Promotion of physical activity among high-school girls: a randomized controlled trial

Interventions to prevent obesity in children aged 12 to 18 years old

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.

School-based physical activity interventions: which intervention characteristics are associated with participation and retention? A meta-analysis

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.

The Influence of a Girls' Health and Well-Being Program on Body Image, Self-Esteem, and Physical Activity Enjoyment

Adolescent girls report low physical activity levels and poor body image and self-esteem. This study evaluated the impact of a girls' health intervention on body image, self-esteem, and physical activity enjoyment. The intervention was grounded in self-determination theory, resulting in lessons designed to promote autonomy, competence, and relatedness. The two primary components of the intervention included opportunities for girls to learn about resistance training as well as ways to improve their psychosocial health (i.e., body image, self-esteem, and physical activity enjoyment). Girls (n = 590), in the intervention (Mage = 12.79, SD = 0.69) and control group (Mage = 12.92, SD = 0.73), completed pre and post measures. A repeated measures MANOVA was conducted to assess changes in body image, self-esteem, and physical activity enjoyment. The intervention resulted in a significant increase in body esteem-appearance, F = 9.23, p = 0.003, and body esteem-weight, F = 4.77, p = 0.029, and a greater, non-significant, increase in self-esteem (3.22%), and physical activity enjoyment (4.01%) compared to the control group. This highlighted the use of the intervention for significant improvements in appearance and weight-related body image. The results support implementing psychosocial lessons, as well as physical activity, in health programming for girls.

The influence of social support, social affiliation and intrinsic motivation for increasing underserved youth's physical activity: A social climate-based intervention study

The purpose of this study was to investigate the influences of intrinsic motivation, social affiliation orientations and reciprocal social support for physical activity (PA) on underserved youths' afterschool period moderate-to-vigorous (MVPA) changing trajectories across the 16-week Connect through PLAY intervention, a social-motivational climate intervention. A total of 113 youth (61.06% African American, 56.64% girls) provided full data. Youths' intrinsic motivation, social affiliation orientations and social support were measured by youth responses to a set of surveys at baseline and post-intervention. Youths' afterschool period MVPA was measured using data from 7-day ActiGraph accelerometer wear at baseline, midpoint and post-intervention. Hierarchical linear modelling analysis found that youth daily afterschool period (3pm-6pm) MVPA increased, on average, 37.94 min across the 16-week intervention. Increases in intrinsic motivation, social affiliation orientations and social support were positive predictors of youth afterschool MVPA changing trajectory. The findings clarify the contributions that a social-motivational climate intervention can have on youth afterschool period MVPA through increasing youth intrinsic motivation, social affiliation and reciprocal social support.

Effects of Sports, Exercise Training, and Physical Activity in Children with Congenital Heart Disease-A Review of the Published Evidence

Children and adolescents with congenital heart disease (CHD) should be encouraged to adopt a physically active lifestyle, ideally by participating in sports activities at school and sports clubs. Children with complex CHD or other risk factors (for example, pacemakers, cardioverter-defibrillators, channelopathies) may, however, need specific individualized training programs. This review article summarizes the current knowledge regarding the clinical effects of sports and exercise training on CHD and its pathophysiologic mechanisms. An evidence-based approach based on a literature search, using PubMed, Medline, CINHAL, Embase, and the Cochrane Library was conducted, last completed on 30 December 2021. In studies with 3256 CHD patients in total, including 10 randomized controlled trials, 14 prospective interventional trials, 9 observational trials, and 2 surveys, exercise training has been shown to improve exercise capacity and physical activity, motoric skills, muscular function, and quality of life. Sports and exercise training appears to be effective and safe in CHD patients. Despite being cost-efficient, training programs are currently scarcely reimbursed; therefore, support from healthcare institutions, commissioners of healthcare, and research-funding institutions is desirable. There is a strong need to establish specialized rehabilitation programs for complex CHD patients to enhance these patients' access to this treatment intervention. Further studies may be desirable to confirm these data to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.

Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015-2021

BACKGROUND

Childhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0-18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised.

METHODS

An update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect.

FINDINGS

Meta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD -0·03, 95%CI -0·06,-0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6-12 years; 13-18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness.

INTERPRETATION

This updated synthesis of obesity prevention interventions for children aged 6-18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning.

FUNDING

This research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).

Influence of implementation strategies on implementation outcomes in a statewide dissemination of Faith, Activity, and Nutrition (FAN)

Faith-based organizations are promising settings for implementation science because they can reach populations bearing a disproportionate burden of chronic disease. This study examined how implementation strategies influenced implementation outcomes in Faith, Activity, and Nutrition (FAN) statewide dissemination. Ninety-three (9%) of 985 invited churches enrolled; 91 (98%) and 83 (89%) completed baseline and 12-month assessments. Community Health Advisors trained and provided phone technical assistance to church committees, led by a FAN coordinator. Church committees were charged with developing plans and installing healthy eating (HE) and physical activity (PA) policies, opportunities, messages and pastor support (implementation outcomes). Structural equation modeling examined how implementation strategies influenced implementation outcomes. Nearly all (99%) FAN coordinators and 60% of pastors attended training, 57% of committees submitted program plans and 51%/54% (HE/PA) of committees met 'every few months'. Statistically significant (P < 0.05) model paths showed positive influences of strategies on implementation outcomes: pastor training on HE and PA pastor support; plan completion on HE and PA messages, PA policies and opportunities as well as FAN committee meetings and committee meetings on HE pastor support, HE policies, PA opportunities and HE and PA messages. This study advances implementation science and provides a model applicable to organizations such as worksites and schools.

A Summary of One Research Team's Contributions to Understanding Physical Activity Behavior in Children and Youth

Schools are well-positioned to provide physical activity opportunities to help youth achieve the recommended 60 or more daily minutes of moderate-to-vigorous physical activity. The Children's Physical Activity Research Group (CPARG) at the University of South Carolina has focused on understanding physical activity in school-aged youth for 30+ years. The purpose of this article was to critically review (CPARG) contributions to the field in school settings and school-age youth. We reviewed 127 published CPARG articles from six research projects conducted between 1993-2019. The review was guided by questions in five categories: measurement of physical activity and its determinants, characteristics of physical activity behavior, correlates/determinants of physical activity, physical activity interventions, and race/ethnicity and physical activity. Results were summarized by question and synthesized across categories. CPARG contributions included assessing physical activity levels, patterns, forms, and contexts; identifying and measuring physical activity correlates/determinants; and conducting school-based physical activity interventions. Identifying multiple domains of physical activity determinants enables researchers and practitioners to select/design age-appropriate, valid, and reliable instruments to assess determinants. Focusing on determinants enables them to create effective physical activity interventions, environments, programs, and policies in schools. These efforts must address race/ethnicity differences, ensuring that measurement instruments and intervention strategies are culturally appropriate.

Do school characteristics, based on the Comprehensive School Health Framework, contribute to youth meeting national physical activity recommendations over time?

INTRODUCTION

Canadian youth are insufficiently active, and schools may play a role in promoting student physical activity (PA). Based on the Comprehensive School Health (CSH) framework, this study examined whether school characteristics are associated with secondary school students meeting national PA recommendations over time.

METHODS

We used COMPASS survey data from 78 schools in Ontario and Alberta and 9870 Grade 9 and 10 students attending those schools. Students who provided two years of linked PA data (2013/14 and 2015/16) and gender were included. Multilevel analysis was conducted by gender, evaluating the relationship of school-level characteristics (guided by CSH) with students achieving all three PA recommendations after two years (≥ 60 min/day of moderate-to-vigorous PA, vigorous PA ≥ 3 days/week, strengthening activities ≥ 3 days/week).

RESULTS

More than half (56.9%) of students achieving the PA recommendations at baseline were no longer achieving them after two years, and just a quarter (25.6%) of students not achieving the recommendations at baseline achieved them after two years. School-level factors were significantly associated with students achieving the recommendations, but these factors differed by student strata (i.e. by gender and baseline PA status). Generally, student access to equipment, public health partnerships and staff time for health were associated with increased odds of achieving the PA recommendations for certain students.

CONCLUSION

Modifications to school characteristics within CSH may play a role in supporting students in achieving or continuing to achieve the PA recommendations after two years. Further research is needed to better understand the underlying dynamics of the observed relationships.

Levels and Patterns of Physical Activity and Sedentary Behaviour of Primary School Learners in Lagos State, Nigeria

BACKGROUND

Physical activity (PA) and sedentary behaviour (SB) assessment in children is critical for the prevention of noncommunicable diseases. African studies examining PA and SB of primary school-age children are few. This study investigated PA, SB levels and their correlates among primary school children in Lagos, Nigeria.

METHOD

In a cross-sectional study of 733 learners, their self-reported PA and SB were assessed using the Children PA Questionnaire (CPAQ) (6-9 years age category) and Youth Activity Profile (YAP) (10-12 years age category) while pedometers were used for objective PA and SB assessment, and socioeconomic status (SES) index were measured using a structured questionnaire. Standardised procedures were used for anthropometric and cardiovascular measures. Results Based on CPAQ, 87.5% and 100% of the learners aged 6-9 years met the recommended PA and SB guidelines, respectively which were lower with pedometers (72.8% and 87.3%). The proportion of boys aged 6-9 years who met the guidelines for PA and SB (using pedometer) was significantly higher than that of the girls(PA: 80.7% vs. 64%, p = 0.018; SB: 94% vs. 80%, p = 0.008). Self-reported PA was positively associated with age (CPAQ: B = 455.39, p < 0.001; YAP: B = 1.638, p = 0.009) and negatively with SES (CPAQ: B = -201.39, p < 0.001; YAP: B = -1.000, p < 0.001). Objective PA was positively associated with waist to hip ratio(WHR) (6-9 years: B = 66090.24, p = 0.032) and negatively with sex (6-9 years: B = -5533.41, p = 0.027) and hip circumference (10-12 years: B = -1269.13, p = 0.017). SB was associated with SES in learners aged 10-12 years (B = -0.282, p = 0.003).

CONCLUSION

High SES is a major predictor of reduced PA among these cohort of learners.

Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

BACKGROUND

Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions.

OBJECTIVES

1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review.

SELECTION CRITERIA

We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines.

MAIN RESULTS

We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review.

AUTHORS' CONCLUSIONS

The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Involvement of high school teachers in Health Promoting School program in selected township, Yangon Region, Myanmar: A cross-sectional mixed methods study

Background

Schools provide a big opportunity for promoting the student’s health, life skill, and behavior. Teachers play a fundamental role in the promotion and successful implementation of school health services. This study aimed to assess the level of involvement in the Health Promoting School program and its associated factors and to explore the benefits and barriers to involvement among high school teachers in Myanmar.

Methods

A mixed methods explanatory sequential study was conducted among 194 high school teachers in Thanlyin Township, Yangon Region, Myanmar, from June to August 2020. Quantitative data were collected with the pretested structural questionnaire and analyzed by Chi-square tests and Fisher’s exact tests. A qualitative strand was added by conducting in-depth interviews (n = 15, five teachers from each level of involvement: poor, medium, and good), analyzed by thematic content analysis.

Results

Of the 194 teachers, 23.7% had a good level of involvement in the Health Promoting School program. The factor associated with involvement in Health Promoting School program were age (p value < 0.001), duration of services (p value = 0.001), and a number of accomplished training-related school health (p value = 0.008). Qualitative data revealed that improvement of the health knowledge and awareness on health problems, the progress of healthy behaviors, development of physical and mental health, prevention of the disease spread, achievement of healthy and productive learning environment, and development of academic achievement were major benefits of teachers’ involvement. Moreover, the main barriers to involvement were insufficient materials and human resources, time constraints, incompetence of the teachers, poor cooperation of school health partnerships, and insufficient awareness of parents.

Conclusions

The proportion of good involvement in the Health Promoting School program among high school teachers was low in this study area. Providing sufficient human resources and material, conducting the on-the-job and refresher training, enhancing parent-teacher cooperation, and strengthening the community partnerships were crucial to improve the level of involvement and reduced the barriers for the achievement of the Health Promoting School program.

Longitudinal association of biological maturation with physical activity behaviors in girls transitioning from 5th to 7th grade

Introduction

This longitudinal study determined if social cognitive variables influence physical activity in girls stratified on the basis of maturity status.

Methods

Participants attended South Carolina public schools (Mage in 5th grade = 11.1 years) and included a cohort of 529 girls who provided physical activity data in the 5th grade and in 6th and/or 7th grade. The measure of maturity status was age at peak height velocity (APHV) estimated from maturity offset when the children were in the 5th grade. The Earlier Maturity (EM) group included girls whose APHV was one standard deviation or more below the mean APHV for the full sample. All other girls were placed in the Later Maturity (LM) group. Physical activity was assessed at each time point via accelerometry. Social‐cognitive variables were assessed at each time point by a questionnaire measuring self‐efficacy, enjoyment, competence, appearance, fitness, and social motives for physical activity. Growth curves for the total, Earlier Maturing, and Later Maturing groups assessed relationships between physical activity over time and time‐varying social cognitive variables.

Results

Physical activity was lower in the Earlier Maturing group and was positively associated with self‐efficacy and enjoyment motivation in the total group. These relationships were observed in the 5th grade and maintained through 7th grade. In the Later Maturing group, we observed positive relationships between physical activity and self‐efficacy, enjoyment and competence motivation.

Conclusions

Strategies to increase confidence, skills, and enjoyment of physical activity may only be effective for promoting activity among later maturing girls.

School-Level Factors within Comprehensive School Health Associated with the Trajectory of Moderate-to-Vigorous Physical Activity over Time: A Longitudinal, Multilevel Analysis in a Large Sample of Grade 9 and 10 Students in Canada

(1) The majority of Canadian youth are insufficiently active, and moderate-to-vigorous physical activity (MVPA) decreases substantially during secondary school. School factors within the comprehensive school health (CSH) framework may help attenuate this decline. This study aimed to examine how youth MVPA changes over a three-year period and evaluate the school characteristics associated with preventing the decline in MVPA over time, guided by the CSH framework. (2) This study uses COMPASS survey data from 78 secondary schools in Ontario and Alberta that participated in Year 2 (2013/14), Year 3 (2014/15), and Year 4 (2015/16), and 17,661 students attending these schools. Multilevel (linear mixed effects) models were used to determine the association between school-level factors and student MVPA (weekly minutes) over time, stratified by gender. (3) Both male and female students had a significant decline in MVPA across the 3 years, with a greater decrease observed among female students. Within the CSH framework, the school's social environment, partnerships, and policies were associated with student MVPA over time, however the specific school factors and directions of associations varied by gender. (4) School-based interventions (e.g., public health partnerships) may help avoid the decline in MVPA observed in this critical period and support student health.

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

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

Connect through PLAY: a randomized-controlled trial in afterschool programs to increase adolescents' physical activity

The current study is a randomized controlled trial to test a novel 10-week climate-based intervention within pre-existing afterschool programs, designed to increase moderate-to-vigorous physical activity (MVPA) in underserved (low-income, minority status) middle school youth by addressing youth social developmental needs. Participants (n = 167; 56% female; 62% Black; 50% overweight/obese) enrolled in 6 middle schools were randomized to either the Connect through PLAY intervention or a wait-list control. Process evaluation measures (i.e., observations of external evaluators; staff surveys) indicated that essential elements were implemented with fidelity, and staff endorsed implementation ease/feasibility and acceptability. Regression analysis demonstrated that participation in the intervention (vs. control) was associated with an increase of 8.17 min of daily accelerometry-measured MVPA (56 min of additional weekly MVPA) at post-intervention controlling for baseline MVPA, school, gender, and weight status. The results provide support for social-motivational climate-based interventions for increasing MVPA in underserved youth that can inform future school-based health initiatives.Trial Registration: NCT03850821: https://clinicaltrials.gov/ct2/show/study/NCT03850821?term=NCT03850821&rank=1.

A Systematic Review of Multi-Component Comprehensive School Physical Activity Program (CSPAP) Interventions

OBJECTIVE

To identify, review, and describe multicomponent physical activity (PA) interventions in terms of: (a) number and combination of Comprehensive School Physical Activity Program (CSPAP) components, (b) study characteristics, and (c) primary outcomes.

DATA SOURCE

Five electronic databases (i.e., PubMed, PsychInfo, Physical Education Index, Sport Discus, and ERIC).

STUDY INCLUSION AND EXCLUSION CRITERIA

Included articles were peer-reviewed, written in English language, published since 1987, and included multicomponent school-based interventions.

DATA EXTRACTION

Data items extracted were: school level, setting, CSPAP component description, health outcomes, academic outcomes, main conclusion, and reference.

DATA SYNTHESIS

Included articles were synthesized by: (1) CSPAP components utilized, and (2) research outcome measured (i.e., health or academic).

RESULTS

Across 32 studies, 11 included physical education plus 1 additional CSPAP component (PE + 1); 10 included PE + 2 additional CSPAP components; 8 included PE + 3 additional CSPAP components; and 1 included all 5 CSPAP components. Two other studies included 2 or 3 CSPAP components without PE. Most interventions targeted health outcomes (94%) rather than academic outcomes (6%).

CONCLUSIONS

Multicomponent approaches aligned with CSPAPs are effective in promoting PA and other positive outcomes for youth in schools. Future research should seek to understand effects of CSPAP components on a variety of outcomes and settings.

Do Intervention Studies to Promote Physical Activity and Reduce Sedentary Behavior in Children and Adolescents Take Sex/Gender Into Account? A Systematic Review

BACKGROUND

Physical inactivity is often reported in youth and differs among boys and girls. The aim of this study is to assess sex/gender considerations in intervention studies promoting physical activity and reducing sedentary behavior in youth using a sex/gender checklist.

METHODS

A systematic search was conducted in August 2018 to identify all relevant controlled trials. Studies screened must have reported a quantified measure of physical activity and/or sedentary behavior, and identified participants by sex/gender at baseline. For evaluation of the sex/gender consideration, the authors used a sex/gender checklist developed by expert consensus.

RESULTS

The authors reviewed sex/gender considerations in all aspects of intervention development, implementation, and evaluation in 217 studies. Sex/gender aspects were only rudimentarily taken into account, most frequently during statistical analyses, such as stratification or interaction analysis.

CONCLUSIONS

Sex/gender effects are not sufficiently reported. To develop guidelines that are more inclusive of all girls and boys, future interventions need to document sex/gender differences and similarities, and explore whether sex/gender influences different phases of intervention programs. The newly developed sex/gender checklist can hereby be used as a tool and guidance to adequately consider sex/gender in the several steps of intervention planning, implementation, and evaluation.

The Effectiveness of Equipment Provisions on Rural Middle School Students' Physical Activity During Lunch Recess

BACKGROUND

Environmental provisions can boost students' discretionary participation in physical activity (PA) during lunchtime at school. This study investigated the effectiveness of providing PA equipment as an environmental intervention on middle school students' PA levels and stakeholders' perceptions of the effectiveness of equipment provisions during school lunch recess.

METHODS

A baseline-intervention research design was used in this study with a first baseline phase followed by an intervention phase (ie, equipment provision phase). A total of 514 students at 2 middle schools (school 1 and school 2) in a rural area of the western United States were observed directly using the System for Observing Play and Leisure Activity in Youth instrument. Interviews were conducted with stakeholders. Paired-sample t tests and visual analysis were conducted to explore differences in PA levels by gender, and common comparison (with trustworthiness measures) was used with the interview data.

RESULTS

The overall percentage of moderate to vigorous PA levels was increased in both schools (ranging from 8.0% to 24.0%). In school 2, there was a significant difference in seventh- and eighth-grade students' moderate to vigorous PA levels from the baseline. Three major themes were identified: (1) unmotivated, (2) unequipped, and (3) unquestionable changes (with students becoming more active).

CONCLUSIONS

Environmental supports (access, equipment, and supervision) significantly and positively influenced middle school students' lunchtime PA levels.

The FitSpirit approach for increasing physical activity in canadian teenage girls: protocol of a longitudinal, quasi-experimental study

Background

Worldwide, most adolescent girls do not meet physical activity (PA) recommendations and very few PA programs are tailored specifically towards them. Even fewer information exists about the long-term effects of such programs. Some Canadian schools have implemented the FitSpirit PA intervention designed specifically for girls aged 12 to 17 years old. This paper describes the protocol of a quasi-experimental study evaluating long-term changes in health behaviours and outcomes following FitSpirit participation.

Methods

The study is conducted among schools that partner with FitSpirit every year. It started in 2018 and will be completed in 2022. The intervention comprises motivational talks, a turnkey running program, PA sessions and special events. Study participants fill out an online questionnaire twice a year. Follow-up questionnaires are sent at the end of each school year to the study participants who dropout from FitSpirit. The main outcome, changes in PA levels, is evaluated using questions validated for adolescents. Secondary outcomes are health (perceived health); lifestyle habits (sedentary activities, eating and sleeping habits); psychosocial outcomes (physical self-efficacy and body satisfaction); and FitSpirit appreciation (activity participation and satisfaction). Most questions originate from questionnaires validated for the adolescent population. Cross-sectional and longitudinal analyses will be performed.

Discussion

This study will provide one of the first longitudinal reports on the impact of a large extra-curricular PA intervention designed specifically for adolescent girls. The current study will uniquely contribute to PA research by assessing outcomes additional to PA levels, including markers of health, lifestyle habits and psychosocial determinants.

Trial registration

NCT, NCT03804151, Registered on January 22, 2019; retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10200-5.

Association of Physical Education With Improvement of Health-Related Physical Fitness Outcomes and Fundamental Motor Skills Among Youths: A Systematic Review and Meta-analysis

IMPORTANCE

Whether quality- or quantity-based physical education (PE) interventions are associated with improvement of health-related physical fitness outcomes and fundamental motor skills (FMSs) in children and adolescents is unknown.

OBJECTIVE

To examine the association of interventions aimed at optimizing PE in terms of quality (teaching strategies or fitness infusion) or quantity (lessons per week) with health-related physical fitness and FMSs in children and adolescents.

DATA SOURCES

For this systematic review and meta-analysis, studies were identified through a systematic search of Ovid MEDLINE, Embase, Cochrane Controlled Trials Registry, and SPORTDiscus databases (from inception to October 10, 2019) with the keywords physical education OR PE OR P.E. AND fitness AND motor ability OR skills. Manual examination of references in selected articles was also performed.

STUDY SELECTION

Studies that assessed the association of quality- or quantity-based PE interventions with improvement in physical fitness and/or FMSs in youths (aged 3-18 years) were included.

DATA EXTRACTION AND SYNTHESIS

Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Random-effects models were used to estimate the pooled effect size (Hedges g).

MAIN OUTCOMES AND MEASURES

Health-related physical fitness outcomes and FMSs.

RESULTS

Fifty-six trials composed of 48 185 youths (48% girls) were included in the meta-analysis. Quality-based PE interventions were associated with small increases in health-related physical fitness (cardiorespiratory fitness [Hedges g = 0.24; 95% CI, 0.16-0.32] and muscular strength [Hedges g = 0.19; 95% CI, 0.09-0.29]) and FMSs (Hedges g = 0.38; 95% CI, 0.27-0.49). Subgroup analyses found stronger associations for quality-based PE interventions on body mass index (Hedges g = -0.18; 95% CI, -0.26 to -0.09), body fat (Hedges g = -0.28; 95% CI, -0.37 to -0.18), cardiorespiratory fitness (Hedges g = 0.31; 95% CI, 0.23-0.39), and muscular strength (Hedges g = 0.29; 95% CI, 0.18-0.39). Quantity-based PE interventions were associated with small increases in only cardiorespiratory fitness (Hedges g = 0.42; 95% CI, 0.30-0.55), muscular strength (Hedges g = 0.20; 95% CI, 0.08-0.31), and speed agility (Hedges g = 0.29; 95% CI, 0.07-0.51).

CONCLUSIONS AND RELEVANCE

The findings suggest that quality-based PE interventions are associated with small increases in both student health-related physical fitness components and FMSs regardless of frequency or duration of PE lessons. Because PE aims to improve more than health, high levels of active learning time may need to be balanced with opportunities for instruction, feedback, and reflection.

A Systematic Review and Qualitative Synthesis Resulting in a Typology of Elementary Classroom Movement Integration Interventions

Background/Objective

Movement integration (MI) involves infusing physical activity into normal classroom time. A wide range of MI interventions have succeeded in increasing children’s participation in physical activity. However, no previous research has attempted to unpack the various MI intervention approaches. Therefore, this study aimed to systematically review, qualitatively analyze, and develop a typology of MI interventions conducted in primary/elementary school settings.

Subjects/Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify published MI interventions. Irrelevant records were removed first by title, then by abstract, and finally by full texts of articles, resulting in 72 studies being retained for qualitative analysis. A deductive approach, using previous MI research as an a priori analytic framework, alongside inductive techniques were used to analyze the data.

Results

Four types of MI interventions were identified and labeled based on their design: student-driven, teacher-driven, researcher-teacher collaboration, and researcher-driven. Each type was further refined based on the MI strategies (movement breaks, active lessons, other: opening activity, transitions, reward, awareness), the level of intrapersonal and institutional support (training, resources), and the delivery (dose, intensity, type, fidelity). Nearly half of the interventions were researcher-driven, which may undermine the sustainability of MI as a routine practice by teachers in schools. An imbalance is evident on the MI strategies, with transitions, opening and awareness activities, and rewards being limitedly studied. Delivery should be further examined with a strong focus on reporting fidelity.

Conclusions

There are distinct approaches that are most often employed to promote the use of MI and these approaches may often lack a minimum standard for reporting MI intervention details. This typology may be useful to effectively translate the evidence into practice in real-life settings to better understand and study MI interventions.

A Controlled Evaluation of a CBPR Intervention's Effects on Physical Activity and the Related Psychosocial Constructs Among Minority Children in an Underserved Community

BACKGROUND

Effective physical activity interventions are needed for children because health behaviors track into adulthood, and risk factors for diseases begin early in life. No study has determined whether an intervention designed using a Community-Based Participatory Research approach can improve moderate to vigorous physical activity (MVPA) and the related psychosocial constructs in underserved children. This study determined whether improvements in MVPA and related psychosocial constructs (self-efficacy, knowledge, beliefs, attitudes, and skills) occurred following a Community-Based Participatory Research intervention in underserved, rural children. It was then determined if these constructs were mediators of MVPA.

METHODS

Two fifth-grade classes at a school (n = 19 and n = 20) were randomly assigned to an intervention or comparison group. The intervention group participated in a 4-week intervention designed to improve MVPA (wGT3X-BT accelerometer; ActiGraph, Pensacola, FL) and the related psychosocial constructs (written survey). Groups were assessed prior to and immediately following the intervention.

RESULTS

There were no differences at baseline between groups. MVPA (30.0 [4.4] min), knowledge, and skill scores were significantly higher in the intervention group compared with the comparison group at follow-up (P < .05). Knowledge and skills were mediating variables of MVPA.

CONCLUSIONS

Priority should be placed on research that determines the sustained impact of similar Community-Based Participatory Research interventions.

Moving adolescents for a lifetime of physical activity: shifting to interventions aligned with the third health revolution

Public health advocates have been calling for an intensified focus on early, middle, and late adolescence health behaviours due to both the short- and long-term health consequences. Hence, both the health-risk (e.g., alcohol consumption) and health-promoting (e.g., physical activity) behaviours of adolescents have been widely studied to better understand the underlying causes or determinants with an eye towards implementing more effective interventions. The success of these interventions, typically grounded in a risk-reduction/prevention-oriented intervention approach has been modest, especially those focused on health-promoting behaviours, such as physical activity. The purposes of this paper are to (1) conduct a conceptual critique of the risk-reduction/prevention-oriented approach underlying traditional adolescent physical activity interventions, and (2) examine the potential usefulness of an emerging person-based, development-oriented (PBDO) approach for enhancing the motivation and sustainability of adolescent physical activity. Within this PBDO perspective, emphasis is on adolescent growth and development as the starting point for initiating and sustaining physical activity. Implications of the PBDO approach for adolescent physical activity interventions are presented.

Effects of the Girls on the Move randomized trial on adiposity and aerobic performance (secondary outcomes) in low-income adolescent girls

BACKGROUND

Limited, mixed evidence exists regarding the effectiveness of physical activity interventions on adiposity and aerobic performance in adolescent underrepresented populations.

OBJECTIVE

To examine effects of Girls on the Move on body mass index z-scores (BMI-z), percent (%) body fat, and aerobic performance in fifth- to eighth-grade underrepresented girls.

METHODS

A group randomized trial, involving 12 intervention and 12 control schools in low-income areas, was conducted. Participants (n = 1519) were low-active girls. The 17-week intervention included (a) a physical activity club, (b) two motivational interviewing sessions, and (c) one Internet-based session. BMI-z was determined from measured height and weight; % body fat was assessed using bioelectric impedance. Aerobic performance was assessed using a shuttle run. Demographics, physical activity (accelerometer), and pubertal development were assessed. Linear mixed models, adjusting for baseline, were used to examine group differences in postintervention.

RESULTS

No significant between-group differences in BMI-z existed at postintervention, but % body fat increased less among intervention than control group girls (M_change = 0.43% vs 0.73%). Aerobic performance decreased less in intervention vs control (M_change = -0.39 vs -0.57).

CONCLUSIONS

Although the intervention positively impacted % body fat and aerobic performance in underrepresented girls, more research is necessary to determine optimal implementation for yielding greater effects.

School-Based Physical Activity Interventions in Prevocational Adolescents: A Systematic Review and Meta-Analyses

PURPOSE

Literature detailing the effectiveness of school-based physical activity promotion interventions in prevocational adolescents was reviewed to identify effective intervention characteristics.

METHODS

The search strategy assessed studies against inclusion criteria study design, study population, school setting, language, and construct. The risk of bias of the included studies was assessed, and extractions were made of the physical activity (PA) level outcome measures and intervention characteristics regarding organizational, social, and content features. A meta-analysis was conducted to determine the overall effect of the interventions on the PA level. Identification of effective intervention characteristics was done by subgroup analyses. Meta-regression analysis was performed with PA level as dependent variable and intervention characteristics as covariates.

RESULTS

A total of 40 eligible studies was included for meta-analyses. Among the included studies, the overall intervention effect on increasing the PA level of prevocational adolescents was weak (standardized mean difference [SMD] .19, 95% confidence interval [CI] .12-.27). Intervention characteristics that improve the effect size to a moderate level were intracurricular PA (SMD .43, 95% CI .19-.68), involving school staff in an intracurricular intervention (SMD .37, 95% CI .16-.58) and a tailored intracurricular intervention (SMD .35, 95% CI .13-.58). Meta-regression analysis confirmed PA as a positive predictor.

CONCLUSIONS

The effect of a school-based PA intervention was small to moderate. A sensible choice in the assembly of a multicomponent school-based PA intervention increases the effectiveness considerably. Physical education teachers, school administrators, and policy makers should consider organizational (intracurriculum, short and medium duration), personal (tailoring, participation), social (school staff) and content (PA) determinants.

Interventions for preventing obesity in children

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.

Development of a context-sensitive physical activity intervention for persons living with HIV and AIDS of low socioeconomic status using the behaviour change wheel

Background

Regular physical activity (PA) has been recommended for the management of HIV and AIDS. The purpose of this study was to develop a contextualised intervention for promoting PA among women living with HIV and AIDS (WLWHA) of low socioeconomic status (SES). A secondary aim of the study was to optimise the PA intervention using behavioural theory/ frameworks derived from preliminary studies and the literature.

Methods

The Behaviour Change Wheel (BCW) for designing behaviour change interventions was used. This method was further supplemented by evidence from the literature, systematic literature review (SLR), a concurrent mixed methods study and two cross-sectional studies. The SLR aided in determining the theoretical frameworks to inform the intervention, the specific PA behaviours to be targeted by the intervention, the intervention functions, the intervention policy category and the mode of delivery of the intervention. The concurrent mixed methods study was used to identify key factors that needed to change in order for participants to engage in regular PA. The first cross-sectional study was used to determine the gender to be targeted by the study. The second cross-sectional study was used to determine the domain and intensity of PA to target in the intervention.

Results

A face-to-face context-sensitive PA intervention employing 14 behavioural change techniques was designed. The PA intervention (a) utilised the Transtheoretical model of behaviour change and the Social Cognitive theory as the underpinning theoretical frameworks (b) included convenient PAs, such as walking, doing simple home-based exercises, engaging in activities of daily living or doing simple exercises at the community centre (c) used education, reward, training in PA, modelling exercise activities and enablement to increase the opportunity to engage in PA as intervention functions (d) used service provision as policy priorities, and (e) used a direct face-to-face mode of delivery.

Conclusions

The PA intervention emphasises behavioural techniques for increasing PA participation, such as goal-setting, self-monitoring, strategies for overcoming PA barriers, social support and rewards. The intervention employs strategies that highlight low-cost local PA resources and opportunities to help HIV infected women of low SES to participate in PA. The BCW provides a useful and comprehensive framework for the development of evidence and theory-based PA interventions for PLWHA of low SES. The BCW can thus be used in the development of interventions that ‘talk’ to policy by bridging the health inequality gap.

Development of the 'Sigue la Huella' physical activity intervention for adolescents in Huesca, Spain

Engaging in physical activity (PA) on a regular and adequate basis generates considerable benefits for health. In developed countries, the time spent doing PA is decreasing, whilst sedentary time (ST) is increasing. A multicomponent school-based intervention programme, called 'Sigue la Huella' (Follow the Footprint), was developed to reduce sedentary lifestyles and increase PA levels. This programme has proven to be effective in increasing the daily levels of moderate to vigorous PA, in decreasing ST and in improving motivational outcomes in secondary education students, in the city of Huesca (Spain). The study design was quasi-experimental, longitudinal and by cohorts, and it was carried out in four schools, two as an experimental group (n = 368) and two as a control group (n = 314). During the 25 months' intervention, this programme adopted a holistic approach aiming to create favourable environments to engage in PA, and the empowerment of students to get actively involved in the design and execution of the activities, assuming responsibility for managing and optimizing their own PA. The programme is theoretically based on the social-ecological model and self-determination theory, and it provided evidence for four actions or components that can be used in school-based PA promotion: tutorial action, Physical Education at school, dissemination of information and participation in institutional programmes and events. The aim of this article is to describe the main characteristics of the intervention programme that have proved to be effective with respect to the objectives proposed.

The Patterns of Moderate to Vigorous Physical Activity and Physical Education Enjoyment Through a 2-Year School-Based Program

BACKGROUND

In this study, we examined the development of children's moderate to vigorous physical activity (MVPA) and physical education (PE) enjoyment through the Physical Activity as Civil Skill Program 2012-2014.

METHODS

Participants were 661 (265 intervention, 396 control) elementary school children in central and northeast Finland. The program was implemented across 2 years with 3 measurement phases using self-reported MVPA and PE enjoyment, and accelerometer-determined MVPA of a random subsample (N = 76).

RESULTS

The proportion of children meeting the current MVPA guidelines declined from 38% to 22% (intervention) and 14% to 9% (control), whereas PE enjoyment was stable in both groups. Boys were more physically active than girls only within control group children. Teachers' feedback indicated that violence and bullying among intervention students reduced during the program, which can be considered as an additional benefit.

CONCLUSIONS

It may be that both MVPA and PE enjoyment may require more tailored actions to be increased across a long-term program. It is important to ensure that school-based physical activity programs, especially including transition from elementary to middle school level, provide all children positive experiences, and thus, may improve their motivation, and MVPA participation during school days and leisure time.

Raising an Active and Healthy Generation: A Comprehensive Public Health Initiative

Physical activity (PA) provides important health benefits to youth, but most U.S. children and adolescents fail to meet federal PA guidelines. The purpose of this article is to present a plan for a large-scale public health initiative aimed at producing population-level increases in PA among U.S. youth.

Adolescent Girls’ Perceptions of Physical Activity: A Systematic Review of Qualitative Studies

Objective:

To synthesize evidence from qualitative studies relating to adolescent girls’ perceptions of physical activity participation. The protocol for this review is registered with PROSPERO (ID no. CRD42017054944).

Data Source:

PubMed, Sports Discus, Academic Search Complete, and Education Resources Information Centre.

Inclusion and Exclusion Criteria:

Studies reporting qualitative data that explored the views/opinions/perceptions of adolescent girls (>12 and <18 years old) published between 2001 and 2016 were included. Studies not in English, those focusing on school physical education or specific sports, and those including special populations were excluded.

Extraction:

Study characteristics and results were extracted to a form developed by the authors and managed using NVivo 10 (QSR International’s NVivo 10 software). Data were extracted by 1 reviewer, and a sample (25%) was checked by a second reviewer.

Synthesis:

Data were synthesized using a thematic network and managed using NVivo 10. The validity of the included studies was assessed using the “Critical Appraisal Skills Programme (2018)” checklist. The ENTREQ and PRISMA statement was followed when reporting this qualitative synthesis.

Results:

Of the 1818 studies identified in the search strategy, 24 met the inclusion criteria and were included in the analysis. Global themes were identified using a thematic network. These themes were “Gender Bias in Sport,” “Motivation and Perceived Competence,” “Competing Priorities during Adolescence,” and “Meeting Societal Expectations.”

Conclusions:

The results of this review provide insights into adolescent girls’ views on physical activity. Future research is needed to investigate the potential impact of alternative activity programs on adolescent girls with appropriate follow-up. Researchers and individuals working with young girls must consider the role of perceived motor competence in participation and how this can impact their perceptions.

Active and Healthy Lifestyle - Nationwide Programs in Israeli Schools

The World Health Organization (WHO) announced the 'Global School Health Initiative' in 1995 following recommendations formulated in the Ottawa Charter for Health Promotion. Hence, the aims of the present study were to describe the various programs for nurturing an active and healthy lifestyle implemented during 2011-12 in schools in Israel, and to identify variables that may explain the success versus lack of success in implementing these programs. Participants were a nationwide representative sample of 126 school principals from six supervisory districts of the Ministry of Education, including six sectors, from the elementary, junior-high and senior-high school levels. Semi-structured telephone interviews were recorded and processed using the ATLAS.ti software for qualitative analysis. Physical education teachers, sciences teachers and social coordinators led the programs' implementation. The programs included four main activities domains: health, physical education, nutrition and sustainability. Three types of program implementation were observed: leading principles, teaching methods, and external programs. Parents were involved mostly in elementary schools. Evidence of program integration into school life was presented by changes in children's behaviors, whereas difficulties stemmed from lack of budget and teaching hours. Science and physical education lessons constituted the anchor for the programs. The schools needed a committed leader to help conduct and maintain the program. Thus, the role of the school principal was to initiate the idea of developing a program, encourage its implementation, select a leader for the program, and then, most importantly, to reinforce the teachers' enthusiasm.

Characteristics of Teacher Training in School-Based Physical Education Interventions to Improve Fundamental Movement Skills and/or Physical Activity: A Systematic Review

BACKGROUND

Fundamental movement skill (FMS) competence is positively associated with physical activity (PA). However, levels of both FMS and PA are lower than expected. Current reviews of interventions to improve FMS and PA have shown that many school-based programs have achieved positive outcomes, yet the maintenance of these interventions is variable. Teachers play a central role in the success and longevity of school-based interventions. Despite the importance of teacher engagement, research into the nature and quality of teacher training in school-based PA and FMS interventions has received little attention.

OBJECTIVE

The aim of this systematic review was to investigate the type and quantity of teacher training in school-based physical education PA and/or FMS interventions, and to identify what role teacher training had on the intervention outcome.

METHODS

A systematic search of eight electronic databases was conducted. Publication date restrictions were not implemented in any database, and the last search was performed on 1 March 2015. School physical education-based interventions facilitated by a school teacher, and that included a quantitative assessment of FMS competence and/or PA levels were included in the review.

RESULTS

The search identified 39 articles. Eleven of the studies measured FMS, 25 studies measured PA and three measured both FMS and PA. Nine of the studies did not report on any aspect of the teacher training conducted. Of the 30 studies that reported on teacher training, 25 reported statistically significant intervention results for FMS and/or PA. It appears that teacher training programs: are ≥ 1 day; provide comprehensive subject and pedagogy content; are framed by a theory or model; provide follow-up or ongoing support; and measure teacher satisfaction of the training, are more effective at improving student outcomes in FMS and/or PA. However, the provision of information regarding the characteristics of the teacher training was largely inadequate. Therefore, it was difficult to ascertain which teacher training characteristics were most important in relation to intervention effectiveness.

CONCLUSION

It is clear that whilst teachers are capable of making substantial improvements in student outcomes in PA and FMS, the findings of this review suggest the teacher training component of school-based PA and/or FMS interventions is not only under-reported but is under-studied, and, perhaps as a result, the value of teacher training is not widely understood. What remains unclear, due to poor reporting, is what role teacher training is having on these outcomes.

Accelerometer-Assessed Physical Activity and School Absenteeism Due to Illness or Injury Among Children and Adolescents: NHANES 2003 to 2006

INTRODUCTION

To examine the association between objectively measured moderate to vigorous physical activity (MVPA) and total physical activity with school absenteeism due to illness or injury among children and adolescents.

DESIGN

Cross-sectional study.

SETTING

National Health and Nutrition Examination Survey 2003 to 2006.

PARTICIPANTS

A total of 1249 children (aged 6-11 years) and 1747 adolescents (aged 12-17 years).

MEASURES

School absenteeism was categorized as no/minimal school absenteeism (0-8 missed school days in the past 12 months), moderate absenteeism (9-17 missed days), or severe absenteeism (18+ missed days). Physical activity was objectively measured via accelerometry.

ANALYSIS

Multinomial logistic regression.

RESULTS

Children in the most active quartile had 89% reduced odds of severe absenteeism relative to the least active quartile (odds ratio [OR]: 0.11; 0.95% confidence interval [CI]: 0.02-0.48); results were similar for MVPA. For adolescents, those in the most active quartile for MVPA had a 41% reduced odds of having moderate (vs no/minimal) absenteeism (OR = 0.59; 95% CI: 0.35-0.99). For children, a multiplicative interaction effect of MVPA and poverty level on severe absenteeism was observed (OR = 0.98, P = .02).

CONCLUSION

Higher levels of physical activity were associated with lower odds of severe school absenteeism. Such an observation is important, as school absenteeism strongly contributes to academic performance. Particular attention for promoting physical activity and closely monitoring school absenteeism among youth below the poverty level may be warranted.

Physical and Social Contexts of Physical Activity Behaviors of Fifth and Seventh Grade Youth

BACKGROUND

The purpose of this study was to characterize the temporal, social, and physical contexts for physical activities commonly reported in a diverse cohort of 753 boys and girls from fifth to seventh grade.

METHODS

Data were obtained from a multilevel longitudinal study, the Transitions and Activity Changes in Kids. The Physical Activity Choices instrument assessed previous 5-day participation in specific physical activities and their temporal, social, and physical contexts. Mixed model repeated measure analyses of variance and multinomial analyses examined sex differences and change over time.

RESULTS

Fifth grade boys and girls reported participation in similar activities at similar frequencies, which declined significantly by seventh grade. One temporal pattern, playing with younger children, changed over time from "both inside/outside" to "outside" school. Boys and females reported more activities performed in class/team groups over time. Most activities took place primarily at home for all participants in both grades.

CONCLUSIONS

Boys and girls reported declines in the variety and frequency of activities from fifth to seventh grade. There were sex-specific patterns in physical activities and groups; however, all participants reported home as the primary location and a shift to class/team groups over time. Schools are well-positioned to provide additional physical activity opportunities.

Reliability and validity of the adapted Resistance Training Skills Battery for Children

OBJECTIVES

Resistance training (RT) is emerging as a training modality to improve motor function and facilitate physical activity participation in children across the motor proficiency spectrum. Although RT competency assessments have been established and validated among adolescent cohorts, the extent to which these methods are suitable for assessing children's RT skills is unknown. This project aimed to assess the psychometric properties of the adapted Resistance Training Skills Battery for Children (RTSBc), in children with varying motor proficiency.

DESIGN

Repeated measures design with 40 participants (M age=8.2±1.7years) displaying varying levels of motor proficiency.

METHODS

Participants performed the adapted RTSBc on two occasions, receiving a score for their execution of each component, in addition to an overall RT skill quotient child (RTSQc). Cronbach's alpha, intra-class correlation (ICC), Bland-Altman analysis, and typical error were used to assess test-retest reliability. To examine construct validity, exploratory factor analysis was performed alongside computing correlations between participants' muscle strength, motor proficiency, age, lean muscle mass, and RTSQc.

RESULTS

The RTSBc displayed an acceptable level of internal consistency (alpha=0.86) and test-retest reliability (ICC range=0.86-0.99). Exploratory factor analysis supported internal test structure, with all six RT skills loading strongly on a single factor (range 0.56-0.89). Analyses of structural validity revealed positive correlations for RTSQc in relation to motor proficiency (r=0.52, p<0.001) and strength scores (r=0.61, p<0.001).

CONCLUSIONS

Analyses revealed support for the construct validity and test-retest reliability of the RTSBc, providing preliminary evidence that the RTSBc is appropriate for use in the assessment of children's RT competency.

Exercise and adiposity in overweight and obese children and adolescents: protocol for a systematic review and network meta-analysis of randomised trials

INTRODUCTION

Overweight and obesity is a worldwide public health problem among children and adolescents. However, the magnitude of effect, as well as hierarchy of exercise interventions (aerobic, strength training or both), on selected measures of adiposity is not well established despite numerous trials on this issue. The primary purposes of this study are to use the network meta-analytical approach to determine the effects and hierarchy of exercise interventions on selected measures of adiposity in overweight and obese children and adolescents.

METHODS AND ANALYSIS

Randomised exercise intervention trials >4 weeks, available in any language up to 31 August 2017 and which include direct and/or indirect evidence, will be included. Studies will be located by searching seven electronic databases, cross-referencing and expert review. Dual selection and abstraction of data will occur. The primary outcomes will be changes in body mass index (in kg/m²), fat mass and percent body fat. Risk of bias will be assessed using the Cochrane Risk of Bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation instrument for network meta-analysis. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of exercise treatments (aerobic, strength or both).

ETHICS AND DISSEMINATION

This study does not require ethics approval. Findings will be presented at a professional conference and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD 42017073103 .

Developing the System for Observing Behavioral Ecology for Youth in Schools Instrument

BACKGROUND

Behavioral support may be effective in increasing physical activity (PA) in school settings. However, there are no data collection systems to concurrently record PA and behavioral support. This paper describes the development and validation of the System for Observing Behavioral Ecology for Youth in Schools (SOBEYS)-an instrument used with existing observation systems to record PA within a behavioral ecological context.

METHODS

In 2013, experts created a set of behavioral categories to record prompting and reinforcement of PA during a recreational school activity program. The school provided supervision and equipment for lunchtime PA, making it possible to assess both PA and behavioral support. The system was implemented in spring semester 2014 at 1 suburban junior high school (N = 1452; 48% girls, 74% Caucasian) in the western Unites States.

RESULTS

Following multiple field trials, the SOBEYS instrument recorded behavioral categories of visual and verbal prompting, verbal, and nonreinforcement by adults and peers, and token reinforcement. Construct validity and acceptable interobserver agreement (>90%; kappa between 0.22 and 0.94) resulted.

CONCLUSION

Trained SOBEYS users can accurately and reliably record the presence of behavioral support aimed at prompting and reinforcing PA in conjunction with established systematic observation instruments to record PA context and quantity.

The effectiveness of school-based physical activity interventions for adolescent girls: A systematic review and meta-analysis

Physical activity (PA) decreases during the transition from childhood to adolescence, with larger declines observed in girls. School-based interventions are considered the most promising approach for increasing adolescents' PA levels although, it is unclear which types of school-based interventions have the greatest impact. The objective of this systematic review is to assess the impact and design of school-based PA interventions targeting adolescent girls. A systematic search was conducted using four electronic databases (PubMed, Web of Science, SPORTDiscus and PsychInfo). This systematic review was registered with PROSPERO (Registration number: CRD42016037428) and PRISMA guidelines (2009) were followed throughout. Twenty studies were identified as meeting the inclusion criteria and were included in a narrative synthesis. Seventeen studies were eligible for inclusion in a meta-analysis. There was a significant small positive treatment effect for school-based PA interventions for adolescent girls (k=17, g=0.37, p<0.05). After an outlier was removed (residual z=7.61) the average treatment effect was significantly reduced, indicating a very small positive effect (k=16, g=0.07, p=0.05). Subgroup analysis revealed very small significant effects for multi-component interventions (k=7, g=0.09, p<0.05), interventions underpinned by theory (k=12, g=0.07, p<0.05), and studies with a higher risk of bias (k=13, g=0.09, p<0.05). Intervention effects were very small which indicates that changing PA behaviors in adolescent girls through school-based interventions is challenging. Multi-component interventions and interventions underpinned by theory may be the most effective approaches to positively change adolescent girls' PA.

Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease

BACKGROUND

A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions.

OBJECTIVES

The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children.

SEARCH METHODS

All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research.

SELECTION CRITERIA

'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated).

MAIN RESULTS

We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review.

AUTHORS' CONCLUSIONS

Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Outcomes of the Y-PATH Randomized Controlled Trial: Can a School-Based Intervention Improve Fundamental Movement Skill Proficiency in Adolescent Youth?

BACKGROUND

Multicomponent, school-based interventions are considered to be an effective method for improving fundamental movement skill (FMS) proficiency levels and physical activity (PA) among youth. This study aimed to evaluate if the youth-physical activity toward health intervention can improve FMS proficiency in a randomized controlled trial among adolescents.

METHODS

Participants were 482 adolescents aged 12-13 years from 20 schools. For an academic year, participants in 10 schools received the youth-physical activity toward health intervention. The remaining 10 schools received their regular weekly physical education lessons. Fifteen FMS were assessed using validated tools; their PA was assessed using accelerometers; their height, weight, and cardiorespiratory fitness were also recorded. Outcomes were assessed at baseline, postintervention, and 3 months later at retention. Multilevel analysis was performed using MLwiN 2.35 software.

RESULTS

Significant intervention effects across time were observed for total object control (P < .0001; β = 2.04; 95% confidence interval, 1.16 to 2.92) and total locomotor (P < .0001; β = 2.13; 95% confidence interval, 1.44 to 2.82), with the greatest improvements evident for total FMS score (P < .0001; β = 4.04; 95% confidence interval, 2.39 to 5.69). The effects of the intervention were significant and positive for all children in the intervention group regardless of gender, weight status, or PA level (P = .03 to < .0001).

CONCLUSIONS

Youth-physical activity toward health has the potential to improve FMS proficiency among adolescents regardless of gender, weight status, and activity levels.

Initial Outcomes of a Participatory-Based, Competency-Building Approach to Increasing Physical Education Teachers' Physical Activity Promotion and Students' Physical Activity: A Pilot Study

This study examined the initial effects of a participatory-based, competency-/skill-building professional development workshop for physical education (PE) teachers on the use of physical activity (PA) promotion practices (e.g., eliminating lines, small-sided games) and students' moderate-to-vigorous physical activity (MVPA). A total of 823 students (52.8% boys) wore accelerometers at baseline (fall 2015) and outcome (spring 2016) on PE and non-PE days. The System for Observing Fitness Instruction Time+ measured changes in PA promotion practices. Teachers ( n = 9) attended a 90-minute workshop prior to outcome data collection. Mixed-model linear regressions estimated changes in teacher practices and students' MVPA. Three of the nine targeted PA promotion practices changed in the desired direction (i.e., p < .05; increased motor content and lessons taught outdoors, reduced activities with lines), with three more teacher practices trending in the desired direction (i.e., reduced management time and activities with elimination, increased small-sided games). During PE, boys and girls increased MVPA by 2.0 (95% confidence interval [1.1, 3.0]), and 1.3 (95% confidence interval [0.5-2.0]) minutes, respectively. However, there were no statistically significant changes in boys' or girls' MVPA during the school day. Greater implementation of promotion practices by the PE teachers was associated with boys', but not girls', MVPA during PE. Girls in high- and low-implementing teachers' lessons experienced increases in MVPA, suggesting that even small changes in PA promotion practices can increase girls' MVPA during PE. Overall, the workshops were effective at increasing teachers' PA promotion and students' MVPA in PE. Other school-based strategies that complement and extend efforts targeting PE are recommended to increase children's total daily PA.

Environmental and Behavioral Influences of Physical Activity in Junior High School Students

BACKGROUND

Increasing access and opportunity for physical activity (PA) in schools are effective; however, not everyone experiences the same effects. Prompting and reinforcement may encourage more frequent participation in recreational PA during the school day. The purpose of this study was to investigate a lunchtime PA intervention on whole school PA participation and whether behavioral support enhanced these effects.

METHODS

A modified reversal design compared an environmental and an environmental plus behavioral support intervention on lunchtime PA participation versus baseline levels in a suburban junior high school in the western United States (N = 1452). PA and related contextual data were collected using systematic observation.

RESULTS

Significantly more girls and boys were observed in PA during the interventions compared with baseline phases (F_2,1173 = 13.52, P < .0001, η² = .023; F_2,1173 = 20.14, P < .0001, η² = .033, for girls and boys, respectively). There were no significant differences between the environmental phase and the environment plus behavioral support phase.

CONCLUSION

Providing access and opportunity significantly increased the number of girls and boys observed in PA during a lunchtime program, with no additive effects of behavioral support. Further research into providing the individual-level contingencies at an institutional level is needed.

Effect of Active Lessons on Physical Activity, Academic, and Health Outcomes: A Systematic Review

PURPOSE

The purpose of this study was to conduct a systematic review of classroom-based physical activity interventions that integrate academic content and assess the effectiveness of the interventions on physical activity, learning, facilitators of learning, and health outcomes.

METHOD

Six electronic databases (ERIC, PubMed, Google Scholar, Science Direct, Cochrane Library, and EMBASE) and reference lists were searched for English-language articles, published January 1990 through March 2015, reporting classroom-based interventions that deliberately taught academic content using physically active teaching methods for at least 1 week duration, with physical activity, health, learning, or facilitators-of-learning outcomes. Two authors reviewed full-text articles. Data were extracted onto an Excel spreadsheet, and authors were contacted to confirm accuracy of the information presented.

RESULTS

Fifteen studies met the inclusion criteria. Six studies reporting on physical activity levels were found to have medium-to-large effect sizes. All 4 studies reporting learning outcomes showed positive effects of intervention lessons. Teachers and students were pleased with the programs, and enhanced on-task behavior was identified (n = 3). Positive effects were also reported on students' body mass index levels (n = 3).

CONCLUSIONS

Physically active academic lessons increase physical activity levels and may benefit learning and health outcomes. Both students and teachers positively received and enjoyed these teaching methods. These findings emphasize the need for such interventions to contribute toward public health policy.

Is Team Sport the Key to Getting Everybody Active, Every Day? A Systematic Review of Physical Activity Interventions Aimed at Increasing Girls' Participation in Team Sport

Background

It is estimated that 21% of boys and 16% of girls in England meet recommended physical activity guidelines. Team sport has the potential to increase physical activity levels; however, studies show that gender-based factors can influence girls' participation in team sport. Furthermore, evidence for the effectiveness of interventions promoting team sport among girls is limited. This systematic review aimed to assess the impact of physical activity interventions on secondary school-aged girls' (aged 11-18 years) participation in team sport and to identify potential strategies for increasing participation.

Methods

Electronic databases and grey literature were systematically searched for studies of interventions targeting team sport participation among girls in the UK. Results were exported to Refworks, duplicates removed and eligible studies identified. Extracted data included: participant details, such as sample size and age; components of the intervention; outcomes assessed; and each study was quality appraised. Due to heterogeneity across studies, results were presented narratively.

Results

Four studies sourced from the grey literature met the inclusion criteria. Findings suggest that physical activity interventions can encourage girls to try new sports, but evidence is limited in relation to sustained participation. Potential strategies for promoting participation included: consultation with girls, implementation of appropriate peer-leaders and friendship group strategies, early intervention and consideration of intervention setting.

Conclusions

This review highlights the limited availability of evidence on the effectiveness of physical activity interventions for promoting team sport participation among girls in the UK. Findings indicate that future research is needed to improve the methodological quality of complex intervention evaluation. Physical activity interventions may have the potential to encourage girls to try team sport, but their impact on sustained participation, and subsequent physical activity outcomes, is less apparent.

Physical Education and Sport: Does Participation Relate to Physical Activity Patterns, Observed Fitness, and Personal Attitudes and Beliefs?

Purpose:

The purpose of this study was to examine the associations between physical education (PE) and sports involvement with physical activity (PA), physical fitness, and beliefs about PA among a national sample of adolescents.

Setting:

Data from the National Health and Nutrition Examination Survey National Youth Fitness Survey were used.

Participants:

A total of 459 adolescents aged 12 to 15 years.

Measures:

Adolescents self-reported engagement in the above parameters; muscular fitness objectively determined.

Analysis:

Multivariable linear regression.

Results:

Adolescents who had PE during school days had a higher enjoyment of participating in PE (β = 0.32; P = .01), engaged in more days of being physically active for ≥60 min/d (β = 1.02; P < .001), and performed the plank fitness test longer (β = 17.2; P = .002). Adolescents who played school sports reported that more PA was needed for good health (β = 0.23; P = .04), had a higher enjoyment of participating in PE (β = 0.31; P = .003), engaged in more days of being physically active for ≥60 min/d (β = 0.70; P = .01), performed more pull-ups (β = 2.33; P = .008), had a stronger grip strength (β = 2.5; P = .01), and performed the plank fitness test longer (β = 11.6; P = .04).

Conclusion:

Adolescents who had PE during school, who had more frequent and long-lasting PE, and who played school sports generally had more accurate perceptions of the amount of PA needed for good health, had greater enjoyment of PE, were more physically active, and performed better on several muscular fitness-related tests. This underscores the importance of PE integration in the schools and encouragement of school sports participation.

Process evaluation of a preschool physical activity intervention using web-based delivery

BACKGROUND AND PURPOSE

Preschool/childcare settings offer a practical target for physical activity interventions. Online learning programs have the potential for greater public health reach and impact. The SHAPES-Dissemination (SHAPES-D) project adapted the original SHAPES in-person intervention for online delivery to teachers. The purpose of this paper is to describe the implementation monitoring and process evaluation for the SHAPES-D project.

METHODS

Nine preschools with 26 classrooms participated. A total of 41 teachers were trained via online learning to implement the SHAPES-D program in their classrooms. The dose received, completeness, and fidelity of implementation were assessed through website metrics, teacher surveys and interviews, and classroom observations.

RESULTS

Dose received was adequate (73%). Observed completeness and physical activity enjoyment fidelity were high (100%), although moderate-to-vigorous physical activity fidelity and social environment fidelity were low (25% each). Overall implementation was high (91%).

DISCUSSION

Results indicate that the online method of delivery is viable for dissemination. The online delivery system provides an easy method of monitoring dose received. This may be the first structural intervention to monitor dose received through web metrics.

CONCLUSION

The adaptation of an in-person intervention to an online delivery system increases the potential for dissemination of a successful program to increase physical activity in preschool settings.

Effect of Physical Activity Interventions for Girls on Objectively Measured Outcomes: A Systematic Review of Randomized Controlled Trials

INTRODUCTION

Most girls are not meeting physical activity (PA) guidelines, and 30% are overweight or obese. The purpose of this systematic review was to evaluate the evidence for PA intervention effects on accelerometer-measured PA, body mass index (BMI), and percent body fat (% BF) among girls.

METHODS

The Cumulative Index of Nursing and Allied Health Literature, PubMed, PsychInfo, and SportDISCUS databases were searched for randomized controlled trials published from 1985-2014. Studies with a PA intervention and outcomes of accelerometer-measured PA, BMI, or % BF were included.

RESULTS

Fifteen studies were reviewed. PA, BMI, and % BF were measured in 5, 15, and 10 studies, respectively. Effect sizes (ES) were highly variable. In one intervention, PA increased (ES = -0.17 to 0.08); in two interventions, BMI was reduced (ES = -0.11 to 0.62); and in five interventions, % BF was lowered (ES = 0.12 to 0.93).

DISCUSSION

Future research should involve preadolescent girls, improve methods for handling missing data, include objective measures of PA, and increase intervention attendance rates.