Movement behaviours (e.g., sleep, sedentary behaviour, and physical activity) in isolation have demonstrated benefits to preschool-aged children's development. However, little is known on the ...integrated nature of movement behaviours and their relationship to healthy development in this age range. Thus, the objective of this study was to examine the relationships between accelerometer-derived movement behaviours and indicators of physical, cognitive, and social-emotional development using compositional analyses in a sample of preschool-aged children. Children (n = 95) were recruited in Edmonton, Canada. Movement behaviours were measured with ActiGraph wGT3X-BT accelerometers worn 24 hours/day. Physical (i.e., body mass index BMI z-scores, percent of adult height, and motor skills), cognitive (i.e., working memory, response inhibition, and vocabulary), and social-emotional (i.e., sociability, externalizing, internalizing, prosocial behaviour, and cognitive, emotional, and behavioural self-regulation) development were assessed. Objective height and weight were measured for BMI z-scores and percent of adult height, while the Test of Gross Motor Development-2 was used to assess motor skills. The Early Years Toolbox was used to assess all cognitive and social-emotional development indicators. Compositional linear regression models and compositional substitution models were conducted in R. Children accumulated 11.1 hours of sleep, 6.1 hours of stationary time, 5.1 hours of light-intensity physical activity (LPA), and 1.8 hours of moderate- to vigorous-intensity physical activity (MVPA) per day. Movement behaviour compositions were significantly associated with physical (i.e., locomotor skills, object motor skills, and total motor skills) and cognitive (i.e., working memory and vocabulary) development (R.sup.2 range: 0.11-0.18). In relation to other movement behaviours in the composition, MVPA was positively associated with most physical development outcomes; while stationary time had mixed findings for cognitive development outcomes (i.e., mainly positive associations in linear regressions but non-significant in substitution models). Most associations for LPA and sleep were non-significant. The overall composition of movement behaviors appeared important for development. Findings confirmed the importance of MVPA for physical development. Mixed findings between stationary time and cognitive development could indicate this sample engaged in both beneficial (e.g., reading) and detrimental (e.g., screen time) stationary time. However, further research is needed to determine the mechanisms for these relationships.
Due 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.
Literature 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).
Thirty-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.
Despite 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.
Globally, many children fail to meet the World Health Organization's physical activity and sedentary behaviour guidelines. Schools are an ideal setting to intervene, yet despite many interventions in ...this setting, success when delivered under real-world conditions or at scale is limited. This systematic review aims to i) identify which implementation models are used in school-based physical activity effectiveness, dissemination, and/or implementation trials, and ii) identify factors associated with the adoption, implementation and sustainability of school-based physical activity interventions in real-world settings.
The review followed PRISMA guidelines and included a systematic search of seven databases from January 1st, 2000 to July 31st, 2018: MEDLINE, EMBASE, CINAHL, SPORTDiscus, PsycINFO, CENTRAL, and ERIC. A forward citation search of included studies using Google Scholar was performed on the 21st of January 2019 including articles published until the end of 2018. Study inclusion criteria: (i) a primary outcome to increase physical activity and/or decrease sedentary behaviour among school-aged children and/or adolescents; (ii) intervention delivery within school settings, (iii) use of implementation models to plan or interpret study results; and (iv) interventions delivered under real-world conditions.
(i) efficacy trials; (ii) studies applying or testing school-based physical activity policies, and; (iii) studies targeting special schools or pre-school and/or kindergarten aged children.
27 papers comprising 17 unique interventions were included. Fourteen implementation models (e.g., RE-AIM, Rogers' Diffusion of Innovations, Precede Proceed model), were applied across 27 papers. Implementation models were mostly used to interpret results (n = 9), for planning evaluation and interpreting results (n = 8), for planning evaluation (n = 6), for intervention design (n = 4), or for a combination of designing the intervention and interpreting results (n = 3). We identified 269 factors related to barriers (n = 93) and facilitators (n = 176) for the adoption (n = 7 studies), implementation (n = 14 studies) and sustainability (n = 7 studies) of interventions.
Implementation model use was predominately centered on the interpretation of results and analyses, with few examples of use across all study phases as a planning tool and to understand results. This lack of implementation models applied may explain the limited success of interventions when delivered under real-world conditions or at scale.
PROSPERO (CRD42018099836).
Implementation trials aim to test the effects of implementation strategies on the adoption, integration or uptake of an evidence-based intervention within organisations or settings. Feasibility and ...pilot studies can assist with building and testing effective implementation strategies by helping to address uncertainties around design and methods, assessing potential implementation strategy effects and identifying potential causal mechanisms. This paper aims to provide broad guidance for the conduct of feasibility and pilot studies for implementation trials.
We convened a group with a mutual interest in the use of feasibility and pilot trials in implementation science including implementation and behavioural science experts and public health researchers. We conducted a literature review to identify existing recommendations for feasibility and pilot studies, as well as publications describing formative processes for implementation trials. In the absence of previous explicit guidance for the conduct of feasibility or pilot implementation trials specifically, we used the effectiveness-implementation hybrid trial design typology proposed by Curran and colleagues as a framework for conceptualising the application of feasibility and pilot testing of implementation interventions. We discuss and offer guidance regarding the aims, methods, design, measures, progression criteria and reporting for implementation feasibility and pilot studies.
This paper provides a resource for those undertaking preliminary work to enrich and inform larger scale implementation trials.
Interventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (> 60) that guide design ...and evaluation of implementation and scale-up processes. Therefore, we sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. We also sought to recommend a minimum data set of implementation outcome and determinant variables (indicators) as well as measures and tools deemed most relevant for PA and nutrition researchers.
We adopted a five-round modified Delphi methodology. For rounds 1, 2, and 3 we administered online surveys to PA and nutrition implementation scientists to generate a rank order list of most commonly used; i) implementation and scale-up frameworks, ii) implementation indicators, and iii) implementation and scale-up measures and tools. Measures and tools were excluded after round 2 as input from participants was very limited. For rounds 4 and 5, we conducted two in-person meetings with an expert group to create a shortlist of implementation and scale-up frameworks, identify a minimum data set of indicators and to discuss application and relevance of frameworks and indicators to the field of PA and nutrition.
The two most commonly referenced implementation frameworks were the Framework for Effective Implementation and the Consolidated Framework for Implementation Research. We provide the 25 most highly ranked implementation indicators reported by those who participated in rounds 1-3 of the survey. From these, the expert group created a recommended minimum data set of implementation determinants (n = 10) and implementation outcomes (n = 5) and reconciled differences in commonly used terms and definitions.
Researchers are confronted with myriad options when conducting implementation and scale-up evaluations. Thus, we identified and prioritized a list of frameworks and a minimum data set of indicators that have potential to improve the quality and consistency of evaluating implementation and scale-up of PA and nutrition interventions. Advancing our science is predicated upon increased efforts to develop a common 'language' and adaptable measures and tools.
Abstract 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 literacy (PL) is considered an important determinant of children's physical activity through which health benefits may be derived. The purpose of this study is to describe a sample of ...Canadian children's baseline levels of PL and movement behaviors, and explore whether the associations between PL and their mental wellbeing, if any, are mediated by moderate-to-vigorous physical activity (MVPA).
All grade two children in 14 elementary schools in the West Vancouver School District, Canada were invited to participate in a two-year longitudinal project. PL was assessed through PLAYfun and PLAYself tools. Physical activity was measured by wrist-worn accelerometers (GT3X + BT) for seven days. Children's mental well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). A score of total difficulties was aggregated for internalizing and externalizing problems.
A total of 355 children aged 7-9 (183 boys, 166 girls, 6 non-binary) participated with 258 children providing valid accelerometer data. Children exhibited an average of 111.1 min of MVPA per day, with 97.3% meeting the physical activity guidelines. Approximately 43% (108/250) of participants were meeting the Canadian 24-h movement guidelines. Children were at an 'emerging' level of overall physical competence (45.8 ± 5.6) and reported a mean score of 68.9 (SD = 12.3) for self-perceived PL, with no significant differences between boys and girls. PL was significantly associated with MVPA (r = .27) and all SDQ variables (rs = -.26-.13) except for externalizing problems. Mediation analyses showed PL was negatively associated with internalizing problems and total difficulties when the association with MVPA was considered. However, the mediating role of MVPA was found only between PL and internalizing problems, β = -.06, 95%CI -.12, -.01.
Although most of our sample was physically active and showed higher adherence to 24-H movement guidelines than comparable population data, the motor competence and self-perceived PL of our sample were similar to those of previous studies. PL has an independent association with children's internalizing problems and total difficulties. Ongoing assessment will investigate the relationships between PL and children's mental health from a longitudinal perspective.
The 'scale-up' of effective physical activity interventions is required if they are to yield improvements in population health. The purpose of this study was to systematically review the ...effectiveness of community-based physical activity interventions that have been scaled-up. We also sought to explore differences in the effect size of these interventions compared with prior evaluations of their efficacy in more controlled contexts, and describe adaptations that were made to interventions as part of the scale-up process.
We performed a search of empirical research using six electronic databases, hand searched reference lists and contacted field experts. An intervention was considered 'scaled-up' if it had been intentionally delivered on a larger scale (to a greater number of participants, new populations, and/or by means of different delivery systems) than a preceding randomised control trial ('pre-scale') in which a significant intervention effect (p < 0.05) was reported on any measure of physical activity. Effect size differences between pre-scale and scaled up interventions were quantified (the effect size reported in the scaled-up study / the effect size reported in the pre-scale-up efficacy trial × 100) to explore any scale-up 'penalties' in intervention effects.
We identified 10 eligible studies. Six scaled-up interventions appeared to achieve significant improvement on at least one measure of physical activity. Six studies included measures of physical activity that were common between pre-scale and scaled-up trials enabling the calculation of an effect size difference (and potential scale-up penalty). Differences in effect size ranged from 132 to 25% (median = 58.8%), suggesting that most scaled-up interventions typically achieve less than 60% of their pre-scale effect size. A variety of adaptations were made for scale-up - the most common being mode of delivery.
The majority of interventions remained effective when delivered at-scale however their effects were markedly lower than reported in pre-scale trials. Adaptations of interventions were common and may have impacted on the effectiveness of interventions delivered at scale. These outcomes provide valuable insight for researchers and public health practitioners interested in the design and scale-up of physical activity interventions, and contribute to the growing evidence base for delivering health promotion interventions at-scale.
PROSPERO CRD42020144842 .
Little research explores how changes in adolescents' peer, family and school environments may influence dietary behaviors during the shift from elementary school to secondary school and whether boys ...and girls experience these changes in similar ways. Drawing on Bronfenbrenner's socio-ecological model and Ridgeway's gendered framework, thematic analysis of twenty-seven semi-structured interviews with parent-adolescent dyads reveals that changes in adolescents' peer, family and school environments affect dietary behaviors following the transition in gendered ways. Within the peer context, food facilitates friendships among girls. Girls use food to forge intimate relationships with their peers whereas boys do not report relying on their peers to influence their dietary choices. In the family environment, gender-based body ideals (i.e., being strong and fit for boys versus being thin for girls) become more apparent and influential over adolescents' dietary behaviors. In some families, parents oppose gender-based body ideals (i.e., food restriction among girls) whereas in others, parents' expectations around food become supportive of gendered norms (i.e., encouraging food consumption among boys to gain muscle or acquiring food literacy skills among girls). Within the school context, socializing emerges as a key priority above eating at lunchtime, but boys and girls engage in this socialization differently. Girls use their lunch hour to socialize with peers through sedentary activities whereas boys socialize through team sports. In summary, gender plays a role in how changes in the peer, family and school environments influence boys' and girls' dietary behaviors as they transition into secondary school. Future public health interventions should consider using a targeted gender approach to encourage adolescents to make healthier food choices.
To examine older adult physical activity (PA) intervention studies that evaluated implementation and/or scale-up. Research question 1: What implementation and/or scale-up indicators (specific, ...observable and measurable characteristics that show the progress of implementation) were reported? Research question 2: What implementation and/or scale-up frameworks were reported? Research question 3: Did studies evaluate the relationship between implementation or scale-up of the intervention and individual level health/behaviour outcomes? If yes, how?
Systematic review.
Publications from electronic databases and hand searches (2000 to December 2019).
Any PA intervention studies with community-dwelling older adult participants (mean age ≥60 years). Required indicators: (a) Must report amount of PA as an outcome, with validated self-report or objective measures, and (b) Must have reported at least one implementation or scale-up framework and/or one implementation or scale-up indicator.
137 studies were included for research question 1, 11 for question 2 and 22 for question 3. 137 studies reported an implementation indicator: 14 unique indicators. None were specified as indicators for scale-up evaluation. 11 studies were guided by an implementation or scale-up framework. 22 studies described a relationship between an implementation indicator and an individual-level health outcome.
There is need for implementation research that extends beyond analysis at the individual level, includes clearly defined indicators and provides a guiding framework to support PA initiatives in older adults. Such implementation studies should evaluate factors in the broader context (eg,political, environmental) that influence scale-up.
CRD42018091839.
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