Initial Outcomes of a Participatory-Based, Competency-Building Approach to Increasing Physical Education Teachers' Physical Activity Promotion and Students' Physical Activity: A Pilot Study

A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

At least 70% of US adults have metabolic disease. However, less is done to address early disease (e.g., overweight, obesity, prediabetes) versus advanced disease (e.g., type 2 diabetes mellitus, coronary artery disease). Given the burden of advanced metabolic disease and the burgeoning pandemics of obesity and prediabetes a systematic response is required. To accomplish this, we offer several recommendations: (A) Patients with overweight, obesity, and/or prediabetes must be consistently diagnosed with these conditions in medical records to enable population health initiatives. (B) Patients with early metabolic disease should be offered in-person or virtual lifestyle interventions commensurate with the findings of the Diabetes Prevention Program. (C) Patients unable to participate in or otherwise failing lifestyle intervention must be screened to assess if they require pharmacotherapy. (D) Patients not indicated for, refusing, or failing pharmacotherapy must be screened to assess if they need bariatric surgery. (E) Regardless of treatment approach or lack of treatment, patients must be consistently screened for the progression of early metabolic disease to advanced disease to enable early control. Progression of metabolic disease from an overweight yet otherwise healthy person includes the development of prediabetes, obesity ± prediabetes, dyslipidemia, hypertension, type 2 diabetes, chronic kidney disease, coronary artery disease, and heart failure. Systematic approaches in health systems must be deployed with clear protocols and supported by streamlined technologies to manage their population's metabolic health from early through advanced metabolic disease. Additional research is needed to identify and validate optimal system-level interventions. Future research needs to identify strategies to roll out systematic interventions for the treatment of early metabolic disease and to improve the metabolic health among the progressively younger patients being impacted by obesity and diabetes.

ACTIVE YOU: Teacher Attributes and Attitudes Predicting Physical Activity Promotion

BACKGROUND

Based on the Health Belief Model, this study examined preservice teacher attributes and attitudes toward providing physical activity opportunities for children in school.

METHODS

A quasi-experimental design was used to collect proof of concept and feasibility data for the ACTIVE YOU intervention as part of teacher education.

CONCLUSIONS

Examination of a diverse sample of preservice teachers during their fieldwork revealed that those who engage in healthy behaviors and had positive attitudes toward physical activity in schools are more likely to take action and promote physical activity for their students.

Physical activity promoting teaching practices and children’s physical activity within physical education lessons underpinned by motor learning theory (SAMPLE-PE)

Purpose

Movement competence is a key outcome for primary physical education (PE) curricula. As movement development in children emerges through physical activity (PA), it is important to determine the extent of PA promotion within movement competence focused teaching pedagogies. Therefore, this study aimed to assess children’s moderate-to-vigorous PA (MVPA) and related teaching practices in primary PE within Linear pedagogy and Nonlinear pedagogy and to compare this to current practice within PE delivery in primary schools.

Methods

Participants (n = 162, 53% females, 5-6y) were recruited from 9 primary schools within the SAMPLE-PE cluster randomised controlled trial. Schools were randomly-allocated to one of three conditions: Linear pedagogy, Nonlinear pedagogy, or control. Nonlinear and Linear pedagogy intervention schools received a PE curriculum delivered by trained deliverers over 15 weeks, while control schools followed usual practice. Children’s MVPA was measured during 3 PE lessons (44 PE lessons in total) using an ActiGraph GT9X accelerometer worn on their non-dominant wrist. Differences between conditions for children’s MVPA were analysed using multilevel model analysis. Negative binomial models were used to analyse teaching practices data.

Results

No differences were found between Linear pedagogy, Nonlinear pedagogy and the control group for children’s MVPA levels during PE. Linear and Nonlinear interventions generally included higher percentages of MVPA promoting teaching practices (e.g., Motor Content) and lower MVPA reducing teaching practices (e.g., Management), compared to the control group. Teaching practices observed in Linear and Nonlinear interventions were in line with the respective pedagogical principles.

Conclusions

Linear and Nonlinear pedagogical approaches in PE do not negatively impact MVPA compared to usual practice. Nevertheless, practitioners may need to refine these pedagogical approaches to improve MVPA alongside movement competence.

Teacher Training and Engagement in Health Promotion Mediates Health Behavior Outcomes

School-based health promotion interventions have been shown to lead to measurable changes in the nutrition and physical activity behaviors. This study examines whether the impact of an intervention program on students’ healthy eating and physical activity was mediated by teacher training and engagement in health promotion. The trial was conducted in three phases: needs assessment of the baseline survey of teachers, mothers’ and children; intervention among seven randomly selected schools that included teacher training in healthy eating and physical activity; and a post-intervention evaluation survey. The SPSS PROCESS for Hayes (Model8) was used to determine moderation and mediation effects. The difference in difference (DID) was calculated for the three main outcomes of the study: eating breakfast daily (DID = 17.5%, p < 0.001); consuming the recommended servings of F&V (DID = 29.4%, p < 0.001); and being physically active for at least 5 days/week (DID = 45.2%, p < 0.001). Schoolchildren’s eating breakfast daily was mediated by their teachers’ training in nutrition (β = 0.424, p = 0.002), teachers’ engagement (β = 0.167, p = 0.036), and mothers preparing breakfast (β = 1.309, p < 0.001). Schoolchildren’s consumption of F&V was mediated by teachers’ engagement (β = 0.427, p = 0.001) and knowing the recommended F&V servings (β = 0.485, p < 0.001). Schoolchildren’s physical activity was mediated by their teachers’ training in physical activity (β = 0.420, p = 0.020) and teachers’ engagement (β = 0.655, p < 0.001). Health behavior changes in the school setting including improvements in eating breakfast, consuming the recommended F&V and physical activity was mediated by teacher training and engagement. Effective teacher training leading to teacher engagement is warranted in the design of health-promotion interventions in the school setting.

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.

Essential Components of Physical Education: Policy and Environment

Purpose: Physical education policies provide guidance and accountability to develop quality programs that increase physical literacy. The purpose of this study was to conduct a systematic review of physical education policy research to explore its effects on the school environment and programming as an essential component of physical education. Methods: Using the PRISMA guidelines of identify, screen, determine eligibility, and include, studies were extracted from four different databases, using search terms related to the essential physical education component of policy and environment. Of the 225 publications identified, 42 studies met the inclusion criteria for this investigation. Each paper was coded, and emergent themes were identified. Results: The policy research was predominantly descriptive and focused on: (a) minutes in physical education (83%), (b) moderate to vigorous physical activity (MVPA; 31%), (c) certified/qualified teachers (24%), (d) exemptions (17%), and (e) student-teacher ratio (12%). Emergent themes of adherence, policy strength, and implementation accountability were identified as influential physical education policy aspects. Conclusions: Policy research over the last 20 years was focused on the regulatory mandate of time. Policy research did not directly address disciplinary process variables of learning activities or outcomes of physical education. The effects of policy exemptions and class size were underrepresented. Themes may explain the lack of reporting student performance as the primary outcome. Further research is needed to examine the downstream effects of physical education policy and determine whether well-written policies increase the number of physically literate individuals.

Diversified Talent Cultivation Mechanism of Early Childhood Physical Education Under the Full-Practice Concept - Oriented by Preschooler Mental Health and Intelligent Teaching

In order to improve early childhood physical education, in this study, the talent cultivation mechanism for undergraduates was explored under the "full-practice" concept, oriented by preschooler mental health. First, from the perspective of preschooler psychology, the mechanisms of ability training and talent cultivation for undergraduates majoring in early childhood education were explored under the "full-practice" concept. Considering that the physical, psychological, and intellectual development of preschoolers shall follow the rules of physical education, and current early childhood education mainly focuses on intelligence education in China, early childhood physical education was analyzed further in this study. By investigating the undergraduate majors of early childhood education in Henan University, this study first summarized the current problems in early childhood education systems in universities. Secondly, combined with the form of physical education in kindergartens, strategies for talent cultivation and curriculum setting of early childhood physical education majors in colleges and universities were proposed. Finally, from the perspective of innovation and diversification of training forms, the cultivation of early childhood educators' physical education ability was analyzed at multiple levels and multiple objectives, and the integrated training system of early childhood education talents was constructed. The results show that, among all the courses for early childhood education major, compulsory courses account for 81.2% and optional courses account for 18.8%. In addition, a survey on undergraduates' attitudes toward the curriculum of their major demonstrates that 81.2% of the undergraduates thought that the range and content of practical courses should be increased, indicating that undergraduates majoring in early childhood education are dissatisfied with the current curriculum system, and they have an increased demand for practical courses. Correspondingly, it is vital to build and improve on the early childhood physical education. In terms of its talent cultivation, the "full-practice" concept helps combine theory with practice to improve the effectiveness of education and teaching, pushing forward the reform of the education system. Meanwhile, data- and intelligence-oriented teaching will become the new direction of modern sports development, as well as an important link for tracking and monitoring children's sports teaching in China. Through the continuous introduction of wearable artificial intelligence (AI) products, real-time monitoring of children's physical conditions can be realized, which helps improve the effectiveness of early childhood physical education.

Prompting Pedagogical Change through Promoting Active Lifestyles Paradoxes

This study explored approaches to promoting active lifestyles (PAL) in schools which aimed to inform and develop physical education (PE) trainees and teachers' health-related philosophies and pedagogies. Thirty-two secondary school PE trainees and teachers involved in a University-based Initial Teacher Education partnership in England participated in this study during the period 2015-2019. The participants were involved in professional development which included an introduction to research-informed PAL 'paradoxes' associated with promoting active lifestyles. Participants were asked to review their own health-related philosophies and practices in light of these paradoxes and were encouraged to use them to influence their own pedagogies as well as those of colleagues/peers. Participants found the PAL paradoxes interesting, surprising and perplexing; expressed a keen desire to address and solve them; and experienced the joys and challenges of influencing colleagues'/peers' health-related philosophies and pedagogies. The findings suggest that this innovative low-cost, flexible and accessible approach to pedagogical change has the potential to engage PE teachers, increase their effectiveness as promoters of physical activity, and to greatly enhance the subject's contribution to public health. This is significant, given calls for new pedagogical approaches and teachers' previously reported lack of engagement in professional development in this area.

Effect of Children's Weight Status on Physical Activity and Sedentary Behavior during Physical Education, Recess, and After School

Children's body mass index may affect physical activity (PA) participation. Therefore, this study examined the effect of children's weight status on underserved elementary school children's PA and sedentary behavior (SB) throughout the segmented day. Participants were 138 children (X¯age = 8.14 years). Children's height and weight were measured with subsequent classification of children as healthy weight or overweight/obese. Durations of moderate-to-vigorous PA (MVPA), light PA (LPA), and SB during physical education (PE), morning recess, lunch recess, after school, and overall were assessed via accelerometry over three days. Independent t-tests evaluated differences in children's MVPA, LPA, and SB during each daily segment by weight status. Significantly higher MVPA was observed for children of healthy weight status versus children with overweight/obesity during morning recess, t(136) = 2.15, p = 0.03, after school, t(136) = 2.68, p < 0.01, and overall, t(136) = 2.65, p < 0.01. Interestingly, comparisons of children of healthy weight status and children with overweight/obesity's LPA and SB during the after-school segment revealed a trend wherein children with overweight/obesity participated in slightly greater LPA/less SB than children of healthy weight status. Higher MVPA was observed among children of healthy weight versus children with overweight/obesity during most daily segments. Concerted efforts should focus on increasing MVPA among children with overweight/obesity.

The effectiveness of a health promotion intervention on the meaning of life, positive beliefs, and well-being among undergraduate nursing students: One-group experimental study

Nursing educators have a responsibility to value undergraduate nursing students' physical, psychological, spiritual, and social health promotion.The purpose of the study was to examine the effectiveness of a health promotion intervention concerning meaning of life, positive beliefs, and well-being among undergraduate nursing students in a health promotion curriculum.The study was adopted a pretest, posttest, and post post-test design in 1-group experimental study with a purposive sample of 112 undergraduate nursing students who attended in a health promotion curriculum and voluntarily completed a reliable 3-part questionnaire (content validity index = 0.95; Cronbach's αs = meaning of life, 0.97; positive beliefs, 0.94; and well-being 0.96).Undergraduate nursing students showed significant (all P < .001) improvements on the meaning of life, positive beliefs, and well-being immediately after the intervention, which were sustained over time.Nursing educators should incorporate these variables into the health promotion curriculum to enhance undergraduate nursing students' physical, psychological, spiritual, and social health promotion.

Simulated directed-learning in life-education intervention on the meaning of life, positive beliefs, and well-being among nursing students: A Quasi-experimental study

Nursing educators have the responsibility to equip nursing students with knowledge about the meaning of life, positive beliefs, and well-being in order to enhance their physical, psychological, spiritual, and social health education and promotion. The purpose of this study was to explore nursing students' simulated directed-learning in a life-education intervention on the meaning of life, positive beliefs, and well-being in regard to immediate and delayed effects in improving physical, psychological, spiritual, and social health education and promotion.The method of this study was constituted a quasi-experimental design with experimental and control groups for pre-test, post-test, and post-post-test. Purposive sampling and non-random distribution were used in the study. Assigned to the experimental group, 54 participants were third-year nursing students enrolled in a health education course with simulated directed-learning in a life-education intervention. Assigned to the control group, 56 participants were third-year nursing students enrolled in a caring care course without simulated directed-learning in a life-education intervention. A 56-item questionnaire was utilized, and the content validity index (CVI) was 0.95, as determined by seven expert scholars. The reliability of the questionnaire (n = 45) on Cronbach's α were: meaning of life 0.96, positive beliefs 0.95, and well-being 0.96. The statistical package SPSS 23.0 was used to analyze all of the data in the study. Frequencies, percentages, pre-test mean and SD, post-test mean and SD, post-post-test mean and SD, chi-squared test, t test, and generalized estimating equation (GEE) were employed for data analysis.Nursing students in the experimental group compared with the control group exhibited significant differences in meaning of life on the pre-post-test (β = 16.40, P < .001) and pre-post post-test (β = 25.94, P < .001), positive beliefs on the pre-post-test (β = 5.64, P < .01) and pre-post post-test (β = 9.21, P < .001), and well-being on the pre-post-test (β = 14.33, P < .001) and pre-post post-test (β = 23.68, P < .001).Nursing students in the experimental group showed a significant improvement in the simulated directed-learning with a life-education intervention on meaning of life, positive beliefs, and well-being in the immediate and delayed effects that enhanced their physical, psychological, spiritual, and social health education and promotion.