Lorraine B. Robbins

Computer- and web-based interventions to increase preadolescent and adolescent physical activity: A systematic review

AIM This review examined evidence regarding computer- or web-based interventions to increase preadolescent and adolescent physical activity. BACKGROUND Todays youth are less active and more overweight than their counterparts from 25 years ago. Overweight youth tend to become overweight adults with weight-related maladies, including type 2 diabetes and cardiovascular problems. Interventions to increase physical activity that reach a large audience are needed. Computer- and web-based physical activity interventions are an appealing means to influence physical activity in preadolescents and adolescents. However, their effectiveness must be determined. DATA SOURCES The following electronic databases were searched for studies published from 1998 through 2010: CINAHL, PubMed, PsycINFO, Sociological Abstracts, SportDISCUS and Proquest. REVIEW METHODS A systemic review was conducted. Fourteen randomized control trials or quasi-experimental studies were reviewed to: (1) determine the effect of computer- or web-based interventions on increasing physical activity and/or improving body mass index, weight, percent body fat or waist circumference as a result of increasing physical activity; and (2) examine if additional components associated with these interventions increased success. RESULTS   Although most interventions demonstrated statistically significant increases in physical activity or positive health changes related to physical activity, findings were small or short-lived. The value of conducting the interventions at school, using a theory or model as a framework, and supplementing with individual tailoring and parental involvement, is discussed. CONCLUSION Computer- and web-based interventions can promote physical activity among preadolescents and adolescents, particularly in schools. However, further efforts are needed to sustain positive changes.

Social Support for Physical Activity of Middle School Students

OBJECTIVE To explore gender and age differences in social support and their relationship with physical activity. DESIGN AND SAMPLE This cross-sectional study with enhanced reliability due to repeated measures involved 105 boys and 101 girls. MEASUREMENTS Information on sources and forms of social support, as well as physical activity, was obtained from students, who completed the same questionnaire twice, 2 weeks apart. RESULTS Boys, compared with girls, were more likely to name fathers and less likely to identify sisters. Compared with older boys, older girls were less likely to identify fathers. Older girls were less likely than both younger girls and older boys to name brothers. Students who identified fathers reported more minutes and days of physical activity and had a stronger physical activity self-definition than those who did not name fathers. Students who selected peers and sisters had more minutes of physical activity and a stronger physical activity self-definition, respectively, than those who did not name peers and sisters. Transportation and encouragement were related to physical activity. CONCLUSIONS Gender differences in social support are not uniform across age groups. Awareness of these differences can inform the development of appropriate physical activity programs.

Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review

AIMS To: (1) determine the effect of computer- and web-based interventions on improving eating behavior (e.g. increasing fruit and vegetable consumption; decreasing fat consumption) and/or diet-related physical outcomes (e.g. body mass index) among children and adolescents; and (2) examine what elements enhance success. BACKGROUND Children and adolescents are the heaviest they have ever been. Excess weight can carry into adulthood and result in chronic health problems. Because of the capacity to reach large audiences of children and adolescents to promote healthy eating, computer- and web-based interventions hold promise for helping to curb this serious trend. However, evidence to support this approach is lacking. DESIGN Systematic review using guidelines from the Cochrane Effective Practice and Organisation of Care Group. DATA SOURCES The following databases were searched for studies from 1998-2011: CINAHL; PubMed; Cochrane; PsycINFO; ERIC; and Proquest. REVIEW METHODS Fifteen randomized controlled trials or quasi-experimental studies were analysed in a systematic review. RESULTS Although a majority of interventions resulted in statistically significant positive changes in eating behavior and/or diet-related physical outcomes, interventions that included post intervention follow-up, ranging from 3-18 months, showed that changes were not maintained. Elements, such as conducting the intervention at school or using individually tailored feedback, may enhance success. CONCLUSION Computer- and web-based interventions can improve eating behavior and diet-related physical outcomes among children and adolescents, particularly when conducted in schools and individually tailored. These interventions can complement and support nursing efforts to give preventive care; however, maintenance efforts are recommended.

Exercise Self-Efficacy, Enjoyment, and Feeling States Among Adolescents

Knowledge of cognitions and feelings related to physical activity (PA) can assist in counseling adolescents to prevent the decrease in PA that occurs during this developmental period. This study, which involves a 2 (gender) 2 (race) 3 (developmental stage) design, examines relationships among PA self-efficacy (SE), enjoyment, and feeling states (FS) during PA and compares responses among 168 African American and European American boys and girls during early, middle, and late adolescence. More positive FS during a standardized PA episode on a treadmill predicts higher postactivity SE and greater enjoyment of the task. FS worsens as the session progresses, particularly for adolescents who in early puberty, report feeling significantly worse than those in both middle and late puberty at 16 minutes and 20 minutes. Findings suggest that nurses should assist adolescents to reduce negative feelings during activity to augment PA enjoyment, as well as SE following PA.

Pilot Intervention to Increase Physical Activity Among Sedentary Urban Middle School Girls: A Two-Group Pretest-Posttest Quasi-Experimental Design

The primary purpose of the study was to determine whether girls in one school receiving nurse counseling plus an after-school physical activity club showed greater improvement in physical activity, cardiovascular fitness, and body composition than girls assigned to an attention control condition in another school (N = 69). Linear regressions controlling for baseline measures showed no statistically significant group differences, but the directionality of differences was consistent with greater intervention group improvement for minutes of moderate to vigorous physical activity/hour (t = 0.95, p = .35), cardiovascular fitness (t = 1.26, p = .22), body mass index (BMI; t = −1.47, p = .15), BMI z score (t = −1.19, p = .24), BMI percentile (t = −0.59, p = .56), percentage body fat (t = −0.86, p = .39), and waist circumference (t = −0.19, p = .85). Findings support testing with a larger sample.

Psychometric assessment of the adolescent physical activity perceived benefits and barriers scales

The purpose of this study was to psychometrically test the Adolescent Physical Activity Perceived Benefits and Barriers Scales developed for middle-school-age youth. A total of 206 racially diverse 6th, 7th, and 8th graders completed questionnaires at two time points (2 weeks apart). For the 10-item Perceived Benefits Scale and the 9-item Perceived Barriers Scale, test–retest reliability (r = .70; r = .71, respectively) and internal consistency (Cronbach’s alpha was .80 and .79, respectively, at time 1) were supported. Principal components analysis with Varimax rotation was employed to assess construct validity. A 2-factor solution emerged for each scale as predicted. The relationship between both scale scores and self-reported physical activity provided additional evidence of validity. Both instruments were found to be reliable and valid for measuring the perceived benefits of and barriers to physical activity in middle school youth.

Treatment Fidelity of Motivational Interviewing Delivered by a School Nurse to Increase Girls' Physical Activity

Motivational interviewing, which involves the use of person-centered, directive counseling techniques, shows promise for changing adolescent behaviors. The purpose of this article was to describe the methodology and findings related to the treatment fidelity of three face-to-face motivational interviewing sessions involving middle school girls and a school nurse to help the girls increase their moderate-to-vigorous physical activity. The following four areas related to treatment fidelity were addressed: (a) study design, (b) training of interventionists, (c) intervention delivery, and (d) intervention receipt. Findings showed that 34 of 37 (91.9%) girls completed all three sessions. An initial motivational interviewing training workshop followed by evaluation of audiotaped sessions with constructive feedback can result in successful and consistent delivery by a school nurse.

Girls on the Move intervention protocol for increasing physical activity among low-active underserved urban girls: a group randomized trial

BackgroundIncreasing moderate to vigorous physical activity among urban girls of low socioeconomic status is both a challenge and a public health priority. Physical activity interventions targeting exclusively girls remain limited, and maintenance of moderate to vigorous physical activity during the post-intervention period has been difficult to maintain. The main aim of the 5-year “Girls on the Move” group randomized trial is to evaluate the efficacy of a comprehensive school-based intervention in increasing girls’ minutes of moderate to vigorous physical activity and improving cardiovascular fitness, body mass index, and percent body fat immediately post-intervention (after 17 weeks) and at 9-month post-intervention follow-up (9 months after end of intervention).Methods/DesignA total of 24 urban middle schools in the Midwestern U.S. will be randomized to either receive the intervention or serve as a control (N = 1200 girls). The intervention, based on the Health Promotion Model and Self-Determination Theory, will include: (1) two face-to-face motivational, individually tailored counseling sessions with a registered nurse, one at the beginning and the other at the end of the intervention period; (2) an interactive Internet-based session during which each girl receives individually tailored motivational and feedback messages via iPad at 11 weeks (shortly after midpoint of intervention); and (3) a 90-minute after-school physical activity club. Racially diverse, low-active, 10- to 14-year-old 5th to 8th-grade girls will complete questionnaires and physical measures at baseline and post-intervention (n = 50 per school). Minutes of moderate to vigorous physical activity will be assessed with accelerometers. Cardiovascular fitness will be assessed by estimating VO2 max with PACER (Progressive Aerobic Cardiovascular Endurance Run) scores. Height and weight will be assessed to calculate body mass index. Percent body fat will be estimated with a foot-to-foot bioelectric impedance scale. Linear mixed effects regression analyses will be performed to assess intervention effects.DiscussionThis multi-component approach is expected to improve girls’ moderate to vigorous physical activity and related physical outcomes.Trial RegistrationClinicalTrials.gov Identifier NCT01503333

Physical activity self-definition among adolescents.

Since research involving adults indicates that physical activity (PA) self-definition influences PA participation, understanding PA self-definition and related factors, such as PA frequency and enjoyment, in youth is essential for designing interventions to reverse the decline in PA that occurs from childhood through adolescence. The objective of this study was to explore correlates of PA self-definition and assess differences in PA self-definition among African American and European American boys and girls in early, middle, and late puberty. A 3 (developmental stage) ¥ 2 (gender) design was used. African American and European American boys and girls, ages 9 to 17, participated. A total of 168 adolescents completed demographic data, developmental stage, and current and future PA self-definition questionnaires. Peak VO2 was obtained as a measure of physical fitness. Current PA self-definition was positively correlated with peak VO2 (p < .01) and future PA self-definition (p < .01). Males had higher current (p = .032) and future (p = .021) PA self-definition than females. The finding that boys have stronger current and future PA self-definitions than girls highlights the challenge for health professionals to enact immediate and effective measures to alter girls’ perceptions of themselves in terms of PA participation. Since current PA self-definition is also significantly correlated with future PA participation, strategies to assist girls in developing a strong PA self-definition may contribute to increased PA in their adult years.

Attention to fidelity: why is it important.

Clinical trials are epitomized by control of extraneous contextual and demographic variables. Participants in intervention and control or comparison groups are assessed for similarities and differences. The content, dose, and duration of interventions are prescribed explicitly. Interventionists are trained, supervised, evaluated, and in some cases retrained during the intervention to ensure adherence to the protocol. Outcome variables are assessed before and after the intervention, and those variables that could influence the results are controlled statistically. Implementing interventions found to be effective in research provides an empirical base for practice, yet control in practice is elusive. Fidelity is paramount in translating research to practice. Fidelity (sometimes called integrity; or delivery, treatment, intervention, or implementation fidelity) is defined as the degree to which an intervention or procedure is delivered as intended. One of the most important factors when implementing empirically supported interventions is that they are delivered with fidelity. In fact, lack of fidelity to an intervention model may underlie why interventions that work well in highly controlled research trials fail to produce the same outcomes in real-world settings. Therefore, monitoring and assuring fidelity is critical in replicating the beneficial results of an intervention in a variety of settings and populations. Therefore, developing a comprehensive fidelity plan is critical for dissemination and translation into practice. Fidelity is an important component of implementation science (Eccles & Mittman, 2006). Implementation science is ‘‘the scientific study of methods to promote the systematic uptake of research findings (and other EBPs) into routine practice, and, hence, to improve the quality and effectiveness of health services and care’’ (Eccles & Mittman, 2006, {2). In other words, implementation science is the study of how research and evidence-based practices (EBPs) are adopted and used in day-to-day practice with fidelity being key to achieving the positive effects in the adoption and implementation process.