More People, More Active, More Often for Heart Health - Taking Action on Physical Activity

Physical inactivity is a leading contributor to increased cardiovascular morbidity and mortality. Almost 500 million new cases of preventable noncommunicable diseases (NCDs) will occur globally between 2020 and 2030 due to physical inactivity, costing just over US$300 billion, or around US$ 27 billion annually (WHO 2022). Active adults can achieve a reduction of up to 35% in risk of death from cardiovascular disease. Physical activity also helps in moderating cardiovascular disease risk factors such as high blood pressure, unhealthy weight and type 2 diabetes. For people with cardiovascular disease, hypertension, type 2 diabetes and many cancers, physical activity is an established and evidence-based part of treatment and management. For children and young people, physical activity affords important health benefits. Physical activity can also achieve important cross-sector goals. Increased walking and cycling can reduce journeys by vehicles, air pollution, and traffic congestion and contribute to increased safety and liveability in cities.

Clinical practice guidelines for the management of overweight and obesity published internationally: A scoping review

With the increasing prevalence of obesity placing additional demands on healthcare systems, many jurisdictions and professional bodies have developed clinical practice guidelines to support practitioners in the management of people with overweight and obesity. This scoping review aimed to identify key features of contemporary guidelines for the clinical management of overweight and obesity. Searches of MEDLINE, Guidelines International Network's international guidelines library, and other grey literature sources identified 38 guidelines of 18 countries and one region published since 2010. Guidelines were developed by committees (n = 36, 95%) that comprised knowledgeable experts (n = 36, 95%) and were multidisciplinary (n = 33, 87%), with limited consumer representation (n = 11, 29%). Guideline documentation incorporated review questions (n = 23, 61%), systematic reviews (n = 25, 66%), evidence grading systems (n = 33, 87%), processes for reaching consensus (n = 19, 50%), and guideline review details (n = 28, 74%). Treatment approaches included in most guidelines were nutrition and physical activity (n = 38, 100%), psychology (n = 37, 97%), pharmacotherapy (n = 32, 84%), and bariatric surgery (n = 31, 82%). Most guidelines targeted populations based on age (n = 30, 79%). Guidelines contained recommendations for pregnancy (n = 12, 32%), older adults (n = 9, 24%), and people with eating disorders (n = 8, 21%). Future guidelines would benefit from involvement of consumers including groups known to be at increased risk of overweight and obesity, targeted guidance for at risk groups, and consideration of weight bias and stigma.

The association between device-measured sitting time and cardiometabolic health risk factors in children

BACKGROUND

There is limited evidence of the associations between postural-derived sitting time, waist-worn derived sedentary time and children's health and the moderation effect of physical activity (PA). This study examined associations of children's device-measured sitting time with cardiometabolic health risk factors, including moderation by physical activity.

METHODS

Cross-sectional baseline data from children (mean-age 8.2 ± 0.5 years) in Melbourne, Australia (2010) participating in the TransformUs program were used. Children simultaneously wore an activPAL to assess sitting time and an ActiGraph GT3X to assess sedentary time and physical activity intensity. Cardiometabolic health risk factors included: adiposity (body mass index [BMI], waist circumference [WC]), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglycerides, fasting plasma glucose (FPG), serum insulin, and 25-hydroxyvitaminD (25[OH]D). Linear regression models (n = 71-113) assessed associations between sitting time with each health risk factor, adjusted for different PA intensities (i.e. light [LIPA], moderate-vigorous intensities [MVPA], separately on each model), age, sex, adiposity, and clustering by school. Interaction terms examined moderation. The analyses were repeated using device-measured sedentary time (i.e. ActiGraph GT3X) for comparison.

RESULTS

Sitting time was positively associated with SBP (b = 0.015; 95%CI: 0.004, 0.026), DBP (b = 0.012; 95%CI:0.004, 0.020), and FPG (b = 0.001; 95%CI: 0.000, 0.000), after adjusting for higher PA intensities. The association between sitting time and insulin (b = 0.003; 95%CI: 0.000, 0.006) was attenuated after adjusting for higher PA intensities. When the models were adjusted for LIPA and MVPA, there was a negative association with LDL (b=-0.001; 95%CI: -0.002, -0.000 and b=-0.001; 95%CI: -0.003, -0.000, respectively). There was a negative association of sedentary time with WCz (b=-0.003; 95%CI: -0.005, 0.000) and BMIz (b=-0.003; 95%CI: -0.006, -0.000) when the models were adjusted by MVPA. Sedentary time was positively associated with triglycerides (b = 0.001; 95%CI: 0.000, 0.001) but attenuated after adjusting for MVPA. No evidence of moderation effects was found.

CONCLUSIONS

Higher volumes of sitting and sedentary time were associated with some adverse associations on some cardiometabolic health risk factors in children. These associations were more evident when sitting time was the predictor. This suggests that reducing time spent sitting may benefit some cardiometabolic health outcomes, but future experimental research is needed to confirm causal relationships and identify the biological mechanisms that might be involved.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12609000715279.

Prevalence of toddlers meeting 24-hour movement guidelines and associations with parental perceptions and practices

OBJECTIVES

Whether toddlers (1-2 years) meet 24-hour Movement Guidelines and how parental practices and perceptions are related to compliance are uncertain. This study: a) estimated the proportion of toddlers meeting individual and combined movement guidelines; and b) examined associations between parental perceptions/practices and toddlers' compliance with movement guidelines.

DESIGN

Cross-sectional study.

METHODS

Australian parents self-reported their parenting practices/perceptions (routines, co-participation, restrictions, concerns, knowledge) and toddlers' movement behaviours in the baseline assessment of Let's Grow (n=1145), a randomised controlled trial. The World Health Organization's Guidelines on Physical Activity, Sedentary Behaviour, and Sleep for children under 5 years were used to estimate the prevalence of compliance with individual and combined movement guidelines. Logistic models assessed cross-sectional associations.

RESULTS

The prevalence of meeting guidelines was 30.9% for screen time, 82.3% for sleep, 81.6% for physical activity, 20.1% for combined, and 2.1% meeting none. Parents' knowledge of the guidelines, fewer concerns and more favourable restrictions concerning movement behaviours were associated with greater compliance with individual and combined movement guidelines. Routines for screen time and for combined behaviours were associated with adherence to their respective guidelines. Less co-participation in screen time and more co-participation in physical activity were associated with greater compliance with the relevant guidelines.

CONCLUSIONS

Given only 20% of toddlers met all guidelines, strategies early in life to establish healthy movement behaviours, especially screen time, are needed. Future studies could target the parental practices/perceptions identified in this study to support toddlers with optimal sleep and physical activity and reduced screen time.

Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors

BACKGROUND

Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion or NCD prevention more generally. This review aimed to: (i) synthesise evidence on the use of systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs; and (ii) to explore how systems approaches have been conceptualised and used in intervention implementation and scale up.

METHOD

Seven electronic databases were searched for studies published 2016-2021. Eligible studies targeted at least one of four NCD behavioural risk factors (physical inactivity, tobacco use, alcohol consumption, diet), or described evaluation of an intervention planned for or scaled up. Studies were categorised as having a (i) high, (ii) moderate, or (iii) no use of a systems approach. A narrative synthesis of how systems approaches had been operationalised in scale up, following PRISMA guidelines.

RESULTS

Twenty-one intervention studies were included. Only 19% (n = 4) of interventions explicitly used systems thinking to inform intervention design, implementation and scale up (targeting all four risk factors n = 2, diet n = 1, tobacco use n = 1). Five studies ('high use') planned and implemented scale up with an explicit focus on relations between system elements and used system changes to drive impact at scale. Seven studies ('moderate use') considered systems elements impacting scale-up processes or outcomes but did not require achieving system-level changes from the outset. Nine studies ('no use') were designed to work at multiple levels among multiple agencies in an intervention setting, but the complexity of the system and relations between system elements was not articulated. We synthesised reported barriers and facilitators to scaling up, and how studies within each group conceptualised and used systems approaches, and methods, frameworks and principles for scaling up.

CONCLUSION

In physical activity research, and NCD prevention more broadly, the use of systems approaches in scale up remains in its infancy. For researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice.

TRIAL REGISTRATION

PROSPERO (CRD42021287265).

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

REGISTRATION

PROSPERO (CRD42020169988).

Before-school physical activity patterns among adolescents using accelerometer and GPS data

Most adolescents do not meet physical activity (PA) guidelines. The before-school segment has been identified as one promising opportunity for intervention; however, there is a need for contextual understanding of PA in this segment. This study aimed to examine: a) adolescents' PA levels across various locations before school (6:00am - school start), b) contributions of before-school PA to daily PA and PA guidelines, and c) correlates of location-specific before-school PA. A cross-sectional analysis was conducted using adolescents' (n = 148, mean age 14.7) accelerometer and GPS data. Adolescents averaged 9.7 min in before-school moderate-to-vigorous PA (MVPA), representing substantial contributions to daily activity. Most MVPA occurred away from home and school. Significant correlates included segment duration, age, socio-economic status, and PA self-efficacy. Future work should consider these patterns and correlates to support adolescents' PA through targeted interventions.

A qualitative exploration of multi-stakeholder perspectives of before-school physical activity

BACKGROUND

Engagement in before-school physical activity can potentially enhance health and learning-related outcomes for children and adolescents. However, influencing factors and stakeholder perceptions of before-school physical activity remain under-researched. This qualitative study aimed to examine stakeholder perceptions of: a) the suitability of the before-school segment for physical activity, b) barriers and facilitators associated with before-school physical activity, and c) strategies for schools to support before-school physical activity.

METHODS

Twelve focus groups and one interview were conducted with 38 participants from a range of school stakeholder groups-students, parents, teachers, school leaders, external physical activity providers, and school health and physical activity experts. Focus groups were analysed using template analysis, guided by a social-ecological model.

RESULTS

Stakeholders perceived before-school physical activity as valuable, for reasons including perceptions of meaningful contributions to students' cognitive functioning, classroom behaviours, and wellbeing. Factors influencing before-school physical activity were identified across multiple social-ecological levels, including the critical role of school leadership support, availability of facilities, and provision of qualified supervision. Proposed strategies highlighted the need for sustainable design, contextual relevance, and community engagement in before-school initiatives. Additionally, communication of the manifold benefits identified by stakeholders was suggested as a means to drive support and engagement in before-school physical activity.

CONCLUSIONS

This study provides insight for schools seeking to enhance opportunities for physical activity in the before-school hours and may inform future intervention research on the subject, taking into account its multi-faceted influences and the need for context-specific strategies.

Cost-effectiveness of reducing children's sedentary time and increasing physical activity at school: the Transform-Us! intervention

BACKGROUND

Improving physical activity and reducing sedentary behavior represent important areas for intervention in childhood in order to reduce the burden of chronic disease related to obesity and physical inactivity in later life. This paper aims to determine the cost-effectiveness of a multi-arm primary school-based intervention to increase physical activity and/or reduce sedentary time in 8-9 year old children (Transform-Us!).

METHODS

Modelled cost-utility analysis, using costs and effects from a cluster randomized controlled trial of a 30-month intervention that used pedagogical and environmental strategies to reduce and break up sedentary behaviour (SB-I), promote physical activity (PA-I), or a combined approach (PA + SB-I), compared to current practice. A validated multiple-cohort lifetable model (ACE-Obesity Policy model) estimated the obesity and physical activity-related health outcomes (measured as change in body mass index and change in metabolic equivalent task minutes respectively) and healthcare cost-savings over the cohort's lifetime from the public-payer perspective, assuming the intervention was delivered to all 8-9 year old children attending Australian Government primary schools. Sensitivity analyses tested the impact on cost-effectiveness of varying key input parameters, including maintenance of intervention effect assumptions.

RESULTS

Cost-effectiveness results demonstrated that, when compared to control schools, the PA-I and SB-I intervention arms were "dominant", meaning that they resulted in net health benefits and healthcare cost-savings if the intervention effects were maintained. When the costs and effects of these intervention arms were extrapolated to the Australian population, results suggested significant potential as obesity prevention measures (PA-I: 60,780 HALYs saved (95% UI 15,007-109,413), healthcare cost-savings AUD641M (95% UI AUD165M-$1.1B); SB-I: 61,126 HALYs saved (95% UI 11,770 - 111,249), healthcare cost-savings AUD654M (95% UI AUD126M-1.2B)). The PA-I and SB-I interventions remained cost-effective in sensitivity analysis, assuming the full decay of intervention effect after 10 years.

CONCLUSIONS

The PA-I and SB-I Transform-Us! intervention arms represent good value for money and could lead to health benefits and healthcare cost-savings arising from the prevention of chronic disease in later life if intervention effects are sustained.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN83725066). Australia and New Zealand Clinical Trials Registry Number (ACTRN12609000715279).

Before-school physical activity levels and sociodemographic correlates among Australian adolescents: A cross-sectional study

Understanding adolescents' physical activity levels and underpinning contextual factors is crucial for health promotion. This cross-sectional study, using 24-hour time use diaries and sociodemographic variables from the Longitudinal Study of Australian Children, addressed gaps in understanding of physical activity in the before-school segment (the time between waking up and commencing classes). The study examined a) adolescents' time spent in before-school physical activity, focusing on location and shared presence, and b) sociodemographic correlates of before-school physical activity. Completed diaries by 12-13 year-olds (n = 3,201) revealed that adolescents reported an average of 10.8 minutes of daily before-school physical activity (average segment length: 114 min), mostly classified as active transport (5.7 min). Most before-school physical activity occurred in a location other than home or school (6.1 min) and with peers (6.1 min). Notably, 51% of boys and 60% of girls did not report any before-school physical activity. Through two-part regression, we found that boys, adolescents from single-parent households, and those with longer before-school segments are more likely to report before-school physical activity compared to their counterparts. Before-school initiatives should promote active transport and diverse opportunities in other settings. Research into barriers and facilitators may inform more inclusive and effective promotion strategies, including school-based initiatives.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

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

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

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

INTRODUCTION

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

OBJECTIVE

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

TRIAL REGISTRATION NUMBER

ACTRN12622000861752.

Scaling up a school-based intervention to increase physical activity and reduce sedentary behaviour in children: protocol for the TransformUs hybrid effectiveness-implementation trial

INTRODUCTION

Efficacious programmes require implementation at scale to maximise their public health impact. TransformUs is an efficacious behavioural and environmental intervention for increasing primary (elementary) school children's (5-12 years) physical activity and reducing their sedentary behaviour within school and home settings. This paper describes the study protocol of a 5-year effectiveness-implementation trial to assess the scalability and effectiveness of the TransformUs programme.

METHODS AND ANALYSIS

A type II hybrid implementation-effectiveness trial, TransformUs is being disseminated to all primary schools in the state of Victoria, Australia (n=1786). Data are being collected using mixed methods at the system (state government, partner organisations), organisation (school) and individual (teacher, parent and child) levels. Evaluation is based on programme Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. RE-AIM domains are being measured using a quasi-experimental, pre/post, non-equivalent group design, at baseline, 12 and 24 months. Effectiveness will be determined in a subsample of 20 intervention schools (in Victoria) and 20 control schools (in New South Wales (NSW), Australia), at baseline, 12 and 24 months. Primary outcomes include TransformUs Reach, Adoption, Implementation and organisational Maintenance (implementation trial), and children's physical activity and sedentary time assessed using accelerometers (effectiveness trial). Secondary outcomes include average sedentary time and moderate to vigorous-intensity physical activity on weekdays and during school hours, body mass index z-scores and waist circumference (effectiveness trial). Linear mixed-effects models will be fitted to compare outcomes between intervention and control participants accounting for clustering of children within schools, confounding and random effects.

ETHICS AND DISSEMINATION

The trial was approved by the Deakin University Human Research Ethics Committee (HEAG-H 28_2017), Victorian Department of Education, the NSW Department of Education, Australian Catholic University (2017-145R), Melbourne Archdiocese Catholic Schools and Catholic Schools NSW. Partners, schools/teachers and parents will provide an informed signed consent form prior to participating. Parents will provide consent for their child to participate in the effectiveness trial. Findings will be disseminated via peer-reviewed publications, scientific conferences, summary reports to schools and our partner organisations, and will inform education policy and practice on effective and sustainable ways to promote physical activity and reduce sedentary behaviours population-wide.

TRIAL REGISTRATION NUMBER

Australian Clinical Trials Registration Registry (ACTRN12617000204347).

Validity, Reliability, and Feasibility of Physical Literacy Assessments Designed for School Children: A Systematic Review

BACKGROUND

While the burgeoning researcher and practitioner interest in physical literacy has stimulated new assessment approaches, the optimal tool for assessment among school-aged children remains unclear.

OBJECTIVE

The purpose of this review was to: (i) identify assessment instruments designed to measure physical literacy in school-aged children; (ii) map instruments to a holistic construct of physical literacy (as specified by the Australian Physical Literacy Framework); (iii) document the validity and reliability for these instruments; and (iv) assess the feasibility of these instruments for use in school environments.

DESIGN

This systematic review (registered with PROSPERO on 21 August, 2022) was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.

DATA SOURCES

Reviews of physical literacy assessments in the past 5 years (2017 +) were initially used to identify relevant assessments. Following that, a search (20 July, 2022) in six databases (CINAHL, ERIC, GlobalHealth, MEDLINE, PsycINFO, SPORTDiscus) was conducted for assessments that were missed/or published since publication of the reviews. Each step of screening involved evaluation from two authors, with any issues resolved through discussion with a third author. Nine instruments were identified from eight reviews. The database search identified 375 potential papers of which 67 full text papers were screened, resulting in 39 papers relevant to a physical literacy assessment.

INCLUSION AND EXCLUSION CRITERIA

Instruments were classified against the Australian Physical Literacy Framework and needed to have assessed at least three of the Australian Physical Literacy Framework domains (i.e., psychological, social, cognitive, and/or physical).

ANALYSES

Instruments were assessed for five aspects of validity (test content, response processes, internal structure, relations with other variables, and the consequences of testing). Feasibility in schools was documented according to time, space, equipment, training, and qualifications.

RESULTS

Assessments with more validity/reliability evidence, according to age, were as follows: for children, the Physical Literacy in Children Questionnaire (PL-C Quest) and Passport for Life (PFL). For older children and adolescents, the Canadian Assessment for Physical Literacy (CAPL version 2). For adolescents, the Adolescent Physical Literacy Questionnaire (APLQ) and Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q). Survey-based instruments were appraised to be the most feasible to administer in schools.

CONCLUSIONS

This review identified optimal physical literacy assessments for children and adolescents based on current validity and reliability data. Instrument validity for specific populations was a clear gap, particularly for children with disability. While survey-based instruments were deemed the most feasible for use in schools, a comprehensive assessment may arguably require objective measures for elements in the physical domain. If a physical literacy assessment in schools is to be performed by teachers, this may require linking physical literacy to the curriculum and developing teachers' skills to develop and assess children's physical literacy.

Defining and reporting activity patterns: a modified Delphi study

BACKGROUND

Despite significant interest in assessing activity patterns in different populations, there has been no consensus concerning the definition and operationalisation of this term. This has limited the comparability, interpretability, and synthesis of study findings to date. The aim of this study was to establish a consensus regarding the way in which activity patterns and activity pattern components are defined and reported.

METHODS

The activity patterns literature was searched to identify experts to be invited to participate and to develop a proposed definition of activity patterns and activity pattern components. A three-round modified Delphi survey was conducted online (November 2021 to May 2022). In Round 1, participants were asked to rate their agreement with a proposed activity patterns definition, which also included six activity pattern components (e.g., activity intensity, activity bout, transitions), six examples of activity patterns (e.g., frequency of postural transitions in discrete time periods) and eight items for reporting activity patterns in future research (n = 21 items). Open-ended questions enabled participants to provide further comments and suggestions for additional items. Consensus was defined a priori as ≥ 80% participants rating their agreement with an item. In Round 2, participants were asked to rate their agreement with 25 items (13 original items, eight amended, and four new). In Round 3, participants rated their agreement with 10 items (five original items, four amended, and one new).

RESULTS

Twenty experts in activity patterns research participated in Round 1, with response rates of 80% and 60% in Rounds 2 and 3, respectively. The proposed activity pattern definition, all activity pattern components definitions, four of the six activity pattern examples, and 10 items in the activity patterns reporting framework achieved consensus. The removal of one activity component item between Rounds 1 and 2 achieved consensus.

CONCLUSION

This modified Delphi study achieved consensus for defining and reporting activity patterns for the first time. This consensus definition enables standardisation of activity patterns terminology, which is important given the significant interest in quantifying how individuals accumulate their physical activity and sedentary behaviour across the lifespan to inform the development of future public health guidelines and interventions efforts.

Making 'being less sedentary feel normal' -investigating ways to reduce adolescent sedentary behaviour at school: a qualitative study

BACKGROUND

Adolescents spend over 50% of a 24-hour period and 63% of the school day sedentary. Few comprehensive qualitative studies have explored teachers' and students' perceptions of potential strategies to reduce sedentary behaviour (SB) in the secondary school setting. This project aimed to elicit students' and teachers' perspectives of feasible and acceptable ways to encourage adolescents to "sit less and stand or move more" during the school day.

METHODS

Students, teachers, and executives from four schools in the Illawarra and surrounding areas (New South Wales) Australia, were invited to participate. Focus group implementation used a participatory research design ('problem and solution tree'). Participants were interviewed in three groups, younger adolescents, older adolescents and teachers/executives. Firstly the 'problem' (high rates of SB) was explained, participants were then asked to identify contributing school related factors, and to suggest feasible ideas to reduce SB during the school day.

RESULTS

Fifty-five students (24 from Years 7/8 aged 12-14 years and 31 from Years 9/10 aged 14-16 years), and 31 teachers consented to participate. Thematic analysis elicited five main 'problems': lesson structure, non-conducive classroom environment/structure, non-conducive break-time environment, curricular pressures and school-related factors increasing sedentary behaviour outside of school. Suggested 'solutions' included: changes to classroom layout/furniture, pedagogical changes, hands-on learning, outdoor lessons, more comfortable uniforms, more breaks during class time, compulsory physical activity, and outdoor equipment.

CONCLUSIONS

The proposed solutions to reduce adolescent SB during the school day have potential to be feasibly implemented in the school setting, even with limited funding.

Transform-Us! cluster RCT: 18-month and 30-month effects on children's physical activity, sedentary time and cardiometabolic risk markers

OBJECTIVE

To test the efficacy of the Transform-Us! school- and home-based intervention on children's physical activity (PA), sedentary behaviour (SB) and cardiometabolic risk factor profiles.

METHODS

A 30-month 2×2 factorial design cluster randomised controlled trial delivered in 20 primary schools (148 Year 3 classes) in Melbourne, Australia (2010-2012), that used pedagogical and environmental strategies to reduce and break up SB, promote PA or a combined approach, compared with usual practice. Primary outcomes (accelerometry data; n=348) were assessed at baseline, 18 and 30 months. Secondary outcomes included body mass index (BMI) and waist circumference (WC) (n=564), blood pressure (BP) (n=537) and biomarkers (minimum n=206). Generalised linear mixed models estimated the interactive effects of the PA and SB interventions on the outcomes. If there was no interaction, the main effects were assessed.

RESULTS

At 18 months, there were intervention effects on children's weekday SB (-27 min, 95% CI: -47.3 to -5.3) for the PA intervention, and on children's average day PA (5.5 min, 95% CI: 0.1 to 10.8) for the SB intervention. At 30 months, there was an intervention effect for children's average day SB (-33.3 min, 95% CI: -50.6 and -16.0) for the SB intervention. Children's BMI (PA and SB groups) and systolic BP (combined group) were lower, and diastolic BP (PA group) was higher. There were positive effects on WC at both time points (SB intervention) and mixed effects on blood parameters.

CONCLUSIONS

The Transform-Us! PA and SB interventions show promise as a pragmatic approach for reducing children's SB and adiposity indicators; but achieving substantial increases in PA remains challenging.

TRIAL REGISTRATION

ISRCTN83725066; ACTRN12609000715279.

Experience and Satisfaction with a Family-Based Physical Activity Intervention Using Activity Trackers and Apps: A Qualitative Study

Wearable activity trackers and smartphone apps have been shown to increase physical activity in children and adults. However, interventions using activity trackers and apps have rarely been tested in whole families. This study examined the experience and satisfaction with an activity tracker and app intervention (Step it Up Family) to increase physical activity in whole families. Telephone interviews were conducted with Queensland-based families (n = 19) who participated in the Step it Up Family intervention (N = 40, single-arm, pre/post feasibility study) in 2017/2018. Using commercial activity trackers combined with apps, the intervention included an introductory session, individual and family-level goal setting, self-monitoring, family step challenges, and weekly motivational text messages. Qualitative content analysis was conducted to identify themes, categories and sub-categories. In summary, parents reported that children were engaged with the activity tracker and app features to reach their daily step goals. Some technical difficulties were experienced with app navigation, syncing of activity tracker data, and tracker band discomfort. Although families liked that the weekly text messages reminded them to be active, they did not find them very motivating. Using text messages for physical activity motivation in families requires further testing. Overall, the intervention was well-received by families for increasing physical activity motivation.

Mapping intervention components from a randomized controlled trial to scale-up of an early life nutrition and movement intervention: The INFANT program

Introduction

Early life parent-focused interventions can effectively improve infant and child nutrition and movement (physical activity and sedentary behavior) as well as parents' health behaviors. Scale-up of such interventions to real-world settings is essential for population-wide benefits. When progressing to scale-up, intervention components may be modified to reflect contextual factors and promote feasibility of scale-up. The INFANT program, an efficacious early life nutrition and movement behavioral intervention began as a randomized controlled trial (RCT), was modified after a small-scale translation, and is currently being scaled-up in Victoria, Australia. This study mapped and compared discrete intervention components of both the original RCT and the scaled-up version of INFANT to examine modifications for scaling up.

Methods

Discrete intervention components, specifically the target behaviors (child-related and parent-related behaviors), delivery features and behavior change techniques (BCTs) from the RCT and the scaled-up program were coded and mapped using established frameworks and taxonomies. Publications and unpublished materials (e.g., facilitator notes, handouts, videos, app) were coded. Coding was performed independently in duplicate, with final coding validated in a meeting with interventionists. Interventionists reported the rationale for modifications made.

Results

The INFANT RCT and scaled-up version targeted the same obesity prevention-related nutrition and movement behaviors. Key modified delivery features at scale-up included reduced number of sessions, a broader range of professionals facilitating groups, the addition of a mobile app for parents replacing hard-copy materials and tangible tools (e.g., pedometers), and broadening of content (e.g., early feeding, updated 24-h movement guidelines). BCTs used across the RCT and scale-up sessions were unchanged. However, the BCTs identified in the between-session support materials were almost double for the scale-up compared with the RCT, primarily due to the reduced number of sessions and the app's capacity to include more content.

Conclusions

INFANT is one of few early life nutrition and movement behavioral interventions being delivered at scale. With INFANT as an example, this study provides critical understanding about what and why intervention components were altered as the RCT was scaled-up. Unpacking these intervention modifications provides important insights for scale-up feasibility, outcome effects, and how to optimize implementation strategies for population-level benefits.

Test-retest reliability of a measure of perceived activity compensation in primary school children and their parents: a mixed methods study

There is a lack of specific tools for assessing children's activity compensatory responses. This study 1) determined test-retest reliability and internal consistency of survey items assessing children's self-reported and parents' proxy-reported perceived compensatory responses; and 2) described children's and parents' views of potential compensatory mechanisms. Children (n = 55; mean age 10.2 ± 0.9) and their parents (n = 60) completed a survey twice, seven days apart. A sub-sample (17 parents; 13 children) participated in a short, semi-structured interview. Intraclass Correlation Coefficients (ICCs) and Cronbach's alpha assessed absolute agreement and internal consistency. Interviews were analysed via thematic analysis. Seven self- and proxy-reported survey sub-scales had excellent test-retest reliability (ICC ≥ 0.75), three had good (ICC ≥ 0.56) and one fair (ICC = 0.44). All survey items and sub-scales had acceptable internal consistency (alpha >0.67). Thematic analysis identified two overarching themes: awareness of compensation and mechanisms of compensation. After an active day at school, most participants perceived that compensation occurred later that day. Mechanisms of compensation included psychological, physiological, environmental, and interpersonal mechanisms. This reliable survey provides a new tool for assessing children's and their parents' perceptions of activity compensation and may inform future intervention designs. Future research is needed to establish concordance between perceived and device-assessed compensation.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Outdoor time, screen time and sleep reported across early childhood: concurrent trajectories and maternal predictors

BACKGROUND

Understanding the developmental trajectories of outdoor time, screen time and sleep is necessary to inform early interventions that promote healthy behaviours. This study aimed to describe concurrent trajectories of outdoor time, screen time and sleep across the early childhood period and their maternal predictors.

METHODS

Data across five time points at child age 4, 9, 19, 42 and 60 months from the INFANT intervention were analysed. Mothers reported their child's usual outdoor time, screen time and sleep duration, in addition to a range of maternal beliefs, attitudes, expectations and behaviours. Group-based multi-trajectory modelling was used to model concurrent trajectories of children's behaviours. Multinomial logistic regression models determined the associations of maternal predictors with trajectory groups, adjusting for child sex and baseline age, intervention allocation, and clustering by recruitment.

RESULTS

Of the 542 children recruited, 528 had data for outdoor time, screen time and sleep at one or more time points and were included in trajectory analyses Four trajectories were identified: 'unstable sleep, increasing outdoor time, low screen' (~ 22% of sample), 'high outdoor time, low screen, high sleep' (~ 24%), 'high sleep, increasing outdoor time, low screen' (~ 45%), 'high screen, increasing outdoor time, high sleep' (~ 10%). The 'high sleep, increasing outdoor time, low screen' group, comprising the largest percentage of the sample, demonstrated the healthiest behaviours. Predictors of group membership included: views of physically active children, screen time knowledge, screen time use, self-efficacy, physical activity optimism, future expectations for children's physical activity and screen time, perceptions of floor play safety, and maternal physical activity, screen time, and sleep quality.

CONCLUSIONS

Four distinct trajectories of outdoor time, screen time and sleep were identified, with the most common (and healthiest) characterized by high levels of sleep. Maternal beliefs, attitudes, expectations and behaviours are important in the development of movement behaviour trajectories across early childhood. Future interventions and public policy may benefit from targeting these factors to support healthy movement behaviours from a young age.

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

BACKGROUND

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

METHODS

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

RESULTS

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

EFFECTIVENESS

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

IMPLEMENTATION

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

CONCLUSIONS

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

TRIAL REGISTRATION

ACTRN12621001132831.

Feasibility of using activity trackers and apps to increase physical activity in whole families: The Step it Up Family intervention

Objective

This study examined the feasibility of an activity tracker and app intervention to increase physical activity in whole families.

Methods

This was a single-arm feasibility study with pre-post-intervention measures. Between 2017 and 2018, 40 families (58 children aged 6-10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family programme in Queensland, Australia. It was delivered using Garmin activity trackers and apps, weekly motivational text messages and an introductory session. Online surveys and semi-structured interviews conducted with parents assessed intervention usage, acceptability, usability, perceived usefulness, use of physical activity self-management strategies and programme influence. Analyses included descriptive statistics, Wilcoxon signed-rank test and qualitative content analysis.

Results

Overall, 38 families completed the post-intervention survey (95% family retention; 90% children, 95% mothers, 88% fathers). Garmin activity tracker usage was high (i.e. nearly 24/7 during the 6 weeks intervention). Families also used the Garmin apps regularly (i.e. mostly 2-6 times per week). Further, 80% of mothers and 52% of fathers read the motivational mobile text messages. Usability and perceived usefulness of the Garmin activity trackers and apps were rated high. Both parents significantly increased their use of physical activity self-management strategies from pre to post-intervention. Parents expressed that the intervention had increased awareness of physical (in)activity in the family, encouraged to be active and promoted outdoor family activities.

Conclusions

Using activity trackers and apps to increase physical activity in the whole family was well received by children and parents which suggests that this intervention approach is feasible. However, further testing is needed amongst more diverse family populations. These early findings support the implementation of a randomised controlled trial to examine intervention efficacy.

Is level of implementation linked with intervention outcomes? Process evaluation of the TransformUs intervention to increase children’s physical activity and reduce sedentary behaviour

Background

TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms.

Methods

At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) ‘Low’ (< 33% delivered); (ii) ‘Moderate’ (33–67% delivered); and (iii) ‘High’ (> 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children’s physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically.

Results

Among intervention recipients, 52% (n = 85) of teachers, 29% (n = 331) of parents and 92% (n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children’s enjoyment, and teachers’ awareness of program benefits all facilitated delivery and sustainability.

Conclusions

This study demonstrated that intervention dose and fidelity increased over time, and that children’s enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia.

Trial registration

International Standard Randomized Controlled Trial Number ISRCTN83725066; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279. Registered 19 August 2009. Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308387&isReview=true

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01354-5.

Does light-intensity physical activity moderate the relationship between sitting time and adiposity markers in adolescents?

BACKGROUND

While the relationship between sedentary time and adiposity markers may be independent of moderate-to-vigorous intensity physical activity (MVPA) among adolescents, little is known about the role of light-intensity physical activity (LIPA) in this relationship. The aim of this cross-sectional study was to examine whether device-measured LIPA and MVPA moderate the associations between objectively measured sitting time and adiposity markers (body mass index (BMI)) and waist circumference (WC)) among adolescents.

METHODS

This study included accelerometer and inclinometer data obtained from 219 adolescents (age = 14.9 ± 1.6 years, mean ± SD), collected during 2014 and 2015 in Melbourne, Australia. ActiGraph GT3X accelerometers were used to determine time spent in total-LIPA (101 counts/min to 3.99 metabolic equivalents (METs)) was dichotomized into low-LIPA (101-799 counts/min) and high LIPA (800 counts/min to 3.99 METs), and MVPA (≥ 4 METs). The average time spent sitting was obtained from activPAL inclinometers. Anthropometric measures were assessed by trained staff. Interactions between sitting and total-LIPA, low-LIPA, high-LIPA, and MVPA on BMI z-score (zBMI) and WC z-score (zWC), respectively, were examined using linear regression, adjusting for age and sex; and moderation by total-LIPA, low-LIPA, high-LIPA, and MVPA were examined by adding interaction terms. Significant interaction effects were probed by comparing associations at the mean and at 1 SD below and above the mean.

RESULTS

Total-LIPA significantly moderated the association between sitting time and zBMI, and low-LIPA significantly moderated the association between sitting time and zBMI and zWC. No other associations were found for total-LIPA, high-LIPA, or MVPA. Specifically, at high levels of total-LIPA (+1 SD), there is a negative association between sitting time and zBMI. In addition, at high levels of low-LIPA (+1 SD), there is a negative association between sitting time and zBMI and zWC.

CONCLUSION

Associations between sitting and adiposity depended on time spent in total-LIPA and low-LIPA, but not high-LIPA or MVPA. Results suggest that increasing time spent in LIPA may provide protection from the deleterious effects of sitting on adiposity markers among adolescents. Experimental evidence is needed to support these conclusions.

"Everything kind of revolves around technology": a qualitative exploration of families' screen use experiences, and intervention suggestions

Background

Managing children’s screen time is challenging for most families. Interventions have had limited success in reducing screen time, potentially due to a lack of understanding of the experiences, needs and recommendations of families. This study aimed to 1) understand the screen time experiences of families, particularly during COVID-19 lockdowns; and 2) explore parent and child suggestions for the design, components, and content of a screen time management program.

Methods

Parents and children from 30 families living in Victoria, Australia completed a semi-structured interview (63 interviews) via Zoom in October–November 2021. Parents were _maged 40.8 (± 8.9) years and predominantly female (90%). Children were _maged 11.4 (± 2.4) years and 47% female. The interviews were audio recorded, transcribed verbatim and analysed using inductive thematic analysis combined with a summative content analysis approach.

Results

Three themes under Aim 1 emerged. Theme 1) ‘Screen time management experiences and practices’, including rules and strategies, challenges, and the impact of COVID-19 lockdowns. Theme 2) ‘Impact of screens on family interaction and communication’ including conflicts within the family, reduced face-to-face interactions, and negative impact on child’s behaviour and wellbeing. Theme 3) ‘Benefits of increased screen time due to COVID-19 lockdowns’ including continuation of social interactions, extracurricular activities, improved technology skills and using screens as a ‘babysitter’. Findings from Aim 2 suggest that families want a screen time management program delivered online to parents and children, which includes static and interactive content that incorporates health information, alternative activities, cyber-safety information, tips for goal setting and rewards, screen monitoring tools, links to reputable information, and parent social connections. Reminders via text message or through the online platform would help maintain engagement in the program.

Conclusions

Families are experiencing challenges in managing the complex balance between the increased need for screens and the impact it has on the family. These findings provide valuable parent and child insights to assist in developing screen time management programs that are created with an understanding of the needs and challenges of families.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14007-w.

Mediators of Effects on Physical Activity and Sedentary Time in an Activity Tracker and Behavior Change Intervention for Adolescents: Secondary Analysis of a Cluster Randomized Controlled Trial

Background

Adolescence is a critical age where steep declines in physical activity and increases in sedentary time occur. Promoting physical activity should therefore be a priority for short- and long-term health benefits. Wearable activity trackers in combination with supportive resources have the potential to influence adolescents’ physical activity levels and sedentary behavior. Examining the pathways through which such interventions work can inform which mediators to target in future studies.

Objective

The aim of this paper is to examine the impact of the Raising Awareness of Physical Activity (RAW-PA) intervention on potential mediators of behavior change after intervention, and whether these mediated the intervention effects on physical activity and sedentary time at 6-month follow-up.

Methods

RAW-PA was a 12-week intervention, grounded in social cognitive theory and behavioral choice theory, aimed at increasing physical activity among inactive adolescents through combining a wearable activity tracker with digital resources delivered via a private Facebook group (n=159 complete cases). The targeted potential mediators were identified from previous studies conducted in adolescents and included self-efficacy, peer support, family support, teacher support, self-regulation strategies, barriers, and enjoyment. Outcomes included sedentary time as well as light- and moderate-to-vigorous–intensity physical activity. A series of mixed linear models were used to estimate intervention effects on physical activity and sedentary behavior at follow-up and on potential mediators after intervention and to test whether there were indirect effects of the intervention on physical activity and sedentary behavior via mediators.

Results

Adolescents in the intervention group (n=75) engaged in higher sedentary time and lower light intensity at 6-month follow-up compared to the wait-list controls (n=84). There were no intervention effects for moderate-to-vigorous–intensity physical activity. The intervention group perceived more barriers to physical activity than the wait-list control group at 6-month follow-up (mean adjusted difference=1.77; 95% CI 0.19-3.34; P=.03). However, indirect effects for each outcome were not statistically significant, indicating that perceived barriers to physical activity did not mediate intervention effects for physical activity or sedentary time.

Conclusions

RAW-PA did not beneficially impact hypothesized mediators in these inactive adolescents, despite strategies being designed to target them. This suggests that the lack of overall intervention effects on physical activity and sedentary time observed in the RAW-PA study could be due to the limited impact of the intervention on the targeted mediators. Future studies should consider different strategies to target theoretically informed potential mediators and identify intervention strategies that effectively target key mediators to improve physical activity among inactive adolescents. Finally, intervention effects according to level of wearable tracker use or level of engagement with the intervention should be explored. This may provide important insights for designing successful wearable activity tracker interventions.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616000899448; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716&isReview=true

International Registered Report Identifier (IRRID)

RR2-10.1186/s12889-016-3945-5

From motorised to active travel: using GPS data to explore potential physical activity gains among adolescents

Background

A high proportion of adolescents worldwide are not doing enough physical activity for health benefits. Replacing short motorised trips with walking or cycling has the potential to increase physical activity at the population level. This study aimed to estimate the proportion of short distance motorised trips that could be replaced with walking or cycling, and the potential physical activity gains by sociodemographic and trip characteristics.

Methods

Data were from a subsample of the NEighbourhood Activity in Youth (NEArbY) study conducted among adolescents in Melbourne. A total of 217 adolescents with at least one motorised trip completed a survey and wore a Global Positioning Systems (GPS) device for eight consecutive days. Classification of travel modes were based on speed. GPS data points were geocoded in ArcGIS. Motorised trips within walkable (1.3 km) and cyclable (4.2 km) distances were identified (threshold based on 80^th percentile of walking and cycling trip distances among Victorian adolescents), and the additional physical activity minutes that could be accrued by replacing walkable or cyclable motorised trip to active trips were quantified. Multilevel linear regression was used to assess differences in physical activity minutes gain by sociodemographic and trip characteristics.

Results

A total of 4,116 motorised trips were made. Of these, 17% were walkable and 61% were cyclable. Replacing motorised trips by walking and cycling resulted in estimated gains of six minutes and 15 min of physical activity per day, respectively.

Conclusion

The sizable proportion of replaceable trips and potential physical activity gains from this shift calls for attention to improve safe and connected infrastructure to support active travel.

Development of a core outcome set for school-based intervention studies on preventing childhood overweight and obesity: study protocol

INTRODUCTION

Prevention of childhood overweight is an important health priority. Evidence synthesis from studies evaluating school-based overweight preventive interventions is hampered by the wealth of different outcomes across studies. Therefore, consensus on a core set of outcomes for school-based overweight prevention studies is needed. This paper presents the protocol for the development of a core outcome set (COS) for school-based intervention studies aimed at childhood overweight prevention.

METHODS AND ANALYSIS

First, a scoping review will be performed to identify outcomes included in studies evaluating school-based overweight prevention interventions in 6-12 year-old children. Additionally, child focus groups will be organised in three countries to list the outcomes children consider important in school-based interventions. Next, an expert panel will identify all unique outcomes (eg, body composition) from the results of the scoping review and focus groups, ruling out how outcomes were defined and measured (eg, body mass index, body fat). In the next phase, a group of international stakeholders will participate in a Delphi study in which they will rate all unique outcomes on a 9-point Likert scale over three rounds to reach consensus on a COS. Participants will include healthcare professionals, policymakers, teachers, school leaders and parents of 6-12 year-olds. All rated outcomes will be presented to stakeholders in two online consensus meetings.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the VU Medical Center approved the child focus group study in the Netherlands (nr. 2020.071) and the Delphi study-including the consensus meeting (nr. 2022.0295). Other sites will obtain ethics approval for focus groups in their country. The University of Strathclyde School of Psychological Sciences ethics committee approved the Delphi study-including consensus meeting (nr. 72.27.04.2022 .A). The final COS will be disseminated through the diverse networks of all authors and participants.

TRIAL REGISTRATION NUMBER

This COS initiative is registered with the Core Outcome Measures in Effectiveness initiative (registration nr. 971).

Intervention effects on children's movement behaviour accumulation as a result of the Transform-Us! school- and home-based cluster randomised controlled trial

Background

It is unknown if and how children’s movement behaviour accumulation patterns change as a result of physical activity and/or sedentary behaviour interventions. It is important to establish the effectiveness of interventions targeting changes in such accumulation patterns. This study aimed to investigate the effect of the Transform-Us! school- and home-based intervention program on children’s movement behaviour accumulation patterns, focusing on sporadic accumulation versus time in bouts.

Methods

Baseline and post-intervention (18 months) accelerometer data from the Transform-Us! 2 × 2 factorial design cluster randomised controlled trial was used (Melbourne, 2010–2012; analytical sample n = 267; aged 8–9 years). Linear mixed models were fitted to examine effects of three different interventions (targeting increases in physical activity [PA-I], reductions in sedentary time [SB-I], or both [PA + SB-I]) compared to a usual practice (control) group on post-intervention movement behaviour accumulation compositions with eight components, including sporadic time and bouts of sedentary time, and light-, moderate- and vigorous-intensity physical activity.

Results

Intervention effects on distribution of time in the post-intervention waking movement behaviour accumulation composition (adjusted for baseline composition) were small and not significant. However, visual inspection of the change in compositions over time revealed that only groups with a sedentary behaviour intervention component (SB-I and PA + SB-I) reduced time in sedentary bouts, compared to the overall sample compositional mean. In addition, the SB-I group was the only group with an increase in vigorous-intensity physical activity. The combined intervention group (PA + SB-I) was characterized by the largest proportional increase in MPA bouts. The usual practice group was characterized by the largest proportional increases in both sporadic and bouts of sedentary time.

Conclusions

This study showed some early evidence to suggest that the “break up your sitting” message may result in greater impact than the “move more” message. Future research, including larger sample sizes, should investigate if this type of messaging is indeed more effective in changing movement behaviours and ultimately child health.

Trial registration

International Standard Randomized Controlled Trial Number ISRCTN83725066; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01314-z.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

A systems thinking approach to understanding youth active recreation

Background

Active recreation contributes to child and adolescent physical activity, however, factors affecting uptake are poorly understood at the systems level. The aims of this study were: (1) to use systems analysis methods to understand youth active recreation in Victoria, Australia, (ii) identify potential system leverage points to enhance active recreation, and (iii) explore stakeholder views of systems analysis methods for informing practice and policy decision-making.

Methods

Phase 1: Umbrella review of systematic reviews (2013–2018), synthesising evidence for correlates, determinants and intervention evidence for promoting active recreation. Phase 2: Development of three systems models (ActorMap and two ActivMaps), depicting active recreation actors/organisations, correlates, determinants and intervention evidence. Phase 3: Development of causal loop diagrams (CLDs) and identification of leverage points based on the Action Scales Model. Phase 4: Model feedback via stakeholder interviews (n = 23; 16 organisations).

Results

From the literature, 93 correlates and determinants, and 49 intervention strategies were associated with child and adolescent active recreation; the majority located at a social or individual level. Ten potential system leverage points were identified in the CLDs, which differed for pre-schoolers versus children and adolescents. Only time outdoors (an event leverage point) emerged for all age groups. Changes to the built and natural environment (i.e., land use planning, urban design) as a complete domain was a key structural leverage point for influencing active recreation in children and adolescents. Subject matter experts and stakeholder interviews identified 125 actors operating across seven hierarchical active recreation system levels in Victoria. Stakeholder interviews identified 12 areas for future consideration and recommendations for practice/policy influence.

Conclusions

Our findings underscore the need for dynamic models of system behaviour in active recreation, and to capture stakeholder influence as more than a transactional role in evidence generation and use. Effective responses to youth inactivity require a network of interventions that target specific leverage points across the system. Our models illustrate areas that may have the greatest system-level impact, such as changes to the built and natural environment, and they provide a tool for policy, appraisal, advocacy, and decision-making within and outside of government.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01292-2.

Complexities and Context of Scaling Up: A Qualitative Study of Stakeholder Perspectives of Scaling Physical Activity and Nutrition Interventions in Australia

Background

Scaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder.

Methods

A qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report “20 Questions for Developing a Scaling up Case Study”, and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically.

Results

Nineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the “Environment”, including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to “Scale up strategy” (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions.

Conclusion

Attributes of the “Environment” and “Scale up strategy” consistently featured as major influences on successful outcomes, while the role of evidence differed greatly between participant groups. A multisector scale up strategy for future interventions may enable the complexities of environmental and political contexts to be incorporated into scale up planning.

School-related sedentary behaviours and indicators of health and well-being among children and youth: a systematic review

BACKGROUND

The purpose of this systematic review was to examine the associations between school-related sedentary behaviours and indicators of health and well-being in children and youth (~ 5-18 years) attending school.

METHODS

This review was conducted to inform the development of School-Related Sedentary Behaviour Recommendations. Peer-reviewed, published, or in-press articles in English were included. Reviews, meta-analyses, and case studies were excluded; all other study designs were eligible. Further, articles had to meet the a priori study criteria for population, intervention, comparator (PROSPERO ID: CRD42021227600). Embase, MEDLINE® ALL, and PsycINFO were searched. Risk of bias was assessed for individual experimental studies using the Cochrane risk of bias assessment tool, and in observational studies based on the GRADE framework and in line with previous systematic reviews examining sedentary behaviours in children. Overall quality of evidence was assessed using the GRADE framework for each outcome category and study design. Results were synthesized narratively, grouped by study design and outcome category. Further, several high-level summaries were conducted to help interpret results.

RESULTS

Evidence was synthesized from 116 reports, including 1,385,038 participants and 1173 extracted associations. More school-related sedentary behaviour was favourably associated with nearly one-third of extracted associations for cognitive (33%) and social-emotional (32%) indicators (e.g., less anxiety), but unfavourably associated with other movement behaviours (e.g., less physical activity) (35%). Active lessons were favourable (72%), compared to more school-related sedentary behaviours, when examining associations for all health and well-being indicators. More homework was favourable across all health and well-being indicators in 4% of extracted associations for primary school children, and 25% of extracted associations for secondary school children. However, ≥2 h/day of homework appeared to be unfavourable for health and well-being. Limitations for synthesized studies included generally low quality of evidence and a lack of studies in South American, African, or low-middle income countries.

CONCLUSIONS

Findings can help inform policy makers, schools, and teachers, regarding the amount of homework assigned and the introduction of active lessons into the classroom to enhance health and well-being of children. More research is needed examining school-related sedentary behaviours and indicators of health and well-being in low- and middle-income countries.

International school-related sedentary behaviour recommendations for children and youth

BACKGROUND

Existing sedentary behaviour guidelines for children and youth target overall sedentary behaviour and recreational screen time, without any specific recommendations regarding school-related sedentary behaviours (i.e., sedentary behaviours performed during the school day, or within the influence of school). The purpose of this paper is to describe the development of international evidence-based recommendations for school-related sedentary behaviours for children and youth, led by the Sedentary Behaviour Research Network (SBRN).

METHODS

A panel of international experts was convened by SBRN in November 2020 to guide the development of these recommendations for children and youth aged ~ 5-18 years. The recommendations were informed by 1) age-relevant existing sedentary behaviour guidelines, 2) published research on the relationship between overall sedentary behaviour and health, 3) a de novo systematic review on the relationship between school-related sedentary behaviours and health and/or academic outcomes, and 4) a de novo environmental scan of the grey literature to identify existing recommendations for school-related sedentary behaviours. Draft recommendations were presented to the Expert Panel in June 2021. Following thorough discussion and modifications, updated recommendations were distributed for stakeholder feedback from July 9-26. Feedback was received from 148 stakeholders across 23 countries, leading to additional updates to the recommendations. Following further rounds of discussion and updates with the Expert Panel in August and September 2021, consensus was achieved on the final recommendations.

RESULTS

A healthy day includes breaking up extended periods of sedentary behaviour and incorporating different types of movement into homework whenever possible, while limiting sedentary homework. School-related screen time should be meaningful, mentally or physically active, and serve a specific pedagogical purpose that enhances learning. Replacing sedentary learning activities with movement-based learning activities, and replacing screen-based learning activities with non-screen-based learning activities, can further support students' health and wellbeing.

DISCUSSION

This paper presents the first evidence-based recommendations for school-related sedentary behaviours for children and youth. These recommendations will support the work of parents, caregivers, educators, school system administrators, policy makers, researchers and healthcare providers interested in promoting student health and academic success.

Cross-sectional and prospective associations of sleep duration and bedtimes with adiposity and obesity risk in 15 810 youth from 11 international cohorts

OBJECTIVES

To investigate associations of bedtimes and sleep durations with adiposity levels in children and adolescents.

METHODS

Individual data were pooled for 12 247 children (5819 with follow-up adiposity at 2.3 ± 1.4 years post-baseline) and 3563 adolescents from 11 international studies. Associations between questionnaire-based sleep durations, bedtimes and four groups of combined bedtimes and sleep lengths (later-shorter [reference]/earlier-shorter/later-longer/earlier-longer) with measured adiposity (body mass index [BMI] and waist circumference z-scores) and weight status, were investigated.

RESULTS

In children, longer sleep durations were consistently associated with lower adiposity markers, and earlier bedtimes were related to lower BMI z-score. Compared to sleeping <10 h, longer baseline sleep duration favourably predicted Δwaist z-score in girls (≥10 and <11 h (β-coefficient (95% confidence interval [CI])): -0.06 (-0.12 to -0.01)) and boys (≥11 h: -0.10 [-0.18 to -0.01]). Combined groups that were defined by longer sleep (later-longer and earlier-longer sleep patterns) were associated with lower adiposity, and later-longer sleep favourably predicted Δwaist z-score in girls (-0.09 [-0.15 to -0.02]). In adolescents, longer sleep durations and earlier bedtimes were associated with lower BMI z-score in the whole sample, and also with lower waist z-score in boys. Combined groups that were characterized by earlier bedtimes were associated with the same outcomes. For example, earlier-shorter (-0.22 (-0.43 to -0.01) and earlier-longer (-0.16 (-0.25 to -0.06) sleep were both associated with lower BMI z-score.

CONCLUSIONS

If the associations are causal, longer sleep duration and earlier bedtimes should be targeted for obesity prevention, emphasizing longer sleep for children and earlier bedtimes for adolescents.

Are There Common Correlates of Adolescents' Sport Participation and Screen Time?

Objective: This study aimed to identify intrapersonal, interpersonal, and environmental correlates of leisure-time participation in sports and examine whether they are also associated with screen-time among adolescents. Methods: Adolescents from eight schools in Victoria, Australia were recruited for this study. Participants (n = 400) comprised of an even distribution of boys (51%) and girls (49%) aged 12-16 years. Their engagement in leisure-time activities (including sports and screen-time) and 13 potential correlates were self-reported. Multinomial logistic regression analyses examined correlates of sports and screen-time participation categories, accounting for clustering by school and adjusting for significant sociodemographic characteristics. Results: The majority (76%) participated in leisure-time sports and exceeded screen-time recommendations (<2 h/day) on both weekdays (69%) and weekend days (85%). Greater internal motivation for sports was positively associated with sports participation and inversely associated with screen-time on weekend days, respectively. Fewer barriers, positive family and coach support and more neighborhood sporting opportunities were significantly associated with greater sports participation. Neighborhood social norms were inversely associated with sports participation. Preference for sports was associated with less weekday and weekend screen-time. Friend support for sports was inversely associated with weekday screen-time. Access to sports facilities in the local neighborhood was associated with more weekday and weekend screen-time. Conclusion: Internal motivation for sports was associated with both sports participation and less screen-time. Preference for leisure-time sports and friend support for sports were associated with less screen-time. Future research should continue to explore common correlates of multiple leisure-time behaviors to inform the development of effective intervention strategies.

Protocol for the Let's Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers

INTRODUCTION

Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let's Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let's Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception.

METHODS AND ANALYSIS

A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let's Grow, compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let's Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T₀), mid-intervention (T₁; 6 months post baseline), at intervention conclusion (T₂; 12 months post baseline) and 1-year post intervention (T₃; 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted.

ETHICS AND DISSEMINATION

The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media.

TRIAL REGISTRATION NUMBER

ACTRN12620001280998; U1111-1252-0599.

Exploring activity compensation amongst youth and adults: a systematic review

BACKGROUND

Globally, significant efforts have focused on increasing physical activity and reducing sedentary behaviour in youth and adults across a range of settings (e.g., schools, workplaces, community, and home). Despite this, interventions have had varied efficacy and typically have failed to sustain changes in behaviours over time. One explanation that has been put forth to explain the mixed success of interventions is activity compensation. However, little is known about activity compensation, including whether compensation occurs, and perceptions and potential mechanisms of activity compensation. Understanding activity compensation would assist in tailoring and targeting of potential intervention strategies. The primary aim of this review was to synthesise research that has investigated activity compensation in youth and adults. The secondary aim was to identify potential reasons for and/or awareness of compensatory changes that may have occurred.

METHODS

An electronic search of the EBSCOhost (via Academic Search Complete, CINAHL Complete, Education Source, Health Source: Nursing/Academic Edition, PsycINFO, SPORTdiscus with Full Text), MEDLINE Complete, Global Health, EMBASE, Scopus and Web of Science databases up to May 2021 was conducted. Quality assessment of included quantitative studies used a modified compensation-specific McMaster Quality Assessment Tool.

RESULTS

A total of 44 studies met the inclusion criteria (22 = adult populations; 22 = youth populations) and were classified as (1) quantitative (n = 31); (2) combination of quantitative and behavioural (n = 11); (3) behavioural only (n = 1); and (4) qualitative (n = 1). Of the 42 studies that included a quantitative component, 11 (26%) reported compensation occurred. Within the 13 studies examining specific behaviours, 35 behaviours were assessed, and evidence of compensation was inconsistent. Compensation mechanisms included fatigue, time constraints, lack of motivation, drive to be inactive, fear of overexertion, and autonomous motivation.

CONCLUSION

Little evidence of compensation was reported in the included quantitative studies; however, inconsistencies between studies makes comparisons difficult. There was considerable variability in the types of behaviours assessed in quantitative studies, and few studies examined potential compensatory mechanisms. Future research, using compensation specific study designs, methods, and analytic techniques, within different population sub-groups, should address these evidence gaps.

“When You Move You Have Fun”: Perceived Barriers, and Facilitators of Physical Activity From a Child's Perspective

In Northern Ireland (NI), many children do not meet the recommended levels of physical activity (PA). To reduce the prevalence of physical inactivity and associated health conditions, it is important to understand the influences on children's PA, which in turn has the potential to inform future intervention design. The purpose of this formative study was to examine the current views, barriers, facilitators, experiences, and perceptions of children in relation to PA in the classroom, school, and home environments, and to assess the acceptability of components for a school-based intervention. Write and draw tasks and semi-structured focus groups (n = 10) were conducted with 50 children aged 7–9 years (22 boys, 28 girls) from six primary schools. Focus groups were recorded, transcribed, and analyzed thematically. Pen profiles were constructed from the transcripts in a deductive manner and represent key emergent themes. Results indicated that children's perception and knowledge of PA was mainly structured and sport-based, while some referred to fun, play and health. Fun, social support and outdoor activity were identified as key facilitators. Barriers included parental restrictions, lack of time and space in the different environments. The acceptability of intervention components was examined, children recognized the potential benefits of additional movement in the classroom, but opinions differed on the sit-to-stand desks. Findings contribute to a more detailed understanding of children's perceptions of context specific PA, the barriers they face, in addition to factors that support them to lead a physically active lifestyle, which may inform future PA promotion strategies.

Using compositional data analysis to explore accumulation of sedentary behavior, physical activity and youth health

PURPOSE

The study aimed to describe youth time-use compositions, focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity (PA), and to examine associations of these time-use compositions with cardiometabolic biomarkers.

METHODS

Accelerometer and cardiometabolic biomarker data from 2 Australian studies involving youths 7-13 years old were pooled (complete cases with accelerometry and adiposity marker data, n = 782). A 9-component time-use composition was formed using compositional data analysis: time in shorter and longer bouts of sedentary behavior; time in shorter and longer bouts of light-, moderate-, or vigorous-intensity PA; and "other time" (i.e., non-wear/sleep). Shorter and longer bouts of sedentary time were defined as <5 min and ≥5 min, respectively. Shorter bouts of light-, moderate-, and vigorous-intensity PA were defined as <1 min; longer bouts were defined as ≥1 min. Regression models examined associations between overall time-use composition and cardiometabolic biomarkers. Then, associations were derived between ratios of longer activity patterns relative to shorter activity patterns, and of each intensity level relative to the other intensity levels and "other time", and cardiometabolic biomarkers.

RESULTS

Confounder-adjusted models showed that the overall time-use composition was associated with adiposity, blood pressure, lipids, and the summary score. Specifically, more time in longer bouts of light-intensity PA relative to shorter bouts of light-intensity PA was significantly associated with greater body mass index z-score (zBMI) (β = 1.79; SE = 0.68) and waist circumference (β = 18.35, SE = 4.78). When each activity intensity was considered relative to all higher intensities and "other time", more time in light- and vigorous-intensity PA, and less time in sedentary behavior and moderate-intensity PA, were associated with lower waist circumference.

CONCLUSION

Accumulating PA, particularly light-intensity PA, in frequent short bursts may be more beneficial for limiting adiposity compared to accumulating the same amount of PA at these intensities in longer bouts.

Quantifying the overall impact of an early childhood multi-behavioural lifestyle intervention

BACKGROUND

The overall impact of interventions targeting multiple behaviours remains largely unexplored.

OBJECTIVES

This study adopted an integrative lifestyle pattern analysis approach to assess the overall effectiveness of an early childhood intervention on change across multiple behaviours.

METHODS

The Melbourne INFANT program was a 15-month cluster-randomized controlled trial involving 4-month-old infants and their parents at baseline in 2008 (n = 542). The intervention included six education sessions helping parents to promote a healthy diet, physical activity and limit sedentary behaviour in their infants. Participants were followed-up twice post-intervention, at ages 3.6 (2011) and 5 years (2013), to assess sustained effects of the intervention. Previous principal component analyses identified two lifestyle patterns from dietary intake, outdoor time and television viewing time. Random effect linear regression models were conducted to assess the impact of the intervention on lifestyle patterns.

RESULTS

The intervention group had a lower 'Discretionary consumption and TV' lifestyle pattern score than the control group at all time points with adjusted mean difference: -0.29, 95% CI -0.49, -0.09, p = 0.004 post-intervention at age 1.5 years; -0.29, 95% CI -0.54, -0.04, p = 0.02 at the first follow-up (age 3.6 years); and -0.21, 95% CI -0.43, 0.01, p = 0.06 at the second follow-up (age 5.0 years). No evidence of between-group differences was found for the 'Fruit, vegetables and outdoor' lifestyle pattern score.

CONCLUSION

This early childhood intervention designed to promote change in more than one obesity-related behaviour was effective in improving correlated unhealthy lifestyle behaviours. Lifestyle pattern analysis is a useful and interpretable approach for evaluating multi-behavioural interventions.

Outdoor public recreation spaces and social connectedness among adolescents

Background

Outdoor public recreation spaces are important settings for leisure and physical activity. Adolescents’ use of these spaces may contribute to social connectedness via social interaction with peers and the community in these settings. However, research on this topic is limited. This exploratory study examined associations of frequency of visitation and physical activity in outdoor public recreation spaces with social connectedness among adolescents in Melbourne, Australia.

Methods

Adolescents self-reported their frequency of visitation to parks, trails, beach/lake, and sports facilities; frequency of physical activity in a park, local street or path, and their street; and social connectedness. Separate analyses were conducted for visitation (n = 349, 15.4 ± 1.6 years, 58% female) and physical activity (n = 441, 15.4 ± 1.6 years, 59% female) using multilevel linear regression models.

Results

No significant associations were observed for frequency of visitation to a park (B = 0.86, 95% CI = − 0.26, 1.99), trails (B = 0.41, 95% CI = − 0.61, 1.44), beach/lake (B = − 0.44, 95% CI = − 1.46, 0.57), or sports facilities (B = 0.64, 95% CI = − 0.43, 1.70), nor for frequency of physical activity in their street (B = − 0.07, 95% CI = − 0.46, 0.31), local street/path (B = − 0.05, 95% CI = − 0.43, 0.33) or in a park (B = 0.23, 95% CI = − 0.14, 0.60) with adolescents’ social connectedness.

Conclusions

The findings did not support the hypothesis that visiting and being active in outdoor public recreation spaces are associated with adolescents’ social connectedness. Future research should consider the duration and context of outdoor public recreation space use (e.g., sports, socialising, relaxing alone) and whether different types and/or a combination of public spaces are more/less conducive to social connectedness.

A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep

Abstract

Background

In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process.

Methods

The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines.

Results

Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years).

Conclusions

To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01236-2.

Association of change in the school travel mode with changes in different physical activity intensities and sedentary time: A International Children's Accelerometry Database Study

Our aim was to assess the association between changes in active travel to school and changes in different intensities of physical activity (i.e. moderate - MPA and vigorous - VPA) and time spent sedentary (SED) among adolescents and assess the moderating effect of children's sex, age and weight status. Data from six cohort studies in the International Children's Accelerometry Database were used (4108 adolescents aged 10-13y at baseline, with 1.9±0.7y of follow-up). Participants self-reported travel mode to school at baseline and follow-up. Mutually exclusive categories of change were created using passive (e.g. by car) or active (cycling or walking) forms of transport (active/active, passive/active, active/passive, passive/passive). Multilevel linear regression analyses assessed associations with change in accelerometer-assessed time spent MPA, VPA and SED, adjusting for potential confounders. The moderation of sex, age and weight status was tested though the inclusion of interaction terms in the regression models. Relative to those remaining in active travel (active/active), participants classified as passive/active increased VPA (B: 2.23 min/d; 95%CI: 0.97-3.48), while active/passive (MPA: -5.38min/d; -6.77 to -3.98; VPA: -2.92min/d; -4.06 to -1.78) and passive/passive (MPA: -4.53min/d; -5.55 to -3.50; VPA: -2.84min/d; -3.68 to -2.01) decreased MPA and VPA. There were no associations with SED. An interaction was observed, age group moderated the association with change in VPA: among 12-13y-olds a greater increase in VPA was observed for the passive/active group compared to active/active. Promoting active travel to school can be a strategy to attenuate the decline in physical activity through adolescence.