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Acceptability and Potential Efficacy of Single-Sex After-School Activity Programs for Overweight and At-Risk Children: The Wollongong SPORT RCT

Rachel A. Jones, Jacque Kelly, Dylan P. Cliff, Marijka Batterham, and Anthony D. Okely


Single sex after-school physical activity programs show potential to prevent unhealthy weight gain. The aim of this study was to assess the acceptability and potential efficacy of single-sex after-school physical activity programs for overweight and at-risk children from low-income communities.


7-month, 2-arm parallel-group, RCT, conducted at an elementary school in a disadvantaged area in Wollongong, Australia (March-November 2010).


20 boys and 17 girls were randomized to intervention (PA) or active comparison groups (HL). Primary outcomes included implementation, acceptability, percentage body fat and BMI z-score.


The PA programs were acceptable with high implementation and enjoyment rates. At 7 months postintervention girls in the PA group displayed greater changes in percentage body fat (adjust diff. = -1.70, [95% CI -3.25, -0.14]; d = -0.83) and BMI z-score (-0.19 [-0.36, -0.03]; d= -1.00). At 7 months boys in the PA group showed greater changes in waist circumference (-3.87 cm [-7.80, 0.15]; d= -0.90) and waist circumference z-score (-0.33 [-0.64, -0.03]; d= -0.98). For both boys’ and girls’ PA groups, changes in adiposity were not maintained at 12-month follow-up.


Single-sex after-school physical activity programs are acceptable and potentially efficacious in preventing unhealthy weight gain among overweight and at-risk children. However improvements are hard to sustain once programs finish operating.

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Promoting Fundamental Movement Skill Development and Physical Activity in Early Childhood Settings: A Cluster Randomized Controlled Trial

Rachel A. Jones, Annaleise Riethmuller, Kylie Hesketh, Jillian Trezise, Marijka Batterham, and Anthony D. Okely

The aim of this study was to assess the feasibility, acceptability and potential efficacy of a physical activity program for preschool children. A 20-week, 2-arm parallel cluster randomized controlled pilot trial was conducted. The intervention comprised structured activities for children and professional development for staff. The control group participated in usual care activities, which included designated inside and outside playtime. Primary outcomes were movement skill development and objectively measured physical activity. At follow-up, compared with children in the control group, children in the intervention group showed greater improvements in movement skill proficiency, with this improvement statically significant for overall movement skill development (adjust diff. = 2.08, 95% CI 0.76, 3.40; Cohen’s d = 0.47) and significantly greater increases in objectively measured physical activity (counts per minute) during the preschool day (adjust diff. = 110.5, 95% CI 33.6, 187.3; Cohen’s d = 0.46). This study demonstrates that a physical activity program implemented by staff within a preschool setting is feasible, acceptable and potentially efficacious.

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Objectively Measured Physical Activity in South African Children Attending Preschool and Grade R: Volume, Patterns, and Meeting Guidelines

Simone A. Tomaz, Trina Hinkley, Rachel A. Jones, Rhian Twine, Kathleen Kahn, Shane A. Norris, and Catherine E. Draper

Purpose: To assess physical activity (PA) and determine the proportion of preschoolers meeting PA recommendations in different income settings in South Africa. Methods: Preschoolers from urban high-income (UH), urban low-income (UL), and rural low-income (RL) settings wore an ActiGraph GT3X+ accelerometer for 7 days. PA variables of interest included volume moderate- to vigorous-intensity PA (MVPA) and total PA (light- to vigorous-intensity PA), hourly PA patterns, and percentage of children meeting guidelines (180 min/d of total PA, inclusive of 60 min/d of MVPA). Between-sex differences were assessed using t tests and Mann–Whitney U tests; between-setting differences assessed using 1-way analyses of variance and Kruskal–Wallis tests. Results: For all children (n = 229, aged 5.17 [0.69] y), average MVPA was 124.4 (37.5) minutes per day and total PA was 457.0 (61.1) minutes per day; 96.9% of children met guidelines. Boys did significantly more MVPA than girls (136.7 [39.37] vs 111.5 [30.70] min/d, P < .001), and UH preschoolers were significantly less active than UL and RL preschoolers (UH 409.1 [48.4] vs UL 471.1 [55.6] and RL 461.6 [61.4], P < .001). Conclusion: In both practice and research, it is necessary to explore ways to ensure that South African preschoolers from all income settings continue to engage in and benefit from healthy volumes of PA. This is especially important as preschoolers transition to a formal school environment.

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Validation of activPAL Defined Sedentary Time and Breaks in Sedentary Time in 4- to 6-Year-Olds

Xanne Janssen, Dylan P. Cliff, John J. Reilly, Trina Hinkley, Rachel A. Jones, Marijka Batterham, Ulf Ekelund, Soren Brage, and Anthony D. Okely

This study examined the classification accuracy of the activPAL, including total time spent sedentary and total number of breaks in sedentary behavior (SB) in 4- to 6-year-old children. Forty children aged 4–6 years (5.3 ± 1.0 years) completed a ~150-min laboratory protocol involving sedentary, light, and moderate- to vigorous-intensity activities. Posture was coded as sit/lie, stand, walk, or other using direct observation. Posture was classified using the activPAL software. Classification accuracy was evaluated using sensitivity, specificity and area under the receiver operating characteristic curve (ROC-AUC). Time spent in each posture and total number of breaks in SB were compared using paired sample t-tests. The activPAL showed good classification accuracy for sitting (ROC-AUC = 0.84) and fair classification accuracy for standing and walking (0.76 and 0.73, respectively). Time spent in sit/lie and stand was overestimated by 5.9% (95% CI = 0.6−11.1%) and 14.8% (11.6−17.9%), respectively; walking was underestimated by 10.0% (−12.9−7.0%). Total number of breaks in SB were significantly overestimated (55 ± 27 over the course of the protocol; p < .01). The activPAL performed well when classifying postures in young children. However, the activPAL has difficulty classifying other postures, such as kneeling. In addition, when predicting time spent in different postures and total number of breaks in SB the activPAL appeared not to be accurate.

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Running Habits and Injury Frequency Following COVID-19 Restrictions in Adolescent Long-Distance Runners

Rachel N. Meyers, Micah C. Garcia, Jeffery A. Taylor-Haas, Jason T. Long, Mitchell J. Rauh, Mark V. Paterno, Kevin R. Ford, and David M. Bazett-Jones

Purpose: A decline in youth running was observed at the start of the COVID-19 pandemic. We investigated whether the resumption of organized running after social distancing restrictions changed running habits or injury frequency in adolescent runners. Methods: Adolescents (age = 16.1 [2.1] y) who participated in long-distance running activities completed an online survey in the Spring and Fall of 2020. Participants self-reported average weekly running habits and whether they sustained an injury during the Fall 2020 season. Poisson regression models and 1-way analysis of variance compared running habits while Fisher exact test compared differences in frequencies of injuries during Fall 2020 among season statuses (full, delayed, and canceled). Results: All runners, regardless of season status, increased weekly distance during Fall 2020. Only runners with a full Fall 2020 season ran more times per week and more high-intensity runs per week compared with their Spring 2020 running habits. There were no differences in running volume or running-related injury frequency among Fall 2020 season statuses. Conclusions: There were no significant differences in running-related injury (RRI) frequency among runners, regardless of season status, following the resumption of cross-country. Health care providers may need to prepare for runners to increase running volume and intensity following the resumption of organized team activities.