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      A cluster-randomized controlled trial of strategies to increase adolescents’ physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial

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          Abstract

          Background

          The physical activity (PA) levels of many children and adolescents in Australia are currently insufficient to promote health benefits. Physical education (PE) programs aim to promote PA and reach nearly all school-aged children, but PA levels within PE lessons are often low. PE teachers may influence children’s motivation to be physically active in PE lessons, but little is known about teacher strategies that effectively motivate children to participate in PA, and few intervention studies have examined motivational strategies in PE. The purpose of this study was to compare the effect of three motivational strategies, each based on Self-Determination Theory (SDT), on PA levels, and their hypothesized antecedents, during year 8 PE lessons.

          Methods/design

          This study employed a cluster-randomized controlled trial design. Following a familiarization session, PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson. Teachers (n = 16) and their classes from five secondary schools in Sydney, Australia were randomly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions: (1) explaining the relevance of activities; (2) providing choice from PA options selected by the teacher; (3) providing equipment and free choice of activities; or (4) usual practice. The primary outcomes were lesson time spent in moderate-to-vigorous PA, and motivation towards the lesson. Secondary outcomes were perceptions of teacher behavior, psychological needs satisfaction, and lesson time spent in sedentary behavior. PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers. Teacher behavior, psychological needs satisfaction, and motivation were assessed via questionnaires at the end of each lesson. Linear mixed-model analyses will be run on all outcomes, with students nested within teachers as a random effect.

          Discussion

          Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students’ psychological needs satisfaction, motivation, and PA levels. More effective teaching strategies may be identified that are capable of improving adolescents’ PA levels, and thereby provide beneficial population health outcomes.

          Trial registration

          This trial is registered with Current Controlled Trials and is traceable as ISRCTN07038258.

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          Most cited references20

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          Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial

          Objective To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren. Design Cluster randomised controlled trial. Setting 28 classes from 15 elementary schools in Switzerland randomly selected and assigned in a 4:3 ratio to an intervention (n=16) or control arm (n=12) after stratification for grade (first and fifth grade), from August 2005 to June 2006. Participants 540 children, of whom 502 consented and presented at baseline. Intervention Children in the intervention arm (n=297) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week, daily short activity breaks, and physical activity homework. Children (n=205) and parents in the control group were not informed of an intervention group. For most outcome measures, the assessors were blinded. Main outcome measures Primary outcome measures included body fat (sum of four skinfolds), aerobic fitness (shuttle run test), physical activity (accelerometry), and quality of life (questionnaires). Secondary outcome measures included body mass index and cardiovascular risk score (average z score of waist circumference, mean blood pressure, blood glucose, inverted high density lipoprotein cholesterol, and triglycerides). Results 498 children completed the baseline and follow-up assessments (mean age 6.9 (SD 0.3) years for first grade, 11.1 (0.5) years for fifth grade). After adjustment for grade, sex, baseline values, and clustering within classes, children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds (−0.12, 95 % confidence interval −0.21 to −0.03; P=0.009). Likewise, their z scores for aerobic fitness increased more favourably (0.17, 0.01 to 0.32; P=0.04), as did those for moderate-vigorous physical activity in school (1.19, 0.78 to 1.60; P<0.001), all day moderate-vigorous physical activity (0.44, 0.05 to 0.82; P=0.03), and total physical activity in school (0.92, 0.35 to 1.50; P=0.003). Z scores for overall daily physical activity (0.21, −0.21 to 0.63) and physical quality of life (0.42, −1.23 to 2.06) as well as psychological quality of life (0.59, −0.85 to 2.03) did not change significantly. Conclusions A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children. Trial registration Current Controlled Trials ISRCTN15360785.
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            Calibration of accelerometer output for children.

            Understanding the determinants of physical activity behavior in children and youths is essential to the design and implementation of intervention studies to increase physical activity. Objective methods to assess physical activity behavior using various types of motion detectors have been recommended as an alternative to self-report for this population because they are not subject to many of the sources of error associated with children's recall required for self-report measures. This paper reviews the calibration of four different accelerometers used most frequently to assess physical activity and sedentary behavior in children. These accelerometers are the ActiGraph, Actical, Actiwatch, and the RT3 Triaxial Research Tracker. Studies are reviewed that describe the regression modeling approaches used to calibrate these devices using directly measured energy expenditure as the criterion. Point estimates of energy expenditure or count ranges corresponding to different activity intensities from several studies are presented. For a given accelerometer, the count cut points defining the boundaries for 3 and 6 METs vary substantially among the studies reviewed even though most studies include walking, running and free-living activities in the testing protocol. Alternative data processing using the raw acceleration signal is recommended as a possible alternative approach where the actual acceleration pattern is used to characterize activity behavior. Important considerations for defining best practices for accelerometer calibration in children and youths are presented.
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              Promoting physical activity participation among children and adolescents.

              With global increases in the prevalence of overweight and obesity among children and adolescents, there has never been a more urgent need for effective physical activity programs. The aim of this narrative review is to summarize the evidence of the effectiveness of interventions that report physical activity outcomes in children aged 4-12 years and adolescents aged 13-19 years. A systematic search of electronic databases identified 76 interventions. Most interventions were delivered via the school setting (57 interventions), nine through the family setting, six via primary care, and four in community- or Internet-based settings. Children's physical activity interventions that were most effective in the school setting included some focus on physical education, activity breaks, and family strategies. Interventions delivered in the family setting were not highly effective, but many were pilot studies. The use of motivationally tailored strategies and program delivery in the primary care setting showed promise among adolescents. Many studies had methodological and reporting flaws (e.g., no baseline data, poor study design, physical activity measures of unknown reliability and validity, and poor reporting of sample size, response rates, attrition/retention, compliance, year of intervention, and duration of intervention). Publications reporting the results of evaluations of intervention studies should follow the Consolidated Standards of Reporting Trials guidelines or, for nonrandomized studies, should follow the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. Further evidence of the effectiveness of interventions promoting young people's physical activity in family and community settings is needed.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2012
                1 October 2012
                : 12
                : 834
                Affiliations
                [1 ]Kansas State University, Manhattan, USA
                [2 ]University of Western Sydney, Penrith, Australia
                [3 ]University of Newcastle, Newcastle, Australia
                Article
                1471-2458-12-834
                10.1186/1471-2458-12-834
                3524026
                23025261
                7801ed13-c492-40e8-b78a-c56cd21df447
                Copyright ©2012 Rosenkranz et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 September 2012
                : 27 September 2012
                Categories
                Study Protocol

                Public health
                physical activity,physical education,self-determination theory,adolescent,motivation,children,youth,school

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