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Mclaughlin M, Duff J, Campbell E, McKenzie T, Davies L, Wolfenden L, Wiggers J, Sutherland R. Process Evaluation of a Scaled-Up School-Based Physical Activity Program for Adolescents: Physical Activity 4 Everyone. J Phys Act Health 2024; 21:741-755. [PMID: 38849120 DOI: 10.1123/jpah.2024-0038] [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: 01/15/2024] [Revised: 03/12/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Physical Activity 4 Everyone (PA4E1) is a whole-school physical activity program, with demonstrated efficacy (2012-2014). PA4E1 was adapted (scaled-up) and tested in a scale-up trial (2017-2020). This process evaluation study of the scale-up trial had 2 aims. First, to describe the acceptability, appropriateness, and feasibility of PA4E1 in the scale-up trial, from the perspective of school staff involved in the program management and delivery. Second, to generate themes that may explain school staff assessments of acceptability, appropriateness, and feasibility. METHODS Data were collected at various time points throughout the 2-year implementation phase. Online surveys were collected from In-School Champions, Head Physical Education teachers, Principals, and Physical Education teachers (quantitative data). Focus groups and interviews were conducted with In-School Champions, Principals, and Physical Education teachers (qualitative data). Existing published data on website engagement, adaptations, modifications, and the scale-up trial primary outcome (implementation of physical activity practices) were triangulated with the quantitative and qualitative during analysis, to generate themes. RESULTS School staff delivering PA4E1 reported it was highly acceptable, appropriate, and feasible. Seven themes were generated relating to acceptability, appropriateness, and feasibility. The themes related to how the program was funded, the delivery modes of implementation support, the identification of easy-wins, the recruitment of the right in-school champion, facilitating principal buy-in, mitigating the impact of school staff turnover, and engaging the whole school. CONCLUSIONS Recommendations are made to inform future adaptations for PA4E1 and potentially school-based physical activity programs more generally. The findings may inform future scalability assessments of the suitability of programs for scale-up.
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Affiliation(s)
- Matthew Mclaughlin
- Center for Child Health Research, University of Western Australia, Nedlands, WA, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Center for Health Behavior, University of Newcastle, Callaghan, NSW, Australia
| | - Jed Duff
- School of Nursing Faculty of Health, Queensland University of Technology, Brisbane City, QLD, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Center for Health Behavior, University of Newcastle, Callaghan, NSW, Australia
| | - Tom McKenzie
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Center for Health Behavior, University of Newcastle, Callaghan, NSW, Australia
| | - Lynda Davies
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Center for Health Behavior, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Center for Health Behavior, University of Newcastle, Callaghan, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Center for Health Behavior, University of Newcastle, Callaghan, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Center for Health Behavior, University of Newcastle, Callaghan, NSW, Australia
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García-Álvarez D, Sempere-Rubio N, Faubel YR. Evaluaciones económicas en promoción de la actividad física: una revisión sistemática. Glob Health Promot 2024:17579759241245413. [PMID: 39086317 DOI: 10.1177/17579759241245413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- David García-Álvarez
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Núria Sempere-Rubio
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Y Raquel Faubel
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
- Unidad de Investigación Conjunta en Ingeniería Biomédica, IIS La Fe-Universitat Politècnica de València, Valencia, España
- PTinMOTION, Fisioterapia en movimiento, Grupo de Investigación Multiespecialidad, Departamento de Fisioterapia, Universitat de València, Valencia, España
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Spiga F, Tomlinson E, Davies AL, Moore TH, Dawson S, Breheny K, Savović J, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 12 to 18 years old. Cochrane Database Syst Rev 2024; 5:CD015330. [PMID: 38763518 PMCID: PMC11102824 DOI: 10.1002/14651858.cd015330.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect. AUTHORS' CONCLUSIONS The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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van der Wurff I, Kirschner M, Golsteijn R, de Jonge M, Berendsen B, Singh A, Savelberg H, de Groot R. School-based physical activity interventions: which intervention characteristics are associated with participation and retention? A meta-analysis. Prev Med 2024; 182:107925. [PMID: 38437923 DOI: 10.1016/j.ypmed.2024.107925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Many school-based intervention studies are conducted to increase students' physical activity (PA). Recruitment and retention problems potentially impact the robustness of RCT findings. We conducted a meta-analysis to summarize recruitment and retention rates in long-term secondary school-based PA intervention studies and examined associated participant and intervention characteristics. METHODS Web of Science, Pubmed, Medline, and PsychInfo were searched until March 20th 2023. We included studies on secondary school-based PA interventions ≥12 weeks, aimed at typically developing adolescents. We abstracted number of schools and students invited, randomized, and participating at follow-up to calculate pooled recruitment and retention rates; participant and intervention characteristics were abstracted to execute subgroup or meta-regression analyses. RESULTS Recruitment rates were 51% for invited schools and 80% for invited students, the retention for schools was almost 100% and for students 91%. Interventions with fixed and flexible components, executed in Asia and South America, and from later publication years had higher student recruitment rates. Students' retention rates were lower for interventions which had flexible components, were theory/model-based, used an accelerometer, had a longer intervention duration, and included more females. CONCLUSION Recruitment and retention rates in school-based PA interventions are high. Some participant and intervention characteristics influence these rates: flexibility of the intervention, theory/model-based intervention, accelerometer use, intervention duration, continent, and number of females. Researchers should consider these characteristics in intervention development to achieve optimal balance between intervention effectiveness, recruitment, and retention.
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Affiliation(s)
- I van der Wurff
- Health Psychology, Faculty of Psychology, Open Univerity of the Netherlands, Heerlen 6419 AT, the Netherlands.
| | - M Kirschner
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, Heerlen 6419 AT, the Netherlands
| | - R Golsteijn
- Health Psychology, Faculty of Psychology, Open Univerity of the Netherlands, Heerlen 6419 AT, the Netherlands
| | - M de Jonge
- (Former Employee of) Mulier Institute, Herculesplein 269, Utrecht 3584 AA, the Netherlands
| | - B Berendsen
- Department of Nutritional and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht 6200 MD, the Netherlands
| | - A Singh
- (Former Employee of) Mulier Institute, Herculesplein 269, Utrecht 3584 AA, the Netherlands; Human Movement. School and Sport, Applied University of Windesheim, Zwolle, the Netherlands
| | - H Savelberg
- Department of Nutritional and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, Maastricht 6200 MD, the Netherlands; SHE, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - R de Groot
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, Heerlen 6419 AT, the Netherlands
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Lin G, Werner K, Alqunaiebet A, Hamza MM, Alkanhal N, Alsukait RF, Alruwaily A, Rakic S, Cetinkaya V, Herbst CH, Lin TK. The cost-effectiveness of school-based interventions for chronic diseases: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:26. [PMID: 38605333 PMCID: PMC11008027 DOI: 10.1186/s12962-024-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions. METHODS We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French. RESULTS Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%). CONCLUSION Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.
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Affiliation(s)
- George Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Kalin Werner
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | - Mariam M Hamza
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Norah Alkanhal
- Saudi Public Health Authority, Riyadh, KSA, Saudi Arabia
| | - Reem F Alsukait
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Severin Rakic
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Volkan Cetinkaya
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA.
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Contardo Ayala AM, Parker K, Mazzoli E, Lander N, Ridgers ND, Timperio A, Lubans DR, Abbott G, Koorts H, Salmon J. Effectiveness of Intervention Strategies to Increase Adolescents' Physical Activity and Reduce Sedentary Time in Secondary School Settings, Including Factors Related to Implementation: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:25. [PMID: 38472550 DOI: 10.1186/s40798-024-00688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness. OBJECTIVE The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation. METHODS Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained. RESULTS Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles. CONCLUSION While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained. REGISTRATION PROSPERO (CRD42020169988).
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Affiliation(s)
- Ana María Contardo Ayala
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
| | - Kate Parker
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Emiliano Mazzoli
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Nicola D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, , Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Newcastle, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Hunter Medical Research institute, New Lambton Heights, NSW, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Brandes M, Brandes B, Sell L, Sacheck JM, Chinapaw M, Lubans DR, Woll A, Schipperijn J, Jago R, Busse H. How to select interventions for promoting physical activity in schools? Combining preferences of stakeholders and scientists. Int J Behav Nutr Phys Act 2023; 20:48. [PMID: 37098620 PMCID: PMC10127415 DOI: 10.1186/s12966-023-01452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/12/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The failure to scale-up and implement physical activity (PA) interventions in real world contexts, which were previously successful under controlled conditions, may be attributed to the different criteria of stakeholders and scientists in the selection process of available interventions. Therefore, the aim of our study was to investigate and compare the criteria applied by local stakeholders and scientists for selecting amongst suitable school-based PA interventions for implementation. METHODS We conducted a three-round repeated survey Delphi study with local stakeholders (n = 7; Bremen, Germany) and international scientific PA experts (n = 6). Independently for both panels, two rounds were utilized to develop a list of criteria and the definitions of criteria, followed by a prioritization of the criteria in the third round. For each panel, a narrative analysis was used to rank-order unique criteria, list the number of scorers for the unique criteria and synthesize criteria into overarching categories. RESULTS The stakeholders developed a list of 53 unique criteria, synthesized into 11 categories with top-ranked criteria being 'free of costs', 'longevity' and 'integration into everyday school life'. The scientists listed 35 unique criteria, synthesized into 7 categories with the top-ranked criteria being 'efficacy', 'potential for reach' and 'feasibility'. The top ranked unique criteria in the stakeholder panel were distributed over many categories, whereas four out of the top six criteria in the scientist panel were related to 'evidence'. CONCLUSIONS Although stakeholders and scientists identified similar criteria, major differences were disclosed in the prioritization of the criteria. We recommend an early collaboration of stakeholders and scientists in the design, implementation, and evaluation of PA interventions.
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Affiliation(s)
- Mirko Brandes
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Berit Brandes
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Louisa Sell
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jennifer M Sacheck
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA
| | - Mai Chinapaw
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - David R Lubans
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Alexander Woll
- Institute of Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Heide Busse
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
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Omorou AY, Manneville F, Achit H, Langlois J, Legrand K, Lecomte E, Briançon S. Economic evaluation of a school-based strategy to prevent overweight and obesity in French adolescents: insights from the PRALIMAP randomised trial. Public Health 2023; 215:75-82. [PMID: 36645962 DOI: 10.1016/j.puhe.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This study aimed to provide cost-effectiveness and budget impact analyses of a school-based overweight/obesity screening and care prevention strategy among adolescents. STUDY DESIGN Cost-effectiveness and budget impact analyses. METHODS Data from 3538 adolescents who participated in a school-based randomised controlled trial in the Northeast of France were used. Costs (from a public payer's perspective) included screening for overweight and obesity and subsequent care. Effectiveness was measured as the change in body mass index (kilogram per square metre), prevalence of overweight/obesity, moderate physical activity energy expenditure, duration and frequency and total sitting time. The incremental cost-effectiveness ratio was calculated, and a budget impact analysis was conducted. RESULTS The screening and care strategy resulted in an incremental cost-effectiveness ratio of €1634.48 per averted case of overweight/obesity and €255.43 per body mass index unit decrease. The costs for increasing moderate physical activity by 1000 metabolic equivalent of task-min/week, duration by 60 min/week and frequency 1 day/week were €165.28, €39.21 and €93.66 per adolescent, respectively. Decreasing total sitting time by 60 min/week had a cost of €8.49 per adolescent. The cost of implementing the strategy nationally was estimated to be €50.1 million with a payback period from 3.6 to 7.3 years. CONCLUSIONS The screening and care strategy could be an efficient way to prevent overweight and obesity among adolescents. Future studies should investigate how the current results could be achieved in schools with different settings and thus justify its relevance for overweight and obesity prevention to policy-makers.
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Affiliation(s)
- A Y Omorou
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France; Université de Lorraine, APEMAC, F-54000, Nancy, France
| | - F Manneville
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France; Université de Lorraine, APEMAC, F-54000, Nancy, France.
| | - H Achit
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France
| | - J Langlois
- National Conservatory of Arts and Crafts (CNAM), Nancy, France
| | - K Legrand
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France
| | - E Lecomte
- National Conservatory of Arts and Crafts (CNAM), Nancy, France
| | - S Briançon
- Université de Lorraine, APEMAC, F-54000, Nancy, France
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9
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Jurczuk M, Thakar R, Carroll FE, Phillips L, van der Meulen J, Gurol-Urganci I, Sevdalis N. Design and management considerations for control groups in hybrid effectiveness-implementation trials: Narrative review & case studies. FRONTIERS IN HEALTH SERVICES 2023; 3:1059015. [PMID: 36926502 PMCID: PMC10012616 DOI: 10.3389/frhs.2023.1059015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 03/12/2023]
Abstract
Hybrid effectiveness-implementation studies allow researchers to combine study of a clinical intervention's effectiveness with study of its implementation with the aim of accelerating the translation of evidence into practice. However, there currently exists limited guidance on how to design and manage such hybrid studies. This is particularly true for studies that include a comparison/control arm that, by design, receives less implementation support than the intervention arm. Lack of such guidance can present a challenge for researchers both in setting up but also in effectively managing participating sites in such trials. This paper uses a narrative review of the literature (Phase 1 of the research) and comparative case study of three studies (Phase 2 of the research) to identify common themes related to study design and management. Based on these, we comment and reflect on: (1) the balance that needs to be struck between fidelity to the study design and tailoring to emerging requests from participating sites as part of the research process, and (2) the modifications to the implementation strategies being evaluated. Hybrid trial teams should carefully consider the impact of design selection, trial management decisions, and any modifications to implementation processes and/or support on the delivery of a controlled evaluation. The rationale for these choices should be systematically reported to fill the gap in the literature.
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Affiliation(s)
- Magdalena Jurczuk
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Ranee Thakar
- Obstetrics & Gynaecology, Croydon University Hospitals NHS Trust, London, United Kingdom
| | - Fran E Carroll
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom
| | - Lizzie Phillips
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Maternity Services, University Hospital Plymouth NHS Trust, Plymouth, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ipek Gurol-Urganci
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
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10
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Ryan M, Alliott O, Ikeda E, Luan J, Hofmann R, van Sluijs E. Features of effective staff training programmes within school-based interventions targeting student activity behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2022; 19:125. [PMID: 36153617 PMCID: PMC9509574 DOI: 10.1186/s12966-022-01361-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluations of school-based activity behaviour interventions suggest limited effectiveness on students' device-measured outcomes. Teacher-led implementation is common but the training provided is poorly understood and may affect implementation and student outcomes. We systematically reviewed staff training delivered within interventions and explored if specific features are associated with intervention fidelity and student activity behaviour outcomes. METHODS We searched seven databases (January 2015-May 2020) for randomised controlled trials of teacher-led school-based activity behaviour interventions reporting on teacher fidelity and/or students' device-measured activity behaviour. Pilot, feasibility and small-scale trials were excluded. Study authors were contacted if staff training was not described using all items from the Template for Intervention Description and Replication reporting guideline. Training programmes were coded using the Behaviour Change Technique (BCT) Taxonomy v1. The Effective Public Health Practice Project tool was used for quality assessment. Promise ratios were used to explore associations between BCTs and fidelity outcomes (e.g. % of intended sessions delivered). Differences between fidelity outcomes and other training features were explored using chi-square and Wilcoxon rank-sum tests. Random-effects meta-regressions were performed to explore associations between training features and changes in students' activity behaviour. RESULTS We identified 68 articles reporting on 53 eligible training programmes and found evidence that 37 unique teacher-targeted BCTs have been used (mean per programme = 5.1 BCTs; standard deviation = 3.2). The only frequently identified BCTs were 'Instruction on how to perform the behaviour' (identified in 98.1% of programmes) and 'Social support (unspecified)' (50.9%). We found moderate/high fidelity studies were significantly more likely to include shorter (≤6 months) and theory-informed programmes than low fidelity studies, and 19 BCTs were independently associated with moderate/high fidelity outcomes. Programmes that used more BCTs (estimated increase per additional BCT, d: 0.18; 95% CI: 0.05, 0.31) and BCTs 'Action planning' (1.40; 0.70, 2.10) and 'Feedback on the behaviour' (1.19; 0.36, 2.02) were independently associated with positive physical activity outcomes (N = 15). No training features associated with sedentary behaviour were identified (N = 11). CONCLUSIONS Few evidence-based BCTs have been used to promote sustained behaviour change amongst teachers in school-based activity behaviour interventions. Our findings provide insights into why interventions may be failing to effect student outcomes. TRIAL REGISTRATION PROSPERO registration number: CRD42020180624.
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Affiliation(s)
- Mairead Ryan
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Olivia Alliott
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Erika Ikeda
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Riikka Hofmann
- Faculty of Education, University of Cambridge, Cambridge, UK
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11
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Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme. BMJ Open 2022. [PMCID: PMC9362792 DOI: 10.1136/bmjopen-2021-052611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents. Design A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted. Participants A hypothetical cohort of 100 adolescents with a mean age of 13 years. Interventions An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling. Outcome measure Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained. Results The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane. Conclusions The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting. Trail registration number ISRCTN74109264.
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12
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Brown V, Tran H, Williams J, Laws R, Moodie M. Exploring the economics of public health intervention scale-up: a case study of the Supporting Healthy Image, Nutrition and Exercise (SHINE) cluster randomised controlled trial. BMC Public Health 2022; 22:1338. [PMID: 35836222 PMCID: PMC9281014 DOI: 10.1186/s12889-022-13754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The costs and benefits of an intervention within the intervention testing phase may differ from those experienced when that intervention is implemented and delivered at scale. Yet limited empirical work has been undertaken to explore how economic constructs related to implementation and scale-up might have an impact on intervention cost. The aim of this study was to explore the potential economic impacts of implementation and scale-up on a healthy weight and body image intervention tested in a Type II translational research trial. METHODS The Supporting Healthy Image, Nutrition and Exercise (SHINE) study is a cluster randomised controlled trial, aiming to deliver universal education about healthy nutrition, physical activity and wellbeing behaviours to adolescents in Australian secondary schools. Data on the cost of the intervention were collected alongside the trial using standard micro-costing techniques. Semi-structured interviews were conducted with key intervention stakeholders to explore the potential economic impacts of implementation and scale-up. Thematic content analysis was undertaken by two authors. RESULTS Fifteen intervention group schools participated in the 8-week online intervention targeting students in 2019 (99 Grade 7 classes; 2,240 students). Booster sessions were delivered during one class session in Grades 8 and 9, in 2020 and 2021 respectively. Time costs of intervention delivery and co-ordination comprised the majority (90%) of intervention cost as per the trial, along with costs associated with travel for intervention training and equipment. Themes related to the benefit of the intervention emerged from interviews with six intervention stakeholders, including the potential for economies of scale afforded by online delivery. Contextual themes that may have an impact on intervention implementation and scale included acceptability across all school sectors, availability and reliability of IT infrastructure for intervention delivery and variations in population characteristics. A number of key alterations to the intervention program emerged as important in supporting and sustaining intervention scale-up. In addition, significant implementation costs were identified if the intervention was to be successfully implemented at scale. CONCLUSIONS The findings from this study provide important information relevant to decisions on progression to a Type III implementation trial, including budget allocation, and will inform modelled economic evaluation.
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Affiliation(s)
- Vicki Brown
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia.
| | - Huong Tran
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia
| | - Joanne Williams
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Rachel Laws
- Deakin University, Geelong, Institute for Physical Activity and Nutrition, Victoria, 3220, Australia
| | - Marj Moodie
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia
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13
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Lane C, Nathan N, Reeves P, Sutherland R, Wolfenden L, Shoesmith A, Hall A. Economic evaluation of a multi-strategy intervention that improves school-based physical activity policy implementation. Implement Sci 2022; 17:40. [PMID: 35765018 PMCID: PMC9238093 DOI: 10.1186/s13012-022-01215-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, government policies mandating schools to provide students with opportunities to participate in physical activity are poorly implemented. The multi-component Physically Active Children in Education (PACE) intervention effectively assists schools to implement one such policy. We evaluated the value of investment by health service providers tasked with intervention delivery, and explored where adaptations might be targeted to reduce program costs for scale-up. METHODS A prospective trial-based economic evaluation of an implementation intervention in 61 primary schools in New South Wales (NSW), Australia. Schools were randomised to the PACE intervention or a wait-list control. PACE strategies included centralised technical assistance, ongoing consultation, principal's mandated change, identifying and preparing in-school champions, educational outreach visits, and provision of educational materials and equipment. Effectiveness was measured as the mean weekly minutes of physical activity implemented by classroom teachers, recorded in a daily log book at baseline and 12-month follow-up. Delivery costs (reported in $AUD, 2018) were evaluated from a public finance perspective. Cost data were used to calculate: total intervention cost, cost per strategy and incremental cost (overall across all schools and as an average per school). Incremental cost-effectiveness ratios (ICERs) were calculated as the incremental cost of delivering PACE divided by the estimated intervention effect. RESULTS PACE cost the health service provider a total of $35,692 (95% uncertainty interval [UI] $32,411, $38,331) to deliver; an average cost per school of $1151 (95%UI $1046, $1236). Training in-school champions was the largest contributor: $19,437 total; $627 ($0 to $648) average per school. Educational outreach was the second largest contributor: $4992 total; $161 ($0 to $528) average per school. The ICER was $29 (95%UI $17, $64) for every additional minute of weekly physical activity implemented per school. CONCLUSION PACE is a potentially cost-effective intervention for increasing schools implementation of a policy mandate. The investment required by the health service provider makes use of existing funding and infrastructure; the additional cost to assist schools to implement the policy is likely not that much. PACE strategies may be adapted to substantially improve delivery costs. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12617001265369; Prospectively registered 1st September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373520.
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Affiliation(s)
- Cassandra Lane
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia. .,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia
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14
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Cummings C, Crochiere R, Lansing AH, Patel R, Stanger C. A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial. JMIR Pediatr Parent 2022; 5:e32420. [PMID: 35343903 PMCID: PMC9002597 DOI: 10.2196/32420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increase program efficacy; however, such programs have not yet been tested with adolescents with overweight and obesity. OBJECTIVE This study aims to examine the feasibility and acceptability of a 12-week, incentive-based, mobile health physical activity program with text-based health coaching, goal setting, and self-monitoring for adolescents with overweight or obesity. Program adherence and changes in tracked physical activity (ie, steps and active minutes while wearing a Fitbit [Google LLC]), body mass, and body fat are assessed. METHODS A total of 28 adolescents aged 13 to 18 years with a BMI ≥90th percentile participated in the program. Of the 28 participants, 2 (7%) were lost to follow-up; thus, data from 26 (93%) participants were used in analyses. RESULTS Participant-reported acceptability was high, with all mean ratings of text-based coaching, Fitbit use, and the overall program being >5 on a 7-point scale. In addition, 85% (23/26) of participants reported that they would like to continue to wear the Fitbit. Program adherence was also high, as participants wore the Fitbit on 91.1% (SD 12.6%) of days on average and met their weekly goals for an average of 7 (SD 3.5) of 11 possible weeks. There were no demographic (ie, sex, age, and baseline body mass) differences in the percentage of days participants wore their Fitbit. Across the 12-week study, there were significant improvements in tracked daily active minutes (P=.006) and steps (P<.001) and significant pre- to posttest improvements in body fat percentage (P=.04). CONCLUSIONS The pilot program improved adolescent physical activity and physical health. A larger factorial design trial with adaptive daily goals may clarify the role of each program component in driving physical activity.
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Affiliation(s)
- Caroline Cummings
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Rebecca Crochiere
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Amy Hughes Lansing
- Department of Psychological Science, University of Vermont, Burlington, VT, United States
| | - Riya Patel
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Catherine Stanger
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
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15
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Onyimadu O, Violato M, Astbury NM, Jebb SA, Petrou S. Health Economic Aspects of Childhood Excess Weight: A Structured Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:461. [PMID: 35455505 PMCID: PMC9028108 DOI: 10.3390/children9040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK;
| | - Nerys M. Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
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16
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Jago R, Tibbitts B, Willis K, Sanderson E, Kandiyali R, Reid T, MacNeill S, Kipping R, Campbell R, Sebire SJ, Hollingworth W. Peer-led physical activity intervention for girls aged 13 to 14 years: PLAN-A cluster RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/zjqw2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing physical activity among girls is a public health priority. Peers play a central role in influencing adolescent behaviour. Peer-led interventions may increase physical activity in adolescent girls, and a feasibility trial had shown that PLAN-A (Peer-led physical Activity iNtervention for Adolescent girls) had evidence of promise to increase physical activity in adolescent girls.
Objective
The objective was to test whether or not PLAN-A can increase adolescent girls’ physical activity, relative to usual practice, and be cost-effective.
Design
This was a two-arm, cluster-randomised controlled trial, including an economic evaluation and a process evaluation.
Participants
State-funded secondary schools in the UK with girls in Year 9 (aged 13–14 years) participated in the trial. All Year 9 girls in participating schools were eligible.
Randomisation
Schools were the unit of allocation. They were randomised by an independent statistician, who was blinded to school identities, to the control or intervention arm, stratified by region and the England Index of Multiple Deprivation score.
Intervention
The intervention comprised peer nomination (i.e. identification of influential girls), train the trainers (i.e. training the instructors who delivered the intervention), peer supporter training (i.e. training the peer-nominated girls in techniques and strategies underpinned by motivational theory to support peer physical activity increases) and a 10-week diffusion period.
Outcomes
The primary outcome was accelerometer-assessed mean weekday minutes of moderate to vigorous physical activity among Year 9 girls. The follow-up measures were conducted 5–6 months after the 10-week intervention, when the girls were in Year 10 (which was also 12 months after the baseline measures). Analysis used a multivariable, mixed-effects, linear regression model on an intention-to-treat basis. Secondary outcomes included weekend moderate to vigorous physical activity, and weekday and weekend sedentary time. Intervention delivery costs were calculated for the economic evaluation.
Results
A total of 33 schools were approached; 20 schools and 1558 pupils consented. Pupils in the intervention arm had higher Index of Multiple Deprivation scores than pupils in the control arm. The numbers randomised were as follows: 10 schools (n = 758 pupils) were randomised to the intervention arm and 10 schools (n = 800 pupils) were randomised to the control arm. For analysis, a total of 1219 pupils provided valid weekday accelerometer data at both time points (intervention, n = 602; control, n = 617). The mean weekday moderate to vigorous physical activity was similar between groups at follow-up. The central estimate of time spent engaging in moderate to vigorous physical activity was 2.84 minutes lower in the intervention arm than in the control arm, after adjustment for baseline mean weekday moderate to vigorous physical activity, the number of valid days of data and the stratification variables; however, this difference was not statistically significant (95% confidence interval –5.94 to 0.25; p = 0.071). There were no between-arm differences in the secondary outcomes. The intervention costs ranged from £20.85 to £48.86 per pupil, with an average cost of £31.16.
Harms
None.
Limitations
The trial was limited to south-west England.
Conclusions
There was no evidence that PLAN-A increased physical activity in Year 9 girls compared with usual practice and, consequently, it was not cost-effective.
Future work
Future work should evaluate the utility of whole-school approaches to promote physical activity in schools.
Trial registration
This trial is registered as ISRCTN14539759.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 6. See the NIHR Journals Library website for further project information. This trial was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a United Kingdom Clinical Research Commission (UKCRC)-registered Clinical Trials Unit that, as part of the Bristol Trials Centre, is in receipt of NIHR Clinical Trials Unit support funding. The sponsor of this trial was University of Bristol, Research and Enterprise Development www.bristol.ac.uk/red/. The costs of delivering the intervention were funded by Sport England.
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Affiliation(s)
- Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Byron Tibbitts
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Kathryn Willis
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Emily Sanderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Rebecca Kandiyali
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tom Reid
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Stephanie MacNeill
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Ruth Kipping
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Simon J Sebire
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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17
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Asif I, Thornton JS, Carek S, Miles C, Nayak M, Novak M, Stovak M, Zaremski JL, Drezner J. Exercise medicine and physical activity promotion: core curricula for US medical schools, residencies and sports medicine fellowships: developed by the American Medical Society for Sports Medicine and endorsed by the Canadian Academy of Sport and Exercise Medicine. Br J Sports Med 2022; 56:369-375. [PMID: 35012931 DOI: 10.1136/bjsports-2021-104819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/04/2022]
Abstract
Regular physical activity provides a variety of health benefits and is proven to treat and prevent several non-communicable diseases. Specifically, physical activity enhances muscular and osseous strength, improves cardiorespiratory fitness, and reduces the risk of hypertension, coronary heart disease, stroke, type 2 diabetes, mental health disorders, cognitive decline and several cancers. Despite these well-known benefits, physical activity promotion in clinical practice is underused due to insufficient training during medical education. Medical trainees in the USA receive relatively few hours of instruction in sports and exercise medicine (SEM). One reason for this shortage of instruction is a lack of curricular resources at each level of medical education. To address this need, the American Medical Society for Sports Medicine (AMSSM) assembled a group of SEM experts to develop curricular guidance for exercise medicine and physical activity promotion at the medical school, residency and sports medicine fellowship levels of training. After an evidence review of existing curricular examples, we performed a modified Delphi process to create curricula for medical students, residents and sports medicine fellows. Three training level-specific curricula emerged, each containing Domains, General Learning Areas, and Specific Learning Areas; options for additional training and suggestions for assessment and evaluation were also provided. Review and comment on the initial curricula were conducted by three groups: a second set of experts in exercise medicine and physical activity promotion, sports medicine fellowship directors representing a variety of fellowship settings and the AMSSM Board of Directors. The final curricula for each training level were prepared based on input from the review groups. We believe enhanced medical education will enable clinicians to better integrate exercise medicine and physical activity promotion in their clinical practice and result in healthier, more physically active patients.
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Affiliation(s)
- Irfan Asif
- Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane S Thornton
- Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Stephen Carek
- University of South Carolina School of Medicine Greenville Campus, Greenville, South Carolina, USA
| | - Christopher Miles
- Family Medicine and Sports Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Melissa Nayak
- Orthopaedics, Henry Ford Health System, Sterling Heights, Michigan, USA
| | - Melissa Novak
- Family Medicine, Howard Hughes Medical Institute-Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Mark Stovak
- Department of Family and Community Medicine, University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - Jason L Zaremski
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Jonathan Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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18
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Gelius PC, Sommer RM, Abu-Omar K, Schätzlein V, Suhrcke M. Toward the economic evaluation of participatory approaches in health promotion: lessons from four German physical activity promotion projects. Health Promot Int 2021; 36:ii79-ii92. [PMID: 34905608 PMCID: PMC8670626 DOI: 10.1093/heapro/daab158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Health promotion increasingly employs participatory approaches, but the question arises whether the likely higher costs of participation also translate into greater benefits. This article takes a first step toward a full health economic evaluation by comprehensively reporting the costs of a specific participatory approach, Cooperative Planning, in a German research consortium to promote physical activity. We conducted a costing analysis of Cooperative Planning at 22 sites across six settings. Project teams used a custom template to record resource use. We calculated average costs per meeting, site and setting using the opportunity costs approach, and obtained feedback from participating researchers. A total of 144 planning meetings with an average of nine participants were conducted. Costs per meeting varied significantly across settings. Differences were mostly attributable to varying meeting duration, preparation time and numbers of participants. Across settings, human resources accounted for roughly 95% of the costs. Implementing researchers reported challenges regarding the logic and methods of the health economic analysis. A participatory approach to physical activity promotion may cause substantially varying costs in different settings despite similar cost structures. However, their value for money could turn out comparably favorable if (and only if) the expected benefits is indeed forthcoming. Despite some challenges implementing the costing exercise into the logistics of ongoing participatory projects, this analysis may pave the way toward a full health economic evaluation, and the template may be useful to future participatory health promotion projects.
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Affiliation(s)
- Peter C Gelius
- Department for Sports Science and Sport, Friedrich-Alexander University of Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany
| | - Raluca M Sommer
- Department for Sports Science and Sport, Friedrich-Alexander University of Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany
| | - Karim Abu-Omar
- Department for Sports Science and Sport, Friedrich-Alexander University of Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany
| | - Valentin Schätzlein
- Department for Sports Science and Sport, Friedrich-Alexander University of Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany
| | - Marc Suhrcke
- Centre for Health Economics (CHE), University of York, Heslington, York, YO10 5DD, UK
- Luxembourg Institute of Socio-Economic Research (LISER), Maison des Sciences Humaines, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
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19
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Ekwaru JP, Ohinmaa A, Dabravolskaj J, Maximova K, Veugelers PJ. Cost-effectiveness and return on investment of school-based health promotion programmes for chronic disease prevention. Eur J Public Health 2021; 31:1183-1189. [PMID: 34355754 PMCID: PMC8643402 DOI: 10.1093/eurpub/ckab130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND While school-based health prevention programmes are effective in addressing unhealthy diet and physical inactivity, little is known about their economic implications. We conducted an economic evaluation of the programmes that were previously identified as feasible, acceptable, and sustainable in the Canadian context. METHODS This study builds on a meta-analysis of the effectiveness of feasible, acceptable, and sustainable school-based health promotion programmes. A micro-simulation model incorporated intervention effects on multiple risk factors to estimate incremental cost-effectiveness and return on investment (ROI) of comprehensive school health (CSH), multicomponent, and physical education (PE) curriculum modification programmes. Cost-effectiveness was expressed as the programme costs below which the programme would be cost-effective at a CA$50 000 threshold level. RESULTS The estimated costs below which interventions were cost-effective per quality-adjusted life year gained were CA$682, CA$444, and CA$416 per student for CSH, multicomponent, and PE curriculum modification programmes, respectively. CSH programmes remained cost-effective per year of chronic disease prevented for costs of up to CA$3384 per student, compared to CA$1911 and CA$1987 for multicomponent and PE curriculum modification interventions, respectively. If the interventions were implemented at total discounted intervention costs of CA$100 per student, ROI through the avoidance of direct healthcare costs related to the treatment and management of chronic diseases would be 824% for CSH, 465% for multicomponent interventions, and 484% for PE curriculum modification interventions. CONCLUSIONS Whereas each examined intervention types showed favourable economic benefits, CSH programmes appeared to be the most cost-effective and to have the highest ROI.
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Affiliation(s)
- John P Ekwaru
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Katerina Maximova
- School of Public Health, University of Alberta, Edmonton, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, Canada
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20
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Mclaughlin M, Campbell E, Sutherland R, McKenzie T, Davies L, Wiggers J, Wolfenden L. Extent, Type and Reasons for Adaptation and Modification When Scaling-Up an Effective Physical Activity Program: Physical Activity 4 Everyone (PA4E1). FRONTIERS IN HEALTH SERVICES 2021; 1:719194. [PMID: 37007208 PMCID: PMC10062321 DOI: 10.3389/frhs.2021.719194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 06/03/2023]
Abstract
Background: Few studies have described the extent, type and reasons for making changes to a program prior to and during its delivery using a consistent taxonomy. Physical Activity 4 Everyone (PA4E1) is a secondary school physical activity program that was scaled-up for delivery to a greater number of schools. We aimed to describe the extent, type and reasons for changes to the PA4E1 program (the evidence-based physical activity practices, implementation support strategies and evaluation methods) made before its delivery at scale (adaptations) and during its delivery in a scale-up trial (modifications). Methods: The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) was used to describe adaptations (planned and made prior to the scale-up trial) and modifications (made during the conduct of the trial). A list of adaptations was generated from a comparison of the efficacy and scale-up trials via published PA4E1 protocols, trial registrations and information provided by trial investigators. Monthly trial team meetings tracked and coded modifications in "real-time" during the conduct of the scale-up trial. The extent, type and reasons for both adaptations and modifications were summarized descriptively. Results: In total, 20 adaptations and 20 modifications were identified, these were to physical activity practices (n = 8; n = 3), implementation support strategies (n = 6; n = 16) and evaluation methods (n = 6, n = 1), respectively. Few adaptations were "fidelity inconsistent" (n = 2), made "unsystematically" (n = 1) and proposed to have a "negative" impact on the effectiveness of the program (n = 1). Reasons for the adaptations varied. Of the 20 modifications, all were "fidelity consistent" and the majority were made "proactively" (n = 12), though most were "unsystematic" (n = 18). Fifteen of the modifications were thought to have a "positive" impact on program effectiveness. The main reason for modification was the "available resources" (n = 14) of the PA4E1 Implementation Team. Conclusions: Adaptations and modifications to public health programs are common. Modifications have the potential to impact the implementation and effectiveness of programs. Our findings underscore the importance of comprehensive reporting of the extent, type and reasons for modifications as part of process evaluations, as this data may be important to the interpretation of trial findings. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870, Identifier ACTRN12617000681358.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Tom McKenzie
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Lynda Davies
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
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21
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Diaz-Castro J, Garcia-Vega JE, Ochoa JJ, Puche-Juarez M, Toledano JM, Moreno-Fernandez J. Implementation of a Physical Activity Program Protocol in Schoolchildren: Effects on the Endocrine Adipose Tissue and Cognitive Functions. Front Nutr 2021; 8:761213. [PMID: 34746212 PMCID: PMC8568884 DOI: 10.3389/fnut.2021.761213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022] Open
Abstract
Practicing exercise is one of the best strategies to promote well-being and quality of life, however physical activity in schoolchildren and adolescents is developed in an unpredictable, intermittent way and in short periods. There are relatively few intervention studies investigating the role of physical activity in schoolchildren endocrine function of adipose tissue and cognitive function. One hundred and three boys, divided into two groups: control (n = 51, did not perform additional physical activity) and exercise (n = 52, performed vigorous physical activity after the regular school classes). The exercise group, developed a 6 months physical activity protocol delivered by the physical education teacher during the second semester of the academic course (6 months). Body composition measurements, adherence to the Mediterranean diet, nutritional intake, hematological and biochemical parameters, endocrine function of the adipose tissue and biomarkers of brain molecular function were assessed at enrolment and after 6 months of intervention. No statistically significant differences between both groups were found for age, height and bone mass. Weight and BMI was lower in the exercise group compared to the control group, increasing lean mass and reducing fat mass. 58.68% of children in the exercise group showed high adherence to the Mediterranean Diet compared to 46.32% of the control group. The exercise group was more concerned about their diet consumed more fiber, vitamin B1, B2, B6, B12, D, Niacin, Folic acid, Fe, Zn, Se and Cu. Triglycerides levels and HDL-cholesterol were higher in the exercise group at the end of the study. Leptin, MCP-1, lipocalin-2, adipsin and PAI-1 levels were lower in the exercise group at the end of the exercise protocol. In contrast, adiponectin and osteocrin markedly increased in the exercise group. Moreover, marked increases were recorded in healthy brain state biomarkers (NGF, BDNF, and irisin) in the exercise group, which could have a positive impact on academic performance. Taken together, all the findings reported are consistent with many benefits of the exercise protocol on adipose tissue and brain molecular function, demonstrating the usefulness of early interventions based on physical activity in children to reduce risk factors related to sedentary lifestyle.
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Affiliation(s)
- Javier Diaz-Castro
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - Jose Eulogio Garcia-Vega
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, Granada, Spain.,Nutrition and Food Sciences Ph.D. Program, University of Granada, Granada, Spain
| | - Julio J Ochoa
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, Granada, Spain
| | - María Puche-Juarez
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, Granada, Spain
| | - Juan M Toledano
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, Granada, Spain
| | - Jorge Moreno-Fernandez
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, Granada, Spain
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22
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Sutherland R, Campbell E, McLaughlin M, Nathan N, Wolfenden L, Lubans DR, Morgan PJ, Gillham K, Oldmeadow C, Searles A, Reeves P, Williams M, Evans N, Bailey A, Boyer J, Lecathelinais C, Davies L, McKenzie T, Robertson K, Wiggers J. Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 24-month implementation and cost outcomes from a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:137. [PMID: 34688281 PMCID: PMC8542325 DOI: 10.1186/s12966-021-01206-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Physical Activity 4 Everyone (PA4E1) is an evidence-based program effective at increasing adolescent physical activity (PA) and improving weight status. This study aimed to determine a) the effectiveness of an adapted implementation intervention to scale-up PA4E1 at 24-month follow-up, b) fidelity and reach, and c) the cost and cost-effectiveness of the implementation support intervention. Methods A cluster randomised controlled trial using a type III hybrid implementation-effectiveness design in 49 lower socio-economic secondary schools, randomised to a program (n = 24) or control group (n = 25). An adapted implementation intervention consisting of seven strategies was developed to support schools to implement PA4E1 over 24-months. The primary outcome was the proportion of schools implementing at least four of the 7 PA practices, assessed via computer assisted telephone interviews (CATI) with Head Physical Education Teachers. Secondary outcomes included the mean number of PA practices implemented, fidelity and reach, cost and cost-effectiveness. Logistic regression models assessed program effects. Results At baseline, no schools implemented four of the 7 PA practices. At 24-months, significantly more schools in the program group (16/23, 69.6%) implemented at least four of the 7 PA practices than the control group (0/25, 0%) (p < 0.001). At 24-months, program schools were implementing an average of 3.6 more practices than control schools (4.1 (1.7) vs. 0.5 (0.8), respectively) (P < 0.001). Fidelity and reach of the implementation intervention were high (> 75%). The total cost of the program was $415,112 AUD (2018) ($17,296 per school; $117.30 per student). Conclusions The adapted implementation intervention provides policy makers and researchers with an effective and potentially cost-effective model for scaling-up the delivery of PA4E1 in secondary schools. Further assessment of sustainability is warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01206-8.
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Matthew McLaughlin
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. .,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - David R Lubans
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Philip J Morgan
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Karen Gillham
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Chris Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Mandy Williams
- South Western Sydney Local Health District, Locked Mail Bag, 7279, BC1871, Liverpool, NSW, Australia
| | - Nicole Evans
- Central Coast Local Health District, 4-6 Watt Street, Gosford, NSW, 2250, Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, P.O. Box 126, Port Macquarie, NSW, Australia
| | - James Boyer
- New South Wales Department of Education, School Sports Unit, Level 3, 1 Oxford Street, Darlinghurst, NSW, 2010, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Lynda Davies
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Tom McKenzie
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Katie Robertson
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - John Wiggers
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
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23
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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: 55] [Impact Index Per Article: 18.3] [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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Zanganeh M, Adab P, Li B, Pallan M, Liu WJ, Hemming K, Lin R, Liu W, Martin J, Cheng KK, Frew E. Cost-Effectiveness of a School-and Family-Based Childhood Obesity Prevention Programme in China: The "CHIRPY DRAGON" Cluster-Randomised Controlled Trial. Int J Public Health 2021; 66:1604025. [PMID: 34531712 PMCID: PMC8439195 DOI: 10.3389/ijph.2021.1604025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/04/2021] [Indexed: 01/22/2023] Open
Abstract
Objectives: Rapid socioeconomic and nutrition transitions in Chinese populations have contributed to the growth in childhood obesity. This study presents a cost-effectiveness analysis of a school- and family-based childhood obesity prevention programme in China. Methods: A trial-based economic evaluation assessed cost-effectiveness at 12 months. Forty schools with 1,641 children were randomised to either receive the multi-component (diet and physical activity) intervention or to continue with usual activities. Both public sector and societal perspectives were adopted. Costs and benefits in the form of quality-adjusted life years (QALYs) were compared and uncertainty was assessed using established UK and US thresholds. Results: The intervention cost was 35.53 Yuan (£7.04/US$10.01) per child from a public sector perspective and 536.95 Yuan (£106/US$151) from a societal perspective. The incremental cost-effectiveness ratio (ICER) was 272.7 Yuan (£54/US$77)/BMI z-score change. The ICER was 8,888 Yuan (£1,760/US$2,502) and 73,831 Yuan (£14,620/US$20,796) per QALY from a public sector and societal perspective, respectively and was cost-effective using UK (£20,000) and US (US$50,000) per QALY thresholds. Conclusion: A multi-component school-based prevention programme is a cost-effective means of preventing childhood obesity in China.
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Affiliation(s)
- Mandana Zanganeh
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peymane Adab
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Bai Li
- School for Public Studies, University of Bristol, Bristol, United Kingdom
| | - Miranda Pallan
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Wei Jia Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Karla Hemming
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rong Lin
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Wei Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - James Martin
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kar Keung Cheng
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Frew
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Cost-effectiveness of physical activity intervention in children - results based on the Physical Activity and Nutrition in Children (PANIC) study. Int J Behav Nutr Phys Act 2021; 18:116. [PMID: 34488794 PMCID: PMC8419957 DOI: 10.1186/s12966-021-01181-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background We assessed the cost-effectiveness of a 2-year physical activity (PA) intervention combining family-based PA counselling and after-school exercise clubs in primary-school children compared to no intervention from an extended service payer’s perspective. Methods The participants included 506 children (245 girls, 261 boys) allocated to an intervention group (306 children, 60 %) and a control group (200 children, 40 %). The children and their parents in the intervention group had six PA counselling visits, and the children also had the opportunity to participate in after-school exercise clubs. The control group received verbal and written advice on health-improving PA at baseline. A change in total PA over two years was used as the outcome measure. Intervention costs included those related to the family-based PA counselling, the after-school exercise clubs, and the parents’ taking time off to travel to and participate in the counselling. The cost-effectiveness analyses were performed using the intention-to-treat principle. The costs per increased PA hour (incremental cost-effectiveness ratio, ICER) were based on net monetary benefit (NMB) regression adjusted for baseline PA and background variables. The results are presented with NMB and cost-effectiveness acceptability curves. Results Over two years, total PA increased on average by 108 h in the intervention group (95 % confidence interval [CI] from 95 to 121, p < 0.001) and decreased by 65.5 h (95 % CI from 81.7 to 48.3, p < 0.001) in the control group, the difference being 173.7 h. the incremental effectiveness was 87 (173/2) hours. For two years, the intervention costs were €619 without parents’ time use costs and €860 with these costs. The costs per increased PA hour were €6.21 without and €8.62 with these costs. The willingness to pay required for 95 % probability of cost-effectiveness was €14 and €19 with these costs. The sensitivity analyses revealed that the ICER without assuming this linear change in PA were €3.10 and €4.31. Conclusions The PA intervention would be cost-effective compared to no intervention among children if the service payer’s willingness-to-pay for a 1-hour increase in PA is €8.62 with parents’ time costs. Trial registration ClinicalTrials.gov: NCT01803776. Registered 4 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=01803776&cntry=&state=&city=&dist=. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01181-0.
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McManus K, Temples H. Obesity in Adolescents: Prevention and Treatment to Change Their Future. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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van Sluijs EMF, Brown HE, Coombes E, Hughes C, Jones AP, Morton KL, Guagliano JM. An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.
Objectives
To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.
Design
The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.
Setting
Norfolk/Suffolk counties, UK.
Participants
Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.
Interventions
The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.
Main outcome measures
Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.
Data sources review
Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).
Review methods
Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.
Inclusion criteria
Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.
Results
The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.
Limitations
Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.
Conclusions
This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.
Future work
Further refinements to intervention delivery and recruitment methods should be investigated.
Study registration
Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Esther MF van Sluijs
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Helen E Brown
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma Coombes
- Norwich Medical School and Centre for Diet and Activity Research (CEDAR), University of East Anglia, Norwich, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Andrew P Jones
- Norwich Medical School and Centre for Diet and Activity Research (CEDAR), University of East Anglia, Norwich, UK
| | - Katie L Morton
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Justin M Guagliano
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Mclaughlin M, Duff J, McKenzie T, Campbell E, Sutherland R, Wiggers J, Wolfenden L. Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study. JMIR Pediatr Parent 2021; 4:e26690. [PMID: 34309565 PMCID: PMC8367175 DOI: 10.2196/26690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. OBJECTIVE The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. METHODS The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the "following a thread" approach. RESULTS For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. CONCLUSIONS Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Jed Duff
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Australia
| | - Tom McKenzie
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
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Woods CB, Volf K, Kelly L, Casey B, Gelius P, Messing S, Forberger S, Lakerveld J, Zukowska J, Bengoechea EG. The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:263-276. [PMID: 33482424 PMCID: PMC8167338 DOI: 10.1016/j.jshs.2021.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Despite the well-established health benefits of physical activity (PA) for young people (aged 4-19 years), most do not meet PA guidelines. Policies that support PA in schools may be promising, but their impact on PA behavior is poorly understood. The aim of this systematic review was to ascertain the level and type of evidence reported in the international scientific literature for policies within the school setting that contribute directly or indirectly to increasing PA. METHODS This systematic review is compliant with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Six databases were searched using key concepts of policy, school, evaluation, and PA. Following title and abstract screening of 2323 studies, 25 progressed to data synthesis. Methodological quality was assessed using standardized tools, and the strength of the evidence of policy impact was described based on pre-determined codes: positive, negative, inconclusive, or untested statistically. RESULTS Evidence emerged for 9 policy areas that had a direct or indirect effect on PA within the school setting. These were whole school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks/recess, physical environment, shared use agreements, active school transport, and surveillance. The bulk of the evidence was significantly positive (54%), 27% was inconclusive, 9% was significantly negative, and 11% was untested (due to rounding, some numbers add to 99% or 101%). Frequency of evidence was highest in the primary setting (41%), 34% in the secondary setting, and 24% in primary/secondary combined school settings. By policy area, frequency of evidence was highest for sport/extracurricular PA (35%), 17% for physical education, and 12% for whole school PA policy, with evidence for shared use agreements between schools and local communities rarely reported (2%). Comparing relative strength of evidence, the evidence for shared use agreements, though sparse, was 100% positive, while 60% of the evidence for whole school PA policy, 59% of the evidence for sport/extracurricular PA, 57% of the evidence for physical education, 50% of the evidence for PA in classroom, and 50% of the evidence for active breaks/recess were positive. CONCLUSION The current evidence base supports the effectiveness of PA policy actions within the school setting but cautions against a "one-size-fits-all" approach and emphasizes the need to examine policy implementation to maximize translation into practice. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed.
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Affiliation(s)
- Catherine B Woods
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland.
| | - Kevin Volf
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Bláthín Casey
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Peter Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen 91058, Germany
| | - Sven Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen 91058, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen 28359, Germany
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam 1081 HV, the Netherlands; Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam 1081 HV, the Netherlands
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk 80-213, Poland
| | - Enrique García Bengoechea
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
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Kennedy SG, Leahy AA, Smith JJ, Eather N, Hillman CH, Morgan PJ, Plotnikoff RC, Boyer J, Lubans DR. Process Evaluation of a School-Based High-Intensity Interval Training Program for Older Adolescents: The Burn 2 Learn Cluster Randomised Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E299. [PMID: 33339356 PMCID: PMC7765884 DOI: 10.3390/children7120299] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/28/2022]
Abstract
Process evaluations can help to optimise the implementation of school-based physical activity interventions. The purpose of this paper is to describe the process evaluation of a school-based high-intensity interval training (HIIT) program for older adolescent students, known as Burn 2 Learn (B2L). B2L was evaluated via a cluster randomised controlled trial in 20 secondary schools (10 intervention, 10 control) in New South Wales, Australia. Teachers (n = 22 (55% female)) from the 10 intervention schools, delivered the program over three phases (Phases 1 and 2, 6 months; Phase 3, 6 months) to older adolescent students (n = 337 (50% female); mean ± standard deviation (SD) age = 16.0 ± 0.4 years). Process evaluation data were collected across the 12-month study period. Teachers delivered 2.0 ± 0.8 and 1.7 ± 0.6 sessions/week in Phases 1 and 2 respectively (mean total 25.9 ± 5.2), but only 0.6 ± 0.7 sessions/week in Phase 3. Observational data showed that session quality was high, however heart rate (HR) data indicated that only half of the students reached the prescribed threshold of ≥85% predicted HRmax during sessions. Over 80% of teachers reported they intended to deliver the B2L program to future student cohorts. Almost 70% of students indicated they intended to participate in HIIT in the future. Teachers considered the program to be adaptable, and both students and teachers were satisfied with the intervention. B2L was implemented with moderate-to-high fidelity in Phases 1 and 2, but low in Phase 3. Our findings add to the relatively scant process evaluation literature focused on the delivery of school-based physical activity programs.
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Affiliation(s)
- Sarah G. Kennedy
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Angus A. Leahy
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Jordan J. Smith
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Narelle Eather
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Charles H. Hillman
- Department of Psychology, Northeastern University, Boston, MA 02115, USA;
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA 02115, USA
| | - Philip J. Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Ronald C. Plotnikoff
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - James Boyer
- New South Wales Department of Education, School Sport Unit, Sydney, NSW 2000, Australia;
| | - David R. Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
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Guagliano JM, Armitage SM, Brown HE, Coombes E, Fusco F, Hughes C, Jones AP, Morton KL, van Sluijs EMF. A whole family-based physical activity promotion intervention: findings from the families reporting every step to health (FRESH) pilot randomised controlled trial. Int J Behav Nutr Phys Act 2020; 17:120. [PMID: 32962724 PMCID: PMC7510101 DOI: 10.1186/s12966-020-01025-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a theory-based child-led family physical activity (PA) intervention delivered online. We also assessed the preliminary effectiveness of the intervention on outcomes of interest and whether pre-specified criteria were met to progress to a full-scale definitive trial. Methods In a three-armed randomised pilot trial, 41 families (with a 7–11-year-old index child) were allocated to a: ‘family’ (FAM), ‘pedometer-only’ (PED), or a no-treatment control (CON) arm. The FAM arm received access to the FRESH website, allowing participants to select step challenges to ‘travel’ to target cities around the world, log their steps, and track progress as families virtually globetrot. FAM and PED arms also received family sets of pedometers. All family members could participate in the evaluation. Physical (e.g., fitness, blood pressure), psychosocial (e.g., social support), behavioural (e.g., objectively-measured PA), and economic (e.g., expenditure for PA) data were collected at baseline, 8- and 52-weeks. Results At 8- and 52-weeks, 98 and 88% of families were retained, respectively. Most children liked participating in the study (> 90%) and thought it was fun (> 80%). Compared to the PED (45%) and CON (39%) arms, a higher percentage of children in the FAM (81%) arm reported doing more activities with their family. Adults agreed that FRESH encouraged their family do more PA and made their family more aware of the amount of PA they do. No notable between-group differences were found for childrens’ minutes in moderate-to-vigorous PA. Sizeable changes of 9.4 (95%CI: 0.4, 18.4) and 15.3 (95%CI: 6.0, 24.5) minutes in moderate-to-vigorous PA was found for adults in the FAM group compared to those in the PED or CON groups, respectively. No other notable differences were found. Conclusion This study demonstrates feasibility and acceptability of the FRESH intervention. All progression criteria were at least partially satisfied. However, we failed to recruit the target sample size and did not find a signal of effectiveness on PA particularly long-term or in children. Further refinements are required to progress to a full-scale trial. Trial registration This study was prospectively registered (ISRCTN12789422) on 16/03/2016.
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Affiliation(s)
- Justin M Guagliano
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.
| | - Sofie M Armitage
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Helen Elizabeth Brown
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Emma Coombes
- Norwich Medical School and Centre for Diet and Activity Research, University of East Anglia, Norwich, UK
| | - Francesco Fusco
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Andrew P Jones
- Norwich Medical School and Centre for Diet and Activity Research, University of East Anglia, Norwich, UK
| | - Katie L Morton
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
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Sutherland R, Campbell E, McLaughlin M, Nathan N, Wolfenden L, Lubans DR, Morgan PJ, Gillham K, Oldmeadow C, Searles A, Reeves P, Williams M, Kajons N, Bailey A, Boyer J, Lecathelinais C, Davies L, McKenzie T, Hollis J, Wiggers J. Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 12-month implementation outcomes from a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2020; 17:100. [PMID: 32771011 PMCID: PMC7414665 DOI: 10.1186/s12966-020-01000-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND 'Physical Activity 4 Everyone' (PA4E1) was an efficacious multi-component school-based physical activity (PA) program targeting adolescents. PA4E1 has seven PA practices. It is essential to scale-up, evaluate effectiveness and assess implementation of such programs. Therefore, the aim is to assess the impact of implementation support on school practice uptake of the PA4E1 program at 12 and 24 months. METHODS A cluster randomised controlled trial, utilising a type III hybrid implementation-effectiveness design, was conducted in 49 randomly selected disadvantaged Australian Government and Catholic secondary schools. A blinded statistician randomly allocated schools to a usual practice control (n = 25) or the PA4E1 program group (n = 24), with the latter receiving seven implementation support strategies to support school PA practice uptake of the seven practices retained from the efficacy trial. The primary outcome was the proportion of schools adopting at least four of the seven practices, assessed via telephone surveys with Head Physical Education Teachers and analysed using exact logistic regression modelling. This paper reports the 12-month outcomes. RESULTS Schools were recruited from May to November 2017. At baseline, no schools implemented four of the seven practices. At 12 months significantly more schools in the program group had implemented four of the seven practices (16/24, 66.7%) than the control group (1/25, 4%) (OR = 33.0[4.15-1556.4], p < 0.001). The program group implemented on average 3.2 (2.5-3.9) more practices than the control group (p < 0.001, mean 3.9 (SD 1.5) vs 0.7 (1.0)). Fidelity and reach of the implementation support intervention were high (both > 80%). CONCLUSIONS Through the application of multiple implementation support strategies, secondary schools were able to overcome commonly known barriers to implement evidence based school PA practices. As such practices have been shown to result in an increase in adolescent PA and improvements in weight status, policy makers and practitioners responsible for advocating PA in schools should consider this implementation approach more broadly when working with schools. Follow-up is required to determine whether practice implementation is sustained. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12th May 2017.
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Matthew McLaughlin
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - David R Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, NSW, Australia
| | - Philip J Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, NSW, Australia
| | - Karen Gillham
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Chris Oldmeadow
- Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Mandy Williams
- South Western Sydney Local Health District, Locked Mail Bag 7279, Liverpool BC, NSW, 1871, Australia
| | - Nicole Kajons
- Central Coast Local Health District, 4-6 Watt Street, Gosford, NSW, 2250, Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, P.O. Box 126, Port Macquarie, NSW, Australia
| | - James Boyer
- New South Wales Department of Education, School Sports Unit, Level 3, 1 Oxford Street, Darlinghurst, NSW, 2010, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Lynda Davies
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Tom McKenzie
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Jenna Hollis
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - John Wiggers
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
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Salam RA, Padhani ZA, Das JK, Shaikh AY, Hoodbhoy Z, Jeelani SM, Lassi ZS, Bhutta ZA. Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:E2208. [PMID: 32722112 PMCID: PMC7468898 DOI: 10.3390/nu12082208] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: -0.12; 95% CI: -0.18 to -0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: -0.41 kg/m2; 95% CI: -0.60 to -0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: -1.59; 95% CI: -2.95 to -0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: -0.07; 95% CI: -0.14 to -0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: -0.08; 95% CI: -0.16 to -0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: -0.13; 95% CI: -0.25 to -0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: -0.13; 95% CI: -0.20 to -0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: -0.88; 95% CI: -1.265 to -0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: -3.01; 95% CI: -5.56 to -0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: -0.08; 95% CI: -0.16 to -0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: -0.16; 95% CI: -0.26 to -0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: -0.09; 95% CI: -0.14 to -0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.
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Affiliation(s)
- Rehana A. Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Zahra A. Padhani
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Jai K. Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Amina Y. Shaikh
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Zahra Hoodbhoy
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (R.A.S.); (Z.A.P.); (J.K.D.); (A.Y.S.); (Z.H.)
| | - Sarah Masroor Jeelani
- Department of Trauma & Orthopaedics, Macclesfield District General Hospital, East Cheshire NHS Trust Victoria Rd, Macclesfield SK10 3BL, UK;
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Corder K, Sharp SJ, Jong ST, Foubister C, Brown HE, Wells EK, Armitage SM, Croxson CHD, Vignoles A, Wilkinson PO, Wilson ECF, van Sluijs EMF. Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial. PLoS Med 2020; 17:e1003210. [PMID: 32701954 PMCID: PMC7377379 DOI: 10.1371/journal.pmed.1003210] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school's social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents. METHODS AND FINDINGS Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] -1.91 minutes [-5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample. CONCLUSIONS In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational-setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale. TRIAL REGISTRATION ISRCTN Registry ISRCTN31583496.
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Affiliation(s)
- Kirsten Corder
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephen J. Sharp
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephanie T. Jong
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Campbell Foubister
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Helen Elizabeth Brown
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Emma K. Wells
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sofie M. Armitage
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Caroline H. D. Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Anna Vignoles
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Paul O. Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Edward C. F. Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Esther M. F. van Sluijs
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
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McHugh C, Hurst A, Bethel A, Lloyd J, Logan S, Wyatt K. The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review. Public Health 2020; 182:116-124. [PMID: 32259722 DOI: 10.1016/j.puhe.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/05/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effectiveness of interventions using the World Health Organization Health Promoting Schools (HPSs) framework approach in increasing physical activity (PA) and improving the diet of 11-18-year-olds. STUDY DESIGN A systematic review guided by the National Health Services Centre for Reviews and Dissemination framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. METHODS Nine databases and trial registries were searched from 2013 to 2018 for cluster randomised controlled trials involving adolescents' aged 11-18 years. We also included relevant studies from a 2014 Cochrane Review of HPS approach on health behaviours. Data were extracted from included studies and assessed for quality. RESULTS Twelve eligible studies were identified from seven countries. The studies varied in outcome measures, sample size, quality and duration of intervention and follow-up. Only four of the included studies were of high to moderate quality. We found some evidence of effectiveness for physical activity only interventions and limited evidence of effectiveness for nutrition only and combined PA and nutrition interventions. CONCLUSIONS There were no discernible patterns across the studies to suggest effective mechanisms for the HPS approach. The family/community component was poorly developed and superficially reported in all studies. Future research should seek to understand how best to work in partnership with secondary schools, to foster and sustain a healthy eating and physical activity culture, which aligns with their core aims. More attention should be paid to the restriction of unhealthy foods in the school environment.
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Affiliation(s)
- C McHugh
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - A Hurst
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - A Bethel
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - J Lloyd
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - S Logan
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
| | - K Wyatt
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, Devon EX1 2LU, UK.
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Stoner L, Beets MW, Brazendale K, Moore JB, Weaver RG. Exercise Dose and Weight Loss in Adolescents with Overweight-Obesity: A Meta-Regression. Sports Med 2020; 49:83-94. [PMID: 30560421 DOI: 10.1007/s40279-018-01040-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A recent meta-analysis reported that exercise interventions are effective for promoting weight loss in adolescents with overweight-obesity. However, the meta-analysis did not investigate whether there is an optimal exercise dose for promoting weight loss in overweight and obese adolescents. A common method of expressing exercise dose is the calculation of metabolic equivalents (METs), expressed as MET-h/week. OBJECTIVES The objective of this study was to determine the association between exercise dose (MET-h/week) and weight loss [body weight, body mass index (BMI)] in adolescents with overweight-obesity. DATA SOURCES Trials included in the original meta-analysis were extracted, and a subsequent search to identify studies published between May 2015 and May 2018 was conducted. The search included electronic databases (PubMed, Web of Science SPORTDiscus, Google Scholar) and the reference lists of eligible articles and relevant reviews. STUDY SELECTION The inclusion criteria were as follows: (i) randomized controlled trial; (ii) structured exercise intervention, alone or combined with other intervention components; (iii) control group received no structured exercise or behavioral modification designed to increase physical activity; (iv) participants overweight or obese (BMI ≥ 85th percentile); and (v) participants aged between 10 and 19 years. APPRAISAL AND SYNTHESIS METHODS Fifteen trials were extracted from the original meta-analysis. The current search identified an additional five trials (three articles). Data from 20 trials (16 articles) involving 1091 participants (54% female, 17% not reported) were included in the analysis. Effect sizes were reported as mean difference, and random effects meta-regression quantified the association between exercise dose and weight loss. Study quality was assessed using a modified Jadad's scale. RESULTS Total body weight change (decrease) ranged from - 2.7 to 19.3 (median 2.5) kg, and BMI change (decrease) ranged from - 1.6 to 6.3 (median 0.9) kg/m2. MET-h/week ranged from 5.4 to 36.0 (median 6.0). Each MET-h/week was associated with a 0.13 kg/m2 (95% confidence interval [CI] 0.08-0.19) and 0.33 kg (95% CI 0.08-0.59) decrease in BMI and body weight, respectively. LIMITATIONS The prescribed exercise dose for the majority of trials was low. As such, we were unable to discern whether there was an optimal exercise dose for weight loss (i.e., if the association between dose and weight loss was non-linear). Additionally, most trials had small sample sizes (median n = 34) and 17 trials had methodological limitations. CONCLUSIONS Each MET-h/week was associated with a 0.13 kg/m2 and 0.33 kg decrease in BMI and body weight, respectively. While this relationship appears to be linear, i.e., no optimal exercise dose, it should be emphasized that the exercise prescription dose for the majority of trials was low. Subsequent trials, with greater exercise dosage, are required to determine whether there is an 'optimal' dose for promoting weight loss in adolescents with overweight-obesity. However, the current findings lend support to the use of exercise prescription for promoting weight loss and improving health outcomes in this population.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Michael W Beets
- Department of Exercise Science, University of South Carolina, Columbia, SC, 29208, USA
| | - Keith Brazendale
- Department of Exercise Science, University of South Carolina, Columbia, SC, 29208, USA
| | - Justin B Moore
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R Glenn Weaver
- Department of Exercise Science, University of South Carolina, Columbia, SC, 29208, USA
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Mclaughlin M, Duff J, Sutherland R, Campbell E, Wolfenden L, Wiggers J. Protocol for a mixed methods process evaluation of a hybrid implementation-effectiveness trial of a scaled-up whole-school physical activity program for adolescents: Physical Activity 4 Everyone (PA4E1). Trials 2020; 21:268. [PMID: 32183902 PMCID: PMC7077014 DOI: 10.1186/s13063-020-4187-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background Physical Activity 4 Everyone (PA4E1) is a physical activity program for secondary schools located in low-socioeconomic areas. Over a 24-month period, schools in the program arm of a cluster randomised controlled trial (n = up to 38 schools) will receive a multi-component implementation support strategy to embed the seven school physical activity practices of the PA4E1 program. This article describes the process evaluation of the PA4E1 hybrid implementation-effectiveness trial. The process evaluation aims to describe the fidelity and reach of the implementation support strategies using quantitative data; and to describe the acceptability, appropriateness and feasibility of the implementation support strategies and physical activity practices to school stakeholders using mixed methods. Methods Quantitative and qualitative data will be collected from participants (Physical Education teachers, in-School Champions, students) in the program arm. Data collection will involve semi-structured interviews, focus groups, a fidelity monitoring log, a fidelity checklist, surveys, and routinely collected administrative and website data. Quantitative data will be analysed descriptively and qualitative data will be analysed thematically within and across data sets. Triangulation between data sources will be used to synthesise findings regarding the implementation and potential mechanisms of impact of PA4E1 on school physical activity practice adoption, with respect to context. Discussion Results of the process evaluation will facilitate the interpretation of the findings of the trial outcomes. It will comprehensively describe what was actually implemented and identify the potential contribution of the various components of the implementation support strategy to the school physical activity practice adoption outcomes. Findings will inform future improvement and scale-up of PA4E1 and approaches to implementing secondary school-based physical activity programs more broadly. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12 May 2017.
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Affiliation(s)
- Matthew Mclaughlin
- Hunter New England Population Health, Longworth Avenue, Wallsend, 2287, NSW, Australia. .,School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, 2305, NSW, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia.
| | - Jed Duff
- School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Longworth Avenue, Wallsend, 2287, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, 2305, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Longworth Avenue, Wallsend, 2287, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, 2305, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Longworth Avenue, Wallsend, 2287, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, 2305, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia
| | - John Wiggers
- Hunter New England Population Health, Longworth Avenue, Wallsend, 2287, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, 2305, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia
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38
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Beets MW, Weaver RG, Ioannidis JPA, Geraci M, Brazendale K, Decker L, Okely AD, Lubans D, van Sluijs E, Jago R, Turner-McGrievy G, Thrasher J, Li X, Milat AJ. Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:19. [PMID: 32046735 PMCID: PMC7014944 DOI: 10.1186/s12966-020-0918-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity. METHODS We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes. RESULTS A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively. CONCLUSIONS Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Marco Geraci
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Keith Brazendale
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lindsay Decker
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - David Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - Esther van Sluijs
- Centre for Diet and Activity Research & MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Russell Jago
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | | | - James Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Andrew J Milat
- New South Wales (NSW) Ministry of Health, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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Sebire SJ, Banfield K, Campbell R, Edwards MJ, Kipping R, Kadir B, Garfield K, Matthews J, Blair PS, Lyons RA, Hollingworth W, Jago R. A peer-led physical activity intervention in schools for adolescent girls: a feasibility RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background
Girls are less active than boys and few adolescent girls meet physical activity (PA) guidelines. Peers are an important influence on the views and behaviours of adolescent girls, yet many PA interventions involving peers use formal approaches that may not harness the power of peer groups. More informal peer-led PA interventions, which work within proximal peer groups, may hold promise for increasing girls’ PA.
Objectives
To examine the feasibility, evidence of promise and cost of the Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A), a peer-led PA intervention.
Design
Phase 1 comprised formative work and a pilot study conducted in one secondary school. Phase 2 was a feasibility study comprising a pilot randomised controlled trial in six secondary schools, including process and economic evaluations.
Setting
Six secondary schools in South Gloucestershire and Wiltshire, recruited from schools above the median local Pupil Premium (i.e. more deprived).
Participants
Year 8 girls (aged 12–13 years).
Intervention
Year 8 girls nominated other girls in their year who are likely to be influential (e.g. who they look up to, are good listeners); the 18% most nominated were invited to be peer supporters (PSs). PSs attended 2 consecutive days of training (plus a top-up day 5 weeks later) outside the school site, led by pairs of PS trainers, to increase their knowledge about PA and their capabilities and confidence to promote PA in their friendship group.
Main outcome measures
Measures focused on establishing evidence for feasibility and promise: recruitment and retention of Year 8 girls and PSs, data provision rates [accelerometer and questionnaire collected pre randomisation/beginning of Year 8 (T0), end of Year 8 (T1) and beginning of Year 9 (T2)], intervention acceptability, PS training attendance, intervention cost, and the between-arm difference in weekday minutes of moderate to vigorous PA (MVPA). A process evaluation was conducted.
Results
Six schools were recruited: four PLAN-A (n = 269) and two control (n = 158). In total, 94.7% of Year 8 girls participated. A total of 55 (17–24% of Year 8 girls) PSs were trained (attendance rate 91–100%). Five girls were trained as PS trainers. Questionnaire data provision exceeded 92% at all time points. Accelerometer return rates were > 85% and wear-time criteria were met by 83%, 71% and 62% of participants at T0, T1 and T2, respectively. Mean weekday MVPA did not differ between intervention arms at T1 (1.1 minutes, 95% CI –4.3 to 6.5 minutes) but did at T2 (6.1 minutes, 95% CI 1.4 to 10.8 minutes), favouring PLAN-A. The mean cost of intervention delivery was £2685 per school or £37 per Year 8 girl. Process evaluation identified good fidelity, engagement and enjoyment of the PS training and peer-support strategies. PSs needed more guidance on how to start conversations.
Limitations
Accelerometer data provision was lowest at T2, suggesting a need for strategies to increase compliance.
Conclusions
Informal peer-led intervention approaches, such as PLAN-A, hold promise as a means of promoting PA to adolescent girls.
Future work
A definitive randomised controlled trial of PLAN-A is warranted.
Trial registration
Current Controlled Trials ISRCTN12543546.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 16. See the NIHR Journals Library website for further project information. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. This study was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a UK CRC-registered clinical trials unit in receipt of NIHR clinical trials unit support funding. The intervention costs were jointly funded by South Gloucestershire Council and Wiltshire Council.
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Affiliation(s)
- Simon J Sebire
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Kathryn Banfield
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Rona Campbell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University, Cardiff, Wales
| | - Mark J Edwards
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Ruth Kipping
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bryar Kadir
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Kirsty Garfield
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Joe Matthews
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Peter S Blair
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Ronan A Lyons
- Farr Institute, Swansea University Medical School, Swansea, UK
| | - William Hollingworth
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Gc VS, Suhrcke M, Atkin AJ, van Sluijs E, Turner D. Cost-effectiveness of physical activity interventions in adolescents: model development and illustration using two exemplar interventions. BMJ Open 2019; 9:e027566. [PMID: 31427318 PMCID: PMC6701678 DOI: 10.1136/bmjopen-2018-027566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To develop a model to assess the long-term costs and health outcomes of physical activity interventions targeting adolescents. DESIGN A Markov cohort simulation model was constructed with the intention of being capable of estimating long-term costs and health impacts of changes in activity levels during adolescence. The model parameters were informed by published literature and the analysis took a National Health Service perspective over a lifetime horizon. Univariate and probabilistic sensitivity analyses were undertaken. SETTING School and community. PARTICIPANTS A hypothetical cohort of adolescents aged 16 years at baseline. INTERVENTIONS Two exemplar school-based: a comparatively simple, after-school intervention and a more complex multicomponent intervention compared with usual care. PRIMARY AND SECONDARY OUTCOME MEASURES Incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. RESULTS The model gave plausible estimates of the long-term effect of changes in physical activity. The use of two exemplar interventions suggests that the model could potentially be used to evaluate a number of different physical activity interventions in adolescents. The key model driver was the degree to which intervention effects were maintained over time. CONCLUSIONS The model developed here has the potential to assess long-term value for money of physical activity interventions in adolescents. The two applications of the model indicate that complex interventions may not necessarily be the ones considered the most cost-effective when longer-term costs and consequences are taken into account.
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Affiliation(s)
- Vijay S Gc
- Centre for Health Economics, University of York, York, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Andrew J Atkin
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
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Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 297] [Impact Index Per Article: 59.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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Canaway A, Frew E, Lancashire E, Pallan M, Hemming K, Adab P. Economic evaluation of a childhood obesity prevention programme for children: Results from the WAVES cluster randomised controlled trial conducted in schools. PLoS One 2019; 14:e0219500. [PMID: 31291330 PMCID: PMC6619792 DOI: 10.1371/journal.pone.0219500] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/21/2019] [Indexed: 01/22/2023] Open
Abstract
Background Childhood obesity is a serious public health challenge and schools have been identified as an ideal place to implement prevention interventions. The aim of this study was to measure the cost-effectiveness of a multi-faceted school-based obesity prevention intervention targeting children aged 6–7 years when compared to ‘usual activities’. Methods A cluster randomised controlled trial in 54 schools across the West Midlands (UK) was conducted. The 12-month intervention aimed to increase physical activity by 30 minutes per day and encourage healthy eating. Costs were captured from a public sector perspective and utility-based health related outcomes measured using the CHU-9D. Multiple imputation using chained equations was used to address missing data. The cost effectiveness was measured at 30 months from baseline using a hierarchical net-benefit regression framework, that controlled for clustering and prespecified covariates. Any uncertainty in the results was characterised using cost-effectiveness acceptability curves. Results At 30 months, the total adjusted incremental mean cost of the intervention was £155 (95% confidence interval [CI]: £139, £171), and the incremental mean QALYs gained was 0.006 (95% CI: -0.024, 0.036), per child. The incremental cost-effectiveness at 30 months was £26,815 per QALY and using a standard willingness to pay threshold of £30,000 per QALY, there was a 52% chance that the intervention was cost-effective. Conclusions The cost-effectiveness of the school-based WAVES intervention was subject to substantial uncertainty. We therefore recommend more research to explore obesity prevention within schools as part of a wider systems approach to obesity prevention. Trial registration This paper uses data collected by the WAVES trial: Controlled trials ISRCTN97000586 (registered May 2010).
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Affiliation(s)
- Alastair Canaway
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Sutherland R, Campbell E, Nathan N, Wolfenden L, Lubans DR, Morgan PJ, Gillham K, Oldmeadow C, Searles A, Reeves P, Williams M, Evans N, Bailey A, Morrison R, McLaughlin M, Wiggers J. A cluster randomised trial of an intervention to increase the implementation of physical activity practices in secondary schools: study protocol for scaling up the Physical Activity 4 Everyone (PA4E1) program. BMC Public Health 2019; 19:883. [PMID: 31272421 PMCID: PMC6610944 DOI: 10.1186/s12889-019-6965-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023] Open
Abstract
Background The implementation of interventions at-scale is required to maximise population health benefits. ‘Physical Activity 4 Everyone (PA4E1)’ was a multi-component school-based program targeting adolescents attending secondary schools in low socio-economic areas. An efficacy trial of the intervention demonstrated an increase in students’ mean minutes of moderate-to-vigorous physical activity (MVPA) per day and lower weight gain at low incremental cost. This study aims to assess the effectiveness and cost effectiveness of a multi-component implementation support intervention to improve implementation, at-scale, of the evidence based school physical activity (PA) practices of the PA4E1 program. Impact on student PA levels and adiposity will also be assessed, in addition to the cost of implementation. Methods A cluster randomised controlled trial, utilising an effectiveness-implementation hybrid design, will be conducted in up to 76 secondary schools located in lower socio-economic areas across four health districts in New South Wales (NSW), Australia. Schools will be randomly allocated to a usual practice control arm or a multi-component implementation support intervention to embed the seven school PA practices of the PA4E1 program. The implementation support intervention incorporates seven strategies including executive support, in-School Champion, teacher training, resources, prompts, audit and feedback and access to an external Support Officer. The primary trial outcome will be the proportion of schools meeting at least four of the seven physical activity practices of the program, assessed via surveys with Head Physical Education teachers at 12 and 24-months. Secondary outcomes will be assessed via a nested evaluation of student PA and adiposity at 12-months (Grade 8 students) and 24 months (Grade 9 students) undertaken in 30 schools (15 per group). Resource use associated with the implementation intervention will be measured prospectively. Linear mixed effects regression models will assess program effects on the primary outcome at each follow-up period. Discussion This study is one of few evidence-based multi-component PA programs scaled-up to a large number of secondary schools and evaluated via randomised controlled trial. The use of implementation science theoretical frameworks to implement the evidence-based program and the rigorous evaluation design are strengths of the study. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12th May 2017. Protocol Version 1. Electronic supplementary material The online version of this article (10.1186/s12889-019-6965-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - David R Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, NSW, Australia
| | - Philip J Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, NSW, Australia
| | - Karen Gillham
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Chris Oldmeadow
- Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Mandy Williams
- South Western Sydney Local Health District, Locked Mail Bag 7279, Liverpool BC, NSW, 1871, Australia
| | - Nicole Evans
- Central Coast Local Health District, 4-6 Watt Street, Gosford, NSW, 2250, Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, P.O. Box 126, Port Macquarie, NSW, Australia
| | - Ross Morrison
- New South Waled Department of Education, Schools Sports Unit, Level 3, 1 Oxford Street, Darlinghurst, NSW, 2010, Australia
| | - Matthew McLaughlin
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - John Wiggers
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
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Cost-Effectiveness of Improvements to the Built Environment Intended to Increase Physical Activity. J Phys Act Health 2019; 16:308-317. [PMID: 30982380 DOI: 10.1123/jpah.2018-0329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Improving sidewalks may encourage physical activity by providing safe, defined, and connected walking spaces. However, it is unknown if reduced health care expenditures assumed by increased physical activity offset the investment for sidewalk improvements. Methods: This cost-effectiveness analysis of sidewalk improvements in Houston, TX, was among adults enrolled in the Houston Travel-Related Activity in Neighborhoods Study, 2013-2017 . The 1-year change in physical activity was measured using self-report (n = 430) and accelerometry (n = 228) and expressed in metabolic equivalent (MET) hours per year (MET·h·y-1). Cost-effectiveness ratios were calculated by comparing annualized sidewalk improvement costs (per person) with 1-year changes in physical activity. Results: The estimated cost-effectiveness ratio were $0.01 and -$0.46 per MET·h·y-1 for self-reported and accelerometer-derived physical activity, respectively. The cost-effectiveness benchmark was $0.18 (95% confidence interval, $0.06-$0.43) per MET·h·y-1 gained based on the volume of physical activity necessary to avoid health care costs. Conclusions: Improving sidewalks was cost-effective based on self-reported physical activity, but not cost-effective based on accelerometry. Study findings suggest that improving sidewalks may not be a sufficient catalyst for changing total physical activity; however, other benefits of making sidewalks more walkable should be considered when deciding to invest in sidewalk improvements.
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Reeves P, Edmunds K, Searles A, Wiggers J. Economic evaluations of public health implementation-interventions: a systematic review and guideline for practice. Public Health 2019; 169:101-113. [PMID: 30877961 DOI: 10.1016/j.puhe.2019.01.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/02/2019] [Accepted: 01/15/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Implementation interventions applied in public health are about using proven strategies to influence the uptake of evidence-based prevention and health promotion initiatives. The decision to invest in implementation has an opportunity cost, which can be overlooked. The purpose of this study was to assess the extent to which economic evaluations have been applied to implementation interventions in public health. STUDY DESIGN We conducted a systematic review of empirical studies examining the costs and consequences, cost-effectiveness or cost-benefit of strategies directed towards enhancing the implementation of public health interventions and policies in developed countries. METHODS The following databases were searched for English language publications reporting both effect measures and costs, from 1990 to current: MEDLINE, Embase, PsycINFO, CINAHL, EconLit, EPPI-Centre database of health promotion research, Cost-Effectiveness Analysis Registry, NHS Economic Evaluation Database, Informit and Scopus. RESULTS The search strategy returned 3229 records after duplicate removal, from which we included 14 economic evaluations. All the included evaluations were conducted and published after 2000. Twelve of the 14 evaluations were based on controlled trials and two reported hypothetical modelled scenarios. The methodologic rigour and compliance with reporting guidelines for economic evaluations was highly varied and not related to the publication date. CONCLUSIONS Our findings offer the first insight into the application and methodologic rigour of economic evaluations of implementation strategies supporting public health policies and interventions. To usefully inform public health policy and investment decisions, there needs to be greater application of economic evaluation to understand the cost-effectiveness of alternative implementation efforts. This review highlights the great paucity and mixed quality of the evidence on this topic and offers guidance by way of a checklist to improve the quality and reporting of future evaluations.
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Affiliation(s)
- P Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2305, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia.
| | - K Edmunds
- Hunter Medical Research Institute, Newcastle, New South Wales 2305, Australia
| | - A Searles
- Hunter Medical Research Institute, Newcastle, New South Wales 2305, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia
| | - J Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2305, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
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46
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Zanganeh M, Adab P, Li B, Frew E. A Systematic Review of Methods, Study Quality, and Results of Economic Evaluation for Childhood and Adolescent Obesity Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030485. [PMID: 30743995 PMCID: PMC6388206 DOI: 10.3390/ijerph16030485] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/24/2019] [Accepted: 02/03/2019] [Indexed: 12/20/2022]
Abstract
Many suggested policy interventions for childhood and adolescent obesity have costs and effects that fall outside the health care sector. These cross-sectorial costs and consequences have implications for how economic evaluation is applied and although previous systematic reviews have provided a summary of cost-effectiveness, very few have conducted a review of methods applied. We undertook this comprehensive review of economic evaluations, appraising the methods used, assessing the quality of the economic evaluations, and summarising cost-effectiveness. Nine electronic databases were searched for full-economic evaluation studies published between January 2001 and April 2017 with no language or country restrictions. 39 economic evaluation studies were reviewed and quality assessed. Almost all the studies were from Western countries and methods were found to vary by country, setting and type of intervention. The majority, particularly "behavioural and policy" preventive interventions, were cost-effective, even cost-saving. Only four interventions were not cost effective. This systematic review suggests that economic evaluation of obesity interventions is an expanding area of research. However, methodological heterogeneity makes evidence synthesis challenging. Whilst upstream interventions show promise, an expanded and consistent approach to evaluate cost-effectiveness is needed to capture health and non-health costs and consequences.
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Affiliation(s)
- Mandana Zanganeh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Peymane Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Emma Frew
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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47
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Sebire SJ, Jago R, Banfield K, Edwards MJ, Campbell R, Kipping R, Blair PS, Kadir B, Garfield K, Matthews J, Lyons RA, Hollingworth W. Results of a feasibility cluster randomised controlled trial of a peer-led school-based intervention to increase the physical activity of adolescent girls (PLAN-A). Int J Behav Nutr Phys Act 2018; 15:50. [PMID: 29880048 PMCID: PMC5992776 DOI: 10.1186/s12966-018-0682-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/20/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Most adolescent girls in the UK do not meet government physical activity recommendations and effective interventions are needed. This study reports the results of a feasibility trial of PLAN-A, a novel school-based peer-led physical activity intervention for adolescent girls. METHODS A two-arm cluster randomised controlled feasibility study was conducted in six English secondary schools (4 intervention & 2 control). Year 8 (age 12-13) girls were eligible and randomisation was at school-level. The intervention involved training Year 8 girls (out of school for two consecutive days, plus one top-up day 5 weeks later), who were identified by their peers as influential, to provide informal support to their friends to increase their physical activity. Feasibility of the intervention and the research was examined, including: recruitment, training attendance and data provision rates, evidence of promise of the intervention to affect weekday moderate-to-vigorous physical activity (MVPA), intervention cost and estimation of the sample size for a definitive trial. Accelerometer and questionnaire data were collected at the beginning of Year 8 (Time 0), the end of Year 8 (10-weeks after peer-supporter training) and the beginning of Year 9 (Time 2). RESULTS Four hundred twenty-seven girls were recruited (95% recruitment rate). 55 girls consented to be a peer-supporter and 53 peer-supporters were trained (97% of those invited). Accelerometer return rates exceeded 85% at each time point and wear time criteria was met by 83%, 71% and 62% participants at Time 0, 1 and 2 respectively. Questionnaire data were provided by >91% of participants at each time point. Complete-case adjusted linear regression analysis showed evidence of a 6.09 minute (95% CI = 1.43, 10.76) between-arms difference in weekday MVPA at Time 2 in favour of the intervention arm. On average PLAN-A cost £2685 per school to deliver (£37 per Year 8 girl). There were no adverse events. A trial involving 20 schools would be adequately powered to detect a between-arms difference in weekday MVPA of at least six minutes. CONCLUSIONS The PLAN-A intervention adopts a novel peer-led approach, is feasible, and shows evidence of promise to positively affect girls' physical activity levels. A definitive trial is warranted. TRIAL REGISTRATION ISCTRN, ISRCTN12543546, Registered on 28/7/2015, URL of registry record: http://www.isrctn.com/ISRCTN12543546.
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Affiliation(s)
- Simon J. Sebire
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kathryn Banfield
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Mark J. Edwards
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Rona Campbell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Bristol, UK
| | - Ruth Kipping
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Bristol, UK
| | - Peter S. Blair
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Bryar Kadir
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Kirsty Garfield
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Joe Matthews
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Ronan A. Lyons
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Bristol, UK
- Farr Institute, Swansea University Medical School, Swansea, UK
| | - William Hollingworth
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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48
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Williams WM, Yore MM, Whitt-Glover MC. Estimating physical activity trends among blacks in the United States through examination of four national surveys. AIMS Public Health 2018; 5:144-157. [PMID: 30094277 PMCID: PMC6079057 DOI: 10.3934/publichealth.2018.2.144] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/23/2018] [Indexed: 11/19/2022] Open
Abstract
Physical activity is essential for overall good health and aids in the prevention and reduction of many diseases. In 2008, the U.S. Department of Health and Human Services (DHHS) issued the Physical Activity Guidelines for Americans to foster appropriate levels of physical activity at various ages of development. Despite these guidelines and the known benefit to being physically active; physical activity levels are significantly lower in Blacks, contributing to higher prevalence of poor health outcomes. Therefore, the purpose of this paper was to look at four national datasets [Youth Risk Behavior Survey (YRBS), Behavioral Risk Factor Surveillance System (BRFSS), The National Health and Nutrition Examination Survey (NHANES), and National Health Interview Survey (NHIS)] to identify any patterns and trends that could be used to improve physical activity behavior within this population. These national datasets were used to estimate the proportion of Black adults and youth meeting national physical activity recommendations overall-stratified by age, gender and other demographic characteristics, to help identify patterns. The proportion of Black youth reporting regular physical activity ranged from 33% to 52%; and of Black adults, 27% to 52%. Physical activity was highest among men, younger age groups, highest education and income groups, and those who were employed or married. Trends were consistent across surveys. Among Black youth, physical activity decline with increasing grade level, and improvements over the past 10 years have been minimal. The percentage of Black adults achieving physical activity guidelines has improved slightly over the last ten years, but physical activity participation is still low and continues to decline with age. Trends identified from examining these national datasets can be used to inform development of physical activity interventions aimed at promoting and maintaining regular physical activity behavior among high risk subgroups across the life span.
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49
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Zanganeh M, Adab P, Li B, Frew E. Protocol for a systematic review of methods and cost-effectiveness findings of economic evaluations of obesity prevention and/or treatment interventions in children and adolescents. Syst Rev 2018; 7:54. [PMID: 29609652 PMCID: PMC5879570 DOI: 10.1186/s13643-018-0718-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Childhood obesity is a major global public health problem, with governments increasingly having to undertake various strategies to reduce excess weight in their populations. Considering the increasing number of well-conducted intervention studies in the field of childhood obesity prevention, there are relatively few published economic evaluations. The proposed systematic review will explore the methods of these economic evaluations, examine the limitations and establish the evidence base for cost-effectiveness analyses. METHODS/DESIGN Systematic review methodology will be applied to identify, select and extract data from published economic evaluation studies (trial-based, non-trial based, simulation-based, decision model and trial based model economic evaluations) of obesity prevention and/or treatment interventions in children and adolescents. A systematic literature search will be conducted using bibliographic databases (MEDLINE, EMBASE, CINAHL, Web of Science, EconLit, PsycINFO, Cochrane Library, Centre for Reviews and Dissemination (CRD) and Cost-Effectiveness Analysis (CEA) Registry). The review will only include full economic evaluations. There will be no restrictions based on language, perspective, follow-up duration, sample size, country or setting. To minimise selection bias, translation of non-English language articles will be undertaken. The quality of included studies will be assessed. Following data extraction, a narrative synthesis of the results from the included studies will be undertaken. Subgroup analysis will be considered where deemed appropriate. DISCUSSION The findings from this review, which will include primary studies, will provide evidence to assist health policy decision makers interpret economic evaluations in this field. In addition, we will identify gaps in the current literature to inform future-related research. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42017062236.
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Affiliation(s)
- Mandana Zanganeh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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50
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Abstract
Obesity in adolescence will probably have major implications not only for the affected adolescents but also for society. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Furthermore, obesity in adolescents is associated with a range of social problems, including difficulties securing an apprenticeship or a job or finding a partner. Adolescents with obesity are also at increased risk of having children with obesity later in life. All these consequences lead to high costs for the health-care system. Although efficient treatment options are available that have been proven in randomized controlled trials, such as lifestyle interventions for adolescents with obesity and bariatric surgery for adolescents with severe obesity, these interventions frequently fail in clinical practice as treatment adherence is low in adolescents and most adolescents with obesity do not seek medical care. Therefore, improving treatment adherence and identifying treatment barriers are necessary.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. Friedrich Steiner Street 5, Datteln 45711, Germany
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