School physical education: effect of the Child and Adolescent Trial for Cardiovascular Health

Safe play spaces to promote physical activity in inner-city children: results from a pilot study of an environmental intervention

OBJECTIVES

We evaluated the effect of providing a safe play space on the physical activity level of inner-city schoolchildren.

METHODS

In 1 of 2 matched neighborhoods, we opened a schoolyard and provided attendants to ensure children's safety. Over the next 2 years we directly observed the number of children and their physical activity levels in the school-yard, as well as in the surrounding intervention and comparison neighborhoods. We also surveyed children in the schools in the intervention and comparison neighborhoods regarding sedentary activities.

RESULTS

After the schoolyard was opened, a mean of 71.4 children used it on weekdays and 25.8 used it on weekends during the school year. When observed, 66% of these children were physically active. The number of children who were outdoors and physically active was 84% higher in the intervention neighborhood than the comparison neighborhood. Survey results showed that children in the intervention school reported declines relative to the children in the comparison school in watching television, watching movies and DVDs, and playing video games on weekdays.

CONCLUSION

When children were provided with a safe play space, we observed a relative increase in their physical activity. Provision of safe play spaces holds promise as a simple replicable intervention.

Correlates of adherence to a physical activity program in young African-American girls

OBJECTIVE

The goal was to identify correlates of adherence to a structured physical activity (PA) program.

RESEARCH METHODS AND PROCEDURES

Subjects were 136 8- to 12-year-old African-American girls. Potential correlates at baseline were: 1) fitness index (FI: % body fat from DXA and cardiovascular fitness from treadmill test), and 2) self-esteem, anxiety, attitude to school and teachers, relationship with parents, and interpersonal relations (Behavioral Assessment System for Children). The 10-month PA program included 80 minutes of PA offered 5 days/wk. Regression tree classification was used to model attendance.

RESULTS

Six splits occurred (34% total variance explained). Less anxious subjects attended more often than highly anxious subjects (3 days/wk vs. 1.5 days/wk) did. Subjects with a healthier FI attended more often than those with a less healthy FI (3 days/wk vs. 0.5 days/wk) did. Younger subjects attended more often than older ones (3 days/wk vs. 2.5 days/wk) did. The next two splits were again with anxiety (3.5 days/wk vs. 3 days/wk) and FI (3 days/wk vs. 2.5 days/wk). Finally, subjects with higher levels of self-esteem attended more often than those with lower levels (3.5 days/wk vs. 2 days/wk) did.

DISCUSSION

Subjects who were self-confident, younger, fitter, and less anxious were more likely to participate regularly. This suggests that children who may be more likely to benefit from a PA program are less likely to participate. To enhance participation in PA programs, especially in older African-American girls: 1) psychological concerns should be identified and addressed before enrollment, and 2) programs should be designed to be appealing to children of all fitness levels.

Health and nutrition education program in primary schools of Crete: changes in blood pressure over 10 years

OBJECTIVE

To examine the long-term effects of the 'Cretan Health and Nutrition Education Program' on blood pressure.

SUBJECTS

A representative population of 176 pupils (85 from the intervention schools and 91 from the control schools).

DESIGN

Blood pressure, dietary, anthropometrical and physical activity data were obtained at baseline (academic year 1992-1993) and at follow-up examination (academic year 2001-2002).

RESULTS

The findings of the current study revealed that the increase over the 10-year period in systolic (SBP) and diastolic blood pressure (DBP) was higher in the control group (CG) than in the intervention group (IG) (P=0.003 and P<0.001 respectively). Regarding dietary indices, the IG were found to have a significantly higher intake of potassium (P=0.018) and magnesium (P=0.011) compared to the CG. Furthermore, the decrease in body mass index (BMI) z-score observed in the IG was found to differentiate significantly from the increase observed in the CG (P=0.042). On the contrary, the increase in leisure time, moderate to vigorous physical activities (MVPA) observed in the IG, was found to differentiate significantly from the decrease observed in the CG (P=0.032). Intervention's effect on SBP was mediated by changes in MVPA (beta=-0.20, P=0.030) and BMI (beta=0.19, P=0.048). Similarly, intervention's effect on DBP was mediated by changes in MVPA (beta=-0.18, P=0.048), BMI (beta=0.26, P=0.007) and magnesium intake (beta=-0.20, P=0.048).

CONCLUSION

The findings of the current study are encouraging, indicating favorable changes in blood pressure, micronutrients intake, BMI and physical activity over the 10 years of follow-up and 4 years after program's cessation, thus providing some support for the effectiveness of school-based health education programs in successfully tackling certain chronic disease risk factors early in life.

Physical activity, health, and dietary patterns of middle school children

PURPOSE

We sought to characterize the physical activity, health, and dietary patterns of middle school children and examine associations between these factors. Parent-child relationships also were examined.

METHODS

Thirty-eight children and parents participated and completed a three-day physical activity recall and 24-hour dietary recall. The Child Health Questionnaire was used to assess child health. Percentage overweight was determined for each participant.

RESULTS

Forty-four percent of children did not meet the current recommendation for physical activity. Fat and sodium consumption exceeded recommendations, and intake of key nutrients was inadequate. Youth who spent more time in sedentary activity had poorer general health. There were positive associations between parent and child percentage overweight and physical activity. Parent physical activity explained an additional 46.2% of the variance in child physical activity.

CONCLUSIONS

Increasing physical activity and reducing sedentary behaviors through strategies that incorporate parents is an important component of a physical therapy program for school children.

Ten-year follow-up of the Cretan Health and Nutrition Education Program on children's physical activity levels

OBJECTIVE

To examine the effect of a 6-year school-based intervention program, implemented on the island of Crete, on children's physical activity levels at the end of the intervention and at a follow-up examination 4 years after program's cessation.

METHODS

Subjects with complete moderate to vigorous physical activity (MVPA) data at baseline, post-intervention and follow-up examination (Academic years 1992-1993, 1997-1998 and 2001-2002 respectively) were included in the analysis [n = 425: Intervention Group (IG): 238; Control Group (CG): 187]. Repeated measures analysis of variance and logistic regression analysis were mainly performed to evaluate the tested hypothesis.

RESULTS

Subject's mean age was 6.3, 11.5 and 15.3 years at baseline, post-intervention and follow-up examination, respectively. MVPA levels were significantly higher for males in the IG than CG at post-intervention (510.2 +/- 404.6 vs. 350.7 +/- 308.0 min/week, P < 0.001) and follow-up (112.3 +/- 78.9 vs. 96.3 +/- 67.0 min/week, P = 0.029). Furthermore, males in the IG were 2.3 (P = 0.011) and 2.1 (P = 0.041) times more likely to meet recommendations for physical activity at the post-intervention and the follow-up examination, respectively, than the CG. No significant findings were observed for females.

CONCLUSION

The current study indicates a favorable effect of the intervention on boys' physical activity levels, which was maintained 4 years after the end of the program.

Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP)

Lifestyle Education for Activity Program (LEAP) was a comprehensive, school-based intervention designed to promote physical activity in high school girls. The intervention focused on changes in instructional practices and the school environment to affect personal, social, and environmental factors related to physical activity. Multiple process evaluation tools and an organizational assessment tool were developed to monitor program implementation from a framework called the LEAP essential elements, which characterized complete and acceptable intervention delivery; secular trends were also monitored. Using process data, LEAP intervention schools were categorized into low- and high-implementing groups and compared with control schools on nine essential elements assessed at the organizational level. The Wilcoxon scores test revealed that low- and high-implementing intervention, and control schools differed significantly on two of nine administrator-reported organizational-level components: having a physical activity team and having a faculty-staff health promotion program. A mixed-model analysis of covariance indicated that, compared to control schools, a greater percentage of girls in high-implementing schools reported engaging in vigorous physical activity. Process evaluation can be used to understand the relationship between level of implementation and successful program outcome.

Impact of the "Planning to be Active" leisure time physical exercise program on rural high school students

PURPOSE

The purpose of the study was to evaluate the effects of a Social Cognitive Theory-based intervention designed to increase the frequency of leisure time planned moderate and vigorous physical exercise among rural high school students attending physical education class.

METHODS

Students in treatment and comparison groups were exposed to an activity-based physical education curricula. The treatment group received eight behavioral skill-building lessons integrated into the existing curriculum.

RESULTS

The Social Cognitive Theory-based educational treatment increased levels of moderate physical exercise occurring outside the classroom.

CONCLUSIONS

This study demonstrated an impact on adolescent leisure time moderate physical exercise using classroom instruction. The intervention was most effective with students who were previously sedentary. The curricular approaches used to promote regular moderate exercise may be useful for sedentary adolescents.

Modifiable environmental and behavioral determinants of overweight among children and adolescents: report of a workshop

The number of children at risk for overweight and the number of overweight children are increasing and have become a serious public health concern. Interventions that could be applied at the population level have not been proven effective. The development of effective strategies is thought to be hampered by the lack of understanding of which behavioral and environmental factors need to be modified. On June 14 and 15, 2004, the NIH held a meeting of experts to discuss the issue of modifiable determinants of obesity in children and adolescents. Included were presentations on interventions among children that have been proven effective, dietary and physical activity behavioral determinants, physical, social, and family environmental determinants, and the quality of measures of determinants and correlates of overweight.

Attitudes towards exercise and physical activity behaviours in Greek schoolchildren after a year long health education intervention

OBJECTIVE

To examine the short term effects of a health education programme on Greek primary schoolchildren

METHODS

The school based intervention programme was applied to 29 children in the 6th grade of the 2nd Primary School of Agios Stefanos (approximately 12,000 inhabitants); 49 pupils from the 1st Primary School constituted the control group. To assess the effectiveness of the intervention, attitude and behavioural variables were measured before and after the intervention.

RESULTS

After adjustment for initial differences in the assessed variables, pupils who took part in the intervention had more positive attitudes towards physical activity than the control group and scored significantly more highly on their intention to participate in physical activity. Moreover, pupils in the intervention group reported more hours/week spent in organised physical activities than pupils in the control group (mean (SD) 3.54 (0.32) v 2.54 (0.26), p<0.020). Finally, a higher proportion of pupils in the intervention classes matched the recommendations of 60 minutes of moderate to vigorous physical activity daily (77.4% v 55.1%, p<0.043).

CONCLUSIONS

Within the limitations of the study, the data show that school health education programmes have the potential to slow the age related decline in physical activity and help pupils establish lifelong, healthy physical activity patterns. Promoting healthy habits and physical activity behaviours during childhood may prevent some of the leading causes of morbidity and mortality in the Greek population, and also decrease direct healthcare costs and improve quality of life.

An integrated curriculum approach to increasing habitual physical activity in children: a feasibility study

A relatively new concept is that of "integrating" physical activity throughout the school curriculum, thereby teaching children about lifestyle physical activity in a variety of contexts. One method by which this may be achieved is by utilizing pedometers as a motivational and educational tool for measuring accumulated physical activity. No research is available that shows in-depth integration of physical activity into the curriculum or that investigates the efficacy of pedometer use for this purpose. The purposes of this study were to (1) design and implement a 4-week elementary school curriculum unit, based around pedometer walking and (2) quantify, using pedometry, the physical activity levels of children (N = 78) prior to, and during, the unit implementation. Results showed that more than one half of the participants were achieving >15,000 steps daily, and children were significantly more active on weekdays than weekends (p = .0001). Boys were more active than girls at baseline (p = .01) and during intervention weekdays (p = .03). Differences between baseline and intervention weekdays were nonsignificant for the complete sample; however, significant increases in step counts were observed when the children with low activity levels, especially females, were examined separately. Overall, the integration of physical activity using pedometer-based activities is feasible. However, any increases in activity may be restricted to children who are least active.

Using school-level interviews to develop a Multisite PE intervention program

The Trial of Activity for Adolescent Girls (TAAG) is a randomized, multicenter field trial in middle schools that aims to reduce the decline of physical activity in adolescent girls. To inform the development of the TAAG intervention, two phases of formative research are conducted to gain information on school structure and environment and on the conduct of physical education classes. Principals and designated staff at 64 eligible middle schools were interviewed using the School Survey during Phase 1. The following year (Phase 2), physical education department heads of the 36 schools selected into TAAG were interviewed. Responses were examined to design a standardized, multicomponent physical activity intervention for six regions of the United States. This article describes the contribution of formative research to the development of the physical education intervention component and summarizes the alignment of current school policies and practices with national and state standards.

Increasing children's physical activity levels during recess periods in elementary schools: the effects of providing game equipment

BACKGROUND

During recess, children can be active on a daily basis, making it an important school environmental factor for the promotion of health-related physical activity. The aim of the present study was to investigate the effects of providing game equipment on children's physical activity levels during morning recess and lunch break in elementary schools.

METHODS

Seven elementary schools were randomly assigned to the intervention group (four schools), including 122 children (75 boys, 47 girls, mean age: 10.8 +/- 0.6 years), and to the control group (three schools), including 113 children (46 boys, 67 girls, mean age: 10.9 +/- 0.7 years). Children's activity levels were measured before and three months after providing game equipment, using MTI accelerometers.

RESULTS

During lunch break, children's moderate and vigorous physical activity significantly increased in the intervention group (moderate: from 38 to 50%, vigorous: from 10 to 11%), while it decreased in the control group (moderate: from 44 to 39%, vigorous: from 11 to 5%). At morning recess, providing game equipment was effective in increasing children's moderate physical activity (from 41 to 45%), while it decreased in the control group (from 41 to 34%).

CONCLUSION

Providing game equipment during recess periods was found to be effective in increasing children's physical activity levels. This finding suggests that promoting physical activity through game equipment provision during recess periods can contribute to reach the daily activity levels recommended for good health.

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community

BACKGROUND

In the context of a national childhood obesity epidemic, this study sought to document the cardiovascular risk status of children in a rural Georgia community.

METHODS

Anthropometrics and blood pressure were measured in 211 children, and fasting glucose and lipid profile in 160, recruited from schools in 2002 (grades 2 to 11, ages 7 to 18 years).

RESULTS

Nearly half the schoolchildren (48%) were overweight or at risk of overweight; 15% had metabolic syndrome. Overweight children were at higher risk for metabolic syndrome and had more risk factors. Blood pressure: 19% had elevated systolic blood pressure; 4% had elevated diastolic blood pressure. Glycemia: 14% had impaired fasting glucose levels; no diabetes cases were detected. Lipid profile: 26% had high total cholesterol (>170 mg/dL), 20% had high low-density lipoprotein (>110 mg/dL), 13% had high triglycerides (>150 mg/dL), 43% had low high-density lipoprotein (females, <50 mg/dL; males, <40 mg/dL). Ethnicity, gender, and grade level were not predictive of risk except that fewer black children had low high-density lipoprotein, and blood pressure and body mass index increased with grade, as expected.

CONCLUSIONS

Results from this study indicate a significant problem with overweight and cardiovascular risk in rural schoolchildren. Notably, younger children were just as likely to have risk factors as adolescents, suggesting that screening and intervention ought to begin by school age. Ethnic and gender differences in prevalence were not found, suggesting that contextual factors in a rural setting may outweigh demographic influences on risk.

The CATCH Kids Club: a pilot after-school study for improving elementary students' nutrition and physical activity

BACKGROUND

Although many school-based diet and physical activity interventions have been designed and evaluated, relatively few have been tested for the after-school setting. After-school day-care programmes at either elementary schools or private locations provide a ready-made opportunity for health programmes that may be difficult to incorporate into an already-full school day. The purpose of this paper is to report on a pilot study of an after-school adaptation of the CATCH (Coordinated Approach To Child Health) elementary school programme called the CATCH Kids Club (CKC).

METHODS

The CKC was pilot-tested and formatively evaluated in 16 Texas after-school programmes: eight in El Paso and eight in Austin (four intervention and four reference sites each). Evaluation consisted of direct observation of moderate to vigorous physical activity during play time, self-reported food intake and physical activity, and focus group interviews with after-school programme staff.

RESULTS

Students responded well to the physical activity and snack components and were less interested in the five-module education component. Routine staff training was a key variable in achieving proper implementation; the ideal would be a full day with repeated follow-up model teaching visits. Staff turnover was a logistic issue, as was programme leader readiness and interest in conducting the programme. Strong and significant effects were observed for the physical activity but not for the education component. The results of the physical education component suggest it is feasible, effective and ready for larger-scale evaluation or dissemination.

Quantifying physical activity in first-through fourth-grade physical education via pedometry

The aim of this study was to determine pedometry steps per minute (SPM) cutscores that accurately quantify physical activity (PA) time in first- through fourth-grade physical education. A total of 257 participants were grouped in two data pools, first- and second-grade (n = 126), and third- and fourth-grade (n = 131). Systematic observation was the PA criterion instrument and pedometry was the predictor instrument. Correlations between physical activity measures were strong (r = .82-.89, p < .01). Ten min of PA and 33.33% of the lesson time engaged in PA within a 30-min class can be quantified by 61-63 SPM for first- and second-grade, and 58-61 SPM for third- and fourth-grade. IN CONCOLUSION: (a) SPM values were a valid indicator of students achieving or not achieving PA criteria, and (b) pedometry is a valid and practical tool for physical activity surveillance within physical education.

Physical education in elementary school and body mass index: evidence from the early childhood longitudinal study

OBJECTIVES

We examined the effect of physical education instruction time on body mass index (BMI) change in elementary school.

METHODS

We examined data from a national sample of 9751 kindergartners in the United States who were reported on for 2 years. We used a difference-in-differences approach to examine the effect of an increase in physical education instruction time between kindergarten and first grade on the difference in BMI change in the 2 grades, using the same child as the control.

RESULTS

One additional hour of physical education in first grade compared with the time allowed for physical education in kindergarten reduces BMI among girls who were overweight or at risk for overweight in kindergarten (coefficient = -0.31, P <.001) but has no significant effect among overweight or at-risk-for-overweight boys (coefficient = -0.07, P =.25) or among boys (coefficient = 0.04, P =.31) or girls (coefficient = 0.01, P =.80) with a normal BMI.

CONCLUSIONS

Expanding physical education programs in schools, in the form in which they currently exist, may be an effective intervention for combating obesity in the early years, especially among girls.

Evaluation of a Two-Year Middle-School Physical Education Intervention: M-SPAN

PURPOSE

School physical education (PE) is highly recommended as a means of promoting physical activity, and randomized studies of health-related PE interventions in middle schools have not been reported. We developed, implemented, and assessed an intervention to increase physical activity during middle-school PE classes.

METHODS

Twenty-four middle schools (approximately 25,000 students, 45% nonwhite) in Southern California participated in a randomized trial. Schools were assigned to intervention (N = 12) or control (N = 12) conditions, and school was the unit of analysis. A major component of the intervention was a 2-yr PE program, which consisted of curricular materials, staff development, and on-site follow-up. Control schools continued usual programs. Student activity and lesson context were observed in 1849 PE lessons using a validated instrument during baseline and intervention years 1 and 2.

RESULTS

The intervention significantly (P = 0.02) improved student moderate to vigorous physical activity (MVPA) in PE, by approximately 3 min per lesson. Effects were cumulative; by year 2 intervention schools increased MVPA by 18%. Effect sizes were greater for boys (d = 0.98; large) than girls (d = 0.68; medium).

CONCLUSIONS

A standardized program increased MVPA in middle schools without requiring an increase in frequency or duration of PE lessons. Program components were well received by teachers and have the potential for generalization to other schools. Additional strategies may be needed for girls.

Non-curricular approaches for increasing physical activity in youth: a review

BACKGROUND

To prevent obesity, the physical activity of youth should be increased. Since time for school physical education has declined and curricular interventions have had limited effects, alternative non-curriculum approaches need to be tested.

METHODS

A systematic review was conducted to identify research that evaluated the effectiveness of non-curricular interventions on the physical activity of children and adolescents.

RESULTS

Results showed that children were active during school break periods and inexpensive interventions further increased activity during these times. Active travel to school offered potential, but its effectiveness was impaired by traffic congestion and parental fears for child safety. Extracurricular, school-based interventions had problems with low attendance, which might be removed if delivered through existing community organizations. Summer day camps offered potential for increasing activity of youth, but research is required to determine how best to convert camp activity into increased post-camp habitual activity.

CONCLUSIONS

Physical activity can be increased during school break periods, through existing youth organizations, summer day camps, and possibly through active transportation. Future research should focus on further enhancing the effectiveness of these innovative interventions.

Psychometric properties of optimism and pessimism: results from the Girls' Health Enrichment Multisite Studies

Background. This study investigated the relationships among optimism, pessimism, physical activity, and dietary behaviors among 8- to 10-year-old African-American girls in the Girls' Health Enrichment Multisite Studies (GEMS). Methods. Ninety-two girls were randomly assigned to a 12-week physical activity and diet intervention or comparison group and completed psychosocial assessments including the Youth Life Orientation Test (YLOT) of optimism and pessimism, physical performance self-concept, physical activity self-efficacy, physical activity outcome expectancies, and physical activity and sedentary preferences. Also, preferences for bottled water and sweetened beverages were assessed. Physical activity and dietary intake were assessed by self-report and parent-report at baseline and follow-up. Also, physical activity was objectively assessed by wearing an accelerometer for 3 days. The psychometric properties of the optimism-pessimism subscales were analyzed. Results. The measures of optimism and pessimism in children were reliable (r = 0.75-0.82). In the multiple regression analyses without the intervention interaction terms, pessimism was positively and significantly related to increases in MET-adjusted usual activity (P = 0.008) and sedentary behaviors (P = 0.0004). Additionally, a negative (P = 0.026) pessimism by intervention interaction term for MET-adjusted usual activity was found such that the intervention group had a lower change in physical activity per unit increase in pessimism compared to the control group.

CONCLUSIONS

Among 8- to 10-year-old African-American girls, pessimism was related to increased sedentary behaviors and usual activity. Previous studies have reported relationships between optimism and health-compromising behaviors. This study found that pessimism may positively or negatively influence efforts to increase health-promoting behaviors. Future research should confirm and clarify the meaning of these findings.

Design, implementation, and quality control in the Pathways American-Indian multicenter trial

BACKGROUND

Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity.

METHODS

Pathways employed a nested cohort design in which 41 schools were randomized to intervention or control conditions and students within these schools were followed as a cohort (1,704 third graders at baseline). The study's primary endpoint was percent body fat. Secondary endpoints were levels of fat in school lunches; time spent in physical activity; and knowledge, attitudes, and behaviors regarding diet and exercise. Quality control (QC) included design of data management systems which provided standardization and quality assurance of data collection and processing. Data QC procedures at study centers included manuals of operation, training and certification, and monitoring of performance. Process evaluation was conducted to monitor dose and fidelity of the interventions. Registration and tracking systems were used for students and schools.

RESULTS

No difference in mean percent body fat at fifth grade was found between the intervention and control schools. Percent of calories from fat and saturated fat in school lunches was significantly reduced in the intervention schools as was total energy intake from 24-hour recalls. Significant increases in self-reported physical activity levels and knowledge of healthy behaviors were found for the intervention school students.

CONCLUSIONS

The Pathways study results provide evidence demonstrating the role schools can play in public health promotion. Its study design and QC systems and procedures provide useful models for other similar school based multi- or single-site studies.

Maximizing children's physical activity: an evaluability assessment to plan a community-based, multi-strategy approach in an ethno-racially and socio-economically diverse city

An evaluability assessment was conducted to plan a community-based, multi-strategy approach to physical activity promotion (MSAPAP) to maximize young children's physical activity in an ethno-racially and socio-economically diverse city. This assessment involved consultation with various stakeholders to develop a program logic model to diagrammatically describe the MSAPAP. First, published literature regarding physical activity was reviewed to describe interventions designed to increase children's physical activity and to identify factors that contributed to program effectiveness. Secondly, key informants from mainstream service organizations and smaller community-based agencies were interviewed to determine their views on how to increase physical activity among children and families. A workgroup developed a draft logic model based on the results of the literature review and community needs assessment results. Thirdly, stakeholders were consulted about the draft model. This consisted of 12 focus groups with members of school boards (two sessions), members of community organizations (three sessions), lay home visitors who provide support to mothers of young children in ethno-racially diverse communities (one session), and parents from six cultural groups (six sessions). The logic model was revised based on the findings from this consultation. The final logic model shows children aged 3-8 years as the main target group, and parents and various community members who influence children as intermediate target groups. The MSAPAP is depicted as six strategies, which are clusters of program activities that are conceptually similar: community engagement, community assessment, accessibility, promotion, education and skill development, and inclusive programming. The logic model shows the 'cause and effect' relationships among program activities, shorter-term outcome objectives (e.g. to reduce user fees for physical activity programs) and longer-term outcome objectives (e.g. to increase the proportion of children who are physically active). The extensive community involvement in planning the MSAPAP facilitated a subsequent plan to develop, implement and evaluate selected program activities in the MSAPAP.

Maintenance of effects of the CATCH physical education program: results from the CATCH-ON study

Long-term maintenance effects of physical education (PE) curriculum and staff development programs have not been studied. The authors assessed the sustainability of the Child and Adolescent Trial for Cardiovascular Health (CATCH) PE intervention using direct observations of 1,904 PE lessons in former intervention and control schools in four U.S. states 5-years postintervention. Student physical activity levels, lesson contexts, and level of CATCH PE training of teachers were analyzed. Student energy expenditure levels and proportion of PE time in moderate-to-vigorous physical activity in intervention schools were maintained 5 years later, but vigorous activity declined sharply. Meanwhile, postintervention gains in former control schools, influenced by delayed program implementation and secular trends, resulted in a convergence of activity levels in intervention and control schools. Use of CATCH PE curricula was associated with increased levels of teacher training and school support for PE in both former intervention and control schools.

Long-term implementation of the CATCH physical education program

To test the effectiveness of the Child and Adolescent Trial for Cardiovascular Health (CATCH) program, a randomized trial was conducted in 96 elementary schools in four regions of the United States. Results from the original trial indicated a significant positive effect on the delivery of physical education (PE). All 56 former intervention schools (FI), 20 randomly selected former control schools (FC), and 12 newly selected unexposed control schools (UC) were assessed 5 years postintervention. Results indicate a strong secular trend of increasing moderate to vigorous physical activity (MVPA) in PE classes among both FC and UC schools. The FI schools surpassed the Healthy People 2010 goal for MVPA during PE lesson time (i.e., 50%), whereas the FC and UC schools came close to it. Barriers to implementing CATCH PE included insufficient training and lower importance of PE compared to other academic areas and indicate the need for in-service training.

Quantifying physical activity via pedometry in elementary physical education

PURPOSE

The objective of this study was to determine a pedometer steps per minute standard for quantifying the lesson time that first- and second-grade physical education students spent in moderate to vigorous physical activity (MVPA).

METHODS

The sample was divided into validation (N = 246) and cross-validation (N = 123) samples using the holdout technique. Using the criterion test model, steps per minute cut points were empirically and judgmentally determined. C-SOFIT systematic observation was the criterion instrument and pedometry was the predictor instrument. Data were collected from 45 physical education lessons implemented in six schools. The three-step analytic procedure of computing mastery/nonmastery outcome probabilities, phi coefficients, and error proportions was used to determine the optimal steps per minute cut point for quantifying 33.33% of the physical education lesson time engaged in MVPA within a 30 class.

RESULTS

Steps per minute was highly correlated with observation (r = 0.74-0.86, P < 0.0001). Five steps per minute scores that were accurate indicators of 33.33% of the class time engaged in MVPA in the validation sample were accurate indicators of steps per minute in the cross-validation sample. The optimal steps per minute cut point ranged from 60.00 to 63.00, which is equivalent to 1800-1890 steps in a 30-min physical education class.

CONCLUSION

Data supports the use of pedometry steps per minute values as an accurate indicator of MVPA. Pedometry demonstrates promise as a viable large-scale surveillance instrument for measuring MVPA in physical education.

Evaluation of a community-based intervention to promote physical activity in youth: lessons from Active Winners

PURPOSE

To test the effects of a community-based physical activity intervention designed to increase physical activity and to conduct an extensive process evaluation of the intervention.

DESIGN

Quasi-experimental.

SETTING

Two rural communities in South Carolina. One community received the intervention, and the other served as the comparison.

SUBJECTS

Public school students who were in fifth grade at the start of the study (558 at baseline) were eligible to participate. A total of 436 students participated over the course of the study.

INTERVENTION

The intervention included after-school and summer physical activity programs and home, school, and community components designed to increase physical activity in youth. The intervention took place over an 18-month period.

MEASURES

Students reported after-school physical activity at three data collection points (prior to, during, and following the intervention) using the Previous Day Physical Activity Recall (PDPAR). They also completed a questionnaire designed to measure hypothesized psychosocial and environmental determinants of physical activity behavior. The process evaluation used meeting records, documentation of program activities, interviews, focus groups, and heart rate monitoring to evaluate the planning and implementation of the intervention.

RESULTS

There were no significant differences in the physical activity variables and few significant differences in the psychosocial variables between the intervention and comparison groups. The process evaluation indicated that the after-school and summer physical activity component of the intervention was implemented as planned, but because of resource and time limitations, the home, school, and community components were not implemented as planned.

CONCLUSIONS

The intervention did not have a significant effect on physical activity in the target population of children in the intervention community. This outcome is similar to that reported in other studies of community-based physical activity intervention.

Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention programme

The effectiveness of a health and nutrition education programme, in changing certain chronic disease risk factors, was assessed after the 6 years intervention period was completed. The school-based intervention programme was applied to all children registered in the first grade (age 5.5-6.5 years) in 1992 in two counties of Crete, while the children from a third county served as a control group. In order to assess the effectiveness of the intervention, a variety of biological and behavioural parameters were measured before and following completion of the intervention in a randomly selected school-based sample of 602 intervention group (IG) and 444 control group (CG) pupils. At the end of the 6-year period, it was found that biochemical indices generally improved significantly more in the IG compared with the CG (mean change for IG v. CG was -0.27 v. -0.12 mmol/l for total cholesterol (TC); -0.07 v. +0.24 for TC:HDL and -0.13 v. +0.14 for LDL:HDL). Similarly, the changes observed in the anthropometric variables in the two groups were in favour of the IG (+3.68 v. +4.28 kg/m2 for BMI; +2.97 v. +4.47 mm for biceps skinfold). Total energy intake and consumption of total fat and saturated fat increased significantly less in the IG compared with the CG (+747.7 v. 1534.7 kJ (+178.7 v. +366.8 kcal); +5.9 v. +18.8 g and +0.8 v. +5.1 g respectively), while time devoted to leisure time physical activity and cardiovascular run test performance increased significantly more in the IG (+281 v. +174 min/week and +2.5 v. +1.2 stages respectively). The findings of the present study underline the importance of such programmes in health promotion and disease prevention. Although the long-term effects of these programmes can only be assessed by tracking this population through to adolescence and adulthood, these programmes seem to have the potential to lead to a healthier lifestyle and thus a reduction in risk factor levels.

How active are rural children in Australian physical education?

Physical education lessons offer a venue for children to accrue valuable and health-conferring time being physically active. The first Australian direct observational data are presented on activity of year 3 and 4 children during physical education. Analysis accounts for the nested nature of the data through multi level logistic regression using 13,080 records within 231 lessons within 18 randomly selected schools. Activity was analysed in relation to lesson context (focus of lesson), child gender, school year of child, teacher gender, lesson duration and start time. Children spent 36.7% of a lesson in moderate to vigorous and 12.9% in vigorous activity. Most of the lesson was spent in the context of management/instruction (37.4%), followed by games (25.0%), skill (21.4%), and fitness (14.7%). The highest level of moderate to vigorous activity was observed in the fitness lesson context (61.9%). followed by skill (46.4%), games (42.6%) and management/instruction (17.1%). Moderate to vigorous activity was significantly higher for boys than girls. There was no significant difference in moderate to vigorous activity in lessons led by male or female teachers. However vigorous activity was significantly higher for female led lessons. Children participated in less physical activity during physical education lessons timetabled in the afternoon, compared to physical education lessons time-tabled in the morning. Physical activity levels were not related to lesson duration. Physical education lessons can potentially be more active. However improvement rests on school capacity and may require a health promoting schools approach to implement curricular policy.

Nutrient intake over time in a multi-ethnic sample of youth

OBJECTIVES

The purpose of this paper is to present longitudinal data on nutrient intakes of youth with emphases on differences by sex and race/ethnicity. Nutrients selected for examination are those implicated in chronic disease.

DESIGN

24-hour dietary recalls were collected from a cohort of third, fifth and eighth graders (n = 1874).

SETTING AND SUBJECTS

The sample is drawn from the Child and Adolescent Trial for Cardiovascular Health and includes students from California, Louisiana, Minnesota and Texas.

RESULTS

Across the total sample, nutrient intakes met recommended levels except that total fat, saturated fat and sodium consistently exceeded recommendations and calcium and iron intake of girls consistently fell short of recommended levels. Nutrient consumption between third and eighth grade differed by sex and race/ethnicity for a number of nutrients. In particular, females' intake of energy from total fat, calcium, iron, folic acid, vitamin A and vitamin D decreased over time relative to males' intakes, controlling for overall energy intake. Compared with the other ethnic/racial groups, African-American students increased their intake of energy from total fat and saturated fat over time.

CONCLUSIONS

Our results suggest that the diets of youth change over time, and negative trends are more common in females than in males and in African-American and Hispanics compared with Caucasian students. Nutrition education and intervention are needed throughout childhood and adolescence with an emphasis on choosing healthful foods. In addition, greater attention to differential opportunities and reinforcements for females and males, and Caucasian, Hispanic and African-American students is warranted.

Ethnic differences in physical activity and inactivity patterns and overweight status

OBJECTIVE

To examine the relationship between physical activity and inactivity patterns and overweight in U.S. adolescents using baseline and 1-year change in activity and inactivity data.

RESEARCH METHODS AND PROCEDURES

Nationally representative data from 12,759 participants (6997 non-Hispanic whites, 2676 non-Hispanic blacks, 2185 Hispanics, and 901 Asians) in the National Longitudinal Study of Adolescent Health (1995 and 1996). Data on moderate to vigorous and low-intensity physical activity, TV/video viewing, and video game/computer use were obtained from questionnaires. Multivariate models assessed the association of overweight (body mass index > or = 95th percentile Centers for Disease Control and Prevention/National Center for Health Statistics 2000 curves) with initial (and 1-year change) activity and inactivity levels, controlling for age, ethnicity, socioeconomic status, urban residence, cigarette smoking, and region of residence.

RESULTS

Overweight prevalence was positively associated with high level TV/video viewing among white boys (odds ratio [OR] = 1.52; 95% confidence interval [1.08 to 2.14]) and girls (OR = 2.45 [1.51 to 3.97]). The odds of overweight decreased with high levels of moderate to vigorous physical activity among white boys (OR = 0.81 [0.76 to 0.87]), non-Hispanic black boys (OR = 0.86 [0.76 to 0.98]) and girls (OR = 0.88 [0.78 to 0.99]), and Hispanic boys (OR = 0.90 [0.83 to 0.97]) and girls (OR = 0.91 [0.84 to 0.99]).

DISCUSSION

Predicted probabilities generated from the logistic regression models, which examined the experimental effects of altering hours of TV/video viewing and bouts of moderate to vigorous physical activity, show lower overweight among adolescents who watched less TV per week combined with frequent moderate to vigorous physical activity than those who watched more TV per week combined with fewer bouts of weekly moderate to vigorous physical activity. Predicted probabilities suggest important sex and ethnic differences in these associations.

Patterns of physical activity among American Indian children: an assessment of barriers and support

Estimates indicate that 10% to 50% of American Indian and non-Indian children in the U.S. are obese, defined as a body mass index > or = 95th percentile of the NHANES II reference data. Pathways is a two-phase, multi-site study to develop and test a school-based obesity prevention program in American Indian schoolchildren in grades three through five. During Phase I feasibility prior to initiation of the Pathways trial, data were collected related to physical activity patterns, and the supports of, and barriers to, physical activity. Nine schools from communities representing six different tribal groups participated in this study. Multiple measures were used for data collection including direct observation, paired child interviews, and in-depth interviews and focus groups with adults. Students completed the self-administered Knowledge, Attitudes, and Behaviors (KAB) survey, and a Physical Activity Questionnaire (PAQ). Barriers to physical activity at schools included a lack of facilities, equipment, and trained staff persons for PE. Adults were not consistently active with their children, but they were highly supportive of their children's activity level. Children reported a strong enjoyment of physical activity and strong peer support to be physically active. Weather conditions, safety concerns, and homework/chores were common barriers to physical activity reported by children and adult caregivers. The information was used to design culturally and age-appropriate, practical interventions including the five physical activity programs for schoolchildren in the Pathways study.

Prevention and treatment of childhood obesity

Obesity has reached epidemic proportions among children and youth in the United States. Surveys indicate that the number of overweight children aged 6 to 17 years has doubled within three decades. In the decade between the late 1970s and the late 1980s, the prevalence of overweight increased from 7.6% to 10.9% for children aged 6 to 11 years, and from 5.7% to 10.8% for adolescents aged 12 to 19 years. Data for 1999 indicates that the epidemic is continuing to increase, so that 13% of 6- to 11-year-old children and 14% of 12- to 19-year- old children are currently overweight (body mass index > or = 95th percentile for age/gender). This article reviews newer concepts related to etiologic factors, comorbidities, and strategies for prevention and treatment.

Effects of the CATCH physical education intervention: teacher type and lesson location

BACKGROUND

Substantial differences exist in how and where physical education (PE) is conducted in elementary schools throughout the United States. Few effectiveness studies of large-scale interventions to improve PE have been reported.

DESIGN

Multicenter randomized trial.

SETTING/ PARTICIPANTS

The Child and Adolescent Trial for Cardiovascular Health (CATCH) was implemented in PE classes in 96 schools (56 intervention, 40 control) in four study centers: California, Louisiana, Minnesota, and Texas.

INTERVENTION

The 2.5-year PE intervention consisted of professional development sessions, curricula, and follow-up consultations.

MAIN OUTCOME MEASURES

Intervention effects on student physical activity and lesson context in PE were examined by teacher type (PE specialists and classroom teachers) and lesson location (indoors and outdoors).

RESULTS

Differential effects by teacher type and lesson location were evidenced for both physical activity and lesson context. Observations of 2016 lessons showed that intervention schools provided more moderate-to-vigorous physical activity (p=0.002) and vigorous physical activity (p=0.02) than controls. Classroom teachers improved physical activity relatively more than PE specialists, but PE specialists still provided longer lessons and more physical activity. Classroom teachers increased lesson length (p=0.02) and time for physical fitness (p=0.03).

CONCLUSIONS

The intervention improved PE of both specialists' and classroom teachers' lessons. States and districts should ensure that the most qualified staff teaches PE. Interventions need to be tailored to meet local needs and conditions, including teacher type and location of lessons.

How are we doing with physical activity?

An estimated 60% of U.S. adults are inactive or underactive, and nearly half of America's youth (aged 12 to 21 years) are not vigorously active on a regular basis. Downstream interventions provide individual strategies that effectively increase short-term participation in physical activity by 10% to 25%. Downstream and midstream approaches tailored to individual preferences have greater success. Packaging and disseminating physical activity programs for community, worksite, and health care settings are not as far along as for other areas, although inactivity prevalence is about twice that of smoking, and both risk factors have substantial morbidity and mortality. Less is known about effectiveness of upstream approaches, which have potential for the greatest public health impact. Suggestions include continued promotion of moderate-intensity physical activity, greater dissemination of successful programs, and investigation of physical environment influences.

Effects of physical activity interventions in youth. Review and synthesis

INTRODUCTION

Physical inactivity has been identified as an important public health concern for youth. School and community settings can be important infrastructures for promoting physical activity (PA). This paper reviews studies of physical activity in school and community settings among preschool through college-aged persons to determine characteristics and effects of interventions. Studies in progress are included.

METHODS

Studies from 1980 to 1997 testing physical activity interventions in schools and community settings were identified by computerized search methods and reference lists of published reviews. Studies needed to have used a quantitative assessment of PA, used a comparison or control group, included participants who were preschool through college age, and be conducted in the United States or foreign school or community settings. Significance of effects was examined overall and for various types of interventions.

RESULTS

Twenty-two school-based studies were reviewed, 14 completed and 8 in progress. Three studies were in countries other than the United States. The 8 studies in progress were all in the United States. Only 7 community studies were reviewed, all in the United States. Four studies were in progress. Several community studies involved a high percentage of African-American or Hispanic youth and their families. Studies showing the best results used randomized designs, valid and reliable measurements, and more extensive interventions. Some follow-up results showed PA was sustained after interventions ended.

CONCLUSIONS

The collection of school and community studies is limited for several age groups with none below third grade and only three at college age. There are few community studies. The most is known about upper-elementary-age-students, including the first multicenter randomized trial to report significant results for increasing moderate to vigorous physical activity (MVPA) in physical education (PE) and increase vigorous PA outside of school. A number of older study designs were weak and assessments less than optimal, but studies in progress are stronger. Special attention is needed for girls, middle schools, and community settings for all youth. More objective assessments are needed for measuring PA outside of school and in younger children, since they cannot provide reliable self-report.

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

INTRODUCTION

Behavioral science provides the foundation for physical activity interventions. The mediating variable framework is used to assess the status of physical activity interventions and the roles that are, or could be played, by behavioral theory.

METHODS

Twenty-five physical activity intervention studies and 45 physical activity correlational studies were found in the literature, tabulated, and included in the analysis.

RESULTS

Behavioral interventions for promoting physical activity have worked primarily when participants were motivated enough to volunteer or when a school-based physical education program changed. In most cases, behavioral or psychosocial theory accounted for 30% or less of the variability in physical activity behaviors. Most intervention studies do not measure mediating variables, and when they do, they do not systematically effect changes in all the mediating variables on which they are predicated.

DISCUSSION

To increase the effectiveness of physical activity interventions, more physical activity research should focus on a better understanding of the predictors of physical activity and toward interventions demonstrated to effect change in these predictors of physical activity.

CONCLUSION

Changing the focus to basic behavioral and social science and mediator change research should provide a more systematic and cost-effective approach to increasing the effectiveness of physical activity interventions.

A controlled trial of health promotion programs in 11-year-olds using physical activity "enrichment" for higher risk children

OBJECTIVE

To evaluate the short and long term benefits of a school and home based physical activity "enrichment" program for children at higher risk of cardiovascular disease as identified by cluster analysis.

STUDY DESIGN

During two 10-week school terms, 800 11-year-olds took part in a randomized controlled trial with the standard physical activity and nutrition program in six schools, the standard program in a further seven schools but with the addition of physical activity enrichment for higher risk children in those schools, and no program in five control schools. Cluster analysis identifying the 29% or so highest risk children used systolic blood pressure, percent body fat, physical fitness, and blood cholesterol.

RESULTS

Fitness improved significantly in program schools, particularly with enrichment in higher risk boys. Substantial improvements persisted 6 months later in girls from program schools. At "Enrichment" schools, cholesterol showed significant benefits in higher risk girls and, 6 months later, in both boys and higher risk girls. Sodium intake and, in girls, subscapular skinfolds were lower in "Enrichment" schools when the program ended, but not 6 months later.

CONCLUSION

Two-semester health programs with physical activity enrichment for higher risk children can produce benefits sustained for at least 6 months. Improvements extend to lower risk children exposed indirectly to the enrichment. Attenuation of effects on diet and body composition in the longer-term suggest the need for on-going programs.

Cardiovascular disease insulin risk in Mexican-American and Anglo-American children and mothers

OBJECTIVE

To evaluate the relationship between insulin levels and cardiovascular risk factors in children and determine whether it varies among ethnic groups.

METHODS

Cardiovascular risk factors and insulin levels were compared in 144 Mexican-American and Anglo-American mother-child pairs, when the children were 11 years of age.

RESULTS

Although mean age did not differ between ethnicities, Mexican-American mothers and children both had a greater body mass index (mothers: 29.2 +/- 6.2 vs 27.2 +/- 7.9; children: 21.7 +/- 4.7 vs 19.7 +/- 4.6) and sum of skinfolds than did Anglo-Americans. Triglycerides, very low-density lipoprotein cholesterol, fasting insulin, and cholesterol/high-density lipoprotein ratio were higher, while high-density lipoprotein cholesterol was lower in both Mexican-American adults and children compared with Anglo-Americans. After adjusting for measures of obesity, only high-density lipoprotein cholesterol levels remained significantly lower in Mexican-Americans. For both adults and children, higher quartiles of insulin levels were associated with significantly higher triglycerides, blood pressure and lower high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol/apolipoprotein B levels (estimate of dense low-density lipoprotein size). A summary variable representing cardiovascular risk factors present in adult syndrome X patients was higher in both Mexican-American adults and children than in Anglo-Americans.

CONCLUSION

Mexican-American children and adults have higher levels of many cardiovascular risk factors, and this appears related to higher insulin levels and overweight. Appropriate nutrition, weight control, and exercise at early ages could be important in slowing the development of atherosclerosis.

Lessons from the Child and Adolescent Trial for Cardiovascular Health (CATCH): interventions with children

School-based, primary prevention programs can be effective in improving children's dietary intake of fat and saturated fat and in increasing their self-reported levels of physical activity. School environments can be modified to provide healthier food options in the school cafeteria and to increase the amount of moderate to vigorous physical activity occurring during physical education class.

The Child and Adolescent Trial for Cardiovascular Health (CATCH): intervention, implementation, and feasibility for elementary schools in the United States

The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest school-based field trial ever sponsored by the National Institutes of Health. The trial demonstrated positive changes in the school food service and physical education program, as well as in students' cardiovascular health behaviors. Because the CATCH intervention programs were implemented in 56 schools (in four states) that were typical of schools throughout the United States, their reception by schools and degree of implementation provide evidence about their feasibility for schools nationally. Extensive process evaluation data were collected from students, teachers, school food service personnel, and physical education specialists throughout the three school years of the CATCH intervention. Four of the CATCH programs--school food service, physical education, classroom curricula, and home programs--were assessed over the three school years. The process data provide information on participation, dose, fidelity, and compatibility of the CATCH programs in the intervention schools for these programs. High levels of participation, dose, fidelity, and compatibility were observed for the four programs during the 3 school years. CATCH emerges as a model of a feasible multilevel health promotion program to improve eating and exercise behaviors for elementary schools in the United States.

Long-term effects of a physical education curriculum and staff development program: SPARK

This 4-year study, conducted in seven elementary schools assigned to three conditions--Physical Education Specialists (PES), Trained Classroom Teachers (TT), and Controls (CO)--had two parts. The first investigated effects of a health-related physical education program on quantity and quality of lessons. Specialists produced the best outcomes, and TT were significantly better than nontrained peers. Part Two assessed maintenance effects approximately 1.5 years after intervention termination. Withdrawal of specialists significantly reduced the quantity and quality of physical education. TT maintained PES frequency but with a loss in lesson quality and a decline in student activity to 88% of intervention levels. Results support employing specialists and demonstrate the need for extensive professional development for classroom teachers responsible for physical education.