Mediators of Physical Activity Behavior Change in the "Girls on the Move" Intervention

Peer-led physical activity intervention for girls aged 13 to 14 years: PLAN-A cluster RCT

Background

Increasing physical activity among girls is a public health priority. Peers play a central role in influencing adolescent behaviour. Peer-led interventions may increase physical activity in adolescent girls, and a feasibility trial had shown that PLAN-A (Peer-led physical Activity iNtervention for Adolescent girls) had evidence of promise to increase physical activity in adolescent girls.

Objective

The objective was to test whether or not PLAN-A can increase adolescent girls’ physical activity, relative to usual practice, and be cost-effective.

Design

This was a two-arm, cluster-randomised controlled trial, including an economic evaluation and a process evaluation.

Participants

State-funded secondary schools in the UK with girls in Year 9 (aged 13–14 years) participated in the trial. All Year 9 girls in participating schools were eligible.

Randomisation

Schools were the unit of allocation. They were randomised by an independent statistician, who was blinded to school identities, to the control or intervention arm, stratified by region and the England Index of Multiple Deprivation score.

Intervention

The intervention comprised peer nomination (i.e. identification of influential girls), train the trainers (i.e. training the instructors who delivered the intervention), peer supporter training (i.e. training the peer-nominated girls in techniques and strategies underpinned by motivational theory to support peer physical activity increases) and a 10-week diffusion period.

Outcomes

The primary outcome was accelerometer-assessed mean weekday minutes of moderate to vigorous physical activity among Year 9 girls. The follow-up measures were conducted 5–6 months after the 10-week intervention, when the girls were in Year 10 (which was also 12 months after the baseline measures). Analysis used a multivariable, mixed-effects, linear regression model on an intention-to-treat basis. Secondary outcomes included weekend moderate to vigorous physical activity, and weekday and weekend sedentary time. Intervention delivery costs were calculated for the economic evaluation.

Results

A total of 33 schools were approached; 20 schools and 1558 pupils consented. Pupils in the intervention arm had higher Index of Multiple Deprivation scores than pupils in the control arm. The numbers randomised were as follows: 10 schools (n = 758 pupils) were randomised to the intervention arm and 10 schools (n = 800 pupils) were randomised to the control arm. For analysis, a total of 1219 pupils provided valid weekday accelerometer data at both time points (intervention, n = 602; control, n = 617). The mean weekday moderate to vigorous physical activity was similar between groups at follow-up. The central estimate of time spent engaging in moderate to vigorous physical activity was 2.84 minutes lower in the intervention arm than in the control arm, after adjustment for baseline mean weekday moderate to vigorous physical activity, the number of valid days of data and the stratification variables; however, this difference was not statistically significant (95% confidence interval –5.94 to 0.25; p = 0.071). There were no between-arm differences in the secondary outcomes. The intervention costs ranged from £20.85 to £48.86 per pupil, with an average cost of £31.16.

Harms

None.

Limitations

The trial was limited to south-west England.

Conclusions

There was no evidence that PLAN-A increased physical activity in Year 9 girls compared with usual practice and, consequently, it was not cost-effective.

Future work

Future work should evaluate the utility of whole-school approaches to promote physical activity in schools.

Trial registration

This trial is registered as ISRCTN14539759.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 6. See the NIHR Journals Library website for further project information. This trial was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a United Kingdom Clinical Research Commission (UKCRC)-registered Clinical Trials Unit that, as part of the Bristol Trials Centre, is in receipt of NIHR Clinical Trials Unit support funding. The sponsor of this trial was University of Bristol, Research and Enterprise Development www.bristol.ac.uk/red/. The costs of delivering the intervention were funded by Sport England.

Feasibility and preliminary efficacy of a school-based health and well-being program for adolescent girls

BACKGROUND

The primary aim of this pilot study was to evaluate the feasibility and preliminary efficacy of a school-based health and well-being program (Health and Well-being for Girls: HWBG) on adolescent girls' well-being, mindfulness, screen-time, and physical activity.

METHOD

The HWBG program was evaluated using a group randomized controlled trial (RCT) in one secondary school. A convenience sample of female students in Grade 8 (mean age 14 ± 0.5 years) was recruited for the study (n=4 classes; 89 girls). The 20-week multi-component HWBG program, guided by Self-Determination Theory and Acceptance and Commitment Therapy, was designed and delivered by a member of the research team. Randomization occurred prior to baseline assessments at the class level (n=4 classes) into dose-matched treatment conditions (i.e., two classes received the HWBG intervention and two classes received an alternate elective course as a wait-list control group). Process evaluation measures of recruitment, retention, adherence, and satisfaction were used to determine program feasibility. This study was designed to assess feasibility (primary outcome) and preliminary efficacy (secondary outcomes), rather than effectiveness. Preliminary efficacy of HWBG for improving mental and social health, screen-time, and physical activity were measured and analyzed using linear mixed-models.

RESULTS

"The health and well-being program" targeting adolescent girls was found to be feasible for implementation as an elective course in a secondary school setting. Participants in the HWBG program reported high levels of satisfaction, the majority of lessons (45 out of 50), were implemented as planned and adherence to the planned HWBG program content was very high. Medium positive effects on mental health (d=0.45) and social health (d=0.50) were observed. Small effects were observed for physical activity, and no significant intervention effects were found for levels of recreational screen time. Participant ratings showed high levels of perceived benefit and enjoyment as indicated in the evaluation data (mean rating of 4.44 out of a possible 5.0) when asked whether the program was enjoyable.

CONCLUSION

The study provides preliminary support for HWBG as a potentially feasible and enjoyable program suitable for use with adolescent girls in the secondary school setting. Potential of the study for facilitating improvements in pro-social and psychological well-being is also supported.

TRIAL REGISTRATION

ACTRN12617000157370 . The trial was registered with the Australian New Zealand Clinical Trials Registry.

Mediators and moderators of physical activity changes in a school-based intervention targeting childhood obesity

This study identifies mediators and moderators of changes in physical activity (PA) following a school-based pilot intervention. Students from two Lebanese schools were randomly allocated into intervention (n = 191) and control (n = 183) groups. The multiple-mediation analysis revealed that active self-identity and perceived barriers mediated the intervention's effect on PA changes. Baseline intention, attitude, PBC, and age moderated PA changes at post-intervention. The youngest participants and those reporting the lowest PA scores at baseline benefited most from the intervention. Future interventions with students should target these mediators and moderators to promote positive change in PA behavior.

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

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.

From Physical Activity Intention to Behavior: The Moderation Role of Mental Toughness Among College Students and Wage Earners

This study explored the correlation between mental toughness (MT) and physical activity (PA), and the moderation role between PA intention and subsequent behavior among college students and wage earners. Five hundred ninety-one college students (251 male, 340 female) aged from 19 to 24 and 285 (157 male, 127 female) wage earners aged from 27 to 58 recruited from seven colleges and five cities in China. A Theory of Planned Behavior (TPB) questionnaire, MT Inventory, and the International PA Questionnaire was completed online. Results showed that attitudes, subjective norms, and perceived behavioral control explained 46.5 and 38.3% variance in PA intention among college students and wage earners separately. Intention predicted PA behavior significantly among college students and wage earners. Structural equation modeling indicated that the TPB model and the moderation model have an adequate to good fit except the TPB model among wage earners. MT was positively correlated with PA among college students and wage earners and had a significant moderation role in intention-behavior gap among college students and partially affected the transfer of PA intention to behavior among college students. Individuals with high MT had high levels of PA regardless of intention, while PA of those with low MT was low and unstable. Future research should further explore the correlation between intention and PA and the moderation role of MT in different populations using a longitudinal study in order to better understand the correlation between intention and PA, and the transition from intention to PA and better guidance PA intervention to promote PA.

The Effect of Teacher Autonomy Support on Leisure-Time Physical Activity via Cognitive Appraisals and Achievement Emotions: A Mediation Analysis Based on the Control-Value Theory

Analyzing students' emotional experience in physical education (PE) is of crucial importance as it may fill an important gap in research examining the role of PE for students' leisure-time physical activity (PA). Based on the control-value theory of achievement emotions, the purpose of this study was to test the assumption that multi-dimensional autonomy support of the PE teacher may affect students' leisure-time PA via their appraisals of control and value and achievement emotions experienced in PE. Variance-based structural equation modelling was used to test the proposed model in a sample of 1030 students aged between 11 and 18 years (M = 13.4, SD = 1.48) stemming from schools with the lowest educational level among secondary schools in Germany. The results indicated that in particular cognitive autonomy support positively predicted students' self-efficacy and intrinsic value. Whereas appraisals of self-efficacy were negatively related to the experience of anxiety, intrinsic value was a major positive predictor of enjoyment. Enjoyment, in turn, was of substantial relevance for leisure-time PA. The findings offer a meaningful contribution in understanding students' emotional experiences and remind PE teachers of their opportunity to adopt an autonomy-supportive teaching style to positively influence the emotions of their students.

"More than just another physical activity program": exploring the GUM program for at-risk adolescent girls

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.

Motivation for Physical Activity in University Students and Its Relation with Gender, Amount of Activities, and Sport Satisfaction

Background: Motivation can be considered a critical factor in encouraging and maintaining physical activity. Despite the many health benefits offered by physical activity, a significant percentage of university students do not meet recommendations. University years are a critical time for promoting and maintaining an active lifestyle. This study aimed to analyze motivations for engaging in physical activity among university students and their relationship with gender, amount of sports activity, and satisfaction with sports activity. Methods: The sample consisted of 1099 Vizcaya university students (45.3% men and 54.7% women), aged between 18 and 29 years old (M = 20.4; SD = 1.7 years). Sports motivation, the number of weekly hours of physical activity, and the level of satisfaction with sports were analyzed. (3) Results: Significant differences were found in intrinsic (d = 0.36, p = 0.000) and external regulation (d = 0.19, p = 0.002), men having a higher motivation level compared to women in these dimensions, but not in participants’ level of satisfaction. The effect of gender on the amount of physical activity was mainly direct, but motivation was significantly mediating. In addition, there was not a significant effect of gender on level of satisfaction, but analyzing its limited effect in the sample, the mediation of intrinsic regulation was significant. (4) Conclusions: To understand the variance of the amount of physical activity and satisfaction in university students, the direct effect of gender must be considered as well as the mediating role of some dimensions of motivation.

Can Positive Affective Variables Mediate Intervention Effects on Physical Activity? A Systematic Review and Meta-Analysis

Well-developed theories are necessary to guide the public in increasing physical activity (PA) and promoting physical health. The role of positive affective variables (PAVs) in exercise is gaining more attention, but none of the literature has provided a systematic review and quantitative analysis of its mediating role. Therefore, the purposes of this study are (1) to systematically review studies of PA interventions, that use PAVs as the mediating variables, in order to evaluate and provide narrative summaries of these studies; (2) to statistically synthesize evidence for the mechanism of the effects of PAVs on PA outcomes. To conduct an extensive search, a PRISMA-compliant protocol was completed, and five electronic databases had been searched by 1 April 2020. We used a two-stage structural equation modeling (TSSEM) analysis approach to test how interventions trigger the critical PA change process to influence outcomes. The search strategy generated 1,732 papers potentially relevant to this study; forty of these studies met the data extraction criteria for meta-analytic mediation analysis. The path coefficient from intervention to PAV a = 0.26 (95% CI = 0.08 to 0.44), the path coefficient from PAV to PA b = 0.21 (95% CI = 0.13 to 0.28), and the direct effect from intervention to PA is also significant (c = 0.19, 95% CI = 0.12 to 0.26). In addition, the indirect effect of intervention on PA via PAV was statistically significant (c' = 0.05, 95% CI = 0.02 to 0.10). This reveals that PAVs partially mediate the relationship between interventions and PA. Our study is the first to systematically summarize the effects of experimental studies to increase PA through PAVs. It is highly recommended to make future interventions more innovative and to target the PAVs as mediators with higher fidelity.

Promoting Healthy Lifestyle through Basic Psychological Needs in Inactive Adolescents: A Protocol Study from Self-Determination Approach

Prevalence of overweight and obesity is an important health problem worldwide. It was shown that physical activity and sedentary behaviour are associated with prevalence of overweight and obesity in youth individuals. However, few children and adolescents meet the World Health Organization recommendations about physical activity levels. The need to start promoting regular physical activity from an early age is crucial to avoid these problems. Therefore, the aim of the current research is to show a school-based motivational program for the promotion of healthy lifestyle in inactive adolescents grounded on Self-Determination Theory aimed at promoting physical activity adherence. The study is a quasi-experimental study (ClinicalTrials.gov ID: NCT03974607) aimed for adolescents from the 1st and 2nd high school level aged between 12 and 14 years old. The program will be based on the promotion of the three basics psychological needs: autonomy, competence and relatedness. The satisfaction of these needs is essential to fulfill the self-determined motivation and psychological well-being. The length of the sessions are 60 min, 3 times per week, during 5 months. The sessions will be based on the participants’ interests. Finally, this protocol will intend to change the perception of physical activity programs in order to focus the strategies on the motivational aspects, rather than physical activity itself as was usually conducted by previous programs

Parent-Child Physical Activity Association in Families With 4-to 16-Year-Old Children

Background: The main aim of this study was to quantify the associations between parents’ and children’s physical activity by age, gender, and the day of the week on the basis of a pedometer-measured step count (SC). Methods: The sample comprised data from 4-to 16-year-old children and their parents from the Czech Republic (1102 mother-child dyads and 693 father-child dyads). The parents and their children wore the Yamax SW200 pedometer during seven days of monitoring. Results: The strongest SC association was found between mothers and daughters aged 4–7.9 years on weekdays (r_p = 0.402; p < 0.01) and at weekends (r_p = 0.577; p < 0.01). In children aged 8–16, the parent-child association is gender-specific, with the father-son relationship being dominant, especially at weekends (weekend SC: fathers-sons_{8–11.9 y} r_p = 0.416, p < 0.01; fathers-sons_{12–16 y} r_p = 0.443, p < 0.01). An increase of 1000 steps in the fathers (mothers) is associated with an increase of more than 400 (200) steps in their sons (daughters). Conclusions: This study confirms a strong parent-child SC relationship in children younger than eight years of age. In older children, the parent-child SC association is gender-specific and dominated by the father-son relationship, particularly on weekends. The SC associations that are revealed can be used for the development of physical activity programs for adolescents.

Interventions to Promote Positive Affect and Physical Activity in Children, Adolescents and Young Adults-A Systematic Review

Interventions to promote physical activity (PA) in children, adolescents and young adults based on social-cognitive theories often fail to increase PA. In recent years, affect-based approaches have gained interest, but the current state of research is not sufficiently reported. Therefore, a systematic review about the influence of interventions to promote positive affect and PA enjoyment and PA in children, adolescents and young adults was conducted. Literature searches were carried out including studies published between September 2009 and April 2019. Intervention studies targeting healthy children, adolescents or young adults and measuring enjoyment and PA were included. Thirteen studies met the inclusion criteria, including five group-based PA interventions, three multi-component school interventions, two internet-based interventions and three exergaming interventions. Most studies use multiple components in their intervention. Group-based PA programs incorporating task-oriented teaching styles and opportunities for voluntary PA are most consistently associated with positive findings. This review shows moderate evidence of interventions for children, adolescents and young adults being effective in increasing enjoyment and PA. Besides physical education and comprehensive school interventions, heterogenous intervention designs limit the comparability of studies. Future research should focus on theory-based, multi-component interventions with mediator analyses.

School-based Physical Activity Interventions in Children and Adolescents: A Systematic Review

Background: The aim of this systematic review was to examinemotivational interventions based on physical activity as precursor of psychosocial benefits inside of the scholar context. Method: studies were identified in seven databases (Web of Science, Sport Discuss, Scopus, Eric, Pubmed, Psycinfo and Google Scholar). The search process was from June 2011 to September 2019. A total of 41 articles met the inclusion criteria. Results: 23 studies showed psychological effects after intervention and also 10 studies showed psychosocial effect after the intervention. The rest of the studies, although they presented changes, did not become significant. Conclusions: this systematic review showed the importance of motivational processes for the performance of physical activity and sport as a precursor of psychosocial changesand highlights the importance of strategies and the temporal nature of studies to maintain significant changes over time.Likewise, the study shows the future trend of motivational interventions, highlighting the female gender as participants of special interest, and changing the methodology through web-based interventions and active breaks or mental breaks during traditional subject classes.