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      Effects of a ‘school-based' physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the ‘Physical Activity 4 Everyone' RCT

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          Obesity prevention during adolescence is a health priority. The ‘Physical Activity 4 Everyone' (PA4E1) study tested a multi-component physical activity intervention in 10 secondary schools from socio-economically disadvantaged communities. This paper aimed to report the secondary outcomes of the study; to determine whether the intervention impacted on adiposity outcomes (weight, body mass index (BMI), BMI z-score), and whether any effect was moderated by sex, baseline BMI and baseline physical activity level, at 12 and 24 months.


          A cluster randomised controlled trial was conducted in New South Wales, Australia. The school-based intervention included seven physical activity strategies targeting the following: curriculum (strategies to maximise physical activity in physical education, student physical activity plans, an enhanced school sport programme); school environment (physical activity during school breaks, modification of school policy); and parents and the community (parent engagement, links with community physical activity providers). Students' weight (kg), BMI and BMI z-score, were collected at baseline (Grade 7), 12 and 24 months. Linear Mixed Models were used to assess between-group mean difference from baseline to 12 and 24 months. Exploratory sub-analyses were undertaken according to three moderators of energy balance.


          A total of 1150 students (mean age=12 years) provided outcome data at baseline, 1051 (91%) at 12 months and 985 (86%) at 24 months. At 12 months, there were group-by-time effects for weight (mean difference=–0.90 kg (95% confidence interval (CI)=–1.50, −0.30), P<0.01) and BMI (−0.28 kg m −2 (−0.50, −0.06), P=0.01) in favour of the intervention group, but not for BMI z-score (−0.05 (−0.11; 0.01), P=0.13). These findings were consistent for weight (−0.62 kg (−1.21, 0.03), P=0.01) and BMI (−0.28 kg m −2 (−0.49, −0.06), P=0.01) at 24 months, with group-by-time effects also found for BMI z-score (−0.08 (−0.14; −0.02), P=0.02) favouring the intervention group.


          The PA4E1 school-based intervention achieved moderate reductions in adiposity among adolescents from socio-economically disadvantaged communities. Multi-component interventions that increase adolescents' engagement in moderate-to-vigorous physical activity (MVPA) may assist in preventing unhealthy weight gain.

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          Most cited references 29

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          The development of instruments to measure the work disability assessment behaviour of insurance physicians

          Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.
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            Effect of school-based physical activity interventions on body mass index in children: a meta-analysis.

            The prevalence of childhood obesity is increasing at an alarming rate. Many local governments have enacted policies to increase physical activity in schools as a way to combat childhood obesity. We conducted a systematic review and meta-analysis to determine the effect of school-based physical activity interventions on body mass index (BMI) in children. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials up to September 2008. We also hand-searched relevant journals and article reference lists. We included randomized controlled trials and controlled clinical trials that had objective data for BMI from before and after the intervention, that involved school-based physical activity interventions and that lasted for a minimum of 6 months. Of 398 potentially relevant articles that we identified, 18 studies involving 18 141 children met the inclusion criteria. The participants were primarily elementary school children. The study duration ranged from 6 months to 3 years. In 15 of these 18 studies, there was some type of co-intervention. Meta-analysis showed that BMI did not improve with physical activity interventions (weighted mean difference -0.05 kg/m(2), 95% confidence interval -0.19 to 0.10). We found no consistent changes in other measures of body composition. School-based physical activity interventions did not improve BMI, although they had other beneficial health effects. Current population-based policies that mandate increased physical activity in schools are unlikely to have a significant effect on the increasing prevalence of childhood obesity.
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              Mediating variable framework in physical activity interventions. How are we doing? How might we do better?

              Behavioral science provides the foundation for physical activity interventions. The mediating variable framework is used to assess the status of physical activity interventions and the roles that are, or could be played, by behavioral theory. Twenty-five physical activity intervention studies and 45 physical activity correlational studies were found in the literature, tabulated, and included in the analysis. Behavioral interventions for promoting physical activity have worked primarily when participants were motivated enough to volunteer or when a school-based physical education program changed. In most cases, behavioral or psychosocial theory accounted for 30% or less of the variability in physical activity behaviors. Most intervention studies do not measure mediating variables, and when they do, they do not systematically effect changes in all the mediating variables on which they are predicated. To increase the effectiveness of physical activity interventions, more physical activity research should focus on a better understanding of the predictors of physical activity and toward interventions demonstrated to effect change in these predictors of physical activity. Changing the focus to basic behavioral and social science and mediator change research should provide a more systematic and cost-effective approach to increasing the effectiveness of physical activity interventions.

                Author and article information

                Int J Obes (Lond)
                Int J Obes (Lond)
                International Journal of Obesity (2005)
                Nature Publishing Group
                October 2016
                10 June 2016
                19 July 2016
                : 40
                : 10
                : 1486-1493
                [1 ]Hunter New England Population Health, The University of Newcastle , Wallsend, New South Wales, Australia
                [2 ]School of Medicine and Public Health, University of Newcastle , Callaghan, New South Wales, Australia
                [3 ]Hunter Medical Research Institute , Lambton, New South Wales, Australia
                [4 ]Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle , Callaghan, New South Wales, Australia
                [5 ]Early Start Research Institute, Faculty of Social Sciences, University of Wollongong , Wollongong, New South Wales, Australia
                [6 ]Illawarra Health and Medical Research Institute, University of Wollongong , Wollongong, New South Wales, Australia
                Author notes
                [* ]Hunter New England Population Health, The University of Newcastle , Locked Bag 10, Wallsend 2287 New South Wales, Australia. E-mail: Rachel.Sutherland@
                Copyright © 2016 The Author(s)

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                Original Article

                Nutrition & Dietetics


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