Jennifer Huberty

After-School Program Impact on Physical Activity and Fitness: A Meta-Analysis

CONTEXT The majority of children do not participate in sufficient amounts of daily, health-enhancing physical activity. One strategy to increase activity is to promote it within the after-school setting. Although promising, the effectiveness of this strategy is unclear. A systematic review was performed summarizing the research conducted to date regarding the effectiveness of after-school programs in increasing physical activity. EVIDENCE ACQUISITION Databases, journals, and review articles were searched for articles published between 1980 and February 2008. Meta-analysis was conducted during July of 2008. Included articles had the following characteristics: findings specific to an after-school intervention in the school setting; subjects aged <or=18 years; an intervention component designed to promote physical activity; outcome measures of physical activity, related constructs, and/or physical fitness. Study outcomes were distilled into six domains: physical activity, physical fitness, body composition, blood lipids, psychosocial constructs, and sedentary activities. Effect sizes (Hedges g) were calculated within and across studies for each domain, separately. EVIDENCE SYNTHESIS Of the 797 articles found, 13 unique articles describing findings from 11 after-school interventions were reviewed. Although physical activity was a primary component of all the tested interventions, only eight studies measured physical activity. From the six domains, positive effect sizes were demonstrated for physical activity (0.44 [95% CI=0.28-0.60]); physical fitness (0.16 [95% CI=0.01-0.30]); body composition (0.07 [95% CI=0.03-0.12]); and blood lipids (0.20 [95% CI=0.06-0.33]). CONCLUSIONS The limited evidence suggests that after-school programs can improve physical activity levels and other health-related aspects. Additional studies are required that provide greater attention to theoretical rationale, levels of implementation, and measures of physical activity within and outside the intervention.

Review and special articleAfter-School Program Impact on Physical Activity and Fitness: A Meta-Analysis

CONTEXT The majority of children do not participate in sufficient amounts of daily, health-enhancing physical activity. One strategy to increase activity is to promote it within the after-school setting. Although promising, the effectiveness of this strategy is unclear. A systematic review was performed summarizing the research conducted to date regarding the effectiveness of after-school programs in increasing physical activity. EVIDENCE ACQUISITION Databases, journals, and review articles were searched for articles published between 1980 and February 2008. Meta-analysis was conducted during July of 2008. Included articles had the following characteristics: findings specific to an after-school intervention in the school setting; subjects aged <or=18 years; an intervention component designed to promote physical activity; outcome measures of physical activity, related constructs, and/or physical fitness. Study outcomes were distilled into six domains: physical activity, physical fitness, body composition, blood lipids, psychosocial constructs, and sedentary activities. Effect sizes (Hedges g) were calculated within and across studies for each domain, separately. EVIDENCE SYNTHESIS Of the 797 articles found, 13 unique articles describing findings from 11 after-school interventions were reviewed. Although physical activity was a primary component of all the tested interventions, only eight studies measured physical activity. From the six domains, positive effect sizes were demonstrated for physical activity (0.44 [95% CI=0.28-0.60]); physical fitness (0.16 [95% CI=0.01-0.30]); body composition (0.07 [95% CI=0.03-0.12]); and blood lipids (0.20 [95% CI=0.06-0.33]). CONCLUSIONS The limited evidence suggests that after-school programs can improve physical activity levels and other health-related aspects. Additional studies are required that provide greater attention to theoretical rationale, levels of implementation, and measures of physical activity within and outside the intervention.

Explaining Long-Term Exercise Adherence in Women Who Complete a Structured Exercise Program

The purpose of this study was to qualitatively examine factors related to physical activity adherence to understand why women continue to participate in long-term exercise after completing a structured exercise program. Data were collected from focus groups, interviews, and e-mails, and analysis used grounded theory. The central category related to physical activity adherence was self-worth. Motivation, activity enjoyment, priorities, body image, ability to access support, and self-regulation skills had an impact on the self-worth of nonadherers and adherers. Women must value themselves enough to continue to participate in physical activity once they start. Exercise and fitness professionals are encouraged to use strategies to increase self-worth and long-term adherence to physical activity. Some recommended strategies include (a) increasing motivation and enjoyment relative to activity, (b) making activity a high priority in a womans life, (c) improving or deemphasizing body image, (d) increasing a womans ability to access support, and (e) facilitating the use of self-regulation strategies. This study is the first to examine qualitative perspectives of exercise adherence among women who completed a structured exercise program. Several concepts related to adherence presented in the quantitative literature are confirmed and enhanced in this study.

Ready for Recess: A Pilot Study to Increase Physical Activity in Elementary School Children.

BACKGROUND Creating an optimal environment at recess may be necessary to maximize physical activity (PA) participation in youth. The purpose of this study was to determine the initial effectiveness of an elementary school recess intervention on the amount of moderate PA (MPA) and vigorous PA (VPA) during recess and the school day. METHODS This school-based intervention included staff training, activity zones, and playground equipment. The PA levels of third, fourth, and fifth grade students (n = 93) at two schools were measured at baseline and post-intervention using ActiGraph accelerometers. Paired t tests were used to compare percentage of time spent during recess in MPA and VPA. Multiple regressions were utilized to model the effect of intervention, age, sex, race, body mass index, and school on minutes spent in MPA and VPA. RESULTS The multiple regression results demonstrated increases of 2.5 minutes of MPA (p < .001) and 2.2 minutes of VPA (p < .001) at recess and an increase of 18.7 minutes of MPA (p < .001) and 4.7 minutes of VPA (p < .001) during the school day. These represent respective increases of 51.2% and 112.2% in the adjusted means of MPA and VPA during recess and respective increases of 92.2% and 71.6% in the adjusted mean of MPA and VPA during school day. CONCLUSION Staff training, recreational equipment, and playground markings are inexpensive, simple ways to increase PA during recess so that children can accumulate minutes of PA to meet the recommended guidelines of 60 minutes per day.

Physical Activity of Children Attending Afterschool Programs Research- and Practice-Based Implications

BACKGROUND Afterschool programs (3PM-6PM; ASPs) are positioned to play a vital role in the improvement of childrens daily physical activity. Recent guidelines specify that children should accumulate 4600 steps per day while attending an ASP. The extent to which ASPs currently meet this goal and how many steps per day children naturally accumulate within the ASP setting is unknown. PURPOSE The purpose of this study was to describe the pedometer-determined physical activity of a large sample of children attending a diverse range of ASPs and evaluate the extent to which ASPs are meeting current physical activity guidelines. METHODS Children (N=934, 51% girls, average 8.2 years; range 4-14 years) enrolled across 25 ASPs wore Walk4Life MVPa pedometers (number of steps accumulated, time spent active [hours:minutes:seconds]) up to 4 days. Data were collected in fall/spring 2010-2011 and analyzed in summer 2011. RESULTS On average, children attended ASPs for 125 minutes per day, accumulated 2944 steps per day, and spent approximately 26.6 minutes per day in physical activity. Only 16.5% of the 1819 daily observations met the 4600 steps per day guideline. No differences in steps per day, minutes per day in physical activity, or demographics were observed among children measured a single day versus 2, 3, or 4 days. Based on current practice, children would need to spend approximately 3.4 hours per day at an ASP to reach 4600 steps per day. CONCLUSIONS Activity levels in ASPs are well below recommendations. Substantial effort is needed to identify strategies ASPs can employ to ensure children are sufficiently active.

Masters Athletes: An Analysis of Running, Swimming and Cycling Performance by Age and Gender

Given the growth in sport participation by masters athletes, the purposes of this paper are to: (1) describe record-level performances of masters athletes in running, swimming and cycling; (2) delineate the age- and gender-related performance decline that occurs in masters athletes in these sports; (3) explain how physiological, sociological and psychological factors affect masters level performance; and (4) provide some tips for continued healthy participation of the masters athlete. World and USA records (criterion and age-group) were plotted by age and gender for masters competitors in running, swimming and cycling. Percent difference was calculated for age-related performance [(age group record – criterion record/criterion record) × 100] and for gender [(womens record – mens record/mens record) × 100]. The smallest performance differences existed between world record performances and records for the youngest masters level competitors (e.g. 35–49 years old). The largest performance differences existed between world record performances and the oldest masters level competitors (e.g. ≥ 80 years old). The slope in declining performances increased notably after the age of 55 years, and womens performances tended to decline faster than those of men, especially in running. In the ≥ 80 years old group, performance declined at a rate that approached or exceeded 100%. Gender differences in middle-distance swimming performance were small compared to gender differences in running and cycling. Although younger athletes still have the advantage with regard to overall performance, masters athletes can continue to compete effectively in a variety of events until late in life.

Agile science: creating useful products for behavior change in the real world

Evidence-based practice is important for behavioral interventions but there is debate on how best to support real-world behavior change. The purpose of this paper is to define products and a preliminary process for efficiently and adaptively creating and curating a knowledge base for behavior change for real-world implementation. We look to evidence-based practice suggestions and draw parallels to software development. We argue to target three products: (1) the smallest, meaningful, self-contained, and repurposable behavior change modules of an intervention; (2) “computational models” that define the interaction between modules, individuals, and context; and (3) “personalization” algorithms, which are decision rules for intervention adaptation. The “agile science” process includes a generation phase whereby contender operational definitions and constructs of the three products are created and assessed for feasibility and an evaluation phase, whereby effect size estimates/casual inferences are created. The process emphasizes early-and-often sharing. If correct, agile science could enable a more robust knowledge base for behavior change.

Translating policies into practice: a framework to prevent childhood obesity in afterschool programs.

Afterschool programs (3-6 p.m.) are positioned to play a critical role in combating childhood obesity. To this end, state and national organizations have developed policies related to promoting physical activity and guiding the nutritional quality of snacks served in afterschool programs. No conceptual frameworks, however, are available that describe the process of how afterschool programs will translate such policies into daily practice to reach eventual outcomes. Drawing from complex systems theory, this article describes the development of a framework that identifies critical modifiable levers within afterschool programs that can be altered and/or strengthened to reach policy goals. These include the policy environment at the national, state, and local levels; individual site, afterschool program leader, staff, and child characteristics; and existing outside organizational partnerships. Use of this framework and recognition of its constituent elements have the potential to lead to the successful and sustainable adoption and implementation of physical activity and nutrition policies in afterschool programs nationwide.

Activate Omaha: The Journey to an Active Living Environment

BACKGROUND Omaha, an urban Nebraska community, represents 26% of the states population. Activate Omaha, formed in 2003, addressed the obesity epidemic caused by physical inactivity and poor infrastructure to support active living in the community. INTERVENTION Activate Omahas efforts focused on a strategic social-marketing campaign, using baseline and annual data for guidance. Complementary programming was implemented parallel to the marketing campaigns. Safe Routes to School infrastructure projects were federally funded, and 20 miles of on-street bicycle facilities were funded privately. The mayors Bicycle Pedestrian Advisory Committee was formed, including directors from city planning and public works. RESULTS The initiative became recognized by the community as the lead resource promoting physical activity. This enabled the initiative to be instrumental in infrastructure changes and programming targeting the underserved. The initiative leveraged an additional

Physical activity barriers and facilitators among working mothers and fathers

1,475,000 over 5 years. These funds created opportunities to invest in shared community resources such as providing bicycles for underserved youth, building infrastructure through Safe Routes to School initiatives, and successful worksite programming. LESSONS LEARNED Partners should be utilized in a strategic manner, where they are engaged purposefully and serve a role in assuring successful outcomes. Community readiness should determine the focus on policy, physical projects, and promotional and programmatic strategies, as well as the integration of these strategies. CONCLUSIONS Activate Omaha grew into a credible organization moving public policy and leveraging new public-private relationships through multilevel strategies. This approach ultimately led to sustainable changes in the community infrastructure and the behavior of its citizens.