An overview of "The Active by Choice Today" (ACT) trial for increasing physical activity

Supporting children's participation in active travel: developing an online road safety intervention through a collaborative integrated knowledge translation approach

Even though regular engagement in physical activity (PA) among children can support their development and encourage the adoption of healthy lifelong habits, most do not achieve their recommended guidelines. Active travel (AT), or any form of human-powered travel (e.g., walking), can be a relatively accessible, manageable, and sustainable way to promote children's PA. One common barrier to children's engagement in AT, however, is a reported lack of education and training. To support children's participation in AT, this paper presents the development of a comprehensive 4-module online road safety education intervention designed to improve children's knowledge and confidence regarding AT. Using a qualitative integrated knowledge translation (iKT) approach undertaken with community collaborators (n = 50) containing expertise in health promotion, public safety, school administration, and transportation planning, our inductive thematic analysis generated fourth themes which constituted the foundation of the intervention modules: Active Travel Knowledge: Awareness of Benefits and Participation; Pedestrian Safety and Skills: Roles, Responsibilities, and Rules; Signs and Infrastructure: Identification, Literacy, and Behaviour; Wheeling Safety and Skills: Technical Training and Personal Maneuvers. Each theme/module was then linked to an explicit learning objective and connected to complementary knowledge activities, resources, and skill development exercises. Implications for research and practice are discussed.

Physical Activity and Sports Participation among Adolescents: Associations with Sports-Related Knowledge and Attitudes

The impact of physical activity and sport on the development of adolescents' knowledge and attitudes has not been studied sufficiently. We assume that young people with more knowledge of sports will continue to be physically active on their own. The aim of this study is to identify the differences in the sports and physical activity-related knowledge and attitudes of adolescents who engage in organised sports training and those who do not. A total of 1033 6th-grade students from (aged 12.7 ± 0.4 years) 52 schools in Estonia were involved in the study. Logistic regression analysis was used to examine the associations between sports-related knowledge and attitudes towards students participating in organised sports training. The main reasons which hindered adolescents from being active were a lack of suitable equipment, being weaker than others, and laziness. Knowledge of physical activity, higher perceived benefits, and lower barriers to physical activity were the predictors contributing to adolescents' participation in sports training. The results demonstrated that physically active students have better knowledge of sports and physical activity. Students participating in organised sports training have strong positive benefits from being regularly physically active and feel that sports training maintains their health.

Feedback Following a Family-Focused Pediatric Weight Management Intervention: Experiences From the New Impact Program

Weight management interventions have the potential to reduce body mass index and help families adopt healthier behaviors. This study examined feedback from families to identify central aspects of various intervention strategies based on self-determination theory constructs that have the strongest influence on patient success, with the aim of understanding how best to approach weight management in a clinical pediatric setting. Telephone interviews were conducted with 22 individuals (20 parents/guardians and 2 teenagers) who participated in a multidisciplinary weight management program and data was analyzed using inductive and deductive thematic analysis processes. Participants identified motivational interviewing strategies that were most influential to their success. Parents and patient's identified barriers and facilitators to success included patient readiness to change, personal logistics, family engagement, and establishing long- and short-term goals. Successful pediatric obesity management requires consideration to both the patient and family's readiness, structured implementation adaptations to address barriers, intentional efforts to move from external reward to internal motivation, and strategies to ensure families develop self-efficacy toward achievable healthy behaviors.

A school-based, peer-led programme to increase physical activity among 13- to 14-year-old adolescents: the GoActive cluster RCT

Background

Adolescent physical activity levels are low and are associated with rising disease risk and social disadvantage. The Get Others Active (GoActive) intervention was co-designed with adolescents and teachers to increase physical activity in adolescents.

Objective

To assess the effectiveness and cost-effectiveness of the school-based GoActive programme in increasing adolescents’ moderate-to-vigorous physical activity.

Design

A cluster randomised controlled trial with an embedded mixed-methods process evaluation.

Setting

Non-fee-paying schools in Cambridgeshire and Essex, UK (n = 16). Schools were computer randomised and stratified by socioeconomic position and county.

Participants

A total of 2862 Year 9 students (aged 13–14 years; 84% of eligible students).

Intervention

The iteratively developed feasibility-tested refined 12-week intervention trained older adolescents (mentors) and in-class peer leaders to encourage classes to undertake two new weekly activities. Mentors met with classes weekly. Students and classes gained points and rewards for activity in and out of school.

Main outcome measures

The primary outcome was average daily minutes of accelerometer-assessed moderate-to-vigorous physical activity at 10 months post intervention. Secondary outcomes included accelerometer-assessed activity during school, after school and at weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness; well-being and a mixed-methods process evaluation. Measurement staff were blinded to allocation.

Results

Of 2862 recruited participants, 2167 (76%) attended 10-month follow-up measurements and we analysed the primary outcome for 1874 (65.5%) participants. At 10 months, there was a mean decrease in moderate-to-vigorous physical activity of 8.3 (standard deviation 19.3) minutes in control participants and 10.4 (standard deviation 22.7) minutes in intervention participants (baseline-adjusted difference –1.91 minutes, 95% confidence interval –5.53 to 1.70 minutes; p = 0.316). The programme cost £13 per student compared with control. Therefore, it was not cost-effective. Non-significant indications of differential impacts suggested detrimental effects among boys (boys –3.44, 95% confidence interval –7.42 to 0.54; girls –0.20, 95% confidence interval –3.56 to 3.16), but favoured adolescents from lower socioeconomic backgrounds (medium/low 4.25, 95% confidence interval –0.66 to 9.16; high –2.72, 95% confidence interval –6.33 to 0.89). Mediation analysis did not support the use of any included intervention components to increase physical activity. Some may have potential for improving well-being. Students, teachers and mentors mostly reported enjoying the GoActive intervention (56%, 87% and 50%, respectively), but struggled to conceptualise their roles. Facilitators of implementation included school support, embedding a routine, and mentor and tutor support. Challenges to implementation included having limited school space for activities, time, and uncertainty of teacher and mentor roles.

Limitations

Retention on the primary outcome at 10-month follow-up was low (65.5%), but we achieved our intended sample size, with retention comparable to similar trials.

Conclusions

A rigorously developed school-based intervention (i.e. GoActive) was not effective in countering the age-related decline in adolescent physical activity. Overall, this mixed-methods evaluation provides transferable insights for future intervention development, implementation and evaluation.

Future work

Interdisciplinary research is required to understand educational setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale.

Trial registration

Current Controlled Trials ISRCTN31583496.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information. This work was additionally supported by the Medical Research Council (London, UK) (Unit Programme number MC_UU_12015/7) and undertaken under the auspices of the Centre for Diet and Activity Research (Cambridge, UK), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation (London, UK), Cancer Research UK (London, UK), Economic and Social Research Council (Swindon, UK), Medical Research Council, the National Institute for Health Research (Southampton, UK) and the Wellcome Trust (London, UK), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (087636/Z/08/Z; ES/G007462/1; MR/K023187/1). GoActive facilitator costs were borne by Essex and Cambridgeshire County Councils.

The role of parental support for youth physical activity transportation and community-level poverty in the healthy communities study

This study evaluates whether parental provision of transportation for physical activity is associated with child/adolescent moderate-to-vigorous physical activity, while also evaluating community-level poverty. Self- and parental-reported surveys were administered with parents/caregivers and children in the Healthy Communities Study (N = 5138). Associations between individual-level demographics, community-level poverty, parental provision of transportation for physical activity, and moderate-to-vigorous physical activity were examined in multi-level models. Even when accounting for community-level poverty, which was significantly associated with lower moderate-to-vigorous physical activity, parental provision of transportation for physical activity was positively associated with greater moderate-to-vigorous physical activity. This study provides evidence for the importance of considering multiple systems of influence (e.g., community and individual factors) and considering how gaps in physical activity transportation for youth can be addressed in future health policies.

Changes in physical activity of adolescent girls in the context of their perception of the Healthy Me programme

BACKGROUND

An assumption was made that results of programme evaluation lead to better understanding for whom this intervention may work. The aim of the article is to compare the changes in physical activity of the intervention programme participants depending on subjective assessment of its impact.

METHODS

The data were obtained from 14- to15-year-old Polish girls (N = 1120) from 48 random selected secondary schools participating in the 1-year Healthy Me programme in the 2017/2018. Schools were randomly assigned to one of two types of intervention or to a control (null) group. Satisfaction with the programme according to 21 criteria was measured retrospectively just after the intervention. Change in MVPA (moderate-to-vigorous physical activity) during the programme implementation was assessed in relation to satisfaction level, and adjusted for initial MVPA.

RESULTS

In total, the MVPA did not change significantly comparing pre- and post-intervention surveys (3.94 ± 1.94 vs. 3.87 ± 1.93)-P = 0.093. However, the perceived notable improvement of functioning in 10 out of 21 areas was related to the unquestionable increase in MVPA (P ≤ 0.001). With respect to the four impact areas, an interaction was demonstrated between an intervention group and an improvement in the domain-specific functioning. The beneficial impact of the programme on these areas was associated with the improvement of physical activity only in case of full and null intervention.

CONCLUSIONS

Indicators related to the implementation process and the results obtained during the Healthy Me programme evaluation could represent a change in motivational and environmental factors that indirectly affects adolescent girl's physical activity.

Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach

We assessed which intervention components were associated with change in moderate-to-vigorous physical activity (MVPA) and wellbeing through proposed psychosocial mediators. Eight schools (n = 1319; 13–14 years) ran GoActive, where older mentors and in-class-peer-leaders encouraged classes to conduct two new activities/week; students gained points and rewards for activity. We assessed exposures: participant-perceived engagement with components (post-intervention): older mentorship, peer leadership, class sessions, competition, rewards, points entered online; potential mediators (change from baseline): social support, self-efficacy, group cohesion, friendship quality, self-esteem; and outcomes (change from baseline): accelerometer-assessed MVPA (min/day), wellbeing (Warwick-Edinburgh). Mediation was assessed using linear regression models stratified by gender (adjusted for age, ethnicity, language, school, BMI z-score, baseline values), assessing associations between (1) exposures and mediators, (2) exposures and outcomes (without mediators) and (3) exposure and mediator with outcome using bootstrap resampling. No evidence was found to support the use of these components to increase physical activity. Among boys, higher perceived teacher and mentor support were associated with improved wellbeing via various mediators. Among girls, higher perceived mentor support and perception of competition and rewards were positively associated with wellbeing via self-efficacy, self-esteem and social support. If implemented well, mentorship could increase wellbeing among adolescents. Teacher support and class-based activity sessions may be important for boys’ wellbeing, whereas rewards and competition warrant consideration among girls.

Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High-Risk Youth

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth's behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth.

Comparing the Psychometric Properties of Two Physical Activity Self-Efficacy Instruments in Urban, Adolescent Girls: Validity, Measurement Invariance, and Reliability

Aims: This study compared the psychometric properties of two self-efficacy instruments related to physical activity. Factorial validity, cross-group and longitudinal invariance, and composite reliability were examined. Methods: Secondary analysis was conducted on data from a group randomized controlled trial investigating the effect of a 17-week intervention on increasing moderate to vigorous physical activity among 5th-8th grade girls (N = 1,012). Participants completed a 6-item Physical Activity Self-Efficacy Scale (PASE) and a 7-item Self-Efficacy for Exercise Behaviors Scale (SEEB) at baseline and post-intervention. Confirmatory factor analyses for intervention and control groups were conducted with Mplus Version 7.4 using robust weighted least squares estimation. Model fit was evaluated with the chi-square index, comparative fit index, and root mean square error of approximation. Composite reliability for latent factors with ordinal indicators was computed from Mplus output using SAS 9.3. Results: Mean age of the girls was 12.2 years (SD = 0.96). One-third of the girls were obese. Girls represented a diverse sample with over 50% indicating black race and an additional 19% identifying as mixed or other race. Both instruments demonstrated configural invariance for simultaneous analysis of cross-group and longitudinal invariance based on alternative fit indices. However, simultaneous metric invariance was not met for the PASE or the SEEB instruments. Partial metric invariance for the simultaneous analysis was achieved for the PASE with one factor loading identified as non-invariant. Partial metric invariance was not met for the SEEB. Longitudinal scalar invariance was achieved for both instruments in the control group but not the intervention group. Composite reliability for the PASE ranged from 0.772 to 0.842. Reliability for the SEEB ranged from 0.719 to 0.800 indicating higher reliability for the PASE. Reliability was more stable over time in the control group for both instruments. Conclusions: Results suggest that the intervention influenced how girls responded to indicator items. Neither of the instruments achieved simultaneous metric invariance making it difficult to assess mean differences in PA self-efficacy between groups.

Using a Co-Creational Approach to Develop, Implement and Evaluate an Intervention to Promote Physical Activity in Adolescent Girls from Vocational and Technical Schools: A Case Control Study

Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September–October 2014) and post (April–May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach.

Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: a review of the clinical trials registration database

Background

Efforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component.

Methods

First, completed home-, community-, and school-based trials involving minority or low-income children aged 2–17 years were identified in a search of the ClinicalTrials.gov registry. Second, a PubMed search of identified trials was conducted to locate publications pertinent to identified trials. Recruitment and retention rates were calculated for studies that included relevant information.

Results

Our final analytic sample included 43 studies. Of these, 25 studies reported recruitment or retention strategies, with the amount of information varying from a single comment to several pages; 4 published no specific information on recruitment or retention; and 14 had no publications listed in PubMed. The vast majority (92 %) of the 25 studies reported retention rates of, on average, 86 %. Retention rates were lower in studies that: targeted solely Hispanics or African Americans (vs. mixed races of African Americans, whites, and others); involved children and parents (vs. children only); focused on overweight or obese children (vs. general children), lasted ≥1 year (vs. <1 year), were home or community-based (vs. school-based), included nutrition and physical activity intervention (vs. either intervention alone), had body mass index or other anthropometrics as primary outcome measures (vs. obesity-related behavior, insulin sensitivity, etc.). Retention rates did not vary based on child age, number of intervention sessions, or sample size.

Conclusions

Variable amounts of information were provided on recruitment and retention strategies in obesity-related trials involving minority or low-income children. Although reported retention rates were fairly high, a lack of reporting limited the available information. More and consistent reporting and systematic cataloging of recruitment and retention methods are needed. In addition, qualitative and quantitative studies to inform evidence-based decisions in the selection of effective recruitment and retention strategies for trials including minority or low-income children are warranted.

Behavior matters: the relevance, impact, and reach of behavioral medicine

BACKGROUND/PURPOSE

Growing evidence suggests behavioral interventions that target a few key behaviors may be effective at improving population-level health outcomes; health status indicators; social, economic, and physical environments; personal capacity; and biological outcomes. A theoretical framework that targets both social and cognitive mechanisms of behavioral interventions is outlined as critical for understanding "ripple effects" of behavioral interventions on influencing a broad range of outcomes associated with improved health and well-being.

METHODS/RESULTS

Evidence from randomized controlled trials is reviewed and demonstrates support for ripple effects-the effects that behavioral interventions have on multiple outcomes beyond the intended primary target of the interventions. These outcomes include physical, psychological, and social health domains across the lifespan.

CONCLUSIONS

Cascading effects of behavioral interventions have important implications for policy that argue for a broader conceptualization of health that integrates physical, mental, and social well-being outcomes into future research to show the greater return on investment.

A multilevel approach to examining time-specific effects in accelerometer-assessed physical activity

OBJECTIVES

Popular methods for analyzing accelerometer data often use a single physical activity outcome variable such as average-weekly or total physical activity. These approaches limit the types of research questions that can be answered and fail to utilize the detailed, time-specific information available from accelerometers. This study proposes the use of multilevel modeling, which tested intervention effects at specific time periods.

DESIGN

The motivating example was the Active by Choice Today trial. Simulations were used to test whether the application of time-specific hypotheses about when physical activity intervention treatment effects were expected to occur (e.g., after-school hours) increased power to detect effects compared to traditional methods.

METHODS

Six simulation conditions were tested: (1) no treatment effects (to test the type 1 error rate), (2) time-specific effects, but no traditionally-tested effects, (3) traditionally-tested effects, but no time-specific effects, and (4) combinations of traditional and time-specific effects in 3 proportions.

RESULTS

Results showed the proposed multilevel approach demonstrated appropriate type 1 error rates and increased power to detect treatment effects during hypothesized times by 31-38 percentage points compared to traditional approaches. This was consistent across varying proportions of traditional versus time-specific effects, and there was no loss of power using the multilevel approach when only traditional effects were present.

CONCLUSIONS

The current study showed potential advantages of testing time-specific hypotheses about intervention effects using a multilevel time-specific approach. This approach may show intervention effects when traditional approaches do not. Future research should explore the application of this additional analytic tool for accelerometer physical activity estimates.

Development of a universal approach to increase physical activity among adolescents: the GoActive intervention

OBJECTIVES

To develop a physical activity (PA) promotion intervention for adolescents using a process addressing gaps in the literature while considering participant engagement. We describe the initial development stages; (1) existing evidence, (2) large scale opinion gathering and (3) developmental qualitative work, aiming (A) to gain insight into how to increase PA among the whole of year 9 (13-14 years-old) by identifying elements for intervention inclusion (B) to improve participant engagement and (C) to develop and refine programme design.

METHODS

Relevant systematic reviews and longitudinal analyses of change were examined. An intervention was developed iteratively with older adolescents (17.3 ± 0.5 years) and teachers, using the following process: (1) focus groups with (A) adolescents (n=26) and (B) teachers (n=4); (2) individual interviews (n=5) with inactive and shy adolescents focusing on engagement and programme acceptability. Qualitative data were analysed thematically.

RESULTS

Limitations of the existing literature include lack of evidence on whole population approaches, limited adolescent involvement in intervention development, and poor participant engagement. Qualitative work suggested six themes which may encourage adolescents to do more PA; choice, novelty, mentorship, competition, rewards and flexibility. Teachers discussed time pressures as a barrier to encouraging adolescent PA and suggested between-class competition as a strategy. GoActive aims to increase PA through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented in tutor groups using a student-led tiered-leadership system.

CONCLUSIONS

We have followed an evidence-based iterative approach to translate existing evidence into an adolescent PA promotion intervention. Qualitative work with adolescents and teachers supported intervention design and addressed lack of engagement with health promotion programmes within this age group. Future work will examine the feasibility and effectiveness of GoActive to increase PA among adolescents while monitoring potential negative effects. The approach developed is applicable to other population groups and health behaviours.

TRIAL REGISTRATION NUMBER

ISRCTN31583496.

Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents

This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure.

RESULTS

Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=0.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=0.41) and group levels (M=3.35, SD=0.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum.

DISCUSSION

Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.

A longitudinal study of the effects of instrumental and emotional social support on physical activity in underserved adolescents in the ACT trial

BACKGROUND

Few previous studies have examined the influence of instrumental and emotional social support on physical activity (PA) longitudinally in underserved adolescents.

PURPOSE

This longitudinal study was a secondary analysis of the Active by Choice Today (ACT) trial examining whether instrumental social support predicts increases in PA in underserved adolescents, above and beyond emotional social support provided by family or peers.

METHODS

Students in the sixth grade (N = 1,422, 73 % African American, 54 % female, M age = 11 years) in the ACT trial participated. At baseline and 19 weeks, previously validated measures of social support (family instrumental, family emotional, and peer emotional) were completed and moderate-to-vigorous PA (MVPA) was assessed using 7-day accelerometry estimates.

RESULTS

A mixed ANCOVA demonstrated that baseline (p = 0.02) and change in family instrumental support (p = 0.01), but not emotional support from family or peers, predicted increases in MVPA across a 19-week period.

CONCLUSIONS

Future interventions in underserved adolescents should enhance opportunities for instrumental support for PA.

Effects of the 3-year Sigue la Huella intervention on sedentary time in secondary school students

BACKGROUND

To examine the effects of the Sigue la Huella (Follow the Footstep) intervention on adolescents' daily sedentary time (ST).

METHODS

This quasi-experimental, cohort study took place in four secondary schools in Huesca (Spain) during the 2009-2010, 2010-2011 and 2011-2012 academic years (students aged 12-15 years). Two schools were assigned to the experimental condition (n = 368) and two schools to the control condition (n = 314). Sigue la Huella adopted a whole school approach and used both curricular and non-curricular intervention channels to empower students to make better decisions. ST was measured for 7 days on four occasions using accelerometers. Growth curve models were used to analyze the data.

RESULTS

In the model with all participants, a significant interaction indicated that the effect of the intervention was dependent on the study cohort considered. While in cohort 1 there were no significant differences in rate of linear change of ST between the experimental and the control group (P = 0.148), in cohorts 2 and 3 significant differences were observed in favor of the experimental group (β = -13.88, 95% CI = -25.00 to -2.76, P = 0.015; β = -76.73, 95% CI = -110.68 to -42.78, P < 0.001), independent of type of school (public vs. private) and gender.

CONCLUSIONS

Sigue la Huella had mainly a protective effect in two of the three study cohorts. Whereas in cohort 2 the intervention prevented increases in ST, in cohort 3 the intervention reduced considerably the increase in ST noted in the control group.

What do adolescents want in order to become more active?

Background

Few large studies have examined adolescents’ views about increasing their physical activity (PA) to inform PA promotion. We assessed adolescent preference for activity type, co-participants, timing and location of PA promotion and examined patterns in their views by population subgroup.

Methods

Participants (n = 457) (Mean ± SD age: 14.3 ± 0.3 years; 45.2% male) responded to questionnaire items: “What activities would you like to try or do more often?” (yes/no to 6 activity types e.g. team sports) and “I would like to do more PA …” followed by options regarding co-participants, timing and PA location (agree/disagree to 10 items). Anthropometry, demographics, accelerometer- and questionnaire-derived PA were obtained. Logistic regression was used to examine differences in views by subgroup (sex, weight status, objective PA level, parental education (SES)).

Results

Most adolescents wanted to increase participation in ≥1 type of PA (94.4%). Gym use (56.7%) and team sports (50.6%) were most popular. Girls were less likely to choose racquet sports (vs. boys OR; 95% CI 0.6;0.4-0.9) but more likely to select dancing (40.3;17.8-91.1). Preference for participation was positively associated with existing participation in a similar activity (all p < 0.02). More adolescents wanted to increase PA with friends (88.8%) than family (63.5%). A leisure centre was most popular for increased participation (81.0%), followed by home (70.0%). Participation during school time was less popular among girls (vs. boys: 0.6;0.4-0.9) and more popular among low SES participants (vs. high: 1.6;1.1-2.4). Overweight/obese adolescents were less likely to choose participation with friends (vs. normal weight 0.5;0.3-0.9).

Conclusions

Targeting adolescent PA promotion by subgroup and providing choice of PA type, co-participants, timing and PA location appears promising. Adolescents want to do more types of PA more often; interventions could increase opportunities and support to facilitate this.

Promising school-based strategies and intervention guidelines to increase physical activity of adolescents

This narrative review describes the available scientific evidence regarding promising school-based strategies to increase physical activity of adolescents. We conducted a literature search for studies published up to 2011, regarding adolescent physical activity intervention studies that resulted in increased physical activity (regardless of measurement) and reviewed 52 intervention articles and 21 review articles. We identified several promising strategies and grouped into five broad intervention guidelines. These guidelines are as follows: (i) design multi-component interventions that foster the empowerment of members of the school community; (ii) develop improvements to Physical Education curricula as a strategy to promote physical activity to adolescents; (iii) design and implement non-curricular programmes and activities to promote physical activity; (iv) include computer-tailored interventions during the implementation and monitoring of physical activity promotion programmes and (v) design and implement specific strategies that respond to the interests and needs of girls. On the basis of our review of the adolescent physical activity promotion literature, we suggest that these five guidelines should be taken into account in school-based interventions geared towards achieving an increase in adolescent physical activity.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades.

OBJECTIVES

The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

SEARCH METHODS

The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

SELECTION CRITERIA

To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate.

DATA COLLECTION AND ANALYSIS

Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured.

MAIN RESULTS

In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review.

AUTHORS' CONCLUSIONS

The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.

Impact of physical activity intervention programs on self-efficacy in youths: a systematic review

Lack of physical activity has contributed to the nation's childhood obesity crisis, but the impact of physical activity on self-efficacy as a mediator of behavior change has not been examined. This systematic review (SR) describes the published evidence related to the impact of physical activity intervention programs on self-efficacy among youths. From January 2000 to June 2011, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to identify publications from PubMed, PsychInfo, Web of Knowledge, and the Cochran Database of Systematic Reviews. The Cochrane Population, Intervention, Control, Outcome, Study Design (PICOS) approach guided this SR articles selection and evaluation process. Of the 102 publications screened, 10 original studies matched the SR inclusion criteria. The types of physical activity interventions and self-efficacy assessments for these 10 studies were diverse. Of the 10 included articles, 6 articles identified an improvement in post-self-efficacy assessments compared to baseline and 4 showed no effect. In conclusion, physical activity intervention programs may improve self-efficacy in youths. A standardized approach to classify and measure self-efficacy is required. Further research is needed to quantify the association of self-efficacy ratings after completing physical activity interventions with objective health improvements, such as weight loss.

Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents

OBJECTIVE

This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income).

METHODS

Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI).

RESULTS

Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores.

CONCLUSIONS

A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

The role of motivation in understanding social contextual influences on physical activity in underserved adolescents in the ACT Trial: a cross-sectional study

BACKGROUND

Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA).

METHODS

Baseline data (n = 1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates).

RESULTS

Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA.

CONCLUSIONS

These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA.

The association of self-efficacy and parent social support on physical activity in male and female adolescents

OBJECTIVE

Previous research has shown that cognitive factors may account for the relationship between interpersonal factors and health behaviors. Given these findings, the current study sought to further explore the direct and indirect relationship between parental social support and adolescent physical activity (PA).

METHOD

Data were collected from 1,421 sixth graders (73% Black, 54% females, 71% on free or reduced lunch) in South Carolina. Measures for emotional social support, instrumental social support, and adolescent self-efficacy (SE) were assessed and PA was assessed via accelerometry.

RESULTS

Parent instrumental social support was directly related to girls' PA and parent emotional social support was inversely related to girls' PA. Parent instrumental social support was indirectly related to boys' PA through boys' SE. The covaried association of SE with PA was significant for boys and marginal for girls.

CONCLUSIONS

SE for overcoming barriers may be an important construct for understanding the relationship between parent instrumental social support and boys' PA in underserved populations. The mechanisms for engaging in PA may be different for adolescent girls and boys.

A qualitative study of staff's perspectives on implementing an after school program promoting youth physical activity

Minimal effects found across youth physical activity (PA) interventions, and increased attention to circumstances that impede adequate delivery of program components, has highlighted the importance of learning from staff what is needed to foster staff comprehension and engagement for developing, adopting, and successfully implementing PA-based youth interventions. The purpose of this study is to address this knowledge gap by conducting a qualitative assessment of school staff perspectives on the positive aspects and challenges of implementing the 17-week ACT program, an after-school intervention that integrated motivational and behavioral components to promote PA in underserved adolescents. Interviews were conducted with one school staff member from each participating school for all four trial cohorts (N=12). Transcripts were coded by independent coders (r=.84) and content analyses of themes was performed using QSR NVivo. Themes were organized into five meta-themes: (1) Logistics; (2) Essential Elements; (3) Staff and Child Challenges; (4) Staff Comprehension, Value, and Enjoyment; (5) Spill-Over Effects. Findings indicate that staff can be successful at understanding, valuing, and reaching fidelity in implementing climate-based mediation components. The insight gained from this study lays the foundation for understanding the components needed for establishing well-implemented, effective, and generalizable interventions for increasing youth PA.

An efficacy trial of 'Steps to Your Health', a health promotion programme for adults with intellectual disability

OBJECTIVE

Although there are evaluation and effectiveness studies of health promotion interventions for adults with intellectual disabilities (ID), randomized efficacy trials of such interventions are lacking.

DESIGN

A randomized active control intervention trial.

SETTING

The participants attended the health promotion classes in local disability agency service facilities. Method: We enrolled 443 individuals and randomly assigned them to one of two eight-week participatory classes. The 'Steps to Your Health' (STYH) classes emphasized moderate to vigorous physical activity (MVPA), healthy eating and body mass index (BMI) reduction. The control intervention focused on hygiene and safety.

RESULTS

We did not find a statistically significant difference in mean MVPA or BMI change between completers of the STYH group compared to the control group one year after the intervention was completed. We did find that participation in STYH classes had a non-significant association with odds of reduction in BMI (odds ratio [OR] 2.87, 95% confidence interval [CI] 0.91-9.11) and completers who lived in group homes were more likely than their counterparts who lived with families or in apartments to decrease their BMI (OR 4.61; 95% CI 1.14-18.64).

CONCLUSIONS

This trial did not demonstrate a significant effect of STYH participation on change in mean minutes of MVPA or mean BMI 12 months after classes ended, although there was a non-significant association with odds of reduction of BMI (p = 0.07). This study has implications for design of intervention studies in people with intellectual disability (ID).

Enhancing the Translation of Physical Activity Interventions in Afterschool Programs

Afterschool programs (3-6 pm, ASPs) represent a promising approach to promote physical activity (PA) and are positioned to make a substantial contribution to children’s overall daily PA. This article synthesizes both descriptive and intervention focused efforts aimed at describing/increasing PA within the ASP setting and outlines future directions for research. ASPs provide anywhere from 8 to 24 minutes of moderate-to-vigorous PA daily, with children accumulating between 2600 and 3200 steps per day. State and national organizations have developed policies related to PA in ASPs, but the limited available evidence indicates that ASPs are far from meeting PA policy goals. A total of 17 ASP PA intervention studies have been conducted, more than half (9/17) within ASPs that were initiated and developed by researchers. Based on the review of evidence, key strategies to increase PA include high-quality professional development training, allocating time in the ASP schedule for children to engage in sufficient amounts of PA, and tailoring the intervention to local conditions. Future directions should focus on evaluating these key strategies, conducting descriptive studies of common ASP characteristics nationally and their influence on children’s PA, evaluation/refinement of existing ASP PA curricula, cost-effectiveness of interventions, and identification of feasible PA policy goals.

Neighborhood and parental supports for physical activity in minority adolescents

BACKGROUND

Few studies have examined environmental, home, and parental supports for physical activity in underserved adolescents (low income, ethnic minority). Given the increasing incidence of obesity in minority adolescents, it is important to better understand ecologic determinants of physical activity in these youth. This study used an ecologic model to evaluate the significance of neighborhood, home, and parental supports for physical activity on moderate-to-vigorous (MV) physical activity in underserved adolescents.

DESIGN

The study was a secondary data analysis of a randomized controlled school-based trial "Active by Choice Today" (ACT) for increasing physical activity in underserved sixth-graders. Schools were matched on school size, percentage minorities, percentage entitled to free or reduced-price lunch, and urban or rural setting prior to randomization. This study used a randomly selected sample of parents (n=280) from the intervention and control schools whose adolescent was enrolled in the larger trial.

SETTING/PARTICIPANTS

A total of 679 6th-grade students (mean age=11.4 years, 70% African-American, 76% free or reduced-price lunch, 52% female) participated in the larger trial. Parents of 280 youth were contacted to participate in a telephone survey and 198 (71%) took part in the study.

INTERVENTIONS

The ACT trial was designed to test the efficacy of a 17-week (1 academic year) motivational plus behavioral skills intervention versus comparison after-school programs on increasing physical activity. A telephone survey was developed and was administered within 6 months after the trial began on parents of 198 adolescents from the ACT randomized school-based trial during 2005-2007.

MAIN OUTCOME MEASURES

The primary outcome measure was adolescent MVPA based on 7-day accelerometry estimates from baseline to mid-intervention. The data were analyzed in 2010-2011 and included both parent and adolescent self-reports of environmental, home, and family supports for physical activity.

RESULTS

Regression analyses indicated a significant effect of parental and neighborhood supports for physical activity on adolescent MVPA. Adolescents who perceived higher (vs lower) levels of parental support for physical activity engaged in more minutes of MVPA (B=3.01, SE=1.38, p<0.05) at mid-intervention. Adolescents who lived in neighborhoods with more (vs fewer) supports for physical activity (parks, lighting), also engaged in more minutes MVPA (B=4.27, SE=2.15, p<0.05).

CONCLUSIONS

Support from parents and neighborhood quality are both associated with increased physical activity in underserved adolescents.

Equating accelerometer estimates of moderate-to-vigorous physical activity: in search of the Rosetta Stone

No universally accepted ActiGraph accelerometer cutpoints for quantifying moderate-to-vigorous physical activity (MVPA) exist. Estimates of MVPA from one set of cutpoints cannot be directly compared to MVPA estimates using different cutpoints, even when the same outcome units are reported (MVPA mind(-1)). The purpose of this study was to illustrate the utility of an equating system that translates reported MVPA estimates from one set of cutpoints into another, to better inform public health policy. Secondary data analysis. ActiGraph data from a large preschool project (N=419, 3-6-yr-olds, CHAMPS) was used to conduct the analyses. Conversions were made among five different published MVPA cutpoints for children: Pate (PT), Sirard (SR), Puyau (PY), Van Cauwengerghe (VC), and Freedson Equation (FR). A 10-fold cross-validation procedure was used to develop prediction equations using MVPA estimated from each of the five sets of cutpoints as the dependent variable, with estimated MVPA from one of the other four sets of cutpoints (e.g., PT MVPA predicted from FR MVPA). The mean levels of MVPA for the total sample ranged from 22.5 (PY) to 269.0 (FR) mind(-1). Across the prediction models (5 total), the median proportion of variance explained (R(2)) was 0.76 (range 0.48-0.97). The median absolute percent error was 17.2% (range 6.3-38.4%). The prediction equations developed here allow for direct comparisons between studies employing different ActiGraph cutpoints in preschool-age children. These prediction equations give public health researchers and policy makers a more concise picture of physical activity levels of preschool-aged children.

Results of the "Active by Choice Today" (ACT) randomized trial for increasing physical activity in low-income and minority adolescents

OBJECTIVE

This study reports the results of the "Active by Choice Today" (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents.

DESIGN

The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program.

MAIN OUTCOME MEASURE

The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention.

RESULTS

At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention.

CONCLUSIONS

Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA.

An overview of the "Positive Action for Today's Health" (PATH) trial for increasing walking in low income, ethnic minority communities

BACKGROUND

Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities.

DESIGN AND SETTING

Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months.

INTERVENTION

The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months.

CONCLUSIONS

Implications of this community-based trial are discussed.

The Physical Education Predisposition Scale: preliminary development and validation

The main aim of this study was to develop and test psychometrically the Physical Education Predisposition Scale, to assess secondary school students' cost-benefit assessment of physical education (PE) participation (PE attitude affective and attitude cognitive) and self-perceptions (PE perceived competence and self-efficacy). Secondary aims were to explore how the two variables were related, and to investigate age and gender differences. Altogether, 315 Year 8 and 9 students (aged 12-14 years) from four North West England schools completed the Physical Education Predisposition Scale. Principal components analysis revealed the presence of a simple two-factor solution explaining 60.7% of the variance. Factor 1 (labelled Perceived PE Worth) reflected attitude affective and attitude cognitive (alpha = 0.91), and factor 2 (Perceived PE Ability) represented perceived competence and self-efficacy (alpha = 0.89). Significant positive correlations were observed between the factors (r = 0.67 to 0.71, P < 0.001). Boys scored significantly higher than girls on Perceived PE Worth (P < 0.001) and Perceived PE Ability (P = 0.02). Similarly, Year 8 students scored significantly higher than Year 9 students on Perceived PE Worth (P = 0.005) and Perceived PE Ability (P < 0.001). Our results support the potential of the Physical Education Predisposition Scale as a concise measurement tool for use in the PE setting, for both teachers and researchers.

Using process evaluation for program improvement in dose, fidelity and reach: the ACT trial experience

Background

The purpose of this study was to demonstrate how formative program process evaluation was used to improve dose and fidelity of implementation, as well as reach of the intervention into the target population, in the "Active by Choice Today" (ACT) randomized school-based trial from years 1 to 3 of implementation.

Methods

The intervention integrated constructs from Self-Determination Theory and Social Cognitive Theory to enhance intrinsic motivation and behavioral skills for increasing long-term physical activity (PA) behavior in underserved adolescents (low income, minorities). ACT formative process data were examined at the end of each year to provide timely, corrective feedback to keep the intervention "on track".

Results

Between years 1 and 2 and years 2 and 3, three significant changes were made to attempt to increase dose and fidelity rates in the program delivery and participant attendance (reach). These changes included expanding the staff training, reformatting the intervention manual, and developing a tracking system for contacting parents of students who were not attending the after-school programs regularly. Process outcomes suggest that these efforts resulted in notable improvements in attendance, dose, and fidelity of intervention implementation from years 1 to 2 and 2 to 3 of the ACT trial.

Conclusion

Process evaluation methods, particularly implementation monitoring, are useful tools to ensure fidelity in intervention trials and for identifying key best practices for intervention delivery.

Interactions of socioeconomic position with psychosocial and environmental correlates of children's physical activity: an observational study of South Australian families

Background

Evidence for psychosocial and environmental correlates on children's physical activity is scattered and somewhat unconvincing. Further, the moderating influences of socioeconomic position (SEP) on these influences are largely unexplored. The aim of this study was to examine the interactions of SEP, operationalised by mother education, and predictors of children's physical activity based on the Youth Physical Activity Promotion Model.

Methods

In 2005, a sample of South Australians (10–15 y) was surveyed on psychosocial and environmental correlates of physical activity using the Children's Physical Activity Correlates Questionnaire (n = 3300) and a parent survey (n = 1720). The following constructs were derived: 'is it worth it?' (perceived outcomes); 'am I able?' (perceived competency); 'reinforcing' (parental support); and 'enabling' (parent-perceived barriers). Self-reported physical activity was represented by a global score derived from the Physical Activity Questionnaire for Adolescents. Associations among physical activity and hypothesised correlates were tested among children with mothers of high (university educated) and low (left school at or before 15 y) SEP.

Results

Among high SEP children, 'is it worth it?' emerged as a significant predictor of physical activity for boys and girls. Among low SEP children, 'is it worth it?' predicted boys' physical activity, while among girls, 'reinforcing' was the only significant predictor, explaining ~35% of the total explained variance in physical activity.

Conclusion

While perceived outcomes emerged as a consistent predictor of physical activity in this sample, parental support was a powerful limiting factor among low SEP girls. Interventions among this high risk group should focus on supporting parents to provide both emotional and instrumental support for their daughters to engage in physical activity.

After-school program impact on physical activity and fitness: a meta-analysis

CONTEXT

The majority of children do not participate in sufficient amounts of daily, health-enhancing physical activity. One strategy to increase activity is to promote it within the after-school setting. Although promising, the effectiveness of this strategy is unclear. A systematic review was performed summarizing the research conducted to date regarding the effectiveness of after-school programs in increasing physical activity.

EVIDENCE ACQUISITION

Databases, journals, and review articles were searched for articles published between 1980 and February 2008. Meta-analysis was conducted during July of 2008. Included articles had the following characteristics: findings specific to an after-school intervention in the school setting; subjects aged <or=18 years; an intervention component designed to promote physical activity; outcome measures of physical activity, related constructs, and/or physical fitness. Study outcomes were distilled into six domains: physical activity, physical fitness, body composition, blood lipids, psychosocial constructs, and sedentary activities. Effect sizes (Hedge's g) were calculated within and across studies for each domain, separately.

EVIDENCE SYNTHESIS

Of the 797 articles found, 13 unique articles describing findings from 11 after-school interventions were reviewed. Although physical activity was a primary component of all the tested interventions, only eight studies measured physical activity. From the six domains, positive effect sizes were demonstrated for physical activity (0.44 [95% CI=0.28-0.60]); physical fitness (0.16 [95% CI=0.01-0.30]); body composition (0.07 [95% CI=0.03-0.12]); and blood lipids (0.20 [95% CI=0.06-0.33]).

CONCLUSIONS

The limited evidence suggests that after-school programs can improve physical activity levels and other health-related aspects. Additional studies are required that provide greater attention to theoretical rationale, levels of implementation, and measures of physical activity within and outside the intervention.

New perspectives on health disparities and obesity interventions in youth

OBJECTIVE

This article reviews intervention studies that address health disparities and the increasing rate of obesity in minority youth. The review focuses on interventions that target obesity-related behaviors (diet, physical activity, sedentary behaviors) and adiposity outcomes (body mass index) in minority children and adolescents.

METHODS

A conceptual framework is presented that integrates ecological, cultural, social, and cognitive approaches to reducing obesity in ethnically diverse youth. The review highlights effective interventions in minority youth and distinguishes between culturally targeted and culturally tailored components.

RESULTS

A limited number of studies have been conducted that target obesity-related behaviors and adiposity outcomes in minority youth. The most successful interventions for minority youth have incorporated culturally targeted and culturally tailored intervention components using multi-systemic approaches.

CONCLUSIONS

Further research is needed that focuses on testing the efficacy of theoretically based approaches that integrate culturally appropriate program elements for improving obesity-related behaviors and adiposity outcomes in minority youth.