Physical activity for bone health in inactive teenage girls: is a supervised, teacher-led program or self-led program best?

Active Children Through Individual Vouchers Evaluation: A Mixed-Method RCT

INTRODUCTION

Physical activity declines in adolescence, especially among those in deprived areas. Research suggests this may result from accessibility barriers (e.g., cost and locality). The Active Children Through Individual Vouchers Evaluation RCT aimed to improve the fitness and heart health of teenagers in Wales with the help of teenagers who co-produced the study.

STUDY DESIGN

This study was a mixed-method RCT.

SETTING/PARTICIPANTS

Before data collection, which took place at baseline, 6 months, and 12 months for both arms, 7 schools were randomized by an external statistician (4 intervention schools, n=524; 3 control schools, n=385).

INTERVENTION

The Active Children Through Individual Vouchers Evaluation intervention included provision of activity vouchers (£20 per month), a peer mentoring scheme, and support worker engagement for 12 months between January and December 2017. Data analysis occurred February-April 2018.

MAIN OUTCOME MEASURES

Data included measures of cardiovascular fitness, cardiovascular health (blood pressure and pulse wave analysis), motivation, and focus groups.

RESULTS

The intervention showed a trend to improve the distance ran (primary outcome) and was significant in improving the likelihood of intervention teenagers being fit (OR=1.21, 95% CI=1.07, 1.38, p=0.002). There was a reduction in teenagers classified as having high blood pressure (secondary outcome) in the intervention group (baseline, 5.3% [28/524]; 12 months, 2.7% [14/524]). Data on where teenagers used vouchers and evidence from focus groups showed that teenagers wanted to access more unstructured, informal, and social activities in their local areas.

CONCLUSIONS

Active Children Through Individual Vouchers Evaluation identified methods that may have a positive impact on cardiovascular fitness, cardiovascular health, and perspectives of activity. Consulting with teenagers, empowering them, and providing more local opportunities for them to take part in activities that are fun, unstructured, and social could positively impact teenage physical activity.

TRIAL REGISTRATION

ISRCTN, ISRCTN75594310.

Predictors of cardiovascular health in teenagers (aged 13-14 years): a cross-sectional study linked with routine data

Objective

To examine the predictors of cardiovascular health in teenagers (aged 13-14 years).

Methods

Measures of arterial stiffness (augmentation index (AIx)), blood pressure and cardiovascular fitness were taken from 234 teenage children (n=152 boys) and subsequently linked to routine data (birth and general practice records, education data and hospital admission data). Deprivation at school and at individual level was measured at birth, at 1 year old, at 13 years old and at secondary school using the Welsh Index of Multiple Deprivation. Multivariate regression analysis determined associations between routinely collected data and cardiovascular measures.

Results

Teenagers had higher AIx (2.41 (95% CI 1.10 to 3.72)), ran fewer metres (-130.08 m (95% CI -234.35 to -25.78)) in the Cooper Run Test if they attended a more deprived school. However, higher individual level deprivation was associated with greater fitness (199.38 m (95% CI 83.90 to 314.84)). Higher systolic blood pressure was observed in first born children (10.23 mm Hg (95% CI 1.58 to 18.88)) and in those who were never breastfed (4.77 mm Hg (95% CI 1.10 to 8.42)).

Conclusions

Improving heart health in deprived areas requires multilevel action across childhood namely, active play and programmes that promote physical activity and fitness and, the promotion of breastfeeding. Recognition of the important early indicators and determinants of cardiovascular health supports further development of the evidence base to encourage policy-makers to implement preventative measures in young people.

Teenage recommendations to improve physical activity for their age group: a qualitative study

BACKGROUND

It is recommended that young people should engage in 60 min of moderate-to-vigorous activity (MVPA) a day for health benefits, but few teenagers actually meet this recommendation. Policy-makers play a vital role in designing physical activity initiatives, but they generally do this with little or no input from the intervention recipients. This study explores the recommendations made by teenagers to improve activity provision, uptake and sustainability of physical activity engagement for both themselves and their peers.

METHODS

Thirteen focus groups were carried out in seven secondary schools in South Wales, United Kingdom. Participants (n = 78) were recruited from a larger mixed-method randomised control trial, which involved the implementation of a voucher scheme to promote physical activity in teenagers (aged 13-14). Thematic analysis was undertaken to identify key issues from the perspective of the teenage participants.

RESULTS

Six key recommendations were identified following analysis of the focus groups: i) Lower/remove the cost of activities without sacrificing the quality, ii) Make physical activity opportunities more locally accessible, iii) Improve the standards of existing facilities, iv) Make activities more specific to teenagers v) Give teenagers a choice of activities/increase variety of activity and vi) Provide activities that teenage girls enjoy (e.g., fun, sociable and not competitive sport). Throughout the focus groups, the increased opportunity to participate in unstructured activity was a key recommendation echoed by both boys and girls in all themes.

CONCLUSION

There is a disconnect between what is available and what teenagers want to do. Policy-makers and those involved in physical activity delivery (e.g., schools, local council and local activity providers) should include young people in designing interventions and facilities to ensure they are meeting the needs of this age group and providing the right opportunities for teenagers to be active. That is unstructured, local, low cost, fun, sociable opportunities and the right facilities to be active.

Lifestyle exercises for bone health and health-related quality of life among premenopausal women: a randomised controlled trial

Purpose:

Growing evidence supports engagement in physical exercise throughout life for optimal bone health. However, promotion of physical exercise among premenopausal women presents significant challenges, which are yet to be addressed in the design of many bone-health exercise regimes. As a deviation from traditional, facility-based, supervised, long-duration and intense exercise regimes, the efficacy of short-duration, practical, lifestyle physical exercises for improving bone health and quality of life was examined.

Methods:

Premenopausal women ( N = 96, mean age 22.25 ± 3.5 years; mean BMI 23.43 ± 3.5 kg/m2) participated in a 6-month randomised trial of lifestyle physical exercises for the intervention group and sham exercises for the control group. The participants’ scores on the outcome measure SF-36 was accessed pre- and post-intervention and compared with general population norms according to the SF-36 scoring manual. Paired t-tests were used to examine changes within trial arms from baseline to post-intervention, while analysis of covariance was performed to examine the effect of the lifestyle exercise programme on quality of life of premenopausal women.

Results:

Compared to 51% at baseline, 63% of the participants were either at or above the general population norm for general health, and the percentage of participants who were below the population health norm for mental health was reduced from 46% at baseline to 38% post-exercise intervention. Comparable improvements in quality of life were found in both trial arms post-participation in the bone-health promotion programme.

Conclusions:

Bone-health exercises, when implemented as easily adoptable, lifestyle physical activity, may also enhance the quality of life of premenopausal women. Hence, a practical lifestyle approach to exercise may offer a much-needed public health strategy for bone-health promotion among women.

Evaluation of physical activity interventions in youth via the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: A systematic review of randomised and non-randomised trials

CONTEXT

An identified limitation of existing reviews of physical activity interventions in school-aged youth is the lack of reporting on issues related to the translatability of the research into health promotion practice.

OBJECTIVE

This review used the Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance framework to determine the extent to which intervention studies promoting physical activity in youth report on factors that inform generalizability across settings and populations.

METHODS AND RESULTS

A systematic search for controlled interventions conducted within the last ten years identified 50 studies that met the selection criteria. Based on Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance criteria, most of these studies focused on statistically significant findings and internal validity rather than on issues of external validity. Due to this lack of information, it is difficult to determine whether or not reportedly successful interventions are feasible and sustainable in an uncontrolled, real-world setting.

CONCLUSIONS

Areas requiring further research include costs associated with recruitment and implementation, adoption rate, and representativeness of participants and settings. This review adds data to support recommendations that interventions promoting physical activity in youth should include assessment of adoption and implementation issues.

Effects of lifestyle exercise on premenopausal bone health: a randomised controlled trial

Osteoporosis, a slowly evolving public health epidemic, often with an insidious presentation is largely preventable but the optimal dimensions of exercise that may be prescribed for enhancing bone-health among premenopausal adults are yet to be elucidated. Hence, the escalating incidence and burden of prevalence of osteoporosis is yet unabated. Considering that exogenous hormones in the form of hormonal contraception are known to modulate bone mass, investigations of their possible influence on the translation of exercise-induced osteogenic stimuli on the mature bone is pertinent. The aim of this study was to examine the effect of specified lifestyle exercise on bone-health of premenopausal women. Premenopausal women (n = 96, mean age: 22.25 ± 3.5 years; mean BMI: 23.43 ± 3.5 kg/m(2)) participated in a 6-month randomised controlled trial involving home-based rest-interspersed bouts of high-impact exercise for the intervention group and sham exercise for the control group. Approximately half (47) of the participants (24-exercise, 23-control) were on hormonal-based contraception while the other half (49: 24-exercise, 25-control) were not on hormonal contraception. The regime led to a significant 3.7 % increase in broadband ultrasound attenuation of exercisers compared to controls; hormonal contraceptive use did not appear to potentiate the osteogenic effects of the lifestyle exercise regime. The research highlights that short, discrete bouts of high-impact exercise may be a potential public health prescription for enhancing premenopausal bone-health regardless of hormonal contraceptive use.

Current Evidence for the Impact of Physical Fitness on Health Outcomes in Youth

Physical fitness is tightly linked to our ability to be physically active, and poor fitness is tied to increased risk of lifestyle diseases such as diabetes and cardiovascular disease in adulthood. In 2011, the Institute of Medicine appointed an expert committee to review the evidence between physical fitness and health outcomes in youth. Specifically, experimental and longitudinal studies published between 2000 and 2010 were reviewed in the areas of body composition, cardiorespiratory fitness, musculoskeletal fitness, and flexibility. Specific fitness tests that were linked to health risk factors or health outcomes in each of these areas were identified. Recommendations for the best fitness test items for use in schools and also for a national survey were given. In addition, guidance was provided for interpretation of fitness test scores along with recommendations for areas of needed future research. Key findings from the final report “Fitness Measures and Health Outcomes in Youth” will be reviewed.

Quantitative Ultrasound and bone's response to exercise: a meta analysis

The utility of Quantitative Ultrasound (QUS) for assessing and monitoring changes in bone health due to exercise is limited for lack of adequate research evidence. Restrictions to bone density testing and the enduring debate over repeat dual energy absorptiometry testing spells uncertainty over clinical and non-clinical evaluation of exercise for prevention of osteoporosis. This study, via systematic review and meta-analysis, aimed to paint a portrait of current evidence regarding QUS' application to monitoring bone's adaptive response to exercise interventions.

METHODS

Structured and comprehensive search of databases was undertaken along with hand-searching of key journals and reference lists to locate relevant studies published up to December 2011. Twelve articles met predetermined inclusion criteria. The effect of exercise interventions for improving bone health, as measured by QUS of the calcaneum, was examined across the age spectrum. Study outcomes for analysis: absolute (dB/MHz) or relative change (%) in broadband ultrasound attenuation (BUA) and/or os calcis stiffness index were compared by calculating standardised mean difference (SMD) using fixed- and random-effects models.

RESULTS

Quality of included trials varied from low to high on a scale of one to three. Four to 36months of exercise led to a significant improvement in calcaneum BUA (0.98 SMD, 95% CI 0.80, 1.16, overall effect Z-value=10.72, p=0.001) across the age spectrum.

CONCLUSION

The meta-analysis attests to the sensitivity of QUS to exercise-induced changes in bone health across the age groups. QUS may be considered for use in exercise-based bone health interventions for preventing osteoporosis.

Adding effect sizes to a systematic review on interventions for promoting physical activity among European teenagers

This commentary adds effect sizes to the recently published systematic review by De Meester and colleagues and provides a more detailed insight into the effectiveness of interventions to promote physical activity among European teenagers. The main findings based on this evidence were: (1) school-based interventions generally lead to short term improvement in physical activity levels, but there were large differences between interventions with regard to effect sizes; (2) a multi-component approach (including environmental components) generally resulted in larger effect sizes, thereby providing evidence for the assumption that a multi-component approach should produce synergistic results; and (3) if an intervention aimed to affect more health behaviours besides physical activity, then the intervention appeared to be less effective in favour of physical activity.

Interventions for promoting physical activity among European teenagers: a systematic review

Background

Although physical activity is considered to yield substantial health benefits, the level of physical activity among European teenagers is not sufficient. Adolescence is characterized by a decline in physical activity level. Many studies investigated the effectiveness of interventions promoting physical activity among young people, but none dealt with the available evidence specific for Europe. This review was conducted to summarize the effectiveness of interventions to promote physical activity among European teenagers.

Methods

A systematic review was conducted to identify European intervention studies published in the scientific literature since 1995. Four databases were searched, reference lists were scanned and the publication lists of the authors of the retrieved articles were checked. The ANGELO framework was used to categorise the included studies by setting and by intervention components.

Results

The literature search identified 20 relevant studies. Fifteen interventions were delivered through the school setting, of which three included a family component and another three a family and community component. One intervention was conducted within a community setting, three were delivered in primary care and one was delivered through the internet. Ten interventions included only an individual component, whereas the other ten used a multi-component approach. None of the interventions included only an environmental component.

Main findings of the review were: (1) school-based interventions generally lead to short term improvements in physical activity levels; (2) improvements in physical activity levels by school-based interventions were limited to school related physical activity with no conclusive transfer to leisure time physical activity; (3) including parents appeared to enhance school-based interventions; (4) the support of peers and the influence of direct environmental changes increased the physical activity level of secondary school children; (5) the assumption that a multi-component approach should produce synergistic results can not be confirmed; (6) when interventions aimed to affect more than one health behaviour the intervention appeared to be less effective in favour of physical activity.

Conclusion

Overall, the current European literature supports the short-term effectiveness of school-based physical activity promotion programmes. The available evidence for the effectiveness in other settings is rather limited and underscores the need for further research.