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Kathleen Van Royen, Roosmarijn Verstraeten, Susana Andrade, Angélica Ochoa-Avilés, Silvana Donoso, Lea Maes and Patrick Kolsteren

Background:

Physical inactivity levels are increasingly prevalent among Ecuadorian adolescents. School-based interventions can be potentially effective in promoting physical activity but must be informed by cultural-specific factors.

Methods:

Twelve focus groups were carried out with adolescents (n = 80) in rural and urban Ecuador to identify factors influencing physical activity. In addition, 4 focus group discussions with parents (n = 32) and 4 with school staff (n = 32) were conducted. Individual and environmental factors were questioned using the ‘Attitude, Social influences and Self-efficacy’ model and the socioecological model as theoretical frameworks.

Results:

Factors influencing physical activity varied between groups. In the rural area farming and norms for girls impeded leisure-time physical activity, whereas urban groups emphasized traffic and crime concerns. Groups from a low socioeconomic status more frequently mentioned a fear of injuries and financial constraints. Several factors were common for all groups including preferences for sedentary activities, poor knowledge, time constraints and laziness, as well as a lack of opportunities at home and school, unsupportive parental rules and lack of role models.

Conclusion:

A conceptual framework including the identified factors emerged to inform the design of a cultural-sensitive school-based intervention to improve physical activity among Ecuadorian adolescents. Future interventions should be tailored to each setting.

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Victoria Catenacci, Christopher Barrett, Lorraine Odgen, Ray Browning, Christine Adele Schaefer, James Hill and Holly Wyatt

Background:

The America on the Move (AOM) Family Intervention Program has been shown to prevent excess weight gain in overweight children. Providing intervention materials via the internet would have the potential to reach more families but may increase sedentary behavior. The purpose was to evaluate whether delivering the AOM Family Intervention via the internet versus printed workbook would have a similar impact on sedentary behaviors in children.

Methods:

131 children (age 8–12) were randomized to receive the AOM Family Intervention via the internet or workbook for 12 weeks. Changes in objectively measured sedentary time and moderate-to vigorous physical activity (MVPA) as well as self-reported screen time were compared between groups.

Results:

There were no significant differences between groups in screen time, sedentary time, or MVPA at the end of the 12 week intervention. Families receiving the intervention via the internet were more likely to remain in the study (98% vs. 82%, P = .016).

Conclusions:

Using the internet to deliver the lifestyle intervention did not increase sedentary behavior in children. Attrition rates were lower when the program was delivered by internet versus via printed materials. These results provide support for using the internet to deliver healthy lifestyle programs for children.

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Stig Eiberg, Henriette Hasselstrom, Vivian Grønfeldt, Karsten Froberg, Ashley Cooper and Lars Bo Andersen

The aim of this study was to investigate whether risk factors for cardiovascular disease cluster in 6- to 7-year-old children and whether low physical fitness is a predictor of risk factor clustering. The study included 369 boys (6.8 ± 0.4 years) and 327 girls (6.7 ± 0.4 years). VO2max was directly measured during a treadmill test. The ratio of total cholesterol to high-density cholesterol, triglyceride levels, the ratio of insulin to glucose, systolic blood pressure, and the sum of four skinfolds were selected as risk factors. A child was considered at risk for individual factors if he or she had values in the least favorable quartile. The number of children with more than three cardiovascular disease cluster risk factors was not significantly different from a binominal distribution. This lack of clustering could be a result of the fact that these young children have not yet developed insulin resistance. Children in the lowest quartile of fitness had an odds ratio of 2.1 (CI: 1.0–4.4) for having three or more risk factors compared with the most fit. This is interesting with regard to prevention because it indicates that an intervention involving increased physical activity might postpone or even prevent the development of risk factors.

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Wagner Luiz Prado, Mara Cristina Lofrano-Prado, Lila Missae Oyama, Michelle Cardel, Priscyla Praxedes Gomes, Maria Laura S.S. Andrade, Camila R.M. Freitas, Prabhakaran Balagopal and James O. Hill

Little is known about how the intensity of aerobic training influences appetite-regulating hormones in obese adolescents. Our goal was to assess the effect of low and high intensity aerobic trainings on food intake and appetite-regulating hormones in obese adolescents. Forty three obese adolescents (age: 13–18y, BMI: 34.48 ± 3.94 kg/m2) were randomized into high intensity training (HIT; n = 20) or low intensity training (LIT; n = 23) groups for 12 weeks. All participants also received the same nutritional, psychological and clinical counseling. Pre- and postintervention energy intake (EI) and circulating levels of insulin, leptin, peptide YY3–36 (PYY3–36) and ghrelin were measured. Adolescents in the HIT showed a reduction in total EI and an increase in PYY3–36 (p < .05). Aerobic exercise training performed at ventilatory threshold 1 intensity, reduced EI and augmented PYY3–36 in obese adolescents, compared with LIT. The data suggest that HIT and LIT have differential effects in the regulation of appetite signals and subsequent EI in obese adolescents.

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Cevdet Cengiz and Mustafa Levent Ince

Background:

The purpose of the study was to determine the effects of a social-ecologic intervention on health-related fitness (HRF) knowledge and behaviors of students (n = 62) living in rural areas.

Methods:

A prepost test control group design was constructed. In addition, qualitative data were collected by focus group discussions in the experimental group. Physical activity environment of a middle school was changed based on the social-ecologic model (SEM) with a focus on intrapersonal, interpersonal, community level, organizational factors, and public policies related to physical activity behavior. Health related fitness knowledge (HRFK) test, pedometer, and perceived physical activity self-efficacy and social support questionnaires were used for data collection.

Results:

Experimental group had significant improvement in HRF knowledge scores, physical activity levels, and social support compared with the control school students. The focus group results also supported the quantitative findings by indicating a perceived increase in physical activity opportunities; knowledge sources; and support from others.

Conclusions:

This study underlines the importance and positive outcomes of SEM in improving HRF knowledge, physical activity level, and social support of students in rural middle school settings.

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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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JoEllen Wilbur, Michael E. Schoeny, Susan W. Buchholz, Louis Fogg, Arlene Michaels Miller, Lynne T. Braun, Shannon Halloway and Barbara L. Dancy

Background:

For interventions to be implemented effectively, fidelity must be documented. We evaluated fidelity delivery, receipt, and enactment of the 48-week Women’s Lifestyle Physical Activity Program conducted to increase physical activity and maintain weight in African American women.

Methods:

Three study conditions all received 6 group meetings; 1 also received 11 motivational interviewing personal calls (PCs), 1 received11 automated motivational message calls (ACs), and 1 received no calls. Group meeting delivery was assessed for adherence and competence. PC delivery was assessed with the Motivational Interviewing Treatment Integrity Code. Receipt was defined as group meeting attendance, completion of PCs, and listening to ACs. Enactment was number of weeks an accelerometer was worn.

Results:

For group meeting delivery, mean adherence was 80.8% and mean competence 2.9 of 3.0. Delivery of PCs did not reach criterion for competence. Receipt of more than one-half the dose was achieved for 84.9% of women for group meetings, 85.5% for PCs, and 42.1% for ACs. Higher group meeting attendance was associated with higher accelerometer steps at 24 weeks and lower BMI at 24 and 48 weeks.

Conclusions:

Fidelity measurement and examination of intervention delivery, receipt, and enactment are important to explicate conditions in which interventions are successful.

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Susanne James-Burdumy, Nicholas Beyler, Kelley Borradaile, Martha Bleeker, Alyssa Maccarone and Jane Fortson

Background:

The Playworks program places coaches in low-income urban schools to engage students in physical activity during recess. The purpose of this study was to estimate the impact of Playworks on students’ physical activity separately for Hispanic, non-Hispanic black, and non-Hispanic white students.

Methods:

Twenty-seven schools from 6 cities were randomly assigned to treatment and control groups. Accelerometers were used to measure the intensity of students’ physical activity, the number of steps taken, and the percentage of time in moderate-to-vigorous physical activity (MVPA) during recess. The impact of Playworks was estimated by comparing average physical activity outcomes in treatment and control groups.

Results:

Compared with non-Hispanic black students in control schools, non-Hispanic black students in Playworks schools recorded 338 more intensity counts per minute, 4.9 more steps per minute, and 6.3 percentage points more time in MVPA during recess. Playworks also had an impact on the number of steps per minute during recess for Hispanic students but no significant impact on the physical activity of non-Hispanic white students.

Conclusions:

The impact of Playworks was larger among minority students than among non-Hispanic white students. One possible explanation is that minority students in non-Playworks schools typically engaged in less physical activity, suggesting that there is more room for improvement.

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Ikuyo Imayama, Catherine M. Alfano, Caitlin E. Mason, Chiachi Wang, Liren Xiao, Catherine Duggan, Kristin L. Campbell, Karen E. Foster-Schubert, Ching-Yun Wang and Anne McTiernan

Background:

Regular exercise increases exercise self-efficacy and health-related quality of life (HRQOL); however, the mechanisms are unknown. We examined the associations of exercise adherence and physiological improvements with changes in exercise self-efficacy and HRQOL.

Methods:

Middle-aged adults (N = 202) were randomized to 12 months aerobic exercise (360 minutes/week) or control. Weight, waist circumference, percent body fat, cardiopulmonary fitness, HRQOL (SF-36), and exercise self-efficacy were assessed at baseline and 12 months. Adherence was measured in minutes/day from activity logs.

Results:

Exercise adherence was associated with reduced bodily pain, improved general health and vitality, and reduced role-emotional scores (P trend ≤ 0.05). Increased fitness was associated with improved physical functioning, bodily pain and general health scores (P trend ≤ 0.04). Reduced weight and percent body fat were associated with improved physical functioning, general health, and bodily pain scores (P trend < 0.05). Decreased waist circumference was associated with improved bodily pain and general health but with reduced role-emotional scores (Ptrend ≤ 0.05). High exercise adherence, increased cardiopulmonary fitness and reduced weight, waist circumference and percent body fat were associated with increased exercise self-efficacy (P trend < 0.02).

Conclusions:

Monitoring adherence and tailoring exercise programs to induce changes in cardiopulmonary fitness and body composition may lead to greater improvements in HRQOL and self-efficacy that could promote exercise maintenance.

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David P. French, Catherine D. Darker, Frank F. Eves and Falko F. Sniehotta

The Theory of Planned Behavior (TPB) has been extensively used in predictive studies, but there have been considerably fewer experimental tests of the theory. One reason for this is that the guidance on developing concrete intervention strategies from the abstract theory is vague, and there are few exemplars of how to do this. The aim of this article is to provide such an exemplar. The development of an intervention to increase walking in the general public is described, based on the TPB, extended to include postvolitional processes. Identification of target constructs, elicitation of key salient beliefs underpinning these constructs, selection of appropriate behavior change techniques, and technique refinement. Each step is based on available evidence and consistent with theory. Perceived behavioral control (PBC) was identified as the key determinant of walking intentions, with an “intention-behavior gap” noted. A brief intervention was developed, using techniques to increase PBC by rehearsal of previous successful performance of behavior, along with planning techniques to translate motivation into behavior. This systematic approach taken should provide a model for others. The intervention has demonstrated efficacy in producing large changes in objectively measured walking behavior, in 2 separate evaluations reported elsewhere.