Policy options to support physical activity in schools

Rates of child and youth obesity and associated chronic diseases are rising worldwide, in part as a result of inadequate physical activity (PA) levels. Environmental change is needed in multiple settings to encourage the adoption of healthy lifestyle behaviours at an early age. Schools are an ideal setting in which to incorporate a variety of interventions in order to improve student PA levels and healthy eating environments. This paper reviews effective and promising policies for increasing PA levels in the school setting and introduces other untested interventions that could become the basis of future well-designed studies. Policies outlined in this review should be considered by a range of stakeholders and be carefully monitored and evaluated. These policies should include daily, quality, safe physical education and physical activity; extracurricular physical activity; training of physical activity leaders; active transportation to and from school; adequate facilities; and community outreach. Successful school initiatives and stakeholders should also be recognized formally for their contribution.     

Differences in the correlates of physical activity between urban and rural Canadian youth

BACKGROUND: Despite the benefits of physical activity (PA), a significant proportion of youth remains inactive. Studies assessing differences in the correlates of PA among urban and rural youth are scarce, and such investigations can help identify subgroups of the population that may need to be targeted for special intervention programs. The purpose of this study was to assess differences in the correlates of PA between Canadian urban and rural youth. METHODS: The sample consisted of 1398 adolescents from 4 urban schools and 1290 adolescents from 4 rural schools. Mean age of the participants was 15.6 +/- 1.3 years. Hierarchical regression analyses were used to examine the association between self-reported PA and a number of demographic, psychological, behavioral, and social correlates. RESULTS: Common correlates between the 2 locations included gender (with girls being less active than boys) perceptions of athletic/physical ability, self-efficacy, interest in organized group activities, use of recreation time, and friends' and siblings' frequency of participation in PA. Active commuting to school and taking a physical education class were unique correlates of PA at the multivariate level in urban and rural students, respectively. Variance explained in PA ranged from 43% for urban school students to 38% for rural school students. CONCLUSIONS: Although more similarities than discrepancies were found in the correlates of PA between the 2 geographical locations, findings from this study strengthen the policies that argue for a coordinated multisector approach to the promotion of PA in youth, which include the family, school, and community.     

Long-term effects of a physical activity intervention in high school girls

BACKGROUND: Physical activity (PA) decreases during childhood and adolescence, and PA levels are significantly lower in females than males, particularly during adolescence. Schools are attractive settings in which to implement interventions designed to promote PA in girls and young women, but few studies have tested the sustained effects of such interventions. DESIGN: Cross-sectional. Data were collected in 2002-2003 and analyzed in 2006-2007. SETTING/PARTICIPANTS: 1594 adolescent girls in 22 high schools. INTERVENTION: The intervention, Lifestyle Education for Activity Program (LEAP), was designed to increase physical activity in 9th-grade girls through two channels: changes in instructional practices and changes in the school environment. This study (LEAP 2) examined the extent to which effects of the intervention were maintained when the girls were in the 12th grade. MAIN OUTCOME MEASURES: Number of 30-minute blocks per day of vigorous physical activity. RESULTS: Girls in the intervention schools that most fully implemented and maintained the intervention were more likely than girls in the other schools to participate in an average of one or more blocks of vigorous physical activity per day (p=0.04, odds ratio=1.49, 95% confidence interval=1.01-2.20). CONCLUSIONS: A comprehensive physical activity intervention that is fully implemented and maintained can increase participation in vigorous physical activity by high school girls.     

视力障碍青少年身体活动水平和久坐时间调查

了解中国视力障碍青少年日常身体活动模式和久坐行为时间,为指导学生科学合理安排作息时间提供参考.方法 采用加速度计对中国西部地区某特殊教育学校78名7~23岁视力障碍青少年的身体活动水平和模式进行测量.结果 男女生相比,男生身高略高、身体略重(t值分别为2.81,2.46,P值均<0.05).基于Puyan等加速度计切点值,学生平均每天进行轻度身体活动(light physical activity,LPA)时间为(285.18±47.29) min,中等强度身体活动(moderatephysical activity,MPA)时间为(141.92±57.63) min,高强度身体活动(vigorous PA,VPA)时间为(17.66± 14.83) min,中高强度身体活动(moderate-to-vigorous-intensity physical activity,MVPA)时间为(159.58±69.83) min,久坐时间为(988.38±110.18)min.98.7%的受试者达到了WHO关于青少年每天应至少进行60 min中等及以上强度的身体活动的推荐量.结论 中国西部地区特殊学校视障青少年每日进行促进身体健康的身体活动,身体活动水平达到且超过WHO身体活动推荐量.     

Patterns of physical activity among Russian youth: The Russian Longitudinal Monitoring Survey

Background: This paper describes physical activity the patternsof 2,101 Russian youth enrolled in the Russian LongitudinalMonitoring Survey (RLMS). The RLMS is a nationally representativehousehold sample survey. Methods: Youth 14–18 years andparents of youth 6–13 years responded to survey questionsabout hours per week of light (cooking and laundry), moderate(walking, bicycling and sports), and vigorous physical activities(karate, wrestling and gymnastics). Sedentary activities (e.g.watching TV, music, homework) were categorized separately. Subjectswere categorized for analyses by sex (boys n=1,072 and girlsn=1,029) and age was grouped by school year: 6–11 years(elementary school), 12–16 years (high school), and 17–18years. Mean hours per week by age and sex were computed fortime spent in sedentary (1 MET), light (1.1–2.9 METs),moderate (3–6 METs), and vigorous (6 METs) activities.The proportion of youth meeting International PA Guidelines1 (any intensity physical activity 30 mln/day, 5 days per week)and 2 (moderate to vigorous physical activity for three sessionsper week) was computed for each group. Results: Russian boysand girls spent approximately 28 h/week in sedentary activities.Boys spent more time than girls in moderate (5.2 versus 4.1h/week) and vigorous (2.5 versus 1.8 h/week) intensity activities;girls spent more time in household activities. Nearly 70% ofRussian youth met Guideline 1, and fewer than 45% met Guideline2. Conclusions: The results suggest that most Russian youthenrolled in the RLMS obtain sufficient amounts of any levelof physical activity per week, but that efforts may be neededto promote more regular moderate to vigorous physical activity.     

Effect of a low-cost, teacher-directed classroom intervention on elementary students' physical activity

BACKGROUND: Effective physical activity (PA) interventions are warranted for youth, and schools have been identified as logical locations for such involvement. Experts and professionals in the field promote comprehensive school PA programs, including classroom PA. The purpose of this study was to determine the effect of a low‐cost, teacher‐directed classroom‐based intervention on the school PA of elementary children. METHODS: Nine classroom teachers were provided inexpensive curricula and trained to implement and instruct PA breaks (2 × 30 minute training sessions). The teachers were encouraged to lead 1 activity break per day after the training. One hundred and six elementary students wore pedometers up to 12 days over 3 monitoring periods during the school year (baseline, follow‐up, post follow‐up) to assess the effectiveness and the sustainability of the intervention. The teachers self‐reported the frequency of activity breaks instructed. RESULTS: The teachers (n = 5) who complied with the recommended 1 activity break per day had students who accrued ～33% more mean school steps/day at follow‐up (～1100) and post follow‐up (～1350) compared to controls. Teachers (n = 4) in the intervention who did not comply with the 1 activity break per day recommendation had students accrue similar mean school steps/day as controls. CONCLUSION: Inexpensive, teacher‐directed classroom‐based PA interventions can be effective in improving children's PA levels if teachers implement 1 activity break per school day. We recommend promoting the notion of 1 activity break per day in the classroom as part of a comprehensive school PA program that includes quality physical education, recess, and before/after school programs.     

Promoting Physical Activity Among Youth Through Community-Based Prevention Marketing

BACKGROUND: Community-based prevention marketing (CBPM) is a program planning framework that blends community-organizing principles with a social marketing mind-set to design, implement, and evaluate public health interventions. A community coalition used CBPM to create a physical activity promotion program for tweens (youth 9–13 years of age) called VERB™ Summer Scorecard. Based on the national VERB™ media campaign, the program offered opportunities for tweens to try new types of physical activity during the summer months. METHODS: The VERB™ Summer Scorecard was implemented and monitored between 2004 and 2007 using the 9-step CBPM framework. Program performance was assessed through in-depth interviews and a school-based survey of youth. RESULTS: The CBPM process and principles used by school and community personnel to promote physical activity among tweens are presented. Observed declines may become less steep if school officials adopt a marketing mind-set to encourage youth physical activity: deemphasizing health benefits but promoting activity as something fun that fosters spending time with friends while trying and mastering new skills. CONCLUSIONS: Community-based programs can augment and provide continuity to school-based prevention programs to increase physical activity among tweens.     

Influences of Preschool Policies and Practices on Children's Physical Activity

The objective of this study was to determine if moderate to vigorous physical activity (MVPA) of 3-5 year old preschool children varied with differences in policies/practices, and overall quality of preschools. A total of 266 children (47% males, 60% African American) from 9 preschools were observed for 1 hour on 3 different days. PA of children was observed twice per minute and scored as 1-5, with 1 for stationary/motionless and 5 for fast movement. Summary MVPA was calculated over the 3 days as percent of times observed at levels of 4 or 5, and percent of time at levels 1 or 2 as sedentary activity. A structured interview about PA policies was conducted with an administrator at each preschool and overall quality of the preschool was assessed using Early Childhood Environment Rating Scale-Revised Edition (ECERS-R). Preschools were divided into groups according to whether a specific policy/practice that would be logically hypothesized to promote PA was in place at the school. MVPA differences between groups of children was assessed using mixed ANOVA controlling for preschool. When preschools offered more field trips, and more college educated teachers, the children participated in more MVPA. Children who attended preschools with lower quality spent more time in sedentary activity. In conclusion, children in preschools which may have more resources and better quality appear to show both more sedentary behavior and more MVPA.     

Differences in physical activity during school recess

BACKGROUND: School recess provides a daily opportunity for physical activity engagement. The purpose of this study was to examine physical activity levels during recess by gender, ethnicity, and grade, and establish the contribution of recess to daily school physical activity levels. METHODS: Two hundred and ten children (45% boys) from grades 3 to 6 in 4 elementary schools had their physical activity during school quantified using uni‐axial accelerometry every 5 seconds for 5 consecutive school days. Data were collected in fall 2009. The proportion of time spent engaged in physical activity during daily school recess was determined using existing age‐appropriate cutpoints. The relative contribution of recess to school day physical activity was also determined. RESULTS: Boys were more active than girls during recess. Girls engaged in more sedentary activity than boys. No main effects for ethnicity were observed. Children in grades 3 and 5 were more active than children in grades 4 and 6. Recess contributed 17.9% and 15.5% toward boys' and girls' school day moderate‐to‐vigorous physical activity, respectively. CONCLUSION: Children engaged in physical activity during recess, though interventions may be needed to increase the intensity of activity in this context.     

School sports opportunities influence physical activity in secondary school and beyond

BACKGROUND: The purpose of the present study was to examine whether the availability of intramural or extramural sports in secondary schools is associated with physical activity levels in youth throughout secondary school and at age 20. METHODS: Eight hundred and eight adolescents from 10 secondary schools in Montreal, Canada, provided physical activity data every 3 months during the school year from ages 13 to 17, and again at age 20. School administrators completed questionnaires on the availability of intramural and extramural sports. Three‐level general linear models were used to examine associations among the number of intramural and extramural sports, moderate and vigorous physical activity controlling for age, sex, body mass index, mother's education, and school‐level socioeconomic status. RESULTS: Regardless of whether or not they reported participating in intramural sports, adolescents in schools with more intramural sports engaged in 3.6 (p = .03) more total, and 1.3 (p = 0.03) more vigorous activities per week than those attending schools with fewer intramural sports. Number of extramural sports was not statistically significantly associated with physical activity, regardless of whether or not individual students participated. CONCLUSION: Providing more opportunities for intramural sports in secondary schools may be an effective strategy to help adolescents attain physical activity recommendations.     

Relation of School Environment and Policy to Adolescent Physical Activity*

Background: Physical activity (PA) declines as children and adolescents age. The purpose of this study was to examine how specific school factors relate to youth PA, TV viewing, and body mass index (BMI). Methods: A sample of 12‐ to 18‐year‐old adolescents in 3 cities (N = 165, 53% females, mean age 14.6 ± 1.7 years, 44% nonwhite) completed surveys assessing days of physical education (PE) class per week, school equipment accessibility, after‐school supervised PA, and after‐school field access. Regression analyses were conducted to examine relationships between these school factors and PA at school facilities open to the public (never active vs active), overall PA level (days per week physically active for 60 minutes), BMI z score, and TV watching (hours per week). Results: Adjusting for demographics, days of PE per week and access to school fields after school were correlated with overall PA (β= 0.286, p = .002, semipartial correlation .236 and β= 0.801, p = .016, semipartial correlation .186, respectively). The association between after‐school field access and overall PA was mediated by use of publicly accessible school facilities for PA. After‐school supervised PA and school PA equipment were not associated with overall PA. In adjusted regression analyses including all school factors, days of PE remained correlated to overall PA independent of other school factors (β= 0.264, p = .007, semipartial correlation = .136). There were no associations between school factors and BMI or TV watching. Conclusions: Based on these study findings, PE is a promising intervention to address improving overall adolescent PA within the school setting.     

Intervention-mediated effects for adult physical activity: A latent growth curve analysis

Data from two randomized clinical trials (RCT) were used to examine the extent to which a health promotion intervention affected changes in growth trajectories of psychosocial constructs and if so, whether these constructs in turn explained changes in physical activity (PA). PA and psychosocial measures on 842 overweight adults in the United States were collected in two RCTs evaluating Internet-based behavior change interventions with assessments at baseline, 6 and 12 months. A physical activity latent variable at 12 months was created using indicators of self-reported walking and leisure time activities. Intervention-mediated effects on PA at 12 months were found via latent growth curves representing self-efficacy and behavioral strategies, where increasing growth curves across time were associated with higher PA values at 12 months. These findings provide some evidence that web-based self-help intervention programs worked through targeted behavior change constructs to influence physical activity levels in overweight adults.     

Black, Hispanic, and white girls' perceptions of environmental and social support and enjoyment of physical activity

BACKGROUND: This study examines the differences among black, Hispanic, and white adolescent girls in their perceptions surrounding physical activity (PA), including support within the school climate, friend and family social support, and personal enjoyment. METHODS: Participants included 1466 sixth-grade girls from 36 middle schools across the United States. Participants were 20% black, 21% Hispanic, 47% white, and 12% of other or mixed races. Multivariate analyses were performed on each scale, adjusting for body mass index and free and reduced-price lunch status. RESULTS: Results showed racial differences on several variables. Black girls, compared with white girls, perceived significantly lower PA enjoyment (p<.001) and teacher support for PA (p=.004). Hispanic girls experienced less PA enjoyment (p=.003) and perceived less support for PA from boys (p=.001) and their families (p=.008) than white girls. Black girls reported significantly higher levels of physical education (PE) enjoyment than did white girls (p=.003). CONCLUSIONS: Differences in perceived PA support and enjoyment across race raise questions about why these differences exist and how best to address disparities within interventions.     

Impact of Garden-Based Youth Nutrition Intervention Programs: A Review

Garden-based nutrition-education programs for youth are gaining in popularity and are viewed by many as a promising strategy for increasing preferences and improving dietary intake of fruits and vegetables. This review examines the scientific literature on garden-based youth nutrition intervention programs and the impact on nutrition-related outcomes. Studies published between 1990 and 2007 were identified through a library search of databases and an examination of reference lists of relevant publications. Studies were included if they involved children and adolescents in the United States and examined the impact of garden-based nutrition education on fruit and/or vegetable intake, willingness to taste fruits and vegetables, preferences for fruits and vegetables, or other nutrition-related outcomes. Only articles published in peer-reviewed journals in English were included in the review. Eleven studies were reviewed. Five studies took place on school grounds and were integrated into the school curriculum, three studies were conducted as part of an afterschool program, and three studies were conducted within the community. Studies included youth ranging in age from 5 to 15 years. Findings from this review suggest that garden-based nutrition intervention programs may have the potential to promote increased fruit and vegetable intake among youth and increased willingness to taste fruits and vegetables among younger children; however, empirical evidence in this area is relatively scant. Therefore, there is a need for well-designed, evidenced-based, peer-reviewed studies to determine program effectiveness and impact. Suggestions for future research directions, including intervention planning, study design, evaluation, and sustainability are provided.     

Determinants of physical activity in active and low-active, sixth grade African-American youth

This study compared the determinants of physical activity in active and low-active African-American sixth grade students (N = 108, 57 F, 51 M). Objective assessments of physical activity over a seven-day period were obtained using the CSA 7164 accelerometer. Students were classified as active if they exhibited three or more 20-minute bouts of moderate to vigorous physical activity over the seven-day period. Relative to low-actives, active boys reported significantly higher levels of self-efficacy, greater involvement in community physical activity organizations, and were significantly more likely to perceive their mother as active. Relative to low-actives, active girls reported significantly higher levels of physical activity self-efficacy, greater positive beliefs regarding physical activity outcomes, and were significantly less likely to watch television or play video games for > or = 3 hrs/day. These observations provide preliminary guidance as to the design of physical activity interventions targeted at African-American youth.     

Physical activity and healthy eating environmental audit tools in youth care settings: A systematic review

BackgroundThere is a growing interest in evaluating the physical activity (PA) and healthy eating (HE) policy and practice environment characteristics in settings frequented by youth (≤ 18 years).ObjectiveThis review evaluates the measurement properties of audit tools designed to assess PA and HE policy and practice environment characteristics in settings that care for youth (e.g., childcare, school, afterschool, summer camp).MethodThree electronic databases, reference lists, educational department and national health organizations' web pages were searched between January 1980 and February 2014 to identify tools assessing PA and/or HE policy and practice environments in settings that care for youth (≤ 18 years).ResultsSixty-five audit tools were identified of which 53 individual tools met the inclusion criteria. Thirty-three tools assessed both the PA and HE domains, 6 assessed the PA domain and 14 assessed the HE domain solely. The majority of the tools were self-assessment tools (n = 40), and were developed to assess the PA and/or HE environment in school settings (n = 33), childcare (n = 12), and after school programs (n = 4). Four tools assessed the community at-large and had sections for assessing preschool, school and/or afterschool settings within the tool. The majority of audit tools lacked validity and/or reliability data (n = 42). Inter-rater reliability and construct validity were the most frequently reported reliability (n = 7) and validity types (n = 5).ConclusionsLimited attention has been given to establishing the reliability and validity of audit tools for settings that care for youth. Future efforts should be directed towards establishing a strong measurement foundation for these important environmental audit tools.     

建成环境对南京市儿童青少年体力活动影响

目的 分析不同建成环境特征对江苏省南京地区儿童青少年体力活动水平的影响,为提高儿童青少年体力活动水平提供科学依据.方法 于2018年5-6月采用现况研究设计,使用多阶段整群随机抽样方法,选择南京市12个行政区4～12年级学生(9～17岁儿童青少年)共4 401人进行问卷调查,采用国际上通用体力活动居住环境量表(PANE...     

Relationship of nutrition and physical activity behaviors and fitness measures to academic performance for sixth graders in a midwest city school district

BACKGROUND: To support curriculum and policy, a midwest city school district assessed the association of selected categories of nutrition and physical activity (NUTR/PA) behaviors, fitness measures, and body mass index (BMI) with academic performance (AP) for 800 sixth graders. METHODS: Students completed an adapted Youth Risk Behavior Surveillance Survey (NUTR/PA behaviors), fitness assessments (mile run, curl‐ups, push‐ups, height, and weight) with results matched to standardized scores (Measures of Academic Progress [MAP]), meal price status, and gender. Differences in mean MAP scores (math and reading) were compared by selected categories of each variable utilizing 1‐way analysis of variance. Associations were determined by stepwise multiple regression utilizing mean MAP scores (for math and for reading) as the dependent variable and NUTR/PA behaviors, fitness, and BMI categories as independent variables. Significance was set at α = 0.05. RESULTS: Higher MAP math scores were associated with NUTR (more milk and breakfast; less 100% fruit juice and sweetened beverages [SB]) and PA (increased vigorous PA and sports teams; reduced television), and fitness (higher mile run performance). Higher MAP reading scores were associated with NUTR (fewer SB) and PA (increased vigorous PA, reduced television). Regression analysis indicated about 11.1% of the variation in the mean MAP math scores and 6.7% of the mean MAP reading scores could be accounted for by selected NUTR/PA behaviors, fitness, meal price status, and gender. CONCLUSION: Many positive NUTR/PA behaviors and fitness measures were associated with higher MAP scores supporting the school district focus on healthy lifestyles. Additional factors, including meal price status and gender, contribute to AP.     

Relationships Between Youth Sport Participation and Selected Health Risk Behaviors From 1999 to 2007

BACKGROUND: How adolescents spend their out-of-school time represents one of the most important factors for predicting positive youth development. Sport participation relates to many beneficial outcomes. However, current economic conditions threaten high school sport programs around the United States. This investigation examined relationships by year between sport participation and numerous health risk behaviors among high school students. METHODS: Data were derived from the Centers for Disease Control and Prevention's Youth Risk Behavior Surveys administered every 2 years from 1999 through 2007. Items assessed were sport participation, vigorous physical activity, dietary habits, weight loss, sexual activity, interpersonal violence and suicidality, and substance use. Multiple logistic regression analyses were used to examine relationships between sport participation and each health behavior. Interaction effects tested whether relationships varied by year, sex, age, and/or race/ethnicity. RESULTS: Analyses revealed some consistencies across years in relationships between sport participation and health risk behaviors for both sexes. However, most relationships varied by race/ethnicity. Among White students, sport participation related to multiple positive health behaviors. Conversely, African American, Hispanic, and Other athletes showed fewer positive health behaviors and some negative behaviors. CONCLUSIONS: Findings suggest that participation in organized sports affords many health benefits to most adolescents, but relates to some negative health behaviors in certain subgroups. Information regarding sport participation and health risk behaviors among subgroups across years can inform school policy, practice, and future research.     

Effects of interventions in health care settings on physical activity or cardiorespiratory fitness

Introduction:This paper reviews studies of physical activity interventions in health care settings to determine effects on physical activity and/or fitness and characteristics of successful interventions.Methods: Studies testing interventions to promote physical activity in health care settings for primary prevention (patients without disease) and secondary prevention (patients with cardiovascular disease [CVD]) were identified by computerized search methods and reference lists of reviews and articles. Inclusion criteria included assignment to intervention and control groups, physical activity or cardiorespiratory fitness outcome measures, and, for the secondary prevention studies, measurement 12 or more months after randomization. The number of studies with statistically significant effects was determined overall as well as for studies testing interventions with various characteristics.Results: Twelve studies of primary prevention were identified, seven of which were randomized. Three of four randomized studies with short-term measurement (4 weeks to 3 months after randomization), and two of five randomized studies with long-term measurement (6 months after randomization) achieved significant effects on physical activity. Twenty-four randomized studies of CVD secondary prevention were identified; 13 achieved significant effects on activity and/or fitness at twelve or more months. Studies with measurement at two time points showed decaying effects over time, particularly if the intervention were discontinued. Successful interventions contained multiple contacts, behavioral approaches, supervised exercise, provision of equipment, and/or continuing intervention. Many studies had methodologic problems such as low follow-up rates.Conclusion: Interventions in health care settings can increase physical activity for both primary and secondary prevention. Long-term effects are more likely with continuing intervention and multiple intervention components such as supervised exercise, provision of equipment, and behavioral approaches. Recommendations for additional research are given.