The effect of sport for LIFE: all island in children from low socio-economic status: a clustered randomized controlled trial

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

CONTEXT

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

STUDY DESIGN

Systematic review with meta-analysis and meta-regression.

LEVEL OF EVIDENCE

Level 1.

METHODS

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

RESULTS

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

CONCLUSION

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

A qualitative study exploring the perceptions of health among pre-teen girls from disadvantaged communities in Dublin

There are disparities in health outcomes between youth from higher and lower socioeconomic backgrounds, and girls are especially vulnerable to changes in health-related behaviours as they develop. Therefore, this study explored how girls from disadvantaged communities in Dublin, Ireland, make sense of 'being healthy.' A phenomenological qualitative design was implemented. Three focus groups were conducted (n = 22, 10-12 years) and data were analysed using thematic analysis. Food and physical appearance featured prominently within the girls' definitions of health. Girls and their families from low-SES backgrounds may experience more difficulties with time scarcity as well as environmental barriers to a healthy lifestyle.

The Effectiveness of Fundamental Movement Skill Interventions on Moderate to Vigorous Physical Activity Levels in 5- to 11-Year-Old Children: A Systematic Review and Meta-Analysis

BACKGROUND

Fundamental movement skill (FMS) competence is associated with physical activity during childhood, with higher FMS competence associated with higher physical activity levels; however, the effectiveness of FMS interventions in primary school-aged children is not fully understood.

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of FMS interventions at improving daily levels of moderate to vigorous physical activity (MVPA) in 5- to 11-year-old children.

METHODS

Systematic searches were completed in eight electronic databases (MEDLINE, CINAHL, PubMed, Web of Science, SPORTDiscus, EMBASE, ERIC and Scopus). Studies were included if they were randomised or non-randomised controlled trials that implemented a physical activity intervention with an FMS component in 5- to 11-year-old children and included objectively measured daily levels of MVPA. Methodological quality was assessed using the Cochrane risk of bias tools for randomised and non-randomised controlled trials. Random effects meta-analysis was performed to determine the pooled intervention effect (mean difference) on minutes spent in MVPA with meta-regression for the use of an operationalised definition of FMS, in line with the criteria reported by Logan et al. RESULTS: A total of 19 studies were identified for review and 14 studies were eligible for meta-analysis. The pooled intervention effect was 4.3 min (95% confidence interval [CI] - 0.03 to 8.8) of MVPA per day. The percentage of future studies likely to find an effect greater than the minimal clinically important difference was 47% (95% CI 22-70). Studies that attempted to conceptualise and define FMS by combining at least one of Logan and colleagues' operational definitions with a measure of FMS had a positive effect on daily MVPA (13.3 min/day, 95% CI 8.0-18.6; R² = 0.89). Meta-regression for the three levels of criteria reported by Logan et al. showed a linear increase in MVPA, with studies using all three criteria experiencing the largest additive effect (15.7 min/day, 95% CI 8.9-22.6; R² = 0.89).

CONCLUSIONS

FMS interventions have the potential to increase daily levels of MVPA in 5- to 11-year-old children. However, future studies should concentrate on establishing an accurate conceptualisation of FMS and how FMS will be integrated within their intervention to further increase physical activity levels.

TRIAL REGISTRATION

Prospero registration number: CRD42017058718.

The Differential Impact of Screen Time on Children's Wellbeing

Increased screen time has been found to be associated with a number of negative health and wellbeing indicators in youth populations. An increasing number of studies have investigated the association between screen time and wellbeing in adolescents, but evidence in younger children is still emerging. This 2017 study explored the effect of leisure screen time and gender on dimensions of wellbeing (measured using KIDSCREEN-27) in a national sample of 897 Irish primary school children aged 8-12 years. Participants had a mean age of 10.9 ± 1.16 years and were 47.7% female. Just over 30% of the sample accumulated 2 h or more of leisure screen time daily. Results show that there was no significant interaction between screen time category (<2 h/2 h + daily) and gender on overall wellbeing, while controlling for BMI. Children who self-reported <2 h of leisure screen time scored significantly higher on four dimensions of wellbeing: physical, parental, peers, and school, but not psychological. This study supports the growing evidence of the impact that leisure screen time has on health. Further longitudinal research investigating the impact of sub-categories of leisure screen time behaviour on wellbeing is warranted.

Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the United Kingdom: a methodological systematic review

Background

Cluster randomised trials (CRTs) are increasingly used to evaluate non-pharmacological interventions for improving child health. Although methodological challenges of CRTs are well documented, the characteristics of school-based CRTs with pupil health outcomes have not been systematically described. Our objective was to describe methodological characteristics of these studies in the United Kingdom (UK).

Methods

MEDLINE was systematically searched from inception to 30^th June 2020. Included studies used the CRT design in schools and measured primary outcomes on pupils. Study characteristics were described using descriptive statistics.

Results

Of 3138 articles identified, 64 were included. CRTs with pupil health outcomes have been increasingly used in the UK school setting since the earliest included paper was published in 1993; 37 (58%) studies were published after 2010. Of the 44 studies that reported information, 93% included state-funded schools. Thirty six (56%) were exclusively in primary schools and 24 (38%) exclusively in secondary schools. Schools were randomised in 56 studies, classrooms in 6 studies, and year groups in 2 studies. Eighty percent of studies used restricted randomisation to balance cluster-level characteristics between trial arms, but few provided justification for their choice of balancing factors. Interventions covered 11 different health areas; 53 (83%) included components that were necessarily administered to entire clusters. The median (interquartile range) number of clusters and pupils recruited was 31.5 (21 to 50) and 1308 (604 to 3201), respectively. In half the studies, at least one cluster dropped out. Only 26 (41%) studies reported the intra-cluster correlation coefficient (ICC) of the primary outcome from the analysis; this was often markedly different to the assumed ICC in the sample size calculation. The median (range) ICC for school clusters was 0.028 (0.0005 to 0.21).

Conclusions

The increasing pool of school-based CRTs examining pupil health outcomes provides methodological knowledge and highlights design challenges. Data from these studies should be used to identify the best school-level characteristics for balancing the randomisation. Better information on the ICC of pupil health outcomes is required to aid the planning of future CRTs. Improved reporting of the recruitment process will help to identify barriers to obtaining representative samples of schools.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

PROSPERO, CRD42018086757.