Knut Løndal

The Outcomes of a 12-Week Internet Intervention Aimed at Improving Fitness and Health-Related Quality of Life in Overweight Adolescents: The Young & Active Controlled Trial

Background Overweight and obesity among adolescents may have consequences, with potentially lasting effects on health and health-related quality of life (HRQoL). Excess weight is also associated with decreases in physical activity and cardiorespiratory fitness. The aim of the current study was to investigate the short-term effects of a 12-week Internet intervention in a primary care setting intended to increase cardiorespiratory fitness and HRQoL among overweight and obese adolescents. Methods In this controlled trial, participants (13–15 years) were non-randomly allocated to an intervention- or a control group. The intervention group received 12-weeks access to an online program providing tailored physical activity counseling based on principles from Self-determination Theory and Motivational Interviewing. The control group received standard follow-up by the school nurses. The primary outcome measure of cardiorespiratory fitness was determined using a shuttle run test. The secondary outcomes: HRQoL, leisure time exercise, body image and self-determined motivation for physical activity and exercise, were assessed by self-report measures. Age- and gender-adjusted body mass index (BMI) was calculated based on measurements of height and weight. To compare pre-to post intervention differences within groups, a paired samples t-test was used while crude differences between groups were analyzed with an independent samples t-test. Results Of the 120 participants, 108 completed the study, 75 in the intervention group and 33 in the control group. Exposure to the intervention had a small effect on cardiorespiratory fitness (0.14; 95% CI [0.01;0.28]; P = 0.04), and a moderate effect on HRQoL (5.22; 95% CI [0.90; 9.53]; P = 0.02). Moreover, the control group increased significantly in BMI, yielding a moderate preventive effect on BMI (−0.39; 95% CI [−0.74;−0.03]; P = 0.03) for the intervention group. Conclusion The results suggest that the Internet intervention with tailored physical activity counseling can have beneficial short-term effect on cardiorespiratory fitness, HRQoL and BMI among adolescents with overweight and obesity. Trial Registration ClinicalTrials.gov NCT01700309

The relationship between fitness and health-related quality of life and the mediating role of self-determined motivation in overweight adolescents

Aim: To examine the relationship between cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) among overweight adolescents and to test whether this relationship is mediated by body image (BI) and self-determined motivation for physical activity (PA) and exercise. Methods: One hundred and twenty adolescents identified as overweight or obese were recruited through the school health service. The participants completed self-report instruments measuring HRQoL, BI and self-determined motivation for physical activity and exercise in addition to a 20 m shuttle-run test, and body mass index was calculated. Confirmatory factor analysis was conducted to evaluate the hypothesised five-dimensional structure of the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) used to measure self-determined motivation. Associations between the study variables were explored using univariate linear regression. Mediation was tested by a multistage regression approach. Results: The five-dimensional model of BREQ-2 showed acceptable fit for the data. We revealed a statistically significant association between cardiorespiratory fitness and HRQoL (4.16 [0.3–8.02]; p < .05). CRF failed to affect BI in the first mediation equation. Hence, body image was excluded from further analyses. However, self-determined motivation proved to mediate the relationship between CRF and HRQoL. Conclusions: The results of this study suggest that the motivational mechanisms related to fitness can contribute to explain the association between CRF and HRQoL in overweight adolescents. The findings are important from a public health point of view and should be taken into account in the development of PA interventions for overweight and obese adolescents for the potential enhancement of their physical and psychosocial well-being.

Development and Usability Testing of an Internet Intervention to Increase Physical Activity in Overweight Adolescents

Background Internet interventions may provide opportunities for low threshold counseling using feedback to guide and support health behavior, including increased physical activity. Research shows that overweight and obese adolescents are less physically active than their peers of normal weight. There are good reasons to believe that Internet-based interventions may be particularly suitable for motivating adolescents to increase physical activity, but we need to gain further knowledge of what features are effective and how to design such interventions. Objective To describe the process of development and evaluation of usability of a Web-based program for increasing physical activity in overweight adolescents. Methods Informed by the self-determination theory, motivational interviewing, and perspectives on self-regulation, this intervention was developed in a stepwise process by an interdisciplinary team of researchers, designers, developers, and representatives from the target group. An iterative qualitative usability testing approach (observation, survey, and interview) was applied in 2 sequences, first in the lab and second in the field, to assess how adolescents (aged 12-16 years) used and experienced the program and to make adjustments to the program based on evaluation of their response. Results The following components were included in the program: self-monitoring through planning and registration of physical activity and graphical response on progress, autonomy supportive individual Web-based counseling, forum for social support, and relevant age-adjusted information about physical activity. The first usability test resulted in adjustments related mainly to making the content and aim of the different features more visible and explicit. The second test evaluated the program with adjustments from the first test, revealing that the program was well accepted by the participants and only small aesthetic adjustments had to be made to complete the final version of the Internet program, Young & Active. Conclusions Thorough preparation, with clear theory foundation and close monitoring in the developmental phase, as well as contribution and iterative evaluation from the target group, is essential to create a user-friendly and engaging program. The efficacy of the program will be evaluated in a controlled trial.

Children's Lived Experience and their Sense of Coherence: Bodily Play in a Norwegian After-school Programme

This article is based on materials gathered from qualitative research interviews among eight-year-old and nine-year-old children participating in an after-school programme (ASP) in Oslo, and investigates how bodily play affects their sense of coherence (SOC). In line with Maurice Merleau-Ponty, childrens lived experiences are regarded as layered emotions, actions and conceptions from previous bodily engagement. They bind together the living body and its environment into a coherent, personal entirety that gives meaning to new practical situations. The study is based on Aaron Antonovskys theory of SOC. The concept of SOC expresses the extent to which an individual has a feeling of confidence in existence as comprehensible, manageable and meaningful. SOC is regarded as an important assumption for managing the world. The study shows that bodily play in the ASP has a considerable potential of promoting the childrens SOC. Most of the children in the study experience their world as comprehensible, manageable and meaningful. Negative thoughts and feelings are reduced during bodily play. Play offers particularly strong opportunities for the children themselves to shape outcomes, and for being together with other children whom they know well. If a child is excluded from joint bodily play or experiences repetitive unfriendly reports, the experiences of comprehensibility and manageability are reduced, and SOC decreases. The study demonstrates the importance of pedagogical competence among ASP professionals in terms of establishing an inclusive framework that encourage and stimulate child-managed bodily play. Future training of ASP professionals should encourage an understanding of the potential of developing SOC through bodily play.

Targeting and tailoring an intervention for adolescents who are overweight Some ethical concerns

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of responsibility for health behavior, liberty to choose, and the effect on the participants’ psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior.

Active Play in After-school Programmes: development of an intervention and description of a matched-pair cluster-randomised trial assessing physical activity play in after-school programmes

Introduction Interventions delivered in after-school programmes (ASPs) have the potential to become a means of ensuring adequate physical activity among schoolchildren. This requires a motivational climate, allowing for self-determined play. If trained, ASP staff may represent a valuable resource for supporting such play. Increasing knowledge and supportive skills among ASP staff may also potentially increase their motivation for work. The purpose of this article is to describe the development of the ‘Active Play in ASP’ intervention, which aims to promote physical activity among first graders attending ASP, and to present a protocol for a matched-pair cluster-randomised trial to evaluate the intervention. Methods and analysis Informed by experiences from practice, evidence-based knowledge and theory, the intervention was developed in a stepwise process including focus group meetings and a small-scale pilot test. The intervention contains a course programme for ASP staff to increase their skills in how to support physical activity through play. In a cluster randomised controlled trial, the ASPs will be matched and randomly allocated to receive the 7-month intervention or to a control group. Outcomes will be assessed at baseline, after 7 and 19 months. First graders attending the ASPs included are eligible. The primary outcome will be accelerometer-determined minutes in moderate to vigorous physical activity in the ASP. The study uses a mixed methods approach including observations and interviews to provide rich descriptions of the concept of childrens physical activity in ASP. Moreover, the trial will assess whether the ASP staff benefits from participation in the intervention in terms of increased work motivation. Lastly, process evaluations of programme fidelity, satisfaction and suggestions on improvement will be performed. Ethics and dissemination The study is approved by the Data Protection Official for Research (reference no 46008). Results will be presented in conferences and peer-reviewed journals. Trial registration number Clinical Trials (NCT02954614), pre-results.