Interventions to promote physical activity among young and adolescent girls: a systematic review

A narrative systematic review was conducted to describe the available evidence from physical activity (PA) interventions that targeted girls aged 5-18 years and to determine their effectiveness and key characteristics of success. Systematic literature searches were conducted using four databases: PubMed, Web of Science, PsychInfo and SPORTDiscus and by examining the reference lists of included articles and published relevant reviews, to identify studies published in English from 2000 to July 2010. Randomized controlled trials or quasi-experimental designs with pre-test and post-test behavioral outcome data (objective or self-report measure) were included. Methodological quality was assessed using a checklist and conclusions were made concerning effectiveness. A total of 29 articles were reviewed, describing the evaluation of 21 interventions. Ten studies reported a favorable intervention effect upon PA outcomes, seven of which were rated as having a high methodological quality. Multi-component school-based interventions that also offer a physical education that address the unique needs of girls seemed to be the most effective. Although family support is revealed as ineffective, peer strategies showed promising evidence. The review finishes highlighting possible intervention strategies and reporting areas where further investigation is required.     

Topic: prevalence and determinants of adolescent pregnancy among sexually active adolescent girls in Niger

Journal of Public Health - All over the world, including in Niger, adolescent pregnancy remains a challenge requiring urgent solution. This study sought to examine the prevalence and determinants...     

Weight-bearing physical activity among girls and mothers: relationships to girls' weight status

OBJECTIVE: To assess weight-bearing physical activity (WBPA) barriers, benefits, self-efficacy, social influence, and behaviors [WBPA and physical activity (PA)] among girls and their mothers according to girls' weight status (nonoverweight vs. overweight). RESEARCH METHODS AND PROCEDURES: Participants were 9- to 11-year-old girls (n = 295) and their mothers who participated in the baseline assessment of a nutrition and PA intervention trial. Girls' and mothers' WBPA attitudes and mothers' WBPA behaviors were self-reported on questionnaires. Girls' WBPA and total PA behaviors were self-reported using a structured interview (Physical Activity Checklist Interview). Stature and weight were measured by standardized anthropometrics. Overweight status was based on BMI. RESULTS: Compared with nonoverweight girls, overweight girls were significantly more likely to report barriers to WBPA participation and perceive social influence from family and friends to do more WBPA. They were also significantly less likely to report self-efficacy regarding WBPA and to believe that they did enough WBPA. Compared with mothers of nonoverweight girls, mothers of overweight girls were significantly more likely to report that it is difficult to persuade their daughters to do more WBPA and significantly less likely to report that WBPA was fun for their daughters. Girls' overweight status was not associated with girls' reports of minutes spent per week in PA or WBPA. DISCUSSION: The present study's findings of lower WBPA self-efficacy, lack of enjoyment of WBPA, and higher perceived social influence to do WBPA among overweight girls suggest that efforts are needed to promote physical competencies and positive perceptions of PA among overweight girls.     

Associations between the school environment and adolescent girls' physical activity

This paper explores school sports facility provision, physical education allocation and opportunities for physical activity and their association with the number of days adolescent girls participate in at least 60 min of moderate-vigorous physical activity per week (MVPAdays). Data were collected through self-administered questionnaires from Scottish secondary school girls (n = 1978) and head teachers (n = 123) participating in the Health Behaviour in School-aged Children 2005/06 study. The best predictor of adolescent girls' MVPAdays was hours allocated to PE in fourth year of secondary school (β = 0.27, 95% CI 0.06-0.48). Having shower facilities resulted in decreased MVPA (β = -0.51, CI -0.90 to -0.12), as did providing less than two team sports clubs (β = -0.69, CI -1.28 to -0.10), compared with schools who provided four or more. Compared with schools with no after school clubs, girls who attended schools with activities at least 1 day per week were likely to have increased MVPAdays. PE allocation and extra-curricular clubs are likely to be of greater importance to girls' participation than school facilities per se. This study demonstrates how schools can maximize their environment to increase girls' PA and offers encouraging findings for those with limited sports facilities.     

The independent relations of both residential self-selection and the environment to physical activity

Residential self-selection is supposed to bias the relation between residential environments and physical activity, but empirical analyses are still rare. This study examines the association while simultaneously considering the effect of residential self-selection criteria. One thousand two hundred and forty-five German students were asked to report their physical activity, their perceived environment, and their reasons for choosing their neighbourhood. Structural equation modelling was employed. Reasons for choosing a neighbourhood were related to actual environmental characteristics. Utilitarian reasons were related to less physical activity, hedonic reasons were related to higher physical activity. The street network was related to higher physical activity independent of residential self-selection. Our results support the weight of both individual preferences and the street network on physical activity. The residential environment has an impact on people’s amount of physical activity regardless of their reasons for choosing a neighbourhood and should therefore be considered a resource in health prevention and promotion.     

Data to action: using formative research to develop intervention programs to increase physical activity in adolescent girls.

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls' stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed.     

Interventions to increase physical activity among healthy adults: meta-analysis of outcomes

Objectives. We conducted a meta-analysis summarizing the effects of interventions designed to increase physical activity among healthy adults.Methods. Our comprehensive searches located 358 reports eligible for inclusion. We used random-effects analyses to synthesize data, and we used meta-analytic analogues of regression and analysis of variance to examine potential moderator variables. We also explored moderator variable robustness and publication bias.Results. We computed meta-analytic results from studies comprising 99 011 participants. The overall mean effect size for comparisons of treatment groups versus control groups was 0.19 (higher mean for treatment participants than for control participants). This effect size is consistent with a mean difference of 496 ambulatory steps per day between treatment and control participants. Exploratory moderator analyses suggested that the characteristics of the most effective interventions were behavioral interventions instead of cognitive interventions, face-to-face delivery versus mediated interventions (e.g., via telephone or mail), and targeting individuals instead of communities. Participant characteristics were unrelated to physical activity effect sizes. Substantial between-studies heterogeneity remained beyond individual moderators.Conclusions. Interventions designed to increase physical activity were modestly effective. Interventions to increase activity should emphasize behavioral strategies over cognitive strategies.Adequate physical activity is linked with important health outcomes, including reductions in cardiovascular disease,¹ type 2 diabetes,^2,3 some cancers,^4,5 falls,⁶ osteoporotic fractures,⁷ and depression,⁸ and improvements in physical function,^9–11 weight management,^12–15 cognitive function,^16,17 and quality of life.¹⁸ Despite this compelling evidence for the benefits of physical activity, healthy adults commonly get an inadequate amount of physical activity.¹⁹Extensive primary research has tested interventions to increase physical activity. Although many meta-analyses have addressed health outcomes of physical activity, few have examined physical activity behavior outcomes. The seminal 1996 meta-analysis of interventions to increase physical activity behavior reported a moderate effect size across 127 studies of healthy and chronically ill adults and children.²⁰ Their moderator analyses documented larger effect sizes when interventions used behavior modification, had face-to-face delivery versus mediated delivery (e.g., telephone), focused on healthy people, measured active leisure versus structured exercise, measured low-intensity activity, encouraged unsupervised physical activity versus supervised physical activity, targeted participants of diverse ages, and targeted groups versus individuals.A recent comprehensive meta-analysis of work site programs for healthy adults documented a d effect size (standardized mean difference) of 0.21 but did not conduct moderator analyses to determine the intervention characteristics linked with the largest physical activity increases.²¹ Other meta-analyses have integrated across chronically ill adults²² or focused on small, specific interventions or populations, such as primary care–based referrals to physical activity programs,²³ older adults,²⁴ computer-based interventions,²⁵ or environmental interventions.²⁶ Many meta-analyses have been plagued by small samples that hinder moderator analyses.^27,28 For example, only 19 studies were included in the most recent Cochrane review that aggregated randomized, controlled trials with follow-up data gathered at least 6 months after interventions to increase physical activity among sedentary adults.²⁷Because of the importance of physical activity and the proliferation of studies testing interventions to increase physical activity, we sought to move this area of science forward by conducting a comprehensive meta-analysis to estimate the overall effect of interventions and, more importantly, to conduct moderator analyses to identify intervention characteristics associated with the best outcomes. We addressed 2 questions: (1) What overall effects do interventions designed to increase physical activity have on physical activity behavior after completion of interventions? (2) Do interventions’ effects on physical activity behavior vary depending on intervention, methodology, or sample characteristics?     

The relationship between unsupervised time after school and physical activity in adolescent girls

Background  

Rising obesity and declining physical activity levels are of great concern because of the associated health risks. Many children are left unsupervised after the school day ends, but little is known about the association between unsupervised time and physical activity levels. This paper seeks to determine whether adolescent girls who are without adult supervision after school are more or less active than their peers who have a caregiver at home.     

The role of peer social network factors and physical activity in adolescent girls

OBJECTIVE: To study the relationship between peer-related physical activity (PA) social networks and the PA of adolescent girls. METHODS: Cross-sectional, convenience sample of adolescent girls. Mixed-model linear regression analyses to identify significant correlates of self-reported PA while accounting for correlation of girls in the same school. RESULTS: Younger girls were more active than older girls. Most activity-related peer social network items were related to PA levels. More PA with friends was significantly related to self-reported PA in multivariate analyses. CONCLUSIONS: Frequency of PA with friends was an important correlate of PA among the peer network variables for adolescent girls.     

Assessment of physical activity among rural Senegalese adolescent girls: influence of age, sexual maturation, and body composition.

PURPOSE: To analyze the level of habitual physical activity and its relationship with age, maturational stage, and growth status in a group of adolescent Senegalese girls. METHODS: Physical activity was assessed for 3 consecutive years in a sample of 40 girls of rural origin. They were 13.3 +/- 0.5 years old at the beginning of the study and belonged to a Sereer community located in the center of Senegal. Minute-by-minute movement counts using accelerometers enabled quantification of levels of physical activity. The assessment was performed during a 4-day period in the first round (1997) and during a 3-day period in 1998 and 1999. Half of the girls were not yet pubescent during the first round, and the whole sample displayed growth retardation in weight and stature, compared with the World Health Organization/National Center for Health Statistics reference. RESULTS: Estimated levels of activity were high, ranging from 1.80 to 1.85 multiples of basal metabolic rate. There was a clear decline in the activity level during the course of study. Schoolgirls were less active than the others. Mature adolescents showed more activity during the night. A weak, but significant and positive correlation existed between body mass index and activity during the day; during the night, there was a positive correlation with fat and lean body mass. CONCLUSION: Factors determining the activity level were intricate but greater maturity and better nutritional status appeared to be positively related to the activity level.     

Promotion of physical activity among high-school girls: a randomized controlled trial

OBJECTIVES: Many adolescent girls fail to meet national guidelines for physical activity, and the prevalence of obesity is increasing among this group. Our study examined the effects of a comprehensive school-based intervention on physical activity among high-school girls. METHODS: A group-randomized controlled field trial was conducted at 24 high schools. A school-based sample of 2744 girls (48.7% African American, 46.7% White) participated in a measurement protocol when they were in eighth and then ninth grade. A comprehensive physical activity intervention was designed to change the instructional program and the school environment to increase support for physical activity among girls. RESULTS: At follow-up, 45% of girls in the intervention schools and 36% of girls in the control schools reported vigorous physical activity during an average of 1 or more 30-minute time blocks per day over a 3-day period. CONCLUSIONS: A comprehensive school-based intervention can increase regular participation in vigorous physical activity among high-school girls.     

Motivation and reasons to quit: predictive validity among adolescent smokers

OBJECTIVES: To examine reasons to quit among adolescents in a smoking cessation program, and whether reasons were associated with subsequent cessation. METHODS: Participants were 351 adolescents. At baseline, adolescents reported motivation, reasons to quit, and stage of change for cessation. Quit status was assessed at end of treatment. RESULTS: Girls were more likely to endorse image and appearance reasons to quit. Cessation was more likely among adolescents with higher motivation and those wanting to quit because of friends. CONCLUSIONS: Different reasons to quit were associated with motivation and cessation. Baseline motivation strongly predicted cessation, suggesting the relative value of assessing global motivation.     

Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment

BACKGROUND: Spatial access to recreational facilities and perceptions of the neighborhood environment and physical activity levels were examined by the socioeconomic status of area of residence (SES). METHODS: A cross-sectional survey of adults (18-59 years) (n = 1,803) stratified by SES using a geographic-based index was conducted. RESULTS: Respondents in low SES areas had superior spatial access to many recreational facilities, but were less likely to use them compared with those living in high SES areas. They were more likely to perceive that they had access to sidewalks and shops, but also perceived that their neighborhood was busier with traffic, less attractive, and less supportive of walking. After adjustment, respondents living in low SES areas were 36% less likely to undertake vigorous activity. While they were more likely to walk for transport, this was not statistically significant (OR, 1.27; 95% CI, 0.98-1.64), nor were other SES differences in walking for recreation and walking as recommended. Modifiable environmental factors were associated with walking and vigorous activity, especially perceived access to sidewalks and neighborhood attractiveness. Spatial access to attractive, public open space was associated with walking. CONCLUSIONS: Creating supportive environments--particularly sidewalks in attractive neighborhoods--has the potential to increase walking and vigorous activity.     

Implementation of a school environment intervention to increase physical activity in high school girls

Physical activity levels begin to decline in childhood and continue falling throughout adolescence, with girls being at greatest risk for inactivity. Schools are ideal settings for helping girls develop and maintain a physically active lifestyle. This paper describes the design and implementation of 'Lifestyle Education for Activity Program', or LEAP. LEAP used a health team approach with participatory strategies to provide training and support, instructional capacity building and opportunities to adapt school instructional program and environmental supports to local needs. The social-ecological model, based on social cognitive theory, served as the organizing framework for the LEAP intervention and elements of the coordinated school health program model as intervention channels. For the 12 intervention schools, LEAP staff documented 191 visits and interactions with 850 individuals over the 2-year period. Teachers reported successful implementation of most components of the intervention and demonstrated optimism for sustainability. These results indicate that a facilitative approach to intervention implementation can be used successfully to engage school personnel, and to change instructional programs and school environments to increase the physical activity level of high school girls.     

Cardiorespiratory fitness and proximity to commercial physical activity facilities among 12th grade girls

PurposeTo investigate the relationship between proximity to commercial physical activity (PA) facilities and cardiorespiratory fitness of 12th grade girls.MethodsAdolescent girls (n = 786, 60% African American, mean age = 17.6 ± .6 years) performed a submaximal fitness test (Physical Work Capacity 170 test). Commercial PA facilities were mapped and counted within a .75-mile street-network buffer around girls' homes using Geographic Information Systems. Sedentary activities and vigorous physical activity (≥6 metabolic equivalents) were determined by the average number of 30-minute blocks reported per day on the 3-Day Physical Activity Recall. Mixed model regressions were calculated using school as a random variable.ResultsGirls had higher weight-relative Physical Work Capacity 170 test scores if there was a commercial PA facility (n = 186, 12.4 ± 4.2 kg m/min/kg) within a .75-mile street-network buffer of home as compared with girls without a nearby facility (n = 600, 11.2 ± 3.6 kg m/min/kg). After adjusting for demographic variables, sports participation, sedentary behaviors, and vigorous physical activity, having one or more commercial PA facilities within a .75-mile street-network buffer of homes was significantly related to cardiorespiratory fitness.ConclusionsBoth with and without adjustment for covariates, the presence of a commercial PA facility within a .75-mile street-network buffer of a girl's home was associated with higher cardiorespiratory fitness.     

Social-cognitive and perceived environment influences associated with physical activity in older Australians

BACKGROUND: Regular physical activity in older adults can facilitate healthy aging, improve functional capacity, and prevent disease. However, factors associated with physical inactivity in older populations are poorly understood. This study attempts to identify social-cognitive and perceived environmental influences associated with physical activity participation in older populations. METHODS: In a randomly selected sample of 449 Australian adults age 60 and older, we assessed self-reported physical activity and a range of social-cognitive and perceived environmental factors. Respondents were classified as sufficiently active and inactive based on energy expenditure estimates (kcal/week) derived from self-reported physical activity. Two logistic regression models, with and without self-efficacy included, were conducted to identify modifiable independent predictors of physical activity. RESULTS: Significantly more males than females were physically active. Physical activity participation was related to age with a greater proportion of those age 65-69 being active than those age 60-64 or 70 or older. High self-efficacy, regular participation of friends and family, finding footpaths safe for walking, and access to local facilities were significantly associated with being active. CONCLUSION: Identifying predictors of physical activity in older populations, particularly social support, facility access, and neighbourhood safety, can inform the development of policy and intervention strategies to promote the health of older people.     

Factors predicting behavioral response to a physical activity intervention among adolescent females

OBJECTIVE: To determine whether individual factors influenced rates of physical activity change in response to a school-based intervention. METHODS: Sedentary adolescent females (N = 63) participated in a 9-month physical activity program. Weekly levels of leisure-time physical activity were reported using an interactive website. RESULTS: Change in vigorous activity was more positive among participants who had higher fitness and lower friend support at baseline. Change in moderate activity was more positive among participants who had lower fitness and external barriers, and higher internal barriers at baseline. CONCLUSIONS: Adolescent females responded differentially to a physical activity intervention depending on individual characteristics.