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You Fu and Ryan D. Burns

Background: The purpose of this study was to explore the effect of an active video gaming (AVG) classroom curriculum on health-related fitness, school day steps, and motivation in sixth graders. Methods: A convenience sample of 65 sixth graders were recruited from 2 classrooms from a school located in the Western United States. One classroom served as the comparison group (n = 32) that participated in active free play, and one classroom served as the intervention group (n = 33) that participated in an AVG curriculum for 30 minutes per day, 3 days per week, for 18 weeks. Cardiorespiratory endurance was assessed using Progressive Aerobic Cardiovascular Endurance Run laps. School day steps were recorded, and motivational variables were collected using questionnaires. Measures were collected at baseline and an 18-week posttest time point. Results: There was a significant group × time interaction for Progressive Aerobic Cardiovascular Endurance Run laps (b = 20.7 laps; 95% confidence interval, 14.6 to 26.8; P < .001). No statistically significant interactions were found for step counts or any of the motivational variables. Conclusions: An 18-week AVG classroom curriculum improved cardiorespiratory endurance relative to the comparison group in sixth graders. This study supports the use of low-cost AVG curricula to improve the health-related fitness of youth.

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You Fu and Ryan D. Burns

The purpose of this study was to examine the relationship between gross motor skills and school day steps per minute, testing various motivational constructs as potential mediators. A convenience sample of 66 sixth-grade children (mean age = 11.6 ± 0.5 years; 30 boys, 36 girls) were recruited from one public “Zoom” school. Gross motor skills were assessed using the Test for Gross Motor Development-3rd Edition. Motivational constructs were assessed using a series of validated questionnaires. Children wore a pedometer for one school week. A bootstrap mediation analysis was employed using gross motor skills scores as the predictor variable and steps per minute as the outcome variable; the motivational constructs consisted of perceived competence, enjoyment, and self-efficacy as potential mediators. The results from a bootstrap mediation analysis yielded a statistically significant average causal mediation effect (ACME) using perceived competence as the mediator (ACME = 0.022, 95% CI [0.001, 0.054], p = .018). Perceived competence mediated 30.8% of the total effect between gross motor skill scores and steps per minute, with the entire model explaining approximately 13.6% of the variance. The relationship between gross motor skills and school day physical activity may be mediated through perceived competence in sixth-grade children.

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Ryan D. Burns, Timothy A. Brusseau and James C. Hannon

Background:

Comprehensive School Physical Activity Programming (CSPAP) has the potential to increase physical activity (PA) in children over time. The purpose of this study was to examine the effect of CSPAP on school day step counts in children.

Methods:

Participants were 327 fourth and fifth grade children recruited from 4 elementary schools. The study was conducted within an Interrupted Time-Series Design framework. School day step counts were collected for 5 days across preintervention and postintervention time-points (10 days total) using NL-1000 piezoelectric pedometers. Robust piecewise regression examined pre- and postintervention intercepts and slopes, and the change in these parameters using postestimation statistics.

Results:

The slope coefficient was statistically significant across preintervention (β = –105.23, P < .001) but not postintervention time-points (β = –63.23, P = .347), suggesting decreases in steps counts across preintervention and stability of step counts across postintervention school days. Postestimation statistics yielded increases in school day step counts from the end of preintervention (day 5) to the start of postintervention (day 6; t(319) = –4.72, P < .001, Cohen’s d = 4.72).

Conclusions:

The CSPAP intervention increased average school day step counts and attenuated decreases in step counts throughout the school week in children.

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Ryan D. Burns, Timothy A. Brusseau and James C. Hannon

Background:

Optimal levels of moderate-to-vigorous physical activity (MVPA) have been shown to improve health and academic outcomes in youth. Limited research has examined MVPA trajectories throughout a daily middle school physical education (PE) curriculum. The purpose of this study was to examine MVPA trajectories over a daily PE curriculum and the modifying effects of sex, body composition, and cardiorespiratory endurance.

Methods:

One hundred 7th- and 8th-grade students participated in daily PE lessons. There were 66 lessons throughout the semester. MVPA was monitored during each lesson using NL-1000 piezoelectric pedometers. Students were classified into FITNESSGRAM Healthy Fitness Zones using estimated VO2 Max and Body Mass Index (BMI). A population averaged generalized estimating equation was employed to examine MVPA trajectories.

Results:

On average, students’ MVPA decreased over time (β = –0.35, P < .001). Poor student VO2max classification significantly modified the trajectories (β = –0.14, P < .001), however poor BMI classification did not have a modifying effect (β = 0.03, P = .158).

Conclusions:

MVPA decreased in daily PE over time and cardiorespiratory endurance significantly modified the trajectories. The results support that extra efforts have to be made by teachers and students to sustain MVPA behaviors over a semester.

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Ryan D. Burns, Timothy A. Brusseau and James C. Hannon

Background:

The purpose of this study was to examine the effect of a 36-week Comprehensive School Physical Activity Program (CSPAP) on cardiometabolic health markers in children from low-income schools.

Methods:

Participants were 217 school-aged children (mean age = 10.1 ± 1.1 years; 114 girls, 103 boys) recruited from 5 low-income elementary schools. Cardiometabolic health markers were collected in a fasted state at 2 time-points, before commencement of the CSPAP for classroom and school level clustering and the modifying effects of grade level and sex, there were statistically significant improvements in HDL cholesterol (Δ = 3.6 mg/dL, 95% CI: 1.4 mg/dL to 5.8 mg/dL, P = .039), triglycerides (Δ = –14.1 mg/dL, 95% CI: –21.4 mg/dL to –6.8 mg/dL, P = .022), and mean arterial pressure (Δ = –4.3 mmHg, 95% CI: –8.5 mmHg to –0.1 mmHg, P = .041) following the 36-week CSPAP intervention. Sixth-grade children showed decreases in LDL cholesterol (Δ = –15.3 mg/dL, 95% CI: –30.5 mg/dL to –0.1 mg/dL, P = .033).

Conclusions:

Improvements in specific cardiometabolic health markers were found following a 36-week CSPAP in children from low-income schools.

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Ryan D. Burns, Youngwon Kim, Wonwoo Byun and Timothy A. Brusseau

Background: To examine the relationships among school day sedentary times (SED), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) with gross motor skills in children using Compositional Data Analysis. Methods: Participants were 409 children (mean age = 8.4 [1.8] y) recruited across 5 low-income schools. Gross motor skills were assessed using the test for gross motor development—third edition (TGMD-3), and physical activity was assessed using accelerometers. Isometric log-ratio coordinates were calculated by quantifying the relative proportion of percentage of the school day spent in SED, LPA, and MVPA. The associations of the isometric log-ratio coordinates with the TGMD-3 scores were estimated using general linear mixed-effects models adjusted for age, body mass index, estimated aerobic capacity, and school affiliation. Results: A higher proportion of the school day spent in %MVPA relative to %SED and %LPA was significantly associated with higher TGMD-3 total scores (γ MVPA = 14.44, P = .01). This relationship was also observed for the ball skills subtest scores (γ MVPA = 16.12, P = .003). Conclusions: Replacing %SED and %LPA with %MVPA during school hours may be an effective strategy for improving gross motor skills, specifically ball skills, in low-income elementary school-aged children.

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You Fu, Zan Gao, James C. Hannon, Ryan D. Burns and Timothy A. Brusseau Jr.

Background:

This study aimed to examine the effect of a 9-week SPARK program on physical activity (PA), cardiorespiratory endurance (Progressive Aerobic Cardiovascular Endurance Run; PACER), and motivation in middle-school students.

Methods:

174 students attended baseline and posttests and change scores computed for each outcome. A MANOVA was employed to examine change score differences using follow-up ANOVA and Bonferroni post hoc tests.

Results:

MANOVA yielded a significant interaction for Grade × Gender × Group (Wilks’s Λ = 0.89, P < .001). ANOVA for PA revealed significant differences between SPARK grades 6 and 7 (Mean Δ = 8.11, P < .01) and Traditional grades 6 and 8 (Mean Δ = –6.96, P < .01). ANOVA also revealed greater PACER change for Traditional boys in grade 8 (P < .01) and SPARK girls in grade 8 (P < .01). There were significant interactions with perceived competence differences between SPARK grades 6 and 8 (Mean Δ = 0.38, P < .05), Enjoyment differences between SPARK grades 6 and 7 (Mean Δ = 0.67, P < .001), and SPARK grades 6 and 8 (Mean Δ = 0.81, P < .001).

Conclusions:

Following the intervention, SPARK displayed greater increases on PA and motivation measures in younger students compared with the Traditional program.

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Jesse C. Christensen, Caitlin J. Miller, Ryan D. Burns and Hugh S. West

Background: Health care payment reform has increased employers and health insurance companies’ incentive to take measures to control the rising costs of medical care in the United States. To date, limited research has investigated the influence outpatient physical therapy (PT) visits have on clinical outcomes following anterior cruciate ligament reconstruction (ACLR) with and without a concurrent meniscal repair. Objective: To examine the relationship between the number of PT visits and patient-reported outcome scores following ACLR outpatient rehabilitation. Study Design: Retrospective cohort. Level of Evidence: 2b. Methods: Patients following ACLR with (n = 62) and without (n = 328) meniscal repair were identified through an electronic medical record database. Results: Patients with more PT visits had higher knee outcome survey—activities of daily living (KOS-ADL) change scores (P = .01) following ACLR without meniscal repair. Younger patients yielded significantly higher KOS-ADL change scores (P = .05) in the same cohort. Patients in the semisupervised PT visit strata recorded an 11.1 higher KOS-ADL change score compared with patients within the unsupervised PT visit stratum (P = .02). Younger patients also yielded significantly larger reductions in numeric pain (P = .01) following ACLR without meniscal repair. No significant differences were found between PT visits and either patient-reported outcome following ACLR with meniscal repair. Conclusions: Our findings suggest that younger patients and those in a semisupervised PT visit model have superior patient-reported outcomes following ACLR without meniscal repair. Preliminary findings indicate no relationship with PT visits and patient-reported outcomes in patients after ACLR with meniscal repair surgery. Clinical Relevance: These findings promote an alternative model to outpatient PT following ACLR without meniscal repair that may be more clinically effective and value based. There appears to be a need for patients to undergo a balanced regimen of supervised PT and effective interventions that can be conducted independently.

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Ryan D. Burns, Timothy A. Brusseau, Yi Fang, You Fu and James C. Hannon

Purpose:

The purpose of this study was to examine the relationships among waist-to-height ratio (WHtR), aerobic fitness, and cardio-metabolic risk factors in Hispanic children from low-income U.S. schools.

Method:

Participants were 198 Hispanic children from low-income schools (Mean age = 10.3 ± 0.5 years; 119 girls, 79 boys). Waist circumference, height, and cardio-metabolic blood markers were collected in a fasted state. Estimated VO2 Peak scores were also collected. Multilevel generalized mixed effects models were employed to examine the independent effect of WHtR and aerobic fitness classification on a child meeting recommended levels for each cardio-metabolic blood marker.

Results:

A child having a WHtR < 0.5 related to meeting recommended levels for HDL cholesterol (OR = 3.25, p < .01), triglycerides (OR = 2.94, p < .01), glucose (OR = 3.42, p < .01), and related to a lower continuous Mean Arterial Pressure (MAP) score (β = −8.5 mmHg, p < .01). Aerobic fitness classification only independently related to meeting recommended levels for HDL cholesterol (OR = 2.94, p = .010).

Conclusion:

Having a WHtR < 0.5 independently associated with favorable cardio-metabolic blood markers and thus serves as an effective screening tool for cardio-metabolic risk in Hispanic children from low-income schools.

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Ryan D. Burns, James C. Hannon, Timothy A. Brusseau, Patricia A. Eisenman, Pedro F. Saint-Maurice, Greg J. Welk and Matthew T. Mahar

Cardiorespiratory endurance is a component of health-related fitness. FITNESSGRAM recommends the Progressive Aerobic Cardiovascular Endurance Run (PACER) or One mile Run/Walk (1MRW) to assess cardiorespiratory endurance by estimating VO2 Peak. No research has cross-validated prediction models from both PACER and 1MRW, including the New PACER Model and PACER-Mile Equivalent (PACER-MEQ) using current standards. The purpose of this study was to cross-validate prediction models from PACER and 1MRW against measured VO2 Peak in adolescents. Cardiorespiratory endurance data were collected on 90 adolescents aged 13–16 years (Mean = 14.7 ± 1.3 years; 32 girls, 52 boys) who completed the PACER and 1MRW in addition to a laboratory maximal treadmill test to measure VO2 Peak. Multiple correlations among various models with measured VO2 Peak were considered moderately strong (R = .74–0.78), and prediction error (RMSE) ranged from 5.95 ml·kg-1, min-1 to 8.27 ml·kg-1.min-1. Criterion-referenced agreement into FITNESSGRAM’s Healthy Fitness Zones was considered fair-to-good among models (Kappa = 0.31–0.62; Agreement = 75.5–89.9%; F = 0.08–0.65). In conclusion, prediction models demonstrated moderately strong linear relationships with measured VO2 Peak, fair prediction error, and fair-to-good criterion referenced agreement with measured VO2 Peak into FITNESSGRAM’s Healthy Fitness Zones.