Effectiveness of a school-community linked program on physical activity levels and health-related quality of life for adolescent girls

Enhancing Adolescent Physical Fitness and Well-Being: A School-Based High-Intensity Interval Training Program

Background: The aim of this study is to investigate the effects of a school-based high-intensity interval training (HIIT) program on quality of life and physical fitness in adolescents. Methods: The study included 60 male adolescents (16.2 ± 0.6 years), randomly assigned to one of two groups: the HIIT group (n = 30) and the control group (CG, n = 30). Participants completed the KIDSCREEN-27 questionnaire to evaluate quality of life and physical fitness tests, including vertical jump, repetitive strength, agility, and flexibility. The experimental program consisted of a 12-week intervention integrated into the warm-up phase of regular physical education (PE) classes. Each PE class lasted 45 min, with the HIIT regimen occupying 10 min of the warm-up phase. The HIIT sessions followed a Tabata-style structure, performed twice weekly. A two-way ANOVA with repeated measures assessed group and time interaction effects. Results: The results revealed changes in physical well-being following the HIIT intervention (p = 0.01) compared to the control group (p = 0.42). The results of the two-way ANOVA with repeated measures revealed interaction effects between group and time for the various fitness tests, countermovement jump (p = 0.04), 4 × 10 m agility test (p = 0.02), medicine ball throw test (p = 0.04), and sit-ups (30 s) (p = 0.01). Conclusions: This study highlights the effectiveness of school-based HIIT in significantly enhancing physical well-being and physical fitness among adolescents.

Are Physical Activity Interventions Effective in Improving Health-Related Quality of Life in Children and Adolescents? A Systematic Review and Meta-Analysis

CONTEXT

Physical activity (PA) interventions improve well-being and positive mental health in children and adolescents, but the results of previous systematic reviews included participants with chronic medical conditions and did not accurately assess the multidimensional nature of health-related quality of life (HRQoL).

OBJECTIVE

The aims of this meta-analysis were to (1) evaluate the effects of PA interventions on several domains of HRQoL in healthy <18-year-olds and (2) examine the effectiveness of interventions on HRQoL according to whether they were successful in increasing PA, the type of intervention delivered, and the duration of the intervention.

DATA SOURCES

PubMed (Medline), EMBASE, the Cochrane Library, SCIELO, SPORTDiscus, and PEDro databases were systematically searched from inception to September 30, 2022.

STUDY SELECTION

Experimental studies that examined the effectiveness of PA interventions on HRQoL participants aged <18 years.

STUDY DESIGN

Systematic review with meta-analysis and meta-regression.

LEVEL OF EVIDENCE

Level 1.

METHODS

Random-effects models were used to calculate pooled effect size (ES) for total HRQoL score and its dimensions. Subgroup analyses were conducted to examine the effect of PA program characteristics.

RESULTS

A total of 17 studies were included. Pooled ES (95% CI) estimations were as follows: 0.179 (0.045, 0.002) for total HRQoL score, 0.192 (0.077, 0.306) for physical well-being, 0.158 (0.080, 0.237) for psychological well-being, 0.118 (0.044, 0.192) for autonomy and parent relation, 0.135 (0.043, 0.227) for social support and peers, and 0.129 (-0.013, 0.270) for school environment. Subgroup analyses suggested there were no differences in the effectiveness of the interventions by category of PA increase or by type and duration of intervention.

CONCLUSION

Exercise interventions are an effective strategy for improving overall HRQoL and its most significant domains in children and adolescents.

Twelve-month outcomes of a community-based, father-daughter physical activity program delivered by trained facilitators

BACKGROUND

Dads and Daughters Exercising and Empowered (DADEE) is a program targeting fathers/father-figures to improve their daughters' physical activity and well-being. Previous randomised controlled efficacy and effectiveness trials of DADEE demonstrated meaningful improvements in a range of holistic outcomes for both fathers and daughters in the short-term. This study aims to assess the long-term impact (12-months) of the program when delivered in the community by trained facilitators.

METHODS

Fathers/father-figures and their primary school-aged daughters were recruited from Newcastle, Australia into a single-arm, non-randomised, pre-post study with assessments at baseline, 10-weeks (post-intervention) and 12-months. The 9-session program included weekly 90-min educational and practical sessions, plus home-based tasks. The primary outcome was fathers' and daughters' days per week meeting national physical activity recommendations (≥ 30 min/day of MVPA for fathers, ≥ 60 min/day MVPA for daughters). Secondary outcomes included physical activity, screen time, self-esteem, father-daughter relationship, social-emotional well-being, parenting measures, and process outcomes (including recruitment, attendance, retention and program acceptability).

RESULTS

Twelve programs were delivered with 257 fathers (40.0 ± 9.2 years) and 285 daughters (7.7 ± 1.9 years). Mixed effects regression models revealed significant intervention effects for the primary outcome, with fathers increasing the days/week meeting physical activity recommendations by 27% at 10-weeks (p < 0.001) and by 19% at 12-months (p < 0.001) compared with baseline. Likewise, for daughters there was a significant increase by 25% at 10-weeks (p < 0.001) and by 14% at 12-months (p = 0.02) when compared to baseline. After conducting a sensitivity analysis with participants unaffected by COVID-19 lockdowns (n = 175 fathers, n = 192 daughters), the primary outcome results strengthened at both time-points for fathers and at 12-months for daughters. Additionally, the sensitivity analysis revealed significant intervention effects at post-program and 12-months for all secondary outcomes in both fathers and daughters. Furthermore, the process outcomes for recruitment capability, attendance, retention and satisfaction levels were high.

CONCLUSIONS

Findings provide support for a sustained effect of the DADEE program while delivered in a community setting by trained facilitators. Further investigation is required to identify optimised implementation processes and contextual factors to deliver the program at scale.

TRIAL REGISTRATION

ACTRN12617001450303 . Date registered: 12/10/2017.

Replicability, adaptability and long-term impact of the 'Healthy Youngsters, Healthy Dads' program in Newcastle, Australia

'Healthy Youngsters, Healthy Dads' (HYHD) targets fathers to improve the health of their preschool-aged children. In a previous randomized trial, fathers and children experienced meaningful improvements in physical activity and eating behaviours. The next phase is to test the replicability and adaptability of HYHD when delivered in the community by trained facilitators. Fathers/father-figures and children aged 3-5 years were recruited from Newcastle, Australia into a 9-week, non-randomized trial with assessments at baseline, 10 weeks, and 12 months. The primary outcome was achievement of pre-registered targets for recruitment (≥ 96 dyads), attendance (≥ 70%), compliance (completing ≥ 70% of home-based tasks), fidelity (≥ 80% of content delivered as intended) and program satisfaction (≥ 4/5). Secondary outcomes included physical activity, nutrition, screen time and parenting measures. Process targets were surpassed for recruitment (140 fathers, 141 children), attendance (79% for fathers-only workshops, 81% for father-child sessions), compliance (80% of home-tasks completed), fidelity (99% for education, ≥ 97% for practical) and program satisfaction (4.8/5). Mixed effects regression models revealed significant effects in fathers for moderate-to-vigorous physical activity, co-physical activity, dietary intake and parenting practises, which were maintained at 12 months. Significant effects were also established for screen time at 10 weeks only. For children, significant effects were observed for screen time and dietary intake at 10 weeks, while effects on energy-dense, nutrient-poor foods and healthy, nutrient-dense core food intake were maintained at 12 months. Findings demonstrate the replicability and adaptability of HYHD when delivered in the community by local trained facilitators. Further investigation into how to optimally scale-up HYHD is warranted.

Exploring Health-Related Quality of Life in Children With Hypertrophic Cardiomyopathy and Relationship to Physical Activity

BACKGROUND

Hypertrophic cardiomyopathy is a burdensome condition that inflicts both physical and psychological impairment on those with the disease, negatively impacting health-related quality of life (HRQoL). Given the abundance of evidence suggesting a role of physical activity (PA) in modulating HRQoL in healthy populations of children, we sought to determine the relationship between HRQoL and PA in children diagnosed with hypertrophic cardiomyopathy.

METHODS AND RESULTS

A multicenter prospective observational cohort study was conducted, with patients with hypertrophic cardiomyopathy aged 10 to 19 years being provided a wrist-worn activity tracker (Fitbit Charge HR) to wear for 14 days. Patients self-reported on Pediatric Quality of Life 4.0 quality of life inventory items, which were associated with PA metrics following covariate adjustment using linear regression. A total of 56 participants were recruited to the study. The median age at enrollment was 15.5 years (interquartile range, 13.8-16.8), and 16 out of 56 (29%) of the cohort were girls. The cohort reported decreased metrics of physical, psychosocial, and total summary scores compared with health reference populations, with scores comparable with that of published populations with chronic disease. Increased physical HRQoL scores were significantly associated with increased daily steps taken, distance traveled, and flights of stairs climbed.

CONCLUSIONS

These results show that impaired PA correlates with reduced HRQoL in children with hypertrophic cardiomyopathy, suggesting PA may partially mediate HRQoL in this population.

Physical activity interventions among youth living in rural and remote areas: A systematic review

OBJECTIVES

Physical activity (PA) interventions have potential to improve health and social outcomes among youth. The aim of this study was to collate the evidence on the effectiveness of PA and sports-based interventions among youth living in rural and remote areas.

METHODS

We searched five databases and grey literature (HealthInfoNet). Search terms included PA, rural status, adolescents, and outcome measures. Studies were included if published in English, recruited 10- to 18-year olds, and were based in rural or remote communities (Modified Monash Model [MMM] area classification range of MMM 3-7). Quasi-experimental and pre-experimental and post-experimental PA interventions were included. Two authors evaluated the articles independently following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, and relevant data were extracted. International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020199001).

RESULTS

Of the 11802 studies identified, 6 were included in the review. Most studies were excluded for not meeting MMM 3-7 criteria. Four of the included studies had sports-related interventions, and 2 had walking-based interventions. Outcomes included self-efficacy, mental health, and academic performance. One study reported a positive effect of PA on self-efficacy (β = 0.26, p=0.018, odds ratio = 1.43 [95% confidence interval: 1.07-1.92]).

CONCLUSION

Few community-based PA interventions have been evaluated in rural areas. There is a need for future evaluations in rural areas and include PA as an outcome measure.

IMPLICATIONS FOR PUBLIC HEALTH

The findings highlight the need for measurement of PA outcomes in PA interventions in rural and remote areas. The findings also highlight the need for research to utilise a standardised measure of rurality.

School-Based Family-Oriented Health Interventions to Promote Physical Activity in Children and Adolescents: A Systematic Review

OBJECTIVE

This study aimed to systematically review and analyse intervention programs in a school context centred on the family, focused on increasing youths' physical activity.

DATA SOURCE

The research was carried out in the PubMed, Scopus and Web of Science databases.

STUDY INCLUSION CRITERIA

Studies were included if participants were children or adolescents, focusing on school-based intervention studies with parental involvement and physical activity, sedentary behaviour or physical fitness outcomes.

DATA EXTRACTION

The search was performed according to the PRISMA protocol. A total of 416 articles were identified. After being considered for eligibility and duplicates, 22 studies were identified as relevant for inclusion.

DATA SYNTHESIS

Sample and intervention characteristics, objective, the role of the family, outcomes measures, main findings regarding the outcomes and risk of bias.

RESULTS

Ten studies reported improvements in physical activity, 6 in sedentary behaviour and 9 in the components of physical fitness and/or skills related to healthy behaviours and lifestyles. Most of the interventions adopted a multidisciplinary and multi-component approach.

CONCLUSIONS

Most interventions employed a school's multidisciplinary/multi-component approach to promoting physical activity, nutrition, and general education for healthier lifestyle behaviours. The impact of school-based interventions involving families on youth's physical activity levels is still a relatively emerging theme. Further research is needed given the diversity of the intervention's characteristics and the disparity in the results' efficacy.

Effectiveness of MOVI-KIDS programme on health-related quality of life in children: Cluster-randomized controlled trial

OBJECTIVE

To test the effectiveness of an 8-month school-based multicomponent intervention (MOVI-KIDS) in improving health-related quality of life (HRQoL) in schoolchildren.

STUDY DESIGN

A randomized cluster trial was conducted including 1168 children aged 4-6 years who attended 21 schools in two Spanish provinces (Cuenca and Ciudad Real). MOVI-KIDS study is a multicomponent physical activity intervention, which consisted of (i) 3 × 60-min sessions/week, (ii) educational materials for parents and teachers, and (iii) school playground modifications. The parent's proxy report of the KINDL-R Spanish version (6 subdimensions and a total score), and the KINDL-R self-reported by children (total score) was used to measure HRQoL. Mixed linear regression models were conducted to test differences in each HRQoL dimension between intervention and control groups, controlling for baseline values, cardiorespiratory fitness, and socioeconomic status, by gender.

RESULTS

The boys in the intervention group presented better scores on total HRQoL than the control group in both the parent (ß = 1.46; 95% CI: 0.23-2.70) and self-reported (ß = 2.13; 95% CI: 0.53-3.74) versions, as well as on the emotional well-being dimension (ß = 2.43; 95% CI: 0.48-4.36). There was no significant effect of the intervention on physical well-being, self-esteem, family, and friends. In girls, no statistically significant differences were found between those who participated in MOVI-KIDS and those who did not.

CONCLUSION

Our data support gender differences in the effect of MOVI-KIDS, such that while in boys the intervention was successful in increasing total scores of HRQoL, as well as emotional well-being scores, the intervention was not effective in improving girls' HRQoL.

Psychosocial Effects of Physical Activity Interventions for Preschoolers, Children, and Adolescents: Role of Intervention Settings

OBJECTIVE

Physical activity interventions are potential strategies to enhance psychosocial health of children and adolescents. Interventions are performed at diverse settings (e.g., school, home, community), but little research has addressed whether and how the effectiveness of these programs vary by setting type. The aim of this review is to summarize the psychosocial effects of physical activity programs for preschoolers, children, and adolescents at various intervention settings.

DATA SOURCE

A systematic search of five electronic databases, MEDLINE-PubMed, CINAHL, PsycINFO, CENTRAL, and Scopus was performed.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included studies had participants between 3-18 years, physical activity intervention duration of at least four weeks, experimental design, and at least one psychosocial health outcome.

DATA EXTRACTION

Data on participants, intervention, comparison, outcomes, and findings were extracted.

DATA SYNTHESIS

Data were synthesized by the intervention setting; school, home, and community.

RESULTS

Of the thirty-five included studies, 74% were performed at schools. Although fewer studies used community (17%)- and home-based (9%) interventions, these were similarly effective in improving psychosocial health as school-based interventions.

CONCLUSIONS

Community- and home-based intervention settings may be underutilized despite being similarly effective as school-based settings. A large proportion of time is spent out of school during weekends and summer-break. Community- and home-based physical activity programs may be pragmatic strategies to deliver improvements in psychosocial health of preschoolers, children, and adolescents.

Quality of life and adiposity in adolescents: direct and indirect effects

This paper aimed to analyze the direct and indirect effects of adiposity and factors related to adolescents' quality of life. This is a cross-sectional study with 635 adolescents (10-16 years) from public schools in Montes Claros-MG, Brazil. Anthropometric data, physical activity (PA), inadequate dietary habits, body image, and quality of life (QoL) of adolescents were collected. A structural equation modeling was performed. The variables addressed as constructs were adiposity and inadequate dietary habits, the exploratory variables were PA and body image, and the outcome variable was QoL. The total effect of PA-mediated adiposity on QoL was positive and significant (β=0.213; p<0.05), in contrast to the total effect mediated by inadequate dietary habits on QoL, which was negative and significant (β=-0.150; p<0.05). The direct effect of PA on QoL was positive and significant (β=0.209; p<0.001). No body image-related effects were observed. The effects of adiposity on adolescents' QoL tend to improve when mediated by PA, and they worsen when mediated by inadequate dietary habits. The effects of PA tend to improve the QoL of adolescents.

Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 24-month implementation and cost outcomes from a cluster randomised controlled trial

Background

Physical Activity 4 Everyone (PA4E1) is an evidence-based program effective at increasing adolescent physical activity (PA) and improving weight status. This study aimed to determine a) the effectiveness of an adapted implementation intervention to scale-up PA4E1 at 24-month follow-up, b) fidelity and reach, and c) the cost and cost-effectiveness of the implementation support intervention.

Methods

A cluster randomised controlled trial using a type III hybrid implementation-effectiveness design in 49 lower socio-economic secondary schools, randomised to a program (n = 24) or control group (n = 25). An adapted implementation intervention consisting of seven strategies was developed to support schools to implement PA4E1 over 24-months. The primary outcome was the proportion of schools implementing at least four of the 7 PA practices, assessed via computer assisted telephone interviews (CATI) with Head Physical Education Teachers. Secondary outcomes included the mean number of PA practices implemented, fidelity and reach, cost and cost-effectiveness. Logistic regression models assessed program effects.

Results

At baseline, no schools implemented four of the 7 PA practices. At 24-months, significantly more schools in the program group (16/23, 69.6%) implemented at least four of the 7 PA practices than the control group (0/25, 0%) (p < 0.001). At 24-months, program schools were implementing an average of 3.6 more practices than control schools (4.1 (1.7) vs. 0.5 (0.8), respectively) (P < 0.001). Fidelity and reach of the implementation intervention were high (> 75%). The total cost of the program was $415,112 AUD (2018) ($17,296 per school; $117.30 per student).

Conclusions

The adapted implementation intervention provides policy makers and researchers with an effective and potentially cost-effective model for scaling-up the delivery of PA4E1 in secondary schools. Further assessment of sustainability is warranted.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01206-8.

Improved Motor Proficiency and Quality of Life in Youth With Prader-Willi Syndrome and Obesity 6 Months After Completing a Parent-Led, Game-Based Intervention

PURPOSE

To determine changes and potential differences in physical activity (PA), gross motor proficiency (MP), and health parameters after a 6-month follow-up (FU) period following participation in a parent-led PA intervention in youth with or without Prader-Willi syndrome (PWS).

METHODS

About 42 youth with PWS and 65 youth without PWS but with obesity (body fat percentage >95th percentile for age and sex), aged 8-16 years, participated. The intervention included preplanned PA sessions containing playground and console-based video games scheduled 4 days per week for 24 weeks. Families received training and curriculum materials. PA (accelerometry), MP (Bruininks-Oseretsky Test of MP), and health-related quality of life were obtained before (PRE), after completing the intervention (POST), and at FU.

RESULTS

There were no significant changes in PA at any time point. At FU and POST, participants showed higher bilateral coordination (PRE = 9.3 [0.4], POST = 11.7 [0.5], and FU = 11.1 [0.6]); speed and agility (PRE = 9.2 [0.4], POST = 10.8 [0.4], and FU = 11.5 [0.5]); and strength (PRE = 8.0 [0.3], POST = 9.2 [0.3], and FU = 9.2 [0.3]) than at PRE. At FU (80.3 [2.1]) and POST (79.8 [1.7]), youth without PWS showed higher health-related quality of life than PRE (75.0 [1.8]).

CONCLUSION

The improvements in MP and health-related quality of life at FU suggest long-term durability of intervention outcomes.

Associations Between Child Maltreatment and Adolescents' Health-Related Quality of Life and Emotional and Social Problems in Low-Income Families, and the Moderating Role of Social Support

This study aimed to examine the associations between different types of child maltreatment and health-related quality of life (HRQoL) and emotional and social problems in adolescents, and to examine the moderating effect of social support on those associations. A cross-sectional survey was conducted between January and June 2016 in Hong Kong. The sample comprised 351 parent and adolescent dyads from low-income families. The parents reported on child maltreatment (physical abuse, psychological aggression, and neglect), and the adolescents reported on their HRQoL, emotional problems, and social problems. The adolescents' perceived social support was included as a potential moderator. Results of the study show that child physical abuse was strongly associated with emotional and social problems (B = 0.91-1.45, p < .05). Lower overall HRQoL was associated with psychological aggression (B = -3.96, p < .05) and neglect (B = -4.14, p < .05). Physical functioning was affected by psychological aggression (B = -3.16, p < .05), and emotional functioning was affected by neglect (B = -4.82, p < .05). Social functioning was impacted by all three types of maltreatment (B = -9.16 to -5.26, p < .05). This study extends previous literature by showing the varying effects of different types of child maltreatment on children's health in the context of low-income families. The findings of this study also support that peer social support may buffer the effects of child physical abuse on adolescents' emotional and social problems.

Randomized Controlled Trial to Increase Physical Activity Among Hispanic-American Middle School Students

BACKGROUND

Moderate-to-vigorous physical activity (MVPA) declines during adolescence, particularly among girls. In this randomized control trial, we examined MVPA in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined.

METHODS

Hispanic-American middle school students (N = 193) were recruited from a school district in Houston, Texas. Participants were randomized to either a circuit-based physical activity intervention or TAU (PE class as usual). MVPA was assessed using accelerometry at baseline and 6 months. Repeated measures ANCOVA were conducted to examine changes in MVPA, overall and stratified by sex and weight classification. This procedure was repeated for zBMI.

RESULTS

Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p < .01). Intervention girls increased weekday MVPA; whereas TAU girls decreased weekday MVPA (F(1,99) = 7.36, p < .01). Among those with obesity, there was no difference in MVPA between conditions (F(1, 56) = 0.33, p = .57), but Intervention decreased zBMI significantly more than TAU (F(1, 56) = 6.16, p < .05).

CONCLUSIONS

Structured PE classes grounded in behavioral theory may be an important strategy to prevent typical decreases in MVPA during adolescence, particularly among girls and for youth with obesity.

Health Literacy in Schools? A Systematic Review of Health-Related Interventions Aimed at Disadvantaged Adolescents

Socioeconomically disadvantaged populations are at greater risk of adopting unhealthy behaviours and developing chronic diseases. Adolescence has been identified as a crucial life stage to develop lifelong healthy behaviours, with schools often suggested as the ideal environment to foster healthy habits. Health literacy (HL) provides a possible solution to promote such healthy behaviours. The aim of this study was to review school-based HL-related interventions targeting socioeconomically disadvantaged adolescents and to identify effective intervention strategies for this population. Searches were performed in six databases. Inclusion criteria included age: 12–16; the implementation of a school-based intervention related to HL aimed at socioeconomically disadvantaged populations; an intervention focused on: physical activity (PA), diet, mental health, substance abuse or sleep. Forty-one articles were included, with the majority focusing on PA and diet (n = 13), PA (n = 9) or mental health (n = 7). Few interventions focused solely on substance abuse (n = 2) or sleep (n = 1), and none targeted or assessed HL as an outcome measure. There was huge heterogeneity in study design, outcomes measures and effectiveness reported. Effective intervention strategies were identified that can be used to guide future interventions, including practical learning activities, peer support and approaches targeting the school environment, the parents or that link the intervention to the community.

Efforts on Changing Lifestyle Behaviors May Not Be Enough to Improve Health-Related Quality of Life Among Adolescents: A Cluster-Randomized Controlled Trial

Schools have been the main context for physical activity (PA) and sedentary behavior (SB) interventions among adolescents, but there is inconsistent evidence on whether they also improve dimensions of the health−related quality of life (HRQoL). The aim of this study was to evaluate the effects of a school-based active lifestyle intervention on dimensions of HRQoL. A secondary aim was to verify whether sex, age, and HRQoL at baseline were moderators of the intervention effect. A cluster-randomized controlled trial was conducted at three control and three intervention schools in Florianopolis, Brazil. All students from 7th to 9th grade were invited to participate. A school year intervention, designed primarily to increase PA and reduce SB, included strategies focused on (i) teacher training on PA, SB, and nutrition, and availability of teaching materials related to these contents; (ii) environmental improvements (i.e., creation and revitalization of spaces for the practice of PA in school); and (iii) education strategies, with the availability of folders and posters regarding PA, SB, and nutrition. Participants and the research staffs were not blinded to group assignment, but a standardized evaluation protocol was applied at baseline and after the intervention (March and November 2017) using the KIDSCREEN−27 to assess HRQoL across five dimensions. Mixed linear models were performed to evaluate the effect of the Movimente intervention on the five HRQoL dimensions. Of the 921 students who answered the questionnaire at baseline, 300 and 434 completed the study in control and intervention groups, respectively (dropouts: 20%). The results revealed no significant effects of the intervention on any HRQoL dimensions. A reduction of the school environment dimension was observed in both the control (-2.44; 95% CI: -3.41 to -1.48) and intervention groups (-2.09; 95% CI: -2.89 to -1.30). Sensitivity analyses showed that students in the highest baseline tertiles of HRQoL in any dimension had a reduction in their respective scores from pre- to post-intervention in both school groups. In conclusion, our results demonstrated no intervention effect on HRQoL dimensions and those students with the highest levels of HRQoL at baseline on all dimensions reduced from pre to post-intervention.

Changes in Self-Reported Physical Activity Predict Health-Related Quality of Life Among South African Schoolchildren: Findings From the DASH Intervention Trial

Introduction: Regular physical activity is associated with multiple health benefits for children. Evidence from cross-sectional studies suggests that physical activity is positively associated with health-related quality of life (HRQoL). The promotion of physical activity, and hence HRQoL, through a school-based intervention is therefore an important endeavor, particularly in disadvantaged areas of low- and middle-income countries, including South Africa.

Methods: We designed a multicomponent physical activity intervention that was implemented over a 20-week period in 2015 in eight disadvantaged primary schools of Port Elizabeth, South Africa. Overall, 758 children aged 8–13 years participated. HRQoL was measured with the 27-item KIDSCREEN questionnaire. Self-reported physical activity was assessed with a single item of the Health-Behavior of School-Aged Children test, and cardiorespiratory fitness with the 20-m shuttle run test. Post-intervention scores were predicted with mixed linear regression models, taking into consideration the clustered nature of the data.

Results: Higher baseline levels as well as increasing levels of self-reported physical activity predicted all dimensions of children's HRQoL. Baseline levels and increases in cardiorespiratory fitness predicted children's self-perceived physical well-being (one of the HRQoL subscales). Participation in the multicomponent physical activity intervention did not affect children's HRQoL.

Conclusion: Higher and increasing self-reported physical activity predict all assessed HRQoL dimensions, which underlines that the promotion of regular physical activity among children living in disadvantaged settings is an important public health measure. Policy makers should encourage schools to create physical activity friendly environments, while schools should implement regular physical education as proposed by the school curriculum.

Gaelic4Girls-The Effectiveness of a 10-Week Multicomponent Community Sports-Based Physical Activity Intervention for 8 to 12-Year-Old Girls

Girls are less active than boys throughout childhood and adolescence, with limited research focusing on female community sports-based programs. This study aims to assess the effectiveness of a multi-component, community sports-based intervention for increasing girl's physical activity (PA) levels, fundamental movement skill (FMS) proficiency, and psychological wellbeing, as relative to a second treatment group (the traditionally delivered national comparative program), and a third control group. One hundred and twenty female-only participants (mean age = 10.75 ± 1.44 years), aged 8 to 12 years old from three Ladies Gaelic Football (LGF) community sports clubs (rural and suburban) were allocated to one of three conditions: (1) Intervention Group 1 (n = 43) received a novel, specifically tailored, research-informed Gaelic4Girls (G4G) intervention; (2) Intervention Group 2 (n = 44) used the traditionally delivered, national G4G program, as run by the Ladies Gaelic Football (LGF) Association of Ireland; and (3) Control Group 3 (n = 33) received no G4G intervention (group 1 or 2) conditions and were expected to carry out their usual LGF community sports activities. Primary outcome measurements (at both pre- and 10-week follow up) examining the effectiveness of the G4G intervention included (1) PA, (2) FMS and (3) Psychological correlates (enjoyment levels, self-efficacy, peer and parental support). Following a two (pre to post) by three (intervention group 1, intervention group 2, and control group 3) mixed-model ANOVA, it was highlighted that intervention group 1 significantly increased in PA (p = 0.003), FMS proficiency (p = 0.005) and several psychological correlates of PA (p ≤ 0.005). The findings demonstrate that the 10-week, specifically tailored, research-informed G4G intervention is a feasible and efficacious program, leading to a positive effect on the physical and psychological wellbeing of pre-adolescent Irish girls, relative to the traditionally delivered national G4G comparative program and control group conditions.

Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 12-month implementation outcomes from a cluster randomized controlled trial

BACKGROUND

'Physical Activity 4 Everyone' (PA4E1) was an efficacious multi-component school-based physical activity (PA) program targeting adolescents. PA4E1 has seven PA practices. It is essential to scale-up, evaluate effectiveness and assess implementation of such programs. Therefore, the aim is to assess the impact of implementation support on school practice uptake of the PA4E1 program at 12 and 24 months.

METHODS

A cluster randomised controlled trial, utilising a type III hybrid implementation-effectiveness design, was conducted in 49 randomly selected disadvantaged Australian Government and Catholic secondary schools. A blinded statistician randomly allocated schools to a usual practice control (n = 25) or the PA4E1 program group (n = 24), with the latter receiving seven implementation support strategies to support school PA practice uptake of the seven practices retained from the efficacy trial. The primary outcome was the proportion of schools adopting at least four of the seven practices, assessed via telephone surveys with Head Physical Education Teachers and analysed using exact logistic regression modelling. This paper reports the 12-month outcomes.

RESULTS

Schools were recruited from May to November 2017. At baseline, no schools implemented four of the seven practices. At 12 months significantly more schools in the program group had implemented four of the seven practices (16/24, 66.7%) than the control group (1/25, 4%) (OR = 33.0[4.15-1556.4], p < 0.001). The program group implemented on average 3.2 (2.5-3.9) more practices than the control group (p < 0.001, mean 3.9 (SD 1.5) vs 0.7 (1.0)). Fidelity and reach of the implementation support intervention were high (both > 80%).

CONCLUSIONS

Through the application of multiple implementation support strategies, secondary schools were able to overcome commonly known barriers to implement evidence based school PA practices. As such practices have been shown to result in an increase in adolescent PA and improvements in weight status, policy makers and practitioners responsible for advocating PA in schools should consider this implementation approach more broadly when working with schools. Follow-up is required to determine whether practice implementation is sustained.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12th May 2017.

Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years

IMPORTANCE

Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth.

OBJECTIVE

This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community.

METHOD

The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research.

RESULTS

One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners.

CONCLUSIONS AND RECOMMENDATIONS

On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence.

WHAT THIS ARTICLE ADDS

When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.

School-related physical activity interventions and mental health among children: a systematic review and meta-analysis

BACKGROUND

Low levels of physical activity, sedentary behaviour and mental health problems are issues that have received considerable attention in the last decade. The aim of this systematic review and meta-analysis was to investigate effects of interventions targeting school-related physical activity or sedentary behaviour on mental health in children and adolescents and to identify the features of effective interventions.

METHODS

Scientific articles published between January 2009 and October 2019 fulfilling the following criteria were included: general populations of children and adolescents between age 4 and 19, all types of school-related efforts to promote physical activity or reduce sedentary behaviour. Study selection, data extraction and quality assessment were done by at least two authors independently of each other. Data were analysed with a random effects meta-analysis and by narrative moderator analyses.

RESULTS

The literature search resulted in 10265 unique articles. Thirty-one articles, describing 30 interventions, were finally included. Eleven relevant outcomes were identified: health-related quality of life, well-being, self-esteem and self-worth, resilience, positive effect, positive mental health, anxiety, depression, emotional problems, negative effect and internalising mental health problems. There was a significant beneficial effect of school-related physical activity interventions on resilience (Hedges' g = 0.748, 95% CI = 0.326; 1.170, p = 0.001), positive mental health (Hedges' g = 0.405, 95% CI = 0.208; 0.603, p = < 0.001), well-being (Hedges' g = 0.877, 95% CI = 0.356; 1.398, p = < 0.001) and anxiety (Hedges' g = 0.347, 95% CI = 0.072; 0.623, p = 0.013). Heterogeneity was moderate to high (I² = 59-98%) between studies for all outcomes except positive effect, where heterogeneity was low (I² = 2%). The narrative moderator analyses of outcomes based on 10 or more studies showed that age of the children moderated the effect of the intervention on internalising mental health problems. Interventions in younger children showed a significantly negative or no effect on internalising mental health problems while those in older children showed a significant positive or no effect. Moreover, studies with a high implementation reach showed a significant negative or no effect while those with a low level of implementation showed no or a positive effect. No signs of effect moderation were found for self-esteem, well-being or positive mental health. Risk of publication bias was evident for several outcomes, but adjustment did not change the results.

CONCLUSIONS

School-related physical activity interventions may reduce anxiety, increase resilience, improve well-being and increase positive mental health in children and adolescents. Considering the positive effects of physical activity on health in general, these findings may reinforce school-based initiatives to increase physical activity. However, the studies show considerable heterogeneity. The results should therefore be interpreted with caution. Future studies should report on implementation factors and more clearly describe the activities of the control group and whether the activity is added to or replacing ordinary physical education lessons in order to aid interpretation of results.

TRIAL REGISTRATION

PROSPERO, CRD42018086757.

Effectiveness of a family intervention on health-related quality of life-a healthy generation, a controlled pilot trial

BACKGROUND

Physical activity is associated with better health, but knowledge about health promoting interventions, including physical activity for families in disadvantaged areas and the impact on health-related quality of life (HRQOL) is sparse. The aim of this study was to assess HRQOL in children and their parents after participation in the programme "A Healthy Generation".

METHODS

The programme is delivered in socioeconomically disadvantaged areas in Sweden and offers physical activity and a healthy meal or fruit twice a week from August to May to families with children in grade 2. Children (n = 67), aged 8-9 years, and their parents (n = 90) participated in this controlled study conducted in four schools, two control and two intervention schools. HRQOL of children and adults was assessed at baseline and follow-up after the intervention with the Pediatric Quality of Life Inventory (PedsQL) 4.0 and the Gothenburg Quality of Life scale, respectively. Analyses of covariance (ANCOVAs), linear regression and Pearson's correlation were conducted.

RESULTS

There were no significant differences between intervention and control in HRQOL among children or adults after the intervention. However, in a subgroup of children (n = 20) and adults (n = 29) with initial low HRQOL scores at baseline, there was a significant difference between the intervention group and control group after the intervention (children (total score): p = 0.02; adults (social domain) p = 0.04). Furthermore, within the intervention group, there was a significant relationship between level of participation in "A Healthy Generation" and the physical domain of HRQOL among girls (r = 0.44, p = 0.01), but not boys (r = - 0.07, p = 0.58).

CONCLUSION

Participation in the programme "A Healthy Generation" did not show a significant intervention effect on HRQOL in general. However, the findings suggest that HRQOL may be increased for children and adults with low HRQOL in disadvantaged areas. This knowledge can contribute to the development of health promoting interventions in such areas, and to more equitable health.

TRIAL REGISTRATION

ISRCTN ISRCTN11660938. Retrospectively registered 23 September 2019.

A two-week summer program promoting physical activity: quality of life assessment in Italian children

Physical activity (PA) can be associated with better health-related quality of life (HRQoL). This study aimed to assess HRQoL before and after a two-week summer program promoting PA in Italian school-aged children. Participants were recruited during the Giocampus summer2017 (Parma, Italy), from June to July. Before (T0) and after (T1) the program, children and one of their parents answered the Kindl questionnaire. For each domain, least-square mean changes (LSmc) at T1 were derived from linear regression models stratified by responder and adjusted for child gender, age group, time spent in PAs and HRQoL score of the responder at T0. 350 children (7-13 years, 52% males) and 342 parents answered the questionnaire at both T0 and T1. At T1, the HRQoL score of the children significantly improved in the emotional (LSmc 2.9, p<0.001), self-esteem (LSmc 3.3, p<0.001), family (LSmc 4.2, p<0.001) and friend (LSmc 3.1, p<0.001) domains. Parents reported significantly more improvement in self-esteem than children (LSmc 6.7 vs 3.3, p=0.012). Children spending more time in PA reported significantly more improvement in self-esteem than those doing less PA (LSmc 4.4 [p<0.001] vs 2.2 [p=0.181]). A short summer program promoting PA may improve HRQoL in the general population of school-aged children.

Occupation- and Activity-Based Interventions to Improve Performance of Instrumental Activities of Daily Living and Rest and Sleep for Children and Youth Ages 5-21: A Systematic Review

IMPORTANCE

Practitioners seek evidence from intervention effectiveness studies to provide best-practice services for children.

OBJECTIVE

To examine the effectiveness of occupation- and activity-based interventions to improve instrumental activities of daily living (IADLs) and sleep outcomes for children and youth ages 5-21 yr.

DATA SOURCES

MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews.

STUDY SELECTION AND DATA COLLECTION

The American Occupational Therapy Association research methodologist conducted the first review of literature published from 2000 to 2017. The results were exported, and we completed the subsequent stages of review. Only peer-reviewed Level I, II, and III evidence was reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane risk-of-bias guidelines were used to compile evidence and risk-of-bias tables.

FINDINGS

We reviewed 96 articles; 28 studies met the inclusion criteria for IADL and rest-sleep outcomes. Analysis resulted in several themes: rest-sleep, health management (nutrition-dietary, physical activity-fitness, wellness), and the IADLs of driving, communication management, and safety. Strong evidence exists for interventions embedded in school programming to improve physical activity and fitness and for sleep preparation activities to maximize quality of rest and sleep. Moderate-strength evidence exists for interactive education and skills training interventions to improve health routines, dietary behaviors, and IADL participation and performance.

CONCLUSIONS AND RELEVANCE

Use of skills-focused training in activity- and occupation-based interventions was supported. Service provision in the context of natural environments, including school settings and with parental or caregiver participation, is recommended for children and youth ages 5-21 yr with varied abilities and diagnoses.

WHAT THIS ARTICLE ADDS

Occupational therapy practitioners can confidently examine their current practices and choose activity- and occupation-based interventions and methods of service delivery that are supported by evidence.

‘No one ever asked us’: a feasibility study assessing the co-creation of a physical activity programme with adolescent girls

Background:

Globally, the poor activity level of adolescent girls is a public health concern. Little research has involved adolescents in the design of interventions. This study assessed the feasibility of involving girls in the co-creation of an activity programme.

Methods:

Thirty-one students (15–17 years old) were recruited from a post-primary school. The Behaviour Change Wheel guided intervention design, providing insights into participants’ capability, opportunity and motivation for change. Step counts and self-reported physical activity levels were recorded pre- and post-intervention. Feasibility benchmarks assessed recruitment, data collection, acceptability and adherence.

Results:

Activity and educational sessions were delivered for six weeks during physical education class. Average attendance was 87% (benchmark = 80%). Eligibility was 61% (benchmark = 60%). There was a 100% retention rate (benchmark = 90%). All participants ( n = 31) completed baseline measures and 71% ( n = 22) completed post-measures. 54% ( n = 17) of students completed pedometer measurements, with 32% ( n = 10) having complete data. Average daily steps were 13,121 pre-intervention and 14,128 post-intervention ( p > 0.05). Data collection was feasible, receiving a mean score > 4/5 (benchmark > 3.5/5).

Conclusions:

The Behaviour Change Wheel can be used to co-create an activity programme with adolescent girls. Predetermined benchmarks, except for pedometer recordings, were reached or exceeded, providing evidence for the need of a randomised controlled trial to test effectiveness.

Application of the Human Well-Being Index to Sensitive Population Divisions: A Children's Well-Being Index Development

The assessment of community well-being is critical as an end-point measure that will facilitate decision support and assist in the identification of sustainable solutions to address persistent problems. While the overall measure is important, it is equally vital to distinguish variations among groups within the population who may be impacted in a different manner. The U.S. Environmental Protection Agency (US EPA) developed the Human Well-Being Index (HWBI), as a way of measuring these outcomes and assessing community characteristics. The HWBI approach produces a suite of indicators, domains and a final composite index appropriate for characterizing well-being of a population. While generalized approaches are needed, it is important to also recognize variations in well-being across community enclaves. This paper presents an adaption of the HWBI for child populations to test the applicability of the index framework to specific community enclaves. First, an extensive literature review was completed to ensure the theoretical integrity of metric and indicator substitutions from the original HWBI framework. Metric data were then collected, refined, imputed where necessary and evaluated to confirm temporal and spatial availability. A Children's Well-Being Index (CWBI) value, representing the same indicators and domains of well-being as the original HWBI, was calculated for the population under age 18 across all US counties for 2011. Implications of this research point to an effective, holistic end-point measure that can be tracked over time. Similarly, there is great potential for the application of the original HWBI method to other statistical population segments within the greater US population. These adaptations could help identify and close gaps in equity of resource distribution among these groups.

The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review

BACKGROUND

The association between physical activity, sedentary behavior and health-related quality of life in children and adolescents has been mostly investigated in those young people with chronic disease conditions. No systematic review to date has synthesized the relationship between physical activity, sedentary behavior and health-related quality of life in the general healthy population of children and adolescents. The purpose of this study was to review systematically the existing literature that evaluated the relations between physical activity, sedentary behavior and health-related quality of life in the general population of children and adolescents.

METHODS

We conducted a computer search for English language literature from databases of MEDLINE, EMBASE, PSYCINFO and PubMed-related articles as well as the reference lists of existing literature between 1946 and the second week of January 2017 to retrieve eligible studies. We included the studies that assessed associations between physical activity and/or sedentary behavior and health-related quality of life among the general population of children and adolescents aged between 3-18 years. The study design included cross-sectional, longitudinal and health intervention studies. We excluded the studies that examined associations between physical activity, sedentary behavior and health-related quality of life among children and adolescents with specific chronic diseases, and other studies and reports including reviews, meta-analyses, study protocols, comments, letters, case reports and guidelines. We followed up the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement in the reporting of this review. The risk of bias of the primary studies was assessed by the Newcastle-Ottawa Scale. We synthesized the difference in health-related quality of life scores between different levels of physical activity and sedentary time.

RESULTS

In total, 31 studies met the inclusion criteria and were synthesized in the review. Most of the included studies used a cross-sectional design (n = 21). There were six longitudinal studies and three school-based physical activity intervention studies. One study used both cross-sectional and longitudinal designs. We found that higher levels of physical activity were associated with better health-related quality of life and increased time of sedentary behavior was linked to lower health-related quality of life among children and adolescents. A dose-response relation between physical activity, sedentary behavior and health-related quality of life was observed in several studies suggesting that the higher frequency of physical activity or the less time being sedentary, the better the health-related quality of life.

CONCLUSIONS

The findings in this study suggest that school health programs promoting active lifestyles among children and adolescents may contribute to the improvement of health-related quality of life. Future research is needed to extend studies on longitudinal relationships between physical activity, sedentary behavior and health-related quality of life, and on effects of physical activity interventions on health-related quality of life among children and youth.

Association between physical activity, sedentary behavior, and fitness with health related quality of life in healthy children and adolescents: A protocol for a systematic review and meta-analysis

BACKGROUND

Health related quality of life (HRQoL) is a subjective, multidimensional and changing over time construct. When HRQoL is decreased, a child is less likely to be able to develop normally and mature into a healthy adult. Physical inactivity is a priority public health problem. Evidence suggests how even moderate levels of physical activity or high fitness levels are associated with benefits for the health in children and adolescents. The aims of this systematic review are to examine the evidence about the relationship between physical activity, sedentary behavior, and fitness with HRQoL, and estimate the effects of interventions that have tested the effectiveness of the increase of the physical activity, the improvement of the physical fitness or the avoidance of sedentary behaviors in HRQoL in healthy subjects aged under 18 years old.

METHODS

This systematic review and meta-analysis protocol was conducted following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. To identify relevant studies, the following electronic databases will be searched: MEDLINE, EMBASE, Cochrane Database, Web of Science, and PEDro. Reference lists of relevant studies will be examined for links to potential related articles. The methodological quality of the observational included studies will be scored using a quality assessment checklist. For the intervention studies, the risk of bias will be estimated using The Cochrane Collaboration tool for assessing risk of bias. Reviewers will determine whether a meta-analysis is possible when data have been extracted. If it is, subgroup analyses will be carried out by age and socioeconomic status, and by the different dimensions of the HRQoL. If is not possible, a descriptive analysis will be conducted.

CONCLUSION

To our knowledge, this systematic review and meta-analysis will be the first that synthesizes the existing results about the relationship between physical activity, sedentary behavior, physical fitness, and HRQoL, and the effect of physical activity interventions on HRQoL, in healthy subjects under 18 years old. This study will clarify this relationship and will provide evidence for decision-making. Limitations may include the quality of the selected studies and their characteristics. Only studies published in English and Spanish will be included.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015025823.

A cluster-randomised controlled trial to promote physical activity in adolescents: the Raising Awareness of Physical Activity (RAW-PA) Study

Background

Recent technological advances provide an alternative yet underutilised opportunity for promoting physical activity in youth. The primary aim of the Raising Awareness of Physical Activity (RAW-PA) Study is to examine the short- and longer-term impact of a wearable activity monitor combined with digital behaviour change resources on adolescents’ daily physical activity levels.

Methods/Design

RAW-PA is a 12 week, multicomponent physical activity intervention that utilises a popular activity tracker (Fitbit® Flex) and supporting digital materials that will be delivered online via social media. The resources target key behaviour change techniques. The intervention structure and components have been informed by participatory research principles. RAW-PA will be evaluated using a cluster randomised controlled trial design with schools as the unit of randomisation. Twelve schools located in Melbourne, Australia, will allocated to either the intervention or wait-list control group. The target sample size is 300 Year 8 adolescents (aged 13–14 years). Participants’ moderate- to vigorous-intensity physical activity will be the primary outcome. Survey measures will be completed. Process factors (e.g. feasibility, acceptability/appeal, fidelity) will also be collected.

Discussion

To our knowledge, this study will provide some of the first evidence concerning the effect of wearable activity trackers and digital behaviour change resources on adolescents’ physical activity levels. This study will provide insights into the use of such technologies for physical activity promotion, which may have a significant impact on health education, promotion, practice and policy.

Trial registration

Australian and New Zealand Clinical Trials Registry No: ACTRN12616000899448. Date of registration: July 7, 2016.

Physical Activity for Cognitive and Mental Health in Youth: A Systematic Review of Mechanisms

CONTEXT

Physical activity can improve cognitive and mental health, but the underlying mechanisms have not been established.

OBJECTIVE

To present a conceptual model explaining the mechanisms for the effect of physical activity on cognitive and mental health in young people and to conduct a systematic review of the evidence.

DATA SOURCES

Six electronic databases (PubMed, PsycINFO, SCOPUS, Ovid Medline, SportDiscus, and Embase) were used.

STUDY SELECTION

School-, home-, or community-based physical activity intervention or laboratory-based exercise interventions were assessed. Studies were eligible if they reported statistical analyses of changes in the following: (1) cognition or mental health; and (2) neurobiological, psychosocial, and behavioral mechanisms.

DATA EXTRACTION

Data relating to methods, assessment period, participant characteristics, intervention type, setting, and facilitator/delivery were extracted.

RESULTS

Twenty-five articles reporting results from 22 studies were included. Mechanisms studied were neurobiological (6 studies), psychosocial (18 studies), and behavioral (2 studies). Significant changes in at least 1 potential neurobiological mechanism were reported in 5 studies, and significant effects for at least 1 cognitive outcome were also found in 5 studies. One of 2 studies reported a significant effect for self-regulation, but neither study reported a significant impact on mental health.

LIMITATIONS

Small number of studies and high levels of study heterogeneity.

CONCLUSIONS

The strongest evidence was found for improvements in physical self-perceptions, which accompanied enhanced self-esteem in the majority of studies measuring these outcomes. Few studies examined neurobiological and behavioral mechanisms, and we were unable to draw conclusions regarding their role in enhancing cognitive and mental health.

Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the 'Physical Activity 4 Everyone' cluster randomized trial

BACKGROUND

Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations. As a result, few cost effectiveness analyses have been reported. The aim of this paper is to report the cost and cost effectiveness of the Physical Activity 4 Everyone (PA4E1) intervention which was a multi-component intervention implemented in secondary schools located in low-income communities. Cost effectiveness was assessed using both the physical activity and weight status trial outcomes.

METHODS

Intervention and Study Design: The PA4E1 cluster randomised controlled trial was implemented in 10 Australian secondary schools (5 intervention: 5 control) and consisted of intervention schools receiving seven physical activity promotion strategies and six additional strategies that supported school implementation of the intervention components. Costs associated with physical activity strategies, and intervention implementation strategies within the five intervention schools were estimated and compared to the costs of usual physical activity practices of schools in the control group. The total cost of implementing the intervention was estimated from a societal perspective, based on the number of enrolled students in the target grade at the start of the intervention (Grade 7, n = 837). Economic Outcomes: The economic analysis outcomes were cost and incremental cost effectiveness ratios for the following: minutes of moderate-to-vigorous physical activity (MVPA) per day gained, MET hours gained per person/day; Body Mass Index (BMI) unit avoided; and 10% reduction in BMI z-score.

RESULTS

The intervention cost AUD $329,952 over 24 months, or AUD$394 per student in the intervention group. This resulted in a cost effectiveness ratio of AUD$56 ($35-$147) per additional minute of MVPA, AUD$1 ($0.6-$2.7) per MET hour gained per person per day, AUD$1408 ($788-$6,570) per BMI unit avoided, and AUD$563 ($282-$3,942) per 10% reduction in BMI z-score.

CONCLUSION

PA4E1 is a cost effective intervention for increasing the physical activity levels and reducing unhealthy weight gain in adolescence, a period in which physical activity typically declines. Additional modelling could explore the potential economic impact of the intervention on morbidity and mortality.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000382875.

The Physical Activity 4 Everyone Cluster Randomized Trial: 2-Year Outcomes of a School Physical Activity Intervention Among Adolescents

INTRODUCTION

Few interventions have been successful in reducing the physical activity decline typically observed among adolescents. The aim of this paper is to report the 24-month effectiveness of a multicomponent school-based intervention (Physical Activity 4 Everyone) in reducing the decline in moderate to vigorous physical activity (MVPA) among secondary school students in disadvantaged areas of New South Wales, Australia.

STUDY DESIGN

A cluster RCT was conducted in five intervention and five control schools with follow-up measures taken at 24 months post-randomization.

SETTING/PARTICIPANTS

The trial was undertaken within secondary schools located in disadvantaged communities in New South Wales, Australia.

INTERVENTION

A multicomponent school-based intervention based on the Health Promoting Schools Framework was implemented. The intervention consisted of seven physical activity promotion strategies that targeted the curriculum (teaching strategies to increase physical activity in physical education lessons, student physical activity plans, and modification of school sport program); school environment (recess/lunchtime activities, school physical activity policy); parents (parent newsletters); and community (community physical activity provider promotion). Six additional strategies supported school implementation of the physical activity intervention strategies.

MAIN OUTCOME MEASURE

Minutes per day spent in MVPA, objectively measured by accelerometer.

RESULTS

Participants (N=1,150, 49% male) were a cohort of students aged 12 years (Grade 7) at baseline (March-June 2012) and 14 years (Grade 9) at follow-up (March-July 2014). At 24-month follow-up, there were significant effects in favor of the intervention group for daily minutes of MVPA. The adjusted mean difference in change in daily MVPA between groups was 7.0 minutes (95% CI=2.7, 11.4, p<0.002) (analysis conducted December 2014-February 2015). Sensitivity analyses based on multiple imputation were consistent with the main analysis (6.0 minutes, 95% CI=0.6, 11.3, p<0.031).

CONCLUSIONS

The intervention was effective in increasing adolescents' minutes of MVPA, suggesting that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000382875.

Effects of a 'school-based' physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the 'Physical Activity 4 Everyone' RCT

BACKGROUND/OBJECTIVES:

Obesity prevention during adolescence is a health priority. The ‘Physical Activity 4 Everyone' (PA4E1) study tested a multi-component physical activity intervention in 10 secondary schools from socio-economically disadvantaged communities. This paper aimed to report the secondary outcomes of the study; to determine whether the intervention impacted on adiposity outcomes (weight, body mass index (BMI), BMI z-score), and whether any effect was moderated by sex, baseline BMI and baseline physical activity level, at 12 and 24 months.

SUBJECTS/METHODS:

A cluster randomised controlled trial was conducted in New South Wales, Australia. The school-based intervention included seven physical activity strategies targeting the following: curriculum (strategies to maximise physical activity in physical education, student physical activity plans, an enhanced school sport programme); school environment (physical activity during school breaks, modification of school policy); and parents and the community (parent engagement, links with community physical activity providers). Students' weight (kg), BMI and BMI z-score, were collected at baseline (Grade 7), 12 and 24 months. Linear Mixed Models were used to assess between-group mean difference from baseline to 12 and 24 months. Exploratory sub-analyses were undertaken according to three moderators of energy balance.

RESULTS:

A total of 1150 students (mean age=12 years) provided outcome data at baseline, 1051 (91%) at 12 months and 985 (86%) at 24 months. At 12 months, there were group-by-time effects for weight (mean difference=–0.90 kg (95% confidence interval (CI)=–1.50, −0.30), P<0.01) and BMI (−0.28 kg m⁻² (−0.50, −0.06), P=0.01) in favour of the intervention group, but not for BMI z-score (−0.05 (−0.11; 0.01), P=0.13). These findings were consistent for weight (−0.62 kg (−1.21, 0.03), P=0.01) and BMI (−0.28 kg m⁻² (−0.49, −0.06), P=0.01) at 24 months, with group-by-time effects also found for BMI z-score (−0.08 (−0.14; −0.02), P=0.02) favouring the intervention group.

CONCLUSION:

The PA4E1 school-based intervention achieved moderate reductions in adiposity among adolescents from socio-economically disadvantaged communities. Multi-component interventions that increase adolescents' engagement in moderate-to-vigorous physical activity (MVPA) may assist in preventing unhealthy weight gain.

Interdisciplinary, child-centred collaboration could increase the success of potentially successful Internet-based physical activity interventions

Physical activity promotes health in children and adolescents, but activity levels are low. The Internet offers opportunities for physical activity interventions because children and adolescents are widely exposed to the web and enjoy being online. This review investigated the success of Internet-based interventions designed to increase physical activity in children and adolescents. Of the 13 studies we included, five reported that Internet-based interventions had significant effects on most physical activities.

CONCLUSION

Internet-based physical activity interventions in children and adolescents are potentially successful, but interdisciplinary, child-centred collaboration is needed to design interventions that align with their Internet experiences and preferences.

Are physical activity, sedentary behaviors and sleep duration associated with body mass index-for-age and health-related quality of life among high school boys and girls?

BACKGROUND

Previous studies reported lower health-related quality of life (HRQOL) scores in overweight and obese adolescents compared to their normal weight counterparts; however, few studies investigated the association between obesity-related behaviors including physical activity and sedentary behaviors and HRQOL in adolescents. This study aimed at investigating the relationship between physical activity, sedentary behaviors, sleep duration and body mass index-for-age (BMI-for-age) and HRQOL among high school Tehranian students.

METHODS

A total of 465 high school students (48.8 % girls) were recruited from three different socio-economic zones in Tehran. The BMI-for-age was determined and physical activity and HRQOL were assessed using validated questionnaires including Quantification de l'Activite Physique en Altitude Chez les Enfants (QAPACE) and Pediatric Quality of Life Inventory (PedsQL) respectively.

RESULTS

Over one third of students (38.5 %) were either overweight or obese. The means of all self- and parent-reported HRQOL scores were significantly lower in girls, compared to boys, except for the parent-reported social functioning subscale. Mean hours of daily sleeping were significantly higher in girls, compared to boys (8.16 ± 1.27 vs. 7.73 ± 1.22 respectively; p < 0.05). Both girls and boys spent more time on sedentary activities than engaging in sport activities. During school and vacation periods, boys had significantly higher daily energy expenditure (DEE) compared to girls (p < 0.05). Only DEE during school period had a significant inverse correlation with BMI-for-age in boys but not girls (r = -0.14, p < 0.05). In addition, self-reported HRQOL scores were significantly associated with weekly hours adolescents spent on videogames/internet, listening to music and reading, watching TV, sports as well as DEE through sex-specific patterns. However according to parents' perspective only weekly hours spent on listening to music and readings and sport activities were significantly associated with their children HRQOL scores.

CONCLUSION

In summary, time spent on physical and sedentary activities were not associated with BMI-for-age, although both of these were associated with the HRQOL of high school students. The potential role of sedentary activities and physical activity should be considered in future interventions aimed at improving HRQOL in adolescents.

Prevalence and Risk Factors of Overweight and Obesity among Adolescents and Their Parents in Central Greece (FETA Project)

The increasing obesity trend in adolescence is a public health concern. The initial phase of Feeding Exercise Trial in Adolescents (FETA) aimed in investigating the prevalence of overweight and obesity in adolescents and their parents and in identifying associated factors among parents’ and adolescents’ demographics, eating habits, and parental style. The sample consisted of 816 adolescents, aged 12–18 years old, and their parents from 17 middle and high schools in Larissa, central Greece. During school visits, anthropometric measurements were performed along with examination of blood pressure. The students completed the study tool that comprised of demographics and the modified versions of Parental Authority Questionnaire (PAQ), the Parent-Initiated Motivational Climate Questionnaire-2 (PIMCQ-2) and the Family Eating and Activity Habits Questionnaire (FEAHQ). Their parents completed a questionnaire with demographics, anthropometrics and FEAHQ. Normal Body Mass Index was found in 75.2% of the adolescents, 2.6% of the adolescents were underweight, 18% overweight and 4.2% obese. Regarding the parents, 76.3% of the fathers and 39.2% of the mothers were overweight or obese. The logistic regression analysis revealed that, overweight or obesity in adolescence was associated with gender (boy), maternal overweight or obesity, lower maternal educational level, eating without feeling hungry, eating in rooms other than kitchen and having a father that motivates by worrying about failing. A significant proportion of adolescents and their parents are overweight or obese. Future interventions should focus both on the parents and children, taking into account the role of parental authority style, in preventing adolescents’ obesity.

Potentially preventable premature deaths in women and men from the two leading causes of death in Austria, mortality statistics of the nine federal states 2010-2012

BACKGROUND

In Austria, mortality from diseases of the circulatory system and malignant neoplasms is high and varies among the federal states. Lower mortality in some states indicates a preventive potential in those states with higher mortality.

METHODS

We computed the number of premature deaths, for women and men separately, from the two leading causes of death, diseases of the circulatory system (ICD-10: I00-I09) and cancer (ICD-10: C00-C97), in the nine Austrian federal states between 2010-2012. The potentially preventable deaths per federal state and sex were calculated by subtracting expected deaths from observed deaths.

RESULTS

The western federal states had the lowest death rates, and thus the smallest preventive potential. In death from circulatory diseases and from cancer the differences between women and men varied remarkably between the federal states. For circulatory diseases among all federal states the highest difference in percent was given in Vorarlberg (6.2%) with more potentially preventable deaths for men. For cancer, Burgenland had the highest difference (8.6%) in comparison with the other federal states, again with the higher preventive potential for men.

CONCLUSIONS

Intervention programs as lifestyle modification interventions as well as improvements in health care services provision, should focus on the characteristics of the specific federal state, which are setting-oriented and account for social determinants including sex/gender differences and economic factors. Relevant data gathering is therefore, urgently needed.

What do we know about how to promote physical activity to adolescents? A mapping review

To date, adolescent physical activity (PA) intervention research has focused on the school setting and suggests a need to extend interventions beyond this setting to influence teenagers' overall level of PA. But, the relative effectiveness of PA promotion strategies that can be part of such multi-setting interventions remains unknown. We completed a mapping review of PA intervention research that focused on increasing adolescents' level of PA to describe the sum of what has been learned in this area and to expose research and knowledge gaps. We searched data bases from 1993 to September 2014, included PA promotion intervention studies targeting 12- to 17-year-old youth and assessing changes in their level of PA, and used ecological and capacity building frameworks to review this research. The 46 included studies suggest that little is known about strategies targeting the interpersonal, organizational, community or policy levels of teenagers' PA behavior influences; our current knowledge remains concentrated in the intrapersonal domain and the school setting. We suggest avenues for researchers as well as practitioners who design and implement adolescent PA programs such that we further develop our research and practice knowledge base and develop programs to positively impact adolescents' PA behavior.

'Physical Activity 4 Everyone' school-based intervention to prevent decline in adolescent physical activity levels: 12 month (mid-intervention) report on a cluster randomised trial

BACKGROUND

Adolescence is a recognised period of physical activity decline, particularly among low-income communities. We report the 12-month (midpoint) effects of a 2-year multicomponent physical activity intervention implemented in disadvantaged secondary schools.

METHODS

A cluster randomised trial was undertaken in 10 secondary schools located in disadvantaged areas in New South Wales, Australia. Students in Grade 7 were recruited, with follow-up in Grade 8. The intervention was guided by socioecological theory and included seven physical activity strategies, and six implementation adoption strategies. The primary outcome was mean minutes of moderate-to-vigorous physical activity (MVPA) per day assessed using Actigraph GT3X accelerometers. Outcome data were analysed using repeated measures linear mixed models.

RESULTS

At baseline, 1150 (93%) students participated in the data collection (mean age 12 years, 48% boys) and 1050 (79%) students participated at 12-month follow-up. By the 12-month follow-up, the six implementation adoption strategies had been used to support schools to deliver four of the seven physical activity elements. There was a significant group-by-time interaction for mean minutes of MVPA per day in favour of the intervention group (adjusted difference between groups at follow-up=3.85 min, 95% CI (0.79 to 6.91), p ≤ 0.01), including significantly more vigorous physical activity (2.45 min, p ≤ 0.01), equating to 27 min more MVPA per week.

SUMMARY

At 12-month follow-up, the intervention had reduced the decline in physical activity among adolescents from disadvantaged schools. The intervention may assist students to meet physical activity guidelines.

Linking secondary school physical education with community sport and recreation for girls: a process evaluation

BACKGROUND

The purpose of this study was to undertake a process evaluation to examine the reach, adoption and implementation of a school-community linked physical activity (PA) program for girls aged 12 - 15 years (School Years 7 - 9) using the RE-AIM framework.

METHODS

Various approaches were used to assess 'reach', 'adoption' and implementation: (a) a school environment survey of intervention schools (n = 6); (b) teacher feedback regarding the professional development component (91.1% response rate) and lesson implementation (60.8% response rate); and (c) post-intervention focus group interviews with physical education (PE) teachers (n = 29), students (n = 125), coaches (n = 13) and instructors (n = 8) regarding program experiences.

RESULTS

Reach and Adoption: Seven schools (n = 1491 Year 7-9 female student enrolment; 70% adoption rate), five tennis clubs, eight football clubs and five leisure centres participated in the program during 2011.

IMPLEMENTATION

Program design and professional development opportunities (training, resource manual and opportunities to work with coaches and instructors during PE classes) supported implementation and student engagement in PA. However, there was a lack of individual and organisational readiness to adopt program principles. For some deliverers there were deeply embedded ideologies that were not aligned with the Game Sense teaching approach upon which the program was based. Further, cognitive components of the program such as self-management were not widely adopted as other components of the program tended to be prioritised.

CONCLUSION

The program design and resources supported the success of the program, however, some aspects were not implemented as intended, which may have affected the likelihood of achieving further positive outcomes. Barriers to program implementation were identified and should be considered when designing school-community linked interventions. In particular, future programs should seek to assess and adjust for organizational readiness within the study design. For example, shared commitment and abilities of program deliverers to implement the program needs to be determined to support program implementation.

TRIAL REGISTRATION

ACTRN12614000446662. April 30th 2014.

Socioecological factors potentially associated with participation in physical activity and sport: A longitudinal study of adolescent girls

OBJECTIVES

Many adolescents are not physically active enough to receive associated health benefits. Furthermore, participation in physical activity generally declines during adolescence, and to a greater degree for females. Longitudinal research is required to better understand the determinants of change in physical activity by adolescent females to inform physical activity-related policy and practice. This study explored patterns of change in socioecological factors hypothesised to be associated with physical activity and sport, across the adolescent period for females.

METHODS

This longitudinal study employed three annual surveys of females from metropolitan and non-metropolitan areas recruited in Year 7 (n = 328) and Year 11 (n = 112). Self-report measures included questions regarding general barriers to participation, as well as factors relating to the socioecological domains.

RESULTS

The barriers where significant changes within or differences between cohorts were observed were mostly intrapersonal (lack of energy, lack of time due to other leisure activities). Lack of time was more prevalent in the Year 11 cohort than in the Year 7 cohort. Perceived importance of life priorities mainly related to education and study and more so for the Year 11 cohort. Perceived competence declined for the Year 7 cohort. Support from family and peers trended downwards in both cohorts, whereas access to facilities increased both within and between cohorts.

CONCLUSIONS

Significant patterns of change in the determinants of physical activity participation were observed across the adolescent period. It is important to consider flexible structure and scheduling of physical activity and strategies to develop competency in childhood and early adolescence.