The Effectiveness of Equipment Provisions on Rural Middle School Students' Physical Activity During Lunch Recess

Sustainability Requires Many Faces of Support

Purpose: This study focused on the sustainability of a school-wide health behavior intervention in rural schools in the Southwestern US. Informed by the seven premises of Theories of Action with Merit, the purpose of this study was to investigate which portion(s) of a five-year, school-wide health behavior intervention were still in practice (i.e. sustainable), and why they were maintained following the removal of funding and resources for the program. Method: Teachers (N = 41) participated in individual, semi-structured interviews during which they shared what aspects of the original intervention were retained as part of personal classroom practices or of the school culture. Teachers reflected on facilitators and barriers to the sustainability of these practices. Data also included field notes from campus visits. To establish trustworthiness, data triangulation (interview transcripts, survey results, and field notes) provided multiple angles of analysis, and two researchers negotiated all themes. Results: Using the premises of the Theories of Action with Merit, teachers' comments often circulated around themes of administrative support and personal investment/interest in healthy behaviors. Additional themes of sustainability included feeling capable and physical activity being the "norm" at their school. Conclusions: Teachers' personal beliefs and self-efficacy in physical literacy held the highest importance in sustaining classroom healthy behavior practices as opposed to the district or state expectations for healthy behaviors. Administrator support was key to whole-school integration and sustainability of practices, however, teachers described evidence of support differently suggesting administrators need awareness of how messages of support are being translated.

Where the children play: Gender gaps in recess physical activity by age and playground area

Objective

Recess contributes meaningfully to physical activity (PA), but recess time has declined. The study's purpose was to report PA by age, gender, and playground feature to inform potential playground configurations more conducive to PA during recess.

Methods

Using the System for Observing Play and Leisure Activity in the Youth, kindergarten through 5th grade recesses were observed on at least four days at four schools in Little Rock, Arkansas, United States during May 2023. Target playground features were ball courts, grass, pavement, play structures, and swings. To provide inferential analysis, a comparison of conditional means across playground features, age, and gender was conducted using linear regression with robust standard errors clustered by school.

Results

3,356 playground scans (intercoder correlation = 0.93) were collected and aggregated by school, day, gender, age (grade), and target feature for a sample size of 292 observations. The gender gap was widest among 4-5th graders, 79 % (95 % CI: 72, 86) for males and 64 % (95 % CI: 58, 70) for females. Among females, PA was highest on swings [82 % (95 % CI: 77, 86)] and lowest on paved areas [56 % (95 % CI: 43, 69)]. Among males, it was highest on both swings [81 % (95 % CI: 75, 86)] and ball courts [83 % (95 % CI: 77, 89)] and lowest on grassy areas [64 % (95 % CI: 60, 67)].

Conclusion

Swings, courts, and play structures were associated with a higher proportion of children being engaged in PA. Research is needed to identify whether physical improvements to facilitate access to these features increase PA.

Human-centered participatory co-design with children and adults for a prototype lifestyle intervention and implementation strategy in a rural middle school

PURPOSE

The significance of regular physical activity (PA) in reducing cardiovascular disease (CVD) risk is widely acknowledged. However, children in rural areas encounter specific barriers to PA compared to their urban counterparts. This study employs human-centered participatory co-design, involving community stakeholders in developing a multi-level PA intervention named Hoosier Sport. The primary hypothesis is the co-design sessions leading to the development of a testable intervention protocol.

METHODS

Two co-design teams, each consisting of six children and six adults, were formed using human-centered participatory co-design facilitated by research faculty and graduate students. The process involved five co-design sessions addressing problem identification, solution generation, solution evaluation, operationalization, and prototype evaluation. Thematic analysis was employed to identify key themes and intervention components.

RESULTS

Child co-designers (n = 6) ranged from 6th to 8th grade, averaging 12.6 years (SD = 1.8), while adult co-designers (n = 6) averaged 43.3 years (SD = 8.08). Thematic analysis revealed children emphasizing autonomy, the freedom to choose physical and non-physical activities, and the importance of building peer relationships during PA. Adult interviews echoed the importance of autonomy and choice in activities, with a focus on relatedness through positive role modeling.

CONCLUSION

The prototype intervention and implementation strategies developed constitute a testable intervention aligned with Phase 1 of the ORBIT model. This testable prototype lays the groundwork for a collaborative campus-community partnership between the university and the local community, ensuring mutual benefits and sustainable impact.

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

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).

Hoosier Sport: a research protocol for a multilevel physical activity-based intervention in rural Indiana

Introduction

Currently, only 1 in 4 children in the U.S. engage in the recommended amount of physical activity (PA) and disparities in PA participation increase as income inequities increase. Moreover, leading health organizations have identified rural health as a critical area of need for programming, research, and policy. Thus, there is a critical need for the development and testing of evidence-based PA interventions that have the potential to be scalable to improve health disparities in children from under-resourced rural backgrounds. As such, the present study utilizes human-centered design, a technique that puts community stakeholders at the center of the intervention development process, to increase our specific understanding about how the PA-based needs of children from rural communities manifest themselves in context, at the level of detail needed to make intervention design decisions. The present study connects the first two stages of the NIH Stage Model for Behavioral Intervention Development with a promising conceptual foundation and potentially sustainable college student mentor implementation strategy.

Methods

We will conduct a three-phase study utilizing human-centered community-based participatory research (CBPR) in three aims: (Aim 1) conduct a CBPR needs assessment with middle school students, parents, and teachers/administrators to identify perceptions, attributes, barriers, and facilitators of PA that are responsive to the community context and preferences; (Aim 2) co-design with children and adults to develop a prototype multi-level PA intervention protocol called Hoosier Sport; (Aim 3) assess Hoosier Sport's trial- and intervention-related feasibility indicators. The conceptual foundation of this study is built on three complementary theoretical elements: (1) Basic Psychological Needs mini-theory within Self-Determination Theory; (2) the Biopsychosocial Model; and (3) the multilevel Research Framework from the National Institute on Minority Health and Health Disparities.

Discussion

Our CBPR protocol takes a human-centered approach to integrating the first two stages of the NIH Stage Model with a potentially sustainable college student mentor implementation strategy. This multidisciplinary approach can be used by researchers pursuing multilevel PA-based intervention development for children.

It Is Not Called Recess Anymore: Breaktime in Middle School

BACKGROUND

School recess offers students a break from the rigors and immobility of academic learning, and a chance for social interaction, play, and physical activity. The recess literature is based on elementary schools, with little attention to older students. Early adolescents also need school breaks, and this study offers some of the first findings on how to organize this time to best support the developmental needs of middle schoolers.

METHODS

The study explores middle school breatktime in 3 schools in California. It uses observations, interviews, and a student survey conducted in 2018. Data were coded thematically and analyzed.

RESULTS

Findings indicate a tradeoff between socialization and physical activity among students who falls along age and gender lines. Adults viewed their roles mainly as safety monitors, including both physical and emotional safety. They were aware of the limitations of their breaktime offerings, which generally included access to outdoor and a few alternative indoor spaces, and attributed not having more options to lack of resources.

CONCLUSIONS

Findings demonstrate the complexities of organizing breaktime space for early adolescents. Middle schools must plan their breaks with attention to developmentally appropriate activities, including games and sports as well as opportunities for other kinds of social interactions in safe, supportive environments.

A direct observation tool to measure interactions between shade, nature, and children's physical activity: SOPLAY-SN

BACKGROUND

Most physical activity (PA) during school occurs at recess; however, recess PA may be influenced by children's thermal comfort and interaction with nature, neither of which have concurrently been measured reliably in previous studies. This study tests the reliability of SOPLAY-SN, an adaption of the validated System for Observing Play and Leisure Activity in Youth (SOPLAY) to measure Shade and Nature (SN) alongside PA, and associations between children's PA and interaction with shade and nature during recess to highlight the utility of the tool.

METHODS

Interactions with shade and nature were measured using systematic direct observation at two playgrounds (primary-grade = ages 5-8, upper-grade = ages 9-12) during recess at an elementary school in Phoenix, Arizona (USA). Pairs conducted observations over four warm days (primary = 29-34 °C, upper-grade = 32-36 °C) in May 2021 (N = 179 scans). Intraclass correlation coefficients (ICC) were used to calculate inter-rater reliability. Mean counts, frequencies, and Kendall rank correlation coefficient tests were used to assess relations between PA level and interactions with shade and nature.

RESULTS

Reliability was good for sedentary behavior (ICC = 0.98); light PA (LPA; ICC = 0.80) and moderate-to-vigorous PA (MVPA; ICC = 0.94); shade interaction (ICC = 0.95); and nature interaction (ICC = 0.80) and average agreement was good (86% overall PA, 88% shade, 90% nature). Most (60%) primary-grade children were observed in the shade, with 64% under a covered play structure where children were mainly (47%) sedentary. Of the 11% of primary-grade students observed interacting with nature, 90% occurred in a grass field with trees. Among upper-grade children, 23% were observed in the shade with 53% in grass fields where 48% of play was light. Few (7%) upper-grade children were observed interacting with nature, with most instances (76%) in a grass field with trees. Among primary-grade children, shade was correlated with sedentary behavior (τb = 0.63, p < .05); LPA (τb = 0.39, p < .05); MVPA (τb = 0.56, p < .05); and nature interactions with sedentary behavior (τb = 0.16, p < .05). Among upper-grade children, shade was correlated with sedentary behavior (τb = 0.27, p < .05) and LPA (τb = 0.21, p < .05).

CONCLUSIONS

SOPLAY-SN is a reliable tool for measuring children's interaction with shade and nature and participation in PA. Understanding how shade and nature impact movement during recess can inform playground design for children's health and well-being.

A digitally enhanced home-based physical activity intervention for high-risk middle school youth during COVID-19

COVID-19 significantly impacted physical activity among high-risk youth. Camp from Home, a digitally enhanced home-based intervention, was developed to address physical activity disparities among middle school youth during COVID-19. Camp from Home enrolled 62 youth in 54 families from five schools in Philadelphia during the summer of 2020. The 6-week intervention comprised of (1) three home deliveries of "activity kits" including exercise equipment and activity booklets, (2) asynchronous sport and exercise videos posted to a private YouTube channel, and (3) supportive text-messages from health coaches. YouTube analytics and self-report surveys completed by parents and youth at baseline and at the end of programming were used to assess engagement, acceptability, and preliminary efficacy. Youth participants were 12.4 (1.2) years, 38.7% female and 90.3% Black/African American. At follow-up, 41 parents (75.9%) and 34 youth (54.8%) completed measures. Youth self-reported increases in self-efficacy (ΔM(sd) = 0.4(1.0), p = .03) and physical activity (ΔM(sd) = 4.2(7.9), p = .004), despite suboptimal engagement in digital program components. Overall, participants highly rated the program. Activity kits and text-messages from health coaches were rated as most helpful. Most parents (95.1%) and youth (83.8%) expressed interested in participating again in the future. A 6-week digitally enhanced, home-based physical activity intervention was acceptable and feasible among parents and youth during the summer of 2020, with youth reporting improvements in self-efficacy and physical activity. Summer programs are critical for reducing disparities in physical activity and hold potential for addressing key barriers for high-risk youth even outside the context of COVID-19.