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Comeau A, Mertens B, Bachwal L, Utter J, van Herwerden L. Effectiveness of nutrition interventions in Australian secondary schools: A systematic review. Health Promot J Austr 2024; 35:567-587. [PMID: 37586361 DOI: 10.1002/hpja.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
ISSUE ADDRESSED Dietary intake of Australian adolescents is suboptimal. Schools are an ideal setting for health promotion initiatives to develop healthy lifestyle behaviours among adolescents. However, we do not know which nutrition-focused, school-based interventions are effective at improving health outcomes in adolescents in Australia. Therefore, the aim was to evaluate the effect of nutrition interventions on health outcomes in Australian secondary school students. METHODS MEDLINE, EMBASE, CINAHL, ERIC and Informit were systematically searched on 4th November 2022. Studies in any language evaluating nutrition interventions implemented in Australian secondary schools were included. Studies evaluating interventions conducted in primary schools or outside the school setting were excluded, as were any grey literature, systematic reviews and meta-analyses. Screening and data extraction were performed in duplicate. Quality was assessed using the Mixed Methods Appraisal Tool. RESULTS Thirteen studies (n = 27 224) reporting on nutrition interventions implemented in Australian secondary schools were included. Studies were conducted in five different states and a capital territory within Australia and were mostly randomised controlled trials. Most studies reported a significant improvement on nutrition-related health outcome measures (dietary behaviour n = 6, nutritional knowledge and attitudes n = 4 and anthropometric n = 1). CONCLUSIONS This review found limited studies reporting on nutrition interventions in Australian secondary schools. However, most were shown to be effective in improving nutrition-related health outcomes. SO WHAT?: Since there were limited studies in peer-reviewed journals, more research in this area is needed to confirm the effectiveness of nutrition interventions in Australian secondary schools and to assess long-term effects on student's health outcomes.
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Affiliation(s)
- Abigail Comeau
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Bradley Mertens
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Lavanya Bachwal
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jennifer Utter
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
- Department of Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia
| | - Louise van Herwerden
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
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Kolovelonis A, Syrmpas I, Marcuzzi A, Khudair M, Ng K, Tempest GD, Peric R, Bartoš F, Maier M, Brandes M, Carlin A, Ciaccioni S, Cortis C, Corvino C, Di Credico A, Drid P, Gallè F, Izzicupo P, Jahre H, Kongsvold A, Kouidi E, Mork PJ, Palumbo F, Rumbold PLS, Sandu P, Stavnsbo M, Vilela S, Woods C, Wunsch K, Capranica L, MacDonncha C, Ling FCM. DE-PASS best evidence statement (BESt): determinants of adolescents' device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis. BMC Public Health 2024; 24:1706. [PMID: 38926707 PMCID: PMC11202347 DOI: 10.1186/s12889-024-19136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents' device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings. METHODS A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents' device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked. PROSPERO ID CRD42021282874. RESULTS Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual-psychological, four individual-behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found. CONCLUSIONS Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents' device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents' PA/SB, including policy and environmental variables.
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Affiliation(s)
- Athanasios Kolovelonis
- Department of Physical Education and Sport Science, University of Thessaly, 42 100 Karies, Trikala, Greece.
| | - Ioannis Syrmpas
- Department of Physical Education and Sport Science, University of Thessaly, 42 100 Karies, Trikala, Greece
| | - Anna Marcuzzi
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mohammed Khudair
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Kwok Ng
- Faculty of Education, University of Turku, Turku, Finland
- Department of Physical Education and Sport Sciences, Physical Activity for Health Centre, University of Limerick, Limerick, Ireland
- Institute of Innovation and Sports Science, Lithuanian Sports University, Kaunas, Lithuania
| | - Gavin Daniel Tempest
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Ratko Peric
- Exercise Physiology Laboratory, OrthoSport Banja Luka, Banja Luka, Bosnia-Herzegovina
| | - František Bartoš
- Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Mirko Brandes
- Department of Prevention and Evaluation, Leibniz, Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University, Belfast, UK
| | - Simone Ciaccioni
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Cristina Cortis
- Department of Human Sciences, Society and Health, University of Cassino and Lazio Meridionale, Cassino, Italy
| | - Chiara Corvino
- Faculty of Economics, Department of Psychology, Universita Cattolica del Sacro Cuore, Milan, Italy
| | - Andrea Di Credico
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Francesca Gallè
- Department of Medical, Movement and Wellbeing Sciences, University of Naples "Parthenope", Naples, Italy
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Henriette Jahre
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Atle Kongsvold
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Evangelia Kouidi
- Laboratory of Sports Medicne, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Federico Palumbo
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | - Petru Sandu
- Health Promotion and Evaluation, National Institute of Public Health in Romania, Bucharest, Romania
| | - Mette Stavnsbo
- Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Sofia Vilela
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - Catherine Woods
- Physical Activity for Health Cluster, Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Laura Capranica
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Ciaran MacDonncha
- Physical Activity for Health Cluster, Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Fiona Chun Man Ling
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
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Spiga F, Tomlinson E, Davies AL, Moore TH, Dawson S, Breheny K, Savović J, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 12 to 18 years old. Cochrane Database Syst Rev 2024; 5:CD015330. [PMID: 38763518 PMCID: PMC11102824 DOI: 10.1002/14651858.cd015330.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect. AUTHORS' CONCLUSIONS The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Contardo Ayala AM, Parker K, Mazzoli E, Lander N, Ridgers ND, Timperio A, Lubans DR, Abbott G, Koorts H, Salmon J. Effectiveness of Intervention Strategies to Increase Adolescents' Physical Activity and Reduce Sedentary Time in Secondary School Settings, Including Factors Related to Implementation: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:25. [PMID: 38472550 DOI: 10.1186/s40798-024-00688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness. OBJECTIVE The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation. METHODS Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained. RESULTS Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles. CONCLUSION While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained. REGISTRATION PROSPERO (CRD42020169988).
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Affiliation(s)
- Ana María Contardo Ayala
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
| | - Kate Parker
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Emiliano Mazzoli
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Nicola D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, , Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Newcastle, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Hunter Medical Research institute, New Lambton Heights, NSW, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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5
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Sequí-Domínguez I, Cavero-Redondo I, Álvarez-Bueno C, López-Gil JF, Martínez-Vizcaíno V, Pascual-Morena C. Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e41649. [PMID: 38381490 PMCID: PMC10918549 DOI: 10.2196/41649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 05/30/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND eHealth interventions have been postulated as a feasible, acceptable, and possibly effective tool to promote physical activity (PA) among children and adolescents; however, a comprehensive quantitative analysis of the effects of eHealth interventions promoting PA is lacking. OBJECTIVE This study aims to conduct a systematic review and meta-analysis on experimental studies reporting the effects of eHealth interventions aimed at promoting PA on PA parameters and sedentary behavior parameters in children and adolescents. METHODS The CENTRAL, MEDLINE, Embase, and Web of Science databases were searched from inception to February 2022 for randomized controlled trials that analyzed the effects of eHealth interventions aimed at promoting PA on PA and sedentary parameters in children and adolescents. The Hartung-Knapp-Sidik-Jonkman random effects method was used to determine the mean differences (MDs) with their respective 95% CIs. The risk of bias was assessed using the Risk of Bias 2 (RoB2; Cochrane) tool and its extension for cluster randomized controlled trials. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS A total of 20 trials reporting the effects of different eHealth interventions aimed at promoting PA were included. Results for each parameter were as follows: counts per minute (MD -16.11 counts, 95% CI -122.76 to 90.53; k=3; n=402; I2=69%; favoring control), steps per day (MD 593.46 steps, 95% CI -2102.27 to 3289.19; k=2; n=152; I2=0%; favoring intervention [FI]), moderate to vigorous PA (MD -1.99 min/d, 95% CI -8.95 to 4.96; k=14; n=2336; I2=86%; favoring control), light PA (MD 3.28 min/d, 95% CI -15.48 to 22.04; k=5; n=355; I2=67%; FI), screen time (MD -31.48 min/d, 95% CI -68.62 to 5.65; k=5; n=904; I2=0%; FI), and sedentary time (MD -33.12 min/d, 95% CI -57.27 to -8.97; k=8; n=819; I2=75%; FI). Our results should be interpreted cautiously because of important limitations such as the scarcity of evidence, overall risk of bias, and low to very low certainty of evidence. CONCLUSIONS We did not find conclusive evidence regarding the impact of PA-targeted eHealth interventions on PA parameters, but the very low certainty of evidence suggests that eHealth interventions may reduce sedentary time in children and adolescents. Our results may have important scientific implications as they highlight that the rapid development of eHealth interventions to promote PA lacks robust supporting evidence. TRIAL REGISTRATION PROSPERO CRD42020211020; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211020.
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Affiliation(s)
- Irene Sequí-Domínguez
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion, Cuenca, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Carlos Pascual-Morena
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
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6
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Silva Filho RCDS, Sasaki JE, Gordia AP, Andaki ACR. Effects of a Physical Exercise Program and Health Advice on Sedentary Behavior of Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1064. [PMID: 36673819 PMCID: PMC9859598 DOI: 10.3390/ijerph20021064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 06/17/2023]
Abstract
Sedentary behavior (SB) is a risk factor for chronic non-communicable diseases. This study aimed to assess the effects of an extracurricular physical exercise program and health advice on SB in adolescents. This was a non-randomized experimental study involving 19 adolescents divided into an intervention group (IG) and a control group (CG), aged 13-16 years from a public school in a Brazilian municipality. SB was measured using self-reports and accelerometers. The intervention included physical exercise and health advice. Repeated measures analysis of variance with a significance level of α = 5% was used. There was a time*group interaction for the subscapular fold ((pre IG = 16.30 mm vs. CG = 13.44 mm, post IG = 14.00 mm vs. CG = 15.89 mm) p = 0.001), and VO2MAX ((pre IG = 32.75 mL/kg/min vs. CG = 30.66 mL/kg/min, post IG = 35.76 mL/kg/min vs. CG = 29.28 mL/kg/min) p = 0.008). The accelerometer showed significant differences between groups in the total SB ((pre IG = 647.49 min/day vs. CG = 535.24 min/day, post IG = 614.02 min/day vs. CG = 586.97 min/day) p = 0.045), with a significant decrease in the IG. In conclusion, an extracurricular physical exercise program and health advice was effective in reducing SB in adolescents.
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Affiliation(s)
| | - Jeffer Eidi Sasaki
- Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba 38061-500, MG, Brazil
| | - Alex Pinheiro Gordia
- Teachers Training Center, Federal University of Recôncavo da Bahia, Amargosa 45300-000, BA, Brazil
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Munusamy G, Shanmugam R. Prevention and Interventional Strategies of Adolescent Obesity / Overweight. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.23.133147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: It’s a known factor that obesity and overweight among adolescentsare major emerging global health problems associated with morbidityand mortality throughout their life in developed and developing countries. There is evidence that reducing overweight and obesity by increasing awareness, self-efficacy, and contemplation to adopt a health-promoting lifestyle.The aim of this review how the theory and model used to reduce this burden through vicarious interventional activities among adolescence (10-19 years)in a school setting. Methods: A literature search was performed in four databases to identify published studies between January 2009 and December 2019. Randomized control trial exploring the multiple interventional effects on obesity and overweight by utilization of with or without theoretical constructs and outcome on body mass index. Results: Originally references searched were 2112 abstracts and full-text articles. The total population was 34,846 adolescents. Most of the multiple interventionshad little positive effect onphysical activity, dietary intake, and sedentary behavior changes directly on BMI. Only three studies show changes in behavior through theory. Minimal studies reported the involvement and motivation of parents, friends, and teachers for themselves and adolescents. Conclusion: The contemporary review to visualizemultiple interventions, and how models and theory focused on various pragmatic activities in the delivery and outcome in school settings among adolescents.
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8
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Verswijveren SJJM, Abbott G, Lai SK, Salmon J, Timperio A, Brown H, Macfarlane S, Ridgers ND. Mediators of Effects on Physical Activity and Sedentary Time in an Activity Tracker and Behavior Change Intervention for Adolescents: Secondary Analysis of a Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e35261. [PMID: 35972777 PMCID: PMC9428775 DOI: 10.2196/35261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/04/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Adolescence is a critical age where steep declines in physical activity and increases in sedentary time occur. Promoting physical activity should therefore be a priority for short- and long-term health benefits. Wearable activity trackers in combination with supportive resources have the potential to influence adolescents' physical activity levels and sedentary behavior. Examining the pathways through which such interventions work can inform which mediators to target in future studies. OBJECTIVE The aim of this paper is to examine the impact of the Raising Awareness of Physical Activity (RAW-PA) intervention on potential mediators of behavior change after intervention, and whether these mediated the intervention effects on physical activity and sedentary time at 6-month follow-up. METHODS RAW-PA was a 12-week intervention, grounded in social cognitive theory and behavioral choice theory, aimed at increasing physical activity among inactive adolescents through combining a wearable activity tracker with digital resources delivered via a private Facebook group (n=159 complete cases). The targeted potential mediators were identified from previous studies conducted in adolescents and included self-efficacy, peer support, family support, teacher support, self-regulation strategies, barriers, and enjoyment. Outcomes included sedentary time as well as light- and moderate-to-vigorous-intensity physical activity. A series of mixed linear models were used to estimate intervention effects on physical activity and sedentary behavior at follow-up and on potential mediators after intervention and to test whether there were indirect effects of the intervention on physical activity and sedentary behavior via mediators. RESULTS Adolescents in the intervention group (n=75) engaged in higher sedentary time and lower light intensity at 6-month follow-up compared to the wait-list controls (n=84). There were no intervention effects for moderate-to-vigorous-intensity physical activity. The intervention group perceived more barriers to physical activity than the wait-list control group at 6-month follow-up (mean adjusted difference=1.77; 95% CI 0.19-3.34; P=.03). However, indirect effects for each outcome were not statistically significant, indicating that perceived barriers to physical activity did not mediate intervention effects for physical activity or sedentary time. CONCLUSIONS RAW-PA did not beneficially impact hypothesized mediators in these inactive adolescents, despite strategies being designed to target them. This suggests that the lack of overall intervention effects on physical activity and sedentary time observed in the RAW-PA study could be due to the limited impact of the intervention on the targeted mediators. Future studies should consider different strategies to target theoretically informed potential mediators and identify intervention strategies that effectively target key mediators to improve physical activity among inactive adolescents. Finally, intervention effects according to level of wearable tracker use or level of engagement with the intervention should be explored. This may provide important insights for designing successful wearable activity tracker interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000899448; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-016-3945-5.
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Affiliation(s)
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Samuel K Lai
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Helen Brown
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | | | - Nicola D Ridgers
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:126. [PMID: 34530867 PMCID: PMC8447784 DOI: 10.1186/s12966-021-01189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time. METHODS A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. RESULTS The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. CONCLUSIONS Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.
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Affiliation(s)
- Alexis Jones
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
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Sex/gender considerations in school-based interventions to promote children’s and adolescents’ physical activity. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [DOI: 10.1007/s12662-021-00724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractPhysical inactivity is an increasing problem worldwide, but especially among girls. This difference by gender increases with age. Schools serve virtually all young people in most parts of the world and can thus play an important role in promoting physical activity. In this systematic review, we qualitatively and comprehensively assessed the treatment of sex/gender considerations (from study design to discussion of results) in 56 school-based intervention studies aiming to promote physical activity in children and adolescents. In all 56 studies, the factor of sex/gender was only rudimentarily considered, regardless of the effectiveness of the intervention. The meta-analysis revealed that the interventions had significant but relatively small effects with both girls and boys, along with high heterogeneity. To obtain better information about effective strategies that promote physical activity for both girls and boys equally, researchers conducting future intervention studies should pay attention to sex/gender differences and report on how they take this factor into account.
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Hargreaves N, Forneris T, Sabiston C, Berg S, Kowalski K, Ferguson L, Caperchione C. "More than just another physical activity program": exploring the GUM program for at-risk adolescent girls. Health Promot Int 2021; 37:6179650. [PMID: 33749728 DOI: 10.1093/heapro/daab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Physical activity (PA) levels among adolescent girls continue to steadily decline, especially for those classified as 'at-risk'. To mitigate these trends, Girls United and on the Move (GUM) was created as a dual-component PA and psychosocial program. The primary purpose of this study was to explore participant experiences within GUM, with a secondary purpose of qualitatively informing future PA programs for 'at-risk' adolescent girls. Semi-structured interviews (N = 30) were conducted with a purposeful sample of girls from the GUM program. An inductive thematic analysis was utilized to analyze verbatim transcripts. Two themes were generated from the data: 1) Girls uplifting girls, outlining the importance of a girls-only environment and introducing opportunities for alternative PAs, and 2) finding balance between the physical and psychological, detailing the importance of the dual-component program. These findings provide support for the acceptability of an integrated psychosocial and PA program for at-risk adolescent girls.
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Affiliation(s)
- Nicole Hargreaves
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - Tanya Forneris
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - Catherine Sabiston
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - Stephen Berg
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - Kent Kowalski
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - Leah Ferguson
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - Cristina Caperchione
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, 3333 University Way, Kelowna, BC V1V 1V7, Canada
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Marzi I, Emmerling S, Demetriou Y, Bucksch J, Schulze C, Brindley C, Reimers AK. Interventions Aiming to Promote Active Commuting in Children and Adolescents: An Evaluation From a Sex/Gender Perspective. Front Sports Act Living 2020; 2:590857. [PMID: 33345167 PMCID: PMC7739596 DOI: 10.3389/fspor.2020.590857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022] Open
Abstract
Active commuting (AC) provides numerous health benefits and is one way to improve physical activity in children and adolescents. Boys are more likely to use active transport modes than girls. Girls and boys benefit differently from interventions that promote AC. The aim of this systematic review is to evaluate the effects of interventions on girls and boys and to appraise the extent to which previous studies have taken sex/gender into account. Eleven electronic databases were searched to identify all relevant randomized and non-randomized controlled trials based on a priori defined eligibility criteria. Two independent reviewers screened the literature for eligibility and assessed risk of bias. Semiquantitative analyses were conducted to evaluate the effects of intervention effects by taking sex/gender aspects into account. To evaluate sex/gender considerations in interventional studies, a recently developed sex/gender checklist was applied. Twelve studies were included that examined intervention effects on AC in girls and boys. Three intervention studies showed significant effects in increasing AC, with one study favoring girls, one favoring boys, and another focusing on a single sex/gender (only girls). According to the checklist, the overall sex/gender rating highlighted a lack of information in sex/gender consideration. Studies with and without significant effects indicated no differences in the sex/gender checklist. The results indicate that sex/gender is not considered adequately in primary interventional research on AC. To evaluate the effectiveness of intervention in boys and girls, detailed analyses of sex/gender are required, and better reporting about sex/gender-specific intervention content is necessary. In future health research to promote AC, sex/gender should be systematically taken into account.
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Affiliation(s)
- Isabel Marzi
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sandra Emmerling
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Yolanda Demetriou
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Jens Bucksch
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Heidelberg, Germany
| | - Carolin Schulze
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Catherina Brindley
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Heidelberg, Germany
| | - Anne Kerstin Reimers
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Dickson TJ, Darcy S. A question of time: a brief systematic review and temporal extension of the socioecological framework as applied in sport and physical activity. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tracey J. Dickson
- University of Canberra Research Institute for Sport and Exercise University of Canberra Canberra ACT Australia
| | - Simon Darcy
- Australian Centre for Olympic and Sport Studies UTS Business School University of Technology Sydney NSW Australia
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Vondung C, Demetriou Y, Reimers AK, Schlund A, Bucksch J. A Sex/Gender Perspective on Interventions to Reduce Sedentary Behaviour in Girls and Boys: Results of the genEffects Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145231. [PMID: 32698412 PMCID: PMC7400439 DOI: 10.3390/ijerph17145231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 01/02/2023]
Abstract
This systematic review aims to evaluate the extent of sex/gender consideration and effectiveness of interventions designed to reduce sedentary behaviour (SB). We searched for randomised or non-randomised controlled trials with the outcome SB and a sex/gender analysis in eleven electronic databases. Sixty-seven studies were included. Sex/gender considerations were qualitatively rated. Sex/gender was reported separately in 44.8% of studies, 14.9% of studies conducted a sex/gender interaction analysis, and 19.4% enrolled either girls or boys. SB was significantly reduced for girls in 16.4%, for boys in 11.9% and for both in 13.4%. No sex/gender intervention effect was found in 38.8%. According to the qualitative rating, studies without significant sex/gender effects reached "detailed" rating twice as often as studies finding a significant intervention effect for either girls or boys, or both. Overall, no clear pattern according to the qualitative rating and in terms of intervention effectiveness can be drawn. The results reveal a lack of sufficient sex/gender information in intervention planning and delivery. Further research should consider analysing sex/gender intervention effects as well as consider sex/gender inclusive intervention planning and delivery.
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Affiliation(s)
- Catherina Vondung
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Keplerstrasse 87, 69120 Heidelberg, Germany;
- Correspondence:
| | - Yolanda Demetriou
- Department of Sport and Health Sciences, Technical University of Munich, Georg- Brauchle-Ring 62, 80992 Munich, Germany; (Y.D.); (A.S.)
| | - Anne K. Reimers
- Department of Sport Science and Sport, Friedrich-Alexander-University of Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany;
| | - Annegret Schlund
- Department of Sport and Health Sciences, Technical University of Munich, Georg- Brauchle-Ring 62, 80992 Munich, Germany; (Y.D.); (A.S.)
| | - Jens Bucksch
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Keplerstrasse 87, 69120 Heidelberg, Germany;
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Paiement K, Drapeau V, Gilbert JA, Lemoyne J, Moreau N, Monthuy-Blanc J, Tremblay J, Marcil V, Mathieu ME. Changes in Lifestyle Habits among Adolescent Girls after FitSpirit Participation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124388. [PMID: 32570878 PMCID: PMC7346009 DOI: 10.3390/ijerph17124388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 01/20/2023]
Abstract
Adolescence is a crucial time in the development and maintenance of lifestyle habits. Interventions to improve health-related behaviors are important, including those that can contribute to an increase in physical activity (PA). During adolescence, PA typically decreases with age, particularly in girls. The FitSpirit program offers services that help Canadian schools from Quebec and Ontario implement PA interventions for adolescent girls. This study aimed to evaluate changes in participants' PA levels and lifestyle habits (sedentary time, sleep duration and eating habits) and to assess whether these changes depended on adherence to the Canadian 24-Hour Movement Guidelines and Canada's Food Guide recommendations at enrollment. At the time of FitSpirit registration (between December 2018 and March 2019) and in May/June 2019, 73 participants answered online questionnaires. The participants reported improvements, with an increase in the number of days with PA and a decrease in daily consumption of sweets. The greatest changes were observed in those who did not adhere to the Canadian recommendations before enrollment and who significantly increased their number of days with PA and their consumption of fruits and vegetables, and decreased their screen time. In conclusion, participation in FitSpirit improved several health behaviors among adolescent girls, particularly those who did not comply with the Canadian recommendations at enrollment.
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Affiliation(s)
- Karine Paiement
- École de Kinésiologie et des Sciences de L’activité Physique, Université de Montréal, 2100 boul. Édouard-Montpetit, Montréal, QC H3T 1J4, Canada; (K.P.); (J.-A.G.); (J.T.)
- Département de Nutrition, Université de Montréal, 2405 chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada;
| | - Vicky Drapeau
- Département D’éducation Physique, Université Laval, 2300 rue de la Terrasse, Québec, QC G1V 0A6, Canada;
| | - Jo-Anne Gilbert
- École de Kinésiologie et des Sciences de L’activité Physique, Université de Montréal, 2100 boul. Édouard-Montpetit, Montréal, QC H3T 1J4, Canada; (K.P.); (J.-A.G.); (J.T.)
| | - Jean Lemoyne
- Département des Sciences de L’act. Physique, Université du Québec à Trois-Rivières, 33351 boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada;
| | - Nicolas Moreau
- School of Social Work, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5, Canada;
| | - Johana Monthuy-Blanc
- GR2TCA-Loricorps, Groupe de Recherche Transdisciplinaire des Troubles du Comportement Alimentaire, Département des Sciences de l’Éducation, Université du Québec à Trois-Rivières, 33351 boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada;
| | - Jonathan Tremblay
- École de Kinésiologie et des Sciences de L’activité Physique, Université de Montréal, 2100 boul. Édouard-Montpetit, Montréal, QC H3T 1J4, Canada; (K.P.); (J.-A.G.); (J.T.)
| | - Valérie Marcil
- Département de Nutrition, Université de Montréal, 2405 chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada;
- Centre de recherche du CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada
| | - Marie-Eve Mathieu
- École de Kinésiologie et des Sciences de L’activité Physique, Université de Montréal, 2100 boul. Édouard-Montpetit, Montréal, QC H3T 1J4, Canada; (K.P.); (J.-A.G.); (J.T.)
- Centre de recherche du CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada
- Correspondence: ; Tel.: +1-514-343-6736
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St George SM, Agosto Y, Rojas LM, Soares M, Bahamon M, Prado G, Smith JD. A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obes Rev 2020; 21:e12939. [PMID: 31808277 PMCID: PMC6980892 DOI: 10.1111/obr.12939] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Lourdes M Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Bahamon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Bock BC, Dunsiger SI, Ciccolo JT, Serber ER, Wu WC, Sillice M, Marcus BH. Mediators of physical activity between standard exercise and exercise video games. Health Psychol 2019; 38:1107-1115. [PMID: 31512923 PMCID: PMC6861627 DOI: 10.1037/hea0000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Exercise video games (EVGs) may offer an attractive, sustainable alternative or supplement to traditional modes of exercise. Understanding the psychosocial factors that influence the appeal of EVGs is important for improving the efficacy of video games as a method of promoting the uptake and long-term maintenance of physical activity. METHODS This study examined changes in psychosocial constructs from self-determination theory and self-efficacy theory as mediators of intervention efficacy among 189 healthy, sedentary adults randomized to 12-week programs of either EVGs or standard exercise (e.g., treadmill walking, stationary cycling) followed by 6 months of follow-up. The EVG group engaged in significantly more weekly minutes of moderate to vigorous physical activity (MVPA) at the end of treatment compared with the standard exercise group. Univariate and multivariate mediational models were used to examine theoretically derived psychosocial constructs as potential mediators of differential intervention effects. RESULTS Univariate mediational models suggest a significant indirect effect of treatment on MVPA outcomes through enjoyment, self-efficacy, stress management, depressive symptoms, and positive engagement (p < .05). Multiple mediational analyses confirm all the univariate results (p < .05), with the exception of enjoyment. CONCLUSIONS Differences in the efficacy of EVG versus standard exercise interventions were mediated by several psychosocial constructs, suggesting that qualities specific to game play may enhance adherence to physical activity both in and outside of the laboratory environment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Beth C Bock
- Centers for Behavioral and Preventive Medicine
| | | | | | - Eva R Serber
- Department of Psychiatry and Behavioral Sciences
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Robbins LB, Wen F, Ling J. Mediators of Physical Activity Behavior Change in the "Girls on the Move" Intervention. Nurs Res 2019; 68:257-266. [PMID: 30882562 PMCID: PMC6602810 DOI: 10.1097/nnr.0000000000000359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The minimal effect of interventions to date on increasing young adolescent girls' physical activity (PA) may be due to inadequate understanding of the mechanisms underlying behavior change, yet sparse research testing a PA intervention has examined the capacity of theories to explain PA, particularly when using objective measures. OBJECTIVES The aim of the study was to examine whether constructs from the health promotion model and self-determination theory mediated changes in moderate-to-vigorous physical activity (MVPA) following a 17-week intervention. METHODS The study was a secondary analysis of data from a group randomized trial, including 12 intervention and 12 control schools in the Midwestern United States. Data were collected in 2012-2016. Girls (fifth- to eighth-grade, N = 1,519) completed surveys on perceived benefits and enjoyment of PA, PA self-efficacy, social support and motivation for PA, and barriers to PA and wore accelerometers. RESULTS The final path model had a good fit: χ(4) = 2.48, p = .648; goodness-of-fit index = 1; comparative fit index = 1; root-mean-square error of approximation = 0; standardized root-mean-square residual = 0.01. For MVPA change from baseline to postintervention, enjoyment (B = 24.48, p < .001) and social support (B = 30.48, p < .001) had a positive direct effect, whereas the intervention had a positive indirect effect through enjoyment and social support (B = 9.13, p < .001). Enjoyment (B = -13.83, p < .001) and social support (B = -17.22, p < .001) had a negative indirect effect on MVPA change from postintervention to follow-up. DISCUSSION Enjoyment of PA and social support for PA may be important mediators of PA in young adolescent girls and warrant consideration when designing interventions.
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Affiliation(s)
- Lorraine B Robbins
- Lorraine B. Robbins, PhD, RN, FNP-BC, FAAN, is Associate Professor, Michigan State University College of Nursing, East Lansing. Fujun Wen, MEd, is Master's Degree in Biostatistics Student, Michigan State University Department of Epidemiology and Biostatistics, East Lansing. Jiying Ling, PhD, RN, is Assistant Professor, Michigan State University College of Nursing, East Lansing
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Barnett TA, Kelly AS, Young DR, Perry CK, Pratt CA, Edwards NM, Rao G, Vos MB. Sedentary Behaviors in Today's Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e142-e159. [PMID: 30354382 DOI: 10.1161/cir.0000000000000591] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This scientific statement is about sedentary behavior and its relationship to obesity and other cardiometabolic outcomes in youth. A deleterious effect of sedentary behavior on cardiometabolic health is most notable for screen-based behaviors and adiposity; however, this relation is less apparent for other cardiometabolic outcomes or when sedentary time is measured with objective movement counters or position monitors. Increasing trends of screen time are concerning; the portability of screen-based devices and abundant access to unlimited programming and online content may be leading to new patterns of consumption that are exposing youth to multiple pathways harmful to cardiometabolic health. This American Heart Association scientific statement provides an updated perspective on sedentary behaviors specific to modern youth and their impact on cardiometabolic health and obesity. As we reflect on implications for practice, research, and policy, what emerges is the importance of understanding the context in which sedentary behaviors occur. There is also a need to capture the nature of sedentary behavior more accurately, both quantitatively and qualitatively, especially with respect to recreational screen-based devices. Further evidence is required to better inform public health interventions and to establish detailed quantitative guidelines on specific sedentary behaviors in youth. In the meantime, we suggest that televisions and other recreational screen-based devices be removed from bedrooms and absent during meal times. Daily device-free social interactions and outdoor play should be encouraged. In addition, parents/guardians should be supported to devise and enforce appropriate screen time regulations and to model healthy screen-based behaviors.
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Bock BC, Dunsiger SI, Wu WC, Ciccolo JT, Serber ER, Lantini R, Marcus BH. Reduction in HbA1c with Exercise videogames among participants with elevated HbA1c: Secondary analysis of the Wii Heart Fitness trial. Diabetes Res Clin Pract 2019; 154:35-42. [PMID: 31238061 PMCID: PMC6698204 DOI: 10.1016/j.diabres.2019.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
AIMS Physical activity plays an important role in blood glucose management, yet most adults with elevated blood glucose do not engage in regular physical activity. Exercise videogames (EVGs) may be an attractive alternative for persons who have not found standard exercise modalities appealing. METHODS This sub-study within a larger trial examined the effects of 12 weeks of EVGs versus standard exercise (e.g., treadmill, cycling) and a control condition among individuals with elevated HbA1c (100% prediabetic). This study was conducted at a university research lab. Outcomes included HbA1c and weekly minutes of moderate to vigorous physical activity (MVPA) assessed using self-report and accelerometer.Other health risk indices (e.g., lipids) and psychosocial constructs shown to influence exercise participation (e.g., intrinsic motivation) were assessed. RESULTS Participants (n = 84), averaged age 51.4 years (range 20-79), 80% were female, and 77.4% were non-Hispanic. Baseline HbA1c ranged from 5.7% to 6.4% (39-49 mmol/mol). At week 12, EVG participants demonstrated an average 2% reduction in HbA1c compared to a 0.6% reduction in Standard and Control groups (p's = 0.04 and 0.03). EVG participants engaged in significantly more MVPA than Standard (+17 min/week) and Controls (+54 min/week) (p's < 0.05), had reduced LDL cholesterol (p = 0.05) and trends suggesting reduced body fat (p = 0.10). EVG participants reported higher exercise enjoyment and motivation compared to other participants. CONCLUSIONS EVGs may be an attractive and effective tool to improve management of blood glucose that might contribute toward preventing the onset of type 2 diabetes among those with prediabetes.
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Affiliation(s)
- Beth C Bock
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States; Department of Behavioral & Social Sciences, School of Public Health of Brown University, Providence, RI, United States.
| | - Shira I Dunsiger
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Wen-Chih Wu
- Department of Medicine, Alpert Medical School of Brown University and Department of Cardiology, Providence VA Medical Center, Providence, RI, United States
| | - Joseph T Ciccolo
- Department of Applied Physiology, Teachers College at Columbia University, New York, NY, United States
| | - Eva R Serber
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Ryan Lantini
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Bess H Marcus
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States; Department of Behavioral & Social Sciences, School of Public Health of Brown University, Providence, RI, United States
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Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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Van Dyck D, D'Haese S, Plaete J, De Bourdeaudhuij I, Deforche B, Cardon G. Opinions towards physical activity interventions using Facebook or text messaging: Focus group interviews with vocational school-aged adolescents. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:654-664. [PMID: 30398291 DOI: 10.1111/hsc.12679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 09/01/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
Feasible and effective interventions to promote physical activity among vocational school-aged adolescents are strongly needed. Text messaging and Facebook are feasible and acceptable delivery modes for PA interventions among youth. However, little is known about the opinion of vocational school-aged adolescents regarding behavioural change techniques that can be applied through Facebook or text messaging. Therefore, our aim was to gain insight into the opinions of vocational school-aged adolescents towards the use of different behaviour change techniques and towards Facebook/text messaging as a delivery mode for PA interventions. Six focus groups were conducted with 41 adolescents from the first grade (12-14 years) of secondary vocational schools in Flanders (Belgium). In total 41 adolescents participated and completed a questionnaire about their text messaging and Facebook use prior to group discussions. Focus group discussions were audio-recorded and analysed using a thematic analysis method in Nvivo. Participants thought that different behaviour change techniques (e.g., providing feedback, goal setting, self-monitoring, social comparison) could be integrated in a PA intervention using text messaging and Facebook and were enthusiastic about participating in such an intervention. They indicated that text messages are an easy way to receive information about PA, and that a group page on Facebook is ideal to share information with others. Participants deemed it very important that the group page on Facebook would only include peers with whom they also share an offline connection. Furthermore, adolescents stressed the importance of having autonomy (e.g., to determine their personal activity goals, to self-monitor their behaviour) and of being active together with friends. This qualitative study revealed that the use of Facebook and text messaging is promising as a delivery method for PA interventions among vocational school-aged adolescents. The adolescents were keen to participate in an intervention that integrates behaviour change techniques using text messaging or Facebook.
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Affiliation(s)
- Delfien Van Dyck
- Research Foundation Flanders, Brussels, Belgium
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sara D'Haese
- Research Foundation Flanders, Brussels, Belgium
- Flemish Institute Healthy Living, Brussels, Belgium
| | | | - Ilse De Bourdeaudhuij
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Benedicte Deforche
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Böhm B, Karwiese SD, Böhm H, Oberhoffer R. Effects of Mobile Health Including Wearable Activity Trackers to Increase Physical Activity Outcomes Among Healthy Children and Adolescents: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e8298. [PMID: 31038460 PMCID: PMC6658241 DOI: 10.2196/mhealth.8298] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 06/18/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children and adolescents do not meet the current recommendations on physical activity (PA), and as such, the health-related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA. OBJECTIVE The aim of this review was to systematically evaluate the effects of mobile health (mHealth) and wearable activity trackers on PA-related outcomes in this target group. METHODS Electronic databases such as the Cochrane Central Register of Controlled Trials, PubMed, Scopus, SPORTDiscus, and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to June 2018. Those included were articles that contained descriptions of interventions designed to increase PA among children (aged 6 to 12 years) only, or adolescents (aged 13 to 18 years) only, or articles that include both populations, and also, articles that measured at least 1 PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets, or mobile apps) or wearable activity trackers. Randomized controlled trials (RCTs) and non-RCTs, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with a PA comparison between groups were assessed for methodological quality. RESULTS In total, 857 articles were identified. Finally, 7 studies (5 with tools of mHealth and 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used an RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone apps were used as a tool. Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as an intervention and evaluation tool. No evidence was found for the effect of mHealth tools, respectively wearable activity trackers, on PA-related outcomes. CONCLUSIONS Given the small number of studies, poor compliance with accelerometers as a measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence.
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Affiliation(s)
- Birgit Böhm
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Svenja D Karwiese
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Aschau im Chiemgau, Germany
| | - Renate Oberhoffer
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
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Vieira JAJ, Lima LRAD, Silva DAS, Petroski EL. Effectiveness of a multicomponent intervention on the screen time of Brazilian adolescents: non-randomized controlled study. MOTRIZ: REVISTA DE EDUCACAO FISICA 2018. [DOI: 10.1590/s1980-657420180003e0046-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ludwig K, Arthur R, Sculthorpe N, Fountain H, Buchan DS. Text Messaging Interventions for Improvement in Physical Activity and Sedentary Behavior in Youth: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e10799. [PMID: 30224335 PMCID: PMC6231724 DOI: 10.2196/10799] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The use of text messages (short message service, SMS) to change physical activity and sedentary behavior in youth is of interest due to the need for novel, more effective intervention approaches. Previous reviews have examined a variety of technology-based interventions and their impact on different health behaviors, but evidence regarding the impact of just SMS on physical activity and sedentary behavior is lacking. OBJECTIVE The aim of this study was to assess the effectiveness and use of theory of SMS interventions for improving physical activity and sedentary behavior in youth. METHODS Authors systematically searched electronic databases from March to November 2017. Citations were sifted using additional reviewers, and a qualitative synthesis of eligible studies was conducted using piloted data extraction forms. To be eligible for inclusion, studies had to be of a randomized controlled or quasi-experimental design, incorporate SMS, involve adolescents between the ages of 10 and 19 years, and assess at least one physical activity or sedentary behavior outcome. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. RESULTS A total of 13 studies reporting 11 interventions were included in the qualitative analysis. Studies included interventions that were conducted in schools, online, or face-to-face. Studies were of high heterogeneity with regard to study duration, participant characteristics, intervention content, and outcome measures. Findings were equivocal with regard to intervention effectiveness for physical activity and sedentary behavior. Overall, 7 interventions resulted in an improvement for physical activity and 6 for sedentary behavior. All studies were judged to be of high risk of bias for at least 1 item. CONCLUSIONS Some studies in this review showed promising results for using SMS to improve physical activity and sedentary behavior in youth. High heterogeneity of design and outcome measures precluded data pooling and conclusions as to which specific intervention elements are linked to increased effectiveness cannot be drawn. The authors propose incorporating the following elements in future studies: specific focus on desired health behavior; mixed-methods design; include long-term follow-up; include self-monitoring, goal setting, and feedback; combine SMS with a mobile app; and send 3 or more SMS text messages per week. More rigorous studies are needed to explore the relationship between intervention effectiveness and specific intervention components such as content and delivery.
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Affiliation(s)
- Kim Ludwig
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, United Kingdom
| | - Rosie Arthur
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, United Kingdom
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, United Kingdom
| | - Hollie Fountain
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Duncan S Buchan
- Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, United Kingdom
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Rose T, Barker M, Jacob C, Morrison L, Lawrence W, Strömmer S, Vogel C, Woods-Townsend K, Farrell D, Inskip H, Baird J. A Systematic Review of Digital Interventions for Improving the Diet and Physical Activity Behaviors of Adolescents. J Adolesc Health 2017; 61:669-677. [PMID: 28822682 PMCID: PMC5702542 DOI: 10.1016/j.jadohealth.2017.05.024] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 02/03/2023]
Abstract
Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data.
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Affiliation(s)
- Taylor Rose
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom.
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Chandni Jacob
- Academic Unit of Human Development and Health, Faculty of Medicine,
University of Southampton, Southampton UK SO16 6YD
| | - Leanne Morrison
- Academic Unit of Psychology, University of Southampton, Southampton
UK SO17 1BJ
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD,Southampton Education School, Faculty of Social and Human Sciences,
University of Southampton, Southampton UK SO17 1BJ
| | | | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit (University of Southampton),
Southampton General Hospital, Southampton UK SO16 6YD,NIHR Southampton Biomedical Research Centre, University Hospital
Southampton NHS Foundation Trust, University of Southampton, Southampton UK SO16
6YD
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Scott JJ, Rowlands AV, Cliff DP, Morgan PJ, Plotnikoff RC, Lubans DR. Comparability and feasibility of wrist- and hip-worn accelerometers in free-living adolescents. J Sci Med Sport 2017; 20:1101-1106. [DOI: 10.1016/j.jsams.2017.04.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/15/2017] [Accepted: 04/16/2017] [Indexed: 11/26/2022]
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Owen MB, Curry WB, Kerner C, Newson L, Fairclough SJ. The effectiveness of school-based physical activity interventions for adolescent girls: A systematic review and meta-analysis. Prev Med 2017; 105:237-249. [PMID: 28964852 DOI: 10.1016/j.ypmed.2017.09.018] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/13/2017] [Accepted: 09/24/2017] [Indexed: 12/15/2022]
Abstract
Physical activity (PA) decreases during the transition from childhood to adolescence, with larger declines observed in girls. School-based interventions are considered the most promising approach for increasing adolescents' PA levels although, it is unclear which types of school-based interventions have the greatest impact. The objective of this systematic review is to assess the impact and design of school-based PA interventions targeting adolescent girls. A systematic search was conducted using four electronic databases (PubMed, Web of Science, SPORTDiscus and PsychInfo). This systematic review was registered with PROSPERO (Registration number: CRD42016037428) and PRISMA guidelines (2009) were followed throughout. Twenty studies were identified as meeting the inclusion criteria and were included in a narrative synthesis. Seventeen studies were eligible for inclusion in a meta-analysis. There was a significant small positive treatment effect for school-based PA interventions for adolescent girls (k=17, g=0.37, p<0.05). After an outlier was removed (residual z=7.61) the average treatment effect was significantly reduced, indicating a very small positive effect (k=16, g=0.07, p=0.05). Subgroup analysis revealed very small significant effects for multi-component interventions (k=7, g=0.09, p<0.05), interventions underpinned by theory (k=12, g=0.07, p<0.05), and studies with a higher risk of bias (k=13, g=0.09, p<0.05). Intervention effects were very small which indicates that changing PA behaviors in adolescent girls through school-based interventions is challenging. Multi-component interventions and interventions underpinned by theory may be the most effective approaches to positively change adolescent girls' PA.
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Affiliation(s)
- Michael B Owen
- Physical Activity and Health Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire, UK.
| | - Whitney B Curry
- Physical Activity and Health Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire, UK
| | | | - Lisa Newson
- Natural Sciences and Psychology, Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK
| | - Stuart J Fairclough
- Physical Activity and Health Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire, UK; Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Kelly S, Stephens J, Hoying J, McGovern C, Melnyk BM, Militello L. A systematic review of mediators of physical activity, nutrition, and screen time in adolescents: Implications for future research and clinical practice. Nurs Outlook 2017; 65:530-548. [PMID: 28823500 DOI: 10.1016/j.outlook.2017.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents are not meeting current recommendations for daily physical activity, nutrition, and screentime which has been associated with overweight and obesity. Understanding the mediators that facilitate teens in improving their healthy lifestyle behaviors may be helpful in halting this crisis. PURPOSE The purpose of this systematic review was to assess published findings regarding mediators of adolescent energy balance behaviors. METHOD We followed the Institute of Medicine guidelines for completing a systematic review. DISCUSSION Fourteen analyses from 12 studies were included with mediating variables tested for nutrition, physical activity, and screen time. Mediators were identified for all three behaviors and were primarily on the individual level of the social ecological model. CONCLUSIONS Combining findings from this and other reviews of mediators can help guide researchers in choosing mediating factors for specific target behaviors.
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Affiliation(s)
| | - Janna Stephens
- The Ohio State University College of Nursing, Columbus, OH
| | | | | | | | - Lisa Militello
- The Ohio State University College of Nursing, Columbus, OH
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Weihrauch-Blüher S, Koormann S, Brauchmann J, Wiegand S. [Electronic media in obesity prevention in childhood and adolescence]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:1452-1464. [PMID: 27757512 DOI: 10.1007/s00103-016-2455-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The increasing prevalence of childhood obesity is - amongst other factors - due to changed leisure time habits with decreased physical activity and increased media consumption. However, electronic media such as tablets and smartphones might also provide a novel intervention approach to prevent obesity in childhood and adolescence. OBJECTIVES A summary of interventions applying electronic media to prevent childhood obesity is provided to investigate short term effects as well as long term results of these interventions. METHODS A systematic literature search was performed in PubMed/Web of Science to identify randomized and/or controlled studies that have investigated the efficacy of electronic media for obesity prevention below the age of 18. RESULTS A total of 909 studies were identified, and 88 studies were included in the analysis. Active video games did increase physical activity compared to inactive games when applied within a peer group. Interventions via telephone had positive effects on certain lifestyle-relevant behaviours. Interventions via mobile were shown to decrease dropout rates by sending regular SMS messages. To date, interventions via smartphones are scarce for adolescents; however, they might improve cardiorespiratory fitness. The results from internet-based interventions showed a trend towards positive effects on lifestyle-relevant behaviors. The combination of different electronic media did not show superior results compared to interventions with only one medium. Interventions via TV, DVD or video-based interventions may increase physical activity when offered as an incentive, however, effects on weight status were not observed. DISCUSSION Children and adolescents currently grow up in a technology- and media-rich society with computers, tablets, smartphones, etc. used daily. Thus, interventions applying electronic media to prevent childhood obesity are contemporary. Available studies applying electronic media are however heterogeneous in terms of applied medium and duration. Positive effects on body composition were not observed, but only on certain lifestyle-relevant behaviours. In addition, these effects could only be seen in the short term. Follow-up data are currently scarce.
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Affiliation(s)
- Susann Weihrauch-Blüher
- IFB Adipositas Erkrankungen, Universitätsmedizin Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Deutschland.
| | - Stefanie Koormann
- IFB Adipositas Erkrankungen, Universitätsmedizin Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Deutschland
| | - Jana Brauchmann
- Interdisziplinäres SPZ, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Susanna Wiegand
- Interdisziplinäres SPZ, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Ridgers ND, Timperio A, Brown H, Ball K, Macfarlane S, Lai SK, Richards K, Ngan W, Salmon J. A cluster-randomised controlled trial to promote physical activity in adolescents: the Raising Awareness of Physical Activity (RAW-PA) Study. BMC Public Health 2017; 17:6. [PMID: 28052773 PMCID: PMC5209805 DOI: 10.1186/s12889-016-3945-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022] Open
Abstract
Background Recent technological advances provide an alternative yet underutilised opportunity for promoting physical activity in youth. The primary aim of the Raising Awareness of Physical Activity (RAW-PA) Study is to examine the short- and longer-term impact of a wearable activity monitor combined with digital behaviour change resources on adolescents’ daily physical activity levels. Methods/Design RAW-PA is a 12 week, multicomponent physical activity intervention that utilises a popular activity tracker (Fitbit® Flex) and supporting digital materials that will be delivered online via social media. The resources target key behaviour change techniques. The intervention structure and components have been informed by participatory research principles. RAW-PA will be evaluated using a cluster randomised controlled trial design with schools as the unit of randomisation. Twelve schools located in Melbourne, Australia, will allocated to either the intervention or wait-list control group. The target sample size is 300 Year 8 adolescents (aged 13–14 years). Participants’ moderate- to vigorous-intensity physical activity will be the primary outcome. Survey measures will be completed. Process factors (e.g. feasibility, acceptability/appeal, fidelity) will also be collected. Discussion To our knowledge, this study will provide some of the first evidence concerning the effect of wearable activity trackers and digital behaviour change resources on adolescents’ physical activity levels. This study will provide insights into the use of such technologies for physical activity promotion, which may have a significant impact on health education, promotion, practice and policy. Trial registration Australian and New Zealand Clinical Trials Registry No: ACTRN12616000899448. Date of registration: July 7, 2016.
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Affiliation(s)
- Nicola D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Helen Brown
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Susie Macfarlane
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Samuel K Lai
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kara Richards
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Winsfred Ngan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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Loescher LJ, Rains SA, Kramer SS, Akers C, Moussa R. A Systematic Review of Interventions to Enhance Healthy Lifestyle Behaviors in Adolescents Delivered via Mobile Phone Text Messaging. Am J Health Promot 2016; 32:865-879. [PMID: 27923885 DOI: 10.1177/0890117116675785] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review healthy lifestyle interventions targeted to adolescents and delivered using text messaging (TM). DATA SOURCE PubMed, Embase, CINAHL, PsycINFO, and Web of Science databases. Study Inclusion Criteria: Research articles published during 2011 to 2014; analyses focused on intervention targeting adolescents (10-19 years), with healthy lifestyle behaviors as main variables, delivered via mobile phone-based TM. DATA EXTRACTION The authors extracted data from 27 of 281 articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. DATA SYNTHESIS Adolescent and setting characteristics, study design and rigor, intervention effectiveness, challenges, and risk of bias. RESULTS Across studies, 16 (59.3%) of 27 included non-Caucasians. The gender was split for 22 (81.5%) of 27 studies. Thirteen studies were randomized controlled trials. There was heterogeneity among targeted conditions, rigor of methods, and intervention effects. Interventions for monitoring/adherence (n = 8) reported more positive results than those for health behavior change (n = 19). Studies that only included message delivered via TM (n = 14) reported more positive effects than studies integrating multiple intervention components. Interventions delivered using TM presented minimal challenges, but selection and performance bias were observed across studies. CONCLUSION Interventions delivered using TM have the potential, under certain conditions, to improve healthy lifestyle behaviors in adolescents. However, the rigor of studies varies, and established theory and validated measures have been inconsistently incorporated.
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Affiliation(s)
- Lois J Loescher
- 1 Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.,2 College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Stephen A Rains
- 3 Department of Communication, The University of Arizona, Tucson, AZ, USA
| | - Sandra S Kramer
- 4 Arizona Health Sciences Library-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Chelsie Akers
- 3 Department of Communication, The University of Arizona, Tucson, AZ, USA
| | - Renee Moussa
- 1 Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
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Howie EK, Straker LM. Rates of attrition, non-compliance and missingness in randomized controlled trials of child physical activity interventions using accelerometers: A brief methodological review. J Sci Med Sport 2016; 19:830-6. [DOI: 10.1016/j.jsams.2015.12.520] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 11/26/2022]
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Acceptance and Commitment Therapy and Implementation Intentions Increase Exercise Enjoyment and Long-Term Exercise Behavior Among Low-Active Women. CURRENT PSYCHOLOGY 2015. [DOI: 10.1007/s12144-015-9349-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sims J, Scarborough P, Foster C. The Effectiveness of Interventions on Sustained Childhood Physical Activity: A Systematic Review and Meta-Analysis of Controlled Studies. PLoS One 2015; 10:e0132935. [PMID: 26193472 PMCID: PMC4507864 DOI: 10.1371/journal.pone.0132935] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 06/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increased physical activity (PA) has been associated with a reduction in non-communicable disease risk factors and outcomes. However, interventions to increase childhood PA typically produce small to negligible effects. Recent reviews are limited due to lack of post-intervention follow-up measurement. This review aimed to examine measured effects at least six months post-intervention. METHODS AND FINDINGS We searched PubMed, MEDLINE, EMBASE, PsychINFO, ScienceDirect, SportDiscus and Google Scholar between 1st January 1991 and 1st November 2014 for controlled studies reporting six-month post-intervention measurement for children aged 5 to 18 years. 14 studies met inclusion criteria; 12 reported moderate-to-vigorous PA (MVPA) (n = 5790) and 10 reported total PA (TPA) (n = 4855). We calculated overall effect estimates and 95% CI's using random effects modelling with inverse variance weighting. Mean difference was calculated for MVPA, with standardised mean difference calculated to TPA due to measurement variation. Meta-regression assessed heterogeneity by continuous level variables. Negligible mean difference in MVPA existed in favour of the intervention group, amounting to 1.47 (95% CI -1.88, 4.82) mins/day compared to controls, while no difference was recorded on TPA. Sub-group analyses revealed males (2.65 mins/day: 95% CI 2.03, 3.27) reported higher levels of MVPA than females (-0.42 mins/day: 95% CI -7.77, 6.94), community settings (2.67 mins/day: 95% CI 2.05, 3.28) were more effective than school settings (1.70 mins/day: 95% CI -4.84, 8.25), and that treatment (4.47 mins/day: 95% CI -0.81, 9.76) demonstrated greater effects than population approaches (1.03 mins/day: 95% CI -2.54, 4.60). Meta-regression revealed no significant differences by factor on pooled effects. Significant heterogeneity existed between studies and potential for small study effects was present. CONCLUSIONS Improved PA levels subsequent to intervention were not maintained six month post-intervention. A potentially useful avenue of future research is to specifically explore community treatment of high risk individuals. REVIEW REGISTRATION PROSPERO CRD42014007545.
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Affiliation(s)
- Jamie Sims
- The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Department of Sport Development and Management, University of Chichester, Chichester, United Kingdom
| | - Peter Scarborough
- The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charlie Foster
- The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Leme ACB, Philippi ST. The “Healthy Habits, Healthy Girls” randomized controlled trial for girls: study design, protocol, and baseline results. CAD SAUDE PUBLICA 2015; 31:1381-94. [DOI: 10.1590/0102-311x00136014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/16/2015] [Indexed: 11/22/2022] Open
Abstract
The purpose of this article is to describe the study design, protocol, and baseline results of the “Healthy Habits, Healthy Girls” program. The intervention is being evaluated through a randomized controlled trial in 10 public schools in the city of São Paulo, Brazil. Data on the following variables were collected and assessed at baseline and will be reevaluated at 7 and 12 months: body mass index, waist circumference, dietary intake, nutrition, physical activity, social cognitive mediators, physical activity level, sedentary behaviors, self-rated physical status, and overall self-esteem. According to the baseline results, 32.4% and 23.4% of girls were overweight in the intervention and control groups, respectively, and in both groups a higher percentage failed to meet daily recommendations for moderate and vigorous physical activity and maximum screen time (TV, computer, mobile devices). There were no significant differences between the groups for most of the variables, except age (p = 0.000) and waist circumference (p = 0.014). The study showed a gap in the Brazilian literature on protocols for randomized controlled trials to prevent obesity among youth. The current study may thus be an important initial contribution to the field.
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Guagliano JM, Lonsdale C, Rosenkranz RR, Parker PD, Agho KE, Kolt GS. Mediators effecting moderate-to-vigorous physical activity and inactivity for girls from an intervention program delivered in an organised youth sports setting. J Sci Med Sport 2015; 18:678-83. [PMID: 26049672 DOI: 10.1016/j.jsams.2015.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/24/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study was to test whether coaches' physical activity levels, contextual variables, and coaches' behavioural variables mediated the effect of an intervention on female basketball players' moderate-to-vigorous physical activity (MVPA) and inactivity in an organised youth sport (OYS) setting. DESIGN Randomised controlled trial METHODS Data for the current study were derived from a two-armed, parallel-group randomised controlled trial. This study ran over the course of a 5-day OYS basketball program in 2 sports centres in Sydney, Australia. A convenience sample of 76 female players and 8 coaches were recruited. Coaches allocated to the intervention condition attended 2 coach education sessions, where strategies to increase MVPA and decrease inactivity were taught. RESULTS There was a significant effect between changes in coach MVPA and player MVPA (unstandardised regression coefficient [B] = 0.26, 95% CI = 0.14 to 0.38) which coincided with a significant indirect effect (B = 1.80, 95% CI = 0.85 to 2.85). There was also a significant effect between changes in coach inactivity and player inactivity (B = -0.23, 95% CI = -0.14 to -0.31), which coincided with a significant indirect effect (B = -3.20, 95% CI = -0.14 to -0.31). No significant indirect effects were found for lesson context and coaches' behaviours variables. CONCLUSIONS Coaches' MVPA and inactivity significantly mediated the effect of the intervention on player MVPA and inactivity, respectively. Consequently, coaches' physical activity levels appear to be important for influencing their players' physical activity levels.
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Affiliation(s)
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, Australia
| | - Richard R Rosenkranz
- School of Science and Health, University of Western Sydney, Australia; Department of Human Nutrition, Kansas State University, USA
| | - Philip D Parker
- Institute for Positive Psychology and Education, Australian Catholic University, Australia
| | - Kingsley E Agho
- School of Science and Health, University of Western Sydney, Australia
| | - Gregory S Kolt
- School of Science and Health, University of Western Sydney, Australia
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Exercise videogames for physical activity and fitness: Design and rationale of the Wii Heart Fitness trial. Contemp Clin Trials 2015; 42:204-12. [PMID: 25896114 DOI: 10.1016/j.cct.2015.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Despite numerous health benefits, less than half of American adults engage in regular physical activity. Exercise videogames (EVG) may be a practical and attractive alternative to traditional forms of exercise. However there is insufficient research to determine whether EVG play alone is sufficient to produce prolonged engagement in physical activity or improvements in cardiovascular fitness and overall health risk. The goal of the present study is to test the efficacy of exercise videogames to increase time spent in moderate to vigorous physical activity (MVPA) and to improve cardiovascular risk indices among adults. METHODS Wii Heart Fitness is a rigorous 3-arm randomized controlled trial with adults comparing three 12-week programs: (1) supervised EVGs, (2) supervised standard exercise, and (3) a control condition. Heart rate is monitored continuously throughout all exercise sessions. Assessments are conducted at baseline, end of intervention (week 12), 6 and 9 months. The primary outcome is time spent in MVPA physical activity. Secondary outcomes include changes in cardiovascular fitness, body composition, blood lipid profiles and maintenance of physical activity through six months post-treatment. Changes in cognitive and affective constructs derived from Self Determination and Social Cognitive Theories will be examined to explain the differential outcomes between the two active treatment conditions. CONCLUSION The Wii Heart Fitness study is designed to test whether regular participation in EVGs can be an adequate source of physical activity for adults. This study will produce new data on the effect of EVGs on cardiovascular fitness indices and prolonged engagement with physical activity.
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Hall E, Chai W, Koszewski W, Albrecht J. Development and validation of a social cognitive theory-based survey for elementary nutrition education program. Int J Behav Nutr Phys Act 2015; 12:47. [PMID: 25886631 PMCID: PMC4403940 DOI: 10.1186/s12966-015-0206-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/26/2015] [Indexed: 12/02/2022] Open
Abstract
Background The Social Cognitive Theory (SCT) is a widely used model for developing elementary nutrition education programs; however, few instruments are available to assess the impact of such programs on the main constructs of the SCT. The purposes of this study were: 1) to develop and validate a SCT-based survey instrument that focuses on knowledge, behavior, and self-efficacy for fifth grade students; 2) to assess the relationships between knowledge, behavior, and self-efficacy; and 3) to assess knowledge, behavior, and self-efficacy for healthy eating among the fifth grade students. Methods A 40-item instrument was developed and validated using content validity and tested among 98 fifth grade students for internal consistency reliability. Relationships between knowledge, behavior, and self-efficacy were assessed using Pearson Correlation Coefficients. Differences in behavior and knowledge scores between children with high and low self-efficacy were examined using t-test. Results Cronbach’s alphas for self-efficacy (0.70) and behavior (0.71) subscales of the survey were acceptable, although lower for knowledge (0.56). Summary scores for self-efficacy and behaviors were positively correlated (r = 0.40, P = 0.0001); however, summary knowledge scores were not associated with self-efficacy (r = 0.02, P = 0.88) or behavior scores (r = 0.14, P = 0.23). Participants with high self-efficacy also had significantly higher scores on consuming fruits (P = 0.0009) and dairy products (P = 0.009), eating breakfast (P = 0.008), helping plan family meals (P = 0.0006) and total behaviors for healthy-eating (P = 0.001) compared to those with low self-efficacy. In addition, approximately two thirds of the fifth grade students reported that they did not eat any fruits or vegetables or ate them only once on a typical day. Conclusions The developed instrument is a reliable and useful tool to assess SCT-based elementary nutrition education programs, particularly for self-efficacy and behavior. Our results also indicated that strategic interventions are necessary to improve dietary behaviors regarding fruit and vegetable consumptions among elementary school students.
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Affiliation(s)
- Elisha Hall
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 110 Leverton Hall, Lincoln, NE, 68583, USA.
| | - Weiwen Chai
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 110 Leverton Hall, Lincoln, NE, 68583, USA.
| | - Wanda Koszewski
- Nutrition and Dietetics, University of North Dakota, Grand Forks, USA.
| | - Julie Albrecht
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 110 Leverton Hall, Lincoln, NE, 68583, USA.
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Pearson N, Braithwaite R, Biddle SJH. The effectiveness of interventions to increase physical activity among adolescent girls: a meta-analysis. Acad Pediatr 2015; 15:9-18. [PMID: 25441655 DOI: 10.1016/j.acap.2014.08.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has shown that a clear decline in physical activity among girls starting in early adolescence. Therefore, adolescent girls have been identified as a key target population for physical activity behavior change. The quantification of intervention effectiveness for this group has not been previously reported in a meta-analysis, and this therefore was the objective of the current meta-analysis. STUDY SELECTION Included were interventions in which the main component, or 1 of the components, was aimed at promoting physical activity through behavior change in any setting. Interventions had to include a non-physical activity control group or comparison group, and include a quantitative outcome assessment of physical activity behavior in girls aged 12 to 18 years. DATA SOURCES Science Direct, PubMed, PsychINFO, Web of Science, Cochrane Libraries, and EPPI Centre databases were searched up to and including May 2013. DATA EXTRACTION AND SYNTHESIS Forty-five studies (k = 34 independent samples) were eligible from an initial 13,747 references. A random-effects meta-analysis was conducted. RESULTS The average treatment effect for adolescent girls involved in physical activity interventions was significant but small (g = 0.350, 95% confidence interval 0.12, 0.58, P < .001). Moderator analyses showed larger effects for interventions that were theory based, performed in schools, were girls only, with younger girls, used multicomponent strategies, and involved targeting both physical activity and sedentary behavior. CONCLUSIONS Interventions to increase physical activity in adolescent girls show small but significant effects, suggesting that behavior change may be challenging. Results suggest some approaches that appear to be successful.
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Affiliation(s)
- Natalie Pearson
- School of Sport, Exercise & Health Sciences, Loughborough University, UK
| | - Rock Braithwaite
- Department of Kinesiology and Recreation Administration, Humboldt State University, Arcata, Calif
| | - Stuart J H Biddle
- School of Sport, Exercise & Health Sciences, Loughborough University, UK; NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, UK.
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Tanaka C, Reilly JJ, Huang WY. Longitudinal changes in objectively measured sedentary behaviour and their relationship with adiposity in children and adolescents: systematic review and evidence appraisal. Obes Rev 2014; 15:791-803. [PMID: 24899125 DOI: 10.1111/obr.12195] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 11/29/2022]
Abstract
This review aimed to determine longitudinal changes in objectively measured overall sedentary behaviour, and to examine their associations with adiposity in children and adolescents. A search for longitudinal studies was performed using several electronic databases. Of 161 potentially eligible papers, 10 for change in sedentary behaviour and 3 for longitudinal associations with change in adiposity were included. Weighted mean increase in daily sedentary behaviour per year was 5.7% for boys and 5.8% for girls. Only one paper included preschool children, and it showed a decrease in sedentary behaviour. Nine studies were from Western countries. Null associations were reported between sedentary behaviour and adiposity in two studies, the other found that increases in sedentary behaviour were associated with increases in adiposity, but only in those with body mass index above the 50th percentile. There was consistent evidence that sedentary behaviour increases with age in school-age children and adolescents, by approximately 30 min extra daily sedentary behaviour per year. There was little evidence on the influence of changes in sedentary behaviour on changes in adiposity. There is a need for more longitudinal research, for more evidence from outside the Western world, and for more studies that examine 'dose-response' associations between changes in sedentary behaviour and changes in adiposity.
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Affiliation(s)
- C Tanaka
- Division of Integrated Sciences, J. F. Oberlin University, Tokyo, Japan; Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
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Lubans DR, Plotnikoff RC, Miller A, Scott JJ, Thompson D, Tudor-Locke C. Using Pedometers for Measuring and Increasing Physical Activity in Children and Adolescents. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827614537774] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The science and practice of step counting in children (typically aged 6-11 years) and adolescents (typically aged 12-19 years) has evolved rapidly over a relatively brief period with the commercial availability of research-grade pedometers and accelerometers. Recent reviews have summarized considerations for assessing physical activity using pedometers in young people (both children and adolescents), but 3 areas have received little attention: pedometer monitoring protocols, minimal (as opposed to optimal) step counts necessary for maintaining basal levels of health, and appropriate pedometer-based interventions for young people. Therefore, the objective of this review was to evaluate the current evidence and identify future research directions in these areas. The challenges of objective monitoring of physical activity in children and adolescents reinforce the importance of using protocols that minimize participant burden and the potential for tampering/reactivity. Evidence for a sedentary lifestyle cut point is limited; researchers are therefore encouraged to investigate several cut points (ie, <5000, <6000, <7000 steps/d) in children and adolescents to identify the health consequences of very low levels of ambulatory activity. Personalized messages may be necessary for health behavior change in pedometer-based interventions, but there is a need for more high-quality studies to develop the existing evidence base.
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Affiliation(s)
- David R. Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan Campus, Australia (DRL, RCP, AM, JJS)
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas (DT)
- Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana (CT-L)
| | - Ronald C. Plotnikoff
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan Campus, Australia (DRL, RCP, AM, JJS)
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas (DT)
- Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana (CT-L)
| | - Andrew Miller
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan Campus, Australia (DRL, RCP, AM, JJS)
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas (DT)
- Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana (CT-L)
| | - Joseph J. Scott
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan Campus, Australia (DRL, RCP, AM, JJS)
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas (DT)
- Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana (CT-L)
| | - Debbe Thompson
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan Campus, Australia (DRL, RCP, AM, JJS)
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas (DT)
- Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana (CT-L)
| | - Catrine Tudor-Locke
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan Campus, Australia (DRL, RCP, AM, JJS)
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas (DT)
- Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana (CT-L)
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Lubans DR, Smith JJ, Skinner G, Morgan PJ. Development and implementation of a smartphone application to promote physical activity and reduce screen-time in adolescent boys. Front Public Health 2014; 2:42. [PMID: 24904909 PMCID: PMC4032995 DOI: 10.3389/fpubh.2014.00042] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/29/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe the development and implementation of a smartphone application (app) designed to promote physical activity and reduce screen-time in adolescent boys considered "at-risk" of obesity. METHODS An app was developed to support the delivery of a face-to-face school-based obesity prevention program known as the "Active Teen Leaders Avoiding Screen-time" (ATLAS) program. ATLAS was guided by self-determination theory and social cognitive theory and evaluated using a cluster randomized controlled trial with 361 boys (12.7 ± 0.5 years) in 14 secondary schools. Following the completion of the study, participants in the intervention group completed a process evaluation questionnaire and focus groups were conducted with 42 students to explore their general perceptions of the ATLAS program and their experience with the smartphone app. Barriers and challenges encountered in the development, implementation, and evaluation of the app are also described. RESULTS Participation in the study was not contingent on ownership of a smartphone, but 70% of participants in the intervention group reported having access to a smartphone or tablet device. Focus group participants reported an enjoyment of the program, and felt that it had provided them with new skills, techniques, and routines for the future. However, their engagement with the smartphone app was limited, due to a variety of reasons. Barriers to the implementation and evaluation of the app included limited access to smartphone devices, technical problems with the push notifications, lack of access to usage data, and the challenges of maintaining participants' interest in using the app. CONCLUSION Although participants reported high levels of satisfaction with the ATLAS program in general, the smartphone app was not used extensively. Additional strategies and features may be needed to enhance engagement in adolescent boys.
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Affiliation(s)
- David R Lubans
- Priority Research Centre for Physical Activity and Nutrition, School of Education, University of Newcastle , Callaghan, NSW , Australia
| | - Jordan J Smith
- Priority Research Centre for Physical Activity and Nutrition, School of Education, University of Newcastle , Callaghan, NSW , Australia
| | - Geoff Skinner
- Faculty of Science and Information Technology, School of Design Communication and Information Technology, University of Newcastle , Callaghan, NSW , Australia
| | - Philip J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, University of Newcastle , Callaghan, NSW , Australia
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12Month changes in dietary intake of adolescent girls attending schools in low-income communities following the NEAT Girls cluster randomized controlled trial. Appetite 2014; 73:147-55. [DOI: 10.1016/j.appet.2013.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 11/20/2022]
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