Increasing Children's Physical Activity During the School Day

Opportunities for physical activity in the school environment and their association with physical activity and sedentary behavior in Brazilian adolescents

The school environment (SE) plays a crucial role in determining adolescents' physical activity (PA), including physical education classes, sports spaces and facilities, and active recreation. This study aimed to evaluate the association between the SE and indicators of PA and sitting time (ST), while exploring Brazilian sociodemographic differences. The SE was characterized by PA practices, PA outside regular class hours, running/athletic track condition, use of the courtyard for PA with a professional, participation in inter-school games or physical-sports competitions, and the number of physical education classes per week. PA and ST were assessed via self-report questionnaires, categorizing participants as active or insufficiently active for PA and as having low or excessive ST. The study included a nationally representative sample of 155,019 Brazilian adolescents (50.9% female). Among them, 28.5% were classified as active and 47.3% had adequate ST. Taking two or more physical education classes was positively associated with being active (OR: 1.669; 95% CI: 1.665-1.673) and with having low ST (OR: 1.050; 95% CI: 1.048-1.052). The association between SE characteristics and PA varied by region and school type (rural/urban, public/private), emphasizing that SE impacts PA and ST differently depending on the sociodemographic context of the adolescents.

The measurement reliability and equivalence of print versus online versions of the Youth Activity Profile

PURPOSE

The Youth Activity Profile (YAP) is a 7-day self-report designed to quantify physical activity and sedentary behaviors among youth. This study evaluated the reliability of the online version of the YAP and equivalence with the paper-based version.

METHOD

A total of 2,490 participants from 17 schools in Iowa and Texas completed the YAP. Each classroom was randomly assigned to complete either the print or online version twice. A variance components model was used to assess the test-retest reliability and equivalence testing was also applied.

RESULTS

Both paper and online versions had similar reliability for the PA estimates in school (ICCprint = 0.69-0.91; ICConline = 0.54-0.84), at home (ICCprint = 0.72-0.83; ICConline = 0.64-0.94), PA at weekend (ICCprint = 0.33-0.72; ICConline = 0.39-0.70), and SB (ICCprint = 0.69-0.90; ICConline = 0.66-0.80). The two versions were statistically equivalent for most YAP items except for recess.

CONCLUSION

The online YAP appears to be a reliable assessment of physical activity and sedentary behavior in youth populations.

Strategies to Improve Physical Activity and Nutrition Behaviours in Children and Adolescents: A Review

Despite widespread acknowledgement of the multifarious health benefits of physical activity (PA), including prevention and control of obesity, an overwhelming majority of children and adolescents are not sufficiently active to realise such benefits. Concurrently, young people are significantly impacted by the rapid global rise of sedentarism, and suboptimal dietary patterns during key phases of development. Regrettably, the cumulative effects of unhealthy behaviours during the growing years predisposes young people to the early stages of several chronic conditions, including obesity. Clear and consistent approaches are urgently needed to improve eating and activity behaviours of children and adolescents. Based on existing evidence of "best bets" to prevent and control obesity and its comorbidities, we present a set of non-negotiable strategies as a 'road map' to achieving prevention and improving the health of children and adolescents.

Health and Academic Performance With Happy Children: A Controlled Longitudinal Study Based on the HOPP Project

Background

Overweight/obesity in children and adolescents, largely arising due to increased food intake and reduced physical activity, is a major health concern. Physical activity (PA) integrated into learning has been shown to not only lead to improved health outcomes and wellbeing but also positively affect academic performance. The Health and Academic Performance with Happy Children (HAPHC) project aims at enhancing health and academic performance in elementary school children via implementation of a daily unit of Physical Activity Across the Curriculum (PAAC), which is carried out within the school setting. In this project, PA as an integrated part of learning will be evaluated and the learning material adapted for a large scale implementation across several European countries.

Methods

In three European countries (Austria, Slovenia, and Belgium), 12 primary schools in total will be recruited to act as either intervention or control school in a large intervention study, which applies the PAAC pedagogy during lectures. It is estimated that, at least 3,000+ children across the three countries will be recruited in this study. All teachers of intervention schools will receive training and materials/teaching equipment that will allow them to integrate a daily PA unit of 45 min over 3 years across the curriculum. In response to the daily PA intervention, the following primary outcomes will be assessed: changes in health related physiological factors, academic achievement, psycho-social aspects and wellbeing.

Impact of Project

The HAPHC project aims at promoting public health by increasing PA at an early age within the school setting and therewith preventing the increasing risk of non-communicable diseases across Europe. HAPHC project aims to develop knowledge and materials, which will ensure that the PAAC can be scalable to other European countries.

Trial Registration Number

ClinicalTrials.gov, identifier: NCT04956003.

The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review

BACKGROUND

Despite the well-established health benefits of physical activity (PA) for young people (aged 4-19 years), most do not meet PA guidelines. Policies that support PA in schools may be promising, but their impact on PA behavior is poorly understood. The aim of this systematic review was to ascertain the level and type of evidence reported in the international scientific literature for policies within the school setting that contribute directly or indirectly to increasing PA.

METHODS

This systematic review is compliant with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Six databases were searched using key concepts of policy, school, evaluation, and PA. Following title and abstract screening of 2323 studies, 25 progressed to data synthesis. Methodological quality was assessed using standardized tools, and the strength of the evidence of policy impact was described based on pre-determined codes: positive, negative, inconclusive, or untested statistically.

RESULTS

Evidence emerged for 9 policy areas that had a direct or indirect effect on PA within the school setting. These were whole school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks/recess, physical environment, shared use agreements, active school transport, and surveillance. The bulk of the evidence was significantly positive (54%), 27% was inconclusive, 9% was significantly negative, and 11% was untested (due to rounding, some numbers add to 99% or 101%). Frequency of evidence was highest in the primary setting (41%), 34% in the secondary setting, and 24% in primary/secondary combined school settings. By policy area, frequency of evidence was highest for sport/extracurricular PA (35%), 17% for physical education, and 12% for whole school PA policy, with evidence for shared use agreements between schools and local communities rarely reported (2%). Comparing relative strength of evidence, the evidence for shared use agreements, though sparse, was 100% positive, while 60% of the evidence for whole school PA policy, 59% of the evidence for sport/extracurricular PA, 57% of the evidence for physical education, 50% of the evidence for PA in classroom, and 50% of the evidence for active breaks/recess were positive.

CONCLUSION

The current evidence base supports the effectiveness of PA policy actions within the school setting but cautions against a "one-size-fits-all" approach and emphasizes the need to examine policy implementation to maximize translation into practice. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed.

School recess and pandemic recovery efforts: ensuring a climate that supports positive social connection and meaningful play

As Canada’s schools reopen, attention to healing the school community is essential. Given the considerable stressors of the COVID-19 pandemic, it is unsurprising that recent studies find Canadian children’s mental health in decline. As social connection is tightly entwined with children’s mental health, supporting school-based spaces for quality social interactions and play will be an important postpandemic recovery strategy. Children will need opportunities to re-establish positive social connections at school, and informal spaces such as recess and lunch are an ideal time to afford these opportunities. Yet many schoolyards have long been challenged by social conflict that can interfere with children’s need to connect with peers. Therefore, efforts should be directed not only at mitigating the effects of social harm, but also toward ensuring social and physical landscapes that are meaningful, inclusive, and engaging for children and adolescents of all ages. Recommendations for postpandemic recovery are provided.

A qualitative study of school leader experiences adopting and implementing a whole of school physical activity and sedentary behaviour programme: Transform-Us!

Purpose

Little is known about the experiences of school leaders adopting and implementing real-world, scaled-up physical activity interventions in the Australian educational system. Transform-Us! is a novel physical activity and sedentary behaviour intervention available to all primary schools in Victoria, Australia, since September 2018. This study explored barriers and facilitators experienced by school leaders during the adoption and early implementation phases of Transform-Us!.

Design/methodology/approach

Qualitative study involving seven semi-structured telephone interviews with school leaders implementing Transform-Us! in primary schools in Victoria, Australia. Interview schedules were developed based on the theoretical domains framework (TDF). Interviews were coded using a framework analysis approach.

Findings

Four key themes emerged relating to ten of the 14 TDF domains. Themes included: knowledge, goals, implementation factors and leadership. School leaders play a central role in creating a positive implementation environment including the delivery setting (classroom) and a supportive culture (knowledge sharing) in the school. The application of the TDF to the study bridges the gap between theory and practice and identifies potential future implementation strategies which may be further tested in professional practice future studies. Recommendations for increased adoption and sustained implementation related to seven core areas: presence of a school/programme champion(s); collaborative knowledge sharing; online training; school-based workshops; promotion of behavioural and mental health outcomes; teacher autonomy in delivery; and a supportive implementation environment.

Originality/value

School leaders have a unique scope to influence the adoption and implementation of physical activity and sedentary behaviour interventions. This study outlines specific barriers and facilitators for implementation of a physical activity programme in the Australian educational setting and offers recommendations for programme optimisation.

What are effective policies for promoting physical activity? A systematic review of reviews

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There is a growing need for evidence on the effectiveness of different policies to promote physical activity.

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We conducted a systematic literature review to collate the available evidence.

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We identified 57 reviews with evidence on 53 types of physical activity policies from 7 areas.

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There is a solid evidence base for the effectiveness of school-based and some infrastructural policies.

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The evidence for other (e.g. economic) policies remains insufficient.

The importance of policy for promoting physical activity (PA) is increasingly recognized by academics, and there is a push by national governments and international institutions for PA policy development and monitoring. However, our knowledge about which policies are actually effective to promote PA remains limited. This article summarizes the currently available evidence by reviewing existing reviews on the subject.

Building on results from a previous scoping review on different types of PA-related evidence, we ran searches for combinations of the terms “physical activity”, “evidence”, “effect”, “review”, and “policy” in six different databases (PubMed, Scopus, SportDiscus, PsycInfo, ERIC, and IBSS). We used EPPI Reviewer 4 to further process the results and conduct an in-depth analysis.

We identified 57 reviews providing evidence on 53 types of policies and seven broader groups of policies. Reviews fell into four main categories: 1) setting- and target group-specific; 2) urban design, environment and transport; 3) economic instruments; and 4) broad-range perspective. Results indicate that there is solid evidence for policy effectiveness in some areas (esp. school-based and infrastructural policies) but that the evidence in other areas is insufficient (esp. for economic policies).

The available evidence provides some guidance for policy-makers regarding which policies can currently be recommended as effective. However, results also highlight some broader epistemological issues deriving from the current research. This includes the conflation of PA policies and PA interventions, the lack of appropriate tools for benchmarking individual policies, and the need to critically revisit research methodologies for collating evidence on policies.

Study protocol and baseline characteristics of "SCHOOL IN ACTION" program on support to physical activity and healthy lifestyles in adolescents

Physical activity promotes positive effects on people's health, but most adolescents do not engage in sufficient physical activity to receive the benefits. Studies suggest that school-based interventions can be effective in increasing physical activity in adolescents. However, the literature is inconsistent on the effect size and the type of intervention. This paper presents the design of the SCHOOL IN ACTION program to increase physical activity engagement and healthy eating habits. The cluster randomized controlled trial was performed during a period of six months of intervention and 12 months of follow-up in adolescents from four Brazilian public schools. The theoretical model is based on health promoting schools and the social-ecological and self-determination theory. The action strategies were: improvement of exercises intensity during physical education classes and during lunch breaks; vegetable gardening experience; active breaks in non-physical education classes; counselling health to parents and adolescents and changes in the school environment to promote physical activity and healthy eating. Primary variables were physical activity and sedentary behavior (both assessed by accelerometers). Secondary variables were body composition (assessed by dual-energy x-ray absorptiometry) and eating habits (assessed by questionnaire and 3-day food recall). Questionnaires were used to assess other information related to life satisfaction, health behavior and socioeconomic information. Statistical analysis will follow the principles of intention-to-treat and will explore the composition data analysis and mediating factors of lifestyle-related behaviors. We propose that SCHOOL IN ACTION program will be effective to provide evidence to increase physical activity and food healthy habits in adolescents' students.

ClinicalTrials.gov registration: NCT03153176.

TRIAL STATUS: Follow-up and data analysis.

Strategies and effects of promising school-based interventions to promote active school transportation by bicycle among children and adolescents: protocol for a systematic review

BACKGROUND

Active school travel by bike may provide appropriate means to promote physical activity through commuting to and from school, expanding the mobility during leisure time, and integrating a lifelong positive behavior routine. However, bicycling seems to be a less common form of active school transport and declining cycling to school trends in some European countries have been observed. Therefore, effective interventions aiming at promoting biking to school are warranted. To gain a better understanding of effective programs, the systematic review will summarize strategies and effects of school-based interventions targeted on positively influencing active school travel by bicycle.

METHODS

The databases ERIC, PsycINFO, PSYNDEX, PubMed, Scopus, SPORTDiscus, SURF, and Web of Science will be searched utilizing a detailed search strategy according to "PICo". Consequently, there will be no restriction regarding the outcomes measured in studies. For inclusion in the review, the identified primary studies (i.e. randomized and non-randomized controlled trials) should be published between 2000 and 2019 due to their current relevance, and written in English. The screening, data extraction, and appraisal of study quality as well as behavior change techniques will be undertaken by two independent researchers. To assess the methodological quality of every included study, the quality assessment tool "Effective Public Health Practice Project" for quantitative studies will be used. Behavior change techniques will be identified by utilizing the "BCT Taxonomy v1". If data permits, meta-analyses for intervention effects will be conducted where appropriate.

DISCUSSION

The planned systematic review can provide information about how bicycling is considered in school-based interventions as an effective strategy to promote active commuting to school among students. In this regard, the conclusions drawn from the review will establish a basis for researchers to plan and implement a comprehensive cycling intervention in the school setting.

SYSTEMATIC REVIEW REGISTRATION

PROSPEROCRD42019125192.

Schoolteachers' Nutrition Knowledge, Beliefs, and Attitudes Before and After an E-Learning Program

OBJECTIVE

Το explore teachers' nutrition knowledge, beliefs, and attitudes and to examine the effectiveness of an electronic learning (e-learning) program in teachers' nutrition knowledge.

DESIGN

Cross-sectional and experimental design.

SETTING

The study took place in Greece, while schoolteachers were invited by e-mail.

PARTICIPANTS

Teachers of primary and secondary education, with no exclusion criteria, were enrolled in the study between March, 2015 and 2016.

MAIN OUTCOME MEASURES

Schoolteachers' nutrition knowledge, beliefs, and attitudes.

INTERVENTION

Teachers completed a 36-item nutrition questionnaire and then a subgroup participated in an e-learning program. After the intervention, teachers completed the same questionnaire.

ANALYSIS

Principal component analysis and multivariate logistic regression were used for data analysis.

RESULTS

A total of 1,094 teachers completed the questionnaire; 619 participated in the e-learning program. Teachers showed moderate nutrition knowledge scores (ie, 65% correct answers) before the intervention, whereas their attitudes regarding acting as role models and their belief in the importance of the role of nutrition were associated with 74% (odds ratio, 1.28; 95% confidence interval, 1.13-1.45) and 79% (odds ratio, 1.21; 95% confidence interval, 1.07-1.37) increased possibility of having good nutrition knowledge, respectively. The e-learning program was effective in strengthening teachers' nutrition knowledge (P < .001) and improving their beliefs and attitudes (P < .05).

CONCLUSIONS AND IMPLICATIONS

Future research is needed to validate the current results, which can be used to design and implement similar educational programs to teachers as a means of creating health-promoting schools.

Association of Teacher-Level Factors With Implementation of Classroom-Based Physical Activity Breaks

BACKGROUND

Classroom-based physical activity (CBPA) breaks are a common strategy to increase elementary school children's physical activity (PA) levels. There is limited research examining how teacher-level factors impact teacher implementation of CBPA breaks. In this study, we assessed the relationship of teacher-level factors with teacher use of a CBPA resource.

METHODS

We randomized 6 elementary schools in rural Oregon into control (N = 3) or intervention (N = 3) conditions. Each teacher at intervention schools received the CBPA resource. Teachers at control schools received 1 CBPA-Toolkit per grade level to share, and received no training. We surveyed teachers on their use of the toolkit, implementation support and self-efficacy, and value for PA. Logistic regression was used to examine the odds of toolkit use by teacher-level factors.

RESULTS

Among survey respondents (N = 83), 57% were self-identified toolkit users and 48% attended a training. Training participation and teacher implementation self-efficacy were associated with greater odds of using the toolkit (odds ratio, OR = 7.76 [95% confidence interval, CI = 1.39-43.19] and OR = 5.54 [95% CI = 1.24-23.87], respectively).

CONCLUSION

CBPA tools supported with training aimed at developing teachers' implementation self-efficacy increased the likelihood of teachers employing CBPA tools.

Exploring the effectiveness of a school-based physical activity policy in British Columbia, Canada: a mixed-methods observational study

The Daily Physical Activity (DPA) policy in British Columbia requires elementary schools to help students achieve 30 min of physical activity during instructional and noninstructional time on school days. The purpose of this study was to determine how elementary teachers implement the DPA policy, and examine differences in children's light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) at school, based on how the teacher implemented the DPA policy during the school day (provision of DPA during instructional time or only noninstructional time). In this observational mixed-methods study, 12 teachers were interviewed on their implementation approaches. Teachers provided DPA opportunities during instructional time (i.e., prescriptive implementers, n = 9) or relied on students to be active during noninstructional times (i.e., nonprescriptive, n = 3). Next, 10 students from each interviewed teacher's classroom were randomly selected to wear accelerometers for one school week. Hierarchical linear modeling was used to examine the contribution of teacher's implementation strategy on student's activity levels. t-Tests examined differences in students' activity levels between implementation groups. Teacher's DPA implementation strategy accounted for a significant proportion of variance in student's activity throughout the school day (p's < .05). The prescriptive group (n = 88) was more active (LPA and MVPA) and spent a greater proportion of their school days in MVPA during instructional time than the nonprescriptive group (n = 23). Heterogeneity in policy implementation creates variations in policy effectiveness. Students provided with opportunities to be active during instructional time may accumulate more MVPA compared with those who are not given these opportunities. Registration: Not applicable.

CARDIOMETABOLIC RISK FACTORS ASSOCIATED WITH ACTIVE COMMUTING TO SCHOOL

OBJECTIVE

To verify if there is an association between cardiometabolic risk factors and active daily commuting to school among children and adolescents.

METHODS

A total of 1,743 schoolchildren aged 7 to 17 years old were evaluated in the city of Santa Cruz do Sul (RS). The way of commuting to school was investigated with a questionnaire, and the cardiometabolic risk factors analyzed were body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, blood glucose, triglycerides, total cholesterol (TC) and fractions, LDL and HDL.

RESULTS

The prevalence of active commuting among schoolchildren was 48.0% (95%CI 45.7-50.4), and it was associated, in the crude analysis, with blood glucose and LDL cholesterol levels. Passive schoolchildren had a 1.1 higher prevalence ratio of high glucose and LDL cholesterol levels. However, when sociodemographic variables were included in the model, these associations were not maintained.

CONCLUSIONS

The prevalence of active commuting in the sample studied is low and it was shown to have a crude association with glucose and LDL cholesterol levels in students. However, sociodemographic factors seem to influence these associations.

Recognition of Barriers to Physical Activity Promotion in Immigrant Children in Spain: A Qualitative Case Study

Physical activity facilitates the acquisition of healthy habits from childhood to adulthood. Differences exist regarding the performance of physical activity among immigrant children compared to native Spanish children. The purpose of the study was to describe the barriers that exist for the promotion of physical activity. A qualitative case-study approach was implemented. Parents of immigrant children, teachers, a school principal, and priests were included, using purposeful sampling. Data were collected from 25 participants, via unstructured and semi-structured interviews, focus groups, and researchers’ field notes. A thematic analysis was performed and ecological levels were identified. Our findings revealed the following barriers to performing physical activity: (a) the meaning of physical activity, (b) gender inequalities, (c) academic burden, (d) lack of social contact, (e) expenses and family economy, (f) lack of infrastructure and natural surroundings, (g) time constraints, (h) fear and insecurity, and (i) the reason for immigrating. These results may be used to revise the school curriculum, promoting equal opportunities for physical activity and encouraging family participation. Additionally, urban design policies should be encouraged to facilitate access to open spaces for recreation within cities.

Untapped Resources: 10- to 13-Year-Old Primary Schoolchildren's Views on Additional Physical Activity in the School Setting: A Focus Group Study

Schools are considered ideal venues to promote physical activity (PA) in children. However, a knowledge gap exists on how to adequately integrate PA into the school day and in particular, on the preferences of children regarding additional PA in school. Therefore, the aim of our qualitative study was to gain comprehensive insight into 10⁻13-year-old primary schoolchildren's perspectives on how to increase PA in the school setting. We conducted nine focus groups (32 girls and 20 boys) with children attending the final two grades of primary school in the Netherlands. We used inductive thematic analysis to analyze the data. The results showed that children were enthusiastic about additional PA in school. Children suggested various ways to increase PA, including more time for PA in the existing curriculum, e.g., physical education (PE), recess, and occasional activities, such as field trips or sports days; school playground adaptation; improving the content of PE; and implementing short PA breaks and physically active academic lessons. Children emphasized variation and being given a voice in their PA participation as a prerequisite to keep PA enjoyable and interesting in the long term. Finally, children mentioned the role of the teacher and making efforts to accommodate all children and their different preferences as important. Children have concrete ideas, acknowledging the challenges that accompany integrating additional PA in school. We therefore recommend actively involving children in efforts to increase school-based PA and to make "additional PA in school" a shared project of teachers and students.

Strength and conditioning in adolescent female athletes

Despite evidence that strength and conditioning (S&C) programs decrease injury risk and increase sport performance, young females are rarely offered S&C programs comparable to those of their male counterparts. The purpose of this study was to evaluate the current body of available literature regarding S&C in adolescent female athletes, describe potential benefits, and generate recommendations for S&C programs for female adolescent athletes. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches of the PubMed and Google Scholar databases were conducted using the following keywords: 'female athletes,' 'injury prevention,' 'adolescent,' 'physical fitness,' 'strength,' 'female adolescent,' and 'conditioning.' Studies included in this review evaluated the effectiveness of S&C protocols and/or the habits and attitudes of coaches and athletic trainers working with female adolescent athletes. Seven articles evaluating S&C programs for the adolescent female athlete were used as the basis for this systematic review. These articles described current protocols and/or factors that should be taken into account when designing S&C programs. The identified articles focused on improving the strength of adolescent female athletes, decreasing the risk of injury, and exposing female athletes to the benefits of S&C that are routinely afforded to their male counterparts. Despite the critical potential benefits of S&C training, such as improved landing mechanics, coaches and athletic trainers do not routinely implement S&C programs for female adolescent athletes. The lack of such programs is largely due to misconceptions surrounding female athletes, such as the perception that females fear bulking up. S&C programs for adolescent female athletes should incorporate stretching of the hip adductors, targeted hamstring, gluteal and quadriceps strengthening, and a synergistic adaptation model, which tailors training protocols to an athlete's pubertal stage.

Effects of a strategy for the promotion of physical activity in students from Bogotá

OBJECTIVE

To examine the effect of the promotion of physical activity during recess on the levels of physical activity, sedentary behaviors, and adiposity of Colombian students.

METHODS

Three schools were randomly selected by an intervention group in Bogotá, Colombia, in 2013: Intervention (Active Module of Active Recess – MARA) + Text Messages (SMS) (MARA+SMS group), intervention (MARA group), control (control group). Intervention was implemented for ten weeks. The duration and intensity of physical activity and sedentary behaviors were measured objectively using accelerometers Actigraph-GT3X+. Adiposity was measured by body mass index and fat percentage. We measured at baseline (T0) and during the tenth week of intervention (T1). We evaluated the effect of the intervention using a difference-in-difference analysis (DID).

RESULTS

We included 120 students (57.5% girls; mean age = 10.5 years; standard deviation [SD] = 0.64). There was a significant increase in the mean daily minutes of moderate to vigorous physical activity in the MARA group (Difference T1-T0 = 6.1 minutes, standard error [SE] = 3.49, p = 0.005) in relation to the control group. There were no significant changes in the minutes of moderate to vigorous physical activity in the MARA+SMS group (Difference T1-T0 = -1.0 minute; SE = 3.06; p = 0.363). The minutes decreased in the control group (Difference T1-T0 = -7.7 minutes; SE = 3.15; p = 0.011). The minutes of sedentary behaviors decreased in the MARA and MARA+SMS groups and increased in the control group (MARA Difference T1-T0 = -15.8 minutes; SE = 10.05; p= 0.279; MARA+SMS Difference T1-T0 = -11.5 minutes; SE = 8.80; p= 0.869; Control Difference T1-T0 = 10.9 minutes; SE = 9.07; p = 0.407). There was a higher participation in the MARA group in relation to the MARA+SMS group (MARA group = 34.4%; MARA+SMS group = 12.1%). There were no significant changes in adiposity at 10 weeks according to difference-in-differences analysis (body mass index p: ΔMARA+SMS group versus Δcontrol group = 0.945, ΔMARA group versus Δcontrol group = 0.847, ΔMARA+SMS group versus ΔMARA group = 0.990; FP p ΔMARA+SMS group versus Δcontrol group = 0.788, ΔMARA group versus Δcontrol group = 0.915, ΔMARA+SMS group versus ΔMARA group = 0.975).

CONCLUSIONS

The Active Module of Active Recess is a promising strategy to increase physical activity levels and decrease sedentary behavior in students. The addition of Text Messages was not associated with increased moderate to vigorous physical activity or changes in adiposity.

Study protocol of the quasi-experimental evaluation of "KEIGAAF": a context-based physical activity and nutrition intervention for primary school children

Background

The environment affects children’s energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention.

Methods

A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data.

Discussion

Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used.

Trial registration

Dutch Trial Register NTR6716 (registration date 27/06/2017, retrospectively registered), METC163027, NL58554.068.16, Fonds NutsOhra project number 101.253.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5764-3) contains supplementary material, which is available to authorized users.

Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs

PURPOSE OF REVIEW

Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives.

RECENT FINDINGS

Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist. The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.

A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After 1 Year

BACKGROUND

The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data.

METHODS

A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses.

RESULTS

Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school's commitment to the project strengthened this effect.

CONCLUSIONS

The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.

Barriers and facilitators to the implementation of a school-based physical activity policy in Canada: application of the theoretical domains framework

Background

In British Columbia Canada, a Daily Physical Activity (DPA) policy was mandated that requires elementary school teachers to provide students with opportunities to achieve 30 min of physical activity during the school day. However, the implementation of school-based physical activity policies is influenced by many factors. A theoretical examination of the factors that impede and enhance teachers’ implementation of physical activity policies is necessary in order to develop strategies to improve policy practice and achieve desired outcomes. This study used the Theoretical Domains Framework (TDF) to understand teachers’ barriers and facilitators to the implementation of the DPA policy in one school district. Additionally, barriers and facilitators were examined and compared according to how the teacher implemented the DPA policy during the instructional school day.

Methods

Interviews were conducted with thirteen teachers and transcribed verbatim. One researcher performed barrier and facilitator extraction, with double extraction occurring across a third of the interview transcripts by a second researcher. A deductive and inductive analytical approach in a two-stage process was employed whereby barriers and facilitators were deductively coded using TDF domains (content analysis) and analyzed for sub-themes within each domain. Two researchers performed coding.

Results

A total of 832 items were extracted from the interview transcripts. Some items were coded into multiple TDF domains, resulting in a total of 1422 observations. The most commonly coded TDF domains accounting for 75% of the total were Environmental context and resources (ECR; n = 250), Beliefs about consequences (n = 225), Social influences (n = 193), Knowledge (n = 100), and Intentions (n = 88). Teachers who implemented DPA during instructional time differed from those who relied on non-instructional time in relation to Goals, Behavioural regulation, Social/professional role and identity, Beliefs about Consequences. Forty-one qualitative sub-themes were identified across the fourteen domains and exemplary quotes were highlighted.

Conclusions

Teachers identified barriers and facilitators relating to all TDF domains, with ECR, Beliefs about consequences, Social influences, Knowledge and Intentions being the most often discussed influencers of DPA policy implementation. Use of the TDF to understand the implementation factors can assist with the systematic development of future interventions to improve implementation.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4846-y) contains supplementary material, which is available to authorized users.

The effect of before school physical activity on child development: A study protocol to evaluate the Build Our Kids Success (BOKS) Program

INTRODUCTION

Most childhood physical activity interventions focus on reducing childhood obesity with varying success, indicating that body mass index (BMI) may be a limited marker of health in children. To better understand overall childhood health and wellbeing, this study is investigating BOKS (Build Our Kids Success), an established ongoing before-school physical activity program, to evaluate students' physical health, mental health, cognitive capacity, and academic performance.

DESIGN AND METHODS

The study is a non-randomized controlled trial with 26 elementary and middle schools in 3 Massachusetts communities, including first through eighth grade (aged 5-14) students, their parents, and teachers. Data collection is occurring during the 2015-2016 school year. Physical fitness is being assessed via 400m run and anthropometrics via height and weight measures (BMI). Psychosocial outcomes are being assessed via student, parent, and teacher survey and include nutrition, daily activities, emotional and relationship scales, bullying and victimization, vitality and energy, student engagement, stress, positive affect, self-efficacy and life satisfaction. Academic performance is reported by grades. Statistical methods include a psychometric evaluation of study measures, Pearson correlations, Student's t-tests, ANOVA/ANCOVA and multivariate linear regression including multilevel modeling analyses to account for the hierarchical organization of the data.

DISCUSSION

This study is investigating a before school physical activity program on parameters of physical health, mental health, cognitive capacity, and academic performance by employing a novel triad approach, correlating the input of the child, parent, and teacher. Outcomes will evaluate the effectiveness of a before school physical activity program in elementary and middle schools and potentially provide valuable information for schools looking to institute innovative physical activity programs.