Peer mentoring is associated with positive change in physical activity and aerobic fitness of grades 4, 5, and 6 students in the heart healthy kids program

Feasibility of Project Mentor: A Mentoring Program Based on Self-Determination Theory for Adolescents Classified as Overweight

Purpose: This study examined the feasibility of Project Mentor, a mentoring program based on self-determination theory (SDT) for youth classified as overweight or obese. Methods: In Study 1, youth (N = 23) ranging from 12-18 years of age were randomly assigned to a mentoring intervention or wait-list control condition. Study 2 served as a replication sample and consisted of N = 38 youth who participated in the mentoring program. As part of a process evaluation, attendance and exercise heart rate were monitored to assess whether participants exercised at a moderate-to-vigorous level as intended. Mentees also rated whether mentors created a need-supportive environment. For outcome evaluation, basic need satisfaction, behavioral regulation, fitness, and body composition were assessed at pre, post, and follow-up. Results: Across both studies, participants attended over 80% of the exercise sessions and exercised at a moderate to vigorous intensity level. Mentees also perceived that mentors created a need-supportive environment. Post-test and follow-up basic need scores were higher than baseline values and autonomous motivation increased for mentoring program participants. Effect sizes were generally moderate to large in magnitude based on partial eta-squared and Cohen d. Aerobic fitness (i.e., Vo2peak) showed a moderate to large increase at post-test that was partially maintained at follow-up. Body composition changes were nonsignificant and small in magnitude. Participants in the wait-list control reported showed small changes or decreases across SDT related constructs, fitness, and body composition across both studies. Conclusions: Results across both studies support the feasibility of a mentoring program focused on CARE (competence, autonomy, relatedness, and enjoyment).

A Randomized Controlled Trial to Examine the Relationship Between Peer Mentoring for Physical Activity and Cardiometabolic Health

Background

Studies examining the effect of peer mentoring on physical activity levels have been conducted in mostly elderly and young populations, and the results have been inconsistent. This study examined the impact of one-on-one peer mentoring on physical activity and cardiometabolic parameters in urban adults.

Methods

The study participants were 353 overweight or obese adults residing in Abuja, Nigeria. They were randomized into two groups, peer-mentored (n = 128) and a control (n = 225) group. All the participants received nutritional counseling and were invited to attend instructor-led physical activity sessions each week for six months. Differences in the frequency, duration, and intensity of physical activity and cardiometabolic parameters, including body fat, muscle mass and lipids, were evaluated within and between the groups with t and rank sum tests.

Results

At the end of the study period, the average time spent on physical activity increased significantly by 14% (p = 0.006), and the average time spent on vigorous physical activity increased by 99% (p = 0.003) compared to baseline for participants in the peer-mentored group. For those in the control group, the average time spent on physical activity decreased significantly by 7% (p = 0.03), while the average time spent on vigorous physical activity increased by 30%, but this was not statistically significant (p = 0.34). In both groups, there were significant improvements in the total cholesterol, low- and high-density lipoproteins and triglycerides levels, at the end of the study period, compared to baseline.

Conclusions

In these overweight or obese adults, we observed that peer mentoring was positively associated with increased physical activity. Peer mentoring also holds great promise for improving cardiometabolic health and promoting a healthy lifestyle in adults.

Youth and Peer Mentor Led Interventions to Improve Biometric-, Nutrition, Physical Activity, and Psychosocial-Related Outcomes in Children and Adolescents: A Systematic Review

The utilization of youth (older) and peer (same age) mentor-led interventions to improve nutrition and physical activity has been an emerging trend in recent years. This systematic review is intended to synthesize the effectiveness of these intervention programs on participants and mentors based on biometric, nutrition, physical activity, and psychosocial outcomes of youth and peer mentor-led interventions among children and adolescents. Online databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar, were searched, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A three-step screening process was used to meet the proposed eligibility criteria, and the risk-of-bias tool for randomized trials (RoB 2) was used to assess bias for the included studies. Nineteen unique intervention programs and twenty-five total studies were deemed eligible when considering the criteria required for review. Multiple studies demonstrated positive evidence of the biometric and physical activity outcomes that were considered significant. The findings regarding the nutritional outcomes across the included studies were mixed, as some studies reported significant changes in eating habits while others did not find a significant change. Overall, the utilization of youth and peer mentor-led models in nutrition- and physical-activity-related interventions may be successful in overweight and obesity prevention efforts for those children and adolescents receiving the intervention and the youths and peers leading the interventions. More research is needed to explore the impact on the youths and peers leading the interventions and disseminating more detailed implementation strategies, e.g., training mentors would allow for advancements in the field and the replicability of approaches. Terminology: In the current youth- and peer-led nutrition and physical activity intervention literature, a varying age differential exists between the targeted sample and the peers, and varying terminology with regards to how to name or refer to the youth. In some instances, the youth mentors were individuals of the same grade as the target sample who either volunteered to serve in the peer role or were selected by their fellow students or school staff. In other cases, the youth mentors were slightly older individuals, either in high school or college, who were selected based upon their experience, leadership skills, passion for the project, or demonstration of healthy lifestyle behaviors.

Impact of Technology-Based Intervention for Improving Self-Management Behaviors in Black Adults with Poor Cardiovascular Health: A Randomized Control Trial

Cardiovascular disease (CVD) is the number one killer of adults in the U.S., with marked ethnic/racial disparities in prevalence, risk factors, associated health behaviors, and death rates. In this study, we recruited and randomized Blacks with poor cardiovascular health in the Atlanta Metro area to receive an intervention comparing two approaches to engagement with a behavioral intervention technology for CVD. Generalized Linear Mixed Models results from a 6-month intervention indicate that 53% of all participants experienced a statistical improvement in Life's Simple 7 (LS7), 54% in BMI, 61% in blood glucose, and 53% in systolic blood pressure. Females demonstrated a statistically significant improvement in BMI and diastolic blood pressure and a reduction in self-reported physical activity. We found no significant differences in changes in LS7 or their constituent parts but found strong evidence that health coaches can help improve overall LS7 in participants living in at-risk neighborhoods. In terms of clinical significance, our result indicates that improvements in LS7 correspond to a 7% lifetime reduction of incident CVD. Our findings suggest that technology-enabled self-management can be effective for managing selected CVD risk factors among Blacks.

Youth Peer Led Lifestyle Modification Interventions: A Narrative Literature Review

The prevalence of obesity remains high among school age children and continues to rise among adolescents in the United States. One strategy to address this challenge is to use peer rather than professional leaders to run weight management programs. Youth peer-led lifestyle interventions have become increasingly common over the last few decades, but there is a lack of review and synthesis of these programs. The purpose of this manuscript was to critically review and synthesize results and lessons learned from evaluated youth peer-led lifestyle modification and weight management programs. We searched the PubMed/MEDLINE database to identify articles published between March 2002 and December 2015. We identified 29 interventions including children from kindergarten to 12th grade from different settings and racial/ethnic and economic backgrounds. We first summarized descriptive information about the interventions and then compared outcomes based on intervention type, peer leader characteristics and training, and other related factors. Our review indicated that youth peer-led interventions of varying structure and content can result in positive changes in behavioral influences, diet, physical activity, body measures and other clinical outcomes. We used information from our analysis to formulate recommendations for design of future youth peer-led lifestyle interventions.

Effectiveness of school-based health promotion interventions prioritized by stakeholders from health and education sectors: A systematic review and meta-analysis

Childhood obesity and associated modifiable risk factors exert significant burden on the health care system. The goal of this systematic review and meta-analysis was to examine the effectiveness of school-based intervention types perceived by Canadian stakeholders in health and education as feasible, acceptable and sustainable in terms of improving physical activity (PA), fruit and vegetable intake, and body weight. We searched multiple databases for studies that evaluated school-based interventions to prevent obesity and associated risk factors (i.e., unhealthy diet, physical inactivity, sedentary behaviour) in children aged 4–18 years from January 1, 2012 to January 28, 2020. From 10,871 identified records, we included 83 and 80 studies in our systematic review and meta-analysis, respectively. Comprehensive School Health (CSH) and interventions which focused on modifications to school nutrition policies showed statistically significant positive effects on fruit intake of 0.13 (95% CI: 0.04, 0.23) and 0.30 (95% CI: 0.1, 0.51) servings per day, respectively. No intervention types showed statistically significant effect on vegetable intake. CSH, modifications to physical education (PE) curriculum, and multicomponent interventions showed statistically significant difference in BMI of −0.26 (95% CI: −0.40, −0.12), −0.16 (95% CI: −0.3, −0.02), and −0.18 (95% CI: −0.29, −0.07), respectively. CSH interventions showed positive effect on step-count per day, but no other types of interventions showed significant effect on any of PA outcome measures. Thus, the results of this systematic review and meta-analysis suggest that decision-makers should carefully consider CSH, multicomponent interventions, modifications to PE curricula and school nutrition policies to prevent childhood obesity.

Promoting Health-Enhancing Physical Activity: a State-of-the-art Review of Peer-Delivered Interventions

PURPOSE OF REVIEW

In this review, we critically examined recent evidence pertaining to the efficacy of peer-delivered physical activity interventions.

RECENT FINDINGS

Peer-delivered interventions appear to represent an efficacious, although under-utilized, means of promoting health-enhancing physical activity, among diverse populations across the lifespan, and in different settings. Nevertheless, research has largely failed to identify the salient behaviors/strategies of peer leaders that can promote behavior change among target populations, as well as explanatory mechanisms (i.e., mediators) of intervention effects. Balanced against recent evidence for the efficacy of peer-delivered interventions to promote physical activity, work in this area appears impeded by an absence of peer-centric explanatory frameworks and theory that may optimize both intervention delivery and efficacy/effectiveness.

Peer approaches to self-management (PALS): comparing a peer mentoring approach for disease self-management in African American women with lupus with a social support control: study protocol for a randomized controlled trial

BACKGROUND

Systemic lupus erythematosus (SLE or lupus) is a chronic autoimmune disease that is associated with increased morbidity, mortality, healthcare costs and decreased quality of life. African Americans in the USA have three to four times greater prevalence of SLE, risk of developing SLE at an earlier age, and SLE-related disease activity, damage, and mortality compared with Caucasians, with the highest rates experienced by African American women. There is strong evidence that patient-level factors are associated with outcomes, which justifies targeting them with intervention. While evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function, and delayed disability among patients with SLE, African Americans and women are still disproportionately impacted by SLE. Peer mentoring interventions are effective in other chronic conditions that disproportionately affect minorities, such as diabetes mellitus, HIV, and kidney disease, but there is currently no empirically tested peer mentoring intervention developed for patients with SLE. Preliminary data from our group suggest that peer mentoring improves self-management, reduces disease activity, and improves health-related quality of life (HRQOL) in African American women with SLE.

METHODS

This study will test an innovative, manualized peer mentorship program designed to provide modeling and reinforcement by peers (mentors) to other African American women with SLE (mentees) to encourage them to engage in activities that promote disease self-management. Through a randomized, "mentored" or "support group" controlled design, we will assess the efficacy and mechanism(s) of this intervention in self-management, disease activity, and HRQOL.

DISCUSSION

This is the first study to test peer mentorship as an alternative strategy to improve outcomes in African American women with SLE. This could result in a model for other programs that aim to improve disease self-management, disease activity, and HRQOL in African American women suffering from chronic illness. The peer mentoring approach is uniquely fitted to African Americans, and this intervention has the potential to lead to health improvements for African American women with SLE that have not been attainable with other interventions. This would significantly reduce disparities and have considerable public health impact.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03734055 . Registered on 27 November 2018.

Difference in Objectively Measured Physical Activity and Obesity in Children With and Without Siblings

Background/Context: Children without siblings (singletons) have higher rates of obesity than do children with siblings (nonsingletons). Higher moderate to vigorous physical activity (PA) and less sedentary behavior (SB) are associated with lower childhood obesity.

PURPOSE

To examine the difference in PA and SB between singleton and nonsingleton children.

METHODS

Mothers of children ages 5.0-7.9 years old who were singletons or nonsingletons with a sibling between the ages of 2.0 and 4.9 years old were recruited. Height, weight, and waist circumference of the 5.0- to 7.9-year-old children were measured, and age and sex percentiles were calculated. Accelerometry measured SB and PA, including light PA, moderate to vigorous PA, and counts per minute.

RESULTS

Fifty-six mother-child dyads (23 singletons and 33 nonsingletons) with an average child age of 5.7 (0.7) years participated. More singletons were classified as overweight or obese than were nonsingletons (49% vs 17%, P = .04). In adjusted linear models, singletons had less light PA per day (β = -38.1, SE = 19.2, P = .001) and more SB (β = 38.0, SE = 16.5, P = .02) than did nonsingletons, with no difference in moderate to vigorous PA or counts per minute.

CONCLUSION

In this sample, singletons had higher obesity and lower light PA than did nonsingleton children. Investigation into differences in singleton/nonsingleton families, including family health behaviors, may help assess sibling influence in early behavior development.

A school-based intervention (‘Girls Active’) to increase physical activity levels among 11- to 14-year-old girls: cluster RCT

Background

Physical activity (PA) levels among adolescent girls in the UK are low. ‘Girls Active’, developed by the Youth Sport Trust (YST), has been designed to increase girls’ PA levels.

Objective

To understand the effectiveness and cost-effectiveness of the Girls Active programme.

Design

A two-arm cluster randomised controlled trial.

Setting

State secondary schools in the Midlands, UK.

Participants

Girls aged between 11 and 14 years.

Intervention

Girls Active involves teachers reviewing PA, sport and physical education provision, culture and practices in their school; attending training; creating action plans; and effectively working with girls as peer leaders to influence decision-making and to promote PA to their peers. Support from a hub school and the YST is offered.

Main outcome measures

The change in objectively measured moderate to vigorous intensity PA (MVPA) levels at 14 months. Secondary outcomes included changes in overall PA level (mean acceleration), light PA levels, sedentary time, body composition and psychosocial outcomes. Cost-effectiveness and process evaluation (qualitative and quantitative) data were collected.

Results

Twenty schools and 1752 pupils were recruited; 1211 participants provided complete primary outcome data at 14 months. No difference was found in mean MVPA level between groups at 14 months [1.7 minutes/day, 95% confidence interval (CI) –0.8 to 4.3 minutes/day], but there was a small difference in mean MVPA level at 7 months (2.4 minutes/day, 95% CI 0.1 to 4.7 minutes/day). Significant differences between groups were found at 7 months, but not at 14 months, in some of the objective secondary outcomes: overall PA level represented by average acceleration (1.39 mg, 95% CI 0.1 to 2.2 mg), after-school sedentary time (–4.7 minutes/day, 95% CI –8.9 to –0.6 minutes/day), overall light PA level (5.7 minutes/day, 95% CI 1.0 to 10.5 minutes/day) and light PA level on school days (4.5 minutes/day, 95% CI 0.25 to 8.75 minutes/day). Minor, yet statistically significant, differences in psychosocial measures at 7 months were found in favour of control schools. Significant differences in self-esteem and identified motivation in favour of intervention schools were found at 7 and 14 months, respectively. Subgroup analyses showed a significant effect of the intervention for those schools with higher numbers of pupils at 14 months. Girls Active was well received by teachers, and they reported that implemented strategies and activities were having a positive impact in schools. Barriers to implementation progress included lack of time, competing priorities and the programme flexibility. Implementation costs ranged from £2054 (£23/pupil) to £8545 (£95/pupil) per school. No differences were found between groups for health-related quality-of-life scores or frequencies, or for costs associated with general practitioner, school nurse and school counsellor use.

Conclusions

Girls Active may not have had an effect on the random 90 girls per school included in the evaluation. Although we included a diverse sample of schools, the results may not be generalisable to all schools. Girls Active was viewed positively but teachers did not implement as many aspects of the programme as they wanted. The intervention was unlikely to have a wide impact and did not have an impact on MVPA level at 14 months. Capitalising on the opportunities of a flexible programme like this, while also learning from the stated barriers to and challenges of long-term implementation that teachers face, is a priority for research and practice.

Trial registration

Current Controlled Trials ISRCTN10688342.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 5. See the NIHR Journals Library website for further project information. The YST funded the intervention. This study was undertaken in collaboration with the Leicester Clinical Trials Unit, a UK Clinical Research Collaboration-registered clinical trials unit in receipt of NIHR Clinical Trials Unit support funding. Neither the YST nor the NIHR Clinical Trials Unit had any involvement in the Trial Steering Committee, data analysis, data interpretation, data collection or writing of the report. The University of Leicester authors are supported by the NIHR Leicester–Loughborough Biomedical Research Unit (2012–17), the NIHR Leicester Biomedical Research Centre (2017–22) and the Collaboration for Leadership in Applied Health Research and Care East Midlands. These funders had no involvement in the Trial Steering Committee, the data analysis, data interpretation, data collection or writing of the report.

Sibling influence on children's objectively measured physical activity: a meta-analysis and systematic review

Abstract

Children without siblings (only children) have higher rates of obesity than children with siblings. Childhood obesity may be prevented by minimising sedentary behaviour and accumulating sufficient physical activity in young children. A growing number of articles have examined the influence of siblings on physical activity and sedentary behaviour, yet these articles have not been synthesised.

Objective

To synthesise literature and describe the influence of siblings on objectively measured physical activity and sedentary behaviour of children (ages 2–18 years).

Design

Outcomes were analysed in a systematic review and meta-analysis.

Data sources

PubMed, EMBASE, Web of Science and Medline OVID were searched for articles related to siblings, physical activity, sedentary behaviour and obesity outcomes from 1947 to March 2018.

Eligibility criteria

Articles that evaluated sibling status on physical activity objectively measured by accelerometer or pedometer were included.

Results

Nineteen articles, representing 17 independent datasets, were included in the review. Nine were included in the quantitative analysis. Pooled data from nine articles indicated children with siblings had higher moderate-to-vigorous physical activity (MVPA) relative to only children, with a potential dose response for higher number of children in household and higher MVPA (Mean Difference=3.13, 95% CI 1.90 to 4.35, p=0.001). Findings were mixed for the influence of siblings on sedentary behaviour and light physical activity.

Summary/Conclusion

Children with siblings had healthier physical activity patterns, as measured by accelerometer or pedometer, than did only children. Suggested mechanisms include peer modelling, encouraging active transport and sports participation, opportunity for playmate and serving as additional caregivers.

Trial registration number

CRD42017055463.

Cytokine balance and behavioral intervention; findings from the Peer Approaches to Lupus Self-Management (PALS) project

The Peer Approaches to Lupus Self-Management program sought to address the disparate impact of systemic lupus erythematosus (SLE) on African American women through a peer mentoring intervention with aims of reducing stress, anxiety, and depression. Given the association between psychological health and immune function this study examines the relationship between patient reported outcomes (PROs) in these domains and immunologic indicators of disease activity. Twenty-three African American women with SLE served as mentees in the intervention from whom PRO measures were collected at the outset, midpoint, and end of the 12week pilot study. Blood samples were collected pre- and post-intervention. Plasma was collected from the samples and cryopreserved for subsequent analyses. The strongest correlations were between the Generalized Anxiety Disorder measure and Th1/Th2 cytokine balance. Weaker correlations existed between depression and the Th1/Th2 cytokine balance. Assessment of fresh versus cryopreserved samples revealed that changes in Th1/Th2 cytokine balance within the intervention were generally equivalent, regardless of sample type. The PALS intervention resulted in significant improvements to anxiety and depression levels which were significantly associated with positive changes in Th1/Th2 cytokine balance indicating a possible underlying mechanism of action. The nature of this relationship warrants further study.

Two Pilot Randomized Trials To Examine Feasibility and Impact of Treated Parents as Peer Interventionists in Family-Based Pediatric Weight Management

BACKGROUND

To examine feasibility and initial efficacy of having previously treated parents serve as peer interventionists in family-based behavioral weight management treatment (FBT).

METHODS

Children aged 7-11 years with overweight/obesity and parents (n = 59 families) were enrolled in one of two pilot trials, the EPICH (Engaging Parents in Child Health) randomized trial comparing professional versus peer FBT delivery or the Parent Partnership trial, which provided professionally delivered FBT to families (first generation) and then randomly assigned first generation parents to either be or not be peer interventionists for subsequent families (second generation). Efficacy (child zBMI change), feasibility, and costs for delivering FBT, and impacts of being a peer interventionist were examined.

RESULTS

In EPICH, families receiving professional versus peer intervention had similar decreases in child zBMI and parent BMI, with markedly lower costs for peer versus professional delivery. In Parent Partnership, families receiving peer intervention significantly decreased weight status, with very preliminary evidence suggesting better maintenance of child zBMI changes if parents served as peer interventionists. Previously treated parents were willing, highly confident, and able to serve as peer interventionists in FBT.

CONCLUSIONS

Two pilot randomized clinical trials suggest parents-as-peer interventionists in FBT may be feasible, efficacious, and delivered at lower costs, with perhaps some additional benefits to serving as a peer interventionist. More robust investigation is warranted of peer treatment delivery models for pediatric weight management.

Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring

Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.

Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months

Background

The number of obese children in the US remains high, which is problematic due to the mental, physical, and academic effects of obesity on child health. Data indicate that school-age children, particularly underserved children, experience unhealthy gains in BMI at a rate nearly twice as fast during the summer months. Few efforts have been directed at implementing evidence-based programming to prevent excess weight gain during the summer recess.

Methods

Camp NERF is an 8-week, multi-component (nutrition, physical activity, and mental health), theory-based program for underserved school-age children in grades Kindergarten - 5th coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites will be randomized to one of the three programming groups: 1) Active Control (non-nutrition, physical activity, or mental health); 2) Standard Care (nutrition and physical activity); or 3) Enhanced Care (nutrition, physical activity, and mental health) programming. Anthropometric, behavioral, and psychosocial data will be collected from child-caregiver dyads pre- and post-intervention. Site-specific characteristics and process evaluation measures will also be collected.

Discussion

This is the first, evidence-based intervention to address the issue of weight gain during the summer months among underserved, school-aged children. Results from this study will provide researchers, practitioners, and public health professionals with insight on evidence-based programming to aid in childhood obesity prevention during this particular window of risk.

Trial Registration

NCT02908230/09-19-2016