Mediating variable framework in physical activity interventions. How are we doing? How might we do better?

Mediating Mechanisms in a Physical Activity Intervention: A Test of Habit Formation

BACKGROUND

A recent randomized controlled trial found that an intervention focused on developing an exercise habit increased weekly minutes of moderate to vigorous physical activity (MVPA) over 8 wk compared to a control group. The purpose of the current study was to test if changes in habit, as well as other behavioral strategy constructs from the Multi-Process Action Control Test, mediated between group condition and MVPA (self-report and accelerometry).

METHODS

Inactive new gym members (N = 94) were randomized into control or experimental (habit-building) groups.

RESULTS

No construct entirely explained mediation condition (experimental and control) and changes in MVPA measured by accelerometry. Self-report MVPA found affective judgments, behavioral regulation, and preparatory habit to be mediated between group (experimental/control conditions) and changes in behavior (β = 0.36, 95% confidence interval [.05-.78]).

CONCLUSIONS

Self-reported and objectively measured behavior models demonstrated complete and partial mediation, respectively. New gym members could benefit from successful behavioral enactment by developing constructs to support habit formation.

Photorealistic Avatar and Teen Physical Activity: Feasibility and Preliminary Efficacy

OBJECTIVE

Exergames played with a photorealistic avatar may enhance motivation to play, in addition to frequency, duration, and intensity of game-play. This article reports the feasibility and preliminary efficacy of an exergame played with a photorealistic avatar on physical activity (PA) intensity in a laboratory-based study.

MATERIALS AND METHODS

Teens (12-14 years old) were recruited from a large, metropolitan area of the southwestern United States. Parents provided written informed consent. Teens completed online data collection, played an exergame with a photorealistic avatar in an observed laboratory setting, and then participated in postassessment data collection that included online questionnaires and a telephone interview.

RESULTS

The program was feasible: 42 out of 48 teens recruited (87.5%) completed all data collection activities; game enjoyment was 21.9 ± 8.4 out of possible score of 32; immersion, 49.7 ± 15.6 out of a possible score of 88; avatar identification, 43.9 ± 16.5 out of a possible score of 68; and program satisfaction, 15.6 ± 3.6 out of possible score of 20. Objectively assessed PA indicated that 15.88 minutes of the laboratory-based gameplay session (74.9% of total time) was in vigorous PA; small effect sizes were observed in autonomy (ES = 0.45; P = 0.01) and competence (ES = 0.36; P = 0.03). Little change was observed in relatedness (ES = 0.04; P = 0.82) Qualitative data confirmed participants enjoyed playing the game with a photorealistic avatar and provided suggestions to enhance the gameplay experience.

CONCLUSION

Playing an exergame with a photorealistic avatar holds promise as a method for increasing PA among youth. Additional research is needed to further explore its effects on gameplay frequency, intensity, and duration in nonlaboratory setting.

Social Cognitive Theory and Physical Activity Among Korean Male High-School Students

The most critical step in developing and implementing effective physical activity interventions is to understand the determinants and correlates of physical activity, and it is strongly suggested that such effort should be based on theories. The purpose of this study is to test the direct, indirect, and total effect of social cognitive theory constructs on physical activity among Korean male high-school students. Three-hundred and forty-one 10th-grade male students were recruited from a private single-sex high school located in Seoul, South Korea. Structural equation modeling was used to test the expected relationships among the latent variables. The proposed model accounted for 42% of the variance in physical activity. Self-efficacy had the strongest total effect on physical activity. Self-efficacy for being physically active was positively associated with physical activity (p < .01). Self-efficacy also had positive indirect effects on physical activity through perceived benefits (p < .05) and goal setting (p < .01). The results of this study indicated that the social cognitive theory is a useful framework to understand physical activity among Korean male adolescents. Physical activity interventions targeting Korean male high-school students should focus on the major sources of efficacy.

Effectiveness of active school transport interventions: a systematic review and update

Background

Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review.

Methods

Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size.

Results

Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities.

Conclusions

Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions.

Trial registration

Registered in PROSPERO: CRD42016033252

Electronic supplementary material

The online version of this article (10.1186/s12889-017-5005-1) contains supplementary material, which is available to authorized users.

Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?

BACKGROUND

Implementing complex and multi-level public health programmes is challenging in school settings. Discrepancies between expected and actual programme outcomes are often reported. Such discrepancies are due to complex interactions between contextual factors. Contextual factors relate to the setting, the community, in which implementation occurs, the stakeholders involved, and the characteristics of the programme itself. This work uses realist evaluation to understand how contextual factors influence the implementation process, to result in variable programme outcomes. This study focuses on identifying contextual factors, pinpointing combinations of contextual factors, and understanding interactions and effects of such factors and combinations on programme outcomes on different levels of the implementation process.

METHODS

Schools which had participated in a school-based health promotion programme between 2012 and 2015 were included. Two sets of qualitative data were collected: semi-structured interviews with school staff and programme coordinators; and written documents about the actions implemented in a selection of four schools. Quantitative data included 1553 questionnaires targeting pupils aged 8 to 11 in 14 schools to describe the different school contexts.

RESULTS

The comparison between what was expected from the programme (programme theory) and the outcomes identified in the field data, showed that some of the mechanisms expected to support the implementation of the programme, did not operate as anticipated (e.g. inclusion of training, initiation by decision-maker). Key factors which influenced the implementation process included, amongst other factors, the mode of introduction of the programme, home/school relationship, leadership of the management team, and the level of delegated power. Five types of interactions between contextual factors were put forward: enabling, hindering, neutral, counterbalancing and moderating effects. Recurrent combinations of factors were identified. Implementation was more challenging in vulnerable schools where school climate was poor.

CONCLUSION

A single programme cannot be suited or introduced in the same manner in every context. However, key recurrent combinations of contextual factors could contribute to the design of implementation patterns, which could provide guidelines and recommendation for grass-root programme implementation.

Screen-based media use and screen time assessment among adolescents residing in an Urban Resettlement Colony in New Delhi, India

Background:

Media forms an important part of the lives of adolescents in as much as the shows they watch on television, playing video games, as well as visiting the various websites. There is a growing concern of the influence of media on every aspect of health of children and adolescents. About 95% of the population in India has availability of television. India has limited studies which have explored the use of screen-based media (SBM) and its effect on child health. This study was conducted to assess the pattern of SBM use.

Methods:

A community-based cross-sectional study was conducted in an Urban Resettlement Colony, New Delhi. The study included 550 adolescents of age group from 10 to 19 years of age selected through simple random sampling from a list of adolescents residing in the area. A semi-structured interview schedule was used.

Results:

About 98% of the adolescents used SBM. Television formed the maximum used media (96.5%). The mean (standard deviation) of the screen time was found to be 3.8 (2.77) h/day. Out of the total screen time, time contributed by television is 2.8 h/day followed by other SBM. About 68% of adolescents reported having screen time more than the recommended (>2 h). Significant association was observed between screen time and watching television while eating [odds ratio (95% confidence interval) = 0.35 (0.22, 0.55)].

Conclusion:

High proportion of adolescents use SBM for more than the recommended screen time. We should have a recommendation for maximum screen time separately for developing countries.

Reciprocal within-day associations between incidental affect and exercise: An EMA study

Previous research suggests that how people feel throughout the course of a day (i.e. incidental affect) is predictive of exercise behaviour. A mostly separate literature suggests that exercise can lead to more positive incidental affect.

OBJECTIVE

This study examines the potential reciprocal effects of incidental affect and exercise behaviour within the same day.

DESIGN

Fifty-nine low-active (exercise <60 min/week), overweight (BMI: 25.0-39.9) adults (ages 18-65) participated in a six-month print-based exercise promotion programme.

MAIN OUTCOME MEASURES

Ecological momentary assessment was used to record self-reported exercise sessions in real time and incidental affective valence (feeling good/bad) as assessed by the 11-point Feeling Scale at random times throughout the day.

RESULTS

Use of a within-subjects cross-lagged, autoregressive model showed that participants were more likely to exercise on days when they experienced more positive incidental affect earlier in the day (b = .58, SE = .10, p < .01), and participants were more likely to experience more positive incidental affect on days when they had exercised (b = .26, SE = .03, p < .01), with the former association significantly stronger than the latter (t = 23.54, p < .01).

CONCLUSION

The findings suggest a positive feedback loop whereby feeling good and exercising are reciprocally influential within the course of a day.

Using the Intervention Mapping and Behavioral Intervention Technology Frameworks: Development of an mHealth Intervention for Physical Activity and Sedentary Behavior Change

Few interventions to promote physical activity (PA) adapt dynamically to changes in individuals' behavior. Interventions targeting determinants of behavior are linked with increased effectiveness and should reflect changes in behavior over time. This article describes the application of two frameworks to assist the development of an adaptive evidence-based smartphone-delivered intervention aimed at influencing PA and sedentary behaviors (SB). Intervention mapping was used to identify the determinants influencing uptake of PA and optimal behavior change techniques (BCTs). Behavioral intervention technology was used to translate and operationalize the BCTs and its modes of delivery. The intervention was based on the integrated behavior change model, focused on nine determinants, consisted of 33 BCTs, and included three main components: (1) automated capture of daily PA and SB via an existing smartphone application, (2) classification of the individual into an activity profile according to their PA and SB, and (3) behavior change content delivery in a dynamic fashion via a proof-of-concept application. This article illustrates how two complementary frameworks can be used to guide the development of a mobile health behavior change program. This approach can guide the development of future mHealth programs.

High Versus Low Theoretical Fidelity Pedometer Intervention Using Social-Cognitive Theory on Steps and Self-Efficacy

PURPOSE

This study was designed to compare a low versus high theoretical fidelity pedometer intervention applying social-cognitive theory on step counts and self-efficacy.

METHOD

Fifty-six public university employees participated in a 10-week randomized controlled trial with 2 conditions that varied in theoretical fidelity. Participants in the high theoretical fidelity condition wore a pedometer and participated in a weekly group walk followed by a meeting to discuss cognitive-behavioral strategies targeting self-efficacy. Participants in the low theoretical fidelity condition met for a group walk and also used a pedometer as a motivational tool and to monitor steps. Step counts were assessed throughout the 10-week intervention and after a no-treatment follow-up (20 weeks and 30 weeks). Self-efficacy was measured preintervention and postintervention.

RESULTS

Participants in the high theoretical fidelity condition increased daily steps by 2,283 from preintervention to postintervention, whereas participants in the low fidelity condition demonstrated minimal change during the same time period (p = .002). Individuals attending at least 80% of the sessions in the high theoretical fidelity condition showed an increase of 3,217 daily steps (d = 1.03), whereas low attenders increased by 925 (d = 0.40). Attendance had minimal impact in the low theoretical fidelity condition. Follow-up data revealed that step counts were at least somewhat maintained. For self-efficacy, participants in the high, compared with those in the low, theoretical fidelity condition showed greater improvements.

CONCLUSION

Findings highlight the importance of basing activity promotion efforts on theory. The high theoretical fidelity intervention that included cognitive-behavioral strategies targeting self-efficacy was more effective than the low theoretical fidelity intervention, especially for those with high attendance.

An RCT to Facilitate Implementation of School Practices Known to Increase Physical Activity

INTRODUCTION

Although comprehensive school-based physical activity interventions are efficacious when tested under research conditions, they often require adaptation in order for implementation at scale. This paper reports the effectiveness of an adapted efficacious school-based intervention in improving children's moderate to vigorous physical activity. The impact of strategies to support program implementation was also assessed.

DESIGN

A cluster RCT of low socioeconomic elementary schools in New South Wales, Australia.

SETTING/PARTICIPANTS

Consenting schools were randomized (25 intervention, 21 control) using a computerized random number function. Follow-up measures were taken at 6 months post-randomization (May-August 2015) by blinded research assistants. The multicomponent school-based intervention, based on an efficacious school-based physical activity program (Supporting Children's Outcomes using Rewards, Exercise and Skills), consisted of four physical activity strategies and seven implementation support strategies. The intervention was adapted for scalability and delivery by a local health service over 6 months. The primary outcome was accelerometer assessed, student mean daily minutes spent in moderate to vigorous physical activity. Physical education lesson quality and other school physical activity practices were also assessed.

RESULTS

Participants (n=1,139, 49% male) were third- through sixth-grade students at follow-up (May-August 2015). Valid wear time and analysis of data were provided for 989 (86%) participants (571 intervention, 568 control). At 6-month follow-up, there were no significant effects in overall daily minutes of moderate to vigorous physical activity between groups (1.96 minutes, 95% CI= -3.49, 7.41, p=0.48). However, adjusted difference in mean minutes of overall vigorous physical activity (2.19, 95% CI=0.06, 4.32, p=0.04); mean minutes of school day moderate to vigorous physical activity (2.90, 95% CI=0.06, 5.85, p=0.05); and mean minutes of school day vigorous physical activity (1.81, 95% CI=0.78, 2.83, p≤0.01) were significantly different in favor of the intervention group. Physical education lesson quality and school physical activity practices were significantly different favoring the intervention group (analyzed October 2015-January 2016).

CONCLUSIONS

The modified intervention was not effective in increasing children's overall daily minutes of moderate to vigorous physical activity, when adapted for implementation at scale. However, the intervention did improve daily minutes of vigorous physical activity and school day moderate to vigorous physical activity, lesson quality, and school physical activity practices.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12615000437561.

Changes in Individual and Social Environmental Characteristics in Relation to Changes in Physical Activity: a Longitudinal Study from Primary to Secondary School

PURPOSE

Physical activity (PA) strongly decreases when children make the transition from primary to secondary school. The study aimed to investigate how individual and social environmental factors toward PA changed when children (11-12 years) made the transition from primary to secondary school (13-14 years) and how changes in these factors were related to changes in different PA domains.

METHODS

In total, 321 children (48.9 % girls) and one of their parents both filled out a questionnaire concerning individual (i.e., attitude, self-efficacy, perceived benefits, and barriers of PA) and social environmental factors related to PA (parental support, friend's co-participation, parental trust in child's ability to be physically active, and social norm) in the last grade of primary school and 2 years later. Children wore an activity monitor for 7 days and self-reported different domains of PA.

RESULTS

Most individual and social factors became less positive toward PA after the transition to secondary school. Among girls, a more positive attitude and an increase in self-efficacy were related to an increase in average daily steps and sports during leisure, respectively. Among boys, a decrease in perceived barriers (lack of time and parental reported lack of transportation to sport activities) was related to a decrease in average daily steps. An increase in parental support and a decrease in the parental perceived barrier of not liking sports were related to an increase in sports during leisure.

CONCLUSIONS

The prevention of adverse changes in individual and social factors toward physical activity may lead to a smaller decrease or an increase in physical activity.

A Telerehabilitation Approach to Enhance Quality of Life Through Exercise Among Adults With Paraplegia: Study Protocol

Background

Despite compelling evidence linking physical activity and quality of life among adults with spinal cord injury (SCI), exercise participation rates are extremely low in this population. Unfortunately, a lack of behavioral exercise interventions, in particular theory-based randomized controlled trials (RCT), exists within the SCI literature. A pilot RCT is needed to first examine the feasibility to conduct such interventions and determine the appropriate effect size to inform future full-scale interventions.

Objective

The overall goal of this pilot RCT is to test an 8-week innovative, video-based telerehabilitation intervention based on self-determination theory and aimed at enhancing the basic psychological needs, motivation, exercise participation, and quality of life‒related outcomes of adults with paraplegia. The objectives are to (1) determine if individuals in the intervention group have greater increases in their basic psychological needs and autonomous motivation and a decrease in controlled motivation compared to the control group, (2) determine whether the intervention group reports greater increases in exercise participation and quality of life‒related variables (eg, life satisfaction, participation in daily/social activities, depressive symptoms) compared to the control group, and (3) examine if adults with paraplegia who received the intervention report improved scores on psychosocial predictors of exercise (eg, action planning) and well-being (eg, positive affect) compared to the control group. We also aimed to examine the implementation characteristics of the intervention (eg, satisfaction with the technology, counselor’s ability to foster the psychological needs).

Methods

Adults with paraplegia (N=24) living in the community will be recruited. All participants will be invited to complete assessments of their psychological needs, motivation, exercise, and quality of life‒related variables at three time points (baseline, 6, and 10 weeks). Following the baseline assessment, participants will be randomly assigned to the intervention or control group. Participants in the intervention group will participate in 8 weekly, 1-hour video-based telerehabilitation sessions with a trained physical activity counselor, while participants in the control group will be asked to continue with their regular routine.

Results

We expect higher ratings of the basic psychological needs and autonomous motivation and lower scores for controlled motivation for the intervention group compared to the control group (Objective 1). We also expect that our video-based intervention will have moderate effects on exercise participation, as well as small-to-moderate positive effects on the quality of life‒related variables (Objective 2). Finally, we expect the intervention to have a small positive effect on psychosocial predictors of physical activity and well-being (Objective 3).

Conclusions

We anticipate that the results will show that the intervention is appropriate for adults with paraplegia and feasible to test in a full-scale RCT.

Trial Registration

ClinicalTrials.gov NCT02833935; https://clinicaltrials.gov/ct2/show/NCT02833935 (Archived by WebCite at http://www.webcitation.org/6u8U9x2yt)

Effects of an after-school care-administered physical activity and nutrition protocol on body mass index, fitness levels, and targeted psychological factors in 5- to 8-year-olds

Over one third of U.S. youth are overweight or obese. Treatments typically have had unreliable effects, inconsistently incorporating behavior-change theory. After-school care might be a viable setting for health behavior-change programs. We evaluated effects of two consecutive 12-week segments of a revised self-efficacy/social cognitive theory-based physical activity and nutrition treatment on fitness levels, body mass index (BMI), and targeted psychosocial factors in after-school care participants, ages 5-8 years. Changes in physiological measures, exercise self-efficacy (ESE), and physical self-concept over 9 months were contrasted in experimental (n = 72) vs. typical-care (n = 42) groups. Mediation of the group-BMI change relationship by the psychosocial factors was also assessed. Improvements in physiological measures and ESE were significantly greater in the experimental group. ESE change completely mediated the association of treatment type with BMI change. The experimental group demonstrated significantly greater improvements in the physiological measures, with its treatment's theoretical basis and application within after-school care supported.

Physical activity and body image among men and boys: A meta-analysis

Three meta-analytic reviews have concluded that physical activity is positively related to body image. Historically, research regarding physical activity and body image has been disproportionately focused on female samples. For example, the most recent meta-analysis (2009) extracted 56 effect sizes for women and only 12 for men. The current paper provides an update to the literature regarding the relationship between physical activity and body image among men and boys across 84 individual effect sizes. The analysis also provides insight regarding moderator variables including participant age, and physical activity type and intensity. Overall, physical activity was positively related to body image among men and boys with various moderator variables warranting further investigation. Pragmatic implications are discussed as well as the limitations within existing research and need for additional research to further understand moderator and mediator variables.

Protocol for the residents in action pilot cluster randomised controlled trial (RiAT): evaluating a behaviour change intervention to promote walking, reduce sitting and improve mental health in physically inactive older adults in retirement villages

INTRODUCTION

Ageing is accompanied by increased risks of chronic disease, declined functioning and increased dependency. Physical activity is critical to retaining health and independence, but the majority of older people are insufficiently physically active to achieve these benefits and have high levels of sedentary (sitting) time. Activity programmes are often offered in retirement villages; however, their uptake is limited. Furthermore, although the physical environment in and around these villages can play an important role in decisions to be physically active, its role is often overlooked by research in these settings. We aim to develop, implement and evaluate a proof-of-concept motivationally embellished intervention designed to increase walking, reduce sitting and improve mental health in residents in retirement villages.

METHODS AND ANALYSIS

This will be a 16-week pilot intervention using a cluster randomised design with retirement villages as the unit of randomisation and residents as the unit of assessment. Fourteen retirement villages around Perth, Western Australia, will be recruited for the intervention. Objective audits of neighbourhood environments around each village will be completed using the Pathway Environmental Audit Tool. Seven villages will be randomised to the experimental arm and seven to the control arm. Only participants in the experimental arm will receive motivational training. All outcomes will be assessed at baseline, end of intervention and 6-month follow-up. Changes in physical activity levels, sitting time and mental health will be examined. Multilevel modelling will be used to analyse the data. A mixed methods process evaluation will also be conducted.

ETHICS AND DISSEMINATION

Ethics approval was granted by Curtin University's Human Research Ethics Committee (HREC2016-0187). The results of the study will be disseminated via peer-reviewed publications, conference presentations and reports to, and seminars with, stakeholders.

TRIAL REGISTRATION

The trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12616001177448.

Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes

OBJECTIVES

Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).

DESIGN

Randomized control trial with two intervention arms and control (standard care).

METHOD

Participants (N=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.

RESULTS

At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < .05) and significantly higher exercise min and subjective norm than the Home group (p's < .05); these effect sizes were medium-large (η2 = .11-.23). There was a medium effect (η2 = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.

CONCLUSION

A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.

Psychosocial and environmental correlates of active and passive transport behaviors in college educated and non-college educated working young adults

Background

This study aimed to examine potential differences in walking, cycling, public transport and passive transport (car/moped/motorcycle) to work and to other destinations between college and non-college educated working young adults. Secondly, we aimed to investigate which psychosocial and environmental factors are associated with the four transport modes and whether these associations differ between college and non-college educated working young adults.

Methods

In this cross-sectional study, 224 working young adults completed an online questionnaire assessing socio-demographic variables (8 items), psychosocial variables (6 items), environmental variables (10 items) and transport mode (4 types) and duration to work/other destinations. Zero-inflated negative binomial regression models were performed in R.

Results

A trend (p<0.10) indicated that more college educated compared to non-college educated young adults participated in cycling and public transport. However, another trend indicated that cycle time and public transport trips were longer and passive transport trips were shorter in non-college compared to college educated working young adults. In all working young adults, high self-efficacy towards active transport, and high perceived benefits and low perceived barriers towards active and public transport were related to more active and public transport. High social support/norm/modeling towards active, public and passive transport was related to more active, public and passive transport. High neighborhood walkability was related to more walking and less passive transport. Only in non-college educated working young adults, feeling safe from traffic and crime in their neighborhood was related to more active and public transport and less passive transport.

Conclusions

Educational levels should be taken into account when promoting healthy transport behaviors in working young adults. Among non-college educated working young adults, focus should be on increasing active and public transport participation and on increasing neighborhood safety to increase active and public transport use. Among college educated working young adults, more minutes of active transport should be encouraged.

Can Policy Alone Stop Decline of Children and Youth Fitness?

Various models and methods have been proposed to address the worldwide decline in children's and youth's physical fitness, and the social-ecological model has shown some promise. Yet, the impact of the policy intervention, 1 component of that model, has not been evaluated carefully. Using limited data from policy documents, the impact of policy related to children and youth fitness in China was examined, and it was found that the policy alone did not seem to work. Possible reasons are explored, and a call for more policy evaluation research is made.

Promoting Active Transport in Older Adolescents Before They Obtain Their Driving Licence: A Matched Control Intervention Study

Background

Active transport has great potential to increase physical activity in older adolescents (17–18 years). Therefore, a theory- and evidence-based intervention was developed aiming to promote active transport among older adolescents. The intervention aimed to influence psychosocial factors of active transport since this is the first step in order to achieve a change in behaviour. The present study aimed to examine the effect of the intervention on the following psychosocial factors: intention to use active transport after obtaining a driving licence, perceived benefits, perceived barriers, subjective norm, self-efficacy, habit and awareness towards active transport.

Methods

A matched control three-arm study was conducted and consisted of a pre-test post-test design with intervention and control schools in Flanders (northern part of Belgium). A lesson promoting active transport was implemented as the last lesson in the course ‘Driving Licence at School’ in intervention schools (intervention group 1). Individuals in intervention group 2 received this active transport lesson and, in addition, they were asked to become a member of a Facebook group on active transport. Individuals in the control group only attended the regular course ‘Driving Licence at School’. Participants completed a questionnaire assessing socio-demographics and psychosocial variables at baseline, post (after one week) and follow-up (after eight weeks). To assess intervention effects, multilevel linear mixed models analyses were performed.

Results

A sample of 441 older adolescents (56.8% female; 17.4 (0.7) years) was analysed. For awareness regarding the existence of car sharing schemes, a significant increase in awareness from baseline to post measurement was found within intervention group 1 (p = 0.001) and intervention group 2 (p = 0.030) compared to the control group in which no change was found. In addition, a significant increase in awareness from baseline to follow-up measurement was found within intervention group 1 (p = 0.043) compared to a decrease in awareness from baseline to follow-up measurement within the control group.

Conclusions

Overall, the intervention was not effective to increase psychosocial correlates of active transport. Future intervention studies should search for alternative strategies to motivate and involve this hard to reach target group.

Determinants of Three-Year Change in Children's Objectively Measured Sedentary Time

BACKGROUND

Sedentary behaviours (SB) are highly prevalent in young people and may be adversely associated with physical and mental health. Understanding of the modifiable determinants of SB is necessary to inform the design of behaviour change interventions but much of the existing research is cross-sectional and focussed upon screen-based behaviours.

PURPOSE

To examine the social, psychological and environmental determinants of change in children's objectively measured sedentary time from age 11 to 14 years.

METHODS

Data are from the second (2008) and third (2011) waves of assessment in the Sport, Physical Activity, and Eating Behaviour: Environmental Determinants in Young People (SPEEDY) study, conducted in the county of Norfolk, United Kingdom. Longitudinal data on accelerometer assessed sedentary time were available for 316 (53.5% female, 11.2±0.3 years at baseline) and 264 children after-school and at the weekend respectively. Information on 14 candidate determinants, including school travel mode and electronic media ownership, was self-reported. Change in the proportion of registered time spent sedentary was used as the outcome variable in cross-classified linear regression models, adjusted for age, sex, body mass index and baseline sedentary time. Simple and multiple models were run and interactions with sex explored.

RESULTS

Daily sedentary time increased by 30-40 minutes after-school and at the weekend from baseline to follow-up. Participants who travelled to school by cycle exhibited smaller increases in after-school sedentary time (beta; 95%CI for change in % time spent sedentary: -3.3;-6.7,-0.07). No significant determinants of change in weekend sedentary time were identified.

CONCLUSIONS

Time spent sedentary increased during the three-year duration of follow-up but few of the variables examined were significantly associated with changes in sedentary time. Children's mode of school travel may influence changes in their sedentary time over this period and should be examined further, alongside broader efforts to identify modifiable determinants of SB during childhood.

The moderating effect of psychosocial factors in the relation between neighborhood walkability and children's physical activity

Background

The study aimed to investigate if psychosocial factors moderate the association between objective walkability and different domains of children’s physical activity (PA). A second aim of the study was to investigate the direct associations between psychosocial factors and children’s PA. Based on previous literature, it was hypothesized that walkability would be more strongly related to PA among children with negative psychosocial profiles.

Methods

Data were collected between December 2011 and May 2013 as part of the Belgian Environmental Physical Activity Study in children (BEPAS-child). In total, data from 494 children and one of their parents were included in the study. Children wore an accelerometer for 7 consecutive days and together with one of their parents, they completed the Flemish Physical Activity Questionnaire. Parents filled out a questionnaire concerning their child’s psychosocial factors toward PA (i.e. parental attitude toward their child’s PA, parental social norm toward their child’s PA, parental support, friend support, children’s self-efficacy, and perceived benefits and barriers toward sports and PA). Neighborhood walkability was calculated using geographical information systems (GIS). Multilevel cross-classified analyses were conducted.

Results

Of the 42 investigated interactions between neighborhood walkability and psychosocial factors in relation to PA among children, only 7 significant interactions were found of which 3 were only significant among children from low-income neighborhoods.

Parental support and self-efficacy were positive correlates of children’s PA in high- and low-income neighborhoods independent of the level of walkability, but effect sizes were small.

Conclusions

The hypothesis that walkability would be more strongly related to PA among children with negative psychosocial profiles could not be confirmed and in general, psychosocial factors and objective walkability did not interact in relation to children’s PA. Focusing on parental support and self-efficacy towards PA can possibly cause small effects on children’s PA in both high- and low-walkable neighborhoods, as well as in high- and low-income neighborhoods.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0452-0) contains supplementary material, which is available to authorized users.

Evaluation of a School-Based Intervention Programme to Promote Physical Activity: An Application of the Theory of Planned Behavior

The Theory of Planned Behavior provides a useful framework to study attitudes toward participation in physical activity. The objective of the study was to test the effectiveness of an intervention in manipulating the variables of the Theory of Planned Behavior and exercise habits with 366 high school students ( M = 14.2 yr., SD = .7; 201 boys and 165 girls). The students were divided into intervention and control groups. A questionnaire to measure components of the theory, and the Baecke Questionnaire of Habitual Activity measuring exercise habits, were administered. The intervention lasted 12 wk. and included posters and lectures promoting participation in physical activity. Analyses showed the intervention was effective in improving attitudes towards physical activity, perceived behavioral control, intention, and self-reported actual behavior, but it was ineffective for improving attitude strength, subjective norms, and role identity. The results provide useful information for physical education teachers interested in promoting students' positive attitudes towards physical activity.

The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion

BACKGROUND

Physical activity interventions targeting children and adolescents (≤18 years) often focus on complex intra- and inter-personal behavioral constructs, social-ecological frameworks, or some combination of both. Recently published meta-analytical reviews and large-scale randomized controlled trials have demonstrated that these intervention approaches have largely produced minimal or no improvements in young people's physical activity levels.

DISCUSSION

In this paper, we propose that the main reason for previous studies' limited effects is that fundamental mechanisms that lead to change in youth physical activity have often been overlooked or misunderstood. Evidence from observational and experimental studies is presented to support the development of a new theory positing that the primary mechanisms of change in many youth physical activity interventions are approaches that fall into one of the following three categories: (a) the expansion of opportunities for youth to be active by the inclusion of a new occasion to be active, (b) the extension of an existing physical activity opportunity by increasing the amount of time allocated for that opportunity, and/or (c) the enhancement of existing physical activity opportunities through strategies designed to increase physical activity above routine practice. Their application and considerations for intervention design and interpretation are presented. The utility of these mechanisms, referred to as the Theory of Expanded, Extended, and Enhanced Opportunities (TEO), is demonstrated in their parsimony, logical appeal, support with empirical evidence, and the direct and immediate application to numerous settings and contexts. The TEO offers a new way to understand youth physical activity behaviors and provides a common taxonomy by which interventionists can identify appropriate targets for interventions across different settings and contexts. We believe the formalization of the TEO concepts will propel them to the forefront in the design of future intervention studies and through their use, lead to a greater impact on youth activity behaviors than what has been demonstrated in previous studies.

Psychological Correlates of Self-Reported and Objectively Measured Physical Activity among Chinese Children-Psychological Correlates of PA

This study aimed to explore the associations among psychological correlates and physical activity (PA) in Chinese children and to further examine whether these associations varied by different PA measures. PA self-efficacy, motivation, and preference were reported in 449 8–13-year-old Chinese children (252 males). Moderate- to vigorous- intensity PA (MVPA) was measured by the Physical Activity Questionnaire for Older Children (PAQ-C) and with an ActiGraph GT3X accelerometer. Correlations and hierarchical regressions were performed to explore their associations. The study psychological variables were all positively related to PAQ-C and objective MVPA (r: 0.22–0.63). The associations with PAQ-C were all substantially stronger than those with accelerometry. Beyond the explained variance accounted for by demographics and social desirability, the addition of the psychological correlates accounted for 45% of the variance of the PAQ-C score, while only 13% for accelerometry-based MVPA. The associations of specific variables with the PAQ-C score (age, PA self-efficacy, autonomous motivation and preference) were somewhat different from those associated with objective MVPA (PA self-efficacy, autonomous motivation, and negatively associated with female gender). This study demonstrated the importance of self-efficacy and autonomous motivation in association with PA and indicated the difference in level of their associations with different PA measures.

The parental role in adolescent screen related sedentary behavior

BACKGROUND

Adolescents spend an increasing amount of their time engaged in screen using activities. The present study aimed at identifying parental factors associated with screen time among Greek adolescents.

METHODS

A sample of 1141 adolescents, as well as their parents, participated in this survey. Adolescents were asked to complete a questionnaire about time spent on screen-viewing behaviors. Respectively, parents completed a questionnaire concerning family predictors. Multiple regression analysis was used to determine correlates of adolescent screen-viewing with family predictors.

RESULTS

The mean screen time per weekday was 193 min. Adolescents, whose parents had received up to secondary school education, spend more time in screen-viewing compared with the other groups. Controlling adolescents' gender and age, all the family variables (perceived rules, parental modeling, parents' screen related sedentary behavior, parental concern for screen viewing, support for physical activity, parental education) were statistically significant in predicting adolescent screen time with Perceived Rules recording a higher negative beta value (β=-0.18, p<0.00).

CONCLUSION

Perceived parental screen time rules play a role in the amount of screen time among adolescents. Interventions that focus on parental limit setting development and physical activity support may be effective in decreasing screen time among youth aged 13-15 years.

Mediating Mechanisms of Theory-Based Psychosocial Determinants on Behavioral Changes in a Middle School Obesity Risk Reduction Curriculum Intervention, Choice, Control, and Change

BACKGROUND

A limited number of school-based intervention studies have explored mediating mechanisms of theory-based psychosocial variables on obesity risk behavior changes. The current study investigated how theory-based psychosocial determinants mediated changes in energy balance-related behaviors (EBRBs) among urban youth.

METHODS

A secondary analysis study was conducted using data from a cluster randomized controlled trial. Data from students at 10 middle schools in New York City (n = 1136) were used. The intervention, Choice, Control, and Change curriculum, was based on social cognitive and self-determination theories. Theory-based psychosocial determinants (goal intention, cognitive outcome expectations, affective outcome expectations, self-efficacy, perceived barriers, and autonomous motivation) and EBRBs were measured with self-report questionnaires. Mediation mechanisms were examined using structural equation modeling, Results: Mediating mechanisms for daily sugar-sweetened beverage (SSB) consumption and purposeful stair climbing were identified. Models with best fit indices (root mean square error of approximation = 0.039/0.045, normed fit index = 0.916/0.882; comparative fit index = 0.945/0.932; Tucker-Lewis index = 0.896/0.882, respectively) suggested that goal intention and reduced perceived barriers were significant proximal mediators for reducing SSB consumption among both boys and girls or increasing physical activity by stair climbing among boys. Cognitive outcome expectations, affective outcome expectations, self-efficacy, and autonomous motivation indirectly mediated behavioral changes through goal intention or perceived barriers (p < 0.05 to p < 0.001). The final models explained 25%-27% of behavioral outcome variances.

CONCLUSIONS

Theory-based psychosocial determinants targeted in Choice, Control, and Change in fact mediated behavior changes in middle school students. Strategies targeting these mediators might benefit future success of behavioral interventions. Further studies are needed to determine other potential mediators of EBRBs in youth.

Associations among measures of energy balance related behaviors and psychosocial determinants in urban upper elementary school children

BACKGROUND

Childhood obesity prevention is a pressing issue. Understanding the relationships among eating and physical activity behaviors and potential psychosocial determinants of behavior will help us design more effective interventions. This study aimed to examine such relationships in a large sample of urban elementary school children.

METHODS

Fifth grade students in 20 recruited New York City public schools completed a validated questionnaire on six "do more" (fruits and vegetables and physical activity) and "do less" (sweetened beverages, processed packaged snacks, fast food and sedentary behavior) energy balance related behaviors (EBRBs) and psychosocial determinants of behavior from social cognitive and self-determination theories. Correlations among behaviors and hierarchical linear model analyses of the relationship between psychosocial determinants and behaviors were conducted for those with complete data (n = 952).

RESULTS

The "do more" and the "do less" behaviors were significantly correlated within categories (p < 0.01). "Do more" food-related behaviors were correlated with physical activity but so were sports drinks, while the "do less" food-related behaviors tended to be correlated to sedentary behavior (p < 0.01). "Do more" behaviors were associated with self-efficacy and habit strength, and "do less" behaviors with outcome expectations, self-efficacy, habit strength, and behavioral intention.

CONCLUSIONS

Interventions can address the healthy and less healthy clusters of behaviors together, focusing on strategies to enhance their self-efficacy and habit strength for the "do more" behaviors and outcome expectations to motivate intention to choose fewer "do less" behaviors, along with enhancing self-efficacy and habit. Research can examine these determinants as potential mediators of change in intervention.

Relationship of Social Cognitive Theory Factors to Exercise Maintenance in Adults

Modifiable variables related to Bandura's social cognitive theory were tested for their relationship to self-reported retrospective exercise maintenance in 178 adults. Significant bivariate correlations were found between length of adherence to regular moderate-to-vigorous exercise and item clusters reflecting social support ( r = .42), self-management ability ( r = .39), and ability to tolerate exercise-induced discomfort ( r = .60). Stepwise multiple regression analysis indicated that each item cluster significantly contributed to the overall explained variance in length of exercise maintenance over 52 weeks ( R2 = .43). When responses from each of the item clusters were summed, participants defined as adherents had significantly higher scores than dropouts. Discussion emphasized the need for replication and implications for exercise adherence intervention.

A Schematic for Focusing on Youth in Investigations of Community Design and Physical Activity

This paper provides a first step in addressing special considerations for youth in a relatively new area of physical activity research. After reviewing the urgent need for novel approaches to increasing physical activity, the growing interest in the effects of community design are discussed. Although most discussion on this topic has focused on adults, there are important differences between youth and adults that warrant a special focus on youth and need to be accounted for. This article presents a schematic that accounts for how and where youth spend their time, decomposing the day into time spent in travel and time spent at destinations, and identifying portions of those times that are spent engaged in physical activity. By focusing on both spatial and behavioral dimensions of youth time, the schematic may help organize and advance scientific inquiry into the relationships between community design and physical activity specifically for youth.

Predicting Changes Across 12 Months in Three Types of Parental Support Behaviors and Mothers' Perceptions of Child Physical Activity

BACKGROUND

Parental support has been established as the critical family-level variable linked to child physical activity with encouragement, logistical support, and parent-child co-activity as key support behaviors.

PURPOSE

This study aims to model these parental support behaviors as well as family demographics as mediators of mothers' perceptions of child physical activity using theory of planned behavior (TPB) across two 6-month waves of longitudinal data.

METHOD

A representative sample of Canadian mothers (N = 1253) with children aged 5 to 13 years of age completed measures of TPB, support behaviors, and child physical activity.

RESULTS

Autoregressive structural equation models showed that intention and perceived behavioral control explained support behaviors, yet child age (inverse relationship) and family income were independent predictors. The three support behaviors explained 19-42 % of the variance in child physical activity between participants, but analyses of change showed much smaller effects.

CONCLUSIONS

Mothers' support behaviors are related to perceived child physical activity, but support is dependent on perception of control, child age, and family income.

Association Between the Built Environment in School Neighborhoods With Physical Activity Among New York City Children, 2012

INTRODUCTION

The benefits of physical activity for health and well-being are well established, yet built environment characteristics in the school neighborhood may constrain students' ability to engage in physical activity and contribute to the considerable variation in physical activity among students at different schools.

METHODS

Baseline data from the Food, Health and Choices obesity prevention trial were used to create multilevel linear models of the relationship between fifth-grade students' (n = 952) physical activity and related psychosocial factors and characteristics of the built environment of the school's neighborhood (park access, public transportation density, total crime, and walkability), controlling for age and body mass index z scores.

RESULTS

Total crime was inversely associated with boys' light physical activity duration (β = -0.189; P = .02) and behavioral intention for physical activity (β = -0.178; P = .03). Boys' habit strength for physical activity was positively associated with public transportation density (β = 0.375; P = .02) and negatively associated with total crime (β = -0.216; P = .01), explaining 67% of between-school variation. Girls' frequency of light physical activity was positively associated with park access (β = 0.188; P = .04). Built environment characteristics explained 97% of the between-school variation in girls' self-efficacy in walking for exercise.

CONCLUSIONS

Characteristics of the built environment surrounding schools were associated with and explain between-school variation in students' physical activity and several theory-based psychosocial factors. Partnerships between public health practitioners, policy makers, and school administrators may be warranted to shape the school neighborhood, specifically to decrease crime rates and increase park access, to encourage physical activity in youth.

The Physical Activity 4 Everyone Cluster Randomized Trial: 2-Year Outcomes of a School Physical Activity Intervention Among Adolescents

INTRODUCTION

Few interventions have been successful in reducing the physical activity decline typically observed among adolescents. The aim of this paper is to report the 24-month effectiveness of a multicomponent school-based intervention (Physical Activity 4 Everyone) in reducing the decline in moderate to vigorous physical activity (MVPA) among secondary school students in disadvantaged areas of New South Wales, Australia.

STUDY DESIGN

A cluster RCT was conducted in five intervention and five control schools with follow-up measures taken at 24 months post-randomization.

SETTING/PARTICIPANTS

The trial was undertaken within secondary schools located in disadvantaged communities in New South Wales, Australia.

INTERVENTION

A multicomponent school-based intervention based on the Health Promoting Schools Framework was implemented. The intervention consisted of seven physical activity promotion strategies that targeted the curriculum (teaching strategies to increase physical activity in physical education lessons, student physical activity plans, and modification of school sport program); school environment (recess/lunchtime activities, school physical activity policy); parents (parent newsletters); and community (community physical activity provider promotion). Six additional strategies supported school implementation of the physical activity intervention strategies.

MAIN OUTCOME MEASURE

Minutes per day spent in MVPA, objectively measured by accelerometer.

RESULTS

Participants (N=1,150, 49% male) were a cohort of students aged 12 years (Grade 7) at baseline (March-June 2012) and 14 years (Grade 9) at follow-up (March-July 2014). At 24-month follow-up, there were significant effects in favor of the intervention group for daily minutes of MVPA. The adjusted mean difference in change in daily MVPA between groups was 7.0 minutes (95% CI=2.7, 11.4, p<0.002) (analysis conducted December 2014-February 2015). Sensitivity analyses based on multiple imputation were consistent with the main analysis (6.0 minutes, 95% CI=0.6, 11.3, p<0.031).

CONCLUSIONS

The intervention was effective in increasing adolescents' minutes of MVPA, suggesting that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000382875.

Psychosocial predictors of changes in adolescent girls' physical activity and dietary behaviors over the course of the Go Girls! group-based mentoring program

Changes in social cognitions targeted within a group-based mentoring program for adolescent girls were examined as predictors of changes in physical activity (PA) and dietary behavior (in two separate models) over the course of the 7-week program. Data were collected from 310 participants who participated in the program. Multilevel path models were used to assess changes in psychosocial variables predicting changes in behavioral outcomes from pre- to post-program. Analyses revealed that 24.4 and 12.3% of the variance in increases in PA and dietary behavior, respectively, was explained by increases in affective and instrumental attitudes, self-regulatory efficacy (SRE), and intentions. Increases in intentions partially mediated the effects of increases in SRE and affective attitudes on increases in PA behavior. In relation to improvements in dietary behavior, increases in intentions and SRE directly predicted improvements in dietary behavior. These findings suggest potential psychological mechanisms through which a group-based mentoring program may lead to changes in adolescent girls' health-enhancing PA and dietary behaviors.

A Health Educator's Guide to Theories of Health Behavior

Numerous health behavior theories (HBTs), each which attempt to explain why individuals engage in (or fail to engage in) health-related behaviors, exist in the literature. While much attention has been devoted to testing individual theories, little attention has been paid to issues that arise in the selection of theories. The current article has three goals. First, to describe some of the most widely used individual-level HBTs. Second, to discuss the application of these theories to successful health promotion efforts. And finally, to compare and contrast numerous HBTs and provide an example for how a selected theory might be applied to a health education program. The overriding goal is to provide guidance to researchers, health educators and other interventionists with regard to the important decision of which theory to use as a basis for one's health promotion efforts.

Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial

BACKGROUND

Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions.

METHODS/DESIGN

This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention "dose", website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme.

DISCUSSION

The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a 'points' based loyalty platform, whereby local businesses 'sponsor' the incentive (retail vouchers) in return for increased footfall to their business.

TRIAL REGISTRATION

ISRCTN17975376 (Registered 19/09/2014).

A Test of Social Cognitive Theory to Explain Men’s Physical Activity During a Gender-Tailored Weight Loss Program

Physical inactivity is a leading contributor to the burden of disease in men. Social–cognitive theories may improve physical activity (PA) interventions by identifying which variables to target to maximize intervention impact. This study tested the utility of Bandura’s social cognitive theory (SCT) to explain men’s PA during a 3-month weight loss program. Participants were 204 overweight/obese men ( M [ SD] age = 46.6 [11.3] years; body mass index = 33.1 [3.5] kg/m2). A longitudinal, latent variable structural equation model tested the associations between SCT constructs (i.e., self-efficacy, outcome expectations, intention, and social support) and self-reported moderate-to-vigorous PA (MVPA) and examined the total PA variance explained by SCT. After controlling for Time 1 cognitions and behavior, the model fit the data well (χ2 = 73.9, degrees of freedom = 39, p < .001; normed χ2 = 1.9; comparative fit index = 0.96; standardized root mean residual = 0.059) and explained 65% of the variance in MVPA at Time 2. At Time 2, self-efficacy demonstrated the largest direct and total effects on MVPA (βdirect = .45, p < .001; βtotal = .67, p = .002). A small-to-medium effect was observed from intention to MVPA, but not from outcome expectations or social support. This study provides some evidence supporting the tenets of SCT when examining PA behavior in overweight and obese men. Future PA and weight loss interventions for men may benefit by targeting self-efficacy and intention, but the utility of targeting social support and outcome expectations requires further examination.

Physical activity and multiple sclerosis: a meta-analysis

Using meta-analytic procedures, this study involved a quantitative synthesis of the difference in physical activity among individuals with multiple sclerosis (MS) compared with nondiseased and diseased populations and then examined factors (i.e., moderators) that explain variation in the overall difference in physical activity. We searched MEDLINE, PsycINFO and Current Contents Plus using the key words physical activity, exercise and physical fitness in conjunction with multiple sclerosis; conducted a manual search of bibliographies of the retrieved papers; and contacted study authors about additional studies. Overall, 53 effects were retrieved from 13 studies with 2360 MS participants and yielded a weighted mean effect size (ES) of -0.60 (95% CI= -0.44,-0.77). The weighted mean ES was heterogenous, Q=1164.11, df=52, p<0.0001. There were larger effects with objective versus self-report measures of physical activity, nondiseased versus diseased populations and primary progressive versus relapsing-remitting MS. The cumulative evidence suggests that individuals with MS are less physically active than nondiseased, but not diseased, populations.

Texting to Increase Adolescent Physical Activity: Feasibility Assessment

OBJECTIVE

Feasibility trials assess whether a behavior change program warrants a definite trial evaluation. This paper reports the feasibility of an intervention consisting of Self Determination Theory-informed text messages, pedometers, and goal prompts to increase adolescent physical activity.

METHODS

A 4-group randomized design with baseline and immediate post-study assessments was used. Groups (pedometer; pedometer + goal prompt; pedometer + goal prompt + theory-informed texts; no-treatment control) were systematically varied to assess the additive effect of intervention components on objectively measured physical activity (ie, ActiGraph). The primary outcome of the 12-week intervention was program feasibility. Changes in average daily step counts and minutes of moderate-to-vigorous physical activity also were examined. Post-intervention research with a subset of participants examined program reactions.

RESULTS

Participants (N = 160) were evenly split by sex, mostly 14-15 years old, and of diverse race/ethnicity. Feasibility criteria were met. The attrition rate was less than 2%. Modest increases in average daily step counts and moderate-to-vigorous physical activity were observed in all groups except the control group. Participants reported positive reactions to the intervention.

CONCLUSIONS

An intervention consisting of pedometers, theory-informed texts, and goal prompts, is a feasible and acceptable method for promoting physical activity to adolescents.

Validity and Reliability of Behavior and Theory-Based Psychosocial Determinants Measures, Using Audience Response System Technology in Urban Upper-Elementary Schoolchildren

OBJECTIVE

To examine the validity and reliability of a questionnaire administered with an audience response system (ARS).

DESIGN

Cross-sectional study.

SETTING

Two New York City public elementary schools.

PARTICIPANTS

Fourth- and fifth-grade students.

MAIN OUTCOME MEASURES

A Food, Health, and Choices questionnaire (FHC-Q) assessed energy balance-related behaviors (EBRBs) including intake of fruits and vegetables, sugar-sweetened beverages, processed packaged snacks, and fast food; physical activity; recreational screen time; and associated psychosocial determinants (≥ 3 questions/outcome scale). Previously validated reference instruments were used for relative validation. The ARS format was compared with a paper-and-pencil format. All measures were administered in a classroom setting.

ANALYSIS

Pearson correlation coefficients between the reference instruments and the FHC-Q were calculated. Internal consistency reliabilities were evaluated with Cronbach α. Spearman rank correlation, intra-class correlation, and percent agreement were used for test-retest reliability between paper-and-pencil and ARS, and between 2 ARS FHC-Q administrations.

RESULTS

Correlations for EBRBs with reference instruments ranged from 0.38 to 0.61 (P < .01). Cronbach α ranged from .77 to .92 for EBRBs and .74 to .90 for psychosocial determinants. Test-retest reliability correlations ranged from 0.36 to 0.87 (P < .001). Agreement for knowledge questions ranged from 69.8% to 84.8%.

CONCLUSIONS AND IMPLICATIONS

The ARS FHC-Q has acceptable validity and reliability for collecting data on EBRBs and associated psychosocial determinants for upper-elementary students.

The Long-Term Impact of a Four-Session Work-Site Intervention on Selected Social Cognitive Theory Variables Linked to Adult Exercise Adherence

Many work-site physical activity interventions use theoretical variables in the design of their programs. Yet, these interventions do not document the degree of change in theoretical variables produced by the intervention. This study examined the construct validity of an intervention designed to affect social cognitive theory variables linked to exercise behavior. Construct validation methods were used to evaluate an instructional intervention composed of four 60-minute sessions delivered across 2 weeks. Increases were found in self-regulation skills, outcome-expectancy values, and self-efficacy for the treatment group. No significant increases were detected for the comparison group on any study variables. Sixty-seven percent of the treatment group was able to maintain exercise behavior across 12 months, whereas the comparison group declined in exercise participation from 68% to 25% across 12 months. The study revealed the intervention effective in producing the intended changes in social cognitive theory constructs. The analysis shows self-regulation-mediated exercise behavior.

An After-School Physical Activity Program for Obesity Prevention in Children

This article describes the process of setting up a 3-year, school-based after-school physical activity intervention in elementary schools. The primary aim of the study is to determine whether adiposity and fitness will improve in children who are exposed to a fitogenic versus an obesogenic environment. Eighteen schools were randomized to the control (obesogenic) or intervention (fitogenic) group. The study design, program components, and evaluation of the intervention are described in detail. The intervention consists of (a) academic enrichment, (b) a healthy snack, and (c) physical activity in a mastery-oriented environment. Successful implementation would show the feasibility of schools’ being able to provide a fitogenic environment. Significant differences between the groups would provide evidence that a fitogenic environment after school has positive health benefits. If feasibility and efficacy are demonstrated, implementing an after-school program like this one in elementary schools could play a major role in preventing and reducing childhood obesity.

Barriers to Physical Activity Among Gay Men

Gay men may not be physically active at recommended levels to achieve health benefits. Thus, a need exists to identify general (i.e., common across populations) and population-specific barriers that hinder or stop gay men from participating in physical activity (PA). Salient barriers may be identified through the extent each barrier limits PA (i.e., barrier limitation) and the level of one’s confidence to overcome barriers and engage in PA (i.e., self-regulatory efficacy). The purposes of this study were to (1) provide a description of general and population-specific barriers to PA among sufficiently and insufficiently active gay men, (2) identify barrier limitation and self-regulatory efficacy for the reported barriers, and (3) examine the associations between meeting the current PA recommendation, barrier limitation, and self-regulatory efficacy. Participants were 108 self-identified gay males aged 21 to 64 years who completed a web-based survey. A total of 35 general barriers and no population-specific barriers were identified by the sufficiently and insufficiently active groups. The sufficiently active group reported higher self-regulatory efficacy and lower barrier limitation for nearly all reported barriers. A binary logistic regression used to examine the associations between PA, barrier limitation, and self-regulatory efficacy was statistically significant, χ2(2, N = 108) = 19.26, p < .0001, R2 = .16. Only barrier limitation significantly contributed to the model. Future research should continue to examine barriers to PA among gay men to determine whether an intervention needs to be designed specifically for gay men or whether a one-size-fits-all intervention would be effective in helping all men overcome common barriers to engaging in PA.

Effects of a 'school-based' physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the 'Physical Activity 4 Everyone' RCT

BACKGROUND/OBJECTIVES:

Obesity prevention during adolescence is a health priority. The ‘Physical Activity 4 Everyone' (PA4E1) study tested a multi-component physical activity intervention in 10 secondary schools from socio-economically disadvantaged communities. This paper aimed to report the secondary outcomes of the study; to determine whether the intervention impacted on adiposity outcomes (weight, body mass index (BMI), BMI z-score), and whether any effect was moderated by sex, baseline BMI and baseline physical activity level, at 12 and 24 months.

SUBJECTS/METHODS:

A cluster randomised controlled trial was conducted in New South Wales, Australia. The school-based intervention included seven physical activity strategies targeting the following: curriculum (strategies to maximise physical activity in physical education, student physical activity plans, an enhanced school sport programme); school environment (physical activity during school breaks, modification of school policy); and parents and the community (parent engagement, links with community physical activity providers). Students' weight (kg), BMI and BMI z-score, were collected at baseline (Grade 7), 12 and 24 months. Linear Mixed Models were used to assess between-group mean difference from baseline to 12 and 24 months. Exploratory sub-analyses were undertaken according to three moderators of energy balance.

RESULTS:

A total of 1150 students (mean age=12 years) provided outcome data at baseline, 1051 (91%) at 12 months and 985 (86%) at 24 months. At 12 months, there were group-by-time effects for weight (mean difference=–0.90 kg (95% confidence interval (CI)=–1.50, −0.30), P<0.01) and BMI (−0.28 kg m⁻² (−0.50, −0.06), P=0.01) in favour of the intervention group, but not for BMI z-score (−0.05 (−0.11; 0.01), P=0.13). These findings were consistent for weight (−0.62 kg (−1.21, 0.03), P=0.01) and BMI (−0.28 kg m⁻² (−0.49, −0.06), P=0.01) at 24 months, with group-by-time effects also found for BMI z-score (−0.08 (−0.14; −0.02), P=0.02) favouring the intervention group.

CONCLUSION:

The PA4E1 school-based intervention achieved moderate reductions in adiposity among adolescents from socio-economically disadvantaged communities. Multi-component interventions that increase adolescents' engagement in moderate-to-vigorous physical activity (MVPA) may assist in preventing unhealthy weight gain.

Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions

Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.

Psychosocial predictors of decay in healthy eating and physical activity improvements in obese women regaining lost weight: translation of behavioral theory into treatment suggestions

Regain of lost weight is a universal problem for behavioral treatments. An increased understanding of theory-based psychosocial predictors of decay in behavioral correlates of weight loss might improve treatments. Data were derived from a previous weight loss investigation of 110 women with obesity. A subsample from the experimental treatment who lost ≥3 % body weight and regained at least one third of that over 24 months (N = 36) was assessed. During months 6 through 24, there were unfavorable changes in behavioral (fruit/vegetable and sweet intake; physical activity) and psychosocial variables. Mood change predicted change in fruit/vegetable and sweet intake, with emotional eating change mediating the latter relationship. Change in self-regulation predicted changes in sweet and fruit/vegetable intake and physical activity, with self-efficacy mediating the self-regulation-fruit/vegetable intake and self-regulation-physical activity relationships. Findings suggest that after treatment-induced weight loss, addressing indicated theory-based psychosocial variables might mitigate decay in behavioral predictors of healthier weight.