Correlates of physical activity in children and adolescents with physical disabilities: A systematic review

BACKGROUND

The benefits of physical activity (PA) for children with disabilities are well documented, and children with physical disabilities (PD) are often less active than peers with other disability types. Various correlates associated with PA in children with PD have been identified in separate studies, and a thorough analysis of these correlates could aid in understanding and designing interventions that promote children with PD to be more physically active. The purpose of this systematic review was to provide a comprehensive summary of the correlates of PA in children with PD.

METHOD

A systematic search using PubMed, CINAHL, Cochrane Library, PsychINFO, Eric, and EMbase was initiated in October 2014 to identify studies examining the correlates of PA in children with PD aged 6-18years. Two researchers independently screened studies, assessed their methodological quality, and extracted relevant data. The correlates were synthesized and further assessed semi-quantitatively.

RESULTS

A total of 45 articles were included in the detailed review. Several modifiable physical, psychological, and environmental correlates were consistently and positively associated with PA in children with PD. Some non-modifiable correlates (e.g., intellectual ability, parents' ethnicity) were found to be consistently and negatively associated with PA.

CONCLUSIONS

The correlates of PA in children with PD are multifaceted and along many dimensions. This review can have implications for future studies and these may confirm the consistency of variables related to PA. Insights derived from the outcomes may also foster the measurement of the magnitude of associations that could assist the development of future interventions.

Public Parks in Hong Kong: Characteristics of Physical Activity Areas and Their Users

Public parks, salient locations for engaging populations in health promoting physical activity, are especially important in high-density cities. We used the System for Observing Physical Activity in Communities (SOPARC) to conduct the first-ever surveillance study of nine public parks in Hong Kong (288 observation sessions during 36 weekdays and 36 weekend days) and observed 28,585 visitors in 262 diverse areas/facilities. Parks were widely used throughout the day on weekdays and weekend days and across summer and autumn; visitor rates were among the highest seen in 24 SOPARC studies. In contrast to other studies where teens and children dominated park use, most visitors (71%) were adults and seniors. More males (61%) than females used the parks, and they dominated areas designed for sports. Over 60% of visitors were observed engaging in moderate-to-vigorous physical activity, a rate higher than other SOPARC studies. Facilities with user fees were less accessible than non-fee areas, but they provided relatively more supervised and organized activities. Assessing parks by age, gender, and physical activity can provide useful information relative to population health. This study not only provides information useful to local administrators for planning and programming park facilities relative to physical activity, but it also provides a baseline for comparison by other high-density cities.

Park characteristics, use, and physical activity: A review of studies using SOPARC (System for Observing Play and Recreation in Communities)

The System for Observing Play and Recreation in Communities (SOPARC) can obtain information on park users and their physical activity using momentary time sampling. We conducted a literature review of studies using the SOPARC tool to describe the observational methods of each study, and to extract public park use overall and by demographics and physical activity levels. We searched PubMed, Embase, and SPORTDiscus for full-length observational studies published in English in peer-reviewed journals through 2014. Twenty-four studies from 34 articles were included. The number of parks observed per study ranged from 3 to 50. Most studies observed parks during one season. The number of days parks were observed ranged from 1 to 16, with 16 studies observing 5 or more days. All studies included at least one weekday and all but two included at least one weekend day. Parks were observed from 1 to 14times/day, with most studies observing at least 4 times/day. All studies included both morning and afternoon observations, with one exception. There was a wide range of park users (mean 1.0 to 152.6 people/park/observation period), with typically more males than females visiting parks and older adults less than other age groups. Park user physical activity levels varied greatly across studies, with youths generally more active than adults and younger children more active than adolescents. SOPARC was adapted to numerous settings and these review results can be used to improve future studies using the tool, demonstrate ways to compare park data, and inform park promotions and programming.

Using systematic observations to understand conditions that promote inter-racial experiences in neighbourhood parks

We analysed observations from 31 neighbourhood parks, with each park mapped into smaller target areas for study, across five US cities generated using the System for Observing Play and Recreation in the Community (SOPARC). In areas where at least two people were observed, less than one-third (31.6%) were populated with at least one white and one non-white person. Park areas that were supervised, had one or more people engaged in vigorous activity, had at least one male and one female present, and had one or more teens present were significantly more likely to involve interracial groups (p<0.01 for each association). Observations in parks located in interracial neighbourhoods were also more likely to involve interracial groups (p<0.05). Neighbourhood poverty rate had a significant and negative relationship with the presence of interracial groups, particularly in neighbourhoods that are predominantly non-white. Additional research is needed to confirm the impact of these interactions. Urban planning and public health practitioners should consider the health benefits of interracial contact in the design and programming of neighbourhood parks.

Longitudinal Analysis of Adolescent Girls' Activity Patterns: Understanding the Influence of the Transition to Licensure

The proportion of teens and young adults with driver's licenses has declined sharply in many industrialized countries including the United States. Explanations for this decline have ranged from the introduction of graduated driver licensing programs to the increase in online social interaction. We used a longitudinal cohort study of teenage girls in San Diego and Minneapolis to evaluate factors associated with licensure and whether teens' travel patterns become more independent as they aged. We found that licensure depended not only on age, but on race and ethnicity as well as variables that correlate with household income. Results also showed evidence that teen travel became more independent as teen's age, and that acquiring a license is an important part of this increased independence. However, we found limited evidence that teen's travel-activity patterns changed as a result of acquiring a driver's license. Rather, teen independence resulted in less parental chauffeuring, but little shift in travel patterns. For the larger debate on declining Millennial mobility, our results suggest the need for more nuanced attention to variation across demographic groups and consideration of the equity implications if declines in travel and licensure are concentrated in low-income and minority populations.

The Paradox of Parks in Low-Income Areas: Park Use and Perceived Threats

Concerns about safety and perceived threats have been considered responsible for lower use of parks in high poverty neighborhoods. To quantify the role of perceived threats on park use we systematically observed 48 parks and surveyed park users and household residents in low-income neighborhoods in the City of Los Angeles. Across all parks, the majority of both park users and local residents perceive parks as safe or very safe. We noted apparently homeless individuals during nearly half of all observations, but very few instances of fighting, intimidating groups, smoking and intoxication. The presence of homeless individuals was associated with higher numbers of park users, while the presence of intoxicated persons was associated with lower numbers. Overall the strongest predictors of increased park use were the presence of organized and supervised activities. Therefore, to increase park use, focusing resources on programming may be more fruitful than targeting perceived threats.

Influence of the built environment on pedestrian route choices of adolescent girls

We examined the influence of the built environment on pedestrian route selection among adolescent girls. Portable global positioning system units, accelerometers, and travel diaries were used to identify the origin, destination, and walking routes of girls in San Diego, CA and Minneapolis, MN. We completed an inventory of the built environment on every street segment to measure the characteristics of routes taken and not taken. Route-level variables covering four key conceptual built environment domains (Aesthetics, Destinations, Functionality, and Safety) were used in the analysis of route choice. Shorter distance had the strongest positive association with route choice, while the presence of a greenway or trail, higher safety, presence of sidewalks, and availability of destinations along a route were also consistently positively associated with route choice at both sites. The results suggest that it may be possible to encourage pedestrians to walk farther by providing high quality and stimulating routes.

Physical activity and food environment assessments: implications for practice

There is growing interest in the use of physical activity and nutrition environmental measures by both researchers and practitioners. Built environment assessment methods and tools range from simple to complex and encompass perceived, observed, and geographic data collection. Even though challenges in tool selection and use may exist for non-researchers, there are opportunities to incorporate these measures into practice. The aims of this paper are to (1) describe examples of built environment assessment methods and tools in the practice context; (2) present case studies that outline successful approaches for the use of built environment assessment tools and data among practitioners; and (3) make recommendations for both research and practice. As part of the Built Environment Assessment Training Think Tank meeting in July 2013, experts who work with community partners gathered to provide input on conceptualizing recommendations for collecting and analyzing built environment data in practice and research. The methods were summarized in terms of perceived environment measures, observational measures, and geographic measures for physical activity and food environment assessment. Challenges are outlined and case study examples of successful use of assessments in practice are described. Built environment assessment tools and measures are important outside the research setting. There is a need for improved collaboration between research and practice in forming partnerships for developing tools, collecting and analyzing data, and using the results to work toward positive environmental changes.

The potential for pocket parks to increase physical activity

PURPOSE

To assess the use of new pocket parks in low-income neighborhoods.

DESIGN

The design of the study was a quasi-experimental post-test only comparison.

SETTING

Los Angeles, California, was the setting for the study.

SUBJECTS

Subjects were park users and residents living within .5 mile of three pocket parks and 15 neighborhood parks.

INTERVENTION

The creation of pocket parks.

MEASURES

We used the System of Observing Play and Recreation in Communities (SOPARC) tool to measure park use and park-based physical activity, and then surveyed park users and residents about their park use.

ANALYSIS

We surveyed 392 and 432 household members within .5 mile of the three pocket parks before and after park construction, respectively, as well as 71 pocket park users, and compared them to 992 neighborhood park users and 342 residents living within .5 mile of other neighborhood parks. We compared pocket park use to playground area use in the larger neighborhood parks. We used descriptive statistics and generalized estimating equations for the analysis.

RESULTS

Overall, pocket park use compared favorably in promoting moderate-to-vigorous physical activity with that of existing playground space in nearby parks, and they were cost-effective at $0.73/MET hour (metabolic equivalent hour) gained. Pocket park visitors walked an average of .25 miles to get to a park.

CONCLUSIONS

Pocket parks, when perceived as attractive and safe destinations, may increase physical activity by encouraging families with children to walk there. Additional strategies and programs may be needed to encourage more residents to use these parks.

Prioritizing school intramural and interscholastic programs based on observed physical activity

PURPOSE

To examine which school sports engage children in more physical activity.

DESIGN

Observational, cross-sectional study examining differences between intramural (IM) and interscholastic (IS) sports.

SETTING

Athletic facilities at two schools with IM sports and two schools with IS sports in Wake County, North Carolina.

SUBJECTS

Middle-school children (N = 6735).

MEASURES

Percentage of children observed in sedentary, moderate, and vigorous activity assessed by the System for Observation Play and Leisure Among Youth (SOPLAY). Energy expenditure and physical activity intensity were also estimated by using MET values.

ANALYSIS

T-tests; generalized linear model using cumulative logit link function.

RESULTS

IM sports had higher MET values than IS sports (t = -3.69, p < .001), and IM sports ranked in four of the top five sports in terms of average MET values. Regression models found a significant interaction between school sport delivery model and gender, with boys significantly less physically active in IS programs than boys in IM programs (B = -.447, p < .001) but more physically active (B = .359, p <.001) than girls in IM sports.

CONCLUSION

Regardless of sport type, IM sports generated more physical activity than IS sports among boys but not girls. Soccer, basketball, and track, regardless of school delivery approach, provide the highest physical activity levels. Results suggest that school administrators consider reassessing their programs to more efficiently use diminishing resources to increase students' physical activity levels.

The potential and reality of physical education in controlling overweight and obesity

Although preventing youth overweight and obesity is a public health priority, quality physical education (PE) is marginalized in practice. In May 2014, we estimated energy expenditure (EE; derived from PE frequency, duration, and intensity; mean student mass; and class size) from national recommendations and data from the 19 US states with PE duration guidelines, under 3 scenarios: potential (quality PE, defined as 50% moderate-to-vigorous physical activity [MVPA]), reality (MVPA = 35%), and classroom instruction only. Students in schools following nationally recommended PE standards from grades 1 through 10 could expend from 35 000 to 90 000 more kilocalories than students who received classroom instruction instead. PE's potential for increasing student EE will only be realized with stronger school policies and increased accountability.

Youth Sport Practice Model Gets More Kids Active with More Time Practicing Skills (Un modelo de entrenamiento deportivo para aumentar los niveles de actividad de los jóvenes y de tiempo de práctica de habilidades)

Abstract. Due to the increasing number of children participating in sport, sport clubs and organizations have been identified as an important setting to facilitate physical activity and health promotion. The purpose of this study was to examine whether new national policies for sport practice increases physical activity time without compromising skill development time. Two comparative samples of youth sport leagues with contrasting sport practice models were evaluated for one year. Eighty-two recreational league hockey practices (ages 9-10). Of the practices, 43 used the new approach while 39 operated under a traditional structure. Momentary time sampling was used to measure player physical activity levels and the practice context in which they occur. A Metabolic Equivalent of Task (MET) score was calculated for each practice. Participants spent 44% of practice time engaged in sedentary activities, 33% in moderate physical activity, and 23% in vigorous physical activity. While individual minutes in MVPA and MET scores did not differ significantly between the practice types, new model practices provided overall higher MET hours than traditional practices. New model practices also accommodated approximately 60% more players while having twice as many coaches, a lower player-to-coach ratio, higher percentage of time in vigorous physical activity, and more time dedicated to skill drills/activities. Findings suggest sport practices can be structured to facilitate high levels of physical activity for more children without compromising attention to skill development and instruction.Resumen. Objetivo: Debido al creciente número de niños que participan en el deporte, los clubes y organizaciones deportivas han sido identificados como un marco importante para facilitar la actividad física y promoción de la salud. El objetivo de este estudio fue examinar si las nuevas políticas nacionales para la práctica del deporte aumentan el tiempo de actividad física sin comprometer el tiempo de desarrollo de habilidades. Se evaluaron durante un año dos muestras comparativas de las ligas deportivas juveniles con modelos contrapuestos de entrenamientos en el deporte. Métodos: Ochenta y dos practicantes a nivel recreativo de la liga de hockey (edades entre 9-10 años). De los entrenamientos, 43 utilizaron el nuevo enfoque mientras que en 39 se trabajó con una estructura tradicional. El muestreo de tiempo momentáneo se utilizó para medir los niveles de actividad física del jugador y el contexto de la práctica en que se producen. Se calculó la puntuación de un equivalente metabólico de tareas (MET) de cada entrenamiento. Resultados: Los participantes dedicaron un 44% del tiempo de la práctica a actividades sedentarias, un 33% en actividad física moderada y el 23% en actividad física vigorosa. Mientras los minutos individuales en AFMV y puntuaciones en MET no difieren significativamente entre los tipos de entrenamiento, los entrenamientos en el nuevo modelo proporcionan valores superiores de MET que los entrenamientos tradicionales. Los entrenamientos del nuevo modelo también acomodan aproximadamente un 60% más de jugadores al tener el doble de entrenadores, un menor ratio de jugador a entrenador, mayor porcentaje de tiempo en actividades físicas vigorosas, y más tiempo dedicado al desarrollo de ejercicios/actividades. Conclusiones: Los resultados sugieren que los entrenamientos deportivos pueden ser estructurados para facilitar altos niveles de actividad física para más niños sin comprometer la atención sobre el desarrollo de habilidades y la enseñanza.

Top 10 research questions related to assessing physical activity and its contexts using systematic observation

Numerous methods are available to assess physical activity (PA) but systematic observation (SO) excels in being able to provide contextually rich data on the setting in which the activity occurs. As SO is particularly useful for determining how activity is influenced by the immediate physical and social environments, its use is becoming more popular. Observation tools have the advantages of flexibility, high internal validity, low inference, and low participant burden, while their disadvantages include the need for careful observer training and recalibration, inaccessibility to certain environments, and potential participant reactivity. There is a need for both scientists and practitioners to have additional information on observation techniques and systems relative to making environmental and policy decisions about PA, and in this article, we describe concepts and identify questions related to using SO in researching PA behavior. We present 10 general questions in 3 sections, including those related to: (a) ensuring data accuracy through the selection of the most appropriate methodological protocols; (b) investigating PA in school settings, including physical education, recess, and other programs; and (c) investigating PA in community settings (e.g., parks, recreation centers, youth and adult sport programs) and homes.

Our Choice/Nuestra Opción: the Imperial County, California, Childhood Obesity Research Demonstration study (CA-CORD)

BACKGROUND

Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study.

METHODS

CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months.

CONCLUSIONS

Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status.

A three-decade evolution to transdisciplinary research: community health research in California-Mexico border communities

BACKGROUND

The Institute for Behavioral and Community Health (IBACH) is a transdisciplinary organization with a team-oriented approach to the translation of research to practice and policy within the context of behavioral medicine.

OBJECTIVES

This paper tracks the growth of IBACH in the context of evolving, multi-university transdisciplinary research efforts from a behavioral medicine research focus to community approaches to disease prevention and control, ultimately specializing in Latino health research and practice. We describe how this growth was informed by our partnerships with community members and organizations, and training a diverse array of students and young professionals.

METHODS

Since 1982, IBACH's research has evolved to address a greater breadth of factors associated with health and well-being. This was driven by our strong community focus and emphasis on collaborations, the diversity of our investigative teams, and our emphasis on training. Although behavioral science still forms the core of IBACH's scientific orientation, research efforts extend beyond those traditionally examined.

CONCLUSIONS

IBACH's "team science" successes have been fueled by a specific population emphasis, making IBACH one of the nation's leaders in Latino health behavior research.

The pill not taken: revisiting Physical Education Teacher Effectiveness in a Public Health Context

In "Physical Education Teacher Effectiveness in a Public Health Context," we took a broad view of physical education (PE) teacher effectiveness that included public health need and support for PE. Public health officials have been consistent and fervent in their support of PE, and for more than two decades, they have called on schools to promote and provide physical activity. They have strongly recommended PE because: (a) It is part of the formalized school curriculum and an essential access point to provide and promote physical activity for nearly all children, and (b) it is the only venue where the least active children experience physical activity at higher intensities. Within the current marginalized status of PE, public health is an ally. Hence, we took a broad public health position, indicated that teacher effectiveness is tied closely to PE program effectiveness, identified physical activity and its assessment as important parts of PE, offered a vision of teacher effectiveness that goes beyond the PE lesson to include components of the comprehensive school physical activity model, and emphasized the need for the collection of data to support PE and physical activity programs. We have read the written reviews and listened to dialogue about our article. In this follow-up article, we address the major comments using 4 themes: prioritizing public health over other PE emphases, PE having a muddled mission, concerns about physical activity, and extending the roles and skills of physical educators.

JROTC as a substitute for PE: really?

PURPOSE

Even though physical education (PE) is an evidence-based strategy for providing and promoting physical activity, alternative programs such as the Junior Reserve Officer Training Corps (JROTC) are commonly substituted for PE in many states. The purpose of this study was to compare student physical activity and lesson contexts during high school PE and JROTC sessions.

METHOD

The System for Observing Fitness Instruction Time was used to assess PE and JROTC sessions (N = 38 each) in 4 high schools that provided both programs. Data were analyzed using t tests, negative binomial regression, and logistic regression.

RESULTS

Students engaged in significantly more moderate-to-vigorous physical activity during PE than during JROTC sessions and they were significantly less sedentary. Significant differences between the 2 program types were also found among lesson contexts.

CONCLUSIONS

PE and JROTC provide substantially different content and contexts, and students in these programs engage in substantially different amounts of moderate-to-vigorous physical activity. Students in JROTC, and perhaps other alternative programs, are less likely to accrue health-supporting physical activity and engage in fewer opportunities to be physically fit and motorically skilled. Policies and practices for providing substitutions for PE should be carefully examined.

Childhood obesity prevention and control in city recreation centres and family homes: the MOVE/me Muevo Project

BACKGROUND

Interventions to prevent and control childhood obesity have shown mixed results in terms of short- and long-term changes.

OBJECTIVES

'MOVE/me Muevo' was a 2-year family- and recreation centre-based randomized controlled trial to promote healthy eating and physical activity among 5- to 8-year-old children. It was hypothesized that children in the intervention group would demonstrate lower post-intervention body mass index (BMI) values and improved obesity-related behaviours compared with the control group children.

METHODS

Thirty recreation centres in San Diego County, California, were randomized to an intervention or control condition. Five hundred forty-one families were enrolled and children's BMI, diet, physical activity and other health indicators were tracked from baseline to 2 years post-baseline. Analyses followed an intent-to-treat approach using mixed-effects models.

RESULTS

No significant intervention effects were observed for the primary outcomes of child's or parent's BMI and child's waist circumference. Moderator analyses, however, showed that girls (but not boys) in the intervention condition reduced their BMI. At the 2-year follow-up, intervention condition parents reported that their children were consuming fewer high-fat foods and sugary beverages.

CONCLUSIONS

Favourable implementation fidelity and high retention rates support the feasibility of this intervention in a large metropolitan area; however, interventions of greater intensity may be needed to achieve effects on child's BMI. Also, further research is needed to develop gender-specific intervention strategies so that both genders may benefit from such efforts.

Shared use of school facilities with community organizations and afterschool physical activity program participation: a cost-benefit assessment

BACKGROUND

Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities.

METHODS

Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011.

RESULTS

Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses.

CONCLUSIONS

These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy.

Physical activity surveillance in parks using direct observation

Introduction

Primary features of observational public health surveillance instruments are that they are valid, can reliably estimate physical activity behaviors, and are useful across diverse geographic settings and seasons by different users. Previous studies have reported the validity and reliability of Systematic Observation of Play and Recreation in Communities (SOPARC) to estimate park and user characteristics. The purpose of this investigation was to establish the use of SOPARC as a surveillance instrument and to situate the findings from the study in the context of the previous literature.

Methods

We collected data by using SOPARC for more than 3 years in 4 locations: Philadelphia, Pennsylvania; Columbus, Ohio; Chapel Hill/Durham, North Carolina; and Albuquerque, New Mexico during spring, summer, and autumn.

Results

We observed a total of 35,990 park users with an overall observer reliability of 94% (range, 85%–99%) conducted on 15% of the observations. We monitored the proportion of park users engaging in moderate-to-vigorous physical activity (MVPA) and found marginal differences in MVPA by both city and season. Park users visited parks significantly more on weekend days than weekdays and visitation rates tended to be lower during summer than spring.

Conclusion

SOPARC is a highly reliable observation instrument that can be used to collect data across diverse geographic settings and seasons by different users and has potential as a surveillance system.

Socioeconomic disparities in elementary school practices and children's physical activity during school

PURPOSE

To examine school socioeconomic status (SES) in relation to school physical activity-related practices and children's physical activity.

DESIGN

A cross-sectional design was used for this study.

SETTING

The study was set in 97 elementary schools (63% response rate) in two U.S. regions.

SUBJECTS

Of the children taking part in this study, 172 were aged 10.2 (standard deviation (SD) = 1.5) years; 51.7% were girls, and 69.2% were White non-Hispanic.

MEASURES

School physical education (PE) teachers or principals responded to 15 yes/no questions on school physical activity-supportive practices. School SES (low, moderate, high) was derived from the percent of students eligible for free and reduced-price lunch. Children's moderate to vigorous physical activity (MVPA) during school was measured with accelerometers.

ANALYSIS

School level analyses involved linear and logistic regression; children's MVPA analyses used mixed effects regression.

RESULTS

Low-SES schools were less likely to have a PE teacher and had fewer physical activity-supportive PE practices than did high-SES schools (p < .05). Practices related to active travel to school were more favorable at low-SES schools (p < .05). Children attending high-SES schools had 4.4 minutes per day more of MVPA during school than did those at low-SES schools, but this finding was not statistically significant (p = .124).

CONCLUSION

These findings suggest that more low- and moderate-SES elementary schools need PE teachers in order to reduce disparities in school physical activity opportunities and that PE time needs to be supplemented by classroom teachers or other staff to meet guidelines.

Physical education teacher effectiveness in a public health context

The health benefits of physical activity are well documented, and the important role that schools and physical education (PE) can play in reducing sedentary behavior and contributing to population health has been identified. Although effective teaching is ultimately judged by student achievement, a major component of teacher and school effectiveness studies has been student engagement. Thus, in PE, it is important to assess the teaching and learning processes related to expected outcomes, including what students and teachers do and how lessons are delivered. Within a public health context, it is then important to assess how teachers provide students with ample health-enhancing physical activity to help them become physically fit and to learn generalizable movement and behavioral skills designed to promote physical activity and fitness outside of class time. In this article, we emphasize that the future of PE in our nation's schools will depend on the ability of schools to provide programs that are perceived to be of importance to the public; moreover, we believe that the future of PE rests on the effectiveness of PE teachers to operate within a public health context. In addition, we also provide a summary of teacher effectiveness research within a public health context and offer visions for the future assessment and evaluation of PE teacher effectiveness that move beyond the PE lesson to include components of the comprehensive school physical activity model.

Physical activity in parks: A randomized controlled trial using community engagement

BACKGROUND

Physical inactivity is an important health risk factor that could be addressed at the community level.

PURPOSE

The goal of the study was to determine whether using a community-based participatory approach with park directors and park advisory boards (PABs) could increase physical activity in local parks. Whether involving PABs would be more effective than working with park directors alone was also tested.

DESIGN

An RCT intervention from October 2007 to April 2012 was used, with partial blinding of observers to the condition. All data were analyzed in 2012.

SETTING/PARTICIPANTS

Of 183 eligible parks in the City of Los Angeles, 50 neighborhood park/recreation centers serving diverse populations participated. Parks were randomized to three study arms: (1) park-director intervention (PD-only); (2) PAB intervention (PAB/PD); and (3) a control arm. Physical activity in each park was systematically observed, and park users and residents living within 1 mile of the park were interviewed.

INTERVENTION(S)

The intervention included assessing park use, obtaining feedback from park users and community residents, training on outreach and marketing, and giving each intervention park $4000 to increase park-based physical activity. The PAB/PD arm required participation and concurrence on all purchases by the PAB.

MAIN OUTCOME MEASURE(S)

Change in the number of park users and change in the level of park-based physical activity, expressed as MET-hours.

RESULTS

Relative to control parks where physical activity declined, in both the PD-only and PAB/PD parks, physical activity increased, generating an estimated average of 600 more visits/week/park, and 1830 more MET-hours of physical activity/week/park. Both residents and park users in the intervention arms in the intervention arms reported increased frequency of exercise. No differences were noted between the PD-only and PAB/PD study arms.

CONCLUSIONS

Providing park directors and PABs with training on outreach and marketing, feedback on park users, and modest funds increased the amount of physical activity observed in parks.

Elementary school practices and children's objectively measured physical activity during school

OBJECTIVE

To examine the relation of physical activity practices covering physical education (PE), recess, and classroom time in elementary schools to children's objectively measured physical activity during school.

METHODS

Participants were 172 children from 97 elementary schools in the San Diego, CA and Seattle, WA USA regions recruited in 2009-2010. Children's moderate-to-vigorous physical activity (MVPA) during school was assessed via accelerometry, and school practices were assessed via survey of school informants. Multivariate linear mixed models were adjusted for participant demographics and unstandardized regression coefficients are reported. The 5 practices with the strongest associations with physical activity were combined into an index to investigate additive effects of these practices on children's MVPA.

RESULTS

Providing ≥ 100 min/week of PE (B=6.7 more min/day; p=.049), having ≤ 75 students/supervisor in recess (B=6.4 fewer min/day; p=.031), and having a PE teacher (B=5.8 more min/day; p=.089) were related to children's MVPA during school. Children at schools with 4 of the 5 practices in the index had 20 more min/day of MVPA during school than children at schools with 0 or 1 of the 5 practices (p<.001).

CONCLUSIONS

The presence of multiple school physical activity practices doubled children's physical activity during school.

Quantifying the contribution of neighborhood parks to physical activity

OBJECTIVE

To quantify the contribution of U.S. neighborhood parks to the time spent in moderate-to-vigorous physical activity (MVPA) by the local population.

METHODS

Observational data on the use of 10 parks in five US cities collected during summer and fall 2008 were analyzed by a model-averaging approach. Estimated MVPA time accrued in parks was compared to estimated total MVPA time accrued by the local population, based upon national estimates.

RESULTS

On average, parks provided roughly 4000hours of use and 1500 MVPA hours per week. Park use accounted for approximately 50% of the vigorous physical activity (VPA) time of those living within 0.5 miles of the park and 16% of those living within 1.0 miles of the park. Parks accounted for a modest proportion of moderate physical activity (MPA) time, about 14% and 4% for those living within 0.5 miles and 1.0 miles of the park, respectively.

CONCLUSION

Parks have significant roles in supporting vigorous physical activity of the local population. Because they are underutilized and vigorous activity is critical to child development and adult physical fitness, efforts should be made to promote vigorous activity within local parks.

Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Niños Study

BACKGROUND

Community-based interventions are needed to reduce the burden of childhood obesity.

PURPOSE

To evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children.

METHODS

Thirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2(nd) grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors.

RESULTS

There were no significant intervention effects on children's BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring).

CONCLUSION

A promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.

Physical activity for children in special school environment

1. We assessed children's physical activity (PA) in structured (physical education) and unstructured (recess, lunch, before and after school) periods in special schools and examined its association with modifiable area contextual characteristics. 2. Children with disabilities were not highly active, but were more active during recess and lunch periods than at other times including physical education classes. 3. Areas were often not accessible during unstructured settings. Children were more active in areas when supervision and organised activities were provided. 4. Providing an interactive game during free play did not significantly increase group's PA. 5. Children's PA accrual is influenced by contextual characteristics of the school environment. There is a need to make areas more accessible and to use social marketing and programming to attract more users. School and health professionals should modify contextual characteristics by providing more direct supervision and organised activities during free play.

Use of neighbourhood parks: does socio-economic status matter? A four-city study

OBJECTIVES

To determine if neighbourhood socio-economic status (SES) is associated with park use and park-based physical activity.

STUDY DESIGN

Cross-sectional study.

METHODS

The use and characteristics of 24 neighbourhood parks in Albuquerque, Chapel Hill/Durham, Columbus and Philadelphia were observed systematically in three seasons (spring, summer and autumn), with nearly 36,000 park users observed. Twelve parks were in high-poverty neighbourhoods and 12 parks were in low-poverty neighbourhoods. In total, 3559 park users and 3815 local residents were surveyed. Park incivilities were assessed and park administrators were interviewed about management practices.

RESULTS

The size and number of facilities in parks in high-poverty neighbourhoods were similar to those in parks in low-poverty neighbourhoods, but the former had more hours of programming. Neighbourhood poverty level, perception of safety and the presence of incivilities were not associated with the number of park users observed. However, programmed activities and the number of activity facilities were strongly correlated with park use and energy expended in the park.

CONCLUSIONS

The finding that park programming is the most important correlate of park use and park-based physical activity suggests that there are considerable opportunities for facilitating physical activity among populations of both high- and low-poverty areas.

Neighborhood Income Matters: Disparities in Community Recreation Facilities, Amenities, and Programs

Physical activity is important for children's development and their current and future health; national recommendations are for them to engage in at least 60 minutes of moderate to vigorous physical activity daily. Most of children's physical activity occurs outside of school hours; thus, access to and the quality of community recreation facilities and programming are particularly relevant. Researchers have identified strong links among socioeconomic disparities, physical inactivity, and poor health, but a limited number of studies have examined how access to community recreation facilities and physical activity programming are affected by local socioeconomic conditions. In many low-income communities, park and recreation facilities may be the only place for children to be physically active outside of school; thus, it is important to understand the connection between community environmental characteristics and child use of facilities. We were interested in determining whether the characteristics of community recreation center environments would be associated with neighborhood income and children's use of the centers. To do this we designed a study to identify whether neighborhood income disparities were associated with recreation center environmental characteristics and whether those characteristics were associated with young children's use of the center. We believed that findings to these questions could inform policy decisions within recreation centers and recreation departments to improve equity, facility use, and levels of physical activity. Thirty community recreation centers and 541 nearby families with children aged 5-8 years in five cities in Southern California participated in the study. To generate data we used multiple research instrumentation including (a) a structured physical activity survey of program offerings and barriers to children's participation in physical activity at the center [completed by recreation center supervisors], (b) direct observation of the presence and condition of recreation center facilities and amenities by trained assessors, and (c) a parent questionnaire on child use of the center. Results indicated that the condition of the community center facilities and amenities, but not their number, was positively related to neighborhood income (p < .05). As well, the number of cost-free, but not total, youth physical activity programs was inversely associated with neighborhood income (p < .05). Parent's report of their children using centers was positively associated with the number of amenities observed there (p < .05). The results suggest that policy makers and community recreation center staff should consider both neighborhood economic issues and environmental characteristics in their efforts to promote children's physical activity at recreation centers.

Neighborhood poverty, park use, and park-based physical activity in a Southern California city

A rich literature indicates that individuals of lower socio-economic status engage in less leisure time physical activity than individuals of higher socio-economic status. However, the source of the difference is believed to be, in part, due to differential access to resources that support physical activity. However, it has not been shown as to whether equal access to parks can mitigate differences in leisure time physical activity. Using systematic direct observation, we quantified physical activity in neighborhood parks in a large Southern California city located in areas with high, medium, and a low percentage of households in poverty. We documented how neighborhood parks are managed and programmed and also interviewed both a sample of park users and a random sample of households within a mile radius of the parks. We found that parks are used less in high-poverty areas compared to medium- and low-poverty area parks, even after accounting for differences in size, staffing, and programming. The strongest correlates of park use were the number of part time staff, the number of supervised and organized programs, and knowing the park staff. Perceptions of safety were not relevant to park use among those interviewed in the park, however it had a small relationship with reported frequency of park use among local residents. Among park users, time spent watching electronic media was negatively correlated with the frequency of visiting the park. Future research should test whether increasing park staffing and programming will lead to increased park use in high-poverty neighborhoods.

Assessing urban walking trail use and changes in the trail environment using systematic observational protocols

This study evaluated the extent to which two systematic observation protocols which were modified for underserved communities (low income, minorities) could be utilized to reliably assess (a) use of walking trails and (b) physical environmental features of these trails. This study was a supplement to the Positive Action for Today's Health (PATH) walking trial. The modified tools were shown to be reliable methods for (a) measuring trail use and (b) assessing physical features of the trail in underserved environments. Reliability data for measuring trail use were found to be high (ICC=.98, p<.01). Reliabilities for measuring features of the trail ranged from fair to highly reliable (κ=.77-1.00; ICC=.34-1.00). The observation tools that were customized for this study were shown to be reliable instruments for measuring trail use and assessing physical features of walking trails in underserved communities.

Physical education's role in public health: steps forward and backward over 20 years and HOPE for the future

The 1991 paper, "Physical education's role in public health" described the importance of physical education in addressing public health problems. On its 20th anniversary, this article reviews accomplishments in improving the health impact of physical education and identifies areas lacking progress. Major accomplishments include development of evidence-based programs, documentation of health and academic benefits of physical education, and acceptance of physical education as a public health resource. Additional work is needed to evaluate the uptake of evidence-based programs, improve national surveillance of physical education quantity and quality, establish stronger policies supporting active physical education, and achieve wide acceptance of public health goals within the physical education field. These opportunities constitute an agenda for actualizing the promise of health-optimizing physical education before the next 20 year anniversary.

Impact and cost-effectiveness of family Fitness Zones: a natural experiment in urban public parks

We evaluated the impact of outdoor exercise equipment (FZ, Fitness Zones) in 12 parks serving diverse populations. We used the System for Observing Play and Recreation in Communities (SOPARC) to assess use and estimate energy expenditure prior to and twice after FZ installation. Park use increased more in FZ parks than in 10 control parks that did not get equipment, but the difference was not statistically significant. However, self-reports of being a new park user increased more in FZ parks, and estimated energy expenditure in FZ parks was higher at both follow-ups than at baseline. Installing Fitness Zones appears to be cost-effective (10.5 cents/MET increase) and most successful in parks in densely populated areas with limited facilities. Longer-term follow-up measures are needed to determine if the early increases in physical activity associated with the Fitness Zone installations are sustained.

School sport policy and school-based physical activity environments and their association with observed physical activity in middle school children

Empirical research on the effects of school sport policies on children's physical activity is limited. This study examined sport policies (intramural vs. varsity), physical settings within schools, and supervision in relation to physical activity using the System for Observing Play and Leisure in Youth (SOPLAY). Data were collected on physical activity levels of children in four middle schools. Regression analyses assessed the main effects of sport policy, type of physical activity setting, and supervision as well as interactions. Regression models were stratified by gender. Children in intramural schools were more likely to use indoor spaces and be boys. Regression models indicated that varsity sport programs were associated with lower physical activity levels among boys but not girls. Significant associations between type of physical activity settings and physical activity levels were observed only for boys. Adult supervision was not associated with children's physical activity levels. Finally, descriptive results showed athletic facilities were under-utilized in all schools.

Examining children's physical activity and play behaviors during school playtime over time

School playtime (recess) provides children an opportunity to engage in a range of active and sedentary play behaviors on a daily basis. However, little data have investigated changes in playtime behaviors over time. The aim of this study was to investigate how children's physical activity levels, the size of their social group, play behaviors and social interactions changed over one academic year (Study 1), and during the transition from Year 5 (aged 9-10 years) to Year 6 (aged 10-11 years; Study 2). Primary school children were directly observed during school playtime using the System for Observing Children's Activity and Relationships during Play. Results revealed children engaged in moderate-to-vigorous physical activity for at least half of the intervals observed. Incidents of physical antisocial behavior significantly decreased, while incidents of verbal antisocial behavior and time spent alone increased across Study 1. Incidents of verbal antisocial behavior, time spent alone and engagement in playground games significantly decreased across Study 2. The data suggest that children are highly physically active during school playtime, and while their play behaviors and activity levels fluctuate, these fluctuations were generally small over one academic year and in the transition between Year 5 and Year 6.

Effects of a multi-pronged intervention on children's activity levels at recess: the Aventuras para Niños study

Latino children spend more time in sedentary activities than other American children, and only ~1 in 5 Latino children in public elementary and middle schools meet all 6 fitness standards in statewide fitness testing. Schools that facilitate physical activity (PA) by maintaining playgrounds and providing physical education classes have children who are more active and less overweight. The aims of the present study were to examine the extent to which several social and physical environmental changes in school settings resulted in observed changes in area characteristics and children's activity levels during recess. Thirteen elementary schools serving predominantly Mexican American children were randomized into control or activity and nutrition environmental intervention conditions. Playgrounds and activities were restructured in 6 intervention schools to promote more PA. After 1 y, there were no overall statistical differences between treatment groups in PA or sedentary behavior in these settings and results did not differ by gender. Changing the social and physical environments to promote children's moderate-to-vigorous PA is important to the design of active and healthy recess environments. The present results are not conclusive as to the link between these interventions and actual behavior, but show sufficient promise for further population and setting specific research.

Leisure-time physical activity in elementary schools: analysis of contextual conditions

BACKGROUND

Little is known about children's leisure-time physical activity (PA) at school and how it is associated with contextual variables. The purpose of this study was to objectively assess children's voluntary PA during 3 daily periods and examine modifiable contextual factors.

METHODS

We conducted SOPLAY (System for Observing Play and Leisure Activity in Youth) observations before school, during recess, and at lunchtime in 137 targeted activity areas in 13 elementary schools over 18 months. During observations, each child was coded as Sedentary, Walking, or Vigorous, and simultaneous entries were made for area characteristics (accessibility, usability, presence of supervision, loose equipment, and organized activities). Logistic regression analysis was used to test associations between PA and area characteristics.

RESULTS

Assessors made 2349 area visits and observed 36,995 children. Boys had more moderate-to-vigorous physical activity (MVPA; 66.2 vs 60.0%, p < .001) and more vigorous PA (29.8 vs 24.6%; p < .001) than girls. Areas were typically accessible and usable, but provided organized activities infrequently (16.5%). Odds of engaging in MVPA were greater during lunch and recess than before school and in areas with play equipment (p < .05).

CONCLUSIONS

Children accrued a substantial amount of voluntary PA during leisure time at school. Their PA would likely be increased if school playground equipment was more readily available and if supervisors were taught to provide active games and promote PA rather than suppress it.

Assessing physical activity in public parks in Brazil using systematic observation

OBJECTIVES

We assessed park use in Recife, Brazil, and differences in physical activity and occupation rates in public parks with and without the Academia da Cidade Program (ACP), which provides cost-free, supervised physical activity classes.

METHODS

We used the System for Observing Play and Recreation in Communities (SOPARC) in 128 targeted areas in 10 park sites (5 ACP sites, 5 non-ACP sites) to obtain data on the number of users and their physical activity levels and estimated age. Each area was assessed 4 times a day for 11 days over a 4-week period.

RESULTS

A total of 32 974 people were observed during 5589 observation visits to target areas. People using ACP parks were more likely to be seen engaging in moderate-to-vigorous (64% vs 49%) and vigorous (25% vs 10%) physical activity. Relatively more participants in ACP sites than in non-ACP sites were females (45% vs 42% of park users) and older adults (14.7% vs 5.7% of park users).

CONCLUSIONS

On the basis of systematic observation, ACP appears to be a useful strategy in promoting park use and physical activity among the population in Recife.

2009 C. H. McCloy Lecture. Seeing is believing: observing physical activity and its contexts

Direct (systematic) observation has been a mainstay of my research for over three decades. I believe it is an important tool for assessing physical activity, because it can simultaneously provide contextually rich data on the setting in which the activity occurs. It is particularly useful for those interested in using ecological and cognitive-behavioral approaches to examine how physical and social environments influence physical activity, and it is currently the only method for assessing group physical activity in open environments. Because physical activity researchers use the method infrequently, this paper provides an overview of systematic observation as it applies to studying physical activity.

Effects of park improvements on park use and physical activity: policy and programming implications

BACKGROUND

Many assume that improving the quality and the perceived safety of facilities in parks and recreation centers is critical to attracting more users and increasing population physical activity. There are few studies in which these assumptions have been tested.

PURPOSE

This study aims to assess the impact of park improvements on park use and physical activity.

METHODS

Five intervention parks and five matched comparison parks were studied by objectively measuring park use and collecting self-reports of park use by residents before and after park improvements. After using the System for Observing Play and Recreation in Communities to count park users and measure their activity levels, and conducting household interviews and intercept surveys with park users, propensity score analyses were used to adjust for differences in respondents' characteristics between pre- and post-intervention and across conditions.

RESULTS

Overall park use and physical activity declined in both intervention and control parks, with 39% of the decline directly attributable to fewer scheduled organized activities. Perceptions of park safety increased more in the intervention parks than in the comparison parks.

CONCLUSIONS

Improvements to parks may not automatically result in increased use and physical activity, especially when programming decreases. Multiple factors contribute to park use and need to be accounted for in future community-level interventions. Further, improving perceptions of safety alone is unlikely to result in increased park use.

New recreational facilities for the young and the old in Los Angeles: policy and programming implications

It is assumed that higher quality recreation facilities promote physical activity and serve communities better. We tested this assumption by comparing changes in the use of an expanded and renovated skate park (a facility for skateboarding) and a modernized senior citizen's center to two similar facilities that were not refurbished. The skate park was nearly tripled in size, and the senior center was remodeled and received new exercise equipment, a courtyard garden, and modern architectural features. We assessed use of these facilities through direct observation and surveyed both facility users and residents living within 2 miles of each facility. We found that making improvements to facilities alone will not always guarantee increased use. Although there was a 510% increase in use of the expanded skate park compared to a 77% increase in the comparison skate park, the senior center had substantially fewer users and provided fewer hours of exercise classes and other programmed activities after the facility was renovated. The implication of our study is that use results from a complex equation that includes not only higher quality recreation facilities but also progamming, staffing, fees, hours of operation, marketing, outreach, and perhaps a host of other human factors.