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Donnelly S, Buchan DS, McLellan G, Roberts R, Arthur R. Exploring the feasibility of a cluster pilot randomised control trial to improve children's 24-hour movement behaviours and dietary intake: Happy homework. J Sports Sci 2023; 41:1787-1800. [PMID: 38219248 DOI: 10.1080/02640414.2023.2300562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
We aimed to explore the feasibility, acceptability, and potential efficacy of Happy Homework (HH); an 8-week home-focussed intervention, with the purpose of encouraging children's positive dietary behaviours and engagement in positive physical activity (PA) and sleep behaviours. We randomised four Scottish schools (n = 71 participants; 5 classrooms) to either the HH intervention (n = 2) or usual curriculum control group (n = 2). HH consisted of movement and dietary-focused parent and child tasks. Primary outcome measures were intervention feasibility, acceptability, and potential efficacy. Secondary outcomes were objectively measured PA via ActiGraph GT3X+, sedentary behaviours (SBs) and sleep duration via activPAL4™ accelerometers and dietary behaviours, fruit and vegetable consumption and screen-time via questionnaires. After controlling for pre-test levels, post intervention stepping time and sleep duration were significantly greater for the HH group in comparison to the control group. The HH group reported eating more fruit and vegetables at post-test than the control group. Participants also reported the intervention to be enjoyable and motivating. These findings provide promising evidence that given a greater sample size, better retention and the prioritisation of health and wellbeing homework, HH could enhance children's health and wellbeing.
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Affiliation(s)
- Samantha Donnelly
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
| | - Duncan S Buchan
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
| | - Gillian McLellan
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
| | - Ross Roberts
- Institute for the Psychology of Elite Performance, School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Rosie Arthur
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
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2
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Seims AL, Hall J, Bingham DD, Creaser A, Christoforou A, Barber S, Daly-Smith A. Interventions targeting children and young people's physical activity behavior at home: A systematic review. PLoS One 2023; 18:e0289831. [PMID: 37556477 PMCID: PMC10411747 DOI: 10.1371/journal.pone.0289831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Increased time at home during the COVID-19 pandemic significantly decreased children's physical activity. This systematic review aimed to evaluate the effectiveness of children's home-based physical activity interventions, and identify 'active ingredients' underpinning these. METHODS Databases searched-AMED, PsychINFO, CINAHL, Cochrane, EMBASE, PubMed/Medline, Scopus, SPORTDiscus and Web of Science, from inception until June 2022. Eligibility criteria-children aged 2-16 years, targeting home-based physical activity, a control group, and physical activity measured pre- and post- intervention. Studies were excluded if it was not possible to identify change in physical activity at home. The review was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Study quality was evaluated using the quality assessment tool for quantitative studies. Study design, intervention characteristics, outcome data, behavior change theory, Behavior Change Techniques (BCTs) and process evaluation data were extracted and discussed using narrative syntheses. RESULTS 13 studies (including 1,182 participants) from 25,967 were included. Interventions primarily involved active video games, with the addition of coaching or telehealth support (n = 5). Three of the 13 studies significantly increased children's physical activity (1 = Moderate to vigorous physical activity, 2 = total volume, P<0.05). The largest effect size (d = 3.45) was for moderate to vigorous physical activity. 29% of BCTs were identified across included interventions; the most common being adding objects to the environment. The most effective intervention scored strong for design quality, incorporated telehealth coaching, and included the most commonly coded BCTs. Variation among studies and insufficient reporting of data made a meta-analysis unfeasible. CONCLUSION COVID-19 emphasized the importance of the home for physical activity. Whilst effectiveness of interventions was limited, building social support and self-efficacy are mechanisms that should be explored further. The review provides recommendations to improve the design and evaluation of future interventions. TRIAL REGISTRATION Prospero registration number: CRD42020193110.
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Affiliation(s)
- Amanda L. Seims
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, United Kingdom
| | - Jennifer Hall
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, United Kingdom
| | - Daniel D. Bingham
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, United Kingdom
- Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
| | - Amy Creaser
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
| | | | - Sally Barber
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
| | - Andy Daly-Smith
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, United Kingdom
- Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
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Cholley-Gomez M, Laujac S, Delpierre C, Carayol M. Effectiveness of multilevel interventions based on socio-ecological model to decrease sedentary time in children: a systematic review of controlled studies. Front Public Health 2023; 11:1106206. [PMID: 37333527 PMCID: PMC10272417 DOI: 10.3389/fpubh.2023.1106206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives Preventive actions of sedentary behavior (SB) based on the socio-ecological model are needed among children and young adolescents. The aim of this systematic review is to ascertain the effectiveness of multilevel interventions (i.e., involving consideration of at least two interventional levels) in reducing sedentary time (ST) in children aged 5-12 years. Methods Adhering to PRISMA guidelines, a systematic literature search was conducted in three databases (PsyInfo, PubMed and ERIC) until July 2021. Results 30 trials met the eligibility criteria and were included. They showed acceptable (< 8, n = 18) and high (≥ 8, n = 12) methodological quality. Among studies targeting 2 (n = 2), 3 (n = 19) and 4 levels (n = 9), 1 (50%), 9 (47%) and 7 (78%) were effective and reported significant reduction of ST, respectively. Conclusion Interventions tend to be more effective when they involve 4 levels, using both agentic and structural strategies (targeting intrinsic determinants, in the organizational environment of the child). Findings underline the relevance of multilevel strategies to reduce ST in children, but also raise issues about operationalization of the socio-ecological perspective. Systematic review registration PROSPERO, identifier: CRD42020209653.
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Affiliation(s)
- Marie Cholley-Gomez
- IAPS Laboratory “Impact of Physical Activity on Health”, University of Toulon, Toulon, France
- ACTES Laboratory, University of Antilles, Pointe-à-Pitre, Guadeloupe
| | - Steven Laujac
- IAPS Laboratory “Impact of Physical Activity on Health”, University of Toulon, Toulon, France
- Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer, Hôpital Sainte Musse, Toulon, France
| | - Cyrille Delpierre
- EQUITY Team, CERPOP UMR 1295, Inserm-Université Toulouse III, Toulouse, France
| | - Marion Carayol
- IAPS Laboratory “Impact of Physical Activity on Health”, University of Toulon, Toulon, France
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Vidmar AP, Cáceres NA, Schneider-Worthington CR, Shirazipour C, Buman MP, de la Haye K, Salvy SJ. Integration of Time-Based Recommendations with Current Pediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth. Curr Obes Rep 2022; 11:236-253. [PMID: 36348216 PMCID: PMC9742346 DOI: 10.1007/s13679-022-00491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep. RECENT FINDINGS Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.
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Affiliation(s)
- Alaina P Vidmar
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, 4650 Sunset Boulevard, Mailstop #61, Los Angeles, CA, 90027, USA.
| | - Nenette A Cáceres
- Cancer Research Center On Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | | | - Celina Shirazipour
- Cancer Research Center On Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Tempe, USA
| | - Kayla de la Haye
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Sarah-Jeanne Salvy
- Cancer Research Center On Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Kääpä M, Palomäki S, Fedewa A, Valleala UM, Hirvensalo M. The Role of Parental Support and the Students' Opinions in Active Finnish Physical Education Homework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11924. [PMID: 36231254 PMCID: PMC9565897 DOI: 10.3390/ijerph191911924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Prior research indicates that adolescent boys are often more active than girls, implying a need for special attention to increase the physical activity levels of adolescent girls. Adolescents are at an age where they are especially susceptible to environmental and social influences but still have a limited amount of autonomy over their own behaviors. The effective physical activity programs implemented at this age may benefit health into adulthood. The fact that adolescents' physical activity is influenced by many factors indicates that to achieve any behavioral change, interventions must target several levels across the socio-ecological model. During childhood, the family is the primary factor in socializing and shaping engagement in physical activity. This study is part of the Physical Education (PE) Homework Study project which was implemented in a midsized secondary school in the middle of Finland from 2016 to 2020. The goal was to develop one easily approachable way to prevent the decreasing physical activity of adolescent girls. This was done by increasing physical activity times of adolescent girls outside of the school by giving them active PE assignments. The aim was also to explore students' and their parents' perceptions of physically active physical education homework. In this part of the study, there were 43 interviews: 38 student interviews and 5 interviews with parents. The analysis process followed the qualitative content analysis (QCA) strategy by Schreirer. In this study, we combined the views of students and parents, and obtained a broad picture of the PE homework assignments given at school but completed at home. According to students and parents, PE homework assignments should be diverse, interesting, and challenging, they should also be provided at flexible schedules outside of school hours with family support. Physical education homework could be a potential approach to influence the physical activity of the student population by involving school curriculum and families.
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Affiliation(s)
- Mari Kääpä
- Faculty of Sport and Health Science, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
| | - Sanna Palomäki
- Faculty of Sport and Health Science, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
| | - Alicia Fedewa
- Educational, School and Counseling Psykology, University of Kentucky, Lexington, KY 40506, USA
| | - Ulla Maija Valleala
- Faculty of Education and Psychology, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
| | - Mirja Hirvensalo
- Faculty of Sport and Health Science, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland
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Lu Y, Yu K, Jin J, Gan X. The Effects of a Multicomponent Social Support Intervention on Physical Fitness and Exercise Attitude in Children: A 12-Week Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9922. [PMID: 36011556 PMCID: PMC9407873 DOI: 10.3390/ijerph19169922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Purpose: The current study is intended to assess the effects of a multicomponent social support intervention program on grip strength, sprinting, jumping, agility, flexibility, core strength and exercise attitude among children over a period of twelve weeks. Method: This study followed a randomized parallel design in which 366 children (age: 9.35 ± 1.12 years) in the 3rd−5th grade at an elementary school in China were allocated to an intervention group (n = 183) or a control group (n = 183). Participants were assessed twice (baseline and postintervention) for the following tests: (i) grip strength, (ii) 50 m dash, (iii) rope skipping, (iv) sit-ups, (v) sit-and-reach, and (vi) exercise attitude. The intervention group received the “Exercise Methods and Wellness Knowledge Guide (EMWKG)” leaflet three times a week. The control group was not required to make any changes. Results: Significant increases in pre−post left-hand grip strength (Cohen’s d = 0.10, p < 0.001), right-hand grip strength (Cohen’s d = 0.09, p < 0.001), and behavioral intention (Cohen’s d = 0.17, p < 0.01) were observed in the intervention group. Students in the control group showed significant decreases in three indicators: both 50 m (Cohen’s d = 0.19, p < 0.01) and sit-ups (Cohen’s d = 0.14, p < 0.05) as well as sit-and-reach (Cohen’s d = 0.46, p < 0.001). Significant differences (p < 0.001) were found between the two groups in right-hand grip strength (F = 7.109, ηp2 = 0.020), sit-and-reach (F = 11.255, ηp2 = 0.031), and subjective standards (F = 15.461, ηp2 = 0.043). A comparison of the post hoc test results showed that the intervention group scored 0.519 kg (95% CI: 0.136−0.901, Cohen’s d = 0.27), 0.944 cm (95% CI: 0.0391−1.497, Cohen’s d = 0.35), and 2.535 points (95% CI: 1.267−3.803, Cohen’s d = 0.41) higher than the control group in right-hand grip strength, sit-and-reach, and subjective standards, respectively. Conclusion: This combined social support theory-based intervention was effective in improving exercise attitude and fitness among children in 12 weeks.
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Affiliation(s)
- Yijuan Lu
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou 310027, China
| | - Kehong Yu
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou 310027, China
- Center for Sports Modernization and Development, Zhejiang University, Hangzhou 310027, China
| | - Jun Jin
- Wensan Education Group, Wensan Street Primary School, Hangzhou 310061, China
| | - Xiaomei Gan
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou 310027, China
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Huang F, Song Y, Zhao Y, Han Y, Fang Q. Fitness Promotion in a Jump Rope-Based Homework Intervention for Middle School Students: A Randomized Controlled Trial. Front Psychol 2022; 13:912635. [PMID: 35783780 PMCID: PMC9244795 DOI: 10.3389/fpsyg.2022.912635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Physical activity (PA) homework offers a promising approach for students to be physically active after school. The current study aims to provide holistic insights into PA homework design and the effects of implementation in practice. In total, ninety-three middle school students were randomly assigned to a homework group (HG) or control group (CG). Participants in HG (n = 47) were requested to complete jump rope homework three times per week for 12 weeks, while their counterparts in CG attended one health education class every week. A homework sheet was used to provide instructions and record information for exercise behaviors during homework completion. Physical fitness tests were conducted to investigate the effects of the jump rope homework on the physical fitness of middle school students. After the intervention, participants in HG reported moderate to vigorous PA during jump rope exercise. The average duration for each practice was approximately 48 min. The returned homework sheets accounted for 86.88% of all homework assignments, indicating a good completion rate. Compared with their counterparts in CG, participants performing jump rope exercise indicated greater improvement in speed, endurance, power, and core muscular endurance. Jump rope homework strengthened physical fitness for middle school students, which provided a valuable addition to comprehensive school PA practice.
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Affiliation(s)
- Fang Huang
- School of Physical Education, Qingdao University, Qingdao, China
| | - Ying Song
- School of Physical Education, Shandong University, Jinan, China
| | - Yingdong Zhao
- Department of Physical Education and Sport Science, Mudanjiang Medical University, Mudanjiang, China
| | - Yating Han
- School of Physical Education, Qingdao University, Qingdao, China
- *Correspondence: Yating Han,
| | - Qun Fang
- School of Physical Education, Qingdao University, Qingdao, China
- Qun Fang,
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Bailey RP, Heck S, Scheuer C. Active Homework: an under-researched element of the active schools concept. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2022. [PMCID: PMC8928014 DOI: 10.1007/s12662-022-00802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Most physical activity (PA) interventions targeting children focus on the school setting. However, children and young people are often less active at home. The purpose of this article is to review evidence from the last ten years of the contribution of physically Active Homework (AH) to the promotion of PA. Methods Using a rapid review methodology, the article reports on evidence contribution of AH and considers conditions for its effective implementation. Results Although research literature on the effects of AH is limited and missing a theoretical base, studies reporting small positive associations between AH and PA levels were identified. Increases in PA were, however, of low intensity; moderate and vigorous intensities remained relatively unchanged. Conclusions Strategies to increase PA extending beyond the school gym are needed. Further and better research is needed to understand the conditions of effective implementation of AH. Nevertheless, there is a plausibility in providing students regular opportunities to further promote PA in students’ lives by practicing movement and sports skills, and offering a flexible way of finding and pursuing meaningful activities. The fact that AH may encourage the engagement of families and communities, multiplies its potential benefits.
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Affiliation(s)
- Richard P. Bailey
- Centre for Academic Partnerships and Engagement, University of Nottingham Malaysia, Jalan Broga, 43500 Semenyih, Selangor Malaysia
| | - Sandra Heck
- Department of Education and Social Work, University of Luxembourg, Campus Belval – MSH 3.225, 11, porte des Sciences, 4365 Esch-sur-Alzette, Luxembourg
| | - Claude Scheuer
- Department of Education and Social Work, University of Luxembourg, Campus Belval – MSH 3.225, 11, porte des Sciences, 4365 Esch-sur-Alzette, Luxembourg
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Wang H, Blake H, Chattopadhyay K. School-based behaviour change intervention to increase physical activity levels among children: a feasibility cluster non-randomised controlled trial in Yangzhou, China. BMJ Open 2021; 11:e052659. [PMID: 34711601 PMCID: PMC8557291 DOI: 10.1136/bmjopen-2021-052659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Children in China have low levels of physical activity. We developed a school-based behaviour change intervention to increase their physical activity levels. The study aimed to determine the feasibility of undertaking a cluster randomised controlled trial (RCT) in the future. This future cluster RCT will evaluate the effectiveness of the intervention. DESIGN Feasibility cluster non-RCT design. SETTING Two public schools (one intervention and one control) in Yangzhou, China. PARTICIPANTS Children aged 10-12 years and their parents. INTERVENTION The 16-week school-based behaviour change intervention to increase physical activity levels consisted of three components (a) health education (physical education), (b) family involvement and (c) school environment support. OUTCOMES MEASURES We estimated important parameters that are needed to design the future cluster RCT, such as SD of the primary outcome (ie, 7-day steps in children), intracluster correlation coefficient (ICC), recruitment of child-parent dyads, follow-up of children, completion of and time needed for data collection among children and intervention attendance. RESULTS Sixty-four children and their parents participated in the study (32 per study group). The SD of the primary outcome was 34 519 steps. The ICC was 0.03. The recruitment and follow-up rates were 100%. The completion of data collection was 100% (except for the 7-day steps at baseline-one child lost the step log in the intervention group and two children lost their pedometer in the control group). The time needed to complete the self-reported questionnaire by children was around 15 min per study group, and the measurement of their anthropometric parameters took around 40 min per study group. The intervention attendance was 100%. CONCLUSIONS Based on the promising recruitment, follow-up, completion of and time needed for data collection and intervention attendance, it would be feasible to undertake the future cluster RCT in China. TRIAL REGISTRATION NUMBER ChiCTR1900026865.
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Affiliation(s)
- Haiquan Wang
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- The Nottingham Centre for Evidence-Based Healthcare: A Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- The Nottingham Centre for Evidence-Based Healthcare: A Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham, UK
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Ding M, Yi X, Yan P, McDonough DJ, Gao Z, Dong X. Application of an Online Combination Exercise Intervention to Improve Physical and Mental Health in Obese Children: A Single Arm Longitudinal Study. Front Psychol 2021; 12:638618. [PMID: 34594257 PMCID: PMC8478076 DOI: 10.3389/fpsyg.2021.638618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/16/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Childhood obesity has become a global public health concern in the past decade. The purpose of this study was to explore the effectiveness of an online combination exercise intervention in improving the physical and mental health of obese children. Methods: This study adopted a one-group pre-test and post-test research design. A total of 28 obese children from 6 elementary schools in Heze City, Shandong Province, China, were recruited. All participants received an 8-week online combination exercise intervention and were tested at a three-month follow-up. Participants were tested and surveyed regarding their demographic, feasibility, and obesity indicators using mental health and quality of life questionnaires. The data were statistically analyzed using a one-way analysis of variance with repeated measures. Results: A total of 26 obese children (Meanage = 10.15 years) completed the study. The retention rate was 92.9% for the entire trial (two obese children withdrew due to their inability to exercise) and no adverse events were reported. In addition, the obese children completed 25/32 (78.1%) of the online courses. After 8 weeks of the intervention, the changes in the body fat percentage of the obese children [mean difference (MD) = –3.126, p < 0.001, Cohen’s d = –1.777], thinking dimension score (MD = 1.654, p < 0.001, Cohen’s d = 0.603), total quality of life score (MD = 6.385, p < 0.05, Cohen’s d = 0.610), and work attitude dimension score (MD = 1.346, p < 0.001, Cohen’s d = 0.744) showed significant differences compared to the baseline. However, no significant differences were identified between the post-intervention and three-month follow-up measurements (p > 0.05), and we assumed that the intervention effect was maintained three months after the intervention. Conclusion: An online combination exercise intervention is a safe and feasible option to improve the mental health and quality of life of obese children and may have long-term health benefits.
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Affiliation(s)
- Meng Ding
- College of Physical Education, Shandong Normal University, Jinan, China
| | - Xiangren Yi
- Department of Sport and Health, School of Physical Education, Shandong University, Jinan, China
| | - Peisai Yan
- College of Physical Education, Shandong Normal University, Jinan, China
| | - Daniel J McDonough
- School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | - Zan Gao
- School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | - Xiaosheng Dong
- Department of Sport and Health, School of Physical Education, Shandong University, Jinan, China
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11
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Defever E, Jones M. Rapid Realist Review of School-Based Physical Activity Interventions in 7- to 11-Year-Old Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:52. [PMID: 33467132 PMCID: PMC7830730 DOI: 10.3390/children8010052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/05/2023]
Abstract
Meta-analysis of physical activity interventions in school settings have revealed low efficacy and that there is a need to explore implementation fidelity. The aim of this rapid realist review was to determine, what physical activity interventions in school settings for children aged 7- to 11-years-old works, for whom, and in what circumstances. The realist synthesis was conducted following RAMESES guidelines. Relevant studies were identified following a systematic search process and data from 28 studies was extracted for evidence to form context-mechanism-outcome configurations that were clustered and refined. Using the five-level socioecological model, the program theories were classified into the levels of intrapersonal (child), interpersonal (teachers), institutional (program content, school administration, and school environment), community (home and neighborhood), and policy. The school level led to most context-mechanism-outcome configurations related to school leadership and policy, workforce structure, program characteristics, and school environment. At each level, we identified features of interventions, alongside implementation considerations that might work to promote efficacy and sustainability. The need to recognize the school environment as part of a complex system with multi-level interaction and influences was a key finding. In line with realist philosophy, the researchers encouraged primary research to confirm, refute, and refine the program theories presented.
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Affiliation(s)
- Emmanuel Defever
- Health and Social Sciences, Faculty of Sport, Southampton Solent University, Southampton SO14 0YN, UK;
| | - Michelle Jones
- Resilience and Human Performance Research and Knowledge Exchange Group, Plymouth Marjon University, Plymouth PL6 8BH, UK
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Marzi I, Emmerling S, Demetriou Y, Bucksch J, Schulze C, Brindley C, Reimers AK. Interventions Aiming to Promote Active Commuting in Children and Adolescents: An Evaluation From a Sex/Gender Perspective. Front Sports Act Living 2020; 2:590857. [PMID: 33345167 PMCID: PMC7739596 DOI: 10.3389/fspor.2020.590857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022] Open
Abstract
Active commuting (AC) provides numerous health benefits and is one way to improve physical activity in children and adolescents. Boys are more likely to use active transport modes than girls. Girls and boys benefit differently from interventions that promote AC. The aim of this systematic review is to evaluate the effects of interventions on girls and boys and to appraise the extent to which previous studies have taken sex/gender into account. Eleven electronic databases were searched to identify all relevant randomized and non-randomized controlled trials based on a priori defined eligibility criteria. Two independent reviewers screened the literature for eligibility and assessed risk of bias. Semiquantitative analyses were conducted to evaluate the effects of intervention effects by taking sex/gender aspects into account. To evaluate sex/gender considerations in interventional studies, a recently developed sex/gender checklist was applied. Twelve studies were included that examined intervention effects on AC in girls and boys. Three intervention studies showed significant effects in increasing AC, with one study favoring girls, one favoring boys, and another focusing on a single sex/gender (only girls). According to the checklist, the overall sex/gender rating highlighted a lack of information in sex/gender consideration. Studies with and without significant effects indicated no differences in the sex/gender checklist. The results indicate that sex/gender is not considered adequately in primary interventional research on AC. To evaluate the effectiveness of intervention in boys and girls, detailed analyses of sex/gender are required, and better reporting about sex/gender-specific intervention content is necessary. In future health research to promote AC, sex/gender should be systematically taken into account.
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Affiliation(s)
- Isabel Marzi
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sandra Emmerling
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Yolanda Demetriou
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Jens Bucksch
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Heidelberg, Germany
| | - Carolin Schulze
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Catherina Brindley
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Heidelberg, Germany
| | - Anne Kerstin Reimers
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Vondung C, Demetriou Y, Reimers AK, Schlund A, Bucksch J. A Sex/Gender Perspective on Interventions to Reduce Sedentary Behaviour in Girls and Boys: Results of the genEffects Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145231. [PMID: 32698412 PMCID: PMC7400439 DOI: 10.3390/ijerph17145231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 01/02/2023]
Abstract
This systematic review aims to evaluate the extent of sex/gender consideration and effectiveness of interventions designed to reduce sedentary behaviour (SB). We searched for randomised or non-randomised controlled trials with the outcome SB and a sex/gender analysis in eleven electronic databases. Sixty-seven studies were included. Sex/gender considerations were qualitatively rated. Sex/gender was reported separately in 44.8% of studies, 14.9% of studies conducted a sex/gender interaction analysis, and 19.4% enrolled either girls or boys. SB was significantly reduced for girls in 16.4%, for boys in 11.9% and for both in 13.4%. No sex/gender intervention effect was found in 38.8%. According to the qualitative rating, studies without significant sex/gender effects reached "detailed" rating twice as often as studies finding a significant intervention effect for either girls or boys, or both. Overall, no clear pattern according to the qualitative rating and in terms of intervention effectiveness can be drawn. The results reveal a lack of sufficient sex/gender information in intervention planning and delivery. Further research should consider analysing sex/gender intervention effects as well as consider sex/gender inclusive intervention planning and delivery.
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Affiliation(s)
- Catherina Vondung
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Keplerstrasse 87, 69120 Heidelberg, Germany;
- Correspondence:
| | - Yolanda Demetriou
- Department of Sport and Health Sciences, Technical University of Munich, Georg- Brauchle-Ring 62, 80992 Munich, Germany; (Y.D.); (A.S.)
| | - Anne K. Reimers
- Department of Sport Science and Sport, Friedrich-Alexander-University of Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany;
| | - Annegret Schlund
- Department of Sport and Health Sciences, Technical University of Munich, Georg- Brauchle-Ring 62, 80992 Munich, Germany; (Y.D.); (A.S.)
| | - Jens Bucksch
- Department of Natural and Sociological Sciences, Heidelberg University of Education, Keplerstrasse 87, 69120 Heidelberg, Germany;
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Wray A, Martin G, Ostermeier E, Medeiros A, Little M, Reilly K, Gilliland J. Physical activity and social connectedness interventions in outdoor spaces among children and youth: a rapid review. Health Promot Chronic Dis Prev Can 2020; 40:104-115. [PMID: 32270668 PMCID: PMC7197641 DOI: 10.24095/hpcdp.40.4.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
INTRODUCTION The rise in sedentary behaviour, coupled with the decline in overall mental health among Canadian children and youth in recent decades, demonstrates a clear need for applied research that focusses on developing and evaluating cross-disciplinary interventions. Outdoor spaces provide opportunities for physical activity and social connectedness, making them an ideal setting to address these critical health concerns among children and youth. METHODS We conducted a rapid review of peer-reviewed (n = 3096) and grey literature (n = 7) to identify physical activity and/or social connectedness outdoor space interventions targeted at children and youth (19 years and under) in Australia and New Zealand, Canada, Europe and the United States. We determined if interventions were effective by analyzing their research design, confidence intervals and reported limitations, and then conducted a narrative synthesis of the effective interventions. RESULTS We found 104 unique studies, of which 70 (67%) were determined to be effective. Overall, 55 interventions targeted physical activity outcomes, 10 targeted social connectedness outcomes and 5 targeted both. Play (n = 47) and contact with nature (n = 25) were dominant themes across interventions, with most taking place in a school or park. We report on the identifying features, limitations and implications of these interventions. CONCLUSION The incorporation of natural and play-focussed elements into outdoor spaces may be effective ways to improve physical activity and social connectedness. There is a considerable need for more Canadian-specific research. Novel methods, such as incorporating smartphone technology into the design and evaluation of these interventions, warrant consideration.
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Affiliation(s)
- Alexander Wray
- Human Environments Analysis Lab, Department of Geography, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Gina Martin
- Human Environments Analysis Lab, Department of Geography, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Emma Ostermeier
- Human Environments Analysis Lab, Department of Geography, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Alina Medeiros
- Human Environments Analysis Lab, Department of Geography, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Malcolm Little
- Human Environments Analysis Lab, Department of Geography, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Kristen Reilly
- Human Environments Analysis Lab, Department of Geography, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Jason Gilliland
- Human Environments Analysis Lab, Department of Geography, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- School of Health Studies, Department of Paediatrics, Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
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Jones M, Defever E, Letsinger A, Steele J, Mackintosh KA. A mixed-studies systematic review and meta-analysis of school-based interventions to promote physical activity and/or reduce sedentary time in children. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:3-17. [PMID: 31921476 PMCID: PMC6943767 DOI: 10.1016/j.jshs.2019.06.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/04/2019] [Accepted: 04/28/2019] [Indexed: 05/17/2023]
Abstract
PURPOSE The aim of this mixed-studies systematic review was to ascertain the effectiveness of school-based interventions in increasing physical activity (PA) and/or reducing sedentary time (ST) in children aged 5-11 years, as well as to explore their effectiveness in relation to categories of the theory of expanded, extended, and enhanced opportunity (TEO). METHODS Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 5 databases were searched using predefined search terms. Following title and abstract screening of 1115 records, the removal of duplicates (n = 584) and articles that did not meet the inclusion criteria agreed to a priori (n = 419) resulted in 112 records that were full-text screened. Two independent reviewers subsequently used the mixed-methods appraisal tool to assess the methodological quality of 57 full-text studies that met the inclusion criteria after full-text screening. The interventions were summarised using the TIDierR checklist and TEO. The strength of evidence was determined using a 5-level rating system utilising a published decision tree. RESULTS Overall evidence ratings for interventions implemented within school settings were: no evidence of effects on moderate-to-vigorous physical activity (MVPA) and inconclusive evidence of effects on sedentary time. In relation to the TEO, expansion of PA appeared to be the most promising intervention type for MVPA, with moderate evidence of effect, whereas extension and enhancement of PA opportunity demonstrated no evidence of effect. A critical issue of possible compensatory behavior was identified by analysis of intervention effect in relation to PA measurement duration; when studies measured changes in PA during the actual intervention, there was moderate evidence of effect, whereas those that measured changes in PA during the school day presented inconclusive evidence of effect, and those that measured changes in PA over a whole day yielded no evidence of effect. Two meta-analyses of those studies using a whole-day accelerometer measure for MVPA or ST showed a significant but moderate effect for MVPA (effect size = 0.51; 95% confidence interval (CI): 0.02-0.99) and a large but nonsignificant effect for ST (effect size = 1.15; 95%CI: -1.03 to 3.33); both meta-analyses demonstrated low precision, considerable inconsistency, and high heterogeneity. CONCLUSION The findings have important implications for future intervention research in terms of intervention design, implementation, and evaluation.
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Affiliation(s)
- Michelle Jones
- Research Office, Plymouth Marjon University, Plymouth PL4 8AA, UK
- Corresponding author.
| | - Emmanuel Defever
- School of Sport, Health and Social Sciences, Solent University, Southampton, SO14 0YN, UK
| | - Ayland Letsinger
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - James Steele
- School of Sport, Health and Social Sciences, Solent University, Southampton, SO14 0YN, UK
- The ukactive Research Institute, London, WC1R 4HE, UK
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Kupolati MD, MacIntyre UE, Gericke GJ, Becker P. A Contextual Nutrition Education Program Improves Nutrition Knowledge and Attitudes of South African Teachers and Learners. Front Public Health 2019; 7:258. [PMID: 31620415 PMCID: PMC6759471 DOI: 10.3389/fpubh.2019.00258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 08/27/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Evaluating the impact of a nutrition education program could provide insight into the effectiveness of an intervention. Researchers tested the hypothesis that a theory-based contextual nutrition education program (NEP) would improve the nutrition knowledge, attitudes, and dietary practices (KAP) of teachers and learners. Methods: Twenty three teachers who taught nutrition in Grades 4-7 (treatment school, n = 12) and 681 learners (treatment school, n = 350) participated in the study. In this quasi-experimental study, two primary schools were randomly selected to implement a contextual NEP. The nutrition KAP were assessed using previously validated questionnaires. The treatment school teachers taught nutrition using a developed nutrition education manual, while the control school teachers taught nutrition in the usual manner. Random effects Generalized Least Squares regression estimated the difference in the teachers' and learners' KAP for the treatment and control schools; p = 0.025 for a one-tailed test. Results: At post-implementation, the treatment school teachers' had higher total nutrition knowledge mean score (85.5% ± 8.2, p = 0.003) compared to the control school. Within the treatment school, total nutrition knowledge mean score of the teachers improved by 14.1%, p ≤ 0.001. Learners in the treatment school had higher total nutrition knowledge (53.2% ± 16.9, p = 0.002) and nutrition attitude (63.9% ± 19.7, p = 0.001) scores compared to learners in the control school. Within the treatment school, learners' total nutrition knowledge and nutrition attitudes scores increased by 4.9%, p ≤ 0.001 and 6.9%, p ≤ 0.001, respectively. The dietary practices of the teachers and the learners, and the nutrition attitudes of the teachers in the treatment school showed no significant within school improvement or in comparison with the control school (p > 0.025). Conclusions: The NEP led to the improvement in the teachers' and the learners' nutrition knowledge and the learners' nutrition attitudes. However, no significant improvement in the dietary practices of either teachers or learners was found.
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Affiliation(s)
| | - Una E. MacIntyre
- Human Nutrition Department, University of Pretoria, Pretoria, South Africa
| | - Gerda J. Gericke
- Human Nutrition Department, University of Pretoria, Pretoria, South Africa
| | - Piet Becker
- Research Office, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Duncan S, Stewart T, McPhee J, Borotkanics R, Prendergast K, Zinn C, Meredith-Jones K, Taylor R, McLachlan C, Schofield G. Efficacy of a compulsory homework programme for increasing physical activity and improving nutrition in children: a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2019; 16:80. [PMID: 31488140 PMCID: PMC6729097 DOI: 10.1186/s12966-019-0840-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/16/2019] [Indexed: 12/02/2022] Open
Abstract
Background Most physical activity interventions in children focus on the school setting; however, children typically engage in more sedentary activities and spend more time eating when at home. The primary aim of this cluster randomised controlled trial was to investigate the effects of a compulsory, health-related homework programme on physical activity, dietary patterns, and body size in primary school-aged children. Methods A total of 675 children aged 7–10 years from 16 New Zealand primary schools participated in the Healthy Homework study. Schools were randomised into intervention and control groups (1:1 allocation). Intervention schools implemented an 8-week applied homework and in-class teaching module designed to increase physical activity and improve dietary patterns. Physical activity was the primary outcome measure, and was assessed using two sealed pedometers that monitored school- and home-based activity separately. Secondary outcome measures included screen-based sedentary time and selected dietary patterns assessed via parental proxy questionnaire. In addition, height, weight, and waist circumference were measured to obtain body mass index (BMI) and waist-to-height ratio (WHtR). All measurements were taken at baseline (T0), immediately post-intervention (T1), and 6-months post-intervention (T2). Changes in outcome measures over time were estimated using generalised linear mixed models (GLMMs) that adjusted for fixed (group, age, sex, group x time) and random (subjects nested within schools) effects. Intervention effects were also quantified using GLMMs adjusted for baseline values. Results Significant intervention effects were observed for weekday physical activity at home (T1 [P < 0.001] and T2 [P = 0.019]), weekend physical activity (T1 [P < 0.001] and T2 [P < 0.001]), BMI (T2 only [P = 0.020]) and fruit consumption (T1 only [P = 0.036]). Additional analyses revealed that the greatest improvements in physical activity occurred in children from the most socioeconomically deprived schools. No consistent effects on sedentary time, WHtR, or other dietary patterns were observed. Conclusions A compulsory health-related homework programme resulted in substantial and consistent increases in children’s physical activity – particularly outside of school and on weekends – with limited effects on body size and fruit consumption. Overall, our findings support the integration of compulsory home-focused strategies for improving health behaviours into primary education curricula. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618000590268. Registered 17 April 2018. Electronic supplementary material The online version of this article (10.1186/s12966-019-0840-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scott Duncan
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand.
| | - Tom Stewart
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Julia McPhee
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Robert Borotkanics
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Kate Prendergast
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Caryn Zinn
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Kim Meredith-Jones
- Edgar Diabetes and Obesity Research Centre, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Rachael Taylor
- Edgar Diabetes and Obesity Research Centre, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Claire McLachlan
- School of Education, Federation University Australia, PO Box 663, Ballarat, VIC 3353, Victoria, Australia
| | - Grant Schofield
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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Ha AS, Ng JYY, Lonsdale C, Lubans DR, Ng FF. Promoting physical activity in children through family-based intervention: protocol of the "Active 1 + FUN" randomized controlled trial. BMC Public Health 2019; 19:218. [PMID: 30786902 PMCID: PMC6383281 DOI: 10.1186/s12889-019-6537-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/12/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Physical activity (PA) is beneficial to people's physical and psychological health. Physically active children are likely to become active adults; thus, active lifestyles should be promoted from childhood. Parents are crucial for shaping their children's behaviors, but many lack the knowledge and skills to provide optimal support for PA. The "Active 1 + FUN" intervention was designed to enhance PA of the whole family, and improve parenting methods of both fathers and mothers. METHODS "Active 1 + FUN" is a family-based intervention designed using the tenets of self-determination theory. The intervention was designed to help parents support their children's basic psychological needs for competence (by providing informational feedback and optimal challenges), autonomy (by exploring a variety of activities and reducing controlling behaviors), and relatedness (by increasing co-PA between parents and child). The intervention components include interactive workshops, activity sessions, physical activity homework, activity planning consultations, easy sports equipment, and online materials. A randomized controlled trial will be conducted to evaluate the intervention. A target sample of 204 Primary three to five students (8 to 11 years) and their parents will be randomly allocated to the experimental group or a wait-list control group. The experimental group will receive a ten-session intervention which spans approximately six months. The control group will receive intervention one year later. Children's accelerometer-based leisure-time physical activity (primary outcome) and secondary outcomes will be assessed at baseline, at end of intervention period (6 months after baseline), and at follow-up (12 months after baseline). Qualitative interviews will be conducted to determine effective intervention components from the perspective of children and parents. We hypothesize that the intervention will increase parents' and children's activity behaviors and that children will experience higher levels of needs satisfaction with regard to physical activity participation. DISCUSSION Physical activity interventions often target children only, but ones that also involve parents may be more beneficial. The "Active 1 + FUN" intervention will be organized and delivered by trained trainers. Consequently, this intervention could be scaled to a larger number of Hong Kong schools in the future and could impact a wider population of schoolchildren. TRIAL REGISTRATION ANZCTR ACTRN12618001524280 . Registered 11 September 2018.
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Affiliation(s)
- Amy S. Ha
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Johan Y. Y. Ng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, 33 Berry Street, North Sydney, NSW 2060 Australia
| | - David R. Lubans
- Priority Research Centre for Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Florrie F. Ng
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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21
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de Vlieger N, Riley N, Miller A, Collins CE, Bucher T. Nutrition education in the Australian New South Wales primary school curriculum: An exploration of time allocation, translation and attitudes in a sample of teachers. Health Promot J Austr 2018; 30:94-101. [PMID: 30054958 DOI: 10.1002/hpja.188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/24/2018] [Indexed: 02/04/2023] Open
Abstract
ISSUE ADDRESSED The dietary intakes of Australian children are not optimal, with few meeting recommended vegetable and fruit intake targets. Nutrition education in childhood is important for developing healthy eating patterns, with schools an ideal setting for a wide reach. The aims of this study were to examine nutrition education within the NSW primary school syllabus, explore how much time teachers spend teaching nutrition, what is taught, what materials are used, and to identify attitudes towards nutrition education. METHOD An online survey consisting of 29 closed questions (with options for comments) was specifically developed for the purpose of this study. Teachers currently teaching at a NSW primary school were eligible to participate. RESULTS A total of 33 NSW primary school teachers completed the survey. Results indicate that limited time is spent on teaching nutrition with some important nutrition education components currently missed, resources perceived to be inadequate and lack of time reported as the largest barrier to teaching nutrition. CONCLUSION In order to improve the quality of nutrition education in NSW primary schools, several important topics need to be integrated into the curriculum, and time constraints of teachers should be taken into account. SO WHAT?: Findings from the current survey will inform the development of future nutrition education programs and resources with the aim of integrating nutrition education within the primary school curriculum.
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Affiliation(s)
- Nienke de Vlieger
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicholas Riley
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia.,School of Education, Faculty of Education and Arts, The University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Miller
- School of Education, Faculty of Education and Arts, The University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Tamara Bucher
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
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22
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McPherson A, Mackay L, Kunkel J, Duncan S. Physical activity, cognition and academic performance: an analysis of mediating and confounding relationships in primary school children. BMC Public Health 2018; 18:936. [PMID: 30064394 PMCID: PMC6069778 DOI: 10.1186/s12889-018-5863-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Exploring the relationship between physical activity, cognition and academic performance in children is an important but developing academic field. One of the key tasks for researchers is explaining how the three factors interact. The aim of this study was to develop and test a conceptual model that explains the associations among physical activity, cognition, academic performance, and potential mediating factors in children. Methods Data were sourced from 601 New Zealand children aged 6–11 years. Weekday home, weekday school, and weekend physical activity was measured by multiple pedometer step readings, cognition by four measures from the CNS Vital Signs assessment, and academic performance from the New Zealand Ministry of Education electronic Assessment Tools for Teaching and Learning (e-asTTle) reading and maths scores. A Structured Equation Modelling approach was used to test two models of variable relationships. The first model analysed the physical activity-academic performance relationship, and the second model added cognition to determine the mediating effect of cognition on the physical activity-academic performance association. Multigroup analysis was used to consider confounding effects of gender, ethnicity and school socioeconomic decile status. Results The initial model identified a significant association between physical activity and academic performance (r = 0.225). This direct association weakened (r = 0.121) when cognition was included in the model, demonstrating a partial mediating effect of cognition. While cognition was strongly associated with academic performance (r = 0.750), physical activity was also associated with cognition (r = 0.138). Subgroups showed similar patterns to the full sample, but the smaller group sizes limited the strength of the conclusions. Conclusions This cross-sectional study demonstrates a direct association between physical activity and academic performance. Furthermore, and importantly, this study shows the relationship between physical activity and academic performance is supported by an independent relationship between physical activity and cognition. Larger sample sizes are needed to investigate confounding factors of gender, age, socioeconomic status, and ethnicity. Future longitudinal analyses could investigate whether increases in physical activity can improve both cognition and academic performance.
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Affiliation(s)
- Adrian McPherson
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Lisa Mackay
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Jule Kunkel
- Institute for Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Duncan
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
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23
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The CHANGE! Project: Changes in Body Composition and Cardiorespiratory Fitness in 10- to 11-Year-Old Children After Completing the CHANGE! Intervention. Pediatr Exerc Sci 2018; 30:81-89. [PMID: 27175903 DOI: 10.1123/pes.2015-0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the effects of the Children's Health, Activity and Nutrition: Get Educated! intervention on body size, body composition, and peak oxygen uptake in a subsample of 10- to 11-year-old children. METHODS Sixty children were recruited from 12 schools (N = 6 intervention) to take part in the CHANGE! subsample study. Baseline, postintervention, and follow-up measures were completed in October 2010, March-April 2011, and June-July 2011, respectively. Outcome measures were body mass index z score, waist circumference, body composition assessed using dual-energy X-ray absorptiometry (baseline and follow-up only), and peak oxygen uptake. RESULTS Significant differences in mean trunk fat mass (control = 4.72 kg, intervention = 3.11 kg, P = .041) and trunk fat % (control = 23.08%, intervention = 17.75%, P = .022) between groups were observed at follow-up. Significant differences in waist circumference change scores from baseline to follow-up were observed between groups (control = 1.3 cm, intervention = -0.2 cm, P = .023). Favorable changes in body composition were observed in the intervention group; however, none of these changes reached statistical significance. No significant differences in peak oxygen uptake were observed. CONCLUSIONS The results of the present study suggest the multicomponent curriculum intervention had small to medium beneficial effects on body size and composition health outcomes.
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24
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Vargas-Garcia EJ, Evans CEL, Prestwich A, Sykes-Muskett BJ, Hooson J, Cade JE. Interventions to reduce consumption of sugar-sweetened beverages or increase water intake: evidence from a systematic review and meta-analysis. Obes Rev 2017; 18:1350-1363. [PMID: 28721697 DOI: 10.1111/obr.12580] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 12/13/2022]
Abstract
A systematic review and meta-analyses were conducted to evaluate the effects of interventions to reduce sugar-sweetened beverages (SSB) or increase water intakes and to examine the impact of behaviour change techniques (BCTs) in consumption patterns. Randomized and nonrandomized controlled trials published after January 1990 and until December 2016 reporting daily changes in intakes of SSB or water in volumetric measurements (mL d-1 ) were included. References were retrieved through searches of electronic databases and quality appraisal followed Cochrane principles. We calculated mean differences (MD) and synthesized data with random-effects models. Forty studies with 16 505 participants were meta-analysed. Interventions significantly decreased consumption of SSB in children by 76 mL d-1 (95% confidence interval [CI] -105 to -46; 23 studies, P < 0.01), and in adolescents (-66 mL d-1 , 95% CI -130 to -2; 5 studies, P = 0.04) but not in adults (-13 mL d-1 , 95% CI -44 to 18; 12 studies, P = 0.16). Pooled estimates of water intakes were only possible for interventions in children, and results were indicative of increases in water intake (MD +67 mL d-1 , 95% CI 6 to 128; 7 studies, P = 0.04). For children, there was evidence to suggest that modelling/demonstrating the behaviour helped to reduce SSB intake and that interventions within the home environment had greater effects than school-based interventions. In conclusion, public health interventions - mainly via nutritional education/counselling - are moderately successful at reducing intakes of SSB and increasing water intakes in children. However, on average, only small reductions in SSBs have been achieved by interventions targeting adolescents and adults. Complementary measures may be needed to achieve greater improvements in both dietary behaviours across all age groups.
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Affiliation(s)
- E J Vargas-Garcia
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - C E L Evans
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - A Prestwich
- School of Psychology, University of Leeds, Leeds, UK
| | | | - J Hooson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - J E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
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25
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Pang B, Kubacki K, Rundle-Thiele S. Promoting active travel to school: a systematic review (2010-2016). BMC Public Health 2017; 17:638. [PMID: 28779756 PMCID: PMC5545094 DOI: 10.1186/s12889-017-4648-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/28/2017] [Indexed: 11/25/2022] Open
Abstract
Background Interventions aiming to promote active school travel (AST) are being implemented globally to reverse AST decline. This systematic literature provides an update of AST interventions assessing study quality and theory use to examine progress in the field. Methods A systematic review was conducted to identify and analyse AST interventions published between 2010 and 2016. Seven databases were searched and exclusion criteria were applied to identify 18 AST interventions. Interventions were assessed using the Active Living by Design (ALBD) Community Action (5P) Model and the Evaluation of Public Health Practice Projects (EPHPP). Methods used to evaluate the effectiveness of each intervention and their outcomes and extent of theory use were examined. Results Seven out of 18 studies reported theory use. The analysis of the interventions using the ALBD Community Action Model showed that Preparation and Promotion were used much more frequently than Policy and Physical projects. The methodological quality 14 out of 18 included interventions were assessed as weak according to the EPHPP framework. Conclusion Noted improvements were an increase in use of objective measures. Lack of theory, weak methodological design and a lack of reliable and valid measurement were observed. Given that change is evident when theory is used and when policy changes are included extended use of the ALBD model and socio-ecological frameworks are recommended in future. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4648-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Pang
- Department of Marketing and Social Marketing @ Griffith, Griffith University, 117 Kessels Road, Nathan, QLD, 4111, Australia.
| | - Krzysztof Kubacki
- Department of Marketing and Social Marketing @ Griffith, Griffith University, 117 Kessels Road, Nathan, QLD, 4111, Australia
| | - Sharyn Rundle-Thiele
- Department of Marketing and Social Marketing @ Griffith, Griffith University, 117 Kessels Road, Nathan, QLD, 4111, Australia
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26
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Brazendale K, Beets MW, Weaver RG, Pate RR, Turner-McGrievy GM, Kaczynski AT, Chandler JL, Bohnert A, von Hippel PT. Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act 2017; 14:100. [PMID: 28747186 PMCID: PMC5530518 DOI: 10.1186/s12966-017-0555-2] [Citation(s) in RCA: 340] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/19/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although the scientific community has acknowledged modest improvements can be made to weight status and obesogenic behaviors (i.e., physical activity, sedentary/screen time, diet, and sleep) during the school year, studies suggests improvements are erased as elementary-age children are released to summer vacation. Emerging evidence shows children return to school after summer vacation displaying accelerated weight gain compared to the weight gained occurring during the school year. Understanding how summer days differ from when children are in school is, therefore, essential. DISCUSSION There is limited evidence on the etiology of accelerated weight gain during summer, with few studies comparing obesogenic behaviors on the same children during school and summer. For many children, summer days may be analogous to weekend days throughout the school year. Weekend days are often limited in consistent and formal structure, and thus differ from school days where segmented, pre-planned, restrictive, and compulsory components exist that shape obesogenic behaviors. The authors hypothesize that obesogenic behaviors are beneficially regulated when children are exposed to a structured day (i.e., school weekday) compared to what commonly occurs during summer. This is referred to as the 'Structured Days Hypothesis' (SDH). To illustrate how the SDH operates, this study examines empirical data that compares weekend day (less-structured) versus weekday (structured) obesogenic behaviors in U.S. elementary school-aged children. From 190 studies, 155 (~80%) demonstrate elementary-aged children's obesogenic behaviors are more unfavorable during weekend days compared to weekdays. CONCLUSION In light of the SDH, consistent evidence demonstrates the structured environment of weekdays may help to protect children by regulating obesogenic behaviors, most likely through compulsory physical activity opportunities, restricting caloric intake, reducing screen time occasions, and regulating sleep schedules. Summer is emerging as the critical period where childhood obesity prevention efforts need to be focused. The SDH can help researchers understand the drivers of obesogenic behaviors during summer and lead to innovative intervention development.
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Affiliation(s)
- Keith Brazendale
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - Michael W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - Gabrielle M. Turner-McGrievy
- Department of Health Promotion, Education and Behavior, University of South Carolina, 915 Greene Street, Columbia, SC 29201 USA
| | - Andrew T. Kaczynski
- Department of Health Promotion, Education and Behavior, University of South Carolina, 915 Greene Street, Columbia, SC 29201 USA
| | - Jessica L. Chandler
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, Charleston, SC 29425 USA
| | - Amy Bohnert
- Department of Psychology, Loyola University Chicago, 1032 West Sheridan Road, Chicago, IL 60626 USA
| | - Paul T. von Hippel
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX 78712 USA
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Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJM, van Sluijs EMF. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obes Rev 2016; 17:345-60. [PMID: 26756281 PMCID: PMC4819691 DOI: 10.1111/obr.12362] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Family-based interventions represent a potentially valuable route to increasing child physical activity (PA) in children. A dual meta-analysis and realist synthesis approach examined existing interventions to assist those developing programmes to encourage uptake and maintenance of PA in children. DESIGN Studies were screened for inclusion based on including participants aged 5-12 years, having a substantive aim of increasing PA by engaging the family and reporting on PA outcome. Duplicate data extraction and quality assessment were conducted. Meta-analysis was conducted in STATA. Realist synthesis included theory development and evidence mapping. RESULTS Forty-seven studies were included, of which three received a 'strong' quality rating, 21 'moderate' and 23 'weak'. The meta-analysis (19 studies) demonstrated a significant small effect in favour of the experimental group (standardized mean difference: 0.41; 95%CI 0.15-0.67). Sensitivity analysis, removing one outlier, reduced this to 0.29 (95%CI 0.14-0.45). Realist synthesis (28 studies) provided insight into intervention context (particularly, family constraints, ethnicity and parental motivation), and strategies to change PA (notably, goal-setting and reinforcement combined). CONCLUSION This review provides key recommendations to inform policy makers and other practitioners in developing evidence-based interventions aimed at engaging the family to increase PA in children, and identifies avenues for future research.
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Affiliation(s)
- H E Brown
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - A J Atkin
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - J Panter
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - G Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - M J M Chinapaw
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - E M F van Sluijs
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Scoggins R, Lambert L, Knight K. Parent’s Use and Likely Utilization of Nutrition Education Resources in the Mississippi Delta Region. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2015. [DOI: 10.17795/intjsh-28880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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29
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Dudley DA, Cotton WG, Peralta LR. Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2015; 12:28. [PMID: 25889098 PMCID: PMC4416340 DOI: 10.1186/s12966-015-0182-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/03/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Healthy eating by primary school-aged children is important for good health and development. Schools can play an important role in the education and promotion of healthy eating among children. The aim of this review was to: 1) perform a systematic review of randomised controlled, quasi-experimental and cluster controlled trials examining the school-based teaching interventions that improve the eating habits of primary school children; and 2) perform a meta-analysis to determine the effect of those interventions. METHODS The systematic review was limited to four healthy eating outcomes: reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; reduced sugar consumption or preference (not from whole fruit); increased nutritional knowledge. In March 2014, we searched seven electronic databases using predefined keywords for intervention studies that were conducted in primary schools which focused on the four healthy eating outcomes. Targeted internet searching using Google Scholar was also used. In excess of 200,000 possible citations were identified. Abstracts and full text of articles of potentially relevant papers were screened to determine eligibility. Data pertaining to teaching strategies that reported on healthy eating outcomes for primary school children was extracted from the 49 eligible papers. RESULTS Experiential learning strategies were associated with the largest effects across the reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; and increased nutritional knowledge outcomes. Reducing sugar consumption and preference was most influenced by cross-curricular approaches embedded in the interventions. CONCLUSIONS As with most educational interventions, most of the teaching strategies extracted from the intervention studies led to positive changes in primary school children's healthy eating behaviours. However, given the finite resources, increased overcrowding of school curriculum and capacity of teachers in primary schools, a meta-analysis of this scope is able to provide stakeholders with the best evidence of where these resources should be focused.
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Affiliation(s)
- Dean A Dudley
- School of Education, Faculty of Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Wayne G Cotton
- Faculty of Education and Social Work, University of Sydney, Sydney, NSW, Australia.
| | - Louisa R Peralta
- Faculty of Education and Social Work, University of Sydney, Sydney, NSW, Australia.
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Fairclough SJ, Hackett AF, Davies IG, Gobbi R, Mackintosh KA, Warburton GL, Stratton G, van Sluijs EMF, Boddy LM. Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study. BMC Public Health 2013; 13:626. [PMID: 23819701 PMCID: PMC3733685 DOI: 10.1186/1471-2458-13-626] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This pragmatic evaluation investigated the effectiveness of the Children's Health, Activity and Nutrition: Get Educated! (CHANGE!) Project, a cluster randomised intervention to promote healthy weight using an educational focus on physical activity and healthy eating. METHODS Participants (n = 318, aged 10-11 years) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011. This consisted of a teacher-led curriculum, learning resources, and homework tasks. Primary outcome measures were waist circumference, body mass index (BMI), and BMI z-scores. Secondary outcomes were objectively-assessed physical activity and sedentary time, and food intake. Outcomes were assessed at baseline, at post-intervention (20 weeks), and at follow-up (30 weeks). Data were analysed using 2-level multi-level modelling (levels: school, student) and adjusted for baseline values of the outcomes and potential confounders. Differences in intervention effect by subgroup (sex, weight status, socio-economic status) were explored using statistical interaction. RESULTS Significant between-group effects were observed for waist circumference at post-intervention (β for intervention effect =-1.63 (95% CI = -2.20, -1.07) cm, p<0.001) and for BMI z-score at follow-up (β=-0.24 (95% CI = -0.48, -0.003), p=0.04). At follow-up there was also a significant intervention effect for light intensity physical activity (β=25.97 (95% CI = 8.04, 43.89) min, p=0.01). Interaction analyses revealed that the intervention was most effective for overweight/obese participants (waist circumference: β=-2.82 (95% CI = -4.06, -1.58) cm, p<0.001), girls (BMI: β=-0.39 (95% CI = -0.81, 0.03) kg/m2, p=0.07), and participants with higher family socioeconomic status (breakfast consumption: β=8.82 (95% CI = 6.47, 11.16), p=0.07). CONCLUSIONS The CHANGE! intervention positively influenced body size outcomes and light physical activity, and most effectively influenced body size outcomes among overweight and obese children and girls. The findings add support for the effectiveness of combined school-based physical activity and nutrition interventions. Additional work is required to test intervention fidelity and the sustained effectiveness of this intervention in the medium and long term. TRIAL REGISTRATION Current Controlled Trials ISRCTN03863885.
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Affiliation(s)
- Stuart J Fairclough
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 62, Great Crosshall Street, Liverpool, UK.
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Arundell L, Ridgers ND, Veitch J, Salmon J, Hinkley T, Timperio A. 5-year changes in afterschool physical activity and sedentary behavior. Am J Prev Med 2013; 44:605-11. [PMID: 23683978 DOI: 10.1016/j.amepre.2013.01.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/29/2012] [Accepted: 01/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The afterschool period holds promise for the promotion of physical activity, yet little is known about the importance of this period as children age. PURPOSE To examine changes in physical activity of children aged 5-6 years and 10-12 years and their sedentary time in the afterschool period over 3 and 5 years, and to determine the contribution of this period to daily physical activity and sedentary behavior over time. METHODS Data from two longitudinal studies conducted in Melbourne, Australia, were used. Accelerometer data were provided for 2053 children at baseline (Children Living in Active Neighbourhoods Study [CLAN]: 2001; Health, Eating and Play Study [HEAPS]: 2002/2003); 756 at 3-year follow-up (time point 2 [T2]); and 622 at 5-year follow-up (T3). Light (LPA), moderate (MPA) and vigorous (VPA) physical activity were determined using age-adjusted cut-points. Sedentary time was defined as ≤ 100 counts/minute. Multilevel analyses, conducted in April 2012, assessed change in physical activity and sedentary time and the contributions of the afterschool period to overall levels. RESULTS Afterschool MPA and VPA decreased among both cohorts, particularly in the younger cohort, who performed less than half of their baseline levels at T3 (MPA: T1=24 minutes; T3=11 minutes; VPA: T1=12 minutes; T3=4 minutes). LPA also declined in the older cohort. Afterschool sedentary time increased among the younger (T1=42 minutes; T3=64 minutes) and older cohorts (T1=57 minutes; T3=84 minutes). The contribution of the afterschool period to overall MPA and VPA increased in the older cohort from 23% to 33% over 5 years. In the younger cohort, the contribution of the afterschool period to daily MPA and VPA decreased by 3% over 5 years. CONCLUSIONS The importance of the afterschool period for children's physical activity increases with age, particularly as children enter adolescence.
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Affiliation(s)
- Lauren Arundell
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Melbourne, Australia
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Militão AG, de Oliveira Karnikowski MG, da Silva FR, Garcez Militão ES, dos Santos Pereira RM, Grubert Campbell CS. Effects of a recreational physical activity and healthy habits orientation program, using an illustrated diary, on the cardiovascular risk profile of overweight and obese schoolchildren: a pilot study in a public school in Brasilia, Federal District, Brazil. Diabetes Metab Syndr Obes 2013; 6:445-51. [PMID: 24348058 PMCID: PMC3848643 DOI: 10.2147/dmso.s52166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Educative strategies need to be adopted to encourage the consumption of healthy foods and to promote physical activity in childhood and adolescence. The effects of recreational physical activity and a health-habit orientation program using an illustrated diary on the cardiovascular risk profile of overweight and obese children was investigated. METHODS The weight and height of 314 schoolchildren aged between 9 and 11 years old, in a public school in Brasilia, Federal District, Brazil, were recorded. According to the body mass index (BMI) classification proposed by the World Health Organization, 84 were overweight or obese for their age and sex. Of these children, 34 (40%) participated in the study. Students were divided into two groups matched for sex, age, BMI, percent body fat (%BF): the intervention group (IG, n = 17) and the control group (CG, n = 17). The IG underwent a program of 10 weeks of exercise with recreational activities and health-habit orientation using an illustrated diary of habits, while no such interventions were used with the CG during the study period. Before and after the intervention, the children's weight, height, BMI, %BF, waist circumference (WC), maximum oxygen intake (VO2max), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides, glucose, eating habits, and physical activity level (PAL) were assessed. In analyzing the data, we used descriptive statistics and paired and unpaired t-tests, using a significance level of 0.05. For assessment of dietary habits, a questionnaire, contingency tables, and the chi-squared test were used, with <0.05 set as the significance level. RESULTS After 10 weeks of intervention, the IG showed a reduction in BMI (pre: 22.2 ± 2.1 kg/m(2) versus [vs] post: 21.6 ± 2.1 kg/m(2), P < 0.01); WC (pre: 70.1 ± 6.1 cm vs post: 69.1 ± 5.8 cm, P < 0.01); %BF (pre: 29.2% ± 4.6% vs post: 28.0% ± 4.8%, P < 0.01); systolic blood pressure (P < 0.01); VO2max (P = 0.014); TC (P < 0.01); LDL (P < 0.01); triglycerides (P < 0.01); and intake of candy (P < 0.01) and soda drinks (P < 0.01), while an increase in the consumption of fruit (P < 0.01) and PAL (P < 0.01) were observed. The CG did not show any change in the health parameters assessed. CONCLUSION The program was effective in reducing risk factors for cardiovascular disease and the use of an illustrative diary may have been the key to this result, since students were motivated to change their poor eating habits and to increase their physical activity level.
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Affiliation(s)
- Angeliete Garcez Militão
- Department of Physical Education, Federal University of Rondonia, Brazil
- Post-Graduate Program in Physical Education, Catholic University of Brasilia, Brazil
- Correspondence: Angeliete Garcez Militão, Departamento de Educação Física Universidade, Federal de Rondônia, Brasil, Rua Jatuarana, 1115, Cs 37, Bairro Lagoa, CEP 820.100, Porto Velho, Rondonia, Brazil, Tel +55 69 9902 8229, Email
| | | | | | | | | | - Carmen Silvia Grubert Campbell
- Post-Graduate Program in Physical Education, Catholic University of Brasilia, Brazil
- Laboratory of Physical Education and Health Studies, Catholic University of Brasilia, Brazil
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