Evaluation of a 2-year physical activity and healthy eating intervention in middle school children

The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) intervention with parental involvement, (ii) intervention alone and (iii) control group. In 10 schools, an intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant positive intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal interventions. The use of personalized computer-tailored interventions seems to be a promising tool for targeting adolescents but needs to be further explored.

Body mass effects of a physical activity and healthy food intervention in middle schools

OBJECTIVE

To evaluate the effects of a 2-year middle school physical activity and healthy food intervention, including an environmental and computer-tailored component on BMI and BMI z-score in boys and girls.

RESEARCH METHODS AND PROCEDURES

A random sample of 15 schools with seventh and eighth graders was randomly assigned to three conditions: an intervention with parental support group, an intervention-alone group, and a control group. Weight and height were measured at the beginning and end of each school year to assess BMI and BMI z-score. A physical activity and healthy food program was implemented over 2 school years.

RESULTS

In girls, BMI and BMI z-score increased significantly less in the intervention with parental support group compared with the control group (p < 0.05) or the intervention-alone group (p = 0.05). In boys, no significant positive intervention effects were found.

DISCUSSION

This was the first study evaluating the effectiveness of an intervention combining environmental changes with personal computer-tailored feedback on BMI and BMI z-score in middle school children. After 2 school years, BMI and BMI z-score changed in a more positive direction in girls as a result of the intervention with parental support.

Environmental and psychosocial correlates of physical activity in Portuguese and Belgian adults

OBJECTIVES

To investigate differences in reported physical activity levels and in perceived environmental and psychosocial correlates of activity between Portuguese and Belgian adults; and to analyse the relative contribution of environmental and psychosocial variables in explaining physical activity within different contexts in Portugal and Belgium.

DESIGN

Cross-sectional study.

SETTING

One city in Portugal (Oeiras) and one in Belgium (Ghent).

SUBJECTS

In total 526 participants, 247 from Portugal and 279 from Belgium, completed the long International Physical Activity Questionnaire and a validated questionnaire on environmental and psychosocial correlates.

RESULTS

For the sum of all activities of at least moderate intensity, a significantly higher mean level of activity was found in Belgian adults (P < 0.001). However, comparable percentages of the Belgian (38%) and Portuguese (42%) samples did not meet the recommendation of 30 min per day. The variance explained by environmental factors was lower (1% to 8%) than by psychosocial factors (maximum 42%). Regression analyses showed activity-specific relations with environmental variables which were analogous in both countries. Walking/cycling for transportation and walking for recreation were related to social support from family and/or friends and to walkability and walking facilities in the neighbourhood. Recreational physical activity was mainly determined by social support, self-efficacy, and perceived benefits and barriers.

CONCLUSIONS

Activity campaigns addressing psychosocial determinants are needed to encourage leisure-time activity, while a combination of neighbourhood design changes and encouragement of social support in walking is warranted to increase walking in different contexts.

Physical activity and psychosocial correlates in normal weight and overweight 11 to 19 year olds

OBJECTIVE

This study examined differences in (1) psychosocial correlates of physical activity and in (2) physical activity within different contexts and sedentary behaviors between normal weight and overweight adolescents. It further explored whether the prediction of physical activity by the psychosocial correlates is different in normal weight and overweight adolescents.

RESEARCH METHODS AND PROCEDURE

A community sample of 6078 11 to 19 year olds from 38 secondary schools, which were randomly selected throughout the country, completed a validated computerized questionnaire about physical activity, sedentary behaviors, and psychosocial correlates. Differences in mean scores on the psychosocial correlates and on the self-rated physical activity were analyzed between the normal weight (n=5563) and the overweight (n=515, 8.5%) group.

RESULTS

This study showed that overweight adolescents do less intense physical activities (p<0.001) and have less favorable psychosocial correlates related to physical activity (p<0.001) than their normal weight counterparts. However, the strength of the associations between psychosocial variables and total physical activity were comparable in overweight and normal weight adolescents. More support from family and friends, more fun in physical activity, higher self-efficacy, the perception of more competition benefits, and the perception of less lack of interest were all associated with higher total levels of physical activity. The results suggest that no specific tailoring on psychosocial correlates of physical activity is necessary for overweight adolescents compared with normal weight ones.

DISCUSSION

Both overweight and normal weight adolescents can be approached by interventions focusing on the same psychosocial variables to increase physical activity.

Explicit and implicit attitudes towards food and physical activity in childhood obesity

This study investigated differences in the explicit and implicit attitudes towards food and physical activities between children with obesity (n=38) and a matched control group (n=38). The implicit attitude was assessed using the Extrinsic Affective Simon Task (EAST; J. Exp. Psychol. (50) (2003) 77), a modified version of the Implicit Association Test (IAT; J. Personality Social Psychol. (74) (1999) 1464). It was expected that both groups would report a positive explicit attitude towards healthy food and intense physical activities, and a negative explicit attitude towards unhealthy food and sedentary activities. Of particular interest was the hypothesis that children with obesity would have a more positive implicit attitude towards unhealthy food and sedentary activities than the control group. Results revealed no differences between groups in the explicit attitude towards food and physical activity. Children and adolescents with obesity had a more pronounced positive implicit attitude towards food in general. The relevance of these findings in terms of prevention, treatment and further research is discussed.

Post-treatment phone contact: a weight maintenance strategy in obese youngsters

This study investigated the effect of post-treatment phone contact on weight-loss maintenance and activity behaviour in obese youngsters. In all, 20 patients who completed a weight reduction program were randomly assigned to a 5-month maintenance programme (experimental) or control condition. Following the maintenance programme, patients sent a weekly activity diary to the therapist, who in turn phoned them biweekly to discuss their activities. Body weight, stature and physical activity were measured before and after the maintenance programme. The control group showed a continuous increase in overweight after initial treatment, while the experimental group showed a steep increase during the summer holidays (no intervention), but this increase slowed down during the maintenance programme (P<0.05). Moderate-to-high intensity activities increased during the maintenance programme in the experimental group, but decreased in the control group (P<0.001). In conclusion, post-treatment phone contact appears to have the potential to be an effective maintenance strategy in obese youngsters.

Role of physical activity and eating behaviour in weight control after treatment in severely obese children and adolescents

AIM

To investigate the role of physical activity and eating behaviour in weight control 1.5 y after a weight-reduction programme in severely obese children.

METHODS

Forty-seven children (13.4 +/- 2.1 y) were measured 1.5 y after the completion of a 10-mo residential treatment programme. Stature and body mass were measured; physical activity, fat and fibre intake, and self-efficacy in relation to physical activity and healthy eating behaviour were assessed using validated structured interviews. The total sample was divided into four subgroups according to unhealthy versus healthy physical activity and eating behaviour at follow-up.

RESULTS

One-and-a-half years after treatment, subjects had regained 34 +/- 19% overweight, but were on average still 20 +/- 19% less overweight than before treatment (p < 0.001). The four subgroups did not differ in level of overweight at the beginning or end of treatment. At follow-up, there was a significant difference in overweight between the four subgroups (p < 0.05). The least healthy group (unhealthy physical activity and unhealthy eating behaviour) had a significantly higher level of overweight 1.5 y after treatment (183 +/- 36%) in comparison with the other groups (unhealthy physical activity and healthy eating: 150 +/- 21%; healthy physical activity and unhealthy eating: 156 +/- 14%; healthy physical activity and healthy eating: 138 +/- 16%) (p < 0.05), whilst the healthiest group showed the lowest level of overweight after treatment when compared to the other groups (p < 0.05).

CONCLUSION

Results suggest that both physical activity and nutritional habits play an important role in weight maintenance after initial weight loss in obese children and that one healthy behaviour can not compensate for another unhealthy behaviour.

Changes in physical activity and psychosocial determinants of physical activity in children and adolescents treated for obesity

The purpose of this study was to describe changes in physical activity and determinants in youngsters treated for obesity. Self-reported physical activity and determinants were assessed at start, during and after an intervention in 24 obese patients (mean age 13.5+/-2.1 years). Participation in activities of moderate to high intensity increased during treatment, but 6-months after treatment this decreased again to pre-treatment levels. Participation in activities of low intensity and television watching decreased during treatment and increased following treatment. Very little change was found in perceived benefits, barriers or self-efficacy scores. Modelling of siblings decreased after treatment, whereas there was no evolution in modelling of parents. Social support by family members increased during treatment, but decreased following treatment. We can conclude that the intervention was successful in activating obese youngsters to move at the desirable exercise intensity and frequency; however, maintenance of the exercise habit after treatment was not successful.

Changes in fat mass, fat-free mass and aerobic fitness in severely obese children and adolescents following a residential treatment programme

The purpose of this study was to describe changes in fat mass (FM), fat-free mass (FFM) and aerobic fitness in severely obese children and adolescents during residential treatment in the Medical Paediatric Centre Zeepreventorium. Treatment consisted of moderate dietary restriction, physical activity and psychological support. This study was a clinical observation of 20 severely obese children and adolescents (8 boys and 12 girls, aged 15.4+/-1.8 years) who completed the 10-month residential programme. Height, weight, FM, FFM and aerobic fitness was measured four times during the intervention: at baseline, 11 weeks, 24 weeks and at 33 weeks (at the end of the programme ). The mean decrease in level of overweight was 46% (P<0.001), with a mean loss of 8.9% FM (P<0.001). Submaximal performance (PWC150) improved from 123+/-35 Watt to 152+/-37 Watt (P<0.001). Maximal performance levels increased (performance time: from 14+/-2.9 min to 15.3+/-3.5 min, peak power: from 186+/-38 Watt to 205+/-45 Watt, P<0.01) without an improvement in absolute VO(2 peak).

CONCLUSION

A moderate dietary restriction in combination with physical activity and psychological support in severely obese children and adolescents is effective in decreasing body fat and improving physical performance. Further research is needed to evaluate the longer-term effects of such a programme.

Physical fitness and physical activity in obese and nonobese Flemish youth

OBJECTIVE

To assess different aspects of physical fitness and physical activity in obese and nonobese Flemish youth.

RESEARCH METHODS AND PROCEDURES

A random sample of 3214 Flemish schoolchildren was selected and divided into an "obese" and "nonobese" group based on body mass index and sum of skinfolds. Physical fitness was assessed by the European physical fitness test battery. Physical activity was estimated by a modified version of the Baecke Questionnaire.

RESULTS

Obese subjects had inferior performances on all tests requiring propulsion or lifting of the body mass (standing-broad jump, sit-ups, bent-arm hang, speed shuttle run, and endurance shuttle run) compared with their nonobese counterparts (p < 0.001). In contrast, the obese subjects showed greater strength on handgrip (p < 0.001). Both groups had similar levels of leisure-time physical activity; however, nonobese boys had a higher sport index than their obese counterparts (p < 0.05).

DISCUSSION

Results of this study show that obese subjects had poorer performances on weight-bearing tasks, but did not have lower scores on all fitness components. To encourage adherence to physical activity in obese youth, it is important that activities are tailored to their capabilities. Results suggest that weight-bearing activities should be limited at the start of an intervention with obese participants and alternative activities that rely more on static strength used.

Effects of distraction on treadmill running time in severely obese children and adolescents

OBJECTIVE

(1) To examine the effects of attentional distraction on running time in an incremental treadmill test in obese youngsters; (2) to investigate whether distraction works at the same extent at the beginning and at the end of residential treatment; and (3) to explore the underlying mechanisms of the possible distraction effects.

METHODS

Thirty severely obese youngsters (10 boys, 20 girls, age range 9-17) who were following a 10 month residential treatment, performed a treadmill test until exhaustion in four different sessions using a within subjects design. The two sessions at the beginning of the treatment and the two sessions at the end the treatment were counterbalanced, one with attentional distraction (music) and one without distraction.

RESULTS

Obese youngsters ran significantly longer during distraction. This distraction effect seemed to be larger at the beginning compared to at the end of obesity treatment. The absence of differences between the condition with music and the condition without music on perceived bodily symptoms is in line with the idea that it took longer to perceive sufficient bodily sensations to decide to stop the treadmill test in the distraction condition. This interpretation is further corroborated by the physiological data indicating a superior peak performance in the condition with distraction.

CONCLUSIONS

Attentional distraction has a positive effect on perseverance in obese youngsters. Further research has to show the usefulness of attentional distraction as a technique to increase exercise adoption and adherence in obesity treatment.

Differences in psychosocial determinants of physical activity in older adults participating in organised versus non-organised activities

BACKGROUND

With the introduction of the new consensus on 30 minutes of moderate physical activity preferably on all days of the week, exercise implemented into daily activities is promoted whereas structured activity programs lose importance. Activity levels of most older people don't come up with current recommendations. Therefore strategies to enhance attendance of older adults in physical activities should be developed. Group programs may be more effective in changing exercise behaviour of older adults than non-supervised physical activity. The purpose of this study was to investigate the differences in level of activity and psychosocial determinants of physical activity between seniors involved in an exercise class and seniors not engaged in any organised physical activity.

METHODS

Seventy-five elderly who were currently involved in structured exercise classes and 75 elderly who did not participate in any organised physical activity during the previous year were recruited in senior citizens' centres and were asked to fill out a questionnaire.

RESULTS

Subjects involved in an exercise program had higher levels of activity and reported more social influences and higher self-efficacy compared to the respondents practising on an individual basis. No differences were found in perceived barriers or benefits.

CONCLUSIONS

Exercising in a group program gives the opportunity to accumulate some extra physical activity and positively affects the level of activity outside the program. Stimulating older adults to join a structured activity program in the company of family or friends in order to enhance supporting social influences and perceived competence could be an important intervention strategy.