Chris Lonsdale

A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons

OBJECTIVES Physical education (PE) that allows students to engage in moderate-to-vigorous physical activity (MVPA) can play an important role in health promotion. Unfortunately, MVPA levels in PE lessons are often very low. In this review, we aimed to determine the effectiveness of interventions designed to increase the proportion of PE lesson time that students spend in MVPA. METHODS In March 2012, we searched electronic databases for intervention studies that were conducted in primary or secondary schools and measured the proportion of lesson time students spent in MVPA. We assessed risk of bias, extracted data, and conducted meta-analyses to determine intervention effectiveness. RESULTS From an initial pool of 12,124 non-duplicate records, 14 studies met the inclusion criteria. Students in intervention conditions spent 24% more lesson time in MVPA compared with students in usual practice conditions (standardized mean difference=0.62). CONCLUSIONS Given the small number of studies, moderate-to-high risk of bias, and the heterogeneity of results, caution is warranted regarding the strength of available evidence. However, this review indicates that interventions can increase the proportion of time students spend in MVPA during PE lessons. As most children and adolescents participate in PE, these interventions could lead to substantial public health benefits.

Athlete burnout in elite sport: A self-determination perspective

Abstract Using self-determination theory (Deci & Ryan, 1985) as the theoretical framework, we examined potential antecedents of athlete burnout in 201 elite Canadian athletes (121 females, 80 males; mean age 22.9 years). Employing a cross-sectional design, our primary aims were to investigate the relationships between behavioural regulations and athlete burnout and to examine whether self-determined motivation mediated relationships between basic needs satisfaction and athlete burnout. Our self-determination theory-derived hypotheses were largely supported. Relationships among athlete burnout and behavioural regulations mostly varied according to their rank on the self-determination continuum, with less self-determined motives showing positive associations and more self-determined motives showing negative correlations with burnout. The basic needs of competence and autonomy, plus self-determined motivation, accounted for significant amounts of variance in athlete burnout symptoms (exhaustion, R 2 = 0.31; devaluation, R 2 = 0.49; reduced accomplishment, R 2 = 0.61; global burnout, R 2 = 0.74). Self-determined motivation fully mediated the relationships that competence and autonomy had with exhaustion. Analyses showed indirect relationships between these two needs and devaluation, through their associations with self-determined motivation. Motivation partially mediated the needs-reduced sense of accomplishment relationships, but the direct effects were more prominent than the indirect effects.

Self-determined motivation and physical activity in children and adolescents : A systematic review and meta-analysis

OBJECTIVE Self-determination theory is used as a framework for examining the relation between motivation and physical activity. The purpose of this review was to systematically review studies that assessed the association between self-determined motivation and physical activity levels in children and adolescents. METHOD We searched electronic databases in April 2013. Included studies assessed the relation between motivation (as outlined in self-determination theory) and physical activity in children and adolescents. RESULTS Forty-six studies (n=15,984 participants) met the inclusion criteria. Meta-analysis indicated that overall levels of self-determined motivation had a weak to moderate, positive associations with physical activity (ρ=.21 to .31). Autonomous forms of motivation (i.e., intrinsic motivation and identified regulation) had moderate, positive associations with physical activity (ρ=.27 to .38), whereas controlled forms of motivation (i.e., introjection and external regulation) had weak, negative associations with physical activity (ρ=-.03 to -.17). Amotivation had a weak, negative association with physical activity (ρ=-.11 to -.21). CONCLUSIONS Evidence provides some support for self-determination theory tenets. However, there was substantial heterogeneity in most associations and many studies had methodological shortcomings.

A cluster-randomized controlled trial of strategies to increase adolescents’ physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial

BackgroundThe physical activity (PA) levels of many children and adolescents in Australia are currently insufficient to promote health benefits. Physical education (PE) programs aim to promote PA and reach nearly all school-aged children, but PA levels within PE lessons are often low. PE teachers may influence children’s motivation to be physically active in PE lessons, but little is known about teacher strategies that effectively motivate children to participate in PA, and few intervention studies have examined motivational strategies in PE. The purpose of this study was to compare the effect of three motivational strategies, each based on Self-Determination Theory (SDT), on PA levels, and their hypothesized antecedents, during year 8 PE lessons.Methods/designThis study employed a cluster-randomized controlled trial design. Following a familiarization session, PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson. Teachers (n = 16) and their classes from five secondary schools in Sydney, Australia were randomly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions: (1) explaining the relevance of activities; (2) providing choice from PA options selected by the teacher; (3) providing equipment and free choice of activities; or (4) usual practice. The primary outcomes were lesson time spent in moderate-to-vigorous PA, and motivation towards the lesson. Secondary outcomes were perceptions of teacher behavior, psychological needs satisfaction, and lesson time spent in sedentary behavior. PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers. Teacher behavior, psychological needs satisfaction, and motivation were assessed via questionnaires at the end of each lesson. Linear mixed-model analyses will be run on all outcomes, with students nested within teachers as a random effect.DiscussionStudy findings will inform the development of effective SDT-based teaching strategy interventions to enhance students’ psychological needs satisfaction, motivation, and PA levels. More effective teaching strategies may be identified that are capable of improving adolescents’ PA levels, and thereby provide beneficial population health outcomes.Trial registrationThis trial is registered with Current Controlled Trials and is traceable as ISRCTN07038258.

Temporal Ordering of Motivational Quality and Athlete Burnout in Elite Sport

INTRODUCTION Using self-determination theory as the theoretical framework, we conducted a longitudinal investigation of the relationships between motivation and athlete burnout. We tested four hypotheses: H0: low self-determination (SD) does not precede burnout, and burnout does not precede low SD; H1: low SD precedes burnout; H2: burnout precedes low SD; and H3: burnout and motivation have a reciprocal relationship. METHODS We used a two-wave design, with the follow-up assessment 4 months after baseline. Elite New Zealand athletes (n=119, mean age=24.74 yr (standard deviation=8.54 yr); 57.14% of whom were females) completed the Athlete Burnout Questionnaire and the Behavioral Regulation in Sport Questionnaire. Structural equation modeling of cross-lagged panel models was used to test the hypotheses. RESULTS The relationship between motivation and burnout varied depending on the type of motivation assessed. Analyses related to overall levels of self-determined motivation, amotivation, and controlled forms of extrinsic motivation provided support for H1: low SD precedes burnout. When compared with external regulation, introjected regulation seemed to be a clearer antecedent of athlete burnout. Analyses related to the self-determined forms of extrinsic motivation provided support for H2: burnout precedes low SD. The only analyses in which the null hypothesis could not be rejected were those relating to intrinsic motivation. Finally, there was little support for a reciprocal effects model. CONCLUSIONS Low levels of self-determination may lead to increases in athlete burnout, whereas athlete burnout may precede decrements in self-determined extrinsic motivation. Particular efforts could be made to help support the basic psychological needs of athletes with controlled forms of motivation, thereby leading to an internalization of motivation and decreased risk of burnout.

Effect of an office worksite-based yoga program on heart rate variability: outcomes of a randomized controlled trial

BackgroundChronic work-related stress is an independent risk factor for cardiometabolic diseases and associated mortality, particularly when compounded by a sedentary work environment. The purpose of this study was to determine if an office worksite-based hatha yoga program could improve physiological stress, evaluated via heart rate variability (HRV), and associated health-related outcomes in a cohort of office workers.MethodsThirty-seven adults employed in university-based office positions were randomized upon the completion of baseline testing to an experimental or control group. The experimental group completed a 10-week yoga program prescribed three sessions per week during lunch hour (50 min per session). An experienced instructor led the sessions, which emphasized asanas (postures) and vinyasa (exercises). The primary outcome was the high frequency (HF) power component of HRV. Secondary outcomes included additional HRV parameters, musculoskeletal fitness (i.e. push-up, side-bridge, and sit & reach tests) and psychological indices (i.e. state and trait anxiety, quality of life and job satisfaction).ResultsAll measures of HRV failed to change in the experimental group versus the control group, except that the experimental group significantly increased LF:HF (p = 0.04) and reduced pNN50 (p = 0.04) versus control, contrary to our hypotheses. Flexibility, evaluated via sit & reach test increased in the experimental group versus the control group (p < 0.001). No other adaptations were noted. Post hoc analysis comparing participants who completed ≥70% of yoga sessions (n = 11) to control (n = 19) yielded the same findings, except that the high adherers also reduced state anxiety (p = 0.02) and RMSSD (p = 0.05), and tended to improve the push-up test (p = 0.07) versus control.ConclusionsA 10-week hatha yoga intervention delivered at the office worksite during lunch hour did not improve HF power or other HRV parameters. However, improvements in flexibility, state anxiety and musculoskeletal fitness were noted with high adherence. Future investigations should incorporate strategies to promote adherence, involve more frequent and longer durations of yoga training, and enrol cohorts who suffer from higher levels of work-related stress.Trial registrationACTRN12611000536965

On the temporal and behavioural consistency of pre-performance routines: an intra-individual analysis of elite basketball players' free throw shooting accuracy.

Abstract The effectiveness of pre-performance routines on skilled performance in a self-paced skill has yet to be verified. In this study, we examine the importance of temporal and behavioural consistency in these routines. The duration and specific pattern of behaviours exhibited before each free throw (n = 284) were observed during 14 National Basketball Association play-off games. An intra-individual standardized score was calculated for each shots duration. Each players dominant behavioural routine was identified and each shot was classified as “sequence followed” or “sequence not followed”. No difference was observed in the success rates of shots associated with brief, long, and regular duration routines (P > 0.05). However, players were more successful when they followed their dominant behavioural sequence (83.77% success) than when they deviated from their specific behavioural pattern (71.43% success) (P < 0.05). The findings are interpreted in light of relevant theory and implications for practice are discussed.

Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

BackgroundPhysical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations.Methods/DesignThis study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded.We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects.DiscussionThis trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations.Trial RegistrationCurrent Controlled Trials ISRCTN63723433

Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092)

Abstract Effectiveness of brief/minimal contact self-activation interventions that encourage participation in physical activity (PA) for chronic low back pain (CLBP >12 weeks) is unproven. The primary objective of this assessor-blinded randomized controlled trial was to investigate the difference between an individualized walking programme (WP), group exercise class (EC), and usual physiotherapy (UP, control) in mean change in functional disability at 6 months. A sample of 246 participants with CLBP aged 18 to 65 years (79 men and 167 women; mean age ± SD: 45.4 ± 11.4 years) were recruited from 5 outpatient physiotherapy departments in Dublin, Ireland. Consenting participants completed self-report measures of functional disability, pain, quality of life, psychosocial beliefs, and PA were randomly allocated to the WP (n = 82), EC (n = 83), or UP (n = 81) and followed up at 3 (81%; n = 200), 6 (80.1%; n = 197), and 12 months (76.4%; n = 188). Cost diaries were completed at all follow-ups. An intention-to-treat analysis using a mixed between–within repeated-measures analysis of covariance found significant improvements over time on the Oswestry Disability Index (Primary Outcome), the Numerical Rating Scale, Fear Avoidance-PA scale, and the EuroQol EQ-5D-3L Weighted Health Index (P < 0.05), but no significant between-group differences and small between-group effect sizes (WP: mean difference at 6 months, 6.89 Oswestry Disability Index points, 95% confidence interval [CI] −3.64 to −10.15; EC: −5.91, CI: −2.68 to −9.15; UP: −5.09, CI: −1.93 to −8.24). The WP had the lowest mean costs and the highest level of adherence. Supervised walking provides an effective alternative to current forms of CLBP management.

Pilates exercise or stationary cycling for chronic nonspecific low back pain: does it matter? a randomized controlled trial with 6-month follow-up.

Study Design. Randomized controlled trial. Objective. This is the companion study to a previous publication that presented 8-week pain, disability, and trunk muscle motor control results. The objective of this study was to compare the effect of 8 weeks of specific trunk exercises and stationary cycling on outcomes measures of catastrophizing and fear-avoidance beliefs (FAB) in patients with chronic nonspecific low back pain, and provide 6-month outcome data for all self-report measures. Summary of Background Data. It is thought that any form of moderate-to-vigorous physical activity is sufficient to address catastrophizing and FAB, and concomitant levels of pain and disability. Methods. Sixty-four patients with low back pain were randomly assigned to 8 weeks of specific trunk exercise group (SEG), or stationary cycling group (CEG). Self-rated pain, disability, catastrophizing and FAB scores were collected before, immediately after (8 wk), and 6 months after the training program. Clinically meaningful improvements were defined as greater than a 30% reduction from baseline in pain and disability scores. “Intention-to-treat” principles were used for missing data. Per-protocol analysis was performed on participants who attended at least two-thirds of the exercise sessions. Results. At 8 weeks, disability was significantly lower in the SEG compared with the CEG (d = 0.62, P = 0.018). Pain was reduced from baseline in both the groups after training (P < 0.05), but was lower for the SEG (P < 0.05). FAB scores were reduced in the SEG at 8 weeks, and in the CEG at 6 months. No between-group differences in FAB scores were observed. Similar reductions in catastrophizing in each group were observed at each time point. At 6 months, the overall data pattern suggested no long-term difference between groups. Per-protocol analysis of clinically meaningful improvements suggests no between-group differences for how many patients are likely to report improvement. Conclusion. Inferential statistics suggest greater improvements at 8 weeks, but not 6 months, for the SEG. Inspection of clinically meaningful changes based on a minimum level of adherence suggests no between-group differences. If a patient with low back pain adheres to either specific trunk exercises or stationary cycling, it is reasonable to think that similar improvements will be achieved. Level of Evidence: 2