Publications by authors named "Russell Jago"

210 Publications

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis.

Int J Behav Nutr Phys Act 2021 02 10;18(1):28. Epub 2021 Feb 10.

MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.

Purpose: The Structured Days Hypothesis (SDH) posits that children's behaviors associated with obesity - such as physical activity - are more favorable on days that contain more 'structure' (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children's moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods: Data were received from the International Children's Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings: Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions: Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.
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http://dx.doi.org/10.1186/s12966-021-01095-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877033PMC
February 2021

A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners.

Int J Behav Nutr Phys Act 2021 02 10;18(1):22. Epub 2021 Feb 10.

The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK.

Background: Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens.

Methods: We conducted a secondary analysis of the interventions included in the Cochrane Review on "Interventions for Preventing Obesity in Children", published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity.

Results: The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years).

Conclusions: This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.
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http://dx.doi.org/10.1186/s12966-021-01082-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874658PMC
February 2021

World Health Organization 2020 guidelines on physical activity and sedentary behaviour.

Br J Sports Med 2020 Dec;54(24):1451-1462

Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland.

Objectives: To describe new WHO 2020 guidelines on physical activity and sedentary behaviour.

Methods: The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations.

Results: The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold.

Conclusion: These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the and to strengthen surveillance systems that track progress towards national and global targets.
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http://dx.doi.org/10.1136/bjsports-2020-102955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719906PMC
December 2020

Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group.

Int J Behav Nutr Phys Act 2020 11 26;17(1):143. Epub 2020 Nov 26.

Physical Activity Unit, Department of Health Promotion, World Health Organization, Geneva, Switzerland.

Background: In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities.

Methods: The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG.

Results: Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities.

Conclusions: Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.
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http://dx.doi.org/10.1186/s12966-020-01042-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690200PMC
November 2020

2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence.

Int J Behav Nutr Phys Act 2020 11 26;17(1):141. Epub 2020 Nov 26.

Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.

Background: The World Health Organization (WHO) released in 2020 updated global guidelines on physical activity and sedentary behaviour for children, adolescents, adults, older adults and sub-populations such as pregnant and postpartum women and those living with chronic conditions or disabilities.

Objective: To summarize the evidence on the associations between physical activity, sedentary behaviour, and health-related outcomes used to inform the 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years.

Methods: The update of the WHO guideline recommendations for children and adolescents utilized and systematically updated the evidence syntheses on physical activity and sedentary behaviour conducted for the 2016 Canadian 24-Hour Movement Guidelines for Children and Youth, the 2019 Australian 24-Hour Movement Guidelines for Children and Young People (5-17 years), and the 2018 Physical Activity Guidelines for Americans, Second Edition. Systematic reviews published from 2017 up to July 2019 that addressed the key questions were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rate the certainty of the evidence for the entire body of evidence.

Results: The updated literature search yielded 21 relevant systematic reviews. The evidence base reviewed (i.e., existing and new systematic reviews) provided evidence that greater amounts and higher intensities of physical activity as well as different types of physical activity (i.e., aerobic and muscle and bone strengthening activities) are associated with improved health outcomes (primarily intermediate outcomes). There was sufficient evidence to support recommendations on limiting sedentary behaviours, which was not addressed in the 2010 WHO guidelines. However, there is still insufficient evidence available to fully describe the dose-response relationships between physical activity or sedentary behaviour and health outcomes, and whether the associations vary by type or domain of physical activity or sedentary behaviour.

Conclusions: Addressing the identified research gaps will better inform guideline recommendations in children and adolescents, and future work should aim to prioritize these areas of research. In the meantime, investment and leadership is needed to scale up known effective policies and programs aimed at increasing activity in children and adolescents.
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http://dx.doi.org/10.1186/s12966-020-01037-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691077PMC
November 2020

Physical Activity and Psychosocial Characteristics of the Peer Supporters in the PLAN-A Study-A Latent Class Analysis.

Int J Environ Res Public Health 2020 10 30;17(21). Epub 2020 Oct 30.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.

PLAN-A is a cluster randomised controlled trial of a peer-led physical activity intervention which uses peer supporters to increase the physical activity of 13-14-year-old girls in the UK. This paper uses latent class analysis to identify classes in the whole study population and investigate how those selected as peer supporters in PLAN-A were drawn from different social groups. We identified five classes of girls, based on psychosocial variables (self-esteem, physical activity self-efficacy, motivation, physical activity values among friends and peer support for physical activity (PA) and physical activity behaviour variables (average minutes of weekday MVPA, sedentary time and screen viewing). Peer supporters were similar to the whole study population in terms of overall demographics, but were drawn unequally from the five classes. In addition, there was considerable variation in the distribution of peer supporters between schools. The selection of peer supporters is an integral component of peer-led interventions and should be explored and linked to underlying theory to understand the characteristics of those recruited. However, demographic representativeness is not necessarily the aim, and simple reporting of overall demographic comparisons may mask important differences within subgroups.
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http://dx.doi.org/10.3390/ijerph17217980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663228PMC
October 2020

School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol.

Front Public Health 2020 22;8:549637. Epub 2020 Sep 22.

Department of Social and Preventive Medicine, Faculty of Medicine, Centre of Population Health, University of Malaya, Kuala Lumpur, Malaysia.

School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, = 4; control, = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling "red flag" foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell "green flag" food and drinks, such as fruits and vegetables. It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.
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http://dx.doi.org/10.3389/fpubh.2020.549637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536333PMC
September 2020

Perceptions of eating practices and physical activity among Malaysian adolescents in secondary schools: a qualitative study with multi-stakeholders.

Public Health Nutr 2020 Aug 3:1-13. Epub 2020 Aug 3.

Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia.

Objective: To conduct formative research using qualitative methods among stakeholders of secondary schools to explore their perceptions, barriers and facilitators related to healthy eating and physical activity (PA) among Malaysian adolescents.

Design: A qualitative study involving eight focus groups and twelve in-depth interviews. Focus groups and interviews were recorded and transcribed verbatim. An inductive thematic analysis approach was used to analyse the data.

Setting: Four secondary schools in Perak and Selangor states (two urban and two rural schools) in Malaysia.

Participants: Focus groups were conducted with seventy-six adolescents aged 13-14 years, and in-depth interviews were conducted with four headmasters, four PA education teachers and four food canteen operators.

Results: Stakeholders thought that adolescents' misperceptions, limited availability of healthy options, unhealthy food preferences and affordability were important challenges preventing healthy eating at school. Low-quality physical education (PE) classes, limited adolescent participation and teachers' commitment during lessons were perceived as barriers to adolescents being active at school. Affordability was the main challenge for adolescents from rural schools. Stakeholders perceived that a future school-based intervention should improve the availability and subsidies for healthy foods, provide health education/training for both adolescents and PE teachers, enhance active adolescent participation in PE and develop social support mechanisms to facilitate engagement with PA.

Conclusions: These findings provide important insights into developing school-based lifestyle interventions to improve healthy eating and strengthening PA of Malaysian adolescents.
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http://dx.doi.org/10.1017/S1368980020002293DOI Listing
August 2020

Associations of body mass index, physical activity and sedentary time with blood pressure in primary school children from south-west England: A prospective study.

PLoS One 2020 29;15(4):e0232333. Epub 2020 Apr 29.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom.

Elevated blood pressure in children is a significant risk factor for the development of cardiovascular disease in adulthood. We examined how children's body mass index (BMI), physical activity and sedentary time at ages 9 and 11 are associated with blood pressure at age 11. Data were from 1283 children from Bristol, UK, who participated in the study aged 11 years, 797 of whom also participated in the study aged 9 years. Child height, weight and blood pressure were measured, and children wore accelerometers for five days, from which moderate-to-vigorous-intensity physical activity and sedentary minutes per day were derived. Multiple imputation of missing data and adjusted linear and logistic regression models were used to examine associations. Child BMI at 11 years was cross-sectionally associated with higher systolic and diastolic blood pressure (mean difference [95% confidence interval]: 0.91 [0.32 to 1.50] mm Hg and 1.08 [0.54 to 1.62] mm Hg, respectively, per standard deviation (SD) of BMI). BMI at age 9 was also positively associated with diastolic blood pressure at age 11 (1.16 mmHg per two years [0.49 to 1.84], per SD of BMI). For girls, sedentary time at age 9 years was associated with increased odds of having high systolic blood pressure at age 11 (odds ratio: 1.08 [1.01 to 1.16], per 10 minutes per day). There was no evidence of associations between sedentary time and blood pressure among boys. Similarly, there was little evidence that physical activity was associated with blood pressure in either cross-sectional or prospective analyses. Effective strategies are needed to prevent excess bodyweight among children in order to reduce cardiovascular disease risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232333PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190166PMC
July 2020

A study protocol for a clustered randomised controlled trial to evaluate the effectiveness of a peer-led school-based walking intervention on adolescent girls' physical activity: the Walking In ScHools (WISH) study.

BMC Public Health 2020 Apr 21;20(1):541. Epub 2020 Apr 21.

Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, University of Ulster, Jordanstown Campus, Newtownabbey, BT37 0QB, UK.

Background: Adolescent girls in the UK and Ireland are failing to meet current physical activity guidelines. Physical activity behaviours track from childhood to adulthood and it is important that adolescent girls are provided with opportunities to be physically active. Walking has been a central focus for physical activity promotion in adults and may effectively increase physical activity levels among younger people. Following on from a pilot feasibility trial, the purpose of this cluster randomised controlled trial (c-RCT) is to evaluate the effectiveness of a novel, low-cost, peer-led school-based walking intervention delivered across the school year at increasing physical activity levels of adolescent girls.

Methods: The Walking In ScHools (WISH) Study is a school-based c-RCT conducted with girls aged 12-14 years from eighteen schools across the Border Region of Ireland / Northern Ireland. Following baseline data collection, schools will be randomly allocated to intervention or control group. In intervention schools, female pupils aged 15-18 years will be invited to train as walk leaders and will lead younger pupils in 10-15 min walks before school, at break and lunch recess. All walks will take place in school grounds and pupils will be encouraged to participate in as many walks as possible each week. The intervention will be delivered for the whole school year (minimum 20-22 weeks). The primary outcome measure is accelerometer-measured total physical activity (counts per minute) (end of intervention). Secondary outcomes will include time spent in sedentary behaviour, light, moderate and vigorous intensity physical activity, anthropometry measures, social media usage and sleep. A mixed-methods process evaluation will also be undertaken.

Discussion: The WISH Study will examine the effectiveness of a low-cost, school-based, peer-led walking intervention in increasing physical activity in adolescent girls when delivered across the school year. If the intervention increases physical activity, it would benefit adolescent girls in the defined target area with potential for wider adoption by schools across the UK and Ireland.

Trial Registration: ISRCTN; ISRCTN12847782; Registered 2nd July 2019.
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http://dx.doi.org/10.1186/s12889-020-08600-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171742PMC
April 2020

"Let's Talk about Physical Activity": Understanding the Preferences of Under-Served Communities when Messaging Physical Activity Guidelines to the Public.

Int J Environ Res Public Health 2020 04 17;17(8). Epub 2020 Apr 17.

The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol National Health Service Foundation Trust, Bristol BS1 3NU, UK.

Despite many countries having physical activity guidelines, there have been few concerted efforts to mobilize this information to the public. The aim of this study was to understand the preferences of under-served community groups about how the benefits of physical activity, and associated guidelines, can be better communicated to the public. Participatory workshops, co-developed between researchers, a local charity, and a community artist, were used to gather data from four groups in Bristol, UK: young people ( = 17); adults ( = 11); older adults ( = 5); and Somali women ( = 15). Workshop content was structured around the study aims. The community artist and/or the local charity delivered the workshops, with researchers gathering data via observation, photos, and audio-recordings, which were analysed using the framework method. All four groups noted that the benefits of physical activity should be included within any communications efforts, though not restricted to health-related benefits. Language used should be simple and jargon-free; terms such as "sedentary", "vigorous" and "intensity" were deemed inaccessible, however all groups liked the message "some is good, more is better". Views about preferred mechanisms, and messenger, for delivering physical activity messages varied both between, and within, groups. Recommendations for those working in physical activity communications, research, and policy are provided.
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http://dx.doi.org/10.3390/ijerph17082782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215851PMC
April 2020

Multidimensional motivation for exercise: A latent profile and transition analysis.

Psychol Sport Exerc 2020 Mar;47:101619

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.

Objectives: To: a) identify motivational profiles for exercise, using Self-Determination Theory as a theoretical framework, among a sample of parents of UK primary school children; b) explore the movement between motivational profiles over a five year period; and c) examine differences across these profiles in terms of gender, physical activity and BMI.

Design: Data were from the B-Proact1v cohort.

Methods: 2555 parents of British primary school children participated across three phases when the child was aged 5-6, 8-9, and 10-11. Parents completed a multidimensional measure of motivation for exercise and wore an ActiGraph GT3X + accelerometer for five days in each phase. Latent profile and transition analyses were conducted using a three-step approach in MPlus.

Results: Six profiles were identified, comprising different combinations of motivation types. Between each timepoint, moving between profiles was more likely than remaining in the same one. People with a more autonomous profile at a previous timepoint were unlikely to move to more controlled or amotivated profiles. At all three timepoints, more autonomous profiles were associated with higher levels of MVPA and lower BMI.

Conclusions: The results show that people's motivation for exercise can be described in coherent and consistent profiles which are made up of multiple and simultaneous types of motivation. More autonomous motivation profiles were more enduring over time, indicating that promoting more autonomous motivational profiles may be central to facilitating longer-term physical activity engagement.
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http://dx.doi.org/10.1016/j.psychsport.2019.101619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015274PMC
March 2020

Perception of Safety and Its Association With Physical Activity in Adolescents in Mexico.

Am J Prev Med 2020 05 13;58(5):748-755. Epub 2020 Feb 13.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom.

Introduction: Low levels of physical activity are associated with several noncommunicable diseases. In Mexico, 39.5% of adolescents do not meet WHO physical activity guidelines. Previous literature suggests an association between perception of safety and physical activity. This paper examines the association between perceived crime and pedestrian safety and physical activity in Mexican adolescents.

Methods: This cross-sectional study used data from 4,079 adolescents aged 15-18 years in Mexico. Physical activity was measured with the Youth Physical Activity Questionnaire and was grouped into the following 5 domains: (1) moderate-to-vigorous physical activity, (2) sports activity, (3) leisure time activity, (4) physical education class, and (5) active commuting to school. Perception of safety was measured as pedestrian safety and crime safety, using the Neighborhood Environment Walkability Scale-Youth. Confirmatory factor analysis was performed to examine the construct validity of this scale on the Mexican population. Data were collected in 2017 and analyzed in 2018. Associations between physical activity and perception of safety were examined using linear regression models.

Results: Low perception of pedestrian safety was associated with lower moderate-to-vigorous physical activity per week (coefficient= -0.12, 95% CI= -0.19, -0.05) and lower sports activity per week (coefficient= -0.13, 95% CI= -0.23, -0.03) in female adolescents. There was no association between perception of safety and physical activity among male adolescents.

Conclusions: Pedestrian safety was negatively associated with moderate-to-vigorous physical activity and sports participation in female youth. Environments with better lighting, crosswalks, and walking/cycle trails could increase physical activity in female youth.
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http://dx.doi.org/10.1016/j.amepre.2019.12.007DOI Listing
May 2020

Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis.

Int J Behav Nutr Phys Act 2020 02 11;17(1):19. Epub 2020 Feb 11.

New South Wales (NSW) Ministry of Health, St Leonards, NSW, Australia.

Background: Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity.

Methods: We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes.

Results: A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively.

Conclusions: Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.
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http://dx.doi.org/10.1186/s12966-020-0918-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014944PMC
February 2020

Evaluating the causal impact of individual alcohol licensing decisions on local health and crime using natural experiments with synthetic controls.

Addiction 2020 11 10;115(11):2021-2031. Epub 2020 Mar 10.

Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Background And Aims: Given the costs of alcohol to society, it is important to evaluate whether local alcohol licensing decisions can mitigate the effects of alcohol misuse. Robust natural experiment evaluations of the impact of individual licensing decisions could potentially inform and improve local decision-making. We aimed to assess whether alcohol licensing decisions could be evaluated at small spatial scale by using a causal inference framework.

Design: Three natural experiments.

Setting And Participants: Three English local areas of 1000-15 000 people each.

Intervention And Comparator: The case study interventions were (i) the closure of a nightclub following reviews; (ii) closure of a restaurant/nightclub following reviews and (iii) implementation of new local licensing guidance (LLG). Trends in outcomes were compared with synthetic counterfactuals created using Bayesian structural time-series.

Measurements: Time-series data were obtained on emergency department admissions, ambulance call-outs and alcohol-related crime at the Lower or Middle Super Output geographical aggregation level.

Findings: Closure of the nightclub led to temporary 4-month reductions in antisocial behaviour (-18%; 95% credible interval - 37%, -4%), with no change in other outcomes. Closure of the restaurant/nightclub did not lead to measurable changes in outcomes. The new licensing guidance led to small reductions in drunk and disorderly behaviour (nine of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of two incidents per month.

Conclusions: The impact of local alcohol policy, even at the level of individual premises, can be evaluated using a causal inference framework. Local government actions such as closure or restriction of alcohol venues and alcohol licensing may have a positive impact on health and crime in the immediate surrounding area.
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http://dx.doi.org/10.1111/add.15002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586832PMC
November 2020

Validity and Reliability of the Wristband Activity Monitor in Free-living Children Aged 10-17 Years.

Biomed Environ Sci 2019 11;32(11):812-822

National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.

Objective: In this study we aimed to examine the reliability and validity of the wristband activity monitor against the accelerometer for children..

Methods: A total of 99 children (mean age = 13.0 ± 2.5 y) wore the two monitors in a free-living context for 7 days. Reliability was measured by intraclass correlation to evaluate consistency over time. Repeated-measures analyses of variance was used to detect differences across days. Spearman's correlation coefficient (rho), median of absolute percentage error, and Bland-Altman analyses were performed to assess the validity of the wristband against the ActiGraph accelerometer. The optimal number of repeated measures for the wristband was calculated by using the Spearman-Brown prophecy formula.

Results: The wristband had high reliability for all variables, although physical activity data were different across 7 days. A strong correlation for steps (rho: 0.72, P < 0.001), and moderate correlations for time spent on total physical activity (rho: 0.63, P < 0.001) and physical activity energy expenditure (rho: 0.57, P < 0.001) were observed between the wristband and the accelerometer. For different intensities of physical activity, weak to moderate correlations were found (rho: 0.38 to 0.55, P < 0.001).

Conclusion: The wristband activity monitor seems to be reliable and valid for measurement of overall children's physical activity, providing a feasible objective method of physical activity surveillance in children.
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http://dx.doi.org/10.3967/bes2019.103DOI Listing
November 2019

Results of the feasibility phase of the managed activity graded exercise in teenagers and pre-adolescents (MAGENTA) randomised controlled trial of treatments for chronic fatigue syndrome/myalgic encephalomyelitis.

Pilot Feasibility Stud 2019 19;5:151. Epub 2019 Dec 19.

1Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 2BN UK.

Background: Chronic fatigue syndrome (CFS) also known as myalgic encephalomyelitis (ME) is relatively common in young people and causes significant disability. Graded exercise therapy (GET) and activity management are recommended by the National Institute for Health and Care Excellence (NICE) despite a limited evidence-base for either treatment in paediatric CFS/ME. This paper reports on feasibility and acceptability measures from the feasibility phase of the ongoing MAGENTA randomised controlled trial (RCT) investigating GET versus activity management for young people with CFS/ME.

Methods: Setting: Three specialist secondary care National Health Service (NHS) Paediatric CFS/ME services (Bath, Cambridge and Newcastle).Participants: Young people aged 8-17 years with a diagnosis of mild to moderate CFS/ME. Young people were excluded if they were severely affected, referred to cognitive behavioural therapy (CBT) at initial assessment or unable to attend clinical sessions.Interventions: GET and activity management delivered by physiotherapists, occupational therapists, nurses and psychologists. Families and clinicians decided the number (typically 8-12) and frequency of appointments (typically every 2-6 weeks).Outcome Measures: Recruitment and follow-up statistics. We used integrated qualitative methodology to explore the feasibility and acceptability of the trial processes and the interventions.

Results: 80/161 (49.7%) of eligible young people were recruited at two sites between September 2015 and August 2016, indicating recruitment to the trial was feasible. Most recruitment (78/80; 97.5%) took place at one centre. Recruitment consultations, online consent and interventions were acceptable, with less than 10% in each arm discontinuing trial treatment. Response rate to the primary outcome (the SF36-PFS at 6 months) was 91.4%. Recruitment, treatment and data collection were not feasible at one centre. The site was withdrawn from the study.In response to data collected, we optimised trial processes including using Skype for recruitment discussions; adapting recruiter training to improve recruitment discussions; amending the accelerometer information leaflets; shortening the resource use questionnaires; and offering interventions via Skype. These amendments have been incorporated into the full trial protocol.

Conclusions: Conducting an RCT investigating GET versus activity management is feasible and acceptable for young people with CFS/ME.

Trial Registration: ISRCTN23962803 10.1186/ISRCTN23962803, date of registration: 03 September 2015.
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http://dx.doi.org/10.1186/s40814-019-0525-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924066PMC
December 2019

A Multilevel Analysis of Neighbourhood, School, Friend and Individual-Level Variation in Primary School Children's Physical Activity.

Int J Environ Res Public Health 2019 12 4;16(24). Epub 2019 Dec 4.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.

Physical activity is influenced by individual, inter-personal and environmental factors. In this paper, we explore the variability in children's moderate-to-vigorous physical activity (MVPA) at different individual, parent, friend, school and neighbourhood levels. Valid accelerometer data were collected for 1077 children aged 9, and 1129 at age 11, and the average minutes of MVPA were derived for weekdays and weekends. We used a multiple-membership, multiple-classification model (MMMC) multilevel model to compare the variation in physical activity outcomes at each of the different levels. There were differences in the proportion of variance attributable to the different levels between genders, for weekdays and weekends, at ages 9 and 11. The largest proportion of variability in MVPA was attributable to individual variation, accounting for half of the total residual variability for boys, and two thirds of the variability for girls. MVPA clustered within friendship groups, with friends influencing peer MVPA. Including covariates at the different levels explained only small amounts (3%-13%) of variability. There is a need to enhance our understanding of individual level influences on children's physical activity.
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http://dx.doi.org/10.3390/ijerph16244889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950546PMC
December 2019

Cardiometabolic Risk Factors and Physical Activity Patterns Maximizing Fitness and Minimizing Fatness Variation in Malaysian Adolescents: A Novel Application of Reduced Rank Regression.

Int J Environ Res Public Health 2019 11 22;16(23). Epub 2019 Nov 22.

Centre for Exercise, Nutrition, and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.

Patterns of physical activity (PA) that optimize both fitness and fatness may better predict cardiometabolic health. Reduced rank regression (RRR) was applied to identify combinations of the type (e.g., football vs. skipping), location and timing of activity, explaining variation in cardiorespiratory fitness (CRF) and Body Mass Index (BMI). Multivariable regressions estimated longitudinal associations of PA pattern scores with cardiometabolic health in n = 579 adolescents aged 13-17 years from the Malaysian Health and Adolescent Longitudinal Research Team study. PA pattern scores in boys were associated with higher fitness (r = 0.3) and lower fatness (r = -0.3); however, in girls, pattern scores were only associated with higher fitness (r = 0.4) (fatness, r = -0.1). Pattern scores changed by β = -0.01 (95% confidence interval (CI) -0.04, 0.03) and β = -0.08 (95% CI -0.1, -0.06) per year from 13 to 17 years in boys and girls respectively. Higher CRF and lower BMI were associated with better cardiometabolic health at 17 years, but PA pattern scores were not in either cross-sectional or longitudinal models. RRR identified sex-specific PA patterns associated with fitness and fatness but the total variation they explained was small. PA pattern scores changed little through adolescence, which may explain the limited evidence on health associations. Objective PA measurement may improve RRR for identifying optimal PA patterns for cardiometabolic health.
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http://dx.doi.org/10.3390/ijerph16234662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926765PMC
November 2019

Association of BMI category with change in children's physical activity between ages 6 and 11 years: a longitudinal study.

Int J Obes (Lond) 2020 01 12;44(1):104-113. Epub 2019 Nov 12.

MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.

Background/objectives: To examine the association of body mass index (BMI) with change in children's physical activity and sedentary time between ages 6 and 11.

Participants: A total of 2132 children participated from 57 schools in Southwest England, from the B-PROACT1V study.

Methods: Mean minutes of MVPA and sedentary time per day were derived from accelerometer-based measurements at ages 6, 9 and 11. Linear multilevel models examined the association of BMI categories with MVPA and sedentary time between 6 and 11, adjusting for seasonality, wear time, gender and household education. Differences in change over time were examined using interaction terms.

Results: Average weekday MVPA decreased between ages 6 and 11 by 2.2 min/day/year (95% CI: 1.9 to 2.5), with a steeper decline at weekends. Average sedentary time increased at a rate of 12.9 min/day/year (95% CI: 12.2 to 13.6). There were no differences in mean levels of MVPA by BMI categories at age 6, but differences emerged as children aged, with the gap between children who were healthy weight and overweight increasing by 1.7 min/day (95% CI: 0.8-2.6) every year, and between healthy and obese by 2.0 min/day (95% CI: 0.9-3.1) each year. Children who were overweight/obese engaged in less average weekday sedentary time at age 6 than those of healthy weight, but the gap closed by age 11.

Conclusion: MVPA declines and sedentary time increases on average for all children between ages 6 and 11. While there are no differences in activity levels by BMI category at age 6, differences in MVPA emerge over time for those who are overweight and obese. Developing interventions that support children to retain activity levels as they approach older childhood, particularly those who are overweight/obese could improve public health.
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http://dx.doi.org/10.1038/s41366-019-0459-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923172PMC
January 2020

A Longitudinal Study of the Associations of Family Structure with Physical Activity across the Week in Boys and Girls.

Int J Environ Res Public Health 2019 10 22;16(20). Epub 2019 Oct 22.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.

The aim of this study was to examine how family structure is associated with moderate-to-vigorous-intensity physical activity (MVPA) for children aged between 6 and 11. At 6, 9 and 11 years, children wore an accelerometer and parents/carers completed questionnaires on demographics and family structure. Linear regression models examined cross-sectional associations between family structure and MVPA at age 9 and 11. Linear multilevel models examined longitudinal associations between age 6 and 11, differences in change over time were examined using interaction terms. No associations between exposures and MVPA were evident at age 9. Compared to boys living in one home, eleven-year-old boys who lived in multiple homes performed 15.99 (2.46-29.52) fewer minutes of MVPA on weekend days. In longitudinal analyses, the evidence was unclear whether the association with family structure changed over time. Models that assumed associations with family structure remained constant over time, found that boys who lived in multiple homes performed 11.02 (0.76-21.28) fewer minutes of MVPA per weekend day, while for each additional sibling, girls performed an extra 1.89 (0.25-3.53) minutes of MVPA per weekend day. Findings indicate a small number of associations, varying in magnitude, between family structure and children's MVPA. Therefore, families of all structures should be supported to help their children meet MVPA recommendations.
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http://dx.doi.org/10.3390/ijerph16204050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843941PMC
October 2019

Validity and Reliability of Chinese Physical Activity Questionnaire for Children Aged 10-17 Years.

Biomed Environ Sci 2019 Sep;32(9):647-658

National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.

Objective: This study is aimed to report the development, the reliability and validity of the Chinese Children Physical Activity Questionnaire (CCPAQ) which was designed for the assessment of physical activity pattern in young population in China.

Methods: The CCPAQ was administered for two times in 119 children (mean age 13.1 ± 2.4 years; boys 47%) to examine reliability by using intraclass correlation coefficients. Validity was determined in 106 participants by agreement with the CCPAQ measures and the objective method, the ActiGraph accelerometer. Data on physical activity pattern including time spent on different intensities and total physical activity, sedentary behavior as well as physical activity energy expenditure were used to assess the validity with Spearman's correlation coefficient and the Bland-Altman plots.

Results: The reliability coefficient of the CCPAQ ranged from 0.63-0.93 (Intra-class correlation coefficient). Spearman's correlation coefficient for validity of time spent on total physical activity and sedentary behavior were all 0.32 (P < 0.001), and for physical activity energy expenditure was 0.58 (P < 0.001). Time spent on moderate-to-vigorous physical activity and light physical activity showed a relatively low correlation with the accelerometer (rho = 0.20, P = 0.040; rho = 0.19, P = 0.054).

Conclusion: The CCPAQ appears to be a promising and feasible method to assess physical activity pattern in Chinese children.
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http://dx.doi.org/10.3967/bes2019.084DOI Listing
September 2019

Striking a Balance: Physical Activity, Screen-Viewing and Homework during the Transition to Secondary School.

Int J Environ Res Public Health 2019 08 30;16(17). Epub 2019 Aug 30.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.

Physical activity levels decline, and screen-viewing behaviours increase during childhood and adolescence. The transition to secondary school appears to coincide with a sharp decline in physical activity. Parents have the potential to influence their child's behaviours, yet little is known about their expectations for their child's physical activity and screen-viewing during this transition. This paper explores parents' expectations for their children's physical activity and screen-viewing as they transition from primary to secondary school, and their proposed strategies for managing these behaviours during this time. Forty-two parents of children aged 10-11 years participated in a semi-structured telephone interviews in July 2017 or March 2018. The interview data were analysed via inductive and deductive content analysis to explore parents' perceptions of physical activity and screen-viewing during the transition, the reasons for their perceptions, and the strategies they intended to implement to help their child balance their behaviours. Most parents expected both physical activity and screen-viewing to increase during this transition. There were several individuals, social and school-level factors influencing these expectations. Overall, parents felt that helping their child balance their activity levels, screen-viewing and homework would be challenging.
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http://dx.doi.org/10.3390/ijerph16173174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747112PMC
August 2019

A process evaluation of the PLAN-A intervention (Peer-Led physical Activity iNtervention for Adolescent girls).

BMC Public Health 2019 Sep 2;19(1):1203. Epub 2019 Sep 2.

Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Background: Few adolescent girls engage in enough physical activity (PA) to meet recommendations and there is a need for new interventions to increase girls PA. We have previously published the results of the PLAN-A cluster randomised feasibility trial which was a peer-led school-based PA intervention, showing that the intervention was feasible and held promise to increase the PA of girls aged 12-13 years. In PLAN-A, pupils nominated by their peers as influential attend training to teach them how to influence, promote and normalise physical activity amongst their peer-group. This paper reports the results of the process evaluation of the PLAN-A feasibility study, specifically focussing on acceptability to key stakeholders, intervention fidelity, receipt/experiences and perceived effect and suggested intervention refinements before proceeding to a definitive RCT.

Methods: A mixed-methods process evaluation triangulated data from qualitative focus groups and interviews with peer-supporter and non peer-supporter pupils (N = 52), parents (N = 12), teachers (N = 6) and intervention training deliverers (N = 5), quantitative questionnaires, and observations of intervention delivery. Quantitative data were analysed descriptively, and qualitative data were analysed with the Framework Method.

Results: The duration, timings, content and delivery of the peer-supporter training were acceptable. There was good fidelity to the intervention manual and its underpinning theory including high fulfilment of session objectives and use of an autonomy-supportive motivational style. Peer-supporters engaged with and enjoyed the training and retained key peer-supporter messages (what counts as PA, encouragement, empathy and subtlety). Parents and teachers were supportive of the intervention and reported perceived effects including increased PA and awareness of it, improved peer relationships, and confidence. Suggested intervention refinements included increasing participatory learning, reducing technical jargon, and providing more support to overcome challenges to giving peer support.

Conclusions: PLAN-A can be delivered as planned, is well-received, and appears to be effective in empowering adolescent girls to support their peer group to become more active. The refinements identified can be made within the original intervention structure, before proceeding to a definitive trial.

Trial Registration: ISCTRN, ISRCTN12543546 , Registered on 28/7/2015.
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http://dx.doi.org/10.1186/s12889-019-7545-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720066PMC
September 2019

The association of school-related active travel and active after-school clubs with children's physical activity: a cross-sectional study in 11-year-old UK children.

Int J Behav Nutr Phys Act 2019 08 22;16(1):72. Epub 2019 Aug 22.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.

Background: Physical activity is associated with improved physical and mental health among children, but many children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to investigate participation in active after-school clubs and active travel to and from school at age 11 and estimate the average daily minutes of MVPA associated with active club attendance and active travel.

Methods: Accelerometer data were collected on three weekdays for 1296 11-year-old children in a cross-sectional study. Children reported attendance at active after-school clubs and how they travelled to and from school for each day of the week. To account for repeat days within child and clustering within schools we used multilevel models with random effects at the school and child level, and fixed effects for all covariates. We calculated odds ratios for participation in active after-school clubs and active travel for gender, measures of socio-economic position and BMI category. We also explored the association between active club attendance, active travel and daily average MVPA.

Results: Boys and girls were equally likely to attend active after-school clubs. Boys were more likely to travel to school using active modes. Attendance at active after-school clubs and active travel home were not associated with each other. Attending an active after-school club was associated with an additional 7.6 min (95% CI: 5.0 to 10.3) average MVPA on that day among both boys and girls. Active travel was associated with an additional 4.7 min (95% CI: 2.9 to 6.5) average MVPA per journey for boys and 2.4 min (95% CI: 1.0 to 3.7) for girls.

Conclusions: Both active after-school clubs and active travel are associated with greater physical activity on the day that children participate in these, and we saw no evidence that those attending active clubs do so at the expense of active travel home afterwards. While the increased daily MVPA is small to moderate, active after-school clubs and active travel on multiple days of the week could make important contributions as part of complex interventions aimed at increasing population levels of physical activity in children.
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http://dx.doi.org/10.1186/s12966-019-0832-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704690PMC
August 2019

Longitudinal associations between parents' motivations to exercise and their moderate-to-vigorous physical activity.

Psychol Sport Exerc 2019 Jul;43:343-349

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.

Objectives: This study is the first examination of the longitudinal associations between behavioural regulation and accelerometer-assessed physical activity in parents of primary-school aged children.

Design: A cohort design using data from the B-Proact1v project.

Method: There were three measurement phases over five years. Exercise motivation was measured using the BREQ-2 and mean minutes of moderate-to-vigorous physical activity (MVPA) were derived from ActiGraph accelerometers worn for a minimum of 3 days. Cross-sectional associations were explored via linear regression models using parent data from the final two phases of the B-Proact1v cohort, when children were 8-9 years-old (925 parents, 72.3% mothers) and 10 to 11 years-old (891 parents, 72.6% mothers). Longitudinal associations across all three phases were explored using multi-level models on data from all parents who provided information on at least one occasion (2374 parents). All models were adjusted for gender, number of children, deprivation indices and school-based clustering.

Results: Cross-sectionally, identified regulation was associated with 5.43 (95% CI [2.56, 8.32]) and 4.88 (95% CI [1.94, 7.83]) minutes more MVPA per day at times 2 and 3 respectively. In the longitudinal model, a one-unit increase in introjected regulation was associated with a decline in mean daily MVPA of 0.52 (95% CI [-0.88, -0.16]) minutes per year.

Conclusions: Interventions to promote the internalisation of personally meaningful rationales for being active, whilst ensuring that feelings of guilt are not fostered, may offer promise for facilitating greater long-term physical activity engagement in parents of primary school age children.
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http://dx.doi.org/10.1016/j.psychsport.2019.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686967PMC
July 2019

Action 3:30R: process evaluation of a cluster randomised feasibility study of a revised teaching assistant-led extracurricular physical activity intervention for 8 to 10 year olds.

BMC Public Health 2019 Aug 14;19(1):1111. Epub 2019 Aug 14.

Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.

Background: Numerous interventions to increase children's physical activity levels are published, yet, few studies report indicators of external validity. Process evaluations are critical for assessing intervention implementation, sustainability and effectiveness. A mixed-methods process evaluation, using the RE-AIM framework, was conducted to evaluate the internal and external validity of Action 3:30R, a revised teaching assistant-led after-school intervention which aimed to increase physical activity in children aged 8-10 years and was underpinned by Self-determination Theory (SDT).

Methods: Data were collected and reported in line with the five components of RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance). Quantitative measures included logbooks, registers and self-reported teaching-efficacy, autonomy support, child enjoyment and perceived exertion questionnaires. Questionnaire data were collected at three points throughout the 15-week intervention. Observations by trained researchers were also conducted to assess fidelity to the intervention manual and its underpinning theory. Post-intervention focus groups with pupils and interviews with teaching assistants (TAs), school staff and external stakeholders explored the implementation and potential sustainability of Action 3:30R from stakeholders' perspectives.

Results: Action 3:30R appealed to a broad range of pupils, including girls and less-active pupils. The Action 3:30R TA training was implemented as intended and was perceived as valuable professional development. Releasing staff for training was a barrier in two of the six intervention schools, which were unable to deliver the intervention as a result. Pupils enjoyed the intervention, and the Action 3:30R core principles underpinned by SDT were implemented with high fidelity, as was the intervention itself. Scheduling conflicts with other clubs and lack of parental support were perceived as the main barriers to recruitment and attendance. Lack of space and season were cited as the main barriers affecting the quality of delivery. The study shows evidence of maintenance, as one intervention school decided to continue Action 3:30R beyond the study. Funding and continued TA training were suggested as factors which may affect the maintenance of Action 3:30R.

Conclusions: Action 3:30R is an enjoyable, autonomy-supportive after-school programme, which engages a range of pupils and offers TAs valuable training. RE-AIM provided helpful structure and is recommended for intervention evaluations.

Trial Registration: ISRCTN34001941 . Prospectively registered 01/12/2016.
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http://dx.doi.org/10.1186/s12889-019-7347-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694632PMC
August 2019