PA children 7-12 Flashcards
Common physical health outcomes studied in PA research in children. Strongest evidence?
BMI - also comp/ lean mass Bone health - particularly girls Cardiometabolic health (cholesterol, metabolic syndrome) Obesity Fitness, Motor control/ perf/ literacy Depression Asthma Injury Academic performance Grades Indicators e.g. Memory
Strongest for cardiometabolic health, mental health, fitness and bone health
Describe risk of bias (ROB) in PA in children literature
Valid measure of SB used
-cut points valid for children/adolescents
Covariates such as MVPA included in analysis
Representative sampling/ random selection
Adequate % with complete data?
TV viewing associated with?
More than 2 hr a day unfavorable:
- body comp
- decreased self esteem
- pro social behaviour
- academic achievement in school aged children
Limitation of TV viewing data
Mostly self report/ proxy report
What is cognition? 3 main areas
Basic mental process we use in everyday life
- Attention
-Memory (working and longer term)
-Executive fuinction - (cognitive control)
Also percepton from various senses
How can we measure cognition?
Event -stimulus ID -Response selection - Response programming Repsonse Cognitive processes jointly measured by reaction time
Behavioural measurements pratical of cognition
D2 test of attention
Phyiological studies e.g. EEG
Activity/ cognition higher after walking than sedentary
Findings from a systematic review of PA/SB and cognitive function, academic achievement and limitations
Fitness, Single bouts of PA, particip[ation in an intervention benefit cognitive function
Depends on constructs measured
Caution as little experimental evidence
Why might there be cognitive benefits with PA/SB?
Not much explaination why?
Physiological mech
INCREASED BF and perfusion - MRI etc
Socialsation in sport - decisions etc.
Exposure - PA, sport, fitness (hard to unpick independent relationships)
Combined impact cognitive, pyscho-socail (ability to work in groups, support etc) and improved school engagement leading to improved education achievement.
Mixed evidence for each.
Another review, CDC, relationship between school-based PA (including PE) and academic performance? Backed up by later evidence?
PE, recess, classroom and extracurricular PA • Of all the associaXons examined, 50.5% were posi;ve, 48% not significant, and 1.5% were negative.
Second review by Singh
Strong evidence of a significant positive relationship between PA and academic performance later. Mostly from observational studies - more PA is related to improved academic from high quality evidence.
How can we measure academic achievement?
Standardised tests vs subjective grades
Can active breaks/ lessons benefit academic perf? CDC
Active breaks/ lessons benefit 8/9 studies
Variation in physically active lesson implementation/ idea behind them
Integration of movement into teaching of academic content
Longer duration
Across the curriculum
Why do PA/Sb and cognitive function outcomes vary?
depends on constructs studies
Single bouts vs daily PA on cognition?
Single bouts can benefit cog function in children, daily PA and cognition is equivocal (ambiguous)
Longer term active lesson evidence?
After 2 years - 4 months learning gains in stardised test scores from maths and spelling PAL (x3 a week)
Associations between SB/PA and GCSEs in the UK?
Objective PA and Self reported sed behaviour e.g. Screen and non screen activities and GCSE results from national records. Prospective 845 adolescents.
1 hr screen time at 14.5y associated with 2 fewer GCSE grades
Still assoc after adjustment for PA and other SB
Inverse u shaped relationship between non screen sedentary behaviour and academic perf with association peaking at 4h/day
Method of a systematic review
Keywords
Search databases
Remove duplicates
Read all abstracts/ papers
Common mental health outcomes/ functioning outcomes in PA research
Anxiety Mental well-being Depression Cognitive functioning Educational performance i.e. Academic achievement
Aims of Cliff et al 2016
Is objectively measure total SB assoc with adverse health/development outcomes
Patterns of SB assoc ^?
Are associations independent of MVPA?
What moderators of the association e.g. Age group or risk of bias?
Reults of Cliff et al 2016
No association with Adiposity (despite 11 with sig pos association)
No association with Cardio-metabolic outcomes (8/29 at keast ibe sig outcome)
Stat sig meta analysis between sedentary time and 5 studies with glucose/insulin. Weak positive association (r=0.07).
ROB and MVPA were sig moderators however
Publication bias
No association with health related fitness
Inconsistent/uncertain association with bone and musculoskeletal outcomes
ROB in all studies regarding psychosocial outcomes
No association (inconsistent/uncertain for 1/4 which was low ROB)
Inconsistent/ uncertain gross motor function - few studies (3)
Inconsitent/ uncertain for cognitive outcomes - few studies (3)
Cliff et al 2016 comment on strength of association between ST and health and development?
Limited evidence that total ST is associated with health and development in children and yound people, particularly when accounting for ROB and MVPA
Limitations in literature highlighted by Cliff et al 2016
However small number of subdies that adjusted for MVPA, bone and MSK, psychosocial development, gross motor skills and cognitiive outcomes.
Small number of studies that examines associations for patterns of ST
Conflicting findings to Cliff et al 2016
Screen based SB time studies
Evidence inadults which indicated overall ST and patterns are adversely associated with health outcomes
Why may Screen time behaviour studies conflict with Cliff et al 2016
May be unique mechanisms for TV viewing/electron media to influence health and development in young ppl, not common to all SB
Proxy report/ self
Increasd sitting time and decreased energy expenditure
Increased energy intake from unhealthy snacking and sugary beverage consumption during and following exposure
Exposure to advertising
Displacement of opportunities for social and education development
Exposure to content which promotes socially undesorable behaviour
Develoment of biological processes of dependence
Interference of cognitive processes
Displacement of MVPA
Why may adults SB literature differ (overall ST and patterns are adversely assoc with health outcomes) Cliff et al 2016
Difficult to say (issues with measuring):
Measurement issues of SB
Validity of cutpoints - standing still classified as SB in accelerometry
However adult studies with these limitation still founds assoc
Potential codependence of SB and PA (waking hours are finite so if not in SB then in LPA) therefore intrisically codependent
Lower levels/ shorted lifetime exposure to SB Higher levels of PA and time in MVPA Healthier profiles for cardio-metabolic outcomes investigated in children Above 3 Indicated by: A day of prolonged sitting did not have adverse effects compared to a daybroken up with LPA Also: Some evidence that obese/ overwight children may benefit as unhealthier cardio-metab profiles, greater SB exposure or lower MVPA. allowing detection of adverse effects earlier.
Implications for literature from comparisons of results with existing literature from Cliff et al 2016
Compositional analyses needed to understand optimal balance between SB, LPA, MVPA and sleep to maximise health and developments
Further experimental evidence needed to detect shifts from sitting to standing or LPA More exp/log evidence using direct measure of sitting posture and examining multiple outocmes at different age groups independent of MVPA.
Can review claim the excessive SB does not adversely impact health and development in children and adolescents? Why?
Premature to conclude that excessive SB does not adversely impact health and development in children and adolescents
Adverse effects among adults and some evidence of tracking of SB across the life course, encouragement of limiting SB in children is prudent.
Limitations of Cliff et al 2016
Limitations of evidence base
No experimental studies
<50% had low ROB
Impacts strength of conclusions
However finding were consitent across ROB categories (not adiposity meta)
Cross sectional with some longitudinal in obesity
Using activity monitors at hip/ wrist still limited to differentiate between sitting and standing likely leading to ST being overestimated
Not all studies in evidence summaries included in met-analysis - not all authors contacted.
Multiple markers of cardiometabolic measured in studies increasing chance of positive result
Validity of outcome measured not considered - ROB
But all but one psychological study were validatied
Strengths of Cliff et al 2016
Wide range of health outcomes explored
First to focus on objectively measured SB vol and patterns
Categorised level of evidence for each outcome
Findings enhances by examination of potential moderating effects of ROM and MVPA adjustment
Why might girls be less active than boys?
Biological maturity affecting social factors
Do we socialise adolescent girls out of PA?
FM and FFM differences gender?
FFM much greater increase in males
FM same
% fat different to boys and girls
Skinfold changes with age gender
Females always higher, more marked after age 12
Both extremities and trunk
Boys sigmoid - drops, increases, drops, increases (overall increasing less marked than girls)
higher in extremities
Muscle mass changes with age
Similar steady increase in male and female
Increases after puberty (age 12ish)
Is there an obesity epidemic?
Epidemic = rapid rise in cases
Both in developed and undeveloped
UK not doing well
Childhood remained stable over last 20 years - national health survey
Describe the national child measurement program, categorisation and key 14/15 findings
80% healthy weight in reception
Obesity = more extreme excess of adiposity
Overweight = >= 85%
Obesity >= 95%
91 and 98 may be better - these are used in letters for parents but 85 95 used in official statements
Most sign posted national programme -
Underweight = <=2%
Year 6
More obese than overweight
65% Healthy
Misclassification from BMI - tends to wash out over whole pop
Health survey for england findings
Health Survey for England
Similar stats
Similar at 2-10, higher older for girls
Measurement issues with national measurement programs?
Critical thought - Measurement issues
Minimal training for nurses
Calibrated scales should be used
Check stadiometer for flexing
No standardisation of time of day - loss of 2cm
Eat more and drink more throughout the day
Wholeschools disadvantaged if measured in the afternoon
7.5% of girls shifted to overweight or obese girls from measuring in afternoon
Changes in obesity prev different areas nationally, meaning?
Overweight prev in West mid and London
Obesity slightly diff - London and North East
Sociodemographic and economic factors?
Describe the trend in prev of excess weight in Uk from health survey for England
Statistically hard to say in 20 years
More marked in Aus and US?
Epidemic?
Similar in obesity - 5% change
trend from national child measurement prog
Not massive change Down in boys over time in reception Overall decrease in reception Year 6 Increasing
How has BMI distribution changed in UK since 1990?
1990 data = reference data Reception Slight shift to right Similar shape Year 6 children Heavy children getting heavier Skewness to the right
Medical complications of obesity in childhood
OSA Type 2 diabetes Gynacoglogical problems Abnormal mesnses Infertility PCOS
Describe OSA
Disorder of breathing during sleep characterised by prolonged partial/ complete upper airway obstruction that disrupts normal ventilation and normal sleep patters
Symptoms including havitual snoring, sleep difficulties and/or daytime neurobehavioural problems
1-1.5%
Causes of OSA in children
Lymphoid tissues blocking (milder lymphoid hypertrophy) associated with obesity
Type II
Obesity cause or consequence
1BMI increase above 50th% = 12% increase in OSA
45% of obese children with OSA have adenotonsillar hypertrophy
What is metabolic syndrome
Clustering of most dangerous RFs for CVD and type 2 diabetes Abdominal obesity High cholesterol HBP Diabetes/ raised fassting glucose Raised fasting plasma glucose Children Many definitions in children Age specific cutoffs - IDF Includes Obesity (WC) Triglycerides HDL-C BP Glucose or T2DM Cant be diagnosed under 10
Prevention and primary management of metabolic syndrome
Non-specific prevention guidelines due to lack of evidence
IDF (international diabetes Fed)
Moderate calorie restriction to achieve a 5-10per cent loss of body weight in first year
Moderate increase in PA
Change in dietary comp
Recommendation for future work on metabolic syndrome IDF
Improved understanding of relationship between body fat and distribution
Do early growth patterns predict future adiposity and other features (LBW too)
Investigate definitions sensitive to normal variation
Better measurement than BMI of central adiposity
Ethnic specific, age specific cut points for waist circum
Screening opportunities for T2DM?
HBA1c and 1,5-anhydroglucitol potentially useful in screening in a pediatric obesity clinic
Cause of T2DM
Destruction of islet cells within the pancreas causes this resistance
Obesity a cause
Other RFs
Changes in prev of T2DM in chidlren?
admission rates in youth <18yrs in UK icnreased by 63.5% from 96-04
Why T2DM in children is a worry?
earlier develop the clinical manifestations of T2DM, the earlier complications might appear
Best predictors of T2DM in children? Mcgavock et al 2007
Metbaolic syndrome RFs better predicter of T2DM than Fx and fasting glucose
Complications of T2DM in children Mcgavock et al 2007
Hypertension
Nephropathy - Microalbuminuria also RF assoc
Dyslipidaemia - specifically TGs, total cholest, LDL, HDL-C
Hepatic steatosis - increased risk of cirrhosis and portal hypertension
-raised liver enzymes
Subclinical risk factors
Elevated CRP
Reduced serum adiponectin
Endothelial dysfunction, arterial stiffness?
Central adiposity
When are PA interventions most effective in reducing BMI in children? Mcgavock et al 2007
Hypertension
Nephropathy - Microalbuminuria also RF assoc
Dyslipidaemia - specifically TGs, total cholest, LDL, HDL-C
Hepatic steatosis - increased risk of cirrhosis and portal hypertension
-raised liver enzymes
Subclinical risk factors
Elevated CRP
Reduced serum adiponectin
Endothelial dysfunction, arterial stiffness?
Central adiposity
What should be considered in ‘dose’ prescription of exercise to youth? Mcgavock et al 2007
Duration and intensity should be considered in the prescription of a dose for management and prevention of T2DM in youth
MVPA better correlated with overweight risk than total PA.
Describe insulin sensitivity in youth Mcgavock et al 2007
Early manifestation of T2DM
PA important in prevention
Resistnace in insulin-mediated glucose disposal causes
Correlated with PA - RCTs confirm
40-60mins daily for a minimum of 4 months
Describe Sedentary (screen) time in youth and relation to DM Mcgavock et al 2007
Time spent watching TV, working on a comp or playing video games
Related to obesity and metabolic risk
Adiposity and RF clustering increase incrementally with incresing screen time, independent of PA patterns.
Interventions targetting screen time attenuate weight gain in young children
Should be targeted as an infependent RF for DM as it is a RF for obesity.
American diabetes association/ AHA recommendation for PA/Screen time/ diet Mcgavock et al 2007
PA, >1hr MVPA daily and reduction of screen time below 2 hours daily - American Diabetes Association and American Heart association.
Adolescents are asked to achieve total and sat fat intake <30% and 10% respectively, fibre intake 25-35g daily and increased consumption of fruit and veg. (based on adults with T2DM).
Yet to perform RCT in children with T2DM, however shown to benefit metab profile in children without.
The effect of exercise alone or with diet Mcgavock et al 2007
Enhance insulin sensitiveity
Reduced SBP
Lower Tc, raise HDLC
Improve endothelial function
The effect of dietary restriction alone Mcgavock et al 2007
Reduce BP
Improve lipoprotein profile
v
How long is CV profile maintained after cessation of exercise? Mcgavock et al 2007
CV profile lost within 3-6months of cessation of trianing
Anecdotal predictor of success in T2DM treatment? Mcgavock et al 2007
Anecdotally: family-based acceptance of and adherence to lifestyle change is the most powerful predictor of sucess of strategies.
Dose of exercise needed for T2DM treatment/ prevention? Mcgavock et al 2007
Dose of exercise yet to be clearly defined:
Review point to 40-60mins of MVPA 3-5times per week (support guidelines)
RCT evidence of 150activity weekly - the LOOK Ahead trial in overwight adolescents with T2DM - reduction in body mass and almost all markers
Looked at long term effectiveness
Including albmin:creatine ratio
More cohort and RCTs needed
Conclusion Mcgavock et al 2007
Premature onset hyperglycaemia predicts increased risk of hard clinical endpoints
Need aggressive strategies to achieve adequate cardioprotection for youth as T2Dm assoc with end-stage renal disease and CVD mortalitity
Clinical target should include:
Minimum 60-90mins of PA of MVPA daily
<60mins screen time
Achievement of weight loss of 7-10% for prevention and management of T2DM in youth
Define sport
Hard to define sport e.g. Physical activity that is governed by a set of rules or customs and often engaged in competitively
Sport based on number doing it? Or overall governing body or IOC or competition or pay?
Potential positives and negatives of sports participation?
Lots of benefits, not just PA
Makes up a large portion of children and adolescent’s MVPA
Benefits to energy expenditure
Lots of psychosocial factors e.g. Assertive, self esteem, team work.
Bad
Are high levels of training harmful to a growing child?
Burnout
Could structured/speciallised sport cause premature drop out?
Psychosocial reasons?
When are most children recruited to sports clubs?
<7 years old
Association between age of recruitment to sports club and PA
earlier the more PA
Can elite sports participation be negative for the growing child?
Only socialise with people in that sport
If drop out may be hard
Negative psychosocial impacts
Can sports stunt growth?
No strong evidence that stature is stuned by female participation in gymnastics
Maybe self-selected - often shorter and have an appropriate weight-for-height
Secedonary sex characteristics, skeletal age and age at PHV indicate later maturation but overlap with gen pop
How does maturity timing impact sports participation
Talent ID and athlete selection
Self selection and drop out
The design of training and conditioning programmes and the potential for injury (late maturer?)
Grouping of athletes for competition and practice
Depends on skill/ sport
Maturity and growth characteristic explained 41% of Vertical Jump Performance
Advantage in early matureres
Maturity much less in shooting accuracy
40m sprint time 50%
How may preferential selection based on talent impact talent ID
Are we missing out on potential sports talent as we are selecting people based on ability now… E.g. Some may be physically and mentally more advanced, doesn’t mean they will be better later
Talent selection should occur not talent IDNot about success of youth team now
Talent ID should involve training large numbers of players instead of cutting all but the ‘elite’ ones
May mature later to be of equal physical size
Describe the relative age effect
More exponsure to sport and confidence (not necessarily bio maturity) if born ealier in the year relative to children in the same age category
Earlier birth dates selected often in non professions
Levels out at pro level - suggest maturity status not as important
Distribution gets more even over time
May depend on position
Goal keeper and defende earlier better?
Influence self selection and talent selection in womens soccer in Switzerland
Unlike male soccer, no RAEs in elite women’s teams
Ealier does not equal more mature
Solutions to selection prblems
More skill/ reduce contact e.g. Touch rugby
Elimination fast tracking?
Bio-banding
- Selection on size may lead to you reling on those characteristics and not necessarily skill, neglect technical development
- Bio-banding group by % of adult height (at the moment done by height)
- England Premier League Growth Study Scientify Advisory Group
Use motor skills tests to monitor progress not select
How do we grow participation in sport? kind of answer
Not loads of data
Fairly stable levels in 16-25
Around half of 16-25 year olds
Over last 25 years not much change in core sports
Because??:
Sport reaches those who are already engaged
Competition with other interests - passive participation in children is discontinued
Merkel 2013 positive effects of youth sport PHYSICAL
INcreased PA
increased fitness
Decreased risk of obesity/ chronic disease
Merkel 2013 positive effects of youth sport PSYCHOLOGICAL
Decreased depression
Decreased suicidal thoughts
Decreased high risk behaviour
Improves self-concept/ self-worth
Merkel 2013 positive effects of youth sport SOCIAL
Enhances social skill Improves positive social behaviours Time management Academic achievement Improves character
Merkel 2013 negative effects of youth sport PHYSICAL
Injuries
Untrained coaches - poor quality often
Inconsistent safety precautions
Lack of sports science influencing policy and practices
Merkel 2013 negative effects of youth sport PHYCOLOGICAL
Increased stress to be elite
High rates of attrition - specialisation not recommended before 12-13
too competitive
Inappropriate expectations to achieving scholarships/professional career
Merkel 2013 negative effects of youth sport SOCIAL
Expense
Inconsistent funding to insure proper safety equipment, venues and equal participation
Inequality across groups (socioeconomic, ethnic, geographic, gender)
Merkel 2013 future prospects SOCIETY
Training of coaches Enforce sports safety Increase funding -safety education for coaches - improved policies and procedures - increeased participation by underserved groups - more facilities, proper safety equipment Rules and regs guided by science Pre-participation physicals
Merkel 2013 future prospects PARENTS
Positive parenting through apropriate praise and emphasis on fun more than winning
Focus on goals of skill acquisition
Positive reinforcement before, during and after games and practices]
Promote desired behaviours
-Sportsmanship
-Punctuality
-Preparedness
Merkel 2013 future prospects COACHES
Emphasise fun
De-emphasise winning
Positive praise of team and individuals
greater emphasis on PA than skill mastery
Obtain education on youth athlete coaching
Provide age appropriate instruction
Gain knowledege of sport and rules
Gain knowledge of strength, conditioning, nutrition and safety
INjury recognition/ first aid training
Merkel 2013 why intervene in youth sport?
High rates of attrition and negative effects
Estabolish a balance between fitness, physcological well-being, healthy lifestyle and make enjoyable.
Describe the different categories of sports
Endurance, strength, Power, team, weight category, winter sports
Requirements for endurance athletes - main concerns
Prolonged moderate/high intensity exercise High energy requirement Main concerns Fuel during exercise Firstly amount Secondly type Then fluid requirement during/post Then post exercise recovery Carb Protein
Causes of fatigue in endurance athletes how how nutrition can affect this
Substrate depletion - glycogen/ substrate utilisation
Loss of body fluid
Hyperthermia - nutrition can even affect this
Caffeine can increase temp?!
Ice slurries can decrease
Beetroot (nitrate) supp, increases core temp (as well as performance)
Saris et al 1989 aim
to quantify the dietary intakes and to find out whether this intake met requirements during the tour de france
Saris et al 1989 method
Calculated nutritional intake from daily food records
EE was estimated from sleeping time and the lower activity period
EE during cycling was predicted based on the race, detailed info about length, altitude difference, road paving etc..
Saris et al 1989 key findings
PRO:CHO:FAT was 15,62,23%
49% of intake during the race- 94g/hr
30% from CHO-rich liquids
High vitamin supplementation
Daily water 6.7l up to 11.8l
Large quantities of CHO-rich liquid seems to be appropriate to maintain energy and fluid balance under extreme conditions
Extreme variation in intake and expenditure
Physiology behind carb supp
Particularly important for events >60mins Peripheral effects Glycogen sparing? Maintainence of blood gluccose Maintainence of CHO oxidation Central effects ? Motivation?
Jentjens et al 2003 aims
To examine the effects of ingesting differing amounts of glucose pre-exercise on the glucose and insulin response during exercise and on time-trial (TT) performance
Jentjens et al 2003 methods
4 exercise trails separated by 3 days 500ml of drink 45 mins beofr 1) Plac 2) 25g (low_ 3) 75g (med) 4) 200g (high) glucose 20min of submax steady state exercise at 65% of max PO followed by a 691kj TT approx 40minute Blood samples via a catheter every 5 mins
Jentjens et al 2003 key findings
Plasma glucose fell rapidly during SS exercise in all glucose trials, steady in placebo
No difference in plasma glucose conc between glucose trails at any time
Hypoglycaemia seen in some individuals with glucose
No difference in performance - carb intake a rebound hypoglycaemia did not affect performance
What matters with carb ingestion? other factors?
CHO Content Usually 6-8%
Lower conc. can improve performance
Higher conc. may delay fluid availability
CHO Type Glucose, Fructose, Galactose, Maltodextrin
Electrolytes Na stimulates CHO and water absorption
Maintains extracellular volume
Osmolality Influences fluid absorption rate
Temperature Ingestion of cool fluids may be beneficial
Flavourings Important factor influencing fluid consumption
Other ingredients(?) Caffeine, taurine, BCAA et
Carter et al aim 2004 aim
To investigate the possible role of CHO receptors in the mouth in influencing exercise performance
Carter et al aim 2004 methods
Crossover
endurance cyclists complete two performance trials
Once with CHO mouth rinsing regularly - 12.5%
Once with placebo rinsing
No allowed to swallow
Carter et al aim 2004 key findings
Performance time significantly improved with CHO
No difference in HR or RPE
Appears to increase central drive or motivation
2.9% decrease
Cox et al aim 2010
to determine whether altering daily carbohydrate intake during daily training affects metabolic adaptations to endurance exercise and substrate utilization during performance
Cox et al methods 2010
Two groups - parallel however within each there was a crossover with during exercise feeding
28 days training
High carb vs energy matched low carb group
5day test block before and after- 100min of Steady state cycling followed by a time trial repeated twice after 72h
Counterbalanced design once with water and once with 10% glucose solution
Accumulated ingested glucose oxidation (consumed in exercise with tracer), how much can they use
Biopsies before and after each training period
Blood samples at regular intervals throughout via a cannuler
Cox et al aim 2010 key findings
High had more max citrate synthase activity
Increased oxidation of glucose consumed during submax exercise
No effect on performance
No increase in GLUT 4 (found at muscle), gut trainability?
Suggests increases elswhere i.e. the gut may be responsible
Common challenges to enegy balance
Injury/ retire
Vast amount of calories required by those with vast training schedules
Need to match energy balance to intake
Other less obvious responsibilities of a sports nutritionist
Promote adequate hydration- a lot of drinks not salty enough (should be 50mmol Na)
Optimise health - EE and UTRI
Adivce on use of supps
Competition eating strategies - avoid GI probs
Main concerns regarding resistnac exercise and maximal strength exercise
Energy balance Much higher mass and absolute energy requirement Timing and amount of protein How much? 20-25g sufficient for most Source of protein important Foods? Timing Sooner = more feedling opportunities
Factors to consider with a PA intervention
Behaviour/ Problem - what and why Who - pop of interest Setting Mediators (mechanisms of change) Strategies for behaviour change (how) Potential barriers/ motivators
What is physically active learning. Describe different forms
PAL - physically active learning
Continuum
Physically active break one end (2-3 minute intejection, break for movement’s sake)
Another spectrum - active break with an education component.
=PAL
What are activity breaks
Breaks from long bouts of sitting
Focus on movement, or movement +content
Performed in limited space during natural transition
2-15 minutes in duration
What are physically active lessons
Longer duration
Integration of movement into teaching of academic content
Across the curriculum
Link between PAL and academic performance?
Growing evidence link between PAL an academic achievement
No neg effect..
Additional benefits of the longer term study
Postive effects on
Pupil’s enjoyment
Pupil’s attention to task - not just novelty
References to PAL from the childhood obesity plan for action
Recommend an active lesson
Schools tasked with 30mins PA at school a day
Give Ash’s current evidence summary on what PA lessons and breaks do and do not do
PA lessons do not
Reduce overall daily PA
Reduce overall dailey ST
Physically active lesson may
Increase PA in classroom
Decrease ST in classroom
Increase attention to tasks (often after)
Increase academic achievement in some subjects (only in certain subjects, may be confounded e.g. fitness) (may be least active?)
Increase pupil’s enjoyment of learning
Physically active breaks can lead to increased PA in the classroom
Limitations of evidence base regarding PAL
Short duration Lack of long follow-up What happens after? Small sample size Few studies based on behavioural theory More chance of success Few use inclinometers Lack of assessment on out of school PA/ST Lack of generalisability from USA + Australia - particularly in schools as different even regionally Lack of implementation data What drive? Why?
Describe the behaviour change wheel
Lots of models, which do you chose? e.g. theory of palnned behaviour… etc.
Need an unbiased coherent way of summarising this
The behaviour change wheel
Centre = 3 forces that shape behaviour: capability, motivation and opportunity
Outside - the techniques available to modify those forces
9 intervention functions and 7 policy categories
Aim of the behaviour change wheel
A systematic way of identifying relevant intervention functions and policy categories (sit outside) based on what is understood about the target behaviour
Describe the COM B model
Based off the behaviour change wheel
Capability and opportunity affect motivation, all 3 affect behaviour
Describe capability and subsets of
an individual’s psychological and physical capacity to engage in the activity concerned
Physical
- Any set of physical actions that requires an ability or proficiency learned through practice e.g. motor skill, fitness level
Psychological
-
Describe opportunity and subsets of
Any mental process or skill that is required for the person to perform the behaviour
More about skills e.g. knowledge (rule of road in cycling, the improtance of PA, rules of the sport), Self-monitoring
Describe motivation and subset of
The sum total of internal influences that energise and directs behaviour: a moment-by-moment property which is shaped by different systems of influence: physiological, impulses and inhibitions, motives, beliefs and identity
relfection
- People’s values and beliefs about what is important (good and bad), conscious intentions, decisions and plans
Autonomic
- Emotional responses, desires and habits resulting from associative learning and physiological stress e.g. make somehing fun/ rewarding
What is the BCT taxonomy
All behaviour change interventions have been categorised in a taxonomy (hundreds)
Called: BCT - taxonomy
Allows consistency within literture
Aim Coombes and Jones 2016
To quantitatively evaluate the impact of Beat the Street on levels of active travel using objective measures of change in physical activity recorded by accelerometry.
Intervention Design Coombes and Jones 2016
Encourages people to walk and cycle around their local environment. Walk tracking tecnology linked to a reward scheme (books for school, prize draw)
Residents get a smartcard which they touch to ‘Beat Boxes’ -sensors on lampposts.
Community wide intervention (study focused on just one school)
Restricted to 3 neighbourhoods in Norwich
40 beat boxes
One point per sensor allowing competition
Target set to go ‘around the world
Method Coombes and Jones 2016
9weeks
Pilot non-randomised controled evaluation
Children recruited from two schools (one control)
3 measurement periods, baseline, mid-intervention (7 weeks) and post intervention (20 weeks)
Wore accelerometer for 7 days, 10second epoch
Simple travel diary completed (validated)
Evaluated the number of times that each of participant touched a Beat Box with smart card
PA measured using CPM and MVPA
Key findings xCoombes and Jones 2016
Beat the Street did not significantly impact childrens overall PA during school commute times
Evidence it had a positive impact on higher intensity PA during commute
Higher levels of engement in intervention were associated with additional MVPA during communting times at 20 weeks follow up (21% increase to post intervention on average).
This occurred for those children who engaged on the mean number of days compared to children with no engagement.
children at the intervention school were less active during the evening compared to the controls post-intervention (compensate)
Active travel increased by 10% to post intervention and decreased by 10% in control (not sig)
Shows more likely to maintain active travel or switch to active travel
Relatively low engagement
Dose response, more engagement = sig increase in MVPA
Limitations Coombes and Jones 2016
Possible some contamination from intervention school to control school dispite 7.5km distance away
Only 2 schools so could not control for school level effects
Activities at one/ both may have been atypical in the period of evaluation (no teacher reports of this)
Commercial nature meant no control over its delivery
Few schools/ children (due to limited time)
Disproportionate boys and girls from each school
Wet month, may be more effective in dry conditions?
9 weeks may not be long enough
Underpowered to detect intervention effect
Geographically restricted to 3 neighbourhoods
Accelerometer may fail to detect changes in cycling behaviour
Got motivation and opportunity but not knowledge and skills (capacity)
What are the 7 best investments?
1) Whole-of-school programme
Whole school
Work best if a number of structures or components e.g. parents
Recess playground with extra curricular with component with parents
2) Transport policies and systems that prioritise walking, cycling and public transport
E.g. Exclusion zones around schools
3) Urban design regulations and infrastructure that provide for equitable and safe access to recreational PA, and recreational and transport-related walking and cycling across the lifespan
4) PA and NCD prevention integrated into primary health care systems
5) Public education, including mass media, to raise awareness and change social norms on PA
6) Community wide programs involvin multile settings and sectors and that mobilize and integrate community engagement and resources
Sport systems and programmes that promote ‘sport for all’ and encourage participation across the lifespan
Aims of Transform-US
Determine whether a Behaviour and environmental intervention in 8-9yr
, 18 month period results in higher PA and lower SB
Determine Idependnent and combined effects of PA and SB on children’s cardiometabolic health
Discover factors which mediate change
Determine if the intervention is cost-effectiveness
Describe the transform-US program
The programme: Over 200 students, 20 schools, Melbourne (Theoretical basis on the social cognitive theory, identified constructsand targetted them to change) 3 arms/ groups - each with school and family setting components Sb-I 18 key learning message Goal setting etc Daily Standing lessons Easels and desks Active breaks after 30min class time Novely timer Family stuff e.g. Reduce sitting time doing home work PA-I 18 learning messages Provision of sporting equipement, line markings, signage Provision of pedometers Family stuff e.g. Homework with PA SA+PA+I All
Evaluation of Transform-US how
Accellerometers and inclinometers Questionnaire for parents e.g. mediators, self-efficacy and access to school Activity diary Cost Classroom resources cheap Upskilling teachers very expensive Why How to manage children walking around Lesson plans Overall Estimate of time burden Time to preoare Parents Spending extra time on homework Cost to schools and research team Implications for wider research
Mid intervention results of Tansform US (why some of results too)
13.3 min less SED for combined groups
SB had higher enjoyment of standing
PA+SB and PA groups more positive perceptions of standing opportunities
No mediating effects were observed
Don’t really know why
Self-reported mediators measurement quality?
Failure to capture the relevant mechanisms that explain the association between I and PA/SB
Time lag between change in mediators and change in behaviour
After 2.5 years results of Transform US
Increased PA by 33 minutes per week
Reduced sitting time by 196minutes per week
$30.08 per child per year.
Describe NYC Active Design Guidelines (ADG)
Lots of agencies, lots of sectors coming together (For developers, planners, government agencies, policy makers) Evidence based strategies Active desing guidelines Look good Improve health Promote safety
Basic concepts/ targets of ADG
Active transport Active recreation Active buildings Healthy eating Lots of others…. E.g. Transit and parking, open spaces,children's play areas, street connectivity,
Evaluation of ADG methods (not specific method)
Of >500 proffessionals - surveys
Cross sectional not pre and post but collected before and after (not neccessarily the same)
Baseline audits of 32 NYC Dept of Construction building projects
Case studies of 4 DoC projects
Survey of ADG method
Architect survey pre and post ADG release as a web survey
Assessed potential change in 4 domains
Confidence to implemetn
Knowledge of evidence linking environemt and health
Implemetation of ADG strategies
Perceptions of clinents’ attitudes towards active designs
20% response rate
Male and white
Fairly old and long time in game
Findings from ADG survey
Small increase in knowledge
Small increase in confidence
9% increase in self-report practice
Only a minority aquire knowledge from research journals
Most interested un energy efficiency and universal accessibility thereofre addressing these issues is likely helpful
Limitations of ADG survey
Low Respnse rate 20%
Anonymous surveys, therefore samples were 2 cross sectional samples rather than longitudinal
Short time frame between release of ADGs and post survey - may not have been enough time to show more or larger impacts (5months post)
Describe an intervention based on the 4th best intestment
Questinonnaire Intervetion for healthy child 22-59 months Gives self administer screening tool FLAIR Fx Playing outside Television Nutrition Physician Assess readiness to change Agree behavioural change goals
Results of the FLAIR project
Parents expressed a desire to change behaviours to achieve healthier families
Believed that doctors should increase their focus on healthy habits during visits
Parents were more accepting of nutrition discussions than increasing activity (lack of safe outdoor space) or decreasing SB (benefits of TV)
Parents expressed fustration with physicicans for offering advice about changing behaviour but not how to achieve it
What is social marketing, benefits and requirements? diffiiculties?
Application of commercial marketing technologies to the analysis, planning, exection and evaluation of programs designed to influence the voluntary behaviour of target audiences in order to improve their personal welfare
Benefots
Translating complex educational messages and behaviour change techniques into concepts and products
Seen by many - 3000 a day
Requires
Change the product to meet consumer preferences
Public health professionals must change their recommendations to receieve maximal benefit
Application of commercial marketing principles
Palatable
Hard for marketing companies and scientists to distill ideas
Describe the C4L campaign
Advertising
Sponsership of The Simpsons
Direct and relationship marketing
Digital communications e.g. Website and emails
Public relations
Partnership marketing
Communications aimed at stakeholders e.g. Health adn teachers
Evaluation of C4L after 1year (done by themselve)
The document did not mention Food, nutrition, PA enough
SB/ TV viewing not mentioned
Target setting reached
8 change for life goals
Based on reach, awareness, response, sign ups, sistained interest
Commercial evidence of families changing habits, adopting all ‘8’ behaviours
Sales data suggests positive impact on types of food families are purchasing
C4L independent evaluation describe methods
Parents from 20 primary schools randomly assigned to control or IV
Mailed C4L materials to IV, retured feedback
Thousands of families
C4L independent evaluation concs and other criticisms
No impact on TV hours, rating of PA importance
Conc
Increased awareness
Little impact on attitudes or behaviour
Low engagement a key issue
Simplification of complex scientific methods
No mention of obesity
Describe investment 1 from the complementary document to the Toronto Charter for PA: A global call to action
Whole-of-school programsCan provide PA for large majority of children
Allow development of knowledge, skills and habits for life-long healthy and active living
Prioritise high quality PE, provision of suitable environment, resources to support PA throughout the day, support active transport, supportive school policy and engaging staff
Describe investment 2 from the complementary document to the Toronto Charter for PA: A global call to action
2) Transport policies and systems that prioritise walking, cycling and public transport.
Also lead to reduced congestion, less CO2
Requires development, policies influencing land use and acess to safe travel routes and promotional programs
Describe investment 3 from the complementary document to the Toronto Charter for PA: A global call to action
3) Urban design regulation and infra-structure providing equitable and safe access for recreational PA and recreational and transport-related walking and cycling across the life course
Multiple types of PA possible to affect opportunities
National, regional and local urban planning
Mixed-use zoning, placing shops, services and jobs near homes
Highly connected street, footpath and bikeway networks
Public open space with recreation facilities
Describe investment 4 from the complementary document to the Toronto Charter for PA: A global call to action
4) PA and NCD prevention integrated into primary health care system
HCPs influence patiet behaviour
PA included in NCD risk factor screening, patient education and referral
Integrated into NCD management
Focus on practical brief advice
links to communicaty-based supports for behaviour change
Addition training for this
Describe investment 5 from the complementary document to the Toronto Charter for PA: A global call to action
Mass media efficiently transmit consistent and clear messages about PA to large pops
Multiple forms, paid and non paid e.g. public relations, social media, internet
Combination with community-based events and community engagement to change community values.
Describe investment 6 from the complementary document to the Toronto Charter for PA: A global call to action
6) Community-wide programs involving multiple setting and sectors and that mobilize and integrate community engagement and resources
Across the life course
Using key settings e.g. local governments, schools and workplaces allowing integrated policies, programs and public education
Describe investment 7 from the complementary document to the Toronto Charter for PA: A global call to action
7) Sports systems and programs that promote ‘sport for all’ and encourage participation across the lifespan
Community/ sport for all policy and programs
Universal appeal of sport
Adapatation to interests to all groups, well-coordinated coaching and trianing opportunities
Enjoyment needs to be priority
Involve partnerships between international, national and regional sporting organizations along with community-based clubs and other sports providers
Sports stars as role models
Sport and fitness industries could provide communication medium
Organisations reduce social and financial barriers and increase motivation for all.
