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Murphy MH, O'Kane SM, Carlin A, Lahart IM, Doherty LC, Jago R, McDermott G, Faulkner M, Gallagher AM. Effectiveness of the Walking in ScHools (WISH) Study, a peer-led walking intervention for adolescent girls: results of a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2024; 21:19. [PMID: 38374037 PMCID: PMC10877798 DOI: 10.1186/s12966-024-01563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Most adolescent girls fail to meet current physical activity guidelines. Physical activity behaviours track from childhood into adulthood and providing adolescent girls with opportunities to be physically active may have health benefits beyond childhood. The effects of walking interventions on adult cardiometabolic health are known, however less is understood about the potential of walking to promote physical activity in adolescents. Following the Walking In ScHools (WISH) feasibility study, this definitive trial aimed to evaluate the effectiveness of a novel, low-cost, school-based walking intervention at increasing physical activity levels of adolescent girls (aged 12-14 years). METHODS Female pupils were recruited from eighteen schools across the border region of Ireland and in Northern Ireland. In intervention schools (n = 9), girls aged 15-18 years, were trained as walk leaders, and led the younger pupils in 10-15 min walks before school, at break and lunch recess. All walks took place in school grounds and pupils were encouraged to participate in as many walks as possible each week. The primary outcome measure was accelerometer determined total physical activity (counts per minutes, cpm). RESULTS In total, 589 pupils were recruited to the study. At baseline, pupils engaged in a median (interquartile range (IQR)) 35.7 (21.2) mins moderate-vigorous physical activity (MVPA) per day and only 12% (n = 66) of participants met physical activity guidelines (60 min MVPA per day). The intervention was delivered for a mean (standard deviation (SD)) 19.9 ± 0.97 weeks. The mean post-intervention total physical activity for the intervention group was 676 cpm and 710 cpm in the control group. Post-intervention total physical activity did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline physical activity (mean difference, -33.5, 95% CI = -21.2 to 88.1; p = 0.213). CONCLUSIONS 'Scaling-up' physical activity interventions is challenging and despite a promising feasibility study, the results of this fully powered trial suggest that in this context, the WISH intervention did not increase device measured physical activity. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low, indicating that there is a need to better understand how to implement interventions within schools. TRIAL REGISTRATION ISRCTN; ISRCTN12847782; Registered 2nd July 2019.
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Affiliation(s)
- Marie H Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Belfast, BT15 1ED, UK
- Physical Activity for Health Research Centre (PHARC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - S Maria O'Kane
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Belfast, BT15 1ED, UK.
- Institute of Nursing and Health Research, Ulster University, Derry/Londonderry, BT48 7JL, UK.
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Belfast, BT15 1ED, UK
| | - Ian M Lahart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, WS1 3BD, UK
| | - Leanne C Doherty
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Belfast, BT15 1ED, UK
| | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PL, UK
| | - Gary McDermott
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Belfast, BT15 1ED, UK
| | - Maria Faulkner
- Sports Lab North West, Atlantic Technological University, Letterkenny, Ireland
| | - Alison M Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Ulster University, Coleraine, BT52 1SA, UK
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Onyimadu O, Violato M, Astbury NM, Hüls H, Heath L, Shipley A, Taylor H, Wilkins LE, Abhari RE, Jebb SA, Petrou S. A systematic review of economic evaluations of interventions targeting childhood overweight and obesity. Obes Rev 2023; 24:e13597. [PMID: 37463862 DOI: 10.1111/obr.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Abstract
This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah Hüls
- The TUM School of Medicine, Technical University Munich, Munich, Germany
- The TUM School of Management, Technical University Munich, Munich, Germany
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexandra Shipley
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | - Harriet Taylor
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | | | - Roxanna E Abhari
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Wang Y, Liu L, Chen Q, Gao K, Wang H, Xu N, Chen Y, Wong DWC, Lam WK. Modified lumbo-pelvic exercise to alleviate mild stress urinary incontinence in middle-aged females. Sci Rep 2023; 13:7142. [PMID: 37130891 PMCID: PMC10153777 DOI: 10.1038/s41598-023-34417-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/29/2023] [Indexed: 05/04/2023] Open
Abstract
Urinary incontinence is one of the common clinical problems of females passing middle age. Traditional pelvic floor muscle training to alleviate urinary incontinence is too dull and unpleasant. Therefore, we were motivated to purpose a modified lumbo-pelvic exercise training incorporating simplified dancing components with pelvic floor muscle training. The objective of this study was to evaluate the 16-week modified lumbo-pelvic exercise program that incorporated dance and abdominal drawing-in maneuvers. Middle-aged females were randomly assigned into the experimental (n = 13) and control (n = 11) groups. Compared to the control group, the exercise group significantly reduced body fat, visceral fat index, waistline, waist-hip ratio, perceived incontinence score, frequency of urine leakage, and pad testing index (p < 0.05). In addition, there were significant improvements in pelvic floor function, vital capacity, and muscle activity of the right rectus abdominis (p < 0.05). This indicated that the modified lumbo-pelvic exercise program can promote benefits of physical training and alleviate urinary incontinence in middle-aged females.
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Affiliation(s)
- Yi Wang
- Department of Physical Education, Renmin University of China, Beijing, China
- Sports and Social Development Research Center, Renmin University of China, Beijing, China
| | - Liangchao Liu
- Physical Education Department, University of International Business and Economics, Beijing, China
| | - Qi Chen
- Physical Education Department, University of International Business and Economics, Beijing, China
| | - Kuiting Gao
- School of Physical Education, Shandong University of Technology, Shandong, China.
| | - Hongchu Wang
- School of Mathematical Sciences, South China Normal University, Guangzhou, China
| | - Naxin Xu
- Sport Science School, Beijing Sport University, Beijing, China
| | - Yinru Chen
- College of Education, Beijing Sport University, Beijing, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong, China.
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Al-Hazzaa HM, Alothman SA, Alghannam AF, Almasud AA. Anthropometric Measurements, Sociodemographics, and Lifestyle Behaviors among Saudi Adolescents Living in Riyadh Relative to Sex and Activity Energy Expenditure: Findings from the Arab Teens Lifestyle Study 2 (ATLS-2). Nutrients 2021; 14:nu14010110. [PMID: 35010983 PMCID: PMC8746972 DOI: 10.3390/nu14010110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of the study was to examine the anthropometric measurements, sociodemographics, and lifestyle behaviors among Saudi adolescents relative to sex and physical activity (PA). A random cross-sectional survey conducted on Saudi adolescents from secondary schools in Riyadh, using a multistage stratified cluster sampling technique. Measurements included demographics, weight, height, waist circumference, PA, sedentary behaviors (SB), sleep duration, and dietary habits using a validated questionnaire. A total of 1262 adolescents (16.4 ± 0.95 years; 52.4% males) were studied. Overweight/obesity was more than 40%. Physical inactivity among adolescents was 53%, which indicates some improvement over the past years, especially among females. More than 80% of adolescents had over three hours/day of screen time, with no significant sex differences. Insufficient sleep was highly prevalent with gender differences. A large proportion of the participants did not consume daily breakfast (65.7%), vegetables (73.2%), fruits (84.2%), or milk/dairy products (62.4%), whereas significant proportions of the adolescents consumed sugar-sweetened drinks, fast food, French fries/potato chips, cake/donuts, and chocolates/candy on at least three days or more per week. It was concluded that non-daily intake of breakfast and vegetables was significantly associated with lower PA. The updated information can aid in effectively planning and implementing promotional programs toward improving the lifestyle behaviors of Saudi adolescent.
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Rieder J, Moon JY, Joels J, Shankar V, Meissner P, Johnson-Knox E, Frohlich B, Davies S, Wylie-Rosett J. Trends in health behavior and weight outcomes following enhanced afterschool programming participation. BMC Public Health 2021; 21:672. [PMID: 33827501 PMCID: PMC8028223 DOI: 10.1186/s12889-021-10700-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. Although recommended, schools have difficulty consistently implement evidence-based obesity programing. We report on the effectiveness of adding structured nutrition education and minimum physical activity (PA) requirements to standard middle school after-school programming. METHODS Using a longitudinal pre-post study design, we evaluated program effectiveness at one year on target behaviors on students recruited during three consecutive school years (2016-2018). We used generalized linear (or logistic) mixed-effects modeling to determine: 1) impact on healthy weight and target healthy behavior attainment, and 2) whether target behavior improvement and weight change were associated with after-school program attendance. The seven target behaviors relate to eating healthy, physical activity, and sleep. RESULTS Over the three years, a total of 76 students enrolled and completed one year of programming (62% Hispanic, 46% girls, 72% with BMI > 85th %ile, 49% with BMI > 95th %ile). Of students with BMI > 85th %ile, 44% maintained or decreased BMI Z-score. There were improvements (non-significant) in BMI Z-score and the adoption of four healthy eating behaviors: fruit, vegetables, sugar-free beverages, and unhealthy snack food. Students with higher after-school attendance (> 75%) had greater improvements (non-significant) in composite behavior scores, BMI Z-score, and in most target behaviors (5/7) than students with lower after-school attendance (< 75%). Sleep improvements were significantly associated with BMI Z-score decrease (Beta = - 0.05, 95% CI (- 0.1,-0.003), p = 0.038.) CONCLUSIONS: Enhancement of existing after-school programming with structured nutrition education and minimum physical activity requirements demonstrates positive improvements in several health behaviors and weight outcomes. Adopting enhanced after-school programming increases access to health activities and may bring us closer to solving obesity in at-risk youth in impoverished communities. TRIAL REGISTRATION ClinicalTrials.gov identifier (NCT number): NCT03565744 . Registered 21 June 2018 - Retrospectively registered.
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Affiliation(s)
- Jessica Rieder
- Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Joanna Joels
- Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY USA
| | - Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Paul Meissner
- Care Management Organization, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467 USA
| | - Elicia Johnson-Knox
- Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY USA
| | - Bailey Frohlich
- Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY USA
| | - Shelby Davies
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Judy Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Bronx, NY 10461 USA
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O'Kane SM, Carlin A, Gallagher AM, Lahart IM, Jago R, Faulkner M, Murphy MH. A study protocol for a clustered randomised controlled trial to evaluate the effectiveness of a peer-led school-based walking intervention on adolescent girls' physical activity: the Walking In ScHools (WISH) study. BMC Public Health 2020; 20:541. [PMID: 32316957 PMCID: PMC7171742 DOI: 10.1186/s12889-020-08600-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background Adolescent girls in the UK and Ireland are failing to meet current physical activity guidelines. Physical activity behaviours track from childhood to adulthood and it is important that adolescent girls are provided with opportunities to be physically active. Walking has been a central focus for physical activity promotion in adults and may effectively increase physical activity levels among younger people. Following on from a pilot feasibility trial, the purpose of this cluster randomised controlled trial (c-RCT) is to evaluate the effectiveness of a novel, low-cost, peer-led school-based walking intervention delivered across the school year at increasing physical activity levels of adolescent girls. Methods The Walking In ScHools (WISH) Study is a school-based c-RCT conducted with girls aged 12–14 years from eighteen schools across the Border Region of Ireland / Northern Ireland. Following baseline data collection, schools will be randomly allocated to intervention or control group. In intervention schools, female pupils aged 15–18 years will be invited to train as walk leaders and will lead younger pupils in 10–15 min walks before school, at break and lunch recess. All walks will take place in school grounds and pupils will be encouraged to participate in as many walks as possible each week. The intervention will be delivered for the whole school year (minimum 20–22 weeks). The primary outcome measure is accelerometer-measured total physical activity (counts per minute) (end of intervention). Secondary outcomes will include time spent in sedentary behaviour, light, moderate and vigorous intensity physical activity, anthropometry measures, social media usage and sleep. A mixed-methods process evaluation will also be undertaken. Discussion The WISH Study will examine the effectiveness of a low-cost, school-based, peer-led walking intervention in increasing physical activity in adolescent girls when delivered across the school year. If the intervention increases physical activity, it would benefit adolescent girls in the defined target area with potential for wider adoption by schools across the UK and Ireland. Trial registration ISRCTN; ISRCTN12847782; Registered 2nd July 2019.
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Affiliation(s)
- S Maria O'Kane
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, University of Ulster, Jordanstown Campus, Newtownabbey, BT37 0QB, UK.
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, University of Ulster, Jordanstown Campus, Newtownabbey, BT37 0QB, UK
| | - Alison M Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, University of Ulster, Coleraine Campus, Coleraine, BT52 1SA, UK
| | - Ian M Lahart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
| | - Maria Faulkner
- Department of Law and Humanities, Letterkenny Institute of Technology, Port Road, Letterkenny, Ireland
| | - Marie H Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, University of Ulster, Jordanstown Campus, Newtownabbey, BT37 0QB, UK
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Beets MW, Weaver RG, Ioannidis JPA, Geraci M, Brazendale K, Decker L, Okely AD, Lubans D, van Sluijs E, Jago R, Turner-McGrievy G, Thrasher J, Li X, Milat AJ. Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:19. [PMID: 32046735 PMCID: PMC7014944 DOI: 10.1186/s12966-020-0918-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity. METHODS We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes. RESULTS A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively. CONCLUSIONS Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Marco Geraci
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Keith Brazendale
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lindsay Decker
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - David Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - Esther van Sluijs
- Centre for Diet and Activity Research & MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Russell Jago
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | | | - James Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Andrew J Milat
- New South Wales (NSW) Ministry of Health, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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Fong Yan A, Cobley S, Chan C, Pappas E, Nicholson LL, Ward RE, Murdoch RE, Gu Y, Trevor BL, Vassallo AJ, Wewege MA, Hiller CE. The Effectiveness of Dance Interventions on Physical Health Outcomes Compared to Other Forms of Physical Activity: A Systematic Review and Meta-Analysis. Sports Med 2018; 48:933-951. [PMID: 29270864 DOI: 10.1007/s40279-017-0853-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Physical inactivity is one of the key global health challenges as it is associated with adverse effects related to ageing, weight control, physical function, longevity, and quality of life. Dancing is a form of physical activity associated with health benefits across the lifespan, even at amateur levels of participation. However, it is unclear whether dance interventions are equally as effective as other forms of physical activity. OBJECTIVE The aim was to systematically review the literature on the effectiveness of structured dance interventions, in comparison to structured exercise programmes, on physical health outcome measures. METHODS Seven databases were searched from earliest records to 4 August 2017. Studies investigating dance interventions lasting > 4 weeks that included physical health outcomes and had a structured exercise comparison group were included in the study. Screening and data extraction were performed by two reviewers, with all disagreements resolved by the primary author. Where appropriate, meta-analysis was performed or an effect size estimate generated. RESULTS Of 11,434 studies identified, 28 (total sample size 1276 participants) met the inclusion criteria. A variety of dance genres and structured exercise interventions were compared. Meta-analyses showed dance interventions significantly improved body composition, blood biomarkers, and musculoskeletal function. The effect of either intervention on cardiovascular function and self-perceived mobility was equivalent. CONCLUSION Undertaking structured dance of any genre is equally and occasionally more effective than other types of structured exercise for improving a range of health outcome measures. Health practitioners can recommend structured dance as a safe and effective exercise alternative.
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Affiliation(s)
- Alycia Fong Yan
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
| | - Stephen Cobley
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Cliffton Chan
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Evangelos Pappas
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | | | - Rachel E Ward
- School of Medical Sciences, UNSW Australia, Sydney, NSW, Australia
| | - Roslyn E Murdoch
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Yu Gu
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Bronwyn L Trevor
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Amy Jo Vassallo
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Michael A Wewege
- School of Medical Sciences, UNSW Australia, Sydney, NSW, Australia
| | - Claire E Hiller
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Ruddy KJ, Stan DL, Bhagra A, Jurisson M, Cheville AL. Alternative Exercise Traditions in Cancer Rehabilitation. Phys Med Rehabil Clin N Am 2018; 28:181-192. [PMID: 27912996 DOI: 10.1016/j.pmr.2016.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Alternative exercise traditions (AETs) such as Pilates, yoga, Tai Chi Chuan, Qigong, and various forms of dance offer the potential to improve diverse outcomes among cancer survivors by reducing adverse symptoms and mood disorders, and by enhancing function. Additionally AETs have emerged as a potential means to address deficits in current disease-focused care delivery models which are marked by prevalent under-treatment of symptoms and physical impairments. Relative to therapeutic exercise in allopathic models, many AETs are comparatively affordable and accessible. AETs have the further potential to simultaneously address needs spanning multiple domains including social, physical, and psycho-emotional. AETs additionally offer the salient benefits of promoting integrated whole body movement and concurrently enhancing strength, coordination, balance, posture, flexibility, and kinesthetic awareness. Despite AETs' benefits, compelling concerns leave many clinicians ambivalent and reluctant to endorse or even discuss them. One issue is the extensive heterogeneity across and even within specific AETs. An additional concern is that the one-size-fits-many nature of AET group classes undermines an instructor's capacity to individualize dose, type, frequency, and intensity, which are cornerstones of effective therapeutic exercise. Inconsistencies in AET practitioner expertise and certification, as well as the extent of practitioner familiarity with vulnerabilities unique to cancer populations, may also be problematic. At this juncture, an extensive literature of inconsistent quality that spans diverse cancer populations frustrates efforts to precisely determine the effect size of any specific AET in improving a specific outcome; Although systematic reviews and meta-analyses have concluded that AETs have beneficial effects, they consistently identify a high risk of bias in a majority of trials related to a lack of blinding, poor allocation concealment, small sample sizes, and incomplete outcome data.
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Affiliation(s)
- Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Daniela L Stan
- Department of General Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Anjali Bhagra
- Department of General Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Mary Jurisson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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11
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Vassallo AJ, Hiller CE, Pappas E, Stamatakis E. Temporal trends in dancing among adults between 1994 and 2012: The Health Survey for England. Prev Med 2018; 106:200-208. [PMID: 29128410 DOI: 10.1016/j.ypmed.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/27/2017] [Accepted: 11/01/2017] [Indexed: 12/19/2022]
Abstract
The benefits of physical activity are established, however, increasing population physical activity levels remains a challenge. Participating in activities that are enjoyable and multidimensional, such as dancing, are associated with better adherence. However, the extent to which the general population participates in dancing and its temporal trends has not been well studied. The aim of this study was to investigate temporal trends and patterns and correlates of dance participation in England from 1994 to 2012 using a series of large nationally representative surveys. We used data from the Health Survey for England 1994, 1997, 1998, 1999, 2003, 2004, 2006, 2008 and 2012 to examine dance temporal trends. Temporal trends data were age-standardized and correlates of dance participation were examined for males and females over each study year. Changes in population prevalence of dance participation were determined using multiple logistical regression with 1997 as the reference year. Of all survey participants (n=98,178) 7.8% (95%CI: 7.63-7.96) reported dance participation. There was a marked steady decrease over time, with the steepest decline from 2003 onwards. The multivariable-adjusted odds ratios for dance participation were 0.51 for males (95%CI 0.408-0.630, p<0.001) and 0.69 for females (95%CI: 0.598-0.973, p<0.001) in 2012 compared to 1997. Dance participation in adults in England has decreased markedly over time. This study suggests that dance is not being adequately utilized as a health enhancing physical activity, and therefore further research and resources should be dedicated to supporting dance in the community.
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Affiliation(s)
- Amy Jo Vassallo
- University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia; University of Sydney, Charles Perkins Centre, School of Public Health, Sydney, NSW, Australia
| | - Claire E Hiller
- University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia
| | - Evangelos Pappas
- University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia; University of Sydney, Charles Perkins Centre, School of Public Health, Sydney, NSW, Australia
| | - Emmanuel Stamatakis
- University of Sydney, Charles Perkins Centre, School of Public Health, Sydney, NSW, Australia.
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