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Making policy practice in afterschool programs: a randomized controlled trial on physical activity changes.

ABSTRACT: In the U.S., afterschool programs are asked to promote moderate to vigorous physical activity. One policy that has considerable public health importance is California's afterschool physical activity guidelines that indicate all children attending an afterschool program accumulate 30 minutes each day the program is operating. Few effective strategies exist for afterschool programs to meet this policy goal. The purpose of this study was to evaluate a multistep adaptive intervention designed to assist afterschool programs in meeting the 30-minute/day moderate to vigorous physical activity policy goal.A 1-year group randomized controlled trial with baseline (spring 2013) and post-assessment (spring 2014). Data were analyzed 2014.Twenty afterschool programs, serving >1,700 children (aged 6-12 years), randomized to either an intervention (n=10) or control (n=10) group.The employed framework, Strategies To Enhance Practice, focused on intentional programming of physical activity opportunities in each afterschool program's daily schedule and included professional development training to establish core physical activity competencies of staff and afterschool program leaders with ongoing technical assistance.The primary outcome was accelerometry-derived proportion of children meeting the 30-minute/day moderate to vigorous physical activity policy.Children attending intervention afterschool programs had an OR of 2.37 (95% CI=1.58, 3.54) to achieve the physical activity policy at post-assessment compared to control afterschool programs. Sex-specific models indicated that the percentage of intervention girls and boys achieving the physical activity policy increased from 16.7% to 21.4% (OR=2.85, 95% CI=1.43, 5.68) and 34.2% to 41.6% (OR=2.26, 95% CI=1.35, 3.80), respectively. At post-assessment, six intervention afterschool programs increased the proportion of boys achieving the physical activity policy to ?45% compared to one control afterschool program, whereas three intervention afterschool programs increased the proportion of girls achieving physical activity policy to ?30% compared to no control afterschool programs.The Strategies To Enhance Practice intervention can make meaningful changes in the proportion of children meeting the moderate to vigorous physical activity policy within one school year. Additional efforts are required to enhance the impact of the intervention.

SUBMITTER: Beets MW

PROVIDER: S-EPMC4441760 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Making policy practice in afterschool programs: a randomized controlled trial on physical activity changes.

Beets Michael W MW Weaver R Glenn RG Turner-McGrievy Gabrielle G Huberty Jennifer J Ward Dianne S DS Pate Russell R RR Freedman Darcy D Hutto Brent B Moore Justin B JB Beighle Aaron A

American journal of preventive medicine 20150601 6

<h4>Introduction</h4>In the U.S., afterschool programs are asked to promote moderate to vigorous physical activity. One policy that has considerable public health importance is California's afterschool physical activity guidelines that indicate all children attending an afterschool program accumulate 30 minutes each day the program is operating. Few effective strategies exist for afterschool programs to meet this policy goal. The purpose of this study was to evaluate a multistep adaptive interve ...[more]

PMID: 25998921

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Project description:BackgroundAfterschool programs are an important setting in which to promote children's physical activity. This study examines the association of environmental and policy characteristics on the moderate-to-vigorous physical activity and sedentary behavior of children attending afterschool programs.MethodsA total of 1302 children attending 20 afterschool programs across South Carolina wore accelerometers (ActiGraph GT3X+) for up to 4non-consecutive days. Policy-level characteristics were evaluated using the Healthy Afterschool Program Index-Physical Activity scale. Physical activity space was measured using a measuring wheel (indoor, ft(2)) and Geographical Information Systems software (outdoor, acres). The structure (free-play or organized) of activity opportunities was evaluated via direct observation. Time spent in moderate-to-vigorous physical activity and sedentary, both indoors and outdoors, was estimated using accelerometry.ResultsFor every 5000 ft(2) of utilized indoor activity space an additional 2.4 and 3.3 min/day of sedentary behavior was observed among boys and girls, respectively. A higher ratio of free-play to organized play was associated with higher indoor sedentary behavior among boys and girls (3.9 min/day and 10.0 min/day, respectively). For every 1 acre of outdoor activity space used, an additional 2.7 min/day of moderate-to-vigorous physical activity was observed for boys. A higher free-play to organized play ratio was associated with higher outdoor moderate-to-vigorous physical activity for boys and girls (4.4 and 3.4 min/day increase, respectively). Policy characteristics were unrelated to moderate-to-vigorous physical activity levels and time spent sedentary.ConclusionFindings indicate that policies and size of activity space had limited influence on moderate-to-vigorous physical activity and sedentary behavior, suggesting that a programmatic structure may be a more effective option to improve moderate-to-vigorous physical activity levels of children attending afterschool programs.

Project description:BackgroundIn 2015, YMCA afterschool programs (ASPs) across South Carolina, USA pledged to achieve the YMCA physical activity standard calling for all children to accumulate 30 min of moderate-to-vigorous physical activity (MVPA) while attending their ASPs. This study presents the final two-year outcomes from the dissemination and implementation efforts associated with achieving this MVPA standard.MethodsTwenty ASPs were sampled from all South Carolina YMCA-operated ASPs (N = 97) and visited at baseline (2015) and first (2016) and second year (2017) follow-up. All ASPs were provided training to increase MVPA during the program by extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Intent-to-treat (ITT) models were conducted summer 2017. Programs were also classified, based on changes in MVPA from 2015 to 2016 and 2016-2017, into one of three categories: gain, maintain, or lost. Implementation, within the three groups, was evaluated via direct observation and document review.ResultsAdoption during the first year was 45% of staff attending training, with this increasing to 67% of staff during the second year. ITT models indicated no increase in the odds of accumulating 30 min of MVPA after the first year for either boys (odds ratio [OR] 1.06, 95CI 0.86-1.31) or girls (OR 1.14, 95CI 0.87-1.50), whereas an increase in the odds was observed during the second year for boys (OR 1.31, 95CI 1.04-1.64) and girls (OR 1.50 95CI 1.01-1.80). Programs that lost MVPA (avg. - 5 to - 7.5 min/d MVPA) elected to modify their program in a greater number of non-supportive ways (e.g., reduce time for activity opportunities, less time spent outdoors), whereas ASPs that gained MVPA (avg. + 5.5 to + 10.1 min MVPA) elected to modify their program in more supportive ways.ConclusionsThe statewide study demonstrated minimal improvements in overall MVPA. However, child MVPA was dramatically influenced by ASPs who elected to modify their daily program in more supportive than non-supportive ways, with no one program modifying their program consistently across the multi-year initiative. These findings have important implications for organizations seeking to achieve the MVPA standard.Trial registrationClinical Trial Registration: NCT02394717 .

Project description:Background: The importance of daily physical activity is crucial for healthy development during the early years. Currently, a formal written physical activity policy is lacking in Canadian childcare centers, but holds promise for offering consistent physical activity opportunities. With eight recommendations, the Childcare PLAY policy is an evidence-informed, institutional-level document, targeting children's physical activity, outdoor play, and sedentary time. The purpose of this study was to examine the impact of the Childcare Physical Activity (PLAY) policy on the physical activity and sedentary time of young children (18 months-4 years) in childcare. Methods: Nine childcare centers in London, Ontario participated in the cluster, randomized controlled trial. The centers in the control condition (n = 4) continued their typical daily routines, while the centers in the intervention condition (n = 5) implemented the PLAY policy for eight weeks. To assess physical activity levels, toddlers and preschoolers wore ActiGraph wGT3X-BT accelerometers for five consecutive days during childcare hours, at baseline, mid- and post-intervention, and at the six-month follow-up. Raw accelerometry data were converted to 15 s epochs, and age- and device-specific cut-points were applied. The participants with two or more days of at least 5 h/day of wear-time at baseline, and at one additional time point, were included in the linear mixed-effects models. An adjusted alpha (p < 0.017) was used to account for multiple comparison bias. Results: A total of 148 children (31.92 ± 7.41 months) had valid accelerometry data. The intervention resulted in a significant increase in light physical activity among the participants in the experimental group at the six-month follow-up (+1.07 min/h, an 11.16% increase; p = 0.0017). The intervention did not have a statistically significant effect on the total physical activity, moderate-to-vigorous physical activity, or sedentary time. Conclusions: The findings indicate that the Childcare PLAY policy was effective at increasing the toddlers' and preschoolers' light physical activity. This pilot intervention appears promising for supporting some improved movement behaviors among children in childcare settings; however, additional investigations are needed to explore the feasibility and effectiveness with larger and more-diverse samples.

Project description:BackgroundComplexity theory and systems-thinking are increasingly popular in physical activity (PA) research and policy discourse. The impact of this perspective shift, across many sectors, may be underwhelming. We explore why, by focusing on how these concepts are understood and applied by PA policy-makers. This is of particular interest given the challenges of multisectoral interest and poorly defined stakeholder boundaries that are associated with PA promotion. In this study, we critique key elements of complexity theory and consider how it is understood and put into practice in PA policy-making.MethodsWe adopted a complex realist position. Ten semi-structured interviews were conducted with national-level policy-makers from United Kingdom government settings (five civil servants, three politicians, two policy advisors). An inductive thematic analysis was conducted, and managed with NVivo 10 software.ResultsThree overarching themes were constructed to reflect policy-makers' uncertainty about complexity and the application of such perspectives to this policy space, their sense that PA was an unexceptionable yet unclaimed policy issue, and their desire for influence and change. Participants discussed complexity in contrasting ways. Its meaning was context-dependent and dynamic, which generated uncertainty about applying the concept. Participants also perceived an increasingly diverse but ill-defined PA policy system that spans the domains of expertise and responsibility. Collaborative practices may contribute to a previously unobserved sense of detachment from the systems' complexity. Nevertheless, participants suggested potentially effective ways to stimulate system change, which require passionate and enterprising leadership, and included varied evidence use, a focus on localised implementation and different ways to connect people.ConclusionsThis research highlighted the importance of extending complexity theory and systems-thinking. While emphasizing the prevalence of these ideas across the PA sector, there is uncertainty as to their meaning and implications. This may prevent their use in ways that enhance PA policies and programmes. Participants conceptualised PA as a tool, which was imposed on the system. While this may support participative decision-making and localised implementation, further research is needed to understand how local systems foster leadership, the practical application of complexity and systems-thinking, and how to support system-wide change in the development and implementation of PA policies.

Project description:BackgroundLess than 45% of U.S. children meet the 60 min·d(-1) physical activity (PA) guideline. Structured after-school PA programing is one approach to help increase activity levels. This study aimed to evaluate the feasibility and short-term impact of a supervised after-school PA and nutrition education program on activity levels.MethodsForty-two 3rd-5th graders from an inner-city school in Boston, MA were randomly assigned to a 10-wk after-school program of either: 1) weekly nutrition education, or 2) weekly nutrition education plus supervised PA 3 d·wk(-1) at a community-based center. At baseline and follow-up, PA was measured using accelerometry and fitness (VO2max) was estimated using the PACER 15-m shuttle run. Additional measures obtained were non-fasting finger stick total cholesterol (TC) and glucose levels, waist circumference (WC), body mass index (BMI), percent body fat (%BF), and blood pressure (BP). Values are presented as mean±SE, unless noted otherwise.ResultsThirty-six participants completed the study (mean±SD; age 9.7±0.9 years). Participants attended >80% of the sessions. After adjusting for accelerometer wear time and other design factors, light and moderate-to-vigorous PA (MVPA) increased in the nutrition+PA group (+21.5±14.5 and +8.6±8.0 min·d(-1), respectively) and decreased in the nutrition only group (-35.2±16.3 and -16.0±9.0 min·d(-1), respectively); mean difference between groups of 56.8±21.7 min·d(-1) (light PA, p = 0.01) and 24.5±12.0 min·d(-1) (MVPA, p = 0.04). Time spent in sedentary behaviors declined in the nutrition+PA group (-14.8±20.7 min·d(-1)) and increased in the nutrition only group (+55.4±23.2 min·d(-1)); mean difference between groups of -70.2±30.9 min·d(-1) (p = 0.02). Neither group showed changes in TC, BP, WC, %BF, BMI percentile, or fitness (p>0.05).ConclusionsThe supervised afterschool community-based nutrition and PA program was well accepted and had high attendance. The changes in light PA and MVPA has potential to promote weight maintenance in inner-city elementary school children, however longer term studies with larger samples are needed.Trial registrationClinicalTrials.gov NCT01104038.

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Making policy practice in afterschool programs: a randomized controlled trial on physical activity changes.

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Making policy practice in afterschool programs: a randomized controlled trial on physical activity changes.

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