Associations between parental perceptions of neighbourhood environment and physical activity in children and adolescents: a systematic review including 149 studies

BACKGROUND

Parental perceptions of the neighbourhood environment can be of particular importance for physical activity of children and adolescents, because parents act as the gatekeepers of their children's behaviour. However, knowledge gaps remain regarding the associations between parental perceptions of neighbourhood environment and physical activity among children and adolescents. Therefore, the aim of this study was to systematically review and summarise evidence on the association between parental perceptions of the neighbourhood environment and physical activity among children and adolescents (5 - 17 years of age).

METHODS

Literature searches were conducted in: CINAHL, Embase, Environmental Science, MEDLINE/PubMed, PsycInfo, Scopus, SPORTDiscus, Transportation Research Information Services, and Web of Science. The associations were coded as: mostly favourable (for 60% - 100% of studies showing a positive association); mostly unfavourable (for 60% - 100% of studies showing a negative association); and mostly non-significant, indeterminate, or inconsistent.

RESULTS

Out of 30,162 records identified in the search, 162 papers from 149 studies were included in the review. The most consistent finding was that a greater distance to school is unfavourably associated with active travel. Evidence of this association was found in children (5/7 associations; pooled sample size in the studies showing significant association [n] = 14,113), adolescents (3/4; n = 2328), and mixed-age group (8/13; n = 5410). There was some consistency in evidence on favourable associations of: (1) access to public transport, good street lighting, and presence of crossing guards with active travel among children; (2) access to sports and recreational facilities, parks and/or playgrounds with sports participation among children; and (3) access to sports and recreational facilities, parks, and/or playgrounds with non-type-specific physical activity among adolescents. Several associations were found in individual studies only, while others were mostly non-significant, indeterminate, or inconsistent. The quality of evidence ranged from very low to low.

CONCLUSIONS

Parental perceptions of traffic safety and access to destinations and services are associated with different types of physical activity among children and adolescents. There is a need for longitudinal and experimental studies, more research among adolescents, more studies from low- and middle-income countries, and exploring a wider range of neighbourhood environment attributes.

Validity and reliability of the Physical Literacy in Children Questionnaire (PL-C Quest) for primary school children aged 8-11 years

OBJECTIVES

The study aimed to provide evidence for validity and reliability of the Physical Literacy in Children Questionnaire (PL-C Quest).

DESIGN

Cross-sectional.

METHODS

Data were obtained from 664 primary school children (52.3 % girls; aged 10.0 ± 0.9 years; 80.6 % white British). Children completed the PL-C Quest: 30 pictorial dichotomous items relating to four Physical Literacy (PL) domains (physical, psychological, social, and cognitive). A convenience sub-sample (n = 66, 54.4 % girls; aged 10.1 ± 0.9 years) completed the PL-C Quest again within 10 days. Construct validity (Confirmatory Factor Analysis) and internal consistency (Polychoric Ordinal Alphas) were assessed on the full sample and test-retest reliability (Intraclass Correlation) was assessed on the sub-sample.

RESULTS

Goodness of fit values for construct validity showed good model fit. All items (PL elements) significantly loaded on domains and all domains significantly loaded on to PL (higher order factor). Nearly all items (28 out of 30) loaded on close or above the standard of λ = 0.3. Removing these two items did not significantly improve model fit. The model was sex- and age-invariant showing evidence of validity for both sexes and school years 4, 5, and 6. The PL-C Quest also showed evidence of good test-retest reliability (ICC = 0.94) and internal consistency (Pα = 0.90).

CONCLUSIONS

This evidence supports the use of the PL-C Quest to assess perceived PL in school children in England/UK.

The relationship between socioeconomic status and organized sports participation among Chinese children and adolescents: the chain-mediated role of parental physical exercise and parental support

OBJECTIVE

To examine the relationship between socioeconomic status and organized sports participation among children and adolescents, and to reveal the mediating role of parental physical exercise and parental support between socioeconomic status and participation in organized sports.

METHODS

A cross-sectional survey of 1512 parents of children and adolescents in Shanghai was conducted via the socioeconomic status scale, physical activity rating scale, and parental support for children's sports training scale. Structural equation modeling was used to test the direct and mediating effects.

RESULTS

(1) The direct effect of socioeconomic status on organized sports participation was significant (β = 0.184, P < 0.001) (2). The simple mediating effect of parental support was significant (β = 0.051; 95% CI [0.030, 0.079]), accounting for 16.56% of the total effect. The chained mediating effect of parental physical exercise and parental support was significant (β = 0.056, 95% CI [0.034, 0.084]), accounting for 18.18% of the total effect (3). The hypothesized paths did not differ significantly in multigroup structural equation modeling of different genders among children and adolescents.

CONCLUSION

Socioeconomic status not only directly influences organized sports participation among children and adolescents but also indirectly influences organized sports participation through parental physical exercise and parental support. This study posits that reducing socioeconomic status disparities in organized sports participation among children and adolescents requires not only a focus on children and adolescents of lower socioeconomic status but also increased parental physical exercise and parental support.

Development of a physical literacy consensus statement for Chile: study protocol

Physical literacy is a multidimensional concept that encompasses various aspects of an individual's ability to engage in physical activities throughout their lifespan. As a holistic approach, physical literacy (PL) has generated a lot of interest in the field of physical education, physical activity, and health promotion. Despite its growing popularity, the conceptualization and understanding differ among the countries. In the case of Latin America, the concept of physical literacy is still relatively new and influenced different countries, making complex the contextualization for this region. Considering some aspects of public policies that seek to promote physical activity in Chile, such as the national policy of physical activity and sport or the curricular bases of the subject of physical education, this paper seeks to propose the systematized elaboration based on evidence to generate a contextualized consensus with the different actors that can contribute to the development of physical literacy in Chile. This protocol will involve mixed methods throughout the implementation of six work package processes: (1) review of the existing evidence about physical literacy for its understanding in Spanish-speaking populations, (2) analysis of drawings (preschoolers), semi-structured interviews (children, adolescents, and adults), and focus groups (older adults) to investigate the community's view of physical activity, (3) discussion groups and nationwide online questionnaire to analyze the understanding of the concept of PL by both physical education teachers and political actors, (4) discussion groups to consolidate community perceptions on the relevance of physical activity and physical literacy to prepare a preliminary consensus, (5) national consultation on the draft Physical Literacy Consensus Statement text, and (6) discussion and definition of the Physical Literacy Consensus Statement for Chile. This consensus will help stakeholders, teachers, researchers, and the community in general to understand a common concept of physical literacy, which will allow its development, promotion, and application in the Chilean context. Likewise, this work could be a spearhead to the implementation of physical literacy in Latin America and low-and middle-income countries in other regions.

Clinical trial registration

The clinical trial will be registered on ClinicalTrials.gov under the name CONALMOT_CL (COnsenso Nacional en ALfabetizaic MOTriz in Spanish: Physical Literacy National Consensus).

Promoting active behaviours in schoolchildren using the socio-ecological model in the physical education class: study protocol of the ACTIBESE project

BACKGROUND

The correlation between parental and child physical activity levels has been the subject of significant investigation. Existing research has illuminated this association, particularly emphasising its influence during childhood. However, as children transition into adolescence, this relationship appears to weaken. Despite the recognised importance of parental involvement in promoting physical activity among children, scant attention has been directed towards understanding effective strategies and interventions to bolster this relationship. Consequently, there exists a critical gap in the literature concerning actionable measures to enhance parent-child physical activity engagement during the pivotal stage of adolescence.

METHODS

The ACTIBESE project aims to assess and intervene in Chilean schoolchildren's active behaviours by examining the influence of personal, interpersonal, and school factors. This study includes a cross-sectional and intervention study involving schools in the Valparaíso and Araucanía Regions, representing urban and rural areas. Participants, divided into children (8-11 years old) and adolescents (12-16 years old), will undergo a comprehensive evaluation, including sociodemographic characteristics, physical activity (PA) levels, parental and peer support, teaching styles of the teachers, and school environment characteristics. In the intervention study, a 5-month continuous training program for teachers will be implemented, focusing on improving teaching styles and enhancing teaching competencies related to physical education and health classes. The research will use mixed models, ANCOVA, and logistic regressions for data analysis, network analysis, exploratory factors analysis, and structural equation modelling.

DISCUSSION

Through innovative research methods, interventions involving schoolteachers, and a diverse geographical scope, this project aims to make significant contributions to both the scientific understanding of promoting PA and public policy efforts aimed at improving the health and well-being of school-aged children. The ACTIBESE project's multifaceted approach, considering school, family, and peer influences, is well positioned to contribute significantly to promoting AB and addressing the alarming decline in PA levels among Chilean youth.

Ecological Network Analysis: Utilizing Machine Learning to Unravel the Effects of Multilevel Pathways of Moderate⁃to⁃Vigorous Physical Activity Facilitators Among School Children

The objective of the present study was to ascertain whether the association between moderate-to-vigorous intensity physical activity (MVPA) levels and individual, interpersonal, organizational, and environmental factors among school children is influenced by their attitudes toward emerging sports participants (ESP). To this end, machine learning (ML) was employed to analyze the data. This cross-sectional study, involved 655 child-parent pairs in Changsha City to assess children's MVPA. Data were collected via self-administered questionnaires, evaluating MVPA levels and attitudes from children and caregivers. Various statistical models, including random forest and LASSO regression, were utilized for analysis. The study revealed that boys engaged in more MVPA than girls. Most participants liked ESP, with significant teacher support noted. Random forest and LASSO regression models identified key factors influencing MVPA, with notable variability among non-achievers. The gradient boosting machine and K-nearest neighbors models demonstrated similar predictive performance. The final model, comprising 37 parameters, indicated significant relationships between variables, particularly highlighting the importance of school offerings ESP and living near sports field. This study concludes that offering ESP in schools, along with positive modeling and encouragement from caregivers and peers, effectively enhances children's participation in MVPA. Living near sports field also positively impacts MVPA levels.

Identifying Social Network Characteristics Associated With Youth Physical Activity Skill Competency at a Summer Care Program

While literature suggests that youth physical activity (PA) behaviors are affected by network influences, less is known about network influences on perceived skill competency, a component of physical literacy and self-efficacy. This study aims to provide an understanding of potential network characteristics which are associated with youth PA skill competency. Youth (n = 158) between the ages of 8 and 12 years recruited from two summer care programs (i.e., Boys & Girls Clubs) participated in researcher-administered surveys. Youth self-reported their age, sex, involvement in team sports, weekly PA, and skill competency assessed using a version of the PLAYself measure. Youth were also asked to report up to five people in the summer program and five out of the program with whom they interacted the most. Linear regression was used to evaluate associations between skill competency and demographics, PA, and social network characteristics. Skill competency was significantly associated (R2 = .17) with age (β = -.06, p = .01), sex (β = -.06, p = .01), sports team involvement (β = .16, p < .001), and weekly PA (β = -.20, p < .001). Skill competency was also significantly associated with the number of connections with whom the youth played frequently (β = .09, p < .001), the number of connections that helped the youth to be active (β = .18, p < .001), and the heterogeneity of the type of relationships within the youth's network (β = .11, p < .001). Skill competency scores were significantly associated with both individual variables and social network composition. In addition, youth with networks comprising several types of relationships (heterogeneity) reported a significantly high skill competency. PA interventions can be most effective when considering the reinforcing aspects of networks and skill competency.

Canadian children and youth with disabilities are not meeting the 24-Hour Movement Guidelines: Cross-sectional results from the national physical activity measurement (NPAM) study for children and youth with disabilities

BACKGROUND

Understanding patterns of movement behaviours for physical activity (PA), screen time (ST) and sleep in children and youth with disabilities (CYD) can identify participation gaps that inform country-specific intervention and policy.

OBJECTIVE

To describe the 24-h movement behaviours and guideline adherence in CYD in Canada. The associations between age, gender, and disability type with meeting movement guidelines were also examined.

METHODS

Cross-sectional caregiver-reported data (N = 524 CYD, Mage = 10.3 ± 3.1 years; 70 % boys; 49 % developmental disabilities) were collected on child PA, ST, and sleep. Items were derived from the Health Behaviour in School-aged Children survey, International Physical Activity Questionnaire-Adolescents and the Childhood Obesity, Lifestyle, and the Environment Diet and Lifestyle Questionnaire. Movement behaviours were described for the total sample and by age, gender, and disability type. Logistic regressions tested predictors of meeting the movement guidelines.

RESULTS

CYD spent 34.2 ± 37.1 min in moderate-to-vigorous PA, 5.3 ± 3.9 h using screens, and 9.9 ± 1.1 h in sleep. 17.2 %, 20.3 %, and 89.0 % met the individual PA, ST, and sleep guidelines; 4.6 % met all three. Youth were less likely to meet the individual ST and sleep guidelines than children (OR = 0.16); participants with multiple disabilities were less likely to meet the ST guideline than those with developmental disabilities (OR = 0.33; ps < 0.001). Age, gender, and disability type did not significantly predict meeting the PA guideline.

CONCLUSION

Most CYD do not meet the Canadian guidelines for PA and ST and the majority meet recommended levels for sleep. Guideline adherence is lower for youth (ST and sleep) and those with multiple disabilities (ST only).

Can active play replace skill-oriented physical education in enhancing fundamental movement skills among preschool children? A systematic review and meta-analysis

BACKGROUND

Active play emphasizes the enjoyment of physical activity, it is affordable and unconstrained. In contrast, skill-oriented physical education, a mainstream physical activity intervention, is more formalized. However, the comparative effects of these interventions on fundamental movement skills in preschool children remain a subject of debate.

PURPOSE

Determine the effectiveness of active play and compare it with skill-oriented physical education on fundamental movement skills.

METHODS

We searched four databases (MEDLINE, ERIC, Web of Science, and SPORTDiscus) from January 2004 to March 2024. Included studies assessed FMS in children aged 2-6 years, with active play interventions lasting ≥ 4 weeks. The effects of active play and skill-oriented physical education on total fundamental movement skills, locomotor skills, object control, and balance were calculated within random effects models (weighted SMD) in meta-analysis.

RESULTS

This systematic review included 23 studies involving 2201 preschool children, with 15 eligible for meta-analysis. The meta-analysis showed no significant differences in the effects of active play compared to skill-oriented physical education on total FMS, locomotor skills, object control, balance (p > 0.05). Subgroup analyses indicated that skill-oriented physical education marginally outperformed unstructured active play in total fundamental movement skills and locomotor skills (SMD=-1.0172, 95% CI -1.6748~ -0.3595, p = 0.0073; SMD=-1.6956, 95% CI -3.3511~ -0.0401, p = 0.0471).

CONCLUSIONS

Both structured active play and skill-oriented physical education are comparable effective in improving fundamental movement skills. However, unstructured active play is less effective. In resource-limited educational settings, structured active play may serve as a viable complement to partial skill-oriented physical education programming.

Worldwide Policy, Surveillance, and Research on Physical Education and School-Based Physical Activity: The Global Observatory for Physical Education (GoPE!) Conceptual Framework and Research Protocol

INTRODUCTION

The Global Observatory for Physical Education (GoPE!) builds on the Global Observatory for Physical Activity (GoPA!) to address gaps in surveillance, policy, and research on physical education (PE) and activity (PA). GoPE! is a worldwide surveillance system of quality PE and school-based PA that informs policy and interventions and allows comparative analysis so that each country and region can check their status and progress. This paper presents GoPE!'s conceptual framework and describes the research protocol as a cross-continental and evidence-based surveillance system.

METHODS

Based on GoPA!'s framework and informed by the European Physical Education Observatory, as well as framed by the socioecological model of PE, United Nations Educational, Scientific, and Cultural Organization's quality PE, and the World Health Organization's whole-of-school approach, the GoPE! stands out by providing a comprehensive methodological approach. This approach relies on independently collected data about PE and PA at school policies, surveillance systems, and research. These data are critically reviewed by local representatives of the GoPE! network of experts. The GoPE! Country Card is the main product released every 5 years. It is a 1-page infographic summary of a country's key dimensions and indicators. The dimensions are: country and demographic data, PA participation, PE policy, PE surveillance, and PE and school-based PA intervention research.

CONCLUSION

Through its vision and methodological framework, GoPE! aims to contribute to the establishment of a minimum common denominator of quality PE and school-based PA, ultimately informing promotion, advocacy, and agenda-setting efforts to achieve international goals and recommendations for more active, equitable, and healthy children and adolescents, schools, and societies.

A Longitudinal Evaluation of an Intervention Program for Physical Education Teachers to Promote Adolescent Motivation and Physical Activity in Leisure Time: A Study Protocol

(1) Background: Research has consistently demonstrated that regular physical activity (PA) is associated with several benefits among adolescents. However, PA levels among adolescents are low worldwide and tend to decrease with age. Consequently, researchers aim to identify psychological antecedents of PA to inform effective interventions, including in physical education (PE) settings. PE lessons provide an ideal environment for conveying health-related messages to adolescents. (2) Methods: This project aims to develop a three-month face-to-face and web-based intervention program for PE teachers to increase autonomy-, competence-, and relatedness-supportive behavior toward their students (main trial phase 1: min n = 78; main trial phase 2: min n = 116) and to avoid the respective need-thwarting behaviors toward their students. The effectiveness of the intervention program is examined at multiple time points during the three-month period. (3) Results: After the intervention program, it is expected that the experimental group students demonstrate significantly higher intrinsic motivation toward PA and are significantly more physically active, as measured by accelerometers, compared to control group students. Additionally, the unique effects of autonomy, competence, and relatedness support interventions on students' intrinsic motivation and PA will be investigated. (4) Conclusions: This project provides highly valuable insights for PE teacher training to increase students' intrinsic motivation and their overall PA.

Impact of the ParticipACTION Report Card on physical activity for children and youth in Canada: 2015-2024

Background

Canada has produced 16 national Report Cards on the Physical Activity of Children and Youth over the past 20 years. This manuscript details the impact of the most recent Report Cards released between 2015 and 2024, updating evidence since the publication of the impact paper focused on the first 10 years (2005-2014).

Methods

Various quantitative and qualitative approaches were employed to catalogue the developmental history and background of the Report Card, its leadership and sources of funding; consolidate and discuss the various evaluations and assessments that have been performed on the Report Card from 2015 to 2024; describe the distribution and reach of the Report Card from 2015 to 2024; and, examine the multi-dimensional impact of the Report Card on propelling the movement to get children and youth moving over the past 10 years in Canada and internationally.

Results

Leadership by ParticipACTION has led to replicating the Children and Youth Report Card in over 70 jurisdictions, with many examples of beneficial cross-fertilization of ideas across jurisdictions and sectors. The multisectoral impact of the Report Card in Canada continues to be substantial, though sustained funding remains a challenge. There is modest evidence that grades for some indicators are drifting upwards. Deliberate efforts have been made to better integrate evidence and gaps related to the physical activity of equity-denied groups.

Conclusions

Over the past 10 years, the ParticipACTION Children and Youth Report Card has continued to have a measurable, positive impact on the pediatric physical activity field in Canada (and beyond).

Global Matrix 4.0 on Physical Activity for Children and Adolescents: Project Evolution, Process Evaluation, and Future Recommendations

BACKGROUND

The Global Matrix initiative provides unique insights into child and adolescent physical activity (PA) worldwide, yet requires substantial human efforts and financial support.

PURPOSE

This study aimed to evaluate the process and outcomes of the latest edition of the initiative, the Global Matrix 4.0, reflect on its evolution from earlier editions, and provide recommendations for future Global Matrices.

METHODS

The evaluation followed a predetermined plan, which included collecting and analyzing qualitative and quantitative data from 3 online surveys to participants and online user activity metrics from MailChimp reports and Google Analytics.

RESULTS

Global Matrix 4.0 participants (57 teams, 682 experts) assessed the PA status in their country/jurisdiction on at least 10 PA indicators and submitted 570 grades for global comparisons. Surveys were completed by 97% to 100% of targeted respondents and demonstrated predominantly high satisfaction rates (>80%) with participation, outputs, and project management. Lack of funding and inadequate national PA data availability were the commonly reported concerns. Suggestions for improvement included amending indicators' benchmarks and expanding the scope of the initiative to early years, underrepresented populations, and additional indicators.

CONCLUSIONS

This evaluation process revealed the positive experience of Global Matrix 4.0 participants and the successful delivery of expected outcomes. Reviewing the core set of indicators and benchmarks, expanding the initiative's scope, and fundraising efforts are recommended to further optimize the use of resources and maximize impact.

Elementary school compliance with a state recess minimum requirement by racial and geographic factors: a cross-sectional study

BACKGROUND

Recess is a part of school-based physical activity promotion offered worldwide with equitable recess access a social justice issue. From a policy perspective, in the U.S. few states currently require elementary school recess and little is known about its implementation. The purpose of this study was to determine the current implementation of one state system as a case study to investigate minimum recess requirement and to compare the implementation between school geographic and racial factors.

METHODS

A cross-sectional, observational study of the implementation of one state's minimum daily recess requirement of 40-minutes recess was conducted during the 2023-2024 academic year. A school audit of provided recess time was conducted of all public elementary schools in Arkansas through an online search of bell schedules, a survey sent to principals and physical education teachers, and phone call surveys to school offices. Key demographic and geographic features of the schools included enrollment data (e.g., race, grade, and % Free-and-Reduced Lunch composition), rurality, and region.

RESULTS

Recess information was obtained from 384 (73%) of 526 eligible schools with an average student enrollment of 398 students (SD 154), 19.8% (SD 27.9) Black student enrollment, and 63.8% (SD 20.0%) students receiving free-and-reduced lunch. 306 (85.5%) schools met recess requirements. There were no differences in meeting recess requirements by rurality. Of schools with higher Black student enrollment (≥ 25% Black enrollment), 75.3% met recess requirements compared to 89.5% in schools with lower Black enrollment (< 25% Black enrollment, OR 0.36, 95%CI: 0.16, 0.78, p =.010). There were differences in survey-reported available playground spaces and equipment between by meeting recess requirements and Black student enrollment (p <.05).

CONCLUSIONS

Schools in a state with a 40-minute daily recess requirement reported high compliance with the state policy. However, students in schools with higher Black student enrollment were less likely to meet the 40-minute recess requirement, and thus strategies are needed to ensure all students have access to recess opportunities. Ensuring equal access to recess through wide-reaching place-based and policy-based strategies may be a step in reducing health and education disparities, especially among populations where disparities are greatest.

A systematic review and meta-analysis of the first decade of compositional data analyses of 24-hour movement behaviours, health, and well-being in school-aged children

INTRODUCTION

Movement behaviours (e.g., sleep, sedentary behaviour, light physical activity [LPA], moderate to vigorous physical activity [MVPA]) are associated with numerous health and well-being outcomes. Compositional data analyses (CoDA) accounts for the interdependent nature of movement behaviours. This systematic review and meta-analysis provides a timely synthesis of the first decade of CoDA research examining the association between movement behaviours, health, and well-being in school-aged children.

METHODS

Databases were systematically searched for peer-reviewed studies examining CoDA associations between movement behaviours and health or well-being in school-aged children (5.0-17.9 years). All health and well-being outcomes were eligible for inclusion, as were all methods of reporting CoDA results. Where possible meta-analyses were conducted.

RESULTS

Twenty-six studies were included in the review. Sample sizes ranged from 88 - 5,828 (median = 387) participants and the mean ages ranged from 8 to 16 years. Regression parameters (kstudies=16) were the most common method of reporting results, followed by substitution effects (kstudies=12), optimal compositions (kstudies=3), and movement behaviour clusters (kstudies =1). Weighted compositional means of movement behaviours were calculated (e.g., 49.8 min/day of MVPA). For regression analyses, results were generally null, though some favourable trends were observed for MVPA and unfavourable trends for LPA and sedentary behaviour within individual health and well-being outcomes categories. Meta-analyses of substitutions supported the benefits of MVPA, with the risks of reducing MVPA for other movement behaviours being double the magnitude compared to the benefits of adding MVPA.

DISCUSSION

The most consistent conclusions within this review align with previous reviews that support the benefits of MVPA. Further, some evidence supported 24-hour movement behaviour guideline recommendations of increasing sleep and decreasing sedentary behaviour. This review also quantified not only the need to promote MVPA, but perhaps more importantly the urgency needed to preserve the limited MVPA children currently accumulate. Findings reinforce the "more/less is better" messages for movement behaviours, but do not allow us to recommend more specific balances of movement behaviours. As CoDA of movement behaviours progresses and accumulates further research, the methods and discussion points within the current review can aide future meta-analyses aimed at advancing the precision health guidance needed for optimizing children's health and well-being.

Sex-Specific Physical Activity and Weight Status in German Schoolchildren: Interim Results from the Hand on Heart Study

BACKGROUND/OBJECTIVES

physical activity (PA) in children offers lifelong benefits, yet nearly four in five children are insufficiently active. We examined sex-specific differences in sport participation by sport type and its association with weight status.

METHODS

in the ongoing hand-on-heart-study ("Hand-aufs-Herz"), comprehensive data on sociodemographic profiles, PA, and anthropometry were collected from 922 school-aged children, adolescents, and young adults (8-20 years) in Germany. Sex-specific differences in sport participation, sport types, and weight status were analyzed using descriptive statistics and logistic regression models.

RESULTS

based on the eligibility criteria for analysis (ages 8-18 years), 883 pupils were included (mean age 13.1 ± 2.4 years), 406 (46%) were females. Compared to females, males had a 43% higher chance of being members of a sports club and were more likely to spend more days/week on sports (44-85%). Males participated more in football, martial arts, and basketball while females favored gymnastics and volleyball. As age increased, males had a 30% higher likelihood of not being sports club members (females: 13%). Overweight/obese males had twice the risk of lacking sports memberships. The largest body mass index (BMI) difference was found in males and females participating in athletics, with -4.64 kg/m2 (males) and -1.99 kg/m2 (females) compared to their counterparts without club memberships.

CONCLUSIONS

in conclusion, sports participation should be encouraged especially among females and overweight/obese males. Targeted strategies should focus on promoting inclusive and non-competitive activities that cater to their interests.

Movimente program: effectiveness and moderators of a cluster-randomized controlled trial on self-reported physical activity among Brazilian adolescents

BACKGROUND

School-based intervention are needed due to the low levels of physical activity among adolescents.

OBJECTIVE

To evaluate a school-based intervention's effectiveness and potential sociodemographic moderators on physical activity (PA) among Brazilian adolescents.

DESIGN

The Movimente Program was a cluster randomized controlled trial conducted at six elementary schools in southern Brazil in 2017.

METHODS

Participants (n = 921) were adolescents from 7th -9th grade (12 to 15 years). From March to December, intervention strategies included teacher training, educational actions, and environmental improvements designed to increase PA levels. PA was self-reported, and the primary outcome was weekly minutes in total PA; secondary outcomes were weekly minutes in leisure-time PA, adherence to guidelines, and diversity (e.g., number of activities). In addition, the moderation effect of sex, school grade, socioeconomic level, weight status, and baseline PA levels was explored. Mixed-model linear regressions were used to test changes between baseline and follow-up (difference-in-differences approach).

RESULTS

Participants were, on average, 13.1 ± 1.1 years old, and 52% were female. Pre-post changes in PA volume did not differ between intervention and control groups (β: 6.64; 95% CI: -104.60; 117.89), nor did adherence to guidelines. No significant interaction effects of sex, socioeconomic level, or weight status were found. Pre-post changes of leisure PA diversity favored the intervention group among 8th but not 7th and 9th grade students.

CONCLUSION

The Movimente Program was not effective in improving PA among the whole sample. Further studies are warranted to explore effective ways to improve PA among adolescents from Brazil.

TRIAL REGISTRATION

The research project is registered with Clinical Trials (NCT02944318 Date of registration 25/10/2016).

Adolescent physical activity during school days: a comparative study before and after COVID-19 pandemic restrictions

Background

Physical activity (PA) during the school day is crucial for the health and well-being of adolescents. This study examines the impact of the COVID-19 pandemic on youth PA patterns to better understand these changes and to provide guidelines for school programming.

Methods

Differences in PA within specific segments of the school day were examined before and after the pandemic using the Youth Activity Profile questionnaire. Participants included 956 boys and 1,317 girls from 21 high schools. The study involved 12 Czech and 9 Polish high schools before the pandemic and 9 Czech and 8 Polish high schools after the pandemic.

Results

Both Czech and Polish boys and girls exhibited significantly less transportation PA to and from school and reduced PA during the school day after the pandemic compared to before. Additionally, Czech and Polish boys were significantly less physically active during school breaks, and Czech boys and girls had notably less PA during physical education lessons. The pandemic disrupted the habit of regular PA on school days, particularly evident in the decline of PA to and from school.

Conclusion

The study confirms a significant difference in PA of Czech and Polish adolescents in various segments of the school day after students return to school following pandemic restrictions. Promoting achievement of the recommendations in the segments of the school day and in comprehensive school PA programs should be an important part of school health and education policy and public health promotion for adolescents.

The Impact of the COVID-19 Pandemic on the Development of Motor Skills of German 5- to 6-Year-Old Children

The closure of educational institutions, playgrounds, and sports facilities has had a significant impact on children's levels of physical activity during the COVID-19 pandemic. Currently, there are only a few studies available that address the consequences of these pandemic-related restrictions on the development of motor skills in younger children. The aim of the present study was to gain insights into the impact of the COVID-19 pandemic on the development of children's fine and gross motor skills by comparing cohorts of German preschoolers. For this purpose, data from annual (years 2015 to 2018 and 2020 to 2024) routine examinations of children's (n = 1426; mean age: 5.46 ± 0.29 years) motor development conducted in the child daycare centers of the SportService des Landessportbund Brandenburg e.V. [Federal Sports Association of Brandenburg, Germany] were subjected to a secondary analysis. While no effects on overall motor performance as measured by the MOT 4-6, a standardized motor skills test, were found for the groups of preschoolers, a more detailed analysis revealed that the cohorts of children differed with respect to certain motor domains, i.e., jumping performance and fine motor skills. The findings are relevant for designing targeted remedial measures for children affected by the pandemic-related restrictions.

Contribution of walking to and from school on overall physical activity: a one-year follow up study

This study is the first in Japan to prospectively examine the relationship between walking to and from school and physical activity in primary school children. A total of 76 participants completed baseline and follow-up assessments, and their mean age was 9.6 ±  1.0 years at baseline and 10.6 ±  1.0 years at follow-up. The participants' mode of school commute was measured by a questionnaire. Step counts, sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) was assessed using an accelerometer. Comparisons of physical activity variables at baseline and follow-up and tracking of physical activity were analyzed. Overall physical activity levels decreased at follow-up compared to baseline. However, the contribution of commuting school activities to overall physical activity significantly increased at follow-up compared to baseline, especially in step counts and MVPA. Walking to and from school contributed to the participants' overall physical activity in MVPA were 39.6 ±  15.3% and 49.1 ±  13.8% for all participants at baseline and follow-up, respectively. Tracking correlation coefficients were high for the steps counts (r =  0.80-0.89) and MVPA (r =  0.71-0.75) in commuting school. In conclusions, walking to and from school significantly contributed to overall physical activity in primary school students. Physical activity during the school commute in short-term exhibited a low-to-strong association. These findings emphasize the importance of promoting physical activity interventions and implementing school policies that encourage walking to and from school. Future research will need to examine other populations and countries over a long-term period.

Trends in physical fitness among Lithuanian adolescents aged 11-17 years between 1992 and 2022

BACKGROUND

Physical fitness is an excellent marker of general health and performance. We aimed to calculate trends in physical fitness among Lithuanian adolescents between 1992 and 2022.

METHODS

Using a repeated cross-sectional design, body size and physical fitness data for 17 918 Lithuanian adolescents (50.3% female) aged 11-17 years were collected in 1992, 2002, 2012 and 2022. Body mass index (BMI) was calculated from measured height and body mass, with BMI z-scores (zBMI) calculated using WHO growth curves. Physical fitness was measured using the Eurofit test battery, with results converted to z-scores using European norms. With adjustment for zBMI, trends in mean fitness levels were calculated using general linear models. Trends in distributional characteristics were visually described and calculated as the ratio of SDs.

RESULTS

We found significant large declines (standardised effect size (ES) ≥ 0.80) in 20-m shuttle run and bent arm hang performance, and significant small declines (ES=0.20-0.49) in standing broad jump, plate tapping, sit-and-reach and sit-ups performance. In contrast, we found a significant moderate improvement (ES=0.50-0.79) in flamingo balance performance and a significant negligible improvement (ES<0.20) in 10×5-m shuttle run performance. Poorer trends were observed in low performers (below the 20th percentile) compared with high performers (above the 80th percentile).

CONCLUSION

Health-related fitness (ie, cardiorespiratory and musculoskeletal fitness) levels have declined among Lithuanian adolescents since 1992, particularly among those with low fitness. National health promotion policies are required to improve current trends.

Inequality in Children's Physical Activity Across Time-Segmented Youth Sport Practice

Purpose: Youth sport (YS) is a community system for promoting children's physical activity (PA). Studies have examined mean PA during YS practices, but few have examined inequalities in the distribution of PA among children during practice time. This study examined PA inequality in time-segmented YS practices and differences in inequality by time segment characteristics. Methods: Children's PA and YS practices were examined using accelerometer and video observation data from a sample of YS teams (n = 36 teams, n = 101 practices) for third- through sixth-grade children (n = 392), approximately eight to 12 years old, in two rural U.S. communities. Practices were time-segmented into smaller units (episodes; n = 991). Episodes were assigned codes for purpose (e.g. warm-up), member arrangement (e.g. whole group), and setting demand (i.e. fosters participation, creates exclusion). Group accelerometer data were paired with episodes, and the Gini coefficient quantified inequality in activity counts and minutes of moderate-to-vigorous PA (MVPA). Beta generalized estimating equations examined the influence of episode structure on PA inequality. Results: Warm-up (Gini = 0.22), fitness (Gini = 0.24), and sport skill (Gini = 0.24) episodes had significantly lower inequality (p < .05) in activity counts than other purpose types. Management (Gini = 0.32) and strategy (Gini = 0.40) episodes had significantly greater inequality (p < .05) in MVPA minutes than other purpose types. Episodes fostering participation (Gini = 0.32) had significantly lower activity count inequality (p < .05) than episodes creating exclusion (Gini = 0.35). Conclusion: PA inequality among children during YS varied by practice structure. Metrics such as the Gini coefficient can illuminate inequalities in PA and may be useful for guiding efforts to improve population PA in children. Trial Registration: This study is registered at www.clinicaltrials.gov (Identifier: NCT03380143).

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Stranger danger or good Samaritan? A cross-sectional study examining correlates of tolerance of risk in outdoor play among Canadian parents

BACKGROUND

Negative parental perceptions of risk may restrict children's opportunities for outdoor play. Excessively minimizing children's exposure to risks in their environment may have a range of developmental consequences. The purpose of this cross-sectional study was to assess correlates of parental tolerance of risk among a large sample of Canadian parents.

METHODS

In this cross-sectional study, a sample of 2,291 parents of 7-12 year olds completed online questionnaires assessing a range of potential individual (e.g., gender), social (e.g., neighbourhood cohesion), and environmental (e.g., walkability) correlates of parental tolerance of risk. Logistic regressions were created to examine associations between these factors and odds of being in the most risk averse quartile. The logistic regression was built in hierarchal steps relying on the Akaike information criterion (AIC) and pseudo R2 for model progression.

RESULTS

The final model had a pseudo R2 of 0.18. Five out of seventeen correlates were associated with risk aversion in parents. Concerns about stranger danger were associated with a higher odds of risk aversion (OR = 2.33, 95%CI[1.93, 2.82]). A higher number of children in the home was associated with lower odds of risk aversion in parents (OR = 0.80, 95%CI[0.69, 0.92], and parents of children born outside of Canada had higher odds of being risk adverse when compared to parents born in Canada (OR = 2.13, 95%CI[1.54, 2.94]). Finally, being very concerned with COVID-19 increased the odds of risk aversion (OR = 3.07, 95%CI[1.93, 5.04], while having a household income of > 100,000 lowered the odds of risk aversion (OR = 0.56, 95%CI[0.36, 0.87]).

CONCLUSIONS

Tailored interventions that reframe perceptions of risk for parents are needed. Such interventions could reframe concerns about stranger danger which persist despite occurrences of stranger abduction being extremely rare. Interventions could also be targeted to immigrant families and those with fewer children as they appear to be more averse to risk. A complementary focus on examining how cultural background influences risk perceptions is needed in future research.

Cluster analysis of physical activity and physical fitness and their associations with components of school skills in children aged 8-9 years

This study aimed to cluster physical activity (PA), physical fitness, visual-motor coordination, household duties, and their associations with school skills in 170 primary school children (88 girls and 82 boys) aged 8-9 years. Conducted as a cross-sectional design, the study analysed moderate-to-vigorous physical activity (MVPA) and household duties, which were assessed via questionnaires. Academic skills were evaluated using methods designed to diagnose school failure in students aged 7-9 years. Physical fitness was measured using the Eurofit test battery, and visual-motor coordination was assessed using a Piórkowski apparatus. Cluster analysis and general linear and non-linear regression analyses were used to determine associations with academic skills. Three clusters emerged: Cluster 1 (C1) was characterised by fast visual-motor coordination, high flexibility, and more time on household duties; Cluster 2 (C2) included children with the highest levels of PA and better performance in physical fitness items; Cluster 3 (C3) consisted of children with the lowest levels of PA, fitness, and low time on household duties. A regression analysis demonstrated a significant positive impact of cluster C1 on visual-auditory integration (total), with significantly better results for children in C1 compared to those in C3 (b = -2.69; p = 0.003). These results suggest that better visual-motor coordination, higher flexibility, and more time on housework are associated with better visual-auditory integration. Further research is needed to explore the physical and mental benefits of PA.

The Montenegrin 2022 Report Card on Physical Activity for Children and Youth

BACKGROUND

The main purpose of this study was to summarize the results of the Montenegrin 2022 Report Card on physical activity (PA) for children and youth, which is used to identify and grade PA to help optimize the current situation and provide an improved basis for the creation of a future monitoring system.

METHODS

Following the methodology established by the Active Healthy Kids Global Alliance, the Montenegrin team conducted an assessment of PA of Montenegrin children and youth through 12 separate indicators. Grades were awarded based on data found in available articles published up to 2022, including the grey literature, such as government and nongovernment reports, and online content from the same period.

RESULTS

Based on the results synthesized from the available data, B was the average rating for all indicators. Individual indicators varied. Six indicators were rated above average, 3 grade A, and 3 grade B. Six were rated slightly lower, 5 in the range of grade C, and 1 in the range of grade D.

CONCLUSIONS

Physical fitness, organized sport and PA, community and environment, government, overall PA, and active transportation are indicators with lower ratings than the others; therefore, they should be given the most attention in the future as it is clear they can be improved.

RETRAGAM: Resistance training based on gamification during physical education. Rationale and study protocol

Children's physical inactivity and increasing sedentary behaviour have become major public health concerns, with a concurrent decline in muscular fitness (MF) contributing to poor physical outcomes during childhood and adolescence, highlighting the importance of developing resistance training (RT) programs. Furthermore, several educational strategies such as gamification seem to increase students' motivation which can produce an increase in performance outcomes. This study describes the rationale and protocol of a school-based randomized controlled trial called "RETRAGAM" (REsistance TRAining based on GAMification). For this investigation, a total of ≃180 children (grades 5 and 6; 10-12 years of age) from 6 randomly selected schools in Valencia (Spain) will be enrolled for 8 weeks in one of the experimental groups: EG (15 min of RT Functional HIIT circuit program), EG + G (the same EG program but with a gamification approach) or CG (Control Group). Outcomes will include physical activity profile, MF, anthropometry and body composition, as well as the enjoyment and motivation during Physical Education (PE). An interactive app for digital devices will be used for gamified storytelling, earning points for personalized children's avatars, and implementing a flipped classroom learning model. We conclude that the RETRAGAM will provide information about the effectiveness and implementation of a school-based RT intervention during PE with and without gamification in students' MF, body composition, motivation and enjoyment.

Physical activity-the past, present and potential future: a state-of-the-art review

This is a state-of-the-art review of historical developments, current approaches and recommended future directions in physical activity (PA) research, practice and policy. Since the early epidemiological studies in the 1950s, PA research has developed from within a biomedical paradigm. There is now a strong evidence base linking PA with positive health outcomes. PA is currently understood as a multi-sector issue, requiring a multi-sector solution (e.g. transport, urban design, sport), resulting in multiple individual and societal benefits (e.g. addresses multiple Sustainable Development Goals), however, there is a disconnect between interventions, policy and practice. This may be due to limited cross-sector collaboration between, and within, the public and private sectors. Furthermore, the mix of policy instruments employed by governments to implement PA policy to date has been dominated by soft (e.g. communication) rather than hard options (e.g. fiscal). To progress in PA promotion, we need to move beyond health outcome and intervention evidence generation (e.g. focus on testing efficacy in highly controlled settings), to more complex, real world, politically informed, multi-sector, scale-up and policies, while concurrently collecting data to evaluate such efforts (e.g. natural experiments and evaluations of the policy process). PA programs may benefit from greater incorporation of public policy considerations, so that proposed interventions and policies are designed with potential political constraints in mind. We conclude by providing a call to action to advance the understanding of the role of politics in PA, in order to develop politically informed action on PA.

Design, Content and Ecological Validity and Reliability of the Physical Activity and Sport Habits Questionnaire for Children Aged 8-12 Years in the Province of Gipuzkoa (Spain)

Background/Objectives: This study aimed to develop a questionnaire to describe and diagnose the physical activity and sport (PAS) habits of 8-12-year-old schoolchildren, assessing its content, ecological validity and reliability, from a multidimensional perspective aligned with Global Matrix 4.0 indicators. Methods: The questionnaire design phase involved seven individuals from the university sector and sport managers from the Gipuzkoa Provincial Council. Seventeen experts later evaluated the questionnaire's content and ecological validity. For reliability testing, 276 schoolchildren aged 8 to 12 completed the questionnaire twice, with a time interval of two weeks to two months. Statistical analyses included the Wilcoxon test to compare expert ratings, effect size and percentage change calculations for magnitude assessment, and McNemar, McN-Bowker or Wilcoxon tests to compare differences between initial and repeat responses. Cohen's Kappa was used to assess agreement. Results: The initial battery of items, submitted to the validation process, comprised 31 items across 10 dimensions, derived from validated questionnaires and published works. Following content and ecological validity evaluations, modifications were made and nine items were removed due to improved wording, clarification of concepts, redundancy or lack of relevance. Expert quantitative analyses indicated improved overall questionnaire values. Reliability analysis revealed significant differences in five of the twenty-two items, though substantial agreement (from slight to almost perfect) was observed in twenty items. Conclusions: The study confirmed the questionnaire's validity and reliability as a suitable tool for assessing PAS practices among 8-12-year-old schoolchildren in Gipuzkoa, Spain, in both Basque and Spanish languages.

Navigating Children's Risky Play: A Comparative Analysis of Saudi Mothers and Fathers

Despite documented benefits for development, children are engaging in considerably fewer risky play activities. Research on parent gender and children's risky play is inconsistent. Gender and cultural context shape how individuals perceive and tolerate children's risky play. Little research exists on gender disparities in approaches to risky play in Eastern cultures, including Saudi Arabia. The study's objective was to examine gender variations in Saudi parents' willingness and tolerance for children's risky play. It included 85 parents: 41 fathers and 44 mothers. Differential Item Functioning analysis revealed a statistically significant difference between mothers and fathers on three Factors Affecting Tolerance of Risk in Play Scale items. While interaction effects and predictors were not significant (p = .22-.97), the overall multiple regression model significantly predicted parents' risk tolerance (p = .04). Within the context of other factors, gender appeared to play a complex and indirect role in determining parents' risk tolerance.

The impact of preschool children's physical fitness evaluation under self organizing maps neural network

To improve the scientific accuracy and precision of children's physical fitness evaluations, this study proposes a model that combines self-organizing maps (SOM) neural networks with cluster analysis. Existing evaluation methods often rely on traditional, single statistical analyses, which struggle to handle the complexity of high-dimensional, nonlinear data, resulting in a lack of precision and personalization. This study uses the SOM neural network to reduce the dimensionality of high-dimensional health data. Moreover, it integrates cluster analysis to categorize and analyze key physical fitness attributes, such as strength, flexibility, and endurance. Experimental results show that the proposed optimized model outperforms comparison models such as T-distributed stochastic neighbor embedding, density peak clustering, and deep embedded clustering in terms of performance. The accuracy for the strength dimension reaches 0.934, the F1 score is 0.862, and the area under the curve of receiver operating characteristic is 0.944. The silhouette coefficients for cluster analysis in strength, flexibility, and endurance dimensions are 0.655, 0.559, and 0.601, respectively, demonstrating good intra-class and inter-class distances. The proposed model enhances the comprehensive analysis of children's physical fitness and provides a scientific basis for personalized health interventions, making an important contribution to research in this field.

Argentina's Global Matrix 4.0 Report Card Results on Physical Activity for Children and Adolescents

BACKGROUND

The objective of the Argentine Global Matrix 4.0 Report Card was to synthesize the available national evidence on topics related to physical activity and health of children and adolescents and, based on that evidence, to assign a grade to some related indicators.

METHODS

The Report Card working group reviewed and compiled the best available evidence on the indicators developed by Active Healthy Kids Global Alliance. Each of the 12 grades (for 10 core and 2 optional indicators) were based on the percentage of children and adolescents meeting a benchmark established in the Global Matrix grading rubric: These grades could range from A+ (best) to F (worst), or an incomplete was assigned when evidence was insufficient or inadequate for grading. The grades were subsequently reviewed and harmonized by 2 independent Active Healthy Kids Global Alliance reviewers.

RESULTS

Overall Physical Activity, Sedentary Behavior, and Government, all received a grade of D+. Organized Sport and Physical Activity and Community and Environment each received a grade of C-. Obesity received a grade of C+. Active Play, Active Transportation, Physical Fitness, Family and Peers, School, and Sleep were graded as incomplete.

CONCLUSIONS

Only half of the indicators were able to be graded, as the other half were inconclusive due to lack of evidence. This leaves a gap and thus a challenge at the national level to improve research, surveillance systems, and policies to promote physical activity during childhood and adolescence.

Results From the First Para Report Card on Physical Activity for Children and Adolescents With Disabilities in Chile

BACKGROUND

Global initiatives have been put in place to attain a thorough understanding of worldwide variations in physical activity (PA) among children and adolescents. Yet, there is limited knowledge about PA-related indicators, specifically for children and adolescents with disabilities (CAWD). To bridge this data gap, the Global Matrix of Para Report Cards (PRCs) of CAWD initiative was established to address the scarcity of information on PA for this population globally. The purpose of this manuscript is to summarize the results of Chile's First PRC on PA for CAWD.

METHODS

Chile's PRC included 10 core PA indicators common to the Global Matrix of PRCs. Evidence from scientific articles, reports, and databases available or released from 2018 to January 2022 was included for each indicator. A scientific committee collected and analyzed the data, assigning letter grades (A-F) based on benchmarks.

RESULTS

The grades assigned were as follows: Overall PA, D-; Organized Sports and Physical Activity Participation, C-; Active Play, INCOMPLETE; Active Transportation, D-; Sedentary Behavior, F; Physical Fitness, INCOMPLETE; Family and Peers, D+; School, C+; Community and Environment, D+; Government, B-.

CONCLUSIONS

Chile scored low in most indicators. Although some efforts have been made in the last decade in terms of policies, these have not been reflected in PA and related behaviors in CAWD. The results underscore that maintaining the current situation is inadequate for addressing the widespread problem of physical inactivity among CAWD in Chile, emphasizing the urgency for substantial changes and a comprehensive approach to effectively combat this crisis.

Improving National and International Surveillance of Movement Behaviours in Childhood and Adolescence: An International Modified Delphi Study

BACKGROUND

The actions required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours (physical activity, sedentary behaviour including screen time, sleep) are unclear.

OBJECTIVE

To identify how to improve surveillance of movement behaviours, from the perspective of experts.

METHODS

This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from 'extremely' to 'not at all' important. Consensus was defined as > 70% rating of 'extremely' or 'very' important.

RESULTS

We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research.

CONCLUSIONS

This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally.

Correlates of active commuting to school across two generations: the Cardiovascular Risk in Young Finns Study

AIMS

Active commuting to school (ACS), a source of physical activity (PA), has declined in many countries over recent decades. This study investigates ACS and the factors associated with it among Finnish children and adolescents across two generations: those born between 1965-74 and 1998-2010. We also explore potential generational differences in these associations.

METHODS

School commuting was self-reported by 2075 participants of the ongoing population-based Young Finns Study in 1983 (generation 1 (G1), aged 9-18, 52% female), and by their 1137 offspring in 2018 (generation 2 (G2), aged 8-20, 53% female). Factors associated with ACS and the moderating effect of generation on these associations were examined using generalized estimating equation models for clustered binary data, for summer and winter seasons separately.

RESULTS

A greater distance to school (p < 0.001) and belonging to G2 (p ⩽ 0.049) were negatively associated with ACS during both seasons. High parental leisure-time PA (p ⩽ 0.025 for both seasons) and urban living area (p < 0.001 for summer) were positively associated with ACS. Generation moderated the associations of school grade and parental income with ACS in the summer (p ⩽ 0.015). Among G1 only, attending lower secondary school (vs. primary school) was negatively associated with ACS, while higher parental income was positively associated with ACS. Neither gender nor parental education was associated with ACS.

CONCLUSIONS

ACS was less common among the younger generation. Several correlates of ACS were identified, with generational differences. These findings can inform further research and guide policy decisions to promote ACS and ultimately enhance the PA of children and adolescents.

Physical Activity Report Card Indicators and the United Nations Sustainable Development Goals: Insights From Global Matrix 4.0

BACKGROUND

The World Health Organization recognizes that physical activity (PA) during childhood is crucial for healthy development, aligning well with the achievement of several United Nations (UN) Sustainable Development Goals (SDGs). This study aimed to explore the associations between 10 key indicators of PA for children and adolescents assessed in the Global Matrix 4.0 project, and the UN SDGs.

METHODS

Data from 57 countries/jurisdictions of the Global Matrix 4.0 project were used. The UN SDG indicators were sourced from the SDG Transformation Center, which publishes each country's performance on each of the 17 SDGs. Given the robust evidence supporting plausible links between PA and SDGs 3 (good health and well-being), 9 (industry, innovation, and infrastructure), 11 (sustainable cities and communities), 13 (climate action), and 16 (peace, justice, and strong institutions), these SDGs were investigated.

RESULTS

Countries/jurisdictions with good and moderate performance in achieving SDG 3, SDG 9, SDG 11, and SDG 16 had higher grades than countries/jurisdictions with fair performance in achieving these SDGs for the following indicators: Organized Sports and PA, Community and Environment, and Government Investments and Strategies. However, countries/jurisdictions with good performance in achieving SDG 13 had lower grades than countries/jurisdictions with fair performance in achieving SDG 13 for the following indicators: Organized Sports and PA, Community and Environment, and Government Investments and Strategies.

CONCLUSIONS

Organized Sports and PA, Community and Environment, and Government Investments and Strategies were the indicators that demonstrated differences between countries/jurisdictions with good and poor performance in achieving the SDGs.

High-intensity interval training for improving cardiometabolic health in children and adolescents: An umbrella review of systematic reviews

High-intensity interval training (HIIT) is an emerging exercise strategy to improve health and fitness, but previous studies have evaluated HIIT interventions across different populations and outcomes. This review aimed to comprehensively synthesize published evidence on the effects of HIIT on key cardiometabolic health parameters in children and adolescents. We searched seven databases until February 2024. Systematic reviews were eligible if they 1) compared HIIT and active/non-active control conditions with meta-analysis, 2) examined cardiorespiratory fitness, body composition and cardiometabolic risk biomarkers, and 3) examined children and adolescents. We included 18 systematic reviews with meta-analysis, including 223 original studies and 13,900 unique participants. HIIT is effective for cardiorespiratory fitness in children and adolescents with diverse health and weight status (median standardized mean difference [SMD] = 0.75). Improvements in body composition and several cardiometabolic risk biomarkers, including systolic blood pressure (median SMD = -0.40), diastolic blood pressure (median SMD = -0.22), triglyceride (median SMD = -0.30), low-density lipoprotein cholesterol (median SMD = -0.90), and high-density lipoprotein cholesterol (median SMD = 0.34), have also been observed following HIIT, with a notably more pronounced effect in youth with overweight/obesity or metabolic disorders. Our umbrella review supports the effectiveness of HIIT in enhancing cardiometabolic health, suggesting its integration into physical activity promotion programmes in schools and communities.

Are there sensitive periods for physical activity to influence the development of executive function in children?

Executive functions emerge throughout childhood and shape multiple cognitive and behavioral outcomes across the lifespan. Given the importance of these functions, there is considerable interest in understanding the role of environmental enrichment to support their development. The past 20 years have seen the emergence of a body of evidence around the beneficial effects of engaging in physical activity for executive functioning in children. Despite this, there are still unanswered questions, particularly about the confounding effects of the timing and dose of exercise-based interventions. During development, sensitive periods with heightened neural plasticity and sensitivity to environmental influences can offer an optimal time to introduce enrichment interventions. As such, sensitive periods for executive function could indicate an ideal time to introduce physical activity or be a potential confounder to study results if not considered. This narrative review discusses the potential presence of sensitive periods in preadolescent development where physical activity has greater benefits for executive function. Initially, we briefly review the largely parallel fields investigating the presence of sensitive periods for executive function and the effects of physical activity on executive function outcomes. We then bring together these 2 concepts to discuss the theoretical basis for developmentally sensitive periods during which children may be particularly amenable to physical activity-based interventions and offer potential ways forward to investigate this phenomenon. We hope this review will attract researchers to collaborate in the area and extend our current understanding of the development of executive functions as well as interventions like physical activity.

Global Comparisons of Age, Gender and Socioeconomic Status Differences of Physical Fitness Health Risk in South African Primary School Children: Longitudinal Data from the NW-CHILD Study

Global physical fitness (PF) levels have declined over the past 50 years, contributing to early health risks in children although it is still unclear how age, gender and socioeconomic status (SES) impact PF risk. This study aimed to identify unique health risks related to age, SES and gender that might influence muscular fitness (MF) and cardiorespiratory fitness (CRF) levels of primary school children in South Africa. Children (N = 349, boys = 165; girls = 184) of low (n = 201) and high SES (n = 148) underwent three time point measurements at 6, 9 and 12 years spanning seven primary school years. MF was assessed with the strength sub-test of the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) and CRF with a 20 m shuttle run. Relationships between biographical data, anthropometric data and PF were analysed using mixed linear regression models. After controlling for covariates, findings from unadjusted interaction models were used, revealing significant (p < 0.05) two-way age and SES interactions in standing long jump (SLJ), push-ups, wall-sit, sit-ups and VO2max and age and gender interactions (p < 0.001) in sit-ups, push-ups and VO2max. Universal cut-points are considered valid monitoring guidelines of PF risk in South African school children. For comparison, standardised global protocols for sit-ups and push-ups should be prioritised and intervention strategies should focus on improving PF in girls, older children from the age of 9 and children from low SES backgrounds.

DE-PASS Best Evidence Statement (BESt): Determinants of self-report physical activity and sedentary behaviours in children in settings: A systematic review and meta-analyses

Previous physical activity interventions for children (5-12yrs) have aimed to change determinants associated with self-report physical activity behaviour (PAB) and/or sedentary behaviour (SB), however, the associations between these determinants and PAB/SB in different settings are uncertain. The present study aimed to identify modifiable determinants targeted in previous PAB/SB interventions for children. Intervention effects on the determinants and their associations with self-report PAB/SB were assessed across settings. Search of relevant interventions from pre-defined databases was conducted up to July 2023. Randomized and non-randomized controlled trials with modifiable determinants were included. Data extraction and risk of bias assessments were conducted by two independent researchers. Where data could be pooled, we performed Robust Bayesian meta-analyses. Heterogeneity, publication bias and certainty of evidence were assessed. Fifteen studies were deemed eligible to be included. Thirty-seven unique determinants within four settings were identified-school, family, school with family/home, and community with(out) other settings. Ninety-eight percent of determinants belonged to individual/interpersonal determinant categories. Narratively, intervention effects on student perception of teachers' behaviour (school), self-management, perceived barriers, external motivation, exercise intention, parental modeling on SB (school with family/home) and MVPA expectations (community) were weak to strong, however, corresponding PAB/SB change was not evident. There were negligible effects for all other determinants and the corresponding PAB/SB. Meta-analyses on self-efficacy, attitude, subjective norm and parental practice and PAB/SB in two settings showed weak to strong evidence against intervention effect, while the effect on knowledge could not be determined. Similarly, publication bias and heterogeneity for most analyses could not be ascertained. We found no concrete evidence of association between the modifiable determinants and self-report PAB/SB in any settings. This is presumably due to intervention ineffectiveness. Design of future interventions should consider to follow the systems-based approach and identify determinants unique to the context of a setting, including policy and environmental determinants.

Parental education, Family Health Climate and accelerometer-based measured physical activity and sedentary behavior of primary school-aged children

Introduction

Sociodemographic factors such as parental education level (ED) influence the physical activity (PA) and sedentary behavior (SED) of primary school-aged children. In this context, family factors, such as the physical activity-related Family Health Climate (FHCPA), are relevant. However, the effect of FHCPA on the interaction between ED and children's activity behavior has not yet been investigated. Therefore, this study aimed to analyze the mediating effect of FHCPA on the relation between parental ED and children's device-based measured PA and SED.

Methods

A total of 94 children and their parents participated in the study. Questionnaires were used to assess parental ED and FHCPA. Children's moderate to vigorous physical activity (MVPA) and SED were measured using accelerometers. Bivariate correlations were conducted to investigate associations between parental ED and MVPA/SED/FHCPA. Mediation analyses were used to investigate the role of FHCPA in the association between maternal and paternal ED and children's MVPA/SED. Results indicate a small correlation between maternal ED and FHCPA for the total sample (ρ = 0.318, p < 0.001) and a medium correlation for girls only (ρ = 0.570, p < 0.001). Mediation analyses showed no significant mediation effect. However, there was a significant direct association when considering FHCPA in the relation between higher maternal ED and SED in girls compared to lower ED.

Discussion

Future research should examine more complex models to further develop and refine to facilitate the derivation of more effective recommendations for health prevention programs, particularly for mothers and girls.

Prevalence and Correlates of Meeting Physical Activity and Screen Time Guidelines Among Children of English- and Non-English-Speaking Backgrounds in Australia

BACKGROUND

Limited evidence suggests inequality in the prevalence of physical activity and screen time for children of non-English-speaking backgrounds (NESB). However, factors associated with these behaviours are understudied. This study identified the prevalence and correlates of meeting guidelines (physical activity, screen time and combined) among children of English-speaking backgrounds (ESB) and NESB.

METHODS

Participants were from the Mothers and their Children's Health Study, a sub-study of the Australian Longitudinal Study on Women's Health (1973-1978 cohort). Mothers provided information on physical activity and screen time behaviours of up to three children (aged 2-12 years). Age-specific Australian guidelines were used to classify children as meeting or not meeting physical activity and screen time guidelines. Those born in a non-English-speaking country or primarily speaking a non-English language at home were classified as 'NESB'. Multivariable-adjusted logistic regression analyses accounting for family-level clustering were used for analysis.

RESULTS

Data were from 4143 children (mean age 7.3 ± 2.9 years, 6.7% NESB). Around 17% children of NESB met physical activity guidelines (vs. 25% ESB, p = 0.002), 63% met screen time guidelines (vs. 58% ESB, p = 0.150), and 9% met combined physical activity and screen time guidelines (vs. 15% ESB, p = 0.011). Increasing age was inversely associated with meeting physical activity guidelines among children of both backgrounds (OR [95%CI]: NESB 0.81 [0.69-0.95], ESB 0.85 [0.82-0.87]). Family-level correlates (maternal education and physical activity level) were associated with meeting physical activity, screen time or combined guidelines among children of ESB only. A screen device in the child's bedroom was inversely associated with all outcomes among children of ESB. Children of NESB with a large yard at home had higher odds of meeting physical activity (4.14 [1.72-10.00]) and combined guidelines (4.48 [1.61-12.41]).

CONCLUSIONS

Children of NESB were less likely to meet physical activity and combined guidelines. Interventions may need to be tailored based on ESB background, with children of NESB (particularly older children and those with limited outdoor space at home) being a higher priority for intervention. Future large-scale studies examining a broader range of potential correlates, including cultural factors, are warranted.

Forces at play: A qualitative study of risk aversion, policy and decision making for children's physically active play in schools

This study investigated (i) the social and political factors driving risk averse decision making for children's physically active play in schools, and (ii) the policies shaping these decisions in Victoria, Australia. A theory-informed multi-method case study design combined policy document mapping, semi-structured interviews, and photo elicitation with 30 education policy actors. Data were analysed using reflexive thematic analysis. Findings showed the policy landscape was heavily skewed towards managing risk and safety (84%; n = 42), with fewer, mostly optional, policies for promoting physical activity, and a lack of policy to promote or protect play. Thematic findings indicated an intersecting range of factors in this setting (including occupational health and safety, knowledge and skill gaps, parent factors, children's physical capabilities, an undervaluing of play) can deter schools from providing an environment that enables children's freely chosen, physically active play. Multi-faceted, systems-based approaches that go beyond interventions aimed at individual behaviour change are needed.

Temporal trends in weight-based disparities in physical fitness of children: 30-years of continuous surveillance through Slovenian national system

BACKGROUND

Obesity in childhood has deleterious consequences for health while improving physical fitness can significantly reduce health risks related to high body mass index. We aimed to examine the evolution of disparities in physical fitness based on weight status among 7-15-year-olds in Slovenia between 1989 and 2019 and compare these trends across sex, age and socioeconomic status.

METHODS

We used annual data collected within the SLOfit monitoring system in the period between 1989 and 2019, totalling 4,256,930 participants (about 137 000 per year). We examined cardiorespiratory fitness (600-m run test), muscular fitness (60-s sit-ups, bent arm hang, and standing broad jump test) and skill-related fitness (backwards obstacle course, 60-m dash, arm plate tapping). We grouped children according to the IOTF cut-offs for BMI to those living with normal weight or excess weight and estimated changes in physical fitness over time by fitting quantile regression models separately by sex and age group, and then using segmented regression to identify the patterns of trends over time.

RESULTS

Weight-based disparities in physical fitness were large in 1989 and have further increased by 2019. The increase in disparities was generally around 5 percentiles larger in boys, and 10-15-year-olds compared to younger children. It was particularly pronounced for body core strength and speed in boys (up to 15 and 19 percentiles, respectively) and upper body strength and speed among girls (up to 13 percentiles). Most of the increase in disparities in health-related fitness accumulated during the 2010s, when the fitness of children generally improved, but much less so in children living with excess weight.

CONCLUSIONS

Despite recent improvements in population fitness levels, children with excess weight seem to be left behind, which adds to existing health inequalities. Our results should encourage policymakers to redesign policies aimed at promoting physical activity and enhancing physical fitness to make them more equitable and ultimately lead to reducing inequalities in fitness.

Reliability assessment of the 'field audit for children's active transport routes to school' (FACTS) tool

BACKGROUND

Children's active travel to school is associated with physical activity and thus health. Safe Routes to School (SR2S) programs identify 'safe routes' to promote children's active travel to school. No field audit tool exists specifically to assess the microscale built environment of these 'safe routes' within Australia. This study describes the reliability assessment of the Field Audit for Children's Active Transport to School (FACTS) tool.

METHODS

The FACTS tool was developed using a multi-step process, including a literature search, expert opinion, and pilot testing. For the reliability assessment, two trained auditors collected data at eight schools over three weeks in April 2021. For inter-rater reliability, auditors conducted audits on the 'safe routes' for the same six schools. For intra-rater reliability, auditors conducted repeat measures on the 'safe routes' for four schools each (eight schools total), including three different schools each from the six used for inter-rater reliability and one additional school. Item-by-item reliability was assessed using Cohen's Kappa, Cohen's Weighted Kappa, and percentage agreement. The reliability of calculated domain scores was assessed using intraclass correlation coefficients.

RESULTS

For inter-rater reliability, 31 of the 45 (68.9%) items had moderate to almost perfect agreement, seven items (15.6%) had below moderate agreement, and a Kappa statistic could not be calculated for seven items (15.6%) due to constant values. For intra-rater reliability, 37 of the 45 (82.2%) items had moderate to almost perfect agreement, two items (4.4%) had below moderate agreement, and a Kappa statistic could not be calculated for six items (13.3%) due to constant values. For inter- and intra-rater reliability of the segment domain scores, three of the four domains had substantial to almost perfect agreement. For inter- and intra-rater reliability of the crossing domain scores, all four domains had moderate to almost perfect agreement. For inter- and intra-rater reliability of the segment, crossing, route, and school scores, all had substantial to perfect agreement.

CONCLUSIONS

The FACTS tool can reliably characterise the microscale built environment of promoted 'safe routes' for their use within SR2S programs, and should be considered for use in future SR2S programs within the suburban Australian context.

A Comprehensive Planning Framework for Designing Effective Physical Activity Interventions in Youth

BACKGROUND

Effective physical activity (PA) interventions are needed to counter the insufficient and declining levels of PA in youth. These require an updated, comprehensive planning framework that consolidates recent decades of progress in promoting PA in young children, children, and adolescents. Effective PA interventions require program planning and conceptual model development that target a coordinated and multilevel set of age-specific PA determinants. Accordingly, this paper presents a comprehensive planning framework that researchers can use to design intervention research to promote PA in youth.

METHODS

The first author conducted targeted searches through Google Scholar to compile PA models/frameworks/guides applicable to youth, a comprehensive set of PA determinants, and determinant-linked strategies to promote PA focusing on review articles. The information was summarized in tables, synthesized, and used to create a planning framework, all of which were reviewed by coauthors.

RESULTS

The APPLE Framework for Planning PA Opportunities for Youth (APPLE = Age, PA focus, Place and time, Leverage relevant influences and strategies, and ensure Enjoyable PA opportunities) incorporated all core elements from targeted reviews to create a comprehensive planning framework. The APPLE Planning Framework has a set of questions/prompts that guide the intervention planning process and conceptual model templates to organize planning efforts for designing intervention research.

CONCLUSIONS

The APPLE Framework for Planning PA Opportunities for Youth will enable researchers to develop comprehensive conceptual models to guide the design of PA interventions for youth. Future research should refine the model and its components to enable PA intervention research in youth to move forward.

How to get children moving? The effectiveness of school-based interventions promoting physical activity in children and adolescents - A systematic review and meta-analysis of randomized controlled- and controlled studies

This systematic review and meta-analysis summarizes the effectiveness of school-based physical activity (PA) interventions on children's and adolescents' PA. As no robust empirical evidence exists regarding what seems to characterize the school-based PA interventions that are most effective, we further aimed to map key factors of particular importance when trying to increase PA in early stages of life through school-based strategies. Intervention effects were calculated as standardized between-group (i.e., intervention vs. control) mean differences (SMD) in PA from baseline to follow-up. In total, 189 publications were included. Few studies (7%) were of high quality. Our results demonstrate that school-based interventions only have a small positive effect on children's and adolescents' PA levels. Compared to the effect observed during total day (SMD = 0.27, p < 0.001), a slightly larger effect was observed during school hours (SMD = 0.37, p < 0.001), while no intervention effect was observed during leisure time (SMD = 0.07, p = 0.20). There was a tendency for interventions to be more effective if theoretical frameworks for behavior changes were used in the design phase. The largest effect size was observed when experts from outside school delivered the program (SMD = 0.56, p = 0.01), but training of personnel involved in delivery was the determining factor for program effectiveness as no effect was observed if interventions were delivered primarily by schools' untrained staff (SMD = 0.06, p = 0.61). Intervention effects where larger if parents were involved in the intervention program (parents involved: SMD = 0.35, p < 0.001; parents not involved: SMD = 0.16, p = 0.02). Small positive intervention effects were sustained at long-term follow-up after end of intervention. Overall, the certainty of the evidence of the findings is rated as low.

Inequality in Physical Activity in Organized Group Settings for Children: A Cross-Sectional Study

BACKGROUND

Adult-led organized settings for children (eg, classrooms) provide opportunities for physical activity (PA). The structure of setting time may influence inequalities (ie, unequalness) in the distribution of PA. This study examined differences in PA inequality by setting and time-segment purpose in time-segmented organized group settings for children.

METHODS

PA and setting meetings were assessed using accelerometer and video observation data from school, before-/after-school, and youth club groups (n = 30) for third- through sixth-grade children (n = 699) in 2 rural US communities. Meetings (n = 130) were time-segmented into smaller units (sessions; n = 835). Each session was assigned a purpose code (eg, PA). Accelerometer data were paired with the meetings and sessions, and the Gini coefficient quantified inequality in activity counts and moderate to vigorous PA minutes for each segment. Beta generalized estimating equations examined differences in PA inequality by setting and session purpose.

RESULTS

Activity count inequality was lowest (P < .05) during youth club meetings (Gini = 0.17, 95% CI, 0.14-0.20), and inequality in moderate to vigorous PA minutes was greatest (P < .01) during school (Gini = 0.34, 95% CI, 0.30-0.38). Organized PA sessions (Gini = 0.20, 95% CI, 0.17-0.23) had lower activity count inequality (P < .0001) than academic (Gini = 0.30, 95% CI, 0.27-0.34), enrichment (Gini = 0.31, 95% CI, 0.27-0.36), and nonactive recreation (Gini = 0.30, 95% CI, 0.25-0.34) sessions. Inequality in moderate to vigorous PA minutes was lower (P < .05) in organized PA (Gini = 0.26, 95% CI, 0.20-0.32) and free play (Gini = 0.28, 95% CI, 0.19-0.39) than other sessions.

CONCLUSIONS

PA inequality differed by setting time structure, with lower inequality during organized PA sessions. The Gini coefficient can illuminate PA inequalities in organized settings and may inform population PA improvement efforts in rural communities.

Multistakeholder Perspectives on the Determinants of Family Fundamental Movement Skills Practice: A Qualitative Systematic Review

BACKGROUND

Childhood obesity is a significant public health crisis that is exposing children to associated morbidities and premature mortality. However, parents can positively influence physical activity trajectories and improve health outcomes by nurturing fundamental movement skills (FMS) in children. This is the first study to explore the determinants of family FMS practice via a systematic synthesis of qualitative evidence.

METHODS

Keyword searches were completed in SPORTDiscus, PubMed, Scopus, Web of Science, and Embase. Studies that offered perspectives relating to influences on the FMS of 2-6-year-old children in the family context via qualitative approaches, including visual methodologies that provided an important voice to children, were included. A thematic analysis was used to establish key themes.

RESULTS

The emergent themes included parent knowledge and beliefs, self-efficacy of parents to teach, and the home environment. Parents often undervalued FMS and lacked the self-efficacy to teach due to poor understanding, conflicting priorities, and multifaceted societal influences. Children preferred autonomous play and socialisation but were negatively influenced by technology and restrictive household rules.

CONCLUSIONS

Greater knowledge exchange between stakeholders is necessary to empower parents and enhance FMS application at home. More community initiatives could facilitate greater access to outdoor spaces, facilities, and equipment, which may improve family engagement with FMS.

Development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS)

BACKGROUND

Teachers are recognized as 'key agents' for the delivery of physical activity programs and policies in schools. The aim of our study was to develop and evaluate a tool to assess teachers' capability, opportunity, and motivation to deliver school-based physical activity interventions.

METHODS

The development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS) involved three phases. In Phase 1, we invited academic experts to participate in a Delphi study to rate, provide recommendations, and achieve consensus on questionnaire items that were based on the Capability, Opportunity, and Motivation Behavior (COM-B) model. Each item was ranked on the degree to which it matched the content of the COM-B model, using a 5-point scale ranging from '1 = Poor match' to '5 = Excellent match'. In Phase 2, we interviewed primary and secondary school teachers using a 'think-aloud' approach to assess their understanding of the items. In Phase 3, teachers (n = 196) completed the COM-PASS to assess structural validity using confirmatory factor analysis (CFA).

RESULTS

Thirty-eight academic experts from 14 countries completed three rounds of the Delphi study. In the first round, items had an average rating score of 4.04, in the second round 4.51, and in the third (final) round 4.78. The final tool included 14 items, which related to the six constructs of the COM-B model: physical capability, psychological capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation. In Phase 2, ten teachers shared their interpretation of COM-PASS via a 20-min interview, which resulted in minor changes. In Phase 3, CFA of the 3-factor model (i.e., capability, opportunity, and motivation) revealed an adequate fit to the data (χ2 = 122.6, p < .001, CFI = .945, TLI = .924, RMSEA = .066). The internal consistencies of the three subscale scores were acceptable (i.e., capability: α = .75, opportunity: α = .75, motivation: α = .81).

CONCLUSION

COM-PASS is a valid and reliable tool for assessing teachers' capability, opportunity, and motivation to deliver physical activity interventions in schools. Further studies examining additional psychometric properties of the COM-PASS are warranted.