Feasibility and Provisional Efficacy of Embedding High-Intensity Interval Training Into Physical Education Lessons: A Pilot Cluster-Randomized Controlled Trial

A systematic review of binge drinking interventions and bias assessment among college students and young adults in high-income countries

Alcohol is the number one substance used by young people and people of college age. Binge drinking (BD) in this age group is considered one of the most important global health issues, as much harm accrues from it and even lives are lost. This study aimed to review the interventions to curb BD or encourage responsible drinking among college students and young adults. MEDLINE (PubMed), ERIC and APA PsycINFO were searched. The selected articles were published in English and had to evaluate a BD reduction program through a randomized control trial (RCT) among college students or young adults between the ages of 17-24 years. The exclusion criteria included research not published in English, systematic review articles, qualitative studies, designs other than RCTs and discussion articles on college students drinking with no findings. The three reviewers independently screened and extracted the data using the PRISMA guidelines. The overall quality of the studies was assessed. Then, 10 of the 12 interventions studied were found to be successful in reducing BD among college students, though the effect sizes were small to medium. A minority of the studies used behavior change theories. Effective interventions for reducing BD among college students and young adults should include robust behavior change theories, longer follow-up time and the operationalization of multiple outcomes. Process evaluation is needed to be conducted in these studies.

Process evaluation of school-based high-intensity interval training interventions for children and adolescents: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Several systematic reviews have been published to investigate the effectiveness of high-intensity interval training (HIIT) in schools. However, there has been limited attention given to understanding the functioning of the intervention processes, which is of paramount importance for interpreting and translating the intervention effectiveness. The aim of this systematic review is to determine the extent to which process evaluation is measured in school-based HIIT interventions and to explore the effects of process evaluation and intervention characteristics on cardiorespiratory fitness (CRF), body composition, muscular strength, and blood pressure.

METHODS

A comprehensive search was conducted in SPORT Discus (EBSCOhost), Web of Science, Scopus, Medline (Ovid) and Cochrane Central Register of Controlled Trials. The extent to which process evaluation is measured was narratively reported, alongside with the guidance of process evaluation of complex interventions by UK Medical Research Council. Meta-analyses and meta-regressions were conducted to determine the effects of process evaluation and intervention characteristics to the intervention outcomes.

RESULTS

The literature search identified 77 studies reporting on 45 school-based HIIT interventions. In total, five interventions reported process evaluation in a section or in a separate study, and only one intervention adopted a process evaluation framework. On average, 6 out of 12 process evaluation measures were reported in all interventions. Subgroup analyses did not indicate any beneficial treatment effects for studies with process evaluation group, whereas all pooled data and studies without process evaluation group showed significant improvement for CRF and body composition.

CONCLUSION

Process evaluation is frequently omitted in the literature of school-based HIIT in children and adolescents. Although reporting of process evaluation measures may not directly associate with better intervention outcomes, it allows accurate interpretation of intervention outcomes, thereby enhancing the generalisability and dissemination of the interventions.

Making a HIIT: co-design of high-intensity interval training workouts with students & teachers within the curriculum

BACKGROUND

High-intensity interval training (HIIT) interventions are becoming more common in schools. However, limited input has been sought from end-users, which can help design interventions that are more engaging and context appropriate, therefore increasing their potential for successful implementation. One method of engaging end-users is co-design, which involves an active collaboration to design solutions to pre-specified problems. This paper aimed to: (1) describe the methodology and results of the co-design process in Making a HIIT to develop HIIT workouts for a school-based intervention; and (2) evaluate the feasibility and impact of co-designing HIIT workouts with students and teachers within the health and physical education (HPE) curriculum.

METHODS

The development of the HIIT workouts occurred during obligatory HPE lessons with year seven and eight students. The co-design process included: (1) identifying barriers and facilitators to exercise to create evaluation criteria for creating the HIIT workouts; (2) exploring HIIT; (3) defining HIIT parameters (intensity and interval length); (4) creating HIIT workouts using the parameters and evaluation criteria; (5) trialling and modifying the HIIT workouts based on class feedback and intensity data. To evaluate the feasibility and impact of the co-design process, a thematic analysis was completed using teacher interviews, student discussions, and student surveys.

RESULTS

Five classes comprised of 121 students (12-14 years; 49% female) and five teachers were involved in the co-design process across three schools in Queensland, Australia. A total of 33 HIIT workouts were created aimed at satisfying the HIIT parameters and variations of the following evaluation criteria: (1) fun; (2) social; (3) achievable skill level; (4) feeling accomplished; and (5) beneficial for health. From the thematic analysis, three themes (acceptability; implementation; integration) and 12 codes contributed to the overarching understanding of the feasibility of the lessons within the curriculum and a further three themes (perceived changes to lessons; educative outcomes; personal and social capabilities) and three codes contributed towards understanding their impact.

CONCLUSION

Overall, co-designing HIIT workouts was feasible within the HPE curriculum and may have contributed to positive educative outcomes. Using this methodology could improve the implementation of HIIT interventions within HPE while supporting educative benefits.

Comparative effectiveness of school-based exercise interventions on physical fitness in children and adolescents: a systematic review and network meta-analysis

Background

Schools provide a favorable setting for health education, however, the most effective school-based exercise mode for improving physical fitness remains unclear. This network meta-analysis was designed to assess and rank the comparative efficacy of six exercise modalities on physical fitness indicators in a school-based setting.

Methods

An online search of the Web of Science, PubMed, SPORTDiscus, and Scopus databases was conducted. Randomized and quasi-randomized controlled trials were considered. Outcomes included measures of anthropometry and body composition, muscular fitness, and cardiorespiratory fitness. Data were pooled with a random effects model using the frequentist framework.

Results

A total of 66 studies with 8,578 participants (48% girls) were included. High-intensity interval training was the most effective intervention reducing body mass index (mean difference (MD) = -0.60 kg·m^-2, 95% confidence interval (95%CI) = -1.04 to -0.15, p = 0.009), elevating VO_2max (MD = 3.59 mL·kg^-1·min^-1, 95% CI = 2.45 to 4.74, p < 0.001), and 20-meter sprint performance (MD = -0.35 s, 95% CI = -0.55 to -0.14, p = 0.001). Aerobic training had the highest probability of reducing waist circumference (standardized mean difference (SMD) = -0.60, 95% CI = -0.88 to -0.32, p < 0.001). Active video games emerged as a promising modality for improving countermovement jump (MD = 2.43 cm, 95% CI = 0.06 to 4.80, p = 0.041) and shuttle running performance (SMD = 0.86, 95% CI = 0.29 to 1.43, p = 0.003). Strength training was the best exercise mode for improving standing long jump performance (SMD = 1.03, 95% CI = 0.07 to 1.98, p = 0.035) while combined training was rated the first for decreasing body fat percent (MD = -2.56%, 95% CI = -4.73 to -0.40, p = 0.022) and increasing push-up repetitions (SMD = 3.59, 95% CI = 0.81 to 6.37, p = 0.012).

Conclusion

School-based exercise interventions have multiple effects on physical fitness. The findings of this study will help to inform physical education teachers and coaches how best to deliver exercise programs in a school setting. Since the study was limited by the original research, the conclusions will require further verification using high-quality randomized controlled trials.

Systematic Review Registration

PROSPERO, Identifier: CRD42023401963.

The Effect of Primary School-Based Physical Education Programs: A Systematic Review of Randomized Controlled Trials

The present article aimed to systematically summarize primary school-based intervention programs and their effects evaluated through randomized-controlled trial design. A systematic review of relevant articles was carried out using 4 electronic databases. From a total of 193 studies initially found, 30 were included in the qualitative synthesis. Main results: (1) Intensive interval training or jump/strength exercises may positively influence physical fitness, promoting challenging task, psychological needs, and guided styles to a greater extent; (2) Games that demand more cognitive function seem more beneficial than those based on repetitive aerobic exertion to improve fundamental motor skills; (3) The jumping/strength exercises may cause benefits in bone area and bone mineral density, while flexibility and balance may reduce the risk of muscle injury; and (4) Programming a greater dose of moderate-to-vigorous physical activity seems to be related to positive effects in core executive function and academic performance. Additionally, providing information and involving the social environment may enhance the positive effects.

Mediating Effect of Motivation on the Relationship of Fitness with Volitional High-Intensity Exercise in High-School Students

We aimed to investigate the relationship between physical fitness and motivation in adolescents and analyze if the associations of physical fitness with volitional exercise intensity in adolescents are mediated by motivation. The participants were 108 adolescents (58 girls 16.0 ± 0.92 years). Cardiorespiratory fitness (CRF) was assessed using the Yo-YoITL1, and the push-up test was used to evaluate strength. Body composition was measured by bioelectrical impedance analysis. The intervention was applied in the first 10-15 min of each Physical Education class (PEC), twice a week, for 16 weeks and ranged from 14 to 20 all-out bouts intervals, adopting a 2:1 work to rest ratio. A cut-point of ≥90% of the maximal heart rate (HR) was used as a criterion for satisfactory compliance with high-intensity exercise. Volition intensity was assessed through a forearm wearable plethysmography heart rate sensor to ensure compliance with the exercise stimulus at the predetermined target HR zone. Motivation was estimated with a validated questionnaire (BREQ-3). Mediation effects were estimated using bootstrapped 95% confidence intervals and were deemed significant if zero was not included in the intervals, and values below 0.05 were considered to indicate statistical significance. The mediation analysis revealed a non-significant indirect effect of physical fitness through motivation on exercise intensity, specifically on CRF (B = -0.0355, 95% BootCI [-0.5838; 0.4559]), muscular fitness (B = -0.7284, 95% BootCI [-2.0272; 0.2219]) and body fat (B = 0.5092, 95% BootCI [-0.4756; 1.6934]). These results suggest that high or low values of motivation did not increase or decrease volitional high-intensity exercise, and lower levels of fitness (CRF, muscular and body fat) were associated with higher volitional exercise intensity. These findings highlight the need for regular moderate-to-vigorous physical exercise for maintaining or improving physical fitness, regardless of motivation regulations, and emphasize the importance of new strategies in PEC with acute vigorous-intensity activities that retain the health-enhancing effects.

Impact of high-intensity interval training including Indigenous narratives on adolescents' mental health: a cluster-randomised controlled trial

OBJECTIVES

We investigated the efficacy of teacher-delivered high-intensity interval training (HIIT) with Indigenous narrative options on the mental health of school students in low-mid socioeconomic areas, compared to standard curriculum physical education practice.

METHODS

A cluster-randomised controlled trial was conducted in eight schools (N=368, age range 11-13 years) over 16 weeks. The primary outcome was the Strengths and Difficulties Questionnaire (SDQ) score. Generalised linear mixed models, controlling for the SDQ at baseline were applied, expressed as β, 95% confidence intervals, standardised effect, and p-value. Focus groups elicited experiences with participating in and delivering the intervention.

RESULTS

There were no clear effects for SDQ total score (β -0.15, CI -0.98 - 0.67, SE 0.42, p=0.714). Teachers did not deliver the Indigenous narrative options consistently owing to the perceived preparation needed and lack of confidence.

CONCLUSIONS

HIIT delivered in this manner had no effect on self-perceived psychological difficulty or mental wellbeing in a cohort of young adolescents.

IMPLICATIONS FOR PUBLIC HEALTH

Future research should continue to explore opportunities to improve mental wellbeing via physical activity, but HIIT should not be implemented as a universal intervention for mental health gains alone. Teachers need more support to utilise Indigenous narratives as part of HIIT delivery.

Scaling-Up Adolescent High-Intensity Interval Training Programs for Population Health

High-intensity interval training (HIIT) has become a polarizing form of exercise. In this article, we argue that adolescent HIIT programs can have population health impact if they are (i) integrated into existing opportunities, (ii) designed to develop physical literacy, (iii) delivered in an engaging manner, and (iv) guided and supported by an implementation framework that addresses relevant barriers and facilitators.