Patti-Jean Naylor

Prevention in the first place: schools a setting for action on physical inactivity

Promoting physical activity has become a priority because of its role in preventing childhood obesity and chronic disease. Ecological approaches that recognise the interaction between individuals and the settings in which they spend their time are currently at the forefront of public health action. Schools have been identified as a key setting for health promotion. An overview of the literature addressed the promotion of physical activity in schools and showed that school-based strategies (elementary or high school) that utilised classroom-based education only did not increase physical activity levels; one notable exception was screen time interventions. Although evidence is sparse, active school models and environmental strategies (interventions that change policy and practice) appear to promote physical activity in elementary schools effectively. There is also strong evidence to support multicomponent models in high schools, particularly models that incorporate a family and community component. An emerging trend is to involve youth in the development and implementation of interventions. In the context of childhood obesity and sedentary lifestyles, modest increases in physical activity levels in school-based trials are important. School initiatives must be supported and reinforced in other community settings. Health professionals play a key role as champions in the community, based on their influence and credibility. Health professionals can lend support to school-based efforts by asking about and emphasising the importance of physical activity with patients, encouraging family-based activities, supporting local schools to adopt an “active school” approach and advocating for support to sustain evidence-based and promising physical activity models within schools.

The challenge of low physical activity during the school day: at recess, lunch and in physical education

Purpose To describe physical activity (PA) intensity across a school day and assess the percentage of girls and boys achieving recommended guidelines. Methods The authors measured PA via accelerometry in 380 children (8–11 years) and examined data representing (1) the whole school day, (2) regular class time, (3) recess, (4) lunch and (5) scheduled physical education (PE). Activity was categorised as sedentary (SED), light physical activity (LPA) or moderate to vigorous physical activity (MVPA) using age-specific thresholds. They examined sex differences across PA intensities during each time period and compliance with recommended guidelines. Results Girls accumulated less MVPA and more SED than boys throughout the school day (MVPA −10.6 min; SED +13.9 min) recess (MVPA −1.6 min; SED +1.7 min) and lunch (MVPA −3.1 min; SED +2.9 min). Girls accumulated less MVPA (−6.2 min), less LPA (−2.5 min) and more SED (+9.4 min) than boys during regular class time. Fewer girls than boys achieved PA guidelines during school (90.9% vs 96.2%), recess (15.7% vs 34.1%) and lunch (16.7% vs 37.4%). During PE, only 1.8% of girls and 2.9% of boys achieved the PA guidelines. Girls and boys accumulated similar amounts of MVPA, LPA and SED. Conclusion The MVPA deficit in girls was due to their sedentary behaviour as opposed to LPA. Physical activity strategies that target girls are essential to overcome this deficit. Only a very small percentage of children met physical activity guidelines during PE. There is a great need for additional training and emphasis on PA during PE. In addition schools should complement PE with PA models that increase PA opportunities across the school day.

An active school model to promote physical activity in elementary schools: Action schools! BC

Objective: To assess the impact of an active school model on children’s physical activity (PA). Design: 16-month cluster randomised controlled trial. Setting: 10 elementary schools in Greater Vancouver, BC. Participants: 515 children aged 9–11 years. Intervention: Action Schools! BC (AS! BC) is an active school model that provided schools with training and resources to increase children’s PA. Schools implemented AS! BC with support from either external liaisons (liaison schools, LS; four schools) or internal champions (champion schools, CS; three schools). Outcomes were compared with usual practice (UP) schools (three schools). Main outcome measurements: PA was measured four times during the study using pedometers (step count, steps/day). Results: Boys in the LS group took 1175 more steps per day, on average, than boys in the UP group (95% CI: 97 to 2253). Boys in the CS group also tended to have a higher step count than boys in the UP group (+804 steps/day; 95% CI: −341 to 1949). There was no difference in girls’ step counts across groups. Conclusions: The positive effect of the AS! BC model on boys’ PA is important in light of the current global trend of decreased PA.

Direct and indirect measurement of physical activity in older adults: a systematic review of the literature

BackgroundDue to physiological and cognitive changes that occur with aging, accurate physical activity (PA) measurement in older adults represents a unique challenge. The primary purpose of this study was to systematically review measures of PA and their use and appropriateness with older adults. A secondary aim was to determine the level of agreement between PA measures in older adults.MethodsLiterature was identified through electronic databases. Studies were eligible if they examined the correlation and/or agreement between at least 2 measures, either indirect and/or direct, of PA in older adults (> 65 years of age).ResultsThirty-six studies met eligibility criteria. The indirect and direct measures of PA across the studies differed widely in their ability to address the key dimensions (i.e., frequency, intensity, time, type) of PA in older adults. The average correlation between indirect and direct measures was moderate (r=0.38). The correlation between indirect and other indirect measures (r=0.29) was weak, while correlations between direct measures with other direct measures were high (real world: r= 0.84; controlled settings: r=0.92). Agreement was strongest between direct PA measures with other direct measures in both real world and laboratory settings. While a clear trend regarding the agreement for mean differences between other PA measures (i.e., direct with indirect, indirect with indirect) did not emerge, there were only a limited number of studies that reported comparable units.ConclusionsDespite the lack of a clear trend regarding the agreement between PA measures in older adults, the findings underscore the importance of valid, accurate and reliable measurement. To advance this field, researchers will need to approach the assessment of PA in older adults in a more standardized way (i.e., consistent reporting of results, consensus over cut-points and epoch lengths, using appropriate validation tools). Until then researchers should be cautious when choosing measures for PA that are appropriate for their research questions and when comparing PA levels across various studies.

Implementation of school based physical activity interventions: A systematic review

OBJECTIVE Implementation science is an emerging area in physical activity (PA) research. We sought to establish the current state of the evidence related to implementation of school-based PA models to explore 1) the relationship between implementation and health outcomes, and 2) factors that influence implementation. METHODS We searched 7 electronic databases (1995-2014) and included controlled studies of school-based PA programmes for healthy youth (6-18 y) measuring at least one physical health-related outcome. For objective 1, studies linked implementation level to student-level health outcome(s). For objective 2, studies reported factors associated with implementation. RESULTS There was substantial variability in how health outcomes and implementation were assessed. Few studies linked implementation and health outcomes (n=15 interventions). Most (11/15) reported a positive relationship between implementation and at least one health outcome. Implementation factors were reported in 29 interventions. Of 22 unique categories, time was the most prevalent influencing factor followed by resource availability/quality and supportive school climate. CONCLUSIONS Implementation evaluation supports scale-up of effective school-based PA interventions and thus population-level change. Our review serves as a call to action to 1) address the link between implementation and outcome within the school-based PA literature and 2) improve and standardize definitions and measurement of implementation.

Physical activity of children in family child care.

Physical activity was monitored for 65 boys and girls, during family child care, using accelerometry. Average accelerometer wear time was 7.0 h (SD = 0.83), and average counts per epoch were 104.6 (SD = 31.6). Mean minutes per hour of moderate-vigorous physical activity and sedentary behaviour were 1.76 min (SD = 0.90) and 39.49 min (SD = 4.50), respectively. The very low levels of moderate-vigorous physical activity suggest that the young children in this study may be insufficiently active during child care.

SARS wars: an examination of the quantity and construction of health information in the news media.

The media have the power to sway public perception of health issues by choosing what to publish and the context in which to present information. The media may influence an individuals tendency to overestimate the risk of some health issues while underestimating the risk of others, ultimately influencing health choices. Although some research has been conducted to examine the number of articles on selected health topics, little research has examined how the messages are constructed. The purpose of this article is to describe an examination of the construction of news reports on health topics using aspects of the social amplification of risk model and the elaboration likelihood model of persuasion for theoretical direction. One hundred news media reports (print, radio, television, and Internet) were analyzed in terms of message repetition, context, source, and grammar. Results showed that health topics were more often discussed in terms of risk, by credible sources using strong language. This content analysis provides an empirical starting point for future research into how such health news may influence consumers perceptions of health topics.

Patterns of physical activity in Spanish children: a descriptive pilot study

BACKGROUND The majority of Spanish adults and children do not engage in enough physical activity to be beneficial for health. There is a need for objective and accurate assessment of the proportion of children meeting the physical activity recommendation for health. Assessing patterns of physical activity both between days (during weekdays and weekend days) and within days is of interest to improve our understanding of the variation in Spanish childrens physical activity and to provide efficient intervention programmes. METHODS A sample of 221 children: 136 9-year-old children (68 boys and 68 girls) and 85 15-year-old children (36 girls and 49 boys) from 12 urban public schools in Madrid, Spain entered the study. The variables measured were anthropometric characteristics (height, weight, body mass index) and physical activity measured during four consecutive days using the GT1M accelerometer. RESULTS Younger children were more active and less sedentary than older ones during week and weekend days. Nine-year-old boys and girls achieved significantly (P < 0.05) more moderate to vigorous physical activity (MVPA) and significantly (P < 0.01) less sedentary time than older 15-year-old children. During weekdays more children achieved physical activity recommendations versus weekend days. Physical activity patterns analyses indicated that boys achieved relatively high values of MVPA from 1100 till 1300 h (school break) and from 1800 till 2000 h in comparison with the rest of the day. Girls were substantially different, with the 9-year-old girls having only two obvious peaks of weekday MVPA at lunch (1300) and after school (1900 h) while the adolescent girls had no clear peak of MVPA. CONCLUSIONS Few children achieved the level of MVPA recommended for health; at particular risk were adolescent girls. More effort needs to be devoted to promoting appropriate opportunities for Spanish girls across the day and to promoting physical activity during weekends for all children.

From policy to practice: implementation of physical activity and food policies in schools

PurposePublic policies targeting the school setting are increasingly being used toaddress childhood obesity; however, their effectiveness depends on theirimplementation. This study explores the factors which impeded or facilitatedthe implementation of publicly mandated school-based physical activity andnutrition guidelines in the province of British Columbia (BC), Canada.MethodsSemi-structured interviews were conducted with 50 school informants (17principals - 33 teacher/school informants) to examine the factors associatedwith the implementation of the mandated Daily Physical Activity (DPA) andFood and Beverage Sales in Schools (FBSS) guidelines. Coding used aconstructivist grounded theory approach. The first five transcripts andevery fifth transcript thereafter were coded by two independent coders withdiscrepancies reconciled by a third coder. Data was coded and analysed inthe NVivo 9 software. Concept maps were developed and current theoreticalperspectives were integrated in the later stages of analysis.ResultsThe Diffusion of Innovations Model provided an organizing framework topresent emergent themes. With the exception of triability (not relevant inthe context of mandated guidelines/policies), the key attributes of theDiffusion of Innovations Model (relative advantage, compatibility,complexity, and observability) provided a robust framework for understandingthemes associated with implementation of mandated guidelines. Specifically,implementation of the DPA and FBSS guidelines was facilitated by perceptionsthat they: were relatively advantageous compared to status quo; werecompatible with school mandates and teaching philosophies; had observablepositive impacts and impeded when perceived as complex to understand andimplement. In addition, a number of contextual factors includingavailability of resources facilitated implementation.ConclusionsThe enactment of mandated policies/guidelines for schools is considered anessential step in improving physical activity and healthy eating. However,policy makers need to: monitor whether schools are able to implement theguidelines, support schools struggling with implementation, and document theimpact of the guidelines on students’ behaviors. To facilitate theimplementation of mandated guidelines/policies, the Diffusion of InnovationsModel provides an organizational framework for planning interventions.Changing the school environment is a process which cannot be undertakensolely by passive means as we know that such approaches have not resulted inadequate implementation.

A window of opportunity? Motor skills and perceptions of competence of children in Kindergarten

BackgroundOur aim was to examine the relationship between motor skill proficiency and perceptions of competence of children in their first year of school. We also explored gender-based differences.FindingsParticipants were 260 kindergarten children (mean age = 5y 9 m; boys = 52%) from eight schools; representing 78% of eligible children in those schools. Motor skills were measured using the Test of Gross Motor Development-2 and perceptions of physical competence were assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children. Motor skill scores were generally low (percentile ranks ranged from 16 - 24) but perceptions of physical competence were positive (boys = 18.1/24.0, girls = 19.5/24.0). A MANOVA showed a significant overall effect for gender (Wilks lambda = .84 with F (3, 254) = 15.84, p < 0.001) and univariate F tests were significant for all outcome variables. The relationship between object control skills and perceptions of physical competence among girls was not significant; however all other correlations were modest but significant.ConclusionsAlthough motor skill levels were quite low, the children generally held positive perceptions of their physical competence. These positive perceptions provide a window of opportunity for fostering skillfulness. The modest relationships between perceptions of competence and motor skill proficiency suggest that the children are beginning to make self-judgments at a young age. Accordingly, opportunities for children to become and feel physically competent need to occur early in their school or preschool life.