more frequent bouts of outdoor playtime (4 × 30 min periods rather than 2 × 60 min periods); 2. new portable play equipment (e.g., obstacle course, balls); and, 3. staff training (1 × 4 hr workshop). Actical accelerometers will be used to assess total physical activity with measurements taken at baseline (i.e., week 0), immediately post-intervention (i.e., week 8), and at 6- and 12-month follow-up. As secondary objectives, we aim to evaluate the effectiveness of the intervention on preschoolers': a) sedentary time; b) standardized body mass index scores (percentiles); c) health-related quality of life; and childcare providers' physical activity-related knowledge and self-efficacy to implement physical activity.

DISCUSSION

The SPACE study aims to increase the low levels of physical activity observed within childcare centres. The findings of this work may be useful to policy makers and childcare providers to consider modifications to the current childcare curriculum and associated outdoor play time.

TRIAL REGISTRATION

ISRCTN70604107 (October 8, 2014).

Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review

Background

Participation in group-based physical activity (GBPA) interventions has been found to result in higher levels of exercise adherence and program compliance. However, previous reviews of GBPA programs have provided limited insight regarding ‘for whom’, ‘under what conditions’, and ‘how’ these interventions increase physical activity behavior.

Methods

A realist review was conducted by following the seven recommended iterative and overlapping steps (J Health Serv Res Policy 10S1:21-34, 2005). The review was limited to group dynamics-based interventions for adults (>17 years of age). The search was conducted in PubMed, PsychInfo, and Web of Science search engines associated with the Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, and MEDLINE.

Results

Using a realist review approach, data from 52 studies were synthesized. Of those, 92 % (n = 48) reported significant increases in participant physical activity. The synthesis resulted in three main observations and recommendations.

Discussion

GBPA interventions have worked for a variety of populations, including those who are hard to reach; however, more research is needed on moderating factors to determine for whom different GBPA programs may be effective. Second, previous interventions have varied in the duration, frequency, and number of group-based strategies used, and comparative effectiveness research may be necessary to isolate the mechanisms of effect. Third, these interventions have been conducted in a diverse range of settings, using a variety of research designs and analytical approaches. Less information is known about the costs or sustainability of these programs in their intended settings.

Conclusion

The results of this realist review have important implications for practice, refining trial designs, and replication across diverse populations and settings.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2270-8) contains supplementary material, which is available to authorized users.

Environmental Influences on Preschoolers' Physical Activity Levels in Various Early-Learning Facilities

PURPOSE

This study aimed to: (a) compare the physical activity (PA) levels (i.e., moderate-to-vigorous PA [MVPA] and total PA [TPA]) of preschoolers in 3 different early-learning environments (center-based childcare, home-based childcare, and full-day kindergarten [FDK]); and (b) assess which characteristics (e.g., play equipment, policies, etc.) of these settings influenced preschoolers' PA.

METHOD

Twenty-seven facilities (9 centers, 10 homes, and 8 FDK) participated in this study. Participants (aged 2.5-5 years; n = 297) were fitted with Actical™ accelerometers for 5 consecutive days during childcare/school hours to assess their PA. The Environment and Policy Assessment and Observation (EPAO) tool was used to objectively examine the PA environment of all participating facilities. Finally, demographic questionnaires were administered to preschoolers' parents/guardians.

RESULTS

Preschoolers in FDK accumulated significantly more MVPA (p < .05; 3.33 min/hr) than those in center- (1.58 min/hr) and home-based (1.75 min/hr) childcare, and they accumulated significantly more TPA (p < .05; 20.31 min/hr) than those in center-based childcare (18.36 min/hr). For FDK, the Active Opportunities, Sedentary Opportunities, Sedentary Environment, and Fixed Play Environment subscales of the EPAO significantly impacted both MVPA and TPA. For center-based childcare, only the Sedentary Environment subscale was found to impact MVPA and TPA. No subscales influenced children's MVPA or TPA in home-based childcare.

CONCLUSIONS

This research underscores the need to encourage/support preschoolers' active behaviors in early-learning settings, particularly for those in center- and home-based childcare. Furthermore, this article highlights environmental and staff characteristics on which future PA programming should focus.

Engaging Men in Chronic Disease Prevention and Management Programs: A Scoping Review

Chronic disease has become one of the largest health burdens facing the developed world. Men are at a higher risk of being diagnosed with chronic disease than women. Although lifestyle interventions have been shown to reduce the risk of chronic disease in participants, men are often underrepresented in such programs. The purpose of this study was to explore the individual-level and program-specific factors that affect male participation rates in chronic disease prevention and management (CDPM) programs. A scoping review methodology was selected, and 25 studies met the criteria for inclusion in the review. Results showed that traditional group-based programs that focused on topics such as nutrition and physical activity were often seen by men as inherently feminine, which served as a barrier for participation. Program-specific factors that attracted men to participate in interventions included a group component with like-minded men, the use of humor in the delivery of health information, the inclusion of both nutrition and physical activity components, and the presence of some manner of competition. A past negative health event, personal concern for health status, and motivation to improve physical appearance were cited by men as facilitators to CDPM program participation. Gaps in the research are identified, and results of this study can be used to inform the development of CDPM programs that will improve the engagement and participation of men.

Using the RE-AIM framework to evaluate a community-based summer camp for children with obesity: a prospective feasibility study

Background

Increasing rates of childhood overweight and obesity highlight a need for the evaluation of lifestyle interventions. The purpose of the study was to determine the Reach, Effectiveness, Adoption, Implementation and Maintenance of a novel family-focused program targeting children with obesity (i.e., the Children’s Health and Activity Modification Program [C.H.A.M.P.]) using the RE-AIM framework, an evaluation tool for community-based health interventions.

Methods

A single-centre, single cohort interventional feasibility study was conducted over the course of two years. Children with obesity and their families completed a 4-week group-based lifestyle intervention in Year 1 (n = 15; M_age = 10.6; 53% female) and/or Year 2 (n = 25; M_age = 10.6; 56% female). Outcome variables were measured pre- and post-intervention, as well as 6- and 12-months following completion of the formal program.

Results

Overall, C.H.A.M.P. had high reach in terms of participant representativeness. In addition, participation in the program was associated with significantly improved standardized body mass index (BMI-z), body fat percentage, lean mass percentage, and child- and parent-proxy reported quality of life (QOL; effectiveness/individual maintenance). Furthermore, a number of community partnerships were built, strengthened, and maintained prior to, during, and following implementation of the two-year program (adoption/setting maintenance, respectively). Finally, the intervention was delivered as intended as evidenced by high adherence to the schedule, attendance rates, and cost effectiveness (implementation).

Conclusions

Based on RE-AIM metrics, C.H.A.M.P. appears to be a promising childhood obesity program. The findings reported will inform researchers and practitioners on how to design and implement future community-based programs addressing pediatric obesity.

Trial registration

ISRCTN Registry, Study ID ISRCTN13143236. Registered 27 March 2015.

The influence of centre-based childcare on preschoolers' physical activity levels: a cross-sectional study

The childcare environment represents an appropriate avenue to support physical activity among preschoolers. The aim of this study was two-fold: (1) to measure the physical activity levels of a sample of preschoolers during childcare hours; and (2) to assess which attributes (e.g., space, equipment, policies) within centre-based childcare environments influenced physical activity. Thirty-one preschoolers from 5 childcare centres across London, Canada participated. Actical accelerometers were worn by participants for one day during childcare hours to assess activity levels using a 15 second epoch length. The Environment and Policy Assessment and Observation instrument was used to conduct a full-day evaluation of the childcare environment. On average, participants engaged in 1.54 min/h of moderate-to-vigorous physical activity and 17.42 min/h of total physical activity. Sedentary opportunities, portable and fixed play equipment, and staff behaviour accounted for 49.3% of the variability in moderate-to-vigorous physical activity and 14.1% of the variability in total physical activity, with sedentary opportunities, fixed play equipment, and staff behaviours displaying an inverse relationship. Results emphasize the critical role the childcare environment plays in supporting physical activity among preschoolers.

Learning Environments' Activity Potential for Preschoolers (LEAPP): Study Rationale and Design

BACKGROUND

The purpose of this paper is to provide an overview of the study protocol for the Learning Environments' Activity Potential for Preschoolers (LEAPP) study, the goal of which is to describe the activity levels of preschoolers attending various early learning venues and explore which attributes of these facilities (e.g. curriculum, policies, equipment, etc.) support activity participation.

DESIGN AND METHODS

This cross-sectional study aimed to recruit approximately 30 early learning environments requesting participation from preschoolers aged 2.5-5 years. Data collection included: Actical accelerometers (MiniMitter, Oregon, USA) to measure the activity levels of children for five consecutive days (15-second epoch length) while in care; the Environment and Policy Assessment and Observation tool to explore the early learning environment's impact on activity; anthropometric data; the Child Temperament Questionnaire to assess the influence of preschoolers' temperament on physical activity; and demographic information from parents/guardians and early learning staff. ANOVA and linear regression analyses will be conducted to assess variances in activity levels among preschoolers attending different early learning types and to explore the impact of early learning environments on their activity levels. Independent sample t-tests will be used to examine differences in activity levels based on sex and weight status.

EXPECTED IMPACT OF THE STUDY FOR PUBLIC HEALTH

This research will provide the first Canadian data to address environmental influences on preschoolers' activity levels in differing early learning environments. Additionally, this work will highlight the extent to which activity levels vary among preschoolers enrolled in full-day kindergarten, centre-, and home-based childcare. Significance for public healthThis study represents the first examination of the differences in physical activity levels among preschoolers attending various early learning environments. As such, it is important that the methodology undertaken be shared in the event that other researchers doing comparable work want to adopt a similar approach. Results of this research may inform the work of health promotion, public health, and early learning stakeholders. Specifically this work may impact early learning curricula, policies, and practices in service of helping Canada's preschool cohort become sufficiently physically active.

Effectiveness of physical activity interventions for preschoolers: a meta-analysis

PURPOSE

The purpose of the meta-analysis was to examine the effectiveness of physical activity interventions on physical activity participation among preschoolers. A secondary purpose was to investigate the influence of several possible moderator variables (e.g., intervention length, location, leadership, type) on moderate-to-vigorous physical activity (MVPA).

METHOD

Nine databases were systematically searched for physical activity interventions. Studies were included if they contained statistics necessary to compute an effect size (ES), were written in or translated into English, examined physical activity in preschoolers, incorporated a physical activity intervention, and targeted preschool-aged children. Fifteen studies satisfied these criteria. ESs were calculated using a random-effects model.

RESULTS

Results indicated that overall, interventions had a small-to-moderate effect on general physical activity (Hedges g = 0.44, p < .05, n = 73 ESs) and a moderate effect on MVPA (Hedges g = 0.51, p < .05, n = 39 ESs). The greatest effects for MVPA were identified for interventions that were less than 4 weeks in duration, were offered in an early-learning environment, were led by teachers, involved outdoor activity, and incorporated unstructured activity.

CONCLUSIONS

This meta-analysis provides an overview and synthesis of physical activity interventions and highlights effective strategies for future interventions aimed at increasing physical activity levels among preschoolers.

Generalizing the findings from group dynamics-based physical activity research to practice settings: what do we know?

The general purpose of this secondary analysis of a prior systematic review was to determine the degree to which group dynamics-based physical activity interventions align with research processes and outcomes that are more likely to facilitate the translation of research into practice. To accomplish this, a systematic search was conducted within Science Citation Index Expanded, Social Sciences Citation Index, Arts and Humanities Citation Index, and MEDLINE databases to identify articles published prior to 2010 that used at least one group dynamics-based strategy (e.g., group interaction, group goal setting) in physical activity promotion. These 17 intervention studies were identified and coded based on the reach, effectiveness, adoption, implementation, maintenance framework and Pragmatic-Explanatory Continuum Indicator Summary (for trial design characteristics). Reporting was infrequent for external validity factors (i.e., representativeness, adoption, cost, maintenance) but more frequent for internal validity factors (e.g., inclusion criteria). Intervention costs were not reported. Studies were more likely to be pragmatic (i.e., designed to determine the effects of an intervention under the usual conditions in which it will be applied) in areas of participant compliance and practitioner adherence and explanatory (i.e., designed to determine the effects of an intervention under ideal conditions) and in areas of practitioner expertise and flexibility of intervention protocol. While a number of these interventions were tested in more pragmatic settings, external validity factors were still underreported.

Parental perspectives of a 4-week family-based lifestyle intervention for children with obesity

OBJECTIVES

The childhood obesity epidemic is now recognized as one of the most serious public health challenges of the 21st century. Community-based behaviour modification treatment programs involving both children and their families are warranted. The purpose of this study was to explore the experiences of parents whose children participated in the Children's Health and Activity Modification Program (C.H.A.M.P.): a 4-week lifestyle program delivered as a day-camp for obese children at risk for type II diabetes and their families. Parents were required to attend four half-day education sessions during the intervention period.

METHODS

Seven focus groups were conducted immediately following the 4-week interventions offered in August 2008 and 2009. The perspectives of 38 parents representing 32 children aged 8-14 with obesity (i.e., body mass index > the 95th percentile) were shared.

RESULTS

Overall, parents were pleased with the impact of the program and proud of their children's accomplishments (e.g., increased physical activity levels, enhanced self-esteem, weight loss). Several facilitators to success (e.g., social support; a positive environment) and barriers to its maintenance (e.g., time management; unsupportive family members) were identified, and recommendations were made for future programs. Although parents found the half-day sessions valuable, post-programmatic bi-monthly booster session adherence declined over the one-year follow-up period.

CONCLUSION

Delivered as a 4-week day-camp, C.H.A.M.P. represents a unique approach to the treatment of childhood obesity. Future family-based interventions should consider avenues for intensifying the parental program component whilst employing strategies to promote parental adherence in service of enhancing long-term sustainability of health behaviour changes.

The Children's Health and Activity Modification Program (C.H.A.M.P.): participants' perspectives of a four-week lifestyle intervention for children with obesity

To date, there is a paucity of qualitative research examining the influence of community-based interventions for childhood obesity on the participants themselves. This study explored the experiences of children who participated in the Children's Health and Activity Modification Program (C.H.A.M.P.), a four-week day camp for children with obesity aged 8-14, in order to uncover key program elements for positive behavior change. Following the intervention, children (n = 36) participated in focus groups where they were asked about their experiences pertaining to physical activity and nutrition, what it was like to be part of a team, and how they felt about themselves. Findings revealed that participants perceived C.H.A.M.P. as helpful (e.g. in making healthier food choices, being more active, and feeling more confident and self-aware). This pilot study offers unique insights into the perspectives of children with obesity. Results are discussed with respect to future program development and research for childhood obesity treatment.