The school environment and adolescent physical activity and sedentary behaviour: a mixed-studies systematic review

Leveraging agent-based modeling and a randomized intervention to advance childhood physical activity: A study protocol

This study (1R01HD107002-01A1) protocol describes the planned creation and use of an agent-based model (ABM) of early childhood physical activity (PA). Successful early childhood PA interventions can potentially play an important role in both increasing overall population health as well as closing health disparities across subpopulations. At present, effective strategies for doing so are currently unknown. In large part, this is because PA determinants operate across levels dynamically, interact with one another, and can differ substantially across children. A complex systems approach-specifically, ABM-can be used to provide important insights about effect pathways driving child PA. Design of the proposed ABM will be based on high-quality extant research on childhood physical activity while allowing for the testing of hypotheses that extend beyond this body of literature. Its primary source of input data will be participants in GROW (NCT01316653), a completed cohort-based randomized controlled trial (RCT) that includes extensive longitudinal PA data collected from accelerometer observations of children from ages 3-9. We will iteratively test and improve upon an etiologic ABM of childhood PA, ensuring that it can satisfactorily reproduce micro- and macro-level influences and trends comparable to those seen in GROW. The tested ABM will then be used to extrapolate beyond the context of the GROW RCT, experimentally identifying potentially efficacious intervention strategies to improve childhood physical activity through program implementation or changes in policies and practices. We will use expert input to identify promising intervention approaches. We will use the model to systematically experiment with a wide array of different hypothetical combinations of intervention specifications and combinations. At the end of the model experimentation step, we expect to generate insights of broad applicability to the field of PA science regarding what might work, and for whom, in promoting PA and reducing disparities in these behaviors.

Effectiveness of wearable activity trackers on physical activity among adolescents in school-based settings: a systematic review and meta-analysis

BACKGROUND

While inactivity and sedentarism among adolescents are increasing globally, technology-based interventions incorporating wearable activity trackers (WATs) demonstrate the potential to combat the situation. With a focus on schools as critical environments in which to perform interventions among adolescents, this meta-analytic review of literature aimed to examine the effectiveness of wearable trackers in objectively measured physical activity (PA).

METHODS

A systematic search was conducted across six databases-PubMed, CENTRAL, Scopus, SPORTDiscus, the Web of Science Core Collection, and PsycINFO-between January 2012 and March 2024. The language was restricted to English only. Both randomized controlled trials and quasi-experiment studies were included. Risk of bias was assessed using Cochrane RoB2 and ROBINS-I tools. Subgroup analyses and sensitivity analyses were performed. Effect direction for a narrative synthesis was also conducted. GRADE criteria were applied to assess quality of evidence.

RESULTS

Fifteen studies were finally included in the literature review, and ten were adopted for meta-analysis. No statistical significance was found in intervention outcomes involving WATs' effect on PA, whether in terms of total daily steps, moderate-to-vigorous PA (MVPA), or calorie counts. However, the subgroup analysis revealed that one study using research-grade assessment showed a substantial positive effect on steps. There were no data reported regarding the effect of objectively measured sedentary behavior.

CONCLUSION

Further study is needed to explore whether wearable activity trackers raise or decrease PA among adolescents in schools.

REGISTRATION

PROSPERO, registration number: CRD42023421008.

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.

Negotiating adolescents' physically active life during the school day

Introduction

School contexts are addressed as important for encouraging adolescents' physically active lives, where whole-school approaches have emerged as globally recognized strategies. Recent research emphasizes the need to further understand the contexts relating to physical activity (PA) and strategies to enhance students' and staff's agency in relation to PA opportunities. In the current study, we explore early adolescent students' daily PA from an ecological perspective, examining the negotiated opportunities and barriers to PA within differing school contexts and how individual agency is expressed in relation to PA.

Methods

This ethnographic collective case study was conducted in four Swedish middle schools that varied in size, resource denseness, and whether they were independent or public providers. The main empirical material was collected through ∼720 h of fieldwork during a school year, along with 86 interviews involving 50 students and 52 staff members. A comparative reflexive thematic analytical approach was used.

Results and discussion

The transition between educational stages brought changes that influenced students and staff's agency related to PA. Against this backdrop, the analytical findings were organized into four themes. Students' PA was negotiated against the logic associated with being a "good" middle school student and teacher. Realizing daily PA also stood in relation to an anything-is-possible spirit, which was pitted against the lack of an organizational structure and high hopes for PA outcomes-creating a tension between vision and practicality, where student voices were overlooked. While all four schools claimed a commitment to providing PA opportunities for all, students negotiated their agency based on gender, age, social status, and previous experiences with traditional sports, which dominated recess activities. Students' PA during and after school was closely interconnected, especially expressed in physical education and health classes. This connection often benefited already active students in resource-rich environments while marginalizing those who were less active, further creating an uneven playing field regarding PA opportunities. Various schools shared challenges connected to students' daily PA, but challenges differed between and within schools. Future school policies, practices, and research should aim at addressing cultural, structural, and material dimensions focusing on sustainability, equity, and pedagogical issues, enabling young people to develop autonomy and ability to shape their PA experiences in ways that are meaningful to them.

From activity to obesity: understanding gender and type of school divide among Saudi adolescents

Background

Obesity has emerged as a significant predictor of the nationwide burden of non-communicable diseases in Saudi Arabia.

Objectives

This study explores patterns in body mass index (BMI), physical activity (PA), and sedentary behavior (SB) among Saudi adolescents, focusing on variations by gender and school type (public vs. private). It identifies key factors affecting BMI.

Methods

A total of 2,815 students (53.64% male, aged 15.21 ± 1.55 years) participated. Body weight and composition were determined by bioelectrical impedance, while PA levels and SB scores were assessed through validated questionnaires. Two models were created, one with overall SB and the other with specific SBs.

Results

Among participants, 28.4% were overweight/obese, with 17.2% classified as obese. Obesity prevalence was higher in boys (26.9%) compared to girls (6.0%). Overweight prevalence was slightly lower in private schools (9.9%) than in public schools (11.8%), while obesity rates were similar (17.3% vs. 17.2%). A significant association between BMI and school type was identified solely in girls (Model 1: p = 0.004, ES = 0.109; Model 2: p = 0.012, ES = 0.096). Age was positively associated with BMI (Model 1: p < 0.004, ES = 0.025; Model 2: p < 0.001, ES = 0.019), as were SB scores (p < 0.001, ES = 0.17). Conversely, PA levels exhibited a negative correlation with BMI (Model 1: p < 0.001, effect size = -0.104; Model 2: p < 0.001, effect size = -0.106). Polynomial analysis revealed a cubic relationship between BMI and PA across all groups, though with low effect sizes.

Conclusion

Gender, age, PA, and SB explained a small portion of BMI variance. Future research should investigate mechanisms underlying these non-linear trends and explore additional confounding variables.

Factor structure and measurement invariance of exercise self-efficacy scale among secondary school students in China

Exercise Self-Efficacy Scale (ESES) is widely used to assess individuals' exercise self-efficacy through self-reporting. It includes one factor and 18 items that gauge one's confidence in exercising under various conditions, such as when tired, stressed, or in unfavourable weather. Evidence indicates that differences in the original factor structure and psychometric properties were observed across different populations, including school-age students, university students, and adults. This study examined the factor structure, reliability, convergent validity, and measurement invariance of the Chinese version of the ESES among secondary school students. Data from 856 students (age: M = 13.80, SD = 0.94) were analysed using exploratory and confirmatory factor analyses to identify the best-fitting factor structure. The reliability and convergent validity were tested using the collected data. Configural, metric, and scalar invariances, as well as the likelihood ratio test, were tested for measurement invariance. A 14-item, two-factor structure of the ESES, consistently demonstrated the best fit among secondary school students. The two-factor structure showed strong internal consistency reliability (McDonald's Omega of 0.921 and 0.843) and satisfactory convergent validity (average variance extracted values of 0.582 and 0.478, composite reliability values of 0.917 and 0.845). Multi-group confirmatory factor analysis (likelihood ratio test, p > 0.01) revealed scalar measurement invariance across sex, ethnic backgrounds, grades, and school locations. These findings suggest that the 14-item, two-factor Chinese version of the ESES is suitable for use with secondary-school students. Future studies could confirm these findings by examining the 14-item, two-factor ESES in diverse samples, considering ethnicity, socioeconomic status, and age range.

School-based environment and physical activity in adolescents: A systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the effectiveness of school environmental factors in promoting adolescents' physical activity.

METHODS

A systematic search of five databases (PubMed, Embase, Web of Science, EBSCO, and Cochrane Library) was conducted from the earliest available records up to September 2023. Meta-analyses were performed for each school environmental factor, provided that at least two studies reported on the association between that factor and adolescents' physical activity. The factors examined included seven school social environmental factors and six school physical environmental factors.

RESULTS

18 studies comprising 340,749 participants were included in the meta-analysis. A significant positive correlation was observed between the school environment and adolescents' physical activity. Specifically, the school social environment was positively associated with adolescents' physical activity. In particular, school-offered daily physical education, school-organized extracurricular physical activities, encouragement of using sports equipment or facilities, and outdoor obstacle course were all significantly positively correlated with adolescents' physical activity. While the overall school physical environment did not show a significant relationship with adolescents' physical activity, the number of school physical activity facilities demonstrated a significant positive correlation with adolescents' physical activity.

CONCLUSIONS

This meta-analysis demonstrates the role of school environment in promoting adolescents' physical activity. School social environmental factors, including school-offered daily physical education, school-organized extracurricular physical activities, encouragement to use sports resources, and outdoor obstacle courses, are particularly effective in enhancing adolescents' physical activity. Among school physical environmental factors, the number of physical activity facilities was found to be a key factor in promoting adolescents' physical activity.

Health promotion meets sustainable movement-based education in school-a "walking school" initiative in Sweden

The World Health Organization states that physical activity has the potential to influence physical, mental, and social dimensions of health in a powerful way. However, in modern society, physical activity is increasingly becoming an active choice, rather than a part of everyday life. Schools have been identified as key settings for health promotion, but physical activity initiatives in schools have rarely had a sustained impact. Interventions have been criticized for seeking to increase levels of physical activity by focusing on individual behaviors rather than considering the contexts and social structures in which individuals live their lives. With a theoretical foundation in settings-based health promotion, this article proposes an alternative initiative for sustainable movement-based education called Walking School. Walking School defines sustainable movement as the movement that is an integral part of the school day and school culture. Walking School, or outdoor teaching while walking, has the potential to (i) be inclusive of both teachers and students, (ii) extend the classroom and make physical activity a collective responsibility of all teachers, not just physical education teachers, (iii) reduce sedentary time and increase physical activity without losing instructional time, (iv) stimulate physical activity and create conditions conducive to the development of new habits by using the outdoor environment as a teaching space, and (5) become part of the school's core business of education, and ultimately a part of the school culture.

Health-related physical fitness in children among five Mediterranean countries: a cross-cultural study from the DELICIOUS project

Background

Health-related fitness (HRF) components are essential for supporting healthy growth and reducing long-term health risks in children. This study explored cross-cultural variations in HRF among children from five Mediterranean countries-Egypt, Italy, Lebanon, Portugal, and Spain-within the framework of the DELICIOUS project.

Methods

A total of 860 children participated in the study, including 204 from Egypt (n = 204, 11.72 ± 1.46 years), 150 from Italy (9.66 ± 1.10 years), 200 from Lebanon (10.73 ± 1.90 years), 181 from Portugal (11.04 ± 1.83 years), and 125 from Spain (12.33 ± 2.27 years). Participants completed the International Physical Performance Test Profile (IPPTP), which assesses sprint speed (20 m dash), coordination (jumping sideways), upper body strength (push-ups), abdominal strength (sit-ups), lower body power (standing long jump), and cardiovascular endurance (6-min run). Children were categorized into two age groups: 8-10 and 11-14 years. ANCOVA, adjusting for BMI, was performed to analyze differences across countries and age groups.

Results

Analysis revealed significant differences in HRF across countries and age groups (p < 0.05). Spanish boys and girls consistently demonstrated superior sprint performance (20 m dash) and cardiovascular endurance (6-min run) compared to peers from other countries. Lebanese and Spanish girls exhibited stronger abdominal performance (sit-ups) than Egyptian girls, while Spanish girls also excelled in lower-body power (standing long jump). These findings underscore cross-cultural variations in HRF outcomes among Mediterranean children.

Conclusion

Cross-cultural differences in physical education programs and sports participation appear to influence HRF in children across the Mediterranean region. These findings underscore the need for culturally tailored physical education strategies and public health initiatives to ensure balanced fitness development in diverse cultural populations.

School-based factors influencing physical activity participation in children and adolescents with disabilities: A qualitative systematic review and meta-synthesis

BACKGROUND

Children and adolescents with disabilities (CAD) frequently encounter barriers to participation in physical activity (PA). Schools play a vital role in promoting PA, making it crucial to understand the school-based factors influencing CAD's PA participation.

OBJECTIVE

This qualitative systematic review and meta-synthesis aims to identify and elucidate the school-based factors influencing PA engagement among this population.

METHODS

A comprehensive search across six databases-Web of Science, PsycINFO, Scopus, SPORTDiscus, and Embase, CNKI-was conducted in August 2023, and subsequently updated in April 2024. English or Chinese peer-reviewed journal articles that contained substantial qualitative data regarding school-based factors affecting PA in CAD were included. The methodological quality of included studies was evaluated utilizing the Critical Appraisal Skills Program Qualitative Checklist. Qualitative data were analyzed through thematic synthesis.

RESULTS

A total of 16 studies (12 qualitative studies and 4 mixed-methods studies) were included, all of which were of moderate to high quality. Thematic synthesis identified four major themes: (a) physical environment (provision of facilities, specialized and adapted equipment, space for activities); (b) social environment (peers, school leaders, teachers and other school staff); (c) opportunities for PA (physical education, classroom movement integration, extra-curricular activities); and (d) characteristics of PA (adaption of rules and task difficulty, competition components, diversified activities, fun).

CONCLUSIONS

This review reveals the complex interplay of different school-based factors affecting PA participation among CAD. The findings provide valuable insights for educators, policymakers, and health professionals to enhance PA participation in this population.

Relations Between Distinct Dimensions of Physical Activity and Preschoolers' ADHD Symptoms

OBJECTIVE

This study examined the unique and interactive effects of PA volume and within-person fluctuations in PA volume (i.e., intraindividual variability in PA volume; PA-var) on preschoolers' (N = 141; 47.5% girls) ADHD symptoms.

METHOD

Preschoolers wore accelerometers during the school day over a 2-week period. Teachers reported on children's hyperactive, impulsive, and inattentive symptoms on the ADHD Rating Scale-IV Preschool Version.

RESULTS

In the context of regression models, higher levels of PA-var were linked with lower levels of impulsive symptoms. Higher levels of PA volume were linked with higher levels of hyperactive and inattentive symptoms, but only when PA fluctuation (i.e., PAvar) was relatively low. Post hoc analyses with teacher-reported impairment as the outcome revealed a significant interaction such that the positive association between PA volume and impairment was stronger at lower, as compared to higher, levels of PA-var.

CONCLUSION

Larger fluctuations in preschoolers' PA volume may indicate lower risk for displaying impulsive symptoms. Moreover, preschoolers with high levels of PA that remain relatively consistent throughout the day may be at increased risk for exhibiting hyperactive and inattentive symptoms and related impairment, suggesting they are unable to regulate their activity to meet expectations in the school environment.

Clustering of diet and physical activity behaviours in adolescents across home and school area-level deprivation in Cameroon, South Africa, and Jamaica

BACKGROUND

Adolescence is a crucial period for establishing healthy behaviours that can reduce the risk of noncommunicable diseases. However, limited data exist on the clustering of health-related behaviours, in adolescents from low- and middle-income countries (LMICs). This study examined how diet and physical activity behaviours cluster and how they are influenced by home and school area-level deprivation.

METHODS

The study surveyed 527 adolescents in Yaoundé (Cameroon), Kingston (Jamaica), and Cape Town (South Africa) and grouped them into three categories according to the socioeconomic status (SES) of their homes and school areas (low-low, low-high, and high-high). A k-median algorithm defined three clusters and measured dietary attributes including Dietary Habit Score (DHS), Healthy Food Score (HFS), Nutritional Knowledge Questionnaire (NKQ), moderate-to-vigorous physical activity (MVPA), and sedentary time using validated questionnaires. The clusters were ranked based on their physical activity levels and compared them within each city using statistical tests.

RESULTS

The scores on the NKQ and HFS indicated a poor level of both nutritional knowledge and healthy food consumption across sites. Cluster analysis revealed a consistent pattern of high screen time clustering with lower (less healthy) dietary scores across sites. This pattern was consistent regardless of SES in Kingston, and SES and school socioeconomic areas in Cape Town and Yaoundé.

CONCLUSION

An inverse clustering of sedentary behaviour duration and eating habits remained consistent across different strata for at least two sites, suggesting that interventions to reduce sedentary time could have a ripple effect on multiple NCD risk factors in adolescence.

School-level variation in children's moderate to vigorous intensity physical activity before and after COVID-19: a multilevel model analysis

Background and objectives

Schools play a crucial role in facilitating physical activity among children, but the COVID-19 pandemic has affected both children's physical activity and the school environment. It is essential to understand between-school differences in children's physical activity post lockdown, to determine if and how the role of schools has changed.

Design and participants

Active-6 is a natural experiment comparing postlockdown accelerometer-estimated physical activity to a pre-COVID-19 comparator group. Accelerometer and individual data were collected on 1296 children aged 10-11 pre-COVID-19 (2017-8), with school characteristics collected from the 50 schools they attended. Post lockdown, we collected accelerometer, individual and school data from 393 children in 23 of the same schools and 436 children in 27 of the same schools in 2021 (Wave 1) and 2022 (Wave 2), respectively.

Methods

Sources of variation (between-school, between-pupil and within-pupil) in child weekday moderate to vigorous physical activity at each wave were modelled using linear mixed-effects models with school-level wave random coefficients. We extended the model to estimate the proportion of between-school variation explained by school policy, curriculum and physical environment factors and school-aggregated pupil characteristics. We also explored the extent to which postlockdown differences in moderate to vigorous physical activity were mediated by individual or school factors.

Results

Between-school variation comprised 13% of the total variation pre-COVID-19, 7% in Wave 1 and 13% in Wave 2. School factors associated with moderate to vigorous physical activity were the following: whether physical education was compromised due to space (often: 9 minutes lower moderate to vigorous physical activity; sometimes: 5.4 minutes lower); high after-school club attendance (7 minutes higher moderate to vigorous physical activity for each additional club attended on average in the school); cycle training policy (4 minutes higher moderate to vigorous physical activity); and higher prevalence of active travel (1 minute higher moderate to vigorous physical activity for each 10% point increase in prevalence). These factors explained 22% of the between-school variation pre-COVID-19, and 72% at Wave 2. The relative importance changed, with cycle training policy and active travel being the most important pre-COVID-19 and cycle training policy, active after-school clubs and compromised physical education space most important in Wave 2. No factors were found to mediate the postlockdown differences in moderate to vigorous physical activity, except compromised physical education space, which had a suppressor effect in Wave 2.

Limitations

Only 27 of the initial 50 schools participated post lockdown, limiting our ability to make comparisons across waves. Sample sizes were additionally affected by missing data for some variables.

Conclusions and future work

While schools continue to play an important role in facilitating children's physical activity, the factors that contribute to this have changed post-COVID-19, with cycle training, active after-school clubs and ensuring physical education is prioritised even when space is limited now explaining nearly three-quarters of the between-school variation in children's moderate to vigorous physical activity. School-level interventions that focus on these areas, and policies that support them, may offer the potential to increase children's physical activity.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

Association of Accelerometer-Measured Physical Activity With College Student Success and Retention

BACKGROUND

This study examined the relationship between physical activity (PA) and academic performance and retention among college students using accelerometer data while controlling for sex and socioeconomic background.

METHODS

Data were collected from 4643 first-year college students at a private university in the south-central United States who began their studies in the Fall semesters between 2015 and 2022. Daily step counts were collected using accelerometers worn as part of the institutions PA requirements. The expected family contribution was calculated based on information provided on the Free Application for Federal Student Aid. Grade point average (GPA) and retention data were collected directly from official university databases.

RESULTS

Female students generally had lower median age and steps count and a higher median GPA than males. The retention rates from fall to spring and fall to fall were 95.9% and 83.8%, respectively, with no significant difference in retention rates between males and females. GPA was significantly positively correlated with steps, expected family contribution, and age, and negatively correlated with being male and having an expected family contribution of zero. The fall to spring retention rate was significantly positively correlated with steps and GPA.

CONCLUSIONS

The study's findings suggest that increasing levels of PA, as measured by daily step counts, may be effective in promoting academic performance and retention, even when controlling for sex and socioeconomic background. The use of device-based measures of PA in this study contributes to the literature on this topic, and policymakers and educational institutions should consider interventions focused on academic performance and physical activity to help students persist.

Test-Retest Reliability of a Physical Activity Behavior, Health and Wellbeing Questionnaire in Adolescents

Background

The aim of this study was to examine the test-retest reliability of the physical activity behavior, health and wellbeing questionnaire, in adolescent populations, administered by teachers in school settings, in the Republic of Ireland.

Methods

A cross-sectional, mixed sample of 55 participants (45.5% males: Age, 13.94 (±.40) years) were included. The participants completed the questionnaire on two occasions (T1 and T2), on the same day and time, one week apart following identical procedures. Variables for testing included physical activity behavior (n=13), health (n=11) and wellbeing (n=2). Test-retest reliability of the questionnaire's covariates, including family affluence and physical impairments were also examined.

Results

Systematic error (Bland-Altman plots) was found to be near to zero for each of the physical activity behavior, health and wellbeing variables. The combined mean coefficient of variation was lower for females (10.19%) in comparison to males (13.01%). The combined mean intraclass correlation coefficients were higher for females (0.901) than males (0.822). Similarly, the combined mean Cronbach alpha coefficient were higher for girls (0.908) than boys (0.821).

Conclusions

This study found the physical activity behavior, health and wellbeing questionnaire to be reliable for use in adolescent populations.

Policies and opportunities for physical activity engagement in Austrian schools: a census survey

Background

Compelling evidence suggests that schools' infrastructure and policy represent potential predictors of health and physical activity (PA) in children and adolescents. However, the translation of these findings into practice has not been examined. This study investigated the activity friendliness of Austrian schools.

Methods

Using a census sampling method, principals of Austrian schools (n = 342) were invited to participate in an online survey assessing 1) the availability of PA facilities (e.g. playgrounds, sports courts, swimming halls) and 2) applied PA policies (e.g. cooperation with sports clubs and involvement in PA projects).

Results

A total of 130 principals answered the survey which corresponds to a minimal response rate of 38%. While most schools (87.4%, n = 111) had a gymnastic hall, only one third (37%, n = 47) had access to a swimming hall. On average, the schools had 4.2 ± 2 PA facilities with significant variation between school types (i.e., high schools: 5 ± 2 vs. primary schools: 3.5 ± 2, p < 0.05). The most common facilities were meadow areas (89%, n = 113), sports fields (71.7%, n = 91), and playgrounds (64.6%, n = 82). Almost half of the schools were part of a PA project (e.g. "active break", 45%, n = 56) and offered extracurricular PA programs and courses (54%, n = 67), but only one in five (22%, n = 27) regularly conducted fitness tests. PA policies varied between school types (p < 0.05) but almost all principals (94%, n = 117) would welcome a stronger promotion of activity friendliness at their school.

Conclusion

Schools are mostly activity-friendly regarding infrastructure although the limited possibilities for swimming lessons seem worrisome. PA promotion through projects, extracurricular PA offerings and fitness tests may be expanded.

National trends and ecological factors of physical activity engagement among U.S youth before and during the COVID-19 pandemic: A cohort study from 2019 to 2021

BACKGROUND

This study aims to investigate the trends and ecological determinants of physical activity among U.S. children and adolescents during the 2019-2021 period, encompassing the COVID-19 pandemic's onset and subsequent years.

METHODS

Utilizing data from the National Survey of Children's Health over three years, this cohort study analyzed physical activity levels and ecological determinants among 82,068 participants aged 6-17. The sample included 36,133 children (44%) and 45,935 adolescents (56%), with variables assessed by caregiver reports.

RESULTS

The analysis revealed a significant decline in physical activity among children from 2019 to 2020, followed by a recovery in 2021, whereas adolescents showed a continued decrease without recovery. Over the study period, children were consistently more active than adolescents. Better health status, normal weight, less screen time, stronger peer relationships, higher parental involvement, better family resilience and greater school participation were consistently correlated with increased physical activity in both age groups. Sleep duration was a predictor of activity only in children, while mental health status was solely a predictor in adolescents. Neighborhood environment consistently predicted children's activity levels but was a significant factor for adolescents only in 2020.

CONCLUSIONS

These findings highlight the differing impacts of the pandemic on physical activity between children and adolescents, emphasizing the need for targeted public health interventions, particularly for adolescents whose activity levels have not recovered from the pandemic period. Age-specific physical activity interventions should consider sleep duration and neighborhood environmental factors when targeting children and mental health factors when focused on adolescents.

Effects of physical exercise on adolescent short video addiction: A moderated mediation model

Objective

To discuss the effects of physical exercise (PE) on adolescent short video addiction (SVA) and analyze the mediating effects of self-control (SC) and the moderating effects of the cumulative ecological risk (CER), aiming to provide theoretical support for PE relative to adolescent SVA, investigate the underlying mechanisms of the effects of PE.

Methods

The Physical Activity Rating Scale-3, Problematic TikTok Use Scale, Self-Control Scale, and Cumulative Ecological Risk Scale were used to survey 756 adolescents in Chongqing and Chengdu, China. SPSS was used to construct a research model by conducting reliability, confirmatory factor, common method bias, and AMOS analyses.

Results

PE was significantly and negatively related to adolescent SVA (β = -0.30, p < 0.01). SC served as a partial mediator between PE and adolescent SVA, the direct and indirect effect values are -0.304 and -0.167 respectively, showing that SC negatively predicted the relationship between the two variables. The CER moderated the effect of PE (t = -11.679, p < 0.001) and SC (t = -15.069, p < 0.001) on adolescent SVA.

Conclusion

PE mitigates and moderates adolescent SVA through the mediating effect of SC and the moderating effect of CER.

Effectiveness of Intervention Strategies to Increase Adolescents' Physical Activity and Reduce Sedentary Time in Secondary School Settings, Including Factors Related to Implementation: A Systematic Review and Meta-Analysis

BACKGROUND

Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness.

OBJECTIVE

The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation.

METHODS

Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained.

RESULTS

Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles.

CONCLUSION

While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained.

REGISTRATION

PROSPERO (CRD42020169988).

Associations of school physical activity environment with comorbid obesity and myopia in children and adolescents: Findings from a Chinese national follow-up study

BACKGROUND

Overweight and obesity (OWOB) and myopia have become two of the most important issues affecting the health of children and adolescents worldwide. Despite the recognition that the school physical activity (PA) environment is a critical factor for preventing and controlling overweight, obesity (OWOB), and myopia in children and adolescents, research on OWOB and myopia as a comorbidity remains unexplored, with evidence for effective strategies still being inconclusive. Hence, this study aimed to assess the prevalence and progression of comorbid OWOB/myopia and each condition alone, and to explore the association with school PA environment.

METHODS

A total of 9814 children and adolescents aged 6-18 years were included from the Chinese National Survey on Students' Constitution and Health follow-up survey conducted from November 2019 to November 2020 in China. Anthropometric measurements, unaided distance vision acuity and non-cycloplegic refraction data were collected to assess OWOB and myopia, while eight indicators from questionnaires for children and adolescents aged 9-18 years were investigated to assess school PA environment. We calculated the one-year incidence and progression rates of comorbid OWOB/myopia, OWOB alone, and myopia alone. Mixed effect logistic regression was evaluated the association between school PA environment and incidence and progression of comorbid OWOB/myopia, OWOB, and myopia.

RESULTS

The prevalence of comorbid OWOB/myopia increased from 11.1% in 2019 to 17.9% in 2020, and the incidence of comorbid OWOB/myopia was 10.9%. Children and adolescents experiencing an unfavorable school PA environment had a higher risk of the incidence of comorbid OWOB/myopia compared to a favorable school environment (OR = 1.85, 95% CI: 1.42-2.42). Similar findings were seen in the incidence of obesity (OR = 1.86, 95% CI: 1.26-2.75). Children and adolescents in an unfavorable school PA environment had a higher risk of myopia progression (OR = 1.29, 95% CI: 1.01-1.65).

CONCLUSIONS

Obesity and myopia and their comorbidity have been serious among children and adolescents in China. A favorable school PA environment might mitigate the risk of comorbid OWOB/myopia, OWOB, and myopia progression.

Psychosocial mediators and moderators of a school-based physical activity intervention among Brazilian adolescents

School-based interventions are needed due to the low levels of physical activity (PA) in adolescents. The aim is to examine the mediation effects of psychosocial factors (attitude, self-efficacy, social support from parents, friends, general teachers, and PE teachers, and environment school perception) and moderation by sex, school grade, and socioeconomic level of a school-based PA intervention on the PA practice among adolescents. The Movimente Programme is a randomised controlled trial at schools in southern Brazil (n = 921 adolescents). Strategies included teacher training, educational actions, and environmental changes. Adolescents self-reported their weekly PA. Potential psychosocial mediators and moderators were investigated through validated questionnaires in a Brazilian sample. The product of the coefficients with percentile bootstrapping 95% confidence interval was performed. The Movimente Programme was related to positive changes in adolescents' perception of the school environment and social support from general and physical education teachers. Most psychosocial variables (attitude, self-efficacy, social support from friends, and social support from teachers) were associated with PA, but none mediated the impact of the Movimente Programme on PA. Results varied according to sex and school grade. The Movimente Programme increased the adolescents' perception of the school environment and social support from teachers, but no mediators were confirmed.

Using Non-Violent Discipline Tools: Evidence Suggesting the Importance of Attunement

Training in non-violent discipline is important to prevent violence against children and ensure that their caregivers remain a safe base for them. This paper aims to deepen understanding of non-violent discipline by exploring attunement as a mechanism in the effectiveness of non-violent discipline tools. Attunement describes the sensitive responsiveness of caregivers towards their children and has been found to be central to the formation of secure attachment bonds and development of self-regulation. It includes understanding or being "in tune with" the child's needs and signals, matching these with appropriate responses. The objective of this paper is to explore attunement in relation to non-violent discipline. Peer-reviewed systematic reviews previously included in a systematic overview of evidence on non-violent discipline options were screened for information relevant to attunement. All reviews were published in English between 1999 and 2018 and offered evidence on at least one non-violent discipline tool. Although no reviews explicitly addressed attunement, evidence was found suggesting its importance in the use and effectiveness of discipline methods. Research directly investigating attunement in discipline is needed.

Multidimensional school features associated with physical activity among youth at risk of obesity: an exploratory principal component and generalized estimating equation analysis

BACKGROUND

Schools may be high-leverage points for the promotion of physical activity (PA), yet little is known about school built and social environments among youth at high risk of obesity.

PURPOSE

To characterise school built and social environments that may be salient for PA and to examine associations between school PA environments and PA in youth at risk of obesity.

METHODS

Data from youth attending 206 schools (314 youth in 2005-2008, and 129 youth in 2008-2010) within the QUALITY cohort study, a longitudinal investigation of youth at high risk of obesity were used. Features of schools, based on built, policy/programming and social environments were identified using principal components (PC) analysis. Gender-stratified generalized estimating equation (GEE) models were used to explore associations between school features and accelerometer measured mean counts per minute (MCPM), mean daily moderate-to-vigorous physical activity (MVPA) and the odds of meeting MVPA guidelines cross-sectionally and prospectively using 90% confidence intervals.

RESULTS

Nine PCs were identified. Associations were observed between PA and 7 of the 9 PCs. The social environment seemed to be particularly important. Social Norms to Promote PA was associated with an increase in girls' baseline MCPM and MVPA. High Willingness to Promote PA was associated with boys' MCPM, MVPA, and odds of meeting MVPA guidelines, at both baseline and follow-up.

CONCLUSION

School built and social contexts may be associated with PA cross-sectionally and over time. Further studies are necessary to confirm the direction and magnitude of effects and to establish their relevance to school-based health promotion efforts.

The impact of perceived school climate on exercise behavior engagement among obese adolescents: a dual mediation effect test of exercise benefits and perseverance qualities

Introduction

This study explores the relationship between perceived school climate and exercise behavior among obese adolescents, as well as the multiple mediating effects of perseverance qualities and exercise benefits.

Methods

A survey was conducted on 586 obese adolescents in Beijing, with an age range of 13-18 years old and an average age of 15.40 ± 1.824, among who 337 were male, 249 were female, 303 were high school students and 238 were middle school students. A standard scale was used to evaluate perceived school climate, exercise benefits, perseverance qualities, and exercise behaviors. The data was analyzed by independent samples t-test, bivariate correlation analysis, descriptive statistical analysis, and structural equation model (SEM).

Results

(1) Perceived school climate among obese adolescents positively predicted exercise behavior (Z = 2.870, p < 0.01), perseverance qualities (Z = 3.107, p < 0.01) and exercise benefits (Z = 4.290, p < 0.001); perseverance qualities positively predicted exercise behavior in obese adolescents (Z = 4.431, p < 0.001); exercise benefits positively predicted the obese adolescents' exercise behavior (Z = 4.267, p < 0.001). (2) Perseverance qualities (Z = 2.282, 95% CI [0.032, 0.191], [0.028, 0.179]) and exercise benefits (Z = 2.518, 95% CI [0.060, 0.287], [0.053, 0.271]) play a mediating role in the obese adolescents' perceived school climate and exercise behavior, respectively. These two factors have parallel multiple mediating effects between obese adolescents' perceived school climate and exercise behavior, with mediating effects accounting for 16 and 25%, respectively. The mediating effect of exercise benefits is greater than that of perseverance qualities. (3) There is no difference in the specific indirect effects of perseverance qualities and exercise benefits (Z = -0.800, 95% CI [- 0.198, 0.064], [-0.190, 0.068]).

Conclusion

Obese adolescents' perception of school climate can effectively enhance their motivation to participate in exercise behavior and indirectly influence exercise behavior through exercise benefits and perseverance qualities, cultivate good physical exercise behavior among obese adolescents, and effectively prevent and intervene in the occurrence of obesity.

Is the transition from primary to secondary school a risk factor for energy balance-related behaviours? A systematic review

OBJECTIVE

The substantial changes in the physical and social environment during the transition from primary to secondary school may significantly impact adolescents' energy balance-related behaviours (i.e. dietary behaviour, sedentary behaviour, sleep behaviour and physical activity (PA)). This is the first review systematically summarising evidence on changes in four energy balance-related behaviours of adolescents across the school transition from primary to secondary school.

DESIGN

For this systematic review, the electronic databases Embase, PsycINFO and SPORTDiscus were searched for relevant studies from inception to August 2021. PubMed was searched for relevant studies from inception to September 2022. Inclusion criteria were: (i) longitudinal studies reporting; (ii) one or more energy balance-related behaviours; and (iii) across the school transition, that is, with measurement(s) during both primary and secondary school.

SETTING

Transition from primary to secondary school.

PARTICIPANTS

Adolescents across the transition from primary to secondary school.

RESULTS

Thirty-four studies were eligible. We found strong evidence for an increase in sedentary time, moderate evidence for a decrease in fruit and vegetable consumption, and inconclusive evidence for a change in total, light, and moderate-to-vigorous PA, active transport, screen time, unhealthy snack consumption, and sugar-sweetened beverages consumption among adolescents across the school transition.

CONCLUSIONS

During the transition from primary to secondary school, sedentary time and fruit and vegetable consumption tend to change unfavourably. More high-quality, longitudinal research is needed specifically on changes in energy balance-related behaviour across the school transition, especially regarding sleep behaviour. (Prospero registration: CRD42018084799).

Ecological correlates of sport and exercise participation among Thai adolescents: A hierarchical examination of a cross-sectional population survey

BACKGROUND

Understanding factors influencing adolescents' sport/exercise participation (S/EP) is vital to developing effective interventions, but currently, evidence from less developed countries is limited. The purpose of this study was to examine correlates of S/EP across individual, interpersonal, and environmental levels in a nationally representative sample of Thai adolescents.

METHODS

Data from 4617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand. Data on S/EP (outcome variable), and psychosocial, home, and community environment covariates were collected from individual adolescents using the Thailand Physical Activity Children Survey, Student Questionnaire. School environmental data were collected at the school level using a School Built Environment Audit. Hierarchical regressions taking into account school clustering effects were applied for data analysis.

RESULTS

At the individual level, age and body mass index were independently and strongly correlated with S/EP. Adolescents with high preference for physical activity (PA) (odd ratio (OR) = 1.71, p < 0.001) and at least a moderate level of self-efficacy (OR = 1.33, p = 0.001) were more likely to have high S/EP. At the interpersonal level, adolescents whose parents joined their sports/exercise at least 1-2 times/week (OR = 1.36, p = 0.003) received ≥3 types of parental support (OR = 1.43, p = 0.005) and who received siblings' (OR = 1.26, p = 0.004) and friends' (OR = 1.99, p < 0.001) support had a greater chance of high S/EP. At the environmental level, adolescents' S/EP was greater when there were at least 3-4 pieces of home sport/exercise equipment (OR = 2.77, p = 0.003), grass areas at school (OR = 1.56, p < 0.001), and at least 1-2 PA facilities in the community (OR = 1.30, p = 0.009).

CONCLUSION

Multiple factors at different levels within an ecological framework influencing Thai adolescents' S/EP were generally similar to those found in developed countries, despite some differences. For those interested in promoting and supporting Thai adolescents' engagement in sports/exercise, further exploration of the influence of self-efficacy and attitude toward PA is required at the individual level; parental and peer support at the interpersonal level; and home sport equipment, school grass areas, and neighborhood PA facilities at the environment level.

Effectiveness of multilevel interventions based on socio-ecological model to decrease sedentary time in children: a systematic review of controlled studies

Objectives

Preventive actions of sedentary behavior (SB) based on the socio-ecological model are needed among children and young adolescents. The aim of this systematic review is to ascertain the effectiveness of multilevel interventions (i.e., involving consideration of at least two interventional levels) in reducing sedentary time (ST) in children aged 5-12 years.

Methods

Adhering to PRISMA guidelines, a systematic literature search was conducted in three databases (PsyInfo, PubMed and ERIC) until July 2021.

Results

30 trials met the eligibility criteria and were included. They showed acceptable (< 8, n = 18) and high (≥ 8, n = 12) methodological quality. Among studies targeting 2 (n = 2), 3 (n = 19) and 4 levels (n = 9), 1 (50%), 9 (47%) and 7 (78%) were effective and reported significant reduction of ST, respectively.

Conclusion

Interventions tend to be more effective when they involve 4 levels, using both agentic and structural strategies (targeting intrinsic determinants, in the organizational environment of the child). Findings underline the relevance of multilevel strategies to reduce ST in children, but also raise issues about operationalization of the socio-ecological perspective.

Systematic review registration

PROSPERO, identifier: CRD42020209653.

The neighborhood physical environment and the 24-hour movement behavior composition among children

The time spent in sleep, sedentary behavior, and physical activity form a 24-hour movement behavior composition. The objective was to identify neighborhood physical environment features associated with multiple components of the movement behavior composition among 10 to 13-year-olds. Twenty-three neighborhood physical environment features were measured in 1 km buffers from the participants' homes and from these walkability, traffic safety, dedicated play spaces, non-dedicated play spaces, noise, and artificial light indices were created. Moderate-to-vigorous physical activity, light physical activity, sedentary time, and sleep duration were measured. Compositional data analysis was used to establish differences in movement behaviors according to neighborhood physical environment features. One hundred and sixteen associations, reflecting four movement behaviors X 29 environment variables and indices, were examined. Only three of these were statistically significant. Therefore, neighborhood physical environment features were not meaningful correlates of 24-hour movement behaviors.

Quantification of the Number of Steps in a School Recess by Means of Smart Bands: Proposal of Referential Values for Children and Adolescents

(1) Background: Regular physical activity has multiple benefits. Therefore, school recess is a key tool to provide opportunities for schoolchildren to engage in extracurricular physical activity, have fun, play and interact with their peers. The aim is to provide reference data to quantify the number of steps that children and adolescents perform in a school recess using smart bands according to age range and sex. (2) Method: A descriptive cross-sectional study was carried out in 494 schoolchildren aged 6 to 17 years (292 males and 202 females). Weight, standing height and waist circumference (WC) were evaluated. The body mass index (BMI) was calculated. The quantification of the number of steps during school recess was performed using a smart band. (3) Results: Percentiles were constructed for the number of steps (number of steps/recess). The cut-off points considered were <p25 (below average), p25 to p75 (average) and >p75 (above average). The median values in both sexes decreased as the age range increased. Youth who walked fewer steps during recess (<p25: below average) had elevated BMI and WC values relative to those who walked within average and above average. (4) Conclusion: The number of steps taken by schoolchildren during school recess decreases drastically with advancing age. The proposed reference values can be used to categorize schoolchildren according to the number of steps taken and to compare them among their peers. The results suggest their use and application in schools as a way of achieving the minimum physical activity recommendations.

Factors Influencing Saudi Youth Physical Activity Participation: A Qualitative Study Based on the Social Ecological Model

BACKGROUND

The growing improvement in urbanisation, modes of transportation and the expansion of sedentary behaviour, both at work and home, have resulted in declining rates of physical activity (PA) worldwide. Nearly one-third of the global population aged 15 and over are insufficiently active. The negative effect of physical inactivity has been evidenced and ranked fourth as the lethal cause of death globally. Therefore, the aim of this research was to explore the factors influencing PA participation among youths from different geographical locations in the Kingdom of Saudi Arabia.

METHODS

Sixteen focus groups (males = 8 and females = 8) were conducted with a total of 120 secondary school students (male = 63 and female = 57) aged between 15 and 19 years. The focus groups were analysed to identify key themes through the process of thematic analysis.

RESULTS

Results from the focus groups indicated that a lack of time, safety, parental support, policies, access to sport and PA facilities, and transportation, as well as climate were reported as barriers to PA participation.

DISCUSSION AND CONCLUSION

The current research contributes to the scarce literature focused on the multidimensional effects on Saudi youth PA behaviour from different geographical locations. This qualitative approach has provided the participants a voice, and the overall study offers valuable evidence as well as invaluable information to policymakers, public health departments, and local authorities for PA intervention based on the environment and the community.

Association between school environment with sedentary behavior and physical activity intensity in children

We examined the association between indicators of the school environment with sedentary behavior and different intensities of physical activity in children. The study that included 515 children (265 boys) aged 9-11 years old from public and private schools in the city of São Caetano do Sul. Sedentary behavior and different intensities of physical activity were evaluated with an accelerometer. Inside school environment (policies, supervision committee, extracurricular activities, breaks, and access to school facilities) was evaluated using a questionnaire. Policies and practice (β: 8.49; 95% CI: 3.62-13.36), supervision committee (5.42; 0.64-10.19), inter-school competitions (2.40, 2.25-2.55), breaks of 15-29 min/day (6.87; 2.20-10.75), and outdoor sports field (5.40; 0.37-10.44), were positively associated with moderate-to-vigorous-intensity physical activity. Furthermore, crossing guards (7.65; 3.00-12.30) were positively associated with moderate-to-vigorous-intensity physical activity. We concluded that an association was found between school environment indicators with higher levels of physical activity and greater odds of meeting physical activity guidelines.

"You Measure Us and You Depress Us": Healthism and the Subjective Impact of Body Measurements on Secondary School Students

This study explores adolescents' subjective experiences when facing body measurements at school, performed to evaluate the effects of a school-based intervention to promote physical activity. Three semi-structured interviews (n = 3) and two focus groups (n = 7 and 3) were conducted with adolescents after measuring some variables related to their weight and adiposity. Observational data (n = 88) collected by the two researchers in charge of the measurements were also obtained. Findings derived from our thematic analysis question the suitability of body measurements as social contexts where the core ideas of healthism emerge. Some adolescents lived body measurements as negative social experiences, promoting body dissatisfaction, social comparison, embarrassment, and simplistic associations between health and body shape, which could hinder their adherence to healthy habits. We emphasize the role of qualitative research when evaluating pre/posttests of school-based intervention studies, not just the interventions themselves, to generate knowledge to improve research protocols and prevent unwanted psychological outcomes in participants.

A systematic review of the clustering and correlates of physical activity and sedentary behavior among boys and girls

Identifying the clustering and correlates of physical activity (PA) and sedentary behavior (SB) is very important for developing appropriate lifestyle interventions for children and adolescents. This systematic review (Prospero CRD42018094826) aimed to identify PA and SB cluster patterns and their correlates among boys and girls (0-19 years). The search was carried out in five electronic databases. Cluster characteristics were extracted in accordance with authors' descriptions by two independent reviewers and a third resolved any disagreements. Seventeen studies met the inclusion criteria and the population age ranged from six to 18 years old. Nine, twelve, and ten cluster types were identified for mixed-sex samples, boys, and girls, respectively. While girls were in clusters characterized by "Low PA Low SB" and "Low PA High SB", the majority of boys were in clusters defined by "High PA High SB" and "High PA Low SB". Few associations were found between sociodemographic variables and all cluster types. Boys and girls in "High PA High SB" clusters had higher BMI and obesity in most of the tested associations. In contrast, those in the "High PA Low SB" clusters presented lower BMI, waist circumference, and overweight and obesity. Different cluster patterns of PA and SB were observed in boys and girls. However, in both sexes, a better adiposity profile was found among children and adolescents in "High PA Low SB" clusters. Our results suggest that it is not enough to increase PA to manage the adiposity correlates, it is also necessary to reduce SB in this population.

Associations between the built environment, policies and curriculum in schools and primary school children’s physical activity

Background: A large proportion of children in the UK do not engage in the recommended amount of physical activity. Schools are an environment where children spend a considerable portion of their time and have the potential to facilitate more physical activity. There has been little exploration of the specific school environment factors that are most pertinent to child physical activity and sedentary behaviour. This study was intended to fill this important gap. Methods: Data were collected between March 2017 and May 2018 from 50 schools and 1223 children who participated in the B-Proact1v cohort study. School level measures were the built environment (e.g. playground equipment, cycling parking, allotments), physical activity-related policies (e.g. policy to encourage active travel) and the use of physical activity in the curriculum (e.g. regular physical activity breaks throughout day). Children’s weekday moderate-to-vigorous physical activity (MVPA) was estimated via Actigraph GT3X accelerometers. Associations between school context measures and children’s weekday MVPA were analysed using linear multilevel models, with children nested within schools, adjusted for individual characteristics. Results: On average, children at schools with allotments, a larger amount of playground equipment and where cycle training was offered, engaged in higher levels of MVPA. PE being compromised due to space was associated with lower levels of MVPA. Conclusions: Whilst there is a need for further exploration, the findings suggest that school-based provision and policies for active travel, sport and active play may be important to encouraging more primary school children to be more active more regularly.

Usability Testing an mHealth Program with Tailored Motivational Messages for Early Adolescents

Obesity among children is a rising concern throughout the world. In the U.S., rates of childhood obesity are the highest among children from diverse and economically disadvantaged households. Obesity in adolescence increases the risk of negative physical and psychological health consequences. Mobile-app-based health interventions have been found to be an effective tool to encourage children to adopt a healthier living style. A novel mobile app prototype was developed for early adolescents to communicate with and engage them interactively about healthy eating and active living. To test the app's usability, students from a U.S. middle school, with a majority of children from low-income families, were recruited to use the app and report their feedback. The usability testing results confirmed that the app was equally well received by participants of different genders, normal weight versus overweight/obesity, and amounts of screen time. Study participants also provided overwhelming positive feedback for the embedded and tailored motivational messages that encourage healthy eating and active living. The conceptualization of the app prototype was guided by the self-determination theory, social cognitive theory, and priming theory, in addition to incorporating evidence-based obesity prevention principles. This prototype, hence, provides a valid platform for building theory-based behavioral interventions.

Normative values of cardiorespiratory fitness in Croatian children and adolescents

Although defining normative values of cardiorespiratory fitness have been the topic of many Western societies, little evidence has been provided for less developed countries like Croatia. Since cardiorespiratory fitness rapidly declines in Croatian children and adolescents, the newly established normative values would help health-related professionals and physical education teachers to detect 'talented' groups and direct them towards sport and 'risky' groups for planning special interventions. Therefore, the main purpose of the study was to determine normative reference values of cardiorespiratory fitness. A total of 1,612 children and adolescents aged 7-14 years (mean±SD; age 9.7±2.4 years; stature 151.0±17.6 cm; body mass 45.1±19.1 kg; 52.5% girls) participated in this cross-sectional study. Cardiorespiratory fitness was assessed by the Maximal multistage 20-m shuttle run test and the performance was expressed as the number of stages. Maximal oxygen uptake (VO2max) was estimated by equations. Smoothed percentile curves were calculated. Boys outperformed girls in the maximal number of levels achieved after the 20-m shuttle run test and in the VO2max values at each age category. In boys, a gradually higher level of performance between ages 11 and 14 was observed, while in girls the values started to rise after the age of 8. Our study provides one of the first sex- and age-specific normative values for cardiorespiratory fitness assessed by the 20-m shuttle run test in Croatian children and adolescents.

The impact of height-adjustable desks and classroom prompts on classroom sitting time, social, and motivational factors among adolescents

PURPOSE

This quasi-experimental study examined the impact of height-adjustable desks in combination with prompts to break up prolonged sitting time during class time and identified social and motivational factors associated with breaking up sitting time among adolescents. Teachers' perceptions of strategies were also examined.

METHODS

Over 17 weeks, 1 classroom in a government secondary school in Melbourne, Australia, was equipped with 27 height-adjustable desks and prompts (posters and desk stickers) to break up classroom sitting time. Teachers received professional development in the use of the desks and prompts. One group of adolescents (n = 55) had 2-5 lessons/week using the height-adjustable desks in an intervention classroom, and a comparison group matched by year level and subject (n = 50) was taught in traditional "seated" classrooms. Adolescents wore an activPAL monitor at baseline (T0), 4 weeks (T1), and 17 weeks (T2) and completed a survey at T0 and T2. Six teachers participated in interviews at T2. Effect sizes were calculated (d).

RESULTS

Linear mixed models found that, compared to the traditional "seated" classrooms, the adolescents in the intervention classroom had significantly lower sitting time (T1: -9.7 min/lesson, d = -0.96; T2: -6.7 min/lesson, d = -0.70) and time spent in sitting bouts >15 min (T2: -11.2 min/lesson, d = -0.62), and had significantly higher standing time (T1: 7.3 min/lesson, d = 0.84; T2: 5.8 min/lesson, d = 0.91), number of breaks from sitting (T1: 1.3 breaks/lesson, d = 0.49; T2: 1.8 breaks/lesson, d = 0.67), and stepping time (T1: 2.5 min/lesson, d = 0.66). Intervention classroom adolescents reported greater habit strength (d = 0.58), self-efficacy for breaking up sitting time (d = 0.75), and indicated that having a teacher/classmate remind them to stand as helpful (d = 0.50).

CONCLUSION

This intervention shows promise for targeting sitting behaviors in the classroom and indicates that incorporating social and motivational strategies may further enhance outcomes.

Exploring the acceptability and feasibility of a whole school approach to physical activity in UK primary schools: a qualitative approach

Background

UK Children generally fail to meet physical activity (PA) recommendations. Whole school approaches (WSA) have the potential to impact large numbers of children due to their ubiquitous nature for school wide implementation, however there is limited knowledge regarding primary school PA WSA implementation in the UK. This study aimed to investigate the acceptability and feasibility of a PA WSA in the UK. 

Methods

Semi structured interviews explored research aims with participants. A qualitative description approach was adopted and data were analysed using thematic analysis to draw codes and themes from the data.

Results

Thirteen primary school senior leadership team (SLT) and Physical Education (PE) leads were interviewed. A PA WSA was found acceptable by all participants. Implementation, however, was questioned when other significant mechanisms were not in place. A PA WSA aided prioritisation and planning of PA provision, providing a holistic overview of all key areas of PE, school-sport and PA (PESSPA). Due to the high acceptability but dependent feasibility of a PA WSA, it is recommended that PA WSAs align with whole-school health policy and improvement plans to advance implementation. Future research, however, is needed to explore how this method is best implemented as additional interventions may also be required to promote the prioritisation of the PA agenda due to the importance of SLT backing for implementation being paramount, as results highlight.

Conclusions

PA WSAs aid awareness, understanding and planning of school wide PESSPA provision, however their implementation in complex. Having SLT support and an appropriately resourced PE lead maximised the impact and utility of a PA WSA.

Association of daily and time-segmented physical activity and sedentary behaviour with mental health of school children and adolescents from rural Northeastern Ontario, Canada

Physical activity (PA) and sedentary behaviour (SED) have been linked to the mental health of children and adolescents, yet the timing of behaviours may play a role in this relationship and clarifying this could inform interventions. We explored cross-sectional associations of PA and SED in varying time segments throughout the school day with the mental health of school-aged children and adolescents from rural Northeastern Ontario, Canada. A total of 161 students (56% female, M = 10.3 years old) wore accelerometers for 8 days (7 nights) and completed a self-report survey (parent reported for children younger than 11). Mental health was measured using the Strengths and Difficulties Questionnaire. Accelerometer-measured SED, light PA (LPA), and moderate and vigorous PA (MVPA) were estimated in the time-segments before school (06:00-08:44), school time (08:45-15:04), after school (15:05-16:59), and evenings (17:00-21:59). Associations were tested with multilevel linear regressions while adjusting for confounding factors. Students spent 72.6 min in MVPA, 209.0 min in LPA, and 621.0 min in SED per day. Daily SED was associated with less conduct problems (β = -0.27, p < 0.05). Evening LPA was inversely associated with hyperactivity (β = -1.45, p < 0.05), while SED was associated with hyperactivity and with peer problems before school (β = 1.70 and β = 1.01, respectively, p < 0.05), and during school (β = -0.83 and β = -0.57, respectively, p < 0.05). No associations were observed for MVPA, emotional symptoms, or prosocial behaviour. In conclusion, displacing SED with LPA in some specific periods of the day may benefit the mental health of students; taking this into account could strengthen interventions.

Ergonomic evaluation of school furniture in Slovenia: From primary school to university

BACKGROUND:

Adequate school furniture is important to prevent musculoskeletal discomfort among students.

OBJECTIVE:

The aim of the study was to assess the suitability of school furniture compared to body dimensions of students.

METHODS:

A cross-sectional study included a total of 442 students from primary school, secondary school, and university. Nine body dimensions along with five furniture dimensions were measured and equations for mismatch criteria were applied.

RESULTS:

In primary school, differences in body dimensions were more evident among students of different age, while in secondary school and university, differences between male and female students became more apparent. The mismatch for desk height ranged from 100.0% at primary school to 48.0% at university. Similarly, the seat height mismatch was the most evident in primary school (89.7% –94.6%), lower at university (52.0%) and the lowest in secondary school (18.0%). The seat depth mismatch was present among all groups, ranging from 23.1% to 40.4%, and was in general more pronounced in males. Seat to desk clearance mismatch was the most evident among secondary school students. In primary school, seat and desk height were generally too high for most of students.

CONCLUSIONS:

Specific differences in body dimensions among groups of students of different age and gender were observed and a high student-furniture mismatch was identified in all educational institutions. Implementation of adjustable school furniture, covering at least two size marks, is needed to provide ergonomic and healthy learning conditions and to further enhance the comfort and well-being of students in the classroom.

Development and Interrater Reliability of an Observational School Environment Checklist: A Practical, Comprehensive Tool to Assess Healthy Eating and Physical Activity Opportunities in Schools

INTRODUCTION

Comprehensive, objective assessment of schools' eating and physical activity environments is critical to developing and evaluating policies and interventions to reduce pediatric obesity inequities; however, few tools exist that describe the entire school comprehensively and are feasible with restricted resources. This study describes development and reliability of the observational school environment checklist (OSEC), a comprehensive observational audit tool.

METHOD

We developed the OSEC through iterative adaptations of existing instruments and pilot testing. The tool assesses four focus areas: cafeteria, lobby/hallway, gym, and outdoor areas. For reliability testing, two trained auditors independently completed the OSEC and met to resolve disagreements. For items with poor agreement, a third independent coder coded photographs taken during auditing. Percent agreement and Cohen's kappa were calculated for all items and across four evidence-based constructs: atmosphere, accessibility, attractiveness, and advertising.

RESULTS

After iterative development, the 88-item OSEC was tested for reliability in 18 schools. Items with poor (<80%) agreement or redundancy were discarded or reworded (n = 16 items). All four constructs had acceptable agreement, ranging by focus area: 72.3% (attractiveness), 86.3% to 97.1% (atmosphere), 82.9% to 100% (accessibility), and 92.9% (advertising). Cohen's kappa ranges were acceptable: 0.66-0.91 (atmosphere), 0.60-1.00 (accessibility), 0.46 (attractiveness), and 0.77 (advertising). After adding similar items across domains (n = 49) to improve comprehensiveness, the final tool contained 121 binary items.

IMPLICATIONS

The OSEC reliably and comprehensively captures the school environment. It requires few resources or expertise to administer, has acceptable reliability, and can assess atmosphere, accessibility, attractiveness, and advertising in school areas where students engage in eating and physical activity.

Do school characteristics, based on the Comprehensive School Health Framework, contribute to youth meeting national physical activity recommendations over time?

INTRODUCTION

Canadian youth are insufficiently active, and schools may play a role in promoting student physical activity (PA). Based on the Comprehensive School Health (CSH) framework, this study examined whether school characteristics are associated with secondary school students meeting national PA recommendations over time.

METHODS

We used COMPASS survey data from 78 schools in Ontario and Alberta and 9870 Grade 9 and 10 students attending those schools. Students who provided two years of linked PA data (2013/14 and 2015/16) and gender were included. Multilevel analysis was conducted by gender, evaluating the relationship of school-level characteristics (guided by CSH) with students achieving all three PA recommendations after two years (≥ 60 min/day of moderate-to-vigorous PA, vigorous PA ≥ 3 days/week, strengthening activities ≥ 3 days/week).

RESULTS

More than half (56.9%) of students achieving the PA recommendations at baseline were no longer achieving them after two years, and just a quarter (25.6%) of students not achieving the recommendations at baseline achieved them after two years. School-level factors were significantly associated with students achieving the recommendations, but these factors differed by student strata (i.e. by gender and baseline PA status). Generally, student access to equipment, public health partnerships and staff time for health were associated with increased odds of achieving the PA recommendations for certain students.

CONCLUSION

Modifications to school characteristics within CSH may play a role in supporting students in achieving or continuing to achieve the PA recommendations after two years. Further research is needed to better understand the underlying dynamics of the observed relationships.

Physical Activity in Mexican High Schools

BACKGROUND

We evaluated the association between availability of specific physical activity (PA) spaces and PA practices among adolescents within Mexican high schools (HS).

METHODS

Data were collected through an online survey applied to principals or person in charge of 4023 Mexican HS during the 2015-2016 school year. Adequate PA was defined as moderate to vigorous intensity PA for ≥60 minutes/day, ≥5 days/week, whereas PA-specific spaces were considered those that were available and specifically designed/used for PA. HS demographic factors were explored as covariates. Associations were estimated using a logistic regression model.

RESULTS

From total participating HS, 83.10% had at least 1 PA-specific space and 31.07% had adequate PA practices. A higher number of PA-specific spaces was associated with greater adequate PA practices (33% to 61%). Possibilities for adequate PA increased when: physical education (PE) classes were led by a designated PE teacher (OR 2.39; 95%CI: 2.03-2.83); the number of enrolled students was higher (OR 1.78; 95%CI, 1.43-2.22 and OR 2.23; 95% CI, 1.71-2.89, second and third tertile, respectively); HS financing sources were autonomous or private (OR 1.76; 95% CI, 1.19-2.60); and HS were located in northern Mexico (OR 1.27; 95%CI, 1.02-1.57).

CONCLUSION

PA-specific spaces, designated PE teachers, and financing sources are important factors in achieving adequate PA within Mexican high schools.

Could the complying with WHO physical activity recommendations improve stress, burnout syndrome, and resilience? A cross-sectional study with physical education teachers

Purpose

Teachers are exposed to inherent psychosocial risks in the workplace such as chronic stress, psychological distress, exhaustion, and burnout syndrome. To compare the values in psychosocial variables based on compliance with the recommendations for physical activity by the World Health Organization (WHO) and the type of physical activity performed.

Methods

The study had a non-experimental and comparative design, with measurements in a single group. The sample was composed of 415 physical education teachers from Spain, with an age range of 21–53 years (28.78 ± 6.15) and a heterogeneous distribution of gender (69.4% male; 30.6% women). The Perceived Stress Scale, the Maslach Burnout Inventory, the Connor–Davidson Resilience Scale, and an Ad-Hoc questionnaire were used to record the sociodemographic aspects and physical-sports practice.

Results

Most of the teachers complied with the recommendations for physical activity practice (n = 335; 80.7%). Physical activity was associated with lower signs of burnout and a greater ability to overcome. Although, teachers who did not comply with WHO recommendations, showed greater stress and emotional exhaustion. In conclusion, enough practice of physical activity based on WHO was shown as a preventive factor of stress and signs of burnout.

Conclusions

The findings suggest that perform physical activity based on the WHO recommendations helps for work stress prevention and burnout syndrome in teachers, as well as to overcome work adversities.

A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland

Background

Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors’ roles in implementing the local obesity program.

Methods

Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009–2016 and five representatives of other core parties.

Results

Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children’s lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process.

Conclusion

Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.

Students' perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity

OBJECTIVE

The objective of this study was to examine the relationships between students' perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity.

DESIGN

Cross-sectional study.

SETTING

Primary, middle and high schools in Taiwan.

PARTICIPANTS

A nationally representative sample of 2433 primary school (5th-6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018.

RESULTS

Multivariate analysis results showed that after controlling for school level, gender and age, the students' perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools' campaigns promoting the eating of vegetables and fruit were positively associated with students' consumption of vegetables. In addition, schools' initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students' engagement in outdoor physical activities and daily moderate-to-vigorous physical activity.

CONCLUSIONS

Students' perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries

BACKGROUND

Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews.

OBJECTIVE

Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years).

METHODS

We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach.

RESULTS

This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit.

DISCUSSION

There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.

Differences and Associations between Physical Activity Motives and Types of Physical Activity among Adolescent Boys and Girls

Interventions aimed at motivation for physical activity (PA) are mostly beneficial, but the effects on preventing the decrease in PA are not entirely clear, especially in girls. The main aim of this study was to identify the differences and associations between PA motives and types of PA in boys and girls and between low and high motivated boys and girls. Another aim is to identify the types of motivation and PA that increase the likelihood of achieving PA recommendations and to propose ways of increasing PA among low motivated adolescents. The research carried out before the COVID-19 pandemic (2010–2019) and involved 2,149 Czech and 1,927 Polish adolescents aged 15–19 years. The International Physical Activity Questionnaire-Long Form was used to identify the level of PA types, while PA motivation was examined through the Motives for Physical Activities Measure-Revised. During the ten years, a decline was observed in enjoyment, fitness, and social motives. An increase in appearance motives was observed in girls, while no significant changes were seen in boys. Boys showed a higher motivation for PA than girls in enjoyment, competence, fitness, and social motives, while girls were high motivated in appearance motives. The greatest statistically significant differences between low and high motivated individuals were found in the associations between recreation/vigorous PA and between all types of motivation in boys and girls in both countries. The strongest associations in both genders were observed between enjoyment/competence motives and recreation/vigorous PA. Respecting and using the associations between the types of PA motives and types of PA in low and high motivated boys and girls can support feelings of PA enjoyment, increase PA, support the achievement of PA recommendations, and positively affect adolescents' healthy lifestyles.

Adolescent Connectedness: A Scoping Review of Available Measures and Their Psychometric Properties

Introduction

Adolescent connectedness, a key component of positive youth development, is associated with various positive health outcomes. Several measures have been developed to assess this construct. However, no study has summarized data on the existing measures of adolescent connectedness. We conducted this scoping review to fill this gap. We specifically aimed to: (i) identify the existing measures of adolescent connectedness, (ii) determine the most frequently used measures among the identified measures, and (iii) summarize the psychometric properties of these measures with a keen interest in highlighting their cross-cultural utility and validity.

Methods

We searched CINAHL, Embase, PsycInfo, PubMed, and Web of Science databases for relevant articles published since database inception to 7th February 2021. Our search structure contained the key words "Adolescents", "Connectedness", and "Measures". We also searched Open Gray for potentially relevant gray literature.

Results

We identified 335 measures from 960 eligible studies assessing various domains of adolescent connectedness, including school, family, community, peer, ethnic, racial, cultural, religious/spiritual, and self-connectedness. Most of the included studies (72.1%) were from North America and Europe. Most of the measures (n = 132, 39.4%) were measures of school connectedness among adolescents. Of the identified measures, 60 of them met our criteria of frequently used measures (i.e., the top five most used measures per domain of connectedness). These frequently used measures were used across 481 of the included studies with 400 of them reporting their psychometric properties. The reported reliability of these measures was adequate (Cronbach's alpha ≥ 0.70) in 89.8% of these studies. These measures also appeared to be valid in terms of their face, content, construct, criterion, convergent, discriminant, concurrent, predictive, measurement invariance, and cross-cultural validity.

Conclusions

There exists a wide array of measures of adolescent connectedness. Sixty of these measures have been frequently used across studies and appear to be reliable and/or valid. However, this evidence is mostly from North America and Europe. This is a reflection of the limitation of this review where only studies published in English were considered. It might also reflect the paucity of research in other regions of the world. More research is needed for clearer insights.