Development of a multi-wear-site, deep learning-based physical activity intensity classification algorithm using raw acceleration data

BACKGROUND

Accelerometers are widely adopted in research and consumer devices as a tool to measure physical activity. However, existing algorithms used to estimate activity intensity are wear-site-specific. Non-compliance to wear instructions may lead to misspecifications. In this study, we developed deep neural network models to classify device placement and activity intensity based on raw acceleration data. Performances of these models were evaluated by making comparisons to the ground truth and results derived from existing count-based algorithms.

METHODS

54 participants (26 adults 26.9±8.7 years; 28 children, 12.1±2.3 years) completed a series of activity tasks in a laboratory with accelerometers attached to each of their hip, wrist, and chest. Their metabolic rates at rest and during activity periods were measured using the portable COSMED K5; data were then converted to metabolic equivalents, and used as the ground truth for activity intensity. Deep neutral networks using the Long Short-Term Memory approach were trained and evaluated based on raw acceleration data collected from accelerometers. Models to classify wear-site and activity intensity, respectively, were evaluated.

RESULTS

The trained models correctly classified wear-sites and activity intensities over 90% of the time, which outperformed count-based algorithms (wear-site correctly specified: 83% to 85%; wear-site misspecified: 64% to 75%). When additional parameters of age, height and weight of participants were specified, the accuracy of some prediction models surpassed 95%.

CONCLUSIONS

Results of the study suggest that accelerometer placement could be determined prospectively, and non-wear-site-specific algorithms had satisfactory accuracies. The performances, in terms of intensity classification, of these models also exceeded typical count-based algorithms. Without being restricted to one specific wear-site, research protocols for accelerometers wear could allow more autonomy to participants, which may in turn improve their acceptance and compliance to wear protocols, and in turn more accurate results.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis

BACKGROUND

The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers.

OBJECTIVE

This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness.

METHODS

We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes.

CONCLUSIONS

eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions.

TRIAL REGISTRATION

PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

Acceptability of a parent-focused program for physical literacy development among parents and children during the COVID-19 pandemic: A qualitative study

Background

A 3-month parent education program was designed and implemented in Hong Kong to improve physical literacy (PL) among primary school children and their parents during the COVID-19 pandemic. This study aims to probe into the acceptability of the intervention from parental perspectives, providing more insights for future implementation.

Methods

Following the 3-month parent-focused PL program, 16 parents (mean age = 43.73 years, 15 mothers) were recruited to participate in semi-structured individual interviews in June 2021. Interviews were analyzed using thematic analysis in NVivo 12. Two coders analyzed interview transcripts deductively based on the interview guide and social cognitive theory (SCT).

Results

Three themes were identified that captured the acceptability of the program: (1) Addressing needs through appropriate delivery enhances acceptability of intervention; (2) Positive behavioral and psychological changes to families; (3) Appropriate support of environmental factors can enhance the sustainability of program effects. The high levels of acceptability were attributable to the fact that parents were able to learn and be a gatekeeper to impact their children positively. Moreover, the design and contents of the program were appropriate for the participating parents because the program provided adequate learning resources and interactive learning support without being overly rigid, and the online learning mode was feasible and convenient. Consequent to their participation in the program, parents expressed that they became more aware of the importance of PL, established physical activity routines with their children, and modified their parenting styles which resulted in improved parent-child relationships.

Conclusions

The current study provided evidence that engaging parents in the intervention was feasible and acceptable approach in supporting both parents and children to establish physically active routines in the family setting. The insights gained regarding the appropriateness and acceptability of the program in this specific context may be used to inform the design, implementation and sustainability of other parent-focused PL programs.

Examining the criterion validity of two scalable, information technology-based systems designed to measure the quantity and quality of movement behaviours of children from Hong Kong primary schools: a cross-sectional validation study

OBJECTIVES

Research has shown that having adequate quantity and quality of physical activity can contribute to the health and well-being of children. Nonetheless, existing tools to measure these constructs in children have limitations in terms of their objectivity and scalability. In this study, we provide criterion validity evidence of two systems built on commercially available sensors (ie, gyroscopes and infrared cameras), designed to measure children's moderate-to-vigorous physical activity and fundamental movement skill proficiencies.

DESIGN

Cross-sectional.

SETTING

Primary schools in Hong Kong.

PARTICIPANTS

Data from 30 (age=8.55±1.25 years) and 1174 (age=9.15±1.63 years) children were included for the validation of physical activity and fundamental movement skills measures, respectively. Children's outcomes were simultaneously measured using the developed systems and existing, well-established measures (accelerometers and expert ratings).

RESULTS

We found a strong correlation between physical activity outcomes measured using our developed system and accelerometers (Pearson r=0.795). Motor skill proficiency scored using our real-time rating system had strong agreement with expert ratings (percentage agreement=84%-94%, kappa=0.661 to 0.859).

DISCUSSION

Results of the current study supported the application of the respective systems in physical education and large-scale research studies. Collection of such data at mass levels could help researchers depict the complex relation between children's quantity and quality of physical activity.

Parent-focused online intervention to promote parents' physical literacy and support children's physical activity: results from a quasi-experimental trial

Background

The development of physical literacy (PL) early in life may influence children's subsequent physical activity (PA) participation and consequent health benefits across the life course. Interventions designed for parents are lacking, but such efforts can potentially enhance the PL of parents and their children’s PA participation. Additionally, there is insufficient evidence to support the feasibility of delivering a PL intervention using an online format. Therefore, the purpose of this study was to examine the feasibility and effectiveness of a parent-focused, theory-driven, online-delivered intervention designed to improve the parents’ PL and children’s PA behaviors.

Methods

A non-randomized trial was conducted to evaluate the effects of the program. 224 Hong Kong families (primary school-aged children and their parents) registered to the program were considered the experimental group and were exposed to an online intervention over three months. Another 220 families in Hong Kong were considered the comparison group and did not receive any intervention. Outcome measures included PA behaviors (daily steps and moderate-to-vigorous PA), parent–child co-activity behaviors, family PA routines, and parent perceived PL. Linear mixed models were used to analyze the differences in terms of changes in measured outcomes between groups over time.

Results

No significant group-by-time effects were found for children’s or parents’ PA behaviors. In terms of the family Co-PA routines, a small positive effect size in favor of the experimental group was found (p = .44, d = 0.2). Group-by-time effects favorable to the experimental group was detected for parent–child co-activity (p < .001, d = 0.7) and parental PL (p < .001, d = 0.9) at post-intervention. The results demonstrated that the intervention was acceptable and that there was potential for scale up.

Conclusions

Findings indicated that the intervention was effective in increasing parent–child co-activity and parent perceived PL. During the pandemic, online intervention delivery was found to be feasible. Using this mode of delivery, the intervention has the potential to reach a wide population in the local context.

Trial registration

The study was prospectively registered at the Chinese Clinical Trial Registry, Registration number: ChiCTR2100041903, Registered 09 January 2021.

Parental Support, Children's Physical Activity, Dietary Behaviors and Health-Related Quality of Life: Evidence From Three Asian Cities

BACKGROUND

Parental support is crucial for children's healthy lifestyle formation. The present study examined the relations between parental support (i.e., encouragement and praise), children's perceived autonomy support and behaviors in the domains of physical activity (PA) and diet, and health-related quality of life (HRQoL) simultaneously in Asia.

METHOD

Children aged 9 to 12 years and their parents (2065 dyads) in three Asian cities completed the respective questionnaires. Children reported perceived PA and dietary autonomy support, PA frequency, dietary behaviors, and HRQoL. Parents reported their PA and dietary support. The relations between parental support, children's perceived autonomy support an behaviors in the PA, and dietary domains as well as HRQoL were examined using multigroup path analyses.

RESULTS

Among three cities, the indirect effects of parental support on children's self-report PA or HRQoL via children's perceived PA autonomy support were significant. A hypothetical sequential indirect effect from parental PA support to children's HRQoL via children's perceived PA autonomy support and self-report PA was observed in Hong Kong. In Hong Kong and Taipei samples, the indirect effect of parental PA support on children's HRQoL via children's self-report PA and the indirect effect of children's perceived PA autonomy support on HRQoL via children's self-report PA were significant. In Hong Kong and Shanghai samples, children's perceived dietary autonomy support showed positive effect on HRQoL via healthy food consumption.

CONCLUSIONS

Congruent findings across three cities suggest that parents should provide support via encouragement and praise to facilitate children's perceived autonomy support and further increase PA and HRQoL. Our study adds to the literature by examining relations of parental support and children's healthy lifestyle in Asia and provides insights to parents and researchers.

Effect of family income and physical activity on children's quality of life

It is unclear whether gender differences exist in the relationship between maternal physical activity (PA) and children's quality of life (QoL). We also know relatively little about the potential role of PA in mitigating the adverse impact of family financial hardship. This study examined the interaction effect of PA with social and demographic factors on QoL among 272 primary school children and their mothers in Hong Kong. Children self-reported their QoL, whereas mothers reported their own and children's PA levels. Mothers also reported their family demographics including monthly household income. Moderated multiple regression models were calculated to examine 1) the relationship between maternal PA and child QoL based on child gender and 2) the relationship between family income status and child QoL based on maternal-child PA level status. The relationship between maternal PA and child QoL varied by child gender (β = .21, p = .049), with boys of active mothers showing higher QoL. Compared to active families, when both mothers and boys were inactive, there were bigger income differences in child QoL scores (β = .37, p = .041). No significant differences were observed in girls. The findings have implications for family-based PA interventions and highlights the benefits of PA toward the QoL of male children in disadvantaged families.

Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol

INTRODUCTION

24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap.

METHODS AND ANALYSIS

SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study.

ETHICS AND DISSEMINATION

The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions.

Examining the relationship between children's health-related quality of life and their perception of parental support toward physical activity: A longitudinal study

This study investigated how health-related quality of life (HRQOL) affected perception of parental support for physical activity (PA) in 529 children from the "Fun to Move@JC Project." They self-reported their HRQOL, PA enjoyment and motivation, barriers to PA, and attachment to parents in the first semester (Time 1) and perceived parental PA support in the second semester (Time 2). Mediation analyses were performed to examine the underlying mechanisms. Greater Time 1 HRQOL scores predicted higher Time 2 perceived parental PA support through PA enjoyment and motivation, barriers to PA, and attachment to parents at Time 1. The specific indirect effect via attachment to parents was particularly strong in girls, whereas the association of PA enjoyment with perceived parental PA support was stronger in boys. Our findings suggest that children with poor HRQOL may not perceive parents to be supportive of their PA. Interventions promoting parental PA support should emphasize PA enjoyment and benefits to attachment security for parents of boys and girls, respectively.

Improving children's fundamental movement skills through a family-based physical activity program: results from the "Active 1 + FUN" randomized controlled trial

Background

Physical activity is related to many positive health outcomes, yet activity levels of many children are low. Researchers have suggested that family-based interventions may improve physical activity behaviors of both children and their parents. In this study, we evaluated the “Active 1 + FUN” program, which was designed based on tenets of self-determination theory. Intervention components included free sporting equipment, ten coach-led workshops and activity sessions, and one booster session.

Methods

We evaluated the intervention program using a randomized controlled trial. One hundred seventy-one families were randomly allocated to either an experimental group or a wait-list control group. Participants were exposed to program contents over a nine-month period, while families in the control did not receive any form of intervention. Measured constructs included moderate-to-vigorous physical activity, co-physical activity behaviors, fundamental movement skills, BMI, and several self-reported questionnaire outcomes. Hierarchical linear modeling was used to compare changes in measured outcomes across the two groups.

Results

No significant intervention effects were found for children’s and parents’ accelerometer-measured moderate-to-vigorous physical activity, or their co-physical activity. However, in terms of children’s fundamental movement skills, a significant Time*Group interaction (B = 0.52, 95% CI [0.07, 0.96] for Times 1 to 2; B = 0.24, 95% CI [0.01, 0.48] for Times 1 to 3) in favor of the experimental group was found.

Conclusions

Results suggested that the “Active 1 + FUN” program was effective in improving children’s fundamental movement skills. Additional research is needed to examine how family-based initiatives could effectively improve physical activity behaviors too.

Trial registration

ANZCTR, ACTRN12618001524280. Registered 11 September 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375660.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01160-5.

Global effect of COVID-19 pandemic on physical activity, sedentary behaviour and sleep among 3- to 5-year-old children: a longitudinal study of 14 countries

BACKGROUND

The restrictions associated with the 2020 COVID-19 pandemic has resulted in changes to young children's daily routines and habits. The impact on their participation in movement behaviours (physical activity, sedentary screen time and sleep) is unknown. This international longitudinal study compared young children's movement behaviours before and during the COVID-19 pandemic.

METHODS

Parents of children aged 3-5 years, from 14 countries (8 low- and middle-income countries, LMICs) completed surveys to assess changes in movement behaviours and how these changes were associated with the COVID-19 pandemic. Surveys were completed in the 12 months up to March 2020 and again between May and June 2020 (at the height of restrictions). Physical activity (PA), sedentary screen time (SST) and sleep were assessed via parent survey. At Time 2, COVID-19 factors including level of restriction, environmental conditions, and parental stress were measured. Compliance with the World Health Organizations (WHO) Global guidelines for PA (180 min/day [≥60 min moderate- vigorous PA]), SST (≤1 h/day) and sleep (10-13 h/day) for children under 5 years of age, was determined.

RESULTS

Nine hundred- forty-eight parents completed the survey at both time points. Children from LMICs were more likely to meet the PA (Adjusted Odds Ratio [AdjOR] = 2.0, 95%Confidence Interval [CI] 1.0,3.8) and SST (AdjOR = 2.2, 95%CI 1.2,3.9) guidelines than their high-income country (HIC) counterparts. Children who could go outside during COVID-19 were more likely to meet all WHO Global guidelines (AdjOR = 3.3, 95%CI 1.1,9.8) than those who were not. Children of parents with higher compared to lower stress were less likely to meet all three guidelines (AdjOR = 0.5, 95%CI 0.3,0.9).

CONCLUSION

PA and SST levels of children from LMICs have been less impacted by COVID-19 than in HICs. Ensuring children can access an outdoor space, and supporting parents' mental health are important prerequisites for enabling pre-schoolers to practice healthy movement behaviours and meet the Global guidelines.

Relation between Perceived Barrier Profiles, Physical Literacy, Motivation and Physical Activity Behaviors among Parents with a Young Child

Objectives: to reveal distinct subgroups of parents by their perception of 6 types of physical activity barriers and challenges (i.e., lack of time, poor health, lack of company, lack of facilities, childcare responsibility, lack of motivation), and examine its relation with related constructs. Design: cross-sectional survey data. Method: the sample consisted of 424 parents who had at least 1 child of primary school age. Latent profile analysis was conducted to identify latent subgroups within participants. Group differences on physical literacy, autonomous motivation, and self-report physical activity (PA) levels were explored. Results: a four-profile solution was obtained from latent profile analysis, labelled as: “Struggling” (29.0%), “Family burden” (41.3%), “Lazy” (13.0%), and “Barriers free” (16.7%). The “Barriers free” profile experienced the least difficulties with physical activity, but the “Struggling” profile suffered the most severe barriers and challenges. “Family burden” and “Lazy” profiles demonstrated qualitative differences on one or two given challenges. Significant group differences on physical literacy, autonomous motivation, and PA levels were found, showing the “Barriers free” profile as the most robust and adaptive group of parents. Conclusions: the findings suggest that it is common for a substantial portion of parents to experience multiple barriers and challenges to a relatively high degree. Intervention on raising parent’s physical literacy to reduce barriers and sustain their motivation may be a target for intervention.

Promoting physical activity in children through family-based intervention: protocol of the "Active 1 + FUN" randomized controlled trial

BACKGROUND

Physical activity (PA) is beneficial to people's physical and psychological health. Physically active children are likely to become active adults; thus, active lifestyles should be promoted from childhood. Parents are crucial for shaping their children's behaviors, but many lack the knowledge and skills to provide optimal support for PA. The "Active 1 + FUN" intervention was designed to enhance PA of the whole family, and improve parenting methods of both fathers and mothers.

METHODS

"Active 1 + FUN" is a family-based intervention designed using the tenets of self-determination theory. The intervention was designed to help parents support their children's basic psychological needs for competence (by providing informational feedback and optimal challenges), autonomy (by exploring a variety of activities and reducing controlling behaviors), and relatedness (by increasing co-PA between parents and child). The intervention components include interactive workshops, activity sessions, physical activity homework, activity planning consultations, easy sports equipment, and online materials. A randomized controlled trial will be conducted to evaluate the intervention. A target sample of 204 Primary three to five students (8 to 11 years) and their parents will be randomly allocated to the experimental group or a wait-list control group. The experimental group will receive a ten-session intervention which spans approximately six months. The control group will receive intervention one year later. Children's accelerometer-based leisure-time physical activity (primary outcome) and secondary outcomes will be assessed at baseline, at end of intervention period (6 months after baseline), and at follow-up (12 months after baseline). Qualitative interviews will be conducted to determine effective intervention components from the perspective of children and parents. We hypothesize that the intervention will increase parents' and children's activity behaviors and that children will experience higher levels of needs satisfaction with regard to physical activity participation.

DISCUSSION

Physical activity interventions often target children only, but ones that also involve parents may be more beneficial. The "Active 1 + FUN" intervention will be organized and delivered by trained trainers. Consequently, this intervention could be scaled to a larger number of Hong Kong schools in the future and could impact a wider population of schoolchildren.

TRIAL REGISTRATION

ANZCTR ACTRN12618001524280 . Registered 11 September 2018.

Rope skipping increases bone mineral density at calcanei of pubertal girls in Hong Kong: A quasi-experimental investigation

Bone mineral accrual during puberty is important, especially in girls, because it is related to reduced risks of osteoporosis in adulthood. Previous research has shown that jumping or plyometric exercises may be effective in increasing bone mineral density in adolescents. Rope skipping is a form of activity that involves jumping, thus regular skipping may also increase bone mineral density in pubertal girls. To this end, we conducted a quasi-experimental to examine the effects of rope skipping on girls' bone mineral density and cardiovascular fitness. 176 Hong Kong girls (age = 12.23 ± 1.80 years at baseline) were recruited to take part in the study. Bone density at their forearms and calcanei were measured twice over two academic years (mean time between visits was 10.3 months). Using multilevel modeling analyses and adjusting for participants' height and physical activity, we found that girls who participated in weekly rope skipping activities, compared to those who did not, had higher levels of bone density at the calcanei (B = 0.023, p < .01). However, no differences were found for bone density at forearms or participants' cardiovascular fitness. The rates of change of these variables across time were also not significantly different. Results suggest that regular rope skipping may increase girls' bone density at the lower extremities, irrespective of the amount of self-report physical activity. However, further research is required to examine the potential dose-response relation between skipping behaviors and the measured outcomes.

A school-based rope skipping program for adolescents: Results of a randomized trial

Despite physical education's health enhancing potential, students' activity levels in lessons are low. We evaluated a school-based intervention that involved rope skipping on students' moderate-to-vigorous physical activity (MVPA) in physical education. The intervention was evaluated using a clustered randomized controlled trial in 24 classes (N=731 students; M=14.38years; all from Secondary 2) from 12 Hong Kong schools during September to December 2013. The primary outcome was percentage of lesson time spent in MVPA. Secondary outcomes included students' vigorous activity, counts per minute, perceived autonomy support and motivation for physical education. Accelerometer-based activity measures were taken from a sub-sample of 168 students during lessons 1 to 3 (baseline) and lessons 5 to 7 (treatment phase). Participants self-reported motivation variables at lessons 4 and 8. Teachers allocated to the experimental group included an intervention during treatment phase; those in the control group continued usual practices. The intervention involved a 15-minute rope skipping activity where students completed intervals of skipping with rests in between. Using multilevel modeling, we examined the intervention effects on measured outcomes, and whether effects differed for boys and girls. Overall intervention effects were not found. However, girls in the intervention group spent more time in MVPA (β=0.25) and had higher counts per minute (β=0.32) than control group counterparts at treatment phase. Perceived autonomy support and motivation variables were similar across groups. The intervention increased activity levels of girls, but not boys. Implementation of the intervention may reduce differences between boys' and girls' physical education activity levels.

TRIAL REGISTRATION

ANZCTR: ACTRN12613000968774.

Increasing students' physical activity during school physical education: rationale and protocol for the SELF-FIT cluster randomized controlled trial

Background

The Self-determined Exercise and Learning For FITness (SELF-FIT) is a multi-component school-based intervention based on tenets of self-determination theory. SELF-FIT aims to increase students’ moderate-to-vigorous physical activity (MVPA) during physical education lessons, and enhance their autonomous motivation towards fitness activities. Using a cluster randomized controlled trial, we aim to examine the effects of the intervention on students’ MVPA during school physical education.

Methods

Secondary 2 students (approximately aged 14 years) from 26 classes in 26 different schools will be recruited. After baseline assessments, students will be randomized into either the experimental group or wait-list control group using a matched-pair randomization. Teachers allocated to the experimental group will attend two half-day workshops and deliver the SELF-FIT intervention for 8 weeks. The main intervention components include training teachers to teach in more need supportive ways, and conducting fitness exercises using a fitness dice with interchangeable faces. Other motivational components, such as playing music during classes, are also included. The primary outcome of the trial is students’ MVPA during PE lessons. Secondary outcomes include students’ leisure-time MVPA, perceived need support from teachers, need satisfaction, autonomous motivation towards physical education, intention to engage in physical activity, psychological well-being, and health-related fitness (cardiorespiratory and muscular fitness). Quantitative data will be analyzed using multilevel modeling approaches. Focus group interviews will also be conducted to assess students’ perceptions of the intervention.

Discussion

The SELF-FIT intervention has been designed to improve students’ health and well-being by using high-intensity activities in classes delivered by teachers who have been trained to be autonomy needs supportive. If successful, scalable interventions based on SELF-FIT could be applied in physical education at large.

Trial registration

The trial is registered at the Australia New Zealand Clinical Trial Registry (Trial ID: ACTRN12615000633583; date of registration: 18 June 2015).

Autonomous Motivation Predicts 7-Day Physical Activity in Hong Kong Students

Autonomous motivation predicts positive health behaviors such as physical activity. However, few studies have examined the relation between motivational regulations and objectively measured physical activity and sedentary behaviors. Thus, we investigated whether different motivational regulations (autonomous motivation, controlled motivation, and amotivation) predicted 7-day physical activity, sedentary behaviors, and health-related quality of life (HRQoL) of students. A total of 115 students (mean age = 11.6 years, 55.7% female) self-reported their motivational regulations and health-related quality of life. Physical activity and sedentary behaviors were measured using accelerometers for seven days. Using multilevel modeling, we found that autonomous motivation predicted higher levels of moderate-to-vigorous physical activity, less sedentary behaviors, and better HRQoL. Controlled motivation and amotivation each only negatively predicted one facet of HRQoL. Results suggested that autonomous motivation could be an important predictor of physical activity behaviors in Hong Kong students. Promotion of this form of motivational regulation may also increase HRQoL.

Outcomes of the Rope Skipping 'STAR' Programme for Schoolchildren

Physical activity in children and adolescents is on a decline trend. To this end, we conducted a matched-pair randomized controlled trial to examine the effects of a 4-week STAR (School-based; Train-the-trainer; Accessibility of resources; Recreational) skipping programme. 1,386 schoolchildren from 20 primary and secondary schools were recruited. Schools were randomized into the experimental or wait-list control group. Participants self-reported their health-related quality of life using the KIDSCREEN-27. Accelerometers were used to measure the time a subgroup of participants (n = 480) spent in moderate-to-vigorous physical activity during school hours on five consecutive days. Measures were taken at pre- and post-test. At post-test, students in the experimental group, compared to those in the control group, engaged in less moderate-to-vigorous physical activity during school hours. Health-related quality of life from two groups of students was similar, but the experimental group reported higher levels of autonomy and parent relationships. Results suggested that although the intervention did not increase students' physical activity levels, it slightly improved their health-related quality of life. Future studies should explore personal factors that might mediate the effect of the intervention.

A school-based rope skipping intervention for adolescents in Hong Kong: protocol of a matched-pair cluster randomized controlled trial

BACKGROUND

Schools present venues for physical activity promotion among youth, with physical education (PE) considered the primary vehicle responsible for increasing activity levels. Yet students are not very physically active during typical school PE classes. With the aim to engage Hong Kong students in more moderate-to-vigorous physical activity (MVPA) during PE, a fitness infusion intervention using rope skipping was designed, and its effectiveness will be examined. Rope skipping was chosen because a) it provides moderate-to-high intensity physical activity; b) is inexpensive; c) students find it enjoyable; and d) is feasible in typical environments in Hong Kong, where PE classes are large in size (up to 40 students) and space available for physical activity is usually limited.

METHODS/DESIGN

A matched-pair cluster randomized controlled trial was designed. Secondary school students from 24 classes (from 12 schools) will be recruited to participate in the trial. Students' baseline MVPA will be measured during school PE. Classes will be matched according to baseline variables and one class from each pair will be randomized into the experimental group. Teachers in the experimental group will be invited to attend a teacher workshop, and will insert a 15-minute rope skipping activity in four consecutive PE lessons. Motivational factors based on self-determination theory will also be measured as secondary outcomes. The effectiveness of the intervention will be evaluated by comparing changes in the proportion of lesson time spent in MVPA from baseline to follow-up across the experimental and control groups.

DISCUSSION

Physical activity levels in PE are often very low and there is a need to identify feasible low-cost interventions that can be easily disseminated. If the results of the study suggest the intervention to be effective, it could be implemented to schools throughout Hong Kong and other cities where space is limited.

TRAIL REGISTRATION ANZCTR

ACTRN12613000968774. Registered on 30 August 2013.