Changes in school-day step counts during a physical activity for Lent intervention: a cluster randomized crossover trial of the Savior's Sandals

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school.

OBJECTIVES

The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information.

SELECTION CRITERIA

Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update.  DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type.

MAIN RESULTS

Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias.  Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events.

AUTHORS' CONCLUSIONS

Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.

Seasonal variation in lifestyle behavior in Poland: Google searches and market sales analysis

BACKGROUND

Detection of the seasonal patterns of healthy and unhealthy behavior could be helpful for designing individual and population health interventions programs. This study investigates the seasonal variation in sales of common types of products in Poland and Polish Google queries related to healthy behavior.

METHODS

Data of index sales from a large Polish retail store franchise, from January 2014 to August 2019, has been analyzed. The commercial data included twelve types of products. The interest of Google users was investigated using Google Trends statistics for the same period for six lifestyle-related topics. The seasonality was checked using time series analysis.

RESULTS

Six of the consumer goods (dairy, ready-made meals, salty snacks, meats, beer, and cigarettes) were most commonly purchased in summer months, four (processed fish, food fats, wine, and alcohol 30%+) in December, and two (bread and sweets) in October. The lowest sales indexes were observed mostly in February. The interest in four topics that have been analyzed ("Diet," "Dietitian," "Weight loss," and "Gym"), was highest in January, while interest in "Dietary supplements" was high in February, and "Running" in May. The search volume of the Google topics were the lowest in December.

CONCLUSION

The purchase of food, drinks, and cigarettes, and the interest in information regarding different components of a healthy lifestyle has seasonal variation. New Year and Lent might be good periods to encourage healthy behavior. The motivation may decrease in summer and during Christmas.

Physical Activity for Lent: Changes in and Associations Between Religiosity, Enjoyment, Motivation, and Physical Activity

Purpose: Given the unequal distribution of physical activity (PA) opportunities across middle schools, alternative options for promoting it should be explored. Faith-based schools are positioned to offer religious-themed PA interventions, yet few have been reported. We replicated previous research by investigating the effects of the Physical Activity for Lent (PAL) program on change in step count (ΔPA) and its associations with religiosity, enjoyment, and motivation (four subscales). Method: Over the 6-week Lenten season, three Catholic middle schools' students (n = 128) participated in a randomly allocated controlled crossover trial of a pedometer-based virtual journey that followed Jesus's life path. We used the Reliable Change Index (RCI), general linear mixed models, and logistic regression to identify changes (pre- to post-Lent) in the independent variables, and their association with ΔPA overall and of being in the highest ΔPA tertile. Results: Between 11.6% (religiosity) and 34.7% (external regulation) of participants' scores changed. School (School 3 > Schools 1 and 2 by ~2,400 steps/day, p < .001) and grade (6th grade > 7th and 8th grades by ~2,500 steps/day, p < .001) - but not religiosity, enjoyment, or motivation - were significant predictors of ΔPA. As RCI for intrinsic motivation and identified regulation increased, students were more (OR = 2.49) and less (OR = 0.74) likely, respectively, to be in the high ΔPA tertile. Conclusion: Desirable ΔPA was situational (i.e., school, grade) and highest ΔPA tertile was associated with autonomous motivation. Faith-based PA interventions may need to include additional components to realize even greater gains.