Supporting public health priorities: recommendations for physical education and physical activity promotion in schools

Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis

BACKGROUND

Capacity building may play an important role in improving classroom teachers' and early childhood educators' (ECE) capacity to implement physical activity and FMS interventions. Capacity building is the development of knowledge, skills, and structures to improve the capability of individuals and organisations to achieve effective health promotion. This review aimed to determine the efficacy of capacity building interventions on teachers' and ECEs' perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills.

METHODS

An exhaustive literature search of six electronic databases was conducted. Controlled, single-group pre-post studies were included if they measured the effect of a capacity building intervention on in-service or pre-service classroom teachers' (primary or secondary) or ECEs' physical activity or fundamental skills related perceived capabilities, knowledge, or attitudes. The effects of interventions were synthesised using random effects meta-analysis. Subgroup analysis and meta-regression was conducted to determine if the effects differed based on study design, type of teacher (ECE vs. primary school), or teacher level (pre-service vs. in-service).

RESULTS

A total of 22 studies reporting on 25 unique samples were included in the meta-analyses. Only studies reporting on ECEs and primary school teachers were identified. Interventions most commonly included training/professional development, resources and toolkits, communities of practice, mentorships, and ongoing support. Results showed that capacity building interventions significantly improved teachers' and ECEs' perceived capabilities (g = 0.614, 95% CI = 0.442, 0.786), knowledge (g = 0.792 95% CI = 0.459, 1.125), and attitudes (g = 0.376 95% CI = 0.181, 0.571). The effects did not differ significantly as a function of any of the moderators examined.

CONCLUSION

Findings from this review provide strong support that capacity building interventions are efficacious at improving teachers' and ECEs' perceived capabilities, knowledge, and attitudes related to promoting physical activity and teaching fundamental movement skills. Pre-service teachers and ECEs should be provided training in physical activity and fundamental movement skills as part of their degrees, and continual professional development and capacity building should be offered to in-service teachers and ECEs to promote physical activity and fundamental movement skills in children.

An examination of the predictors of change in BMI among 38 026 school students in Makkah, Saudi Arabia

BACKGROUND

The prevalence of childhood obesity has substantially increased in the Gulf Cooperation Council countries, including Saudi Arabia. The Rashaka initiative is a Saudi national school-based multicomponent intervention that was introduced in the school year 2016-2017 to address childhood overweight and obesity. This study aims to examine the effect of the Rashaka initiative on students' body mass index (BMI) for two academic years (2016-2017 and 2018-2019) and to analyse predictors of BMI change.

METHODS

Secondary data for this pre-post study was provided by the Ministry of Health for 38 026 students from 89 intermediate and secondary schools that implemented the initiative in Makkah City, Saudi Arabia. It was analysed using non-parametric tests and multiple regressions at a 5% level of significance.

RESULTS

Over 2 y of implementation, BMI was reduced significantly across the schools (p < 0.001). Based on the regression modelling, school gender and education stage were found to be the only significant predictors of BMI change. Girls and intermediate schools had greater BMI reductions than boys and secondary schools (p < 0.001 and p = 0.031).

CONCLUSIONS

This study provides tentative evidence for the effectiveness of the Rashaka intervention in Makkah City. In addition, our study has identified that the Rashaka initiative may require modification to improve its effect on boys and students in secondary schools.

Identifying latent classes of physical activity profiles over time among adolescents in Ontario, Canada

BACKGROUND

Physical activity behaviours are known to be highly correlated. Adolescents who participate in one type of physical activity (e.g., physical education) have a greater likelihood of participating in other physical activities (e.g., organized sports); however, little research has examined participation rates in various physical activity behaviours concurrently. This study identified longitudinal physical activity profiles among secondary school aged youth in Ontario, Canada.

METHODS

We used data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada. Using a repeated measures latent class analysis, Ontario students who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917). Latent classes were defined by: PE participation, guideline adherence (≥ 60 min/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics.

RESULTS

Three distinct latent classes were identified for females and four were identified for males. These classes were: (1) Guidelines (high probability of guideline adherence; females: 44%; males: 16%), (2) PE & Sports (high probability of PE and sport participation; females: 33%; males: 43%), (3) Guidelines & Sports (high probability of guideline adherence and sport participation; females: 23%; males: 23%;), and (4) Inactive (low probability of all physical activity indicators; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethno-racial identity, weekly spending money, strength training, and English and math grades were associated with class membership among males.

CONCLUSIONS

Findings suggest that latent physical activity profiles differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sport participation was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these activities alone may not be providing sufficient levels of physical activity that align with current recommendations for Canadian youth.

Physical activity interventions in European primary schools: a scoping review to create a framework for the design of tailored interventions in European countries

Introduction

Schools provide a unique environment to facilitate physical activity for children. However, many school-based physical activity interventions have not been effective. We propose a new approach, which allows schools to tailor interventions to their specific context. This scoping review aimed to identify intervention components from previous school-based physical activity interventions to form the basis of a tailored approach in a European setting.

Methods

Joanna Briggs Institute guidelines for conducting scoping reviews were followed. European school-based intervention studies aimed at increasing physical activity in children aged 7-11 years published in English since 2015 were included. Databases searched were Ovid Medline, Embase, PsycINFO, Web of Science Social Sciences Citation Index, ERIC and British Education Index. Data was extracted on intervention components, context-related factors (geographical location, school size, child socioeconomic status and ethnicity), feasibility, acceptability and cost-effectiveness. A data-driven framework was developed to summarize the identified intervention components.

Results

79 articles were included, constituting 45 intervention studies. We identified 177 intervention components, which were synthesized into a framework of 60 intervention component types across 11 activity opportunities: six within the school day, three within the extended school day and two within the wider school environment. Interventions most frequently targeted physical education (21%), active and outdoor learning (16%), active breaks (15%), and school-level environmewnt (12%). Of the intervention components, 41% were delivered by school staff, 31% by the research team, and 24% by external organizations. Only 19% of intervention studies reported geographical location and only 10% reported school size. Participant ethnicity and socioeconomic information was reported by 15% and 25%, respectively. Intervention acceptability was reported in 51% of studies, feasibility in 49%, and cost effectiveness in 2%.

Discussion

This review offers a first step in developing a future framework to help schools to develop context-specific, tailored interventions. However, there was a lack of reporting of contextual factors within the included studies, making it difficult to understand the role of context. Future research should seek to measure and report contextual factors, and to better understand the important aspects of context within school-based physical activity.

Assessment of multidimensional self-concept in the area of physical education: validation of a scale

Introduction

Self-concept is a person's perception of him/herself and how he/she performs in different situations. This aspect must be developed during the formative stages and Physical Education is a fundamental area due to its enormous methodological possibilities.

Aim

Therefore, the aim of this study is to evaluate the factor structure and reliability of an instrument that allows to analyze the multidimensional self-concept of high school students in the context of Physical Education.

Method

The sample consisted of 1,155 secondary school students from public schools in the Autonomous Community of Extremadura, Spain. After the exploratory and confirmatory analyses, a structure composed of 30 items divided into 5 factors was.

Results

This design showed excellent goodness-of-fit indices as well as good internal reliability indicators (Cronbach's Alpha = 0.76 - 0.88).

Conclusion

Therefore, this scale can be considered as a tool to assess the self-concept of high school students in a quick and easy way.

A meta-analysis of the relationship between social support and physical activity in adolescents: the mediating role of self-efficacy

Introduction

Social support influences physical activity (PA) in adolescents. However, whether mediating and moderating effects impact the relationship between them or the underlying mechanism remains unclear. This study aimed to investigate the mediating effects of self-efficacy as well as a series of moderating influences using a meta-analytic approach.

Methods

A total of 56 studies published between January 2001 and May 2023 were obtained from the Web of Science, EBSCO, Taylor and Francis, Scopus, Wiley, ProQuest, and CNKI (core) databases, comprising 65 independent samples (total sample size = 47,196).

Results and discussion

The mean weighted correlation coefficients between social, family, peer, and school support and adolescent PA were 0.298, 0.226, 0.256, and 0.142, respectively, which were significant, except for school support. Family support and teenage PA were related, although the connection was moderated by gender and socioeconomic characteristics. While social, family, and peer support had a direct influence on adolescent PA, school support did not. Self-efficacy mediated the relationship between social support and its subtypes and adolescent PA.

Effect of exercise given to factory workers with ergonomics training on pain and functionality: A randomized controlled trial

BACKGROUND

Exercise and manual therapy are used with pharmacological interventions to manage low back pain and prevent work-related musculoskeletal disorders. However, the potential benefits of incorporating exercise and ergonomics training for factory workers experiencing low back pain have not been definitively established.

OBJECTIVE

The objective of this study was to assess the impact of ergonomics training with exercises on pain, functionality, sleep, and fatigue among factory employees experiencing low back pain.

METHODS

This research was conducted as a randomized controlled trial involving workers with back pain employed in a plastic molding factory in Gebze, Kocaeli. Both groups received ergonomics training, but only the experimental group was given exercise training inclusive of stretching and core stabilization exercises. The workers in the experimental group were instructed to perform the exercises regularly for three days a week over a period of eight weeks. The McGill Pain Questionnaire (MPQ), the Visual Analogue Scale (VAS), the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the Oswestry Disability Index (ODI) were used for pre-and post-treatment assessment.

RESULTS

The ODI, FSS, PSQI, and MPQ scores were significantly reduced in both groups. In the intergroup comparison, the exercise group showed a significantly greater decrease in all test scores compared to the control group.

CONCLUSION

The exercise group showed a statistically significant decrease in ODI, FSS, MPQ, and PSQI scores compared to the control group. This study demonstrated that exercise is a more effective practice than ergonomic training for factory workers suffering from chronic low back pain.

Effects of a School-Based Physical Activity Intervention on Adolescents' Mental Health: A Cluster Randomized Controlled Trial

BACKGROUND

The aim of this study was to evaluate the effectiveness of a school-based multicomponent physical activity intervention on mental health of adolescents.

METHODS

A clustered, randomized, controlled trial was employed in 8 high schools in Dhaka, Bangladesh, which were randomly assigned to either an intervention or control group; 40 students in grades 8 and 9 from each school took part in the trial (n = 160/group). Students in the intervention schools participated in a 12-week physical activity intervention with multiple components (eg, supervised circuits, lunchtime sports, health education, infographics), while control schools received no intervention. Participants completed baseline and postintervention surveys measuring depressive symptoms (Center for Epidemiologic Studies Depression Scale) and life satisfaction (Cantril Ladder), along with other sociodemographic and behavioral characteristics. Linear mixed-effects modeling was used to evaluate the intervention effects.

RESULTS

Depressive symptoms in the intervention group decreased at postintervention, but remained stable in the control group. There was an increase in life satisfaction in the intervention group and a decrease in the control group. Multivariable modeling showed that students in the intervention group had a significantly lower level of depressive symptoms (β = -4.60; 95% confidence interval, -5.76 to -3.46) and higher level of life satisfaction (β = 1.43; 95% confidence interval, 0.77 to 2.10) compared with their counterparts in the control group. Sensitivity analyses supported the positive effects of the intervention.

CONCLUSIONS

Our school-based, multicomponent physical activity intervention is effective in improving mental health indicators in adolescents. Future trials should be ramped up to include schools in rural and regional settings, using robust measures  of mental well-being.

Clinical assessment, treatment, and referral trends for adolescent runners seeking care at an injured runners' clinic

PURPOSE

Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine.

METHODS

This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame.

RESULTS

Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: <  0.001-0.003), and referrals (X2 = 132, p <  0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p <  0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015.

CONCLUSION

Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.

Moderate-to-vigorous intensity physical activity levels of children with intellectual disability during physical education classes

Background

Physical education (PE) class is an excellent way to improve moderate-to-vigorous intensity physical activity (MVPA). Increasing number of research has explored the children's PA based on movement during PE classes, but data for children with intellectual disability (ID) is still lacking.

Purpose

The purpose of this study was to investigate the current status of MVPA levels of children with ID during PE classes in China, as well as differences of MVPA levels according to gender and grade.

Methods

Accelerometers were used to record MVPA levels of fifty-three children with severe ID from 9 to 16 years of age (mean age: 12.60 ± 1.66 years) during standard PE classes.

Results

The mean time spent in MVPA during PE classes was 8.00 ± 2.10 min, meaning only 22.88% of PE class time was spent in MVPA. As grade levels progresses, time spent in MVPA during PE classes tended to decrease; the fourth-grade children tended to spend more time in MVPA during PE classes compared with the fifth-grade and the sixth-grade (9.15 vs. 7.61 vs. 7.25 min, all p < 0.05). Boys spend significantly more time in MVPA during PE classes than girls; both in the entire sample (9.20 vs. 5.70 min) as well as in each grade (9.76 vs. 6.09 min, 9.35 vs. 5.68 min, 8.31 vs. 5.59 min, all p < 0.05).

Conclusion

Findings from this study indicate that the proportion of PE class spent in the MVPA of children with ID was lower than the 50% recommended by the U.S. Department of Health and Human Services (DHHS) and U.K. Association for Physical Education (AfPE). And the amount of MVPA participation varied by the grade and gender as well as by the activity performed. Therefore, in order to help children with ID achieve MVPA goals, educators need to reevaluate the PE curriculum as well as take due consideration of grade and gender when devising new content.

Supporting adolescents' participation in muscle-strengthening physical activity: protocol for the 'Resistance Training for Teens' (RT4T) hybrid type III implementation-effectiveness trial

INTRODUCTION

In Australia, only 22% of male and 8% of female adolescents meet the muscle-strengthening physical activity guidelines, and few school-based interventions support participation in resistance training (RT). After promising findings from our effectiveness trial, we conducted a state-wide dissemination of the 'Resistance Training for Teens' (RT4T) intervention from 2015 to 2020. Despite high estimated reach, we found considerable variability in programme delivery and teachers reported numerous barriers to implementation. Supporting schools when they first adopt evidence-based programmes may strengthen programme fidelity, sustainability, and by extension, programme impact. However, the most effective implementation support model for RT4T is unclear.

OBJECTIVE

To compare the effects of three implementation support models on the reach (primary outcome), dose delivered, fidelity, sustainability, impact and cost of RT4T.

METHODS AND ANALYSIS

We will conduct a hybrid type III implementation-effectiveness trial involving grade 9 and 10 (aged 14-16 years) students from 90 secondary schools in New South Wales (NSW), Australia. Schools will be recruited across one cohort in 2023, stratified by school type, socioeconomic status and location, and randomised in a 1:1:1 ratio to receive one of the following levels of implementation support: (1) 'low' (training and resources), (2) 'moderate' (training and resources+external support) or 'high' (training and resources+external support+equipment). Training includes a teacher workshop related to RT4T programme content (theory and practical sessions) and the related resources. Additional support will be provided by trained project officers from five local health districts. Equipment will consist of a pack of semiportable RT equipment (ie, weighted bars, dumbbells, resistance bands and inverted pull up bar stands) valued at ~$A1000 per school. Study outcomes will be assessed at baseline (T0), 6 months (T1) and 18 months (T2). A range of quantitative (teacher logs, observations and teacher surveys) and qualitative (semistructured interviews with teachers) methods will be used to assess primary (reach) and secondary outcomes (dose delivered, fidelity, sustainability, impact and cost of RT4T). Quantitative analyses will use logistic mixed models for dichotomous outcomes, and ordinal or linear mixed effects regression models for continuous outcomes, with alpha levels set at p<0.025 for the outcomes and cost comparisons of the moderate and high support arms against the low support arm.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the University of Newcastle (H-2021-0418), the NSW Department of Education (SERAP:2022215), Hunter New England Human Research Ethics Committee (2023/ETH00052) and the Catholic Schools Office. The design, conduct and reporting will adhere to the Consolidated Standards of Reporting Trials statement, the Standards for Reporting Implementation Studies statement and the Template for Intervention Description and Replication checklist. Findings will be published in open access peer-reviewed journals, key stakeholders will be provided with a detailed report. We will support ongoing dissemination of RT4T in Australian schools via professional learning for teachers.

TRIAL REGISTRATION NUMBER

ACTRN12622000861752.

The Comprehensive School Physical Activity Program: An Invited Review

Physical inactivity is a global challenge that necessitates early intervention during childhood. Schools are positioned to make a significant impact on children's current and future physical activity behavior, but numerous barriers hinder the implementation and sustainability of school-based physical activity opportunities. The purpose of this invited article is to provide an overview of the comprehensive school physical activity program (CSPAP) as a concept, framework, and promising approach to institutionalizing physical activity within the school environment. Despite the availability of numerous published reviews on the topic, a broad, up-to-date panorama of the CSPAP literature that encompasses and consolidates historical, conceptual, empirical, and practical perspectives is currently lacking. Contained within this article is an explanation of the public health context that undergirds the CSPAP concept, a historical perspective of the concept's origins and evolution, examples of CSPAP research, recommendations for advancing the knowledge base, and evidence-informed frameworks and principles for professional practice.

Effect of Extracurricular After-School Physical Activities on Academic Performance of Schoolchildren: A Cluster Randomized Clinical Trial

Importance

The beneficial effects of increasing outdoor physical activity time on children's myopia onset and physical well-being are widely acknowledged. However, in countries with competitive educational systems, such as China, parents and school administrators may be relatively reluctant to increase the extracurricular physical activity time for children due to concerns that this action will compromise children's academic performance.

Objective

To investigate whether additional extracurricular physical activity time after school compromises the academic performance of schoolchildren.

Design, Setting, and Participants

This cluster randomized clinical trial was conducted from October 2020 to June 2021 in Yudu, Jiangxi, China. Eligible children in grades 3 and 4 from 24 elementary schools were randomized to the intervention or control group. Primary analysis was conducted in the full sample using the intention-to-treat principle.

Interventions

The intervention group received 2 hours of after-school physical activity time outdoors on school days. The control group was free to arrange their after-school activity.

Main Outcomes and Measures

The primary outcome was the between-group mean difference in mathematics test scores at the end of 1 academic year, with a noninferiority margin of -3.3 points. Standardized mathematics tests, physical fitness assessments (in reference to the 2018 National Physical Fitness Survey Monitoring Programme in China), and cycloplegic autorefraction were performed at baseline and the end of 1 academic year. Myopia was defined as a cycloplegic spherical equivalent refraction of -0.5 diopters or less in either eye.

Results

A total of 2032 children (mean [SD] age, 9.22 [0.62] years; 1040 girls [51.2%]) from 24 schools were randomized to the intervention group (12 schools; 1012 children) or control group (12 schools; 1020 children). The mean (SD) mathematics score at the end of 1 academic year was 78.01 (17.56) points in the intervention group and 77.70 (17.29) points in the control group. The adjusted between-group mean difference was 0.65 points (95% CI, -2.85 to 4.15). The adjusted between-group mean difference in physical fitness score was 4.95 points (95% CI, 3.56-6.34; P < .001) and -1.90% (95% CI, -18.72% to 14.91%; P > .99) in myopia incidence.

Conclusions and Relevance

Results of this trial indicate that, compared with the control practice of free play after school, adding 2 hours of extracurricular physical activity outdoors after school was noninferior in academic performance and had superior efficacy in improving physical fitness.

Trial Registration

ClinicalTrials.gov Identifier: NCT04587765.

Structural modeling of EFL/ESL teachers' physical activity, mental health, psychological well-being, and self-efficacy

BACKGROUND

Physical activity (PA) is known to positively affect individuals' mental and physical health, especially those who experience high levels of stress, such as teachers. Previous studies have examined the relationship between teachers' PA, mental health, and well-being. Still, there is a lack of research on the direct and indirect effects of PA and self-efficacy.

PURPOSE

This study aimed to investigate the structural relationship between teachers' PA, mental health, well-being, and self-efficacy among ESL/EFL teachers. A total of 364 Chinese English language teachers were selected through convenience sampling. Mental health, physical activity, psychological well-being, and self-efficacy instruments were used.

METHODOLOGY

The data was analyzed using Smart PLS software, and the hypothesized model was evaluated. The results indicated an acceptable level of divergent and convergent validity and goodness of fit.

RESULTS

The findings revealed that PA directly predicts teachers' mental health and well-being, but the direct structural relationship between teachers' PA and self-efficacy was not confirmed. However, the results showed that teachers' PA contributes to their self-efficacy by enhancing their mental and psychological well-being. The total effect of teachers' PA on their self-efficacy was significant. Additionally, mental health and psychological well-being strongly influenced teachers' self-efficacy.

CONCLUSION

In conclusion, regular weekly physical activity can help EFL/ESL teachers foster their mental health, psychological well-being, and self-efficacy. These findings have theoretical and practical significance for teachers, trainers, and educational psychologists.

The effects of a physical exercise program in Chinese kidney transplant recipients: a prospective randomised controlled trial

Background

Kidney transplant has become the preferred therapy for end-stage renal disease. However, kidney transplant recipients (KTRs) still face several challenges, such as physical inactivity. The purpose of this study was to explore the effects of a nurse-led physical exercise program in Chinese KTRs.

Methods

A total of 106 participants were enrolled from the Third Xiangya Hospital of Central South University between July 2021 and June 2022 and randomly assigned to the control or intervention groups. Participants in the control group were provided with routine nursing care and participants in the intervention group received a nurse-led rigorous physical exercise program that was divided into two stages: the pre-discharge stage and the post-discharge stage. The pre-discharge stage included the non-ambulatory and ambulatory stages. The Chinese traditional exercise Baduanjin was incorporated into the physical exercise during the ambulatory stage. The post-discharge stage continued the same exercise as the ambulatory stage at home. After 3 months of intervention, both groups received the same follow-up for 3 months. The primary and secondary outcomes of all participants were collected. The data were analysed with repeated measures analysis of variance to examine the effectiveness of the intervention.

Results

Compared with the control group, the intervention group had less fatigue and more motivation to be active in primary outcomes. Moreover, patients in the intervention group had a higher phase angle, a longer 6-minute walk distance, more 30-second chair stand times and decreased anxiety and depression levels in secondary outcomes. No adverse events were observed during the intervention. There were no significant differences in all dimensions of the quality-of-life questionnaire between the intervention and the control group.

Conclusion

Chinese KTRs could benefit from the nurse-led physical exercise program post-operatively.

Trial registration

ChiCTR2100048755.

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.

Measuring physical literacy for an evidence-based approach: Validation of the French perceived physical literacy instrument for emerging adults

Background/Objectives

Physical Literacy (PL) is increasingly recognized as a key element in studies aimed at promoting Physical Activity (PA), but measurement tools for emerging adults and evidence for assessing and using this concept is lacking in a wide range of contexts. We aimed to validate the French version of the Perceived Physical Literacy Instrument (PPLI): a scale for investigating PL in young French adults.

Methods

After PL and PA data collection (n = 2,248, age_mean = 19 ± 1.53 yrs), exploratory and confirmatory factor analyses, Cronbach's α and Omega's ω and an Intraclass-Correlation analysis were undertaken. Spearman's rank correlation and the Boruta algorithm were used to investigate the association between PL and PA. Boruta's algorithm examined deeper external validation by analyzing the strength of an overall PL score in explaining PA, compared with separate dimensions of PL and individual characteristics (BMI, sex).

Results

Results showed an acceptable level of reliability (ICC = 0.91), internal validity (α = 0.88; ω = 0.77), and external validity (Rhô >0.18, p < 0.01). The Boruta algorithm highlighted that the construct of PL is a significant predictor of PA, although not the strongest one which is social and affective dimension.

Conclusion

This study provided data on validity and reliability of the first French assessment tool to measure PL constituted by four intertwined dimensions (physical, cognitive, social, affective). At the same time, it provides new evidence of the association between PL and PA.

Perceptions of food environments in the school and at home during Covid-19: An online cross-sectional study of parents, teachers and experts from Latin America

BACKGROUND

The high prevalence of overweight and obesity in children from Latin America (LA) have been related to obesogenic food environments. Besides, the negative effects of the Covid-19 pandemic should also be considered. The objective of this research was to describe and compare the perceptions of parents, teachers, and experts in LA of food environments at home and school that favor healthy habits in schoolchildren in pre Covid-19 stage and during the pandemic.

METHODS

This study used a survey self-reporting regarding conditions at home and the school favoring healthy habits, for three profiles: parents, primary school teachers, and experts. A fisher exact test was used to establish the difference between the response categories between countries and profiles. Logistic regression models were used to determine the probability of response in the levels of importance adjusted for sex and nationality.

RESULTS

Information from 954 questionnaires was reported: 48.4% experts, 32.0% teachers, and 19.6% parents. There were differences in the perception of food environments at school between profiles (p<0.001). In multivariate logistic regression models, experts and teachers were 20% more likely to give greater importance to elements of the food environment at school compared to parents (p<0.001).

CONCLUSIONS

Our findings showed that parents were less likely to perceive important elements of the school food environment compared to experts and teachers. Interventions are required to improve healthy eating environments that consider children's interpersonal mediators.

Fostering pupils' critical health literacy: examining the potential of physical education in lower secondary school

Background

In Norway, the introduction of an interdisciplinary subject named Public Health and Life skills has brought about renewed attention to how health is conceptualized and taught within and across school subjects. Physical education (PE) is one subject that has traditionally been linked to health outcomes. However, a narrow focus on increased physical activity as the main outcome of PE could be counterproductive in the pursuit of health. Critical health literacy (CHL) is put forward as a resource for health that can be nurtured in the PE context; this study hypothesizes that academic achievement in PE is positively associated with some aspects of CHL.

Methods

This cross-sectional study included 521 pupils aged 13-15 years old from five lower secondary schools in Norway. Structural equation models were used as the primary statistical analysis to test the hypothesis. The study controlled for parents' education, leisure physical activity, and participation in sports club activities.

Results

The results confirm the hypothesis, showing a positive and significant association between PE and CHL. The association remains when controlling for parents' education, leisure physical activity, and participation in sports club activities (β^_PE→_CHL-C1= 0.264, p = 0.001; β^_PE→_CHL-C2= 0.351, p < 0.000).

Conclusion

In our sample, academic achievement in PE was associated with higher levels of CHL. This study contributes to the ongoing discussion on the health benefits of PE. We argue that a resource-based health perspective can produce the appropriate aims for health in PE contexts and that the CHL concept contributes to illuminating key areas, promoting suitable teaching strategies, and bringing balance between an individual and collective focus for future health education, both within PE and across different subjects in school contexts.

The Effects of Physical Activity on Academic Performance in School-Aged Children: A Systematic Review

Schools offer a unique environment to influence children's physical activity (PA) levels positively. This study aims to systematically review the evidence surrounding how PA affects academic performance by analysing how the frequency, intensity, time, and type of PA mediate academic performance outcomes. This review was conducted using the PRISMA framework. Keyword searches were conducted in Science Direct, PubMed, and SPORTDiscus. Children that were obese, typically developing, typical weight, disabled, with a developmental disability, from a low socio-economic background, or an ethnic minority were included. A total of 19 studies were included, with a total of 6788 participants, a mean age of 9.3 years (50.2% boys, and 49.8% girls). Overall, 63.2% were nondisabled, while 36.8% were diagnosed with a disability. Two authors met, reviewed papers with regard to the inclusion criteria, and agreed on outputs to be included. Evidence suggests that associations between PA and academic performance were primarily positive or nonsignificant. PA levels of 90 min plus per week were associated with improved academic performance, as was PA performed at moderate to vigorous intensity. The optimal duration of PA was 30-60 min per session, whilst various sports induced positive academic effects. Importantly, findings support that PA does not have a deleterious effect on academic performance but can enhance it.

The feasibility of using the Körperkoordinationstest fur Kinder (KTK) in a U.S. elementary physical education setting to assess gross motor skills specific to postural balance

Introduction

For the past ten years, falls have been the leading cause of nonfatal injuries for all age groups less than 15 years old. A significant rise in childhood sedentary behavior in schools and limited opportunities to be outside has led to motor coordination deficits which have contributed to fall injuries.

Method

A German assessment tool, the Körperkoordinationstest fur Kinder (KTK), which has been used for decades in Western European countries, allows researchers and physical education teachers to evaluate typical and atypical children's motor coordination competencies related to dynamic postural balance successfully. No research has been published on the use of this assessment tool in the United States. If its use were found to be feasible in this country for identifying motor coordination deficits in typical and atypical children, it would close the gap in determining motor coordination. Therefore, this study sought in Phase 1 to determine the feasibility of using the KTK assessment in U.S. children and Phase 2 sought to determine the adaptability of the scoring protocol from use in other countries to the United States.

Results

The Phase 1 results revealed the KTK assessment was feasible to administer in U.S. physical education class by addressing three challenges for U.S. schools: 1) KTK implementation, 2) time to assess each skill, and 3) the equipment availability and cost to implement the test in a physical education setting. In Phase 2, the researchers were able to determine the raw scores and motor quotient scores in this population and then were able to show similar scoring trends between U.S. children and Flemish children from a previous study.

Conclusion

This assessment tool was deemed feasible and adaptable which is the first step to use the KTK in U.S. physical education elementary school settings.

School-Based Circuit Training Intervention Improves Local Muscular Endurance in Primary School Students: A Randomized Controlled Trial

BACKGROUND

This study aimed to explore the effectiveness of a 12-week circuit training program in improving local muscular endurance in normal-weighted primary school students.

METHODS

The study involved a parallel-group randomized trial with 606 primary school boys assigned to an experimental or a control group. The participants underwent a 12-week circuit training program that involved multi-joint, total-body workouts using body weight, resistance bands, and medicine ball exercises. The study measured the participants' local muscular endurance during sit-ups, dynamic trunk extensions on a Roman bench (DTE), and push-ups.

RESULTS

After adjusting for the baseline, the treatment-grade interaction was significant for sit-ups (F = 7.74, p < 0.001, η_p² = 0.04), DTE (F = 6.49, p < 0.001, η_p² = 0.03), and push-ups (F = 9.22, p < 0.001, η_p² = 0.05), where the experimental treatment was more beneficial than the control. The treatment effect seemed to vary depending on the individual's baseline local muscle endurance capacity. As the baseline local muscular endurance values increased, the treatment and grade effects became less beneficial.

CONCLUSION

A 12-week circuit training program involving body weight, resistance bands, and medicine ball exercises suits school-based programs and can improve local muscular endurance in normal-weighted primary school boys. The experimental treatment was more effective than the control, and the individual baseline muscular endurance should be considered when designing training programs.

Effects of a games-based physical education lesson on cognitive function in adolescents

Despite the importance of physical education (PE) lessons for physical activity in adolescents, the acute cognitive responses to PE lessons have not been explored; a gap in the literature that this study addresses. Following familiarisation, 76 (39 female) adolescents (12.2 ± 0.4 y) completed two trials (60 min games-based PE lesson and 60 min academic lesson) separated by 7-d in a counterbalanced, crossover design. Attention, executive function, working memory, and perception were assessed 30 min before, immediately post, and 45 min post-lesson in both trials. Participants were split into high-and low-fit groups based on a gender-specific median split of distance run on the multi-stage fitness test. Furthermore, participants were split into high and low MVPA groups based on a gender-specific median split of MVPA time (time spent &gt;64% HR max) during the PE lesson. Overall, a 60 min games-based PE lesson had no effect on perception, working memory, attention, or executive function in adolescents (all p &gt; 0.05) unless MVPA time is high. The physical activity-cognition relationship was moderated by MVPA, as working memory improved post-PE lesson in adolescents who completed more MVPA during their PE lesson (time*trial*MVPA interaction, p &lt; 0.05, partial η2 = 0.119). Furthermore, high-fit adolescents displayed superior cognitive function than their low-fit counterparts, across all domains of cognitive function (main effect of fitness, all p &lt; 0.05, partial η2 0.014–0.121). This study provides novel evidence that MVPA time moderates the cognitive response to a games-based PE lesson; and emphasises that higher levels of fitness are beneficial for cognitive function in adolescents.

The association of families' socioeconomic and demographic characteristics with parents' perceived barriers to returning to youth sport following the COVID-19 pandemic

Developmentally appropriate sport contexts have the potential to positively influence young people's physiological, psychological, and social outcomes. However, little is known about how families returned to sport in the wake of COVID-19-related restrictions or how socioeconomic and demographic factors influenced parents' perceptions of barriers to returning. A nationally representative sample (N = 6183) of American youth sport parents completed a questionnaire in which they provided demographic information and answered questions related to the barriers they perceived in returning to sport, such as the risk of their child getting sick. Structural equation modeling was used to examine the relationships among a range of socioeconomic and demographic factors and these barriers to returning. Results suggest that parents from racially minoritized and urban neighborhoods held higher levels of concern over health-related and practical barriers to returning to sport. Findings highlight the importance of designing available, equitable, and appropriate youth sport contexts.

The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect

BACKGROUND

Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness.

AIMS

This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables.

METHODS

Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified.

RESULTS

The 'Move & Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task.

CONCLUSIONS

This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move & Connect' intervention and allow researchers to replicate its components.

The effectiveness of school-based run/walk programmes to develop physical literacy and physical activity components in primary school children: A systematic review

The objectives of this review were to systematically review the research on school-based run/walk programmes and their measurements of physical literacy (PL) and physical activity (PA)-related components and to assess the different intervention methods and their impact on encouraging PL and PA. To be included in the review, studies had to satisfy all inclusion criteria. An electronic search was conducted on six databases, the last date search was 25 April 2022. All outcome measures were grouped using the Shearer et al. (2021) PL checklist and additional PA related outcomes. Ten studies were included in the final review. Five different run/walk interventions were identified and six studies followed or referred to The Daily Mile (TDM) protocol. Outcomes relating to the physical domain were most commonly explored, and no studies explored the cognitive domain. Four studies reported significant differences in cardiovascular endurance measures. Positive findings were also reported for outcomes relating to motivation and self-perception/self-esteem in the affective domain. Overall, run/walk programmes appear to provide promising results in favour of physical and affective development in PL. However, further high-quality studies are needed to draw firm conclusions. This review highlights the popularity of TDM and its potential to contribute to PL development.

Attitudes towards Peers with Disabilities among Schoolchildren in Physical Education Classes

All children, including those living with disabilities, have the right to be provided with Inclusive Education (IE) together with appropriate support in scholarly settings. A key factor for educational inclusion is peers' attitudes towards disabilities, which impact disabled students' social participation and learning. Physical Education (PE) classes represent an opportunity for students with disabilities to get psychological, social, health, and educational benefits. This study aimed to assess Spanish students' attitudes regarding their peers with disabilities during PE lessons and to explore possible differences between gender, school location, and age group. The sample consisted of 1437 students from public schools in Extremadura (Spain) from the primary and secondary stages. Participants completed the Attitude towards Students with Disabilities in Physical Education (EAADEF-EP) Questionnaire. The Mann-Whitney U test was carried out to establish differences in scores according to sex, school location, age group, and correlations between age and item scores using the Spearman's Rho test. The results displayed significant differences in the total and item scores considering sex and centre location, with good reliability values (Cronbach's alpha = 0.86). The EAADEF-EP Questionnaire has proven to be a quick, easy, and inexpensive tool to assess attitudes. Girls and participants whose school was in a rural setting had better attitudes towards inclusion. This study's results highlight the importance of carrying out educational actions and programs to improve students' attitudes towards their peers with disabilities considering the influences of the studied variables.

A school-family blended multi-component physical activity program for Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC): protocol for a cluster randomized controlled trial

BACKGROUND

Fundamental motor skills (FMSs) are crucial for children's health and comprehensive development. Obese children often encounter a considerable challenge in the development of FMSs. School-family blended PA programs are considered a potentially effective approach to improve FMSs and health-related outcomes among obese children, however, empirical evidence is still limited. Therefore, this paper aims to describe the development, implementation, and evaluation of a 24-week school-family blended multi-component PA intervention program for promoting FMSs and health among Chinese obese children, namely the Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC) employing behavioral change techniques (BCTs) and building on the Multi-Process Action Control (M-PAC) framework as well as using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for improving and evaluating the program.

METHODS

Using a cluster randomized controlled trial (CRCT), 168 Chinese obese children (8-12 years) from 24 classes of six primary schools will be recruited and randomly assigned to one of two groups by a cluster randomization, including a 24-week FMSPPOC intervention group and a non-treatment waiting-list control group. The FMSPPOC program includes a 12-week initiation phase and a 12-week maintenance phase. School-based PA training sessions (2 sessions/week, 90 min each session) and family-based PA assignments (at least three times per week, 30 min each time) will be implemented in the initiation phase (semester time), while three 60-min offline workshops and three 60-min online webinars will be conducted in the maintenance phase (summer holiday). The implementation evaluation will be undertaken according to the RE-AIM framework. For intervention effectiveness evaluation, primary outcome (FMSs: gross motor skills, manual dexterity and balance) and secondary outcomes (health behaviors, physical fitness, perceived motor competence, perceived well-being, M-PAC components, anthropometric and body composition measures) will be collected at four time-points: at baseline, 12-week mid-intervention, 24-week post-intervention, and 6-month follow-up occasions.

DISCUSSION

The FMSPPOC program will provide new insights into the design, implementation, and evaluation of FMSs promotion among obese children. The research findings will also supplement empirical evidence, understanding of potential mechanisms, and practical experience for future research, health services, and policymaking.

TRIAL REGISTRATION

Chinese Clinical Trial Registry; ChiCTR2200066143; 25 Nov 2022.

"I Felt I Was Actually Inside the Movie" An Exploratory Study into Children's Views of Staging a Physically Active Experience, with Implications for Future Interventions

Current levels of inactivity suggest novel approaches are needed to engage children in physical activity (PA), and enjoyment is a strong motivator for children's PA engagement. A physically active experience (PAE) was proposed as a way to use entertainment, education, (e)aesthetics and escapist methods to promote PA to children in a way that is immersive and enables them to actively partake whilst enjoying their experience. In this current mixed methods study, three physically active experiences based on popular children's movies were designed and staged, in order to explore children's views on staging a PAE and provide implications for future PA interventions. Seventeen children (boys n = nine, girls n = eight) between the ages of nine and ten years provided feedback on the experiences. The children watched a pre-recorded video presenting the physically active experiences and then completed a survey including affective forecasting responses, which was followed by participation in an online focus group where views on the experiences were explored further. For all three experiences, the mean anticipated affective response for valence was between "fairly good" and "good", and for arousal between "a bit awake" and "awake". Further, when asked, the children reported wanting to take part in the experiences (experience 1: 82.4%, experience 2: 76.5%, experience 3: 64.7%). The qualitative data revealed that children felt that they would enjoy the sessions, feel immersed in their environment, transported away from reality, and that they would be able to learn something new regarding PA. These results support the implementation of a PAE to engage children in enjoyable PA; future interventions should use these findings to engage children in a PAE, examining their actual responses to the activities.

A Scoping Review on Quality Physical Education Programmes and Their Outcomes on Primary-Level Pupils

A scoping review was carried out on the literature relating to the evaluation of the implementation of quality physical education (QPE) programmes and related outcomes on final-stage primary-level pupils' attitudes towards physical education (ATPE), physical activity behaviour (PAB), mental wellbeing (MWB) and academic achievement (AA). The scoping review included studies published between 2000 and 2020 in the PubMed, Elsevier, SCOPUS and CINAHL databases and was completed in accordance with the PRISMA extension for scoping reviews' guidelines. Based on the inclusion criteria, 15 out of 2869 studies were included in the review. A thematic analysis was used to inductively and deductively analyse the studies for common themes of features of QPE programmes in primary schools, arising from nine different countries, considering the four outcome dimensions (ATPE, PAB, MWB and AA). The common themes identified as features of QPE across all four dimensions were as follows: (1) government leadership; (2) PE curriculum; (3) school principal and leaders; (4) organisational management from leadership in school; (5) teachers; (6) parental involvement; and (7) community partnerships. Based on these findings, recommendations were made for an evaluation framework on QPE in primary education.

Evaluation of the peer leadership for physical literacy intervention: A cluster randomized controlled trial

PURPOSE

The purpose of this research was to develop, implement, and test the efficacy of a theory-driven, evidence-informed peer leadership program for elementary school students (Grade 6 and 7; age 11-12 years) and the Grade 3/4 students with whom they were partnered. The primary outcome was teacher ratings of their Grade 6/7 students' transformational leadership behaviors. Secondary outcomes included: Grade 6/7 students' leadership self-efficacy, as well as Grade 3/4 motivation, perceived competence, general self-concept, fundamental movement skills, school-day physical activity, and program adherence, and program evaluation.

METHODS

We conducted a two-arm cluster randomized controlled trial. In 2019, 6 schools comprising 7 teachers, 132 leaders, and 227 grade 3 and 4 students were randomly allocated to the intervention or waitlist control conditions. Intervention teachers took part in a half-day workshop (January 2019), delivered 7 x 40 minute lessons to Grade 6/7 peer leaders (February and March 2019), and these peer leaders subsequently ran a ten-week physical literacy development program for Grade 3/4 students (2x30 minutes sessions per week). Waitlist-control students followed their usual routines. Assessments were conducted at baseline (January 2019) and immediately post-intervention (June 2019).

RESULTS

The intervention had no significant effect on teacher ratings of their students' transformational leadership (b = 0.201, p = .272) after controlling for baseline and gender. There was no significant condition effect for Grade 6/7 student rated transformation leadership (b = 0.077, p = .569) or leadership self-efficacy (b = 3.747, p = .186) while controlling for baseline and gender. There were null findings for all outcomes related to Grade 3 and 4 students.

DISCUSSION

Adaptions to the delivery mechanism were not effective in increasing leadership skills of older students or components of physical literacy in younger Grade 3/4 students. However, teacher self-reported adherence to the intervention delivery was high.

TRIAL REGISTRATION

This trial was registered on December 19th, 2018 with Clinicaltrials.gov (NCT03783767), https://clinicaltrials.gov/ct2/show/NCT03783767.

Physical Activity Patterns According to the Type of Physical Education Classes by Sex and Obesity among Korean Adolescents

This study aimed to compare physical activity patterns according to the type of physical education by sex and body mass index categories among Korean adolescents. We analyzed physical activity using an accelerator in a physical education class among Korean middle school students (1305 boys and 1328 girls). An independent t-test and regression analysis were conducted to compare differences between the obesity groups by sex. As game play time increased, light activity increased in boys in the normal group. Among the girls, sedentary time decreased in the normal, at-risk for obesity, and obese groups. Moderate activity increased in the underweight, normal, at-risk for obesity, and obese groups. Vigorous activity increased in the normal group. As free activity time increased, sedentary time also increased in the normal, at-risk for obesity, and obese groups. Vigorous activity decreased in the normal group. Among the girls, sedentary time increased in the underweight group. Light activity decreased in the underweight and normal groups. A strategy to increase physical activity during physical education class is to increase game play time for girls and decrease free activity time for boys.

Editorial on the Research Topic of Sports Training and the Promotion of Physical Health

Sport activities are a deciding factor in maintaining or achieving physical health [...].

School-Based Family-Oriented Health Interventions to Promote Physical Activity in Children and Adolescents: A Systematic Review

OBJECTIVE

This study aimed to systematically review and analyse intervention programs in a school context centred on the family, focused on increasing youths' physical activity.

DATA SOURCE

The research was carried out in the PubMed, Scopus and Web of Science databases.

STUDY INCLUSION CRITERIA

Studies were included if participants were children or adolescents, focusing on school-based intervention studies with parental involvement and physical activity, sedentary behaviour or physical fitness outcomes.

DATA EXTRACTION

The search was performed according to the PRISMA protocol. A total of 416 articles were identified. After being considered for eligibility and duplicates, 22 studies were identified as relevant for inclusion.

DATA SYNTHESIS

Sample and intervention characteristics, objective, the role of the family, outcomes measures, main findings regarding the outcomes and risk of bias.

RESULTS

Ten studies reported improvements in physical activity, 6 in sedentary behaviour and 9 in the components of physical fitness and/or skills related to healthy behaviours and lifestyles. Most of the interventions adopted a multidisciplinary and multi-component approach.

CONCLUSIONS

Most interventions employed a school's multidisciplinary/multi-component approach to promoting physical activity, nutrition, and general education for healthier lifestyle behaviours. The impact of school-based interventions involving families on youth's physical activity levels is still a relatively emerging theme. Further research is needed given the diversity of the intervention's characteristics and the disparity in the results' efficacy.

Ability of the Sport Education Model to Promote Healthy Lifestyles in University Students: A Randomized Controlled Trial

Although studies on sports performance, leadership abilities, group cohesion, and learning motivation have revealed that the sport education model contributes considerably to the development of healthy lifestyles, few studies have explored the development of healthy lifestyles from an educational intervention perspective. This study fills this gap in the literature. In addition, studies have mostly recruited elementary or middle school students; few have explored the effectiveness of sport education for college students. To fill this gap, this study conducted quasi-experimental research on university students by using different teaching strategies, with healthy lifestyles as the dependent variable. The research participants consisted of 95 students from Ming Chuang University distributed to an experimental group or control group. The experimental group was taught using the sport education model; the control group was taught using direct instruction. The results indicate that the sport education model has a stronger ability to promote healthy lifestyles than conventional teaching. Additionally, the results suggest that teachers should apply specific teaching strategies to cultivate and reinforce exercise habits and healthy behaviors among students. On the basis of the results, the researchers suggest that physical education teachers establish effective teaching strategies and promote healthy lifestyles to students.

Assessment of serum Vit A, D and zinc nutritional status and related dietary and exercise behaviors of children and adolescents in rural and urban area

Vitamin A and vitamin D deficiency in children and adolescents has a negative impact on their growth and development. This study aimed to learn the nutritional status of vitamin A and D among rural children and adolescents and to explore related dietary and exercise behaviors. A total of 10 counties (cities, districts) from 90 counties (cities, districts) in Zhejiang Province were selected by the method of random cluster sampling. Children and adolescents were investigated and their food and nutrient intake were calculated. The concentration of serum vitamin A in urban area was 0.38 ng/ml, which was higher than that in rural area (p < 0.05); while the concentration of serum vitamin D in urban area was 21.25 mg/L, which was lower than that in rural area (p < 0.05). The concentration of serum zinc was 101 μg/dl in urban area and 107 μg/dl in rural area (p < 0.05). The intake of dietary fiber, calcium, vitamin A, vitamin B1, vitamin B2, and vitamin C was lower than the recommended value. In rural area, the intakes of cereals, tubers and beans, livestock, poultry and meat of children and adolescents were higher than the recommended values; while the intake of vegetables, fruits, eggs, milk, fish and shrimp, soybean and nuts was lower than the recommended value. The intake of edible oil and salt is higher than the recommended value. The time of medium and high intensity exercise time in rural area is more than that in urban area in the age group of 12-17 years, while the sitting time is less than that in urban area. Children and adolescents living in rural area should be guided to eat reasonably, and to choose foods with high nutrient density and with low oil, salt and sugar.

Physical Activity and Mental Health in Undergraduate Students

Most research support positive relationships between physical activity and mental health. However, possible moderating variables of these relationships have also been identified, such as age, gender, level of physical activity, and the scope of physical activity. This study aimed to analyze the relationships between physical activity and mental health levels in undergraduate students, assessing whether these associations can change depending on the level of physical activity (low, medium, or high) and the setting (occupational, commuting, or leisure time physical activity) in which it was performed. A descriptive and cross-sectional study was conducted. The sample comprised 847 undergraduate students. Physical activity and mental health were measured by the Global Physical Activity Questionnaire (GPAQv2) and the General Health Questionnaire (GHQ-12). We found relationships between students' physical activity level and their mental health status. The higher the total physical activity, the better their mental health scores. High levels of commuting and leisure time physical activity is also associated with better mental health, while only moderate levels of occupational physical activity are associated with better mental health status. Regarding the possible associations between physical activity and vulnerability to mental health problems, with the fully adjusted regression model, leisure time and occupational physical activity remain protective of a poor state of mental health. Leisure time physical activity, performed at a high level, and moderate occupational physical activity seems to be the best combination of physical activity to reduce students' vulnerability to potential mental health problems.

16 Weeks of Physically Active Mathematics and English Language Lessons Improves Cognitive Function and Gross Motor Skills in Children Aged 8-9 Years

The aim of the present study was to examine the effects of physically active lessons, implemented through the Mathematics and English Language curriculum, on cognitive function and gross motor skill development. Following ethical approval, 192 children aged 8-9 years were randomly allocated to an intervention group (n = 98) or a control group (n = 94). The intervention consisted of 8 h.wk^-1 of physically active lessons, equally split between Mathematics and English Language, for 16 weeks. Cognitive function (digit span, coding and arithmetic reasoning) and gross motor skill development (TGMD-3) were assessed at baseline and follow-up. The improvement in every domain of cognitive function was greater in the intervention group compared to the control group (group * time, p = 0.008-0.023, d = 0.34-0.42). Furthermore, total TGMD-3 score (group * time, p < 0.001, d = 1.16) and both sub-scales (locomotor, p < 0.001, d = 0.63; object control, p < 0.001, d = 1.29) also improved by a greater extent in the intervention group than in the control group. These findings suggest that 16 weeks of physically active lessons, taught in both Mathematics and English Language curriculum, synergistically improved cognitive function and gross motor skill development in primary school children aged 8-9 years.

Development of a German Physical Literacy Assessment for Children in the Context of Health Promotion-An Explorative Approach

Addressing physical literacy (PL) has become increasingly relevant to counteract sedentary behaviour in children and youth. We developed an assessment tool to measure and evaluate the promotion of individual PL and its four subdomains: motivation and confidence (the affective dimension), physical competence (physical dimension), knowledge and understanding (cognitive dimension), and participation in physical activity. Within this cross-sectional study, we tested 567 children aged 6−12 years from four primary schools that differed in socioeconomic status (SES). A subsequent exploratory factor analysis conducted to examine the conformity revealed a five-factor structure. The five factors explained 39.8% of the total cumulative variance. Children with a low SES yielded lower scores in all subdomains except participation in physical activity. This effect was most pronounced in motor skills (p < 0.001, r = 0.28). Among the children with a low SES, 16.9% were overweight and 17.4% were obese, compared to 11.5% and 5.4%, respectively, for those with a high SES (p < 0.001). In conclusion, although the assessment tool was largely in line with the postulated structure, further adjustments are necessary in terms of participation and motivation. Nevertheless, this holistic view of PL, taking SES into account, should enable the focused promotion of health and health literacy.

Adapting Active Science to PE Curricula: Examining Feasibility and Acceptability in Low-Income, Urban Public Schools

Purpose: Children in low-income, urban areas are at a greater risk of poor physical activity (PA) and academic outcomes. The purpose of this study was to examine feasibility, acceptability, and engagement of a pilot implementation of the Active Science (AS) exer-learning program in 3^rd grade physical education (PE) classes to inform potential upscaling after efficacy evaluation. Methods: AS was implemented within PE at five public schools serving low-income, urban neighborhoods, using a phased implementation approach. A mixed methods approach was utilized; feasibility and engagement were measured using quantitative dose and fidelity measures, students were surveyed regarding acceptability, and PE teachers were interviewed pre/post-intervention regarding perceptions of the program. Results: N = 638 students in k = 25 PE classes across five schools averaged 8.8 weeks of AS implementation with nearly universal inclusivity. Students averaged 1468 steps/session; an average of 15% of available PE class time was spent in MVPA. Semi-structured interviews revealed high staff perceptions of feasibility, as well as specific improvements that should be implemented before upscaling. Conclusions: Process and PA measures indicate high feasibility, with excellent engagement across all five schools. Together with high acceptability reported by students and staff, these results show that AS can feasibly integrate into PE classes low-income, urban schools to improve student engagement in both PA and science learning.

The Impact of Distance Education during the COVID-19 Pandemic on Physical Activity and Well-Being of Czech and Polish Adolescents

BACKGROUND

The aim of this study was to identify the changes in the structure of weekly physical activity (PA) and well-being among adolescent boys and girls between habitual education (HE) and distance education (DE) during the pandemic in secondary schools.

METHODS

The research was carried out in 12 Czech and 18 Polish schools during 2019 to 2020 academic session for HE and 2020 to 2021 academic session for DE. The research involved 723 girls and 626 boys aged 15 to 18 years. The structure of the weekly PA was assessed using the International Physical Activity Questionnaire-Long Form, while well-being was assessed using the World Health Organization-5 Well-Being Index.

RESULTS

There was a statistically significant decrease of PA among boys in school PA, transportation PA, recreation PA, vigorous PA, moderate PA, walking, and overall weekly PA during the DE resulting from the pandemic. In girls, during DE, a decrease was observed in school PA, vigorous PA, and overall PA. During DE, a high level of well-being was reported by only 34.9% of girls (43.8% during HE) and 50% of boys (65.6% during HE).

CONCLUSIONS

The observed low PA and high incidence of depressive symptoms in adolescents in distance education during pandemic constraints are a challenge for schools to change in supporting physical activity, eliminating similar negative impacts on school life in the future.

Scale-up of the Internet-based Professional Learning to help teachers promote Activity in Youth (iPLAY) intervention: a hybrid type 3 implementation-effectiveness trial

BACKGROUND

Whole-of-school programs have demonstrated success in improving student physical activity levels, but few have progressed beyond efficacy testing to implementation at-scale. The purpose of our study was to evaluate the scale-up of the 'Internet-based Professional Learning to help teachers promote Activity in Youth' (iPLAY) intervention in primary schools using the RE-AIM framework.

METHODS

We conducted a type 3 hybrid implementation-effectiveness study and collected data between April 2016 and June 2021, in New South Wales (NSW), Australia. RE-AIM was operationalised as: (i) Reach: Number and representativeness of students exposed to iPLAY; (ii) Effectiveness: Impact of iPLAY in a sub-sample of students (n = 5,959); (iii) Adoption: Number and representativeness of schools that received iPLAY; (iv) Implementation: Extent to which the three curricular and three non-curricular components of iPLAY were delivered as intended; (v) Maintenance: Extent to which iPLAY was sustained in schools. We conducted 43 semi-structured interviews with teachers (n = 14), leaders (n = 19), and principals (n = 10) from 18 schools (11 from urban and 7 from rural locations) to determine program maintenance.

RESULTS

Reach: iPLAY reached ~ 31,000 students from a variety of socio-economic strata (35% of students were in the bottom quartile, almost half in the middle two quartiles, and 20% in the top quartile).

EFFECTIVENESS

We observed small positive intervention effects for enjoyment of PE/sport (0.12 units, 95% CI: 0.05 to 0.20, d = 0.17), perceptions of need support from teachers (0.26 units, 95% CI: 0.16 to 0.53, d = 0.40), physical activity participation (0.28 units, 95% CI: 0.10 to 0.47, d = 0.14), and subjective well-being (0.82 units, 95% CI: 0.32 to 1.32, d = 0.12) at 24-months. Adoption: 115 schools received iPLAY.

IMPLEMENTATION

Most schools implemented the curricular (59%) and non-curricular (55%) strategies as intended. Maintenance: Based on our qualitative data, changes in teacher practices and school culture resulting from iPLAY were sustained.

CONCLUSIONS

iPLAY had extensive reach and adoption in NSW primary schools. Most of the schools implemented iPLAY as intended and effectiveness data suggest the positive effects observed in our cluster RCT were sustained when the intervention was delivered at-scale.

TRIAL REGISTRATION

ACTRN12621001132831.

The Developing Brain: Considering the Multifactorial Effects of Obesity, Physical Activity & Mental Wellbeing in Childhood and Adolescence

Obesity during childhood has been associated with many important physiological and neurological health considerations. Specifically concerning are the associations between youth obesity and declines in mental health, as shown with increasing rates of adolescent depression and anxiety worldwide. The emergence of mental health disorders commonly arises during adolescent development, and approximately half the global population satisfy the criteria for at least one psychiatric disorder in their lifetime, suggesting a need for early intervention. Adolescence is critical time whereby brain structure and functions are not only negatively associated with obesity and declines in mental health, while also coinciding with significant declines in rates of physical activity among individuals in this age group. Physical activity is thus a prime candidate to address the intersection of obesity and mental health crises occurring globally. This review addresses the important considerations between physiological health (obesity, aerobic fitness, physical activity), brain health (structure and function), and mental wellbeing symptomology. Lastly, we pose a theoretical framework which asks important questions regarding the influence of physiological health on the association between brain health and the development of depression and anxiety symptoms in adolescence. Specifically, we hypothesize that obesity is a mediating risk factor on the associations between brain health and psychopathology, whereas physical activity is a mediating protective factor. We conclude with recommendations for promoting physical activity and reducing sedentary time.

Elementary Students’ Perceptions of Cognitively Challenging Physical Activity Games in Physical Education

This study examined 10–11-year-old students’ perceptions regarding three different types of physical activity games based on different principles of mental engagement (contextual interference, mental control, or discovery). A total of 156 students (84 girls) from five fourth-grade (75 students) and five fifth-grade (81 students) classes of five elementary schools located in a middle-sized city in central Greece participated in the study. These students participated in a larger project consisting of a series of acute experiments aiming to examine the effectiveness of cognitively challenging physical activity games in elementary physical education. Students responded to open-ended questions regarding their perceptions of the physical activity games. Their responses were analyzed through a thematic analysis. A total number of 706 quotes were identified and categorized into the lower-order themes which were organized into four higher-order themes: (a) characteristics of the games, (b) effects of the games, (c) areas for improvement, and (d) preferences for specific games. Students’ views provided supporting evidence regarding the employment of cognitively challenging physical activity games in physical education. Useful insights regarding the characteristics of the games, their effects, and their areas for improvement were also gained.

'A Physically Active Experience': Setting the Stage for a New Approach to Engage Children in Physical Activity Using Themed Entertainment Experiences

Despite the multiple health benefits that result from engaging in physical activity, data suggest that children are moving less. Novel approaches to engaging children in physical activity are needed to address this public health concern. Recently, a new definition of physical activity was proposed that emphasizes, among other things, the fact that physical activity is deeply affective, emotional and situated in spaces that shape the experience. With the need to increase engagement in physical activity and this new proposed definition, this paper presents a more novel approach to addressing this problem through staging a physically active experience. The idea draws upon the well-established area of experience economy, which aims to engage those partaking in an educational, (e)aesthetic, escapist, and entertaining way. When staging something as an experience, the focus is on engagement. By staging physical activity as an experience, it is proposed that children can actively partake in physical activity in a way that is focused on the experience offered. This review explains the notion of experience economy and provides examples of how it could be applied to children's physical activity. By creating an aesthetically pleasing, escapist and entertaining environment where children can learn and engage in physical activity, a more engaging positive experience of physical activity can be offered. Future research should examine the staging of physically active experiences for children and evaluate the practical implementation and effectiveness of this new approach to increasing children's engagement in physical activity.

Promoting Physical Activity Habits after Completing Secondary School: Does the Age Matter?

Physical inactivity is one of the most important problems in our society, especially during adolescence. During this stage of schooling, students practice physical activity in physical education classes, but after they finish school, many of them stop practicing it. This research aims to determine which variables predict the intention to practice physical activity after finishing secondary school and to discover the effect that age during adolescence has on these predictive variables. A questionnaire was administered to a sample of secondary school students. The results show that physical exercise identity influences the three antecedents of this theory, while the attitude towards the behaviour (β = 0.13; p < 0.05), perceived behavioural control (β = 0.46; p < 0.05), and physical self-concept (β = 0.41; p < 0.05), have a statistically significant influence on the intention to be physically active. Moreover, when the age is lower, is more important to develop a positive perceived behavioural control and physical exercise identity. Moreover, for younger male adolescents instead of the physical exercise itself, identity seems more important in developing a positive attitude towards behaviour. Likewise, in young female adolescents a low level of support from their close environment (subjective norm) leads to dropping out. The research concludes with the importance of including these variables in physical education classes to promote physical activity practice after completion of secondary school. Some practical implications are presented.

The Use of Wearable Activity Trackers in Schools to Promote Child and Adolescent Physical Activity: A Descriptive Content Analysis of School Staff's Perspectives

BACKGROUND

The school environment is an ideal setting for promoting physical activity (PA). Wearable activity trackers (wearables) have previously been implemented, in research, as intervention tools within the school-environment. However, the large-scale use and acceptance of wearables, in schools, is unknown.

METHODS

This study distributed a cross-sectional survey to school staff to investigate the prevalence of child and adolescent wearable use in schools, including when and how they are used, and school staff's willingness to use them in the future (as implemented by school staff). This survey consisted of between 13 and 22 items, including closed-ended and open-ended questions. Closed-ended responses were displayed descriptively (wearable prevalence and characteristics), and open-ended qualitative responses were categorised using descriptive content analysis (how wearables are used).

RESULTS

1087 school staff provided valid responses. Of those, 896 (82.4%) had never used a wearable as a teaching or support tool for their students, and 120 (11%) currently used- and 71 (6.5%) had previously used- a wearable as a teaching or support tool for their students. When wearables were used, school staff implemented their use regularly and during physical education lessons or throughout the entire school day. Wearables were used to monitor or increase student's PA levels, or for student and staff educational purposes (e.g., academic learning, movement breaks). Most school staff were willing to use a wearable as a teaching or support tool to promote student's PA, and/or learning about PA, in the future.

CONCLUSIONS

This study is the first study to explore the widescale use and acceptance of children and adolescents using wearables in the school-setting. Findings may inform the development of future school-based interventions and public health initiatives for physical activity promotion, using wearables.

When are you taking us outside? An exploratory study of the integration of the outdoor learning in preschool and primary education in Quebec

Introduction

Recent research investigating the benefits of being outdoors and contact with nature in children showed strong associations with children’s health and development. More teachers are choosing to integrate outdoor learning (OL) into their practice in Quebec, but few studies have focused on OL in the school environment, particularly in Canada and more specifically in Quebec, despite the fact that the school context lends itself favorably to this practice.

Objective

The purpose of this study was to portray OL in preschool and primary schools in Québec by identifying three key elements: (1) teachers’ perception of the outdoors, (2) the uses of OL in schools, and (3) teaching strategies and factors that influence teachers’ integration of OL.

Methodology

Semi-structured group interviews (n = 4) conducted with 14 teachers and participant observations (n = 4) were used for data collection. Inclusion criteria were to be a preschool or primary school teacher, to have taught at least eight sessions of OL in the past year, and to have no connection or contact with the research team prior to the start of the study.

Results

First, the results showed that teachers commonly understood the outdoors as being in the open air, practicing a physical activity, having the presence of nature, providing physical freedom and targeting a pedagogical intention. Second, teachers appeared to incorporate a variety of pedagogical intentions in OL (e.g., environmental awareness, interdisciplinary learning), in a variety of settings (e.g., city parks, woodlands), and with a variety of academic subjects (e.g., French, mathematics) and learning tasks (e.g., walking, nature shelter building). Third, teachers used a wide range of teaching strategies in OL (e.g., flexible planning, well-established routines). Participants also identified multiple factors specific to their setting that appeared to facilitate (e.g., parental support) or limit (e.g., storage of materials) their integration of OL into the school environment.

Conclusion

This study provided a better understanding of the current use of the OL in the Quebec school environment by identifying the common characteristics, limitations and winning strategies of its use in schools. Teachers and schools interested in OL could benefit from the results of this study, particularly those interested in adopting a Forest School or Udeskole approach.