An exploratory analysis examining differences in physical activity and motor competence in children with and without asthma: brief report

OBJECTIVE

The purpose of this pilot study was to examine potential differences in motor competence (MC) and physical activity (PA) between children with and without asthma.

METHODS

Thirty-seven children and adolescents completed the Exercises for a Healthy Asthma Lifestyle and Enjoyment study (46% with asthma, 51% female, 11.1 ± 0.4 years, and 46% White). Motor competence was assessed using the Movement Assessment Battery for Children 2nd edition (MABC-2). PA was assessed using accelerometry.

RESULTS

Children with asthma had significantly lower MC in the domain of aiming and catching (with asthma: 8.2 ± 0.4 vs. without asthma: 9.9 ± 0.5; p = 0.03) and fewer daily minutes spent in moderate-to-vigorous PA (MVPA) (with asthma: 18.0 ± 2.3 min vs. without asthma: 27.2 ± 3.6 min; p = 0.047). There were no significant group differences in manual dexterity, balance, total MABC-2 score, or total daily PA (all ps > 0.05).

CONCLUSIONS

This study provides confirmatory evidence that children with asthma display lower MC and spend less time in MVPA compared to children without asthma. Because MC is a prerequisite for engaging in PA, future research should seek to determine if the differences observed in MC contribute to disparities in MVPA observed in this clinical population.

Use of a Novel Theory-Based Pragmatic Tool to Evaluate the Quality of Instructor-Led Exercise Videos to Promote Youth Physical Activity at Home: Preliminary Findings

BACKGROUND

Exercise videos that work to minimize cognitive load (the amount of information that working memory can hold at one time) are hypothesized to be more engaging, leading to increased PA participation.

PURPOSE

To use a theory-based pragmatic tool to evaluate the cognitive load of instructor-led exercise videos associated with the Interrupting Prolonged Sitting with ACTivity (InPACT) program.

METHODS

Exercise videos were created by physical education teachers and fitness professionals. An evaluation rubric was created to identify elements each video must contain to reduce cognitive load, which included three domains with four components each [technical (visual quality, audio quality, matching modality, signaling), content (instructional objective, met objective, call-to-action, bias), and instructional (learner engagement, content organization, segmenting, weeding)]. Each category was scored on a 3-point scale from 0 (absent) to 2 (proficient). A video scoring 20-24 points induced low cognitive load, 13-19 points induced moderate cognitive load, and less than 13 points induced high cognitive load. Three reviewers independently evaluated the videos and then agreed on scores and feedback.

RESULTS

All 132 videos were evaluated. Mean video total score was 20.1 ± 0.7 points out of 24. Eighty-five percent of videos were rated low cognitive load, 15% were rated moderate cognitive load, and 0% were rated high cognitive load. The following components scored the highest: audio quality and matching modality. The following components scored the lowest: signaling and call-to-action.

CONCLUSIONS

Understanding the use of a pragmatic tool is a first step in the evaluation of InPACT at Home exercise videos. Our preliminary findings suggest that the InPACT at Home videos had low cognitive load. If future research confirms our findings, using a more rigorous study design, then developing a collection of instructor-led exercise videos that induce low cognitive load may help to enhance youth physical activity participation in the home environment.

Aligning Organizational Priorities and System Policies to Support Implementation Scale-Up of a Tailored Classroom-Based Physical Activity Intervention in Low-Resource Schools

BACKGROUND

A mismatch between organizational priorities and system-level policies can negatively impact implementation and sustainment of classroom-based physical activity (PA) interventions. The purpose of this study was twofold: (1) present methods to systematically identify organization- and system-level implementation barriers, and (2) align organizational priorities and system policies by designing multi-level implementation strategies. This alignment will support implementation scale-up of a tailored PA intervention in one low-resource intermediate school district (ISD; 16 districts, 32 schools) in central Michigan.

METHODS

Multi-level assessments of organizational readiness were conducted using the Hexagon Discussion and Analysis Tool to assess intervention-context fit, the Wellness School Assessment Tool 3.0 to evaluate district PA policy strength and comprehensiveness, and semi-structured interviews were conducted to assess administrative support and priorities related to PA programming.

RESULTS

Our assessments revealed three implementation barriers: limited structural capacity to sustain teacher training, limited resources across districts and school buildings to support teachers, and misalignment of ISD and district PA policies and priorities.

CONCLUSIONS

Greater attention to organizational capacity and existing infrastructure should be considered a priori to support effective implementation and sustainment of PA interventions in low-resource schools.

A Novel Policy Alignment and Enhancement Process to Improve Sustainment of School-Based Physical Activity Programming

The purpose of the current study was twofold: (1) to evaluate the strength and comprehensiveness of district wellness policies in one central Michigan intermediate school district (ISD; 16 districts), and (2) to pilot a novel policy alignment and enhancement process in one district within the ISD to improve sustainment of district-wide physical activity (PA) programming. Policy evaluation and alignment were determined using WellSAT 3.0. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was used to guide a seven-step policy alignment and enhancement process. Initial evaluation of the PA policy for the ISD revealed a strength score of 19/100 (i.e., included weak and non-specific language) and 31/100 for comprehensiveness (i.e., mentioned few components of the Comprehensive School Physical Activity Program). For the pilot school district, initial strength scores were 19/100 and 38/100 for comprehensiveness (exploration). An alignment of the tailored PA policy with current practices resulted in a 100% increase in strength (score of 38/100), and 132% increase in comprehensiveness (score of 88/100; preparation). However, district administrators encountered barriers to adopting the tailored policy and subsequently integrated the PA requirements into their curriculum guide and school improvement plan (implementation and sustainment). Future research should examine the effectiveness of our EPIS-informed policy evaluation, alignment, and enhancement process to promote widespread increases in student PA.

Classroom-Based Strategies to Reduce Disparities in Physical Activity Among Children with Asthma

Children with asthma often experience physical activity (PA) induced symptoms 5-15 min following the start of exercise. Classroom PA breaks provide short intermittent bouts of PA and may represent a novel strategy to safely promote PA participation in this clinical population. The purpose of this study was to determine the feasibility of a classroom-based PA intervention, Interrupting Prolonged Sitting with Activity (InPACT), where teachers implement 5 × 4-min moderate-to-vigorous physical activity (MVPA) breaks throughout the school day. Nine classrooms at one elementary-middle school in Detroit, MI (student demographics: 79% Hispanic; 80% on free/reduced lunch; 31% prevalence of asthma and asthma-like symptoms) participated in this 20-week intervention. Asthma status was self-reported via the International Study of Asthma and Allergies in Childhood (ISAAC) Video Questionnaire in conjunction with nurse documentation. PA participation, exercise intensity, and asthmatic symptom occurrence were assessed via direct observation. Students accumulated approximately 17 min of activity per day during PA breaks. Compared to students without asthma, a higher percentage of students with asthma participated in MVPA (asthma: 52.9% ± 1.2%; non-asthma: 46.2% ± 0.8%; p = 0.01), a lower percentage participated in light PA (asthma: 25.9% ± 1.0%; non-asthma: 30.1% ± 0.7%; p = 0.01), and sedentary time during activity breaks (asthma: 21.2% ± 0.9%; non-asthma: 23.8% ± 0.7%; p = 0.02). Out of 294 observations, six instances of asthmatic symptoms (coughing) were observed in students with asthma 5-15 min following the PA break. Symptoms self-resolved within 15-min of the PA break and did not result in sustained exercise-induced bronchoconstriction. Classroom-based interventions that incorporate short intermittent bouts of PA represent safe exercises for children with asthma and may help to reduce PA disparities in this clinical population.

Psychological Stress and Lowered Physical Activity Enjoyment in Adolescents With Overweight/Obesity

PURPOSE

The purpose of this study was 2-fold: 1) to determine the cross-sectional associations between psychological stress, physical activity enjoyment, and physical activity participation [moderate-to-vigorous physical activity (MVPA), total physical activity (TPA)]; and 2) to determine the moderating effect of physical activity enjoyment on the associations between stress, MVPA, and TPA in adolescents with overweight/obesity.

DESIGN

Cross-sectional, secondary data analysis of the Health and Culture Project and the Stress, Obesity, and Diabetes in Adolescents study.

SAMPLE

One hundred and ten adolescents (73% female; 65.4% non-white; age 15.8 ± 1.9 years) with overweight/obesity (BMI percentile ≥ 85th percentile) were included in this analysis.

MEASURES

Psychological stress was assessed using the Perceived Stress Scale (PSS-14); enjoyment was measured via the Physical Activity Enjoyment Scale; and MVPA and TPA were objectively measured using accelerometry over a minimum of 4 days.

RESULTS

Higher perceived stress was associated with lower physical activity enjoyment (β = -0.41 ± 0.15; p = 0.008). Stress was not associated with MVPA or TPA (ps > 0.05), nor was enjoyment a significant moderator in the associations between stress and MVPA or stress and TPA (p_interaction > 0.05).

CONCLUSIONS

These findings suggest that psychological stress is associated with lower physical activity enjoyment among adolescents with overweight/obesity. Longitudinal studies are needed to understand the long-term effects of stress on psychological factors that may serve as antecedents to physical activity participation among adolescents with overweight/obesity.

Adapting the InPACT Intervention to Enhance Implementation Fidelity and Flexibility

Adapting classroom-based physical activity interventions are critical for program feasibility and fidelity in low-resource elementary schools. The purpose of this pilot study was to use Replicating Effective Programs (REP) framework to tailor the Interrupting Prolonged sitting with ACTivity (InPACT) intervention and evaluate its effectiveness on program fidelity in classrooms within a low-resource school. REP was applied to adapt program packaging, teacher training, and technical assistance to disseminate Tailored InPACT, a 20-week intervention where teachers implemented 5 × 4-min activity breaks per day. Tailored InPACT was implemented in nine, 3rd-6th grade classrooms in one low-resource school in Detroit Michigan (80% qualified for free/reduced lunch). Intervention fidelity was measured via daily, weekly, and end-of-study self-report questionnaires and direct observation. Throughout the 20-week intervention period, 3rd-5th grade teachers achieved intervention dose (5 activity breaks per day at an average duration of 4 min 8 s). Sixth grade teachers did not achieve intervention dose as they were only able to implement 2 activity breaks per day at an average duration of 4 min 12 s. These findings suggest 5 × 4-min classroom activity breaks per day is a feasible dose of classroom activity that 3rd-5th grade teachers can implement in low-resource classroom settings. Additional adaptations are needed to maximize fidelity in 6th grade classrooms.

Patterning of physical activity and sedentary behavior at and away from school in preadolescent children

Background

Understanding how and where children accumulate their physical activity (PA) and sedentary minutes throughout the day has important implications for behavioral interventions.

Purpose

The purpose of this study was to examine the duration and intensity of habitual PA and sedentary time (SED) at and away from school among preadolescent children.

Methods

Data from twenty-one children ages 7-11 (57% girls; 57% non-white; 24% overweight/obese) were included in this analysis. Proportion of time spent in PA, SED, and SED bouts were examined on school days (in-school and out-of-school) and non-school days via accelerometry.

Results

When comparing school time with non-school time on school days, children accumulated a higher proportion of light PA while in-school [49.3% (i.e. 5 minutes 18 seconds) vs. 39.6% (i.e. 3 hours 53 minutes), p=0.01]. While at school, the proportion of time spent in SED was less [46.3% (i.e. 3 hours 7 minutes) vs. 56.3% (i.e. 5 hours 32 minutes), p=0.01] and fewer children spent time engaged in prolonged sitting compared to out-of-school [uninterrupted SED for 30 minutes 52.4% (i.e. 11 children) vs. 85.7% (i.e. 18 children), p=0.02].

Discussion

These findings suggest children are proportionately most active and least sedentary when at school, yet children only accumulated approximately 18 minutes of moderate-to-vigorous PA in this environment.

Translation to Health Education Practice

These preliminary findings can help to inform physical activity programming designed to promote life-long physical activity behaviors in children.

A Pilot Intervention Using Gamification to Enhance Student Participation in Classroom Activity Breaks

The purpose of this study was to determine the effect of adding game design elements (goal setting, feedback, and external rewards) to an evidence-based physical activity intervention to increase in-class physical activity participation (intensity of activity breaks performed). Nine third- through sixth-grade classrooms (n = 292 students) in one elementary-middle school in Detroit, Michigan (49% female, 95% nonwhite; 80% qualified for free/reduced lunch) participated in this 20-week intervention where teachers implemented 5 × 4 min moderate-to-vigorous activity breaks per day. Gamification of activity breaks occurred during weeks 13-20 of the intervention and included the use of game design elements and classroom goals for activity break intensity. Moderate-to-vigorous physical activity (MVPA) during activity breaks was measured via direct observation. There was a significant effect of intervention with a 27% increase in student MVPA participation during the gamified intervention weeks compared with the standard intervention weeks (p = 0.03). Gamification of activity breaks resulted in 55% (compared with 25% during the standard intervention) of students accumulating approximately 20 min of health-enhancing physical activity per day in their classroom. These findings provide preliminary evidence that gamifying activity breaks may be an important strategy for increasing student participation in classroom activity breaks.