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      Time-efficient intervention to improve older adolescents’ cardiorespiratory fitness: findings from the ‘Burn 2 Learn’ cluster randomised controlled trial

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          Abstract

          Background

          Cardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents’ CRF.

          Methods

          Two-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering.

          Results

          We observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol.

          Conclusions

          Implementing HIIT during curricular time improved adolescents’ CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day.

          Trial registration number

          Australian New Zealand Clinical Trials Registry (ACTRN12618000293268).

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          Most cited references57

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          A Global Measure of Perceived Stress

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            Executive Functions

            Executive functions (EFs) make possible mentally playing with ideas; taking the time to think before acting; meeting novel, unanticipated challenges; resisting temptations; and staying focused. Core EFs are inhibition [response inhibition (self-control—resisting temptations and resisting acting impulsively) and interference control (selective attention and cognitive inhibition)], working memory, and cognitive flexibility (including creatively thinking “outside the box,” seeing anything from different perspectives, and quickly and flexibly adapting to changed circumstances). The developmental progression and representative measures of each are discussed. Controversies are addressed (e.g., the relation between EFs and fluid intelligence, self-regulation, executive attention, and effortful control, and the relation between working memory and inhibition and attention). The importance of social, emotional, and physical health for cognitive health is discussed because stress, lack of sleep, loneliness, or lack of exercise each impair EFs. That EFs are trainable and can be improved with practice is addressed, including diverse methods tried thus far.
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              Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

              Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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                Author and article information

                Journal
                Br J Sports Med
                Br J Sports Med
                bjsports
                bjsm
                British Journal of Sports Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-3674
                1473-0480
                July 2021
                21 December 2020
                : 55
                : 13
                : 751-758
                Affiliations
                [1 ] departmentPriority Research Centre for Physical Activity and Nutrition, Faculty of Education and Arts , University of Newcastle , Callaghan, New South Wales, Australia
                [2 ] departmentInstitute for Positive Psychology and Education, Faculty of Health Sciences , Australian Catholic University , North Sydney, New South Wales, Australia
                [3 ] departmentCentre for Rehab Innovations and Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Callaghan, New South Wales, Australia
                [4 ] departmentSchool of Medicine and Public Health , University of Newcastle , Callaghan, New South Wales, Australia
                [5 ] departmentSchool of Behavioural and Health Sciences , Australian Catholic University , Banyo, Queensland, Australia
                [6 ] departmentDepartment of Psychology , Northeastern University , Boston, Massachusetts, USA
                [7 ] departmentEarly Start, School of Education , University of Wollongong , Wollongong, New South Wales, Australia
                [8 ] departmentSchool of Biomedical Sciences and Pharmacy , University of Newcastle , Callaghan, New South Wales, Australia
                [9 ] departmentSchool of Health and Wellbeing, Faculty of Health, Engineering and Sciences , University of Southern Queensland , Toowoomba, Queensland, Australia
                [10 ] departmentSchool of Exercise and Nutrition Sciences , Deakin University , Geelong, Victoria, Australia
                [11 ] departmentDepartment of Physical Therapy, Movement and Rehabilitation Sciences , Northeastern University , Boston, Massachusetts, USA
                Author notes
                [Correspondence to ] Dr David R Lubans, Priority Research Centre for Physical Activity and Nutrition, Faculty of Education and Arts, The University of Newcastle, Callaghan, New South Wales, Australia; david.lubans@ 123456newcastle.edu.au
                Author information
                http://orcid.org/0000-0003-2147-9420
                http://orcid.org/0000-0002-2523-5565
                Article
                bjsports-2020-103277
                10.1136/bjsports-2020-103277
                8223670
                33355155
                4b01ce31-d975-4544-97c4-27f0f7bf4206
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 17 November 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001101, NSW Department of Education and Training;
                Award ID: Not applicable
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: APP1120518
                Categories
                Original Research
                1506
                2314
                Custom metadata
                unlocked

                Sports medicine
                aerobic fitness,physical activity,physical fitness,exercise,intervention effectiveness

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