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The SCORES physical activity intervention for children attending schools in low-income communities: A cluster RCT
Friday 17 October Papers / Journal of Science and Medicine in Sport 18S (2014) e108–e135
31
Award finalist
Changing the sedentary time and physical activity trajectories of obese adolescents: Results from the CAFAP controlled clinical trial
32
L. Straker 1,∗ , E. Howie 1 , J. McVeigh 1 , K. Smith 1 , A. Fenner 1 , T. Olds 1,2 , R. Abbott 1 , A. Smith 1 1 2
Curtin University, Australia University of South Australia, Australia
Introduction: Adolescents are typically on trajectories of increasing sedentary time and decreasing moderate/vigorous physical activity. Overweight and obese adolescents may have poorer activity profiles than normal weight adolescents and therefore be at increased risk of activity-related physical and mental health problems. As activity behaviours tend to track from adolescence to adulthood, altering adolescent activity trajectories is likely to have long-term health consequences. This study aimed to evaluate the immediate and 12 month post-intervention effectiveness of an intervention focused on changing the sedentary and physical activity behaviours of obese adolescents. Methods: Sixty nine adolescents aged 14.1 (SD 1.6) years participated in a within-subjects staggered-entry waitlist controlled trial of Curtin University’s Activity, Food and Attitudes Program (CAFAP). CAFAP involved an 8 week intensive multi-disciplinary familybased community intervention with tapered text message and phone support for 12 months. Sedentary time and light, moderate and vigorous activity were measured using Actical accelerometers worn on the hip for a week. Fifty six participants provided adequate accelerometer data in at least two assessments and were included in linear mixed model analysis. Activity profile patterns were assessed with Exposure Variation Analysis. Results: On entry to the study adolescents were sedentary for 70.3% of their awake wear day, with 25.4% spent in light activity, 4.2% in moderate activity and just 0.2% spent in vigorous activity. 28.1% of their wear day was spent in bouts of sedentary time of at least 30 min duration, with 9.8% spent in sedentary bouts of 60 min or more. During the control period adolescents showed trajectories of increasing daily sedentary time (mean 532.3 [SE 3.3] to 548.2 [3.7], p = 0.003) and decreasing daily light activity (199.7 [2.7] to 186.4 [3.5], p = 0.007) with decreasing trends for moderate (31.1 [1.3] to 29.4 [1.1], p = 0.147) and vigorous (1.5 [0.2] to 1.3 [0.2], p = 0.470) activity. During the intervention period these trajectories were reversed with monthly rates of change showing a decrease for sedentary time (−5.1 [95% CI −11.0, 0.8]) and an increase for moderate physical activity (1.8 [−0.04, 3.6]). Sedentary time and light, moderate and vigorous activity levels remained stable over the 12month maintenance period. There were no significant reductions in prolonged bouts of sedentary time following the intervention. Discussion: The CAFAP intervention was effective in changing the sedentary time and physical activity trajectories of obese adolescents suggesting behavior focused interventions have the potential to create long-term health changes. However trajectories of prolonged sedentary time were not changed in the intervention and thus further development of interventions targeting the pattern of sedentary behaviour is required. http://dx.doi.org/10.1016/j.jsams.2014.11.089
e121
The SCORES physical activity intervention for children attending schools in low-income communities: A cluster RCT D. Lubans ∗ , K. Cohen, R. Plotnikoff, R. Callister, P. Morgan University of Newcastle, Australia Background: Schools have been identified as important settings for the promotion of physical activity (PA) among children and provide access to populations ‘at risk’ of inactivity, such as those from low socio-economic backgrounds. The purpose of this study was to evaluate the impact of a PA intervention guided by the socio-ecological model, known as SCORES (Supporting Children’s Outcomes using Rewards, Exercise and Skills). Methods: The SCORES intervention was evaluated using a cluster randomized controlled trial. Participants were 460 children (54.1% girls) aged 8.5 ± 0.6 years from 8 primary schools (25 classes) located in low-income communities. The socio-ecological model provided a framework for the 12-month intervention, which included the following components: teacher professional learning, student leadership workshops (including leadership accreditation and rewards, such as stickers and water bottles), PA school policy review, equipment packs, parental engagement via newsletters, PA homework and a parent evening, and community partnerships with local sporting organizations. Primary outcomes were objectively measured minutes per day of moderate-to-vigorous physical activity (MVPA)(GT3X + accelerometers) and cardiorespiratory fitness (20 meter multistage fitness test). Outcomes were assessed at baseline, mid-program (6-months) and posttest (12-months). Analyses were conducted using linear mixed models, adjusted for sex, age and school class (included as a random factor). A detailed process evaluation was also conducted. Results: Eighty-four percent of participants were retained in the study after 12-months. At mid-program, there were no statistically significant between-group differences for PA or cardiorespiratory fitness. At posttest, there were statistically significant group-bytime effects for PA (adjusted mean difference, 12.2 MVPA mins/day; 95% CI, 4.4–19.9, p = 0.011) and cardiorespiratory fitness (adjusted mean difference 5.3 laps; 95% CI, 2.1–8.5, p = 0.004). Overall, teachers were satisfied with the intervention (mean [SD], 4.9 [0.3]; rating scale, 1 = strongly disagree to 5 = strongly agree), as were children (mean [SD], 2.7 [0.6]; rating scale, 1 = not really to 3 = a lot). On average, teachers at the intervention schools adhered to 62.9% of the recommended PE lesson structure at observation 1, 70.5% at observation 2, and 79.0% at observation 3. Discussion: The SCORES multi-component school-based intervention improved PA and fitness in children attending primary schools in low-income communities, without increasing physical education curriculum time. Implementation of the SCORES program may help to improve the health and fitness of children and prevent the onset of lifestyle-related diseases. Trial registration: Australian New Zealand Clinical Trials Registry No: ACTRN12611001080910. http://dx.doi.org/10.1016/j.jsams.2014.11.090
31
Award finalist
Changing the sedentary time and physical activity trajectories of obese adolescents: Results from the CAFAP controlled clinical trial
32
L. Straker 1,∗ , E. Howie 1 , J. McVeigh 1 , K. Smith 1 , A. Fenner 1 , T. Olds 1,2 , R. Abbott 1 , A. Smith 1 1 2
Curtin University, Australia University of South Australia, Australia
Introduction: Adolescents are typically on trajectories of increasing sedentary time and decreasing moderate/vigorous physical activity. Overweight and obese adolescents may have poorer activity profiles than normal weight adolescents and therefore be at increased risk of activity-related physical and mental health problems. As activity behaviours tend to track from adolescence to adulthood, altering adolescent activity trajectories is likely to have long-term health consequences. This study aimed to evaluate the immediate and 12 month post-intervention effectiveness of an intervention focused on changing the sedentary and physical activity behaviours of obese adolescents. Methods: Sixty nine adolescents aged 14.1 (SD 1.6) years participated in a within-subjects staggered-entry waitlist controlled trial of Curtin University’s Activity, Food and Attitudes Program (CAFAP). CAFAP involved an 8 week intensive multi-disciplinary familybased community intervention with tapered text message and phone support for 12 months. Sedentary time and light, moderate and vigorous activity were measured using Actical accelerometers worn on the hip for a week. Fifty six participants provided adequate accelerometer data in at least two assessments and were included in linear mixed model analysis. Activity profile patterns were assessed with Exposure Variation Analysis. Results: On entry to the study adolescents were sedentary for 70.3% of their awake wear day, with 25.4% spent in light activity, 4.2% in moderate activity and just 0.2% spent in vigorous activity. 28.1% of their wear day was spent in bouts of sedentary time of at least 30 min duration, with 9.8% spent in sedentary bouts of 60 min or more. During the control period adolescents showed trajectories of increasing daily sedentary time (mean 532.3 [SE 3.3] to 548.2 [3.7], p = 0.003) and decreasing daily light activity (199.7 [2.7] to 186.4 [3.5], p = 0.007) with decreasing trends for moderate (31.1 [1.3] to 29.4 [1.1], p = 0.147) and vigorous (1.5 [0.2] to 1.3 [0.2], p = 0.470) activity. During the intervention period these trajectories were reversed with monthly rates of change showing a decrease for sedentary time (−5.1 [95% CI −11.0, 0.8]) and an increase for moderate physical activity (1.8 [−0.04, 3.6]). Sedentary time and light, moderate and vigorous activity levels remained stable over the 12month maintenance period. There were no significant reductions in prolonged bouts of sedentary time following the intervention. Discussion: The CAFAP intervention was effective in changing the sedentary time and physical activity trajectories of obese adolescents suggesting behavior focused interventions have the potential to create long-term health changes. However trajectories of prolonged sedentary time were not changed in the intervention and thus further development of interventions targeting the pattern of sedentary behaviour is required. http://dx.doi.org/10.1016/j.jsams.2014.11.089
e121
The SCORES physical activity intervention for children attending schools in low-income communities: A cluster RCT D. Lubans ∗ , K. Cohen, R. Plotnikoff, R. Callister, P. Morgan University of Newcastle, Australia Background: Schools have been identified as important settings for the promotion of physical activity (PA) among children and provide access to populations ‘at risk’ of inactivity, such as those from low socio-economic backgrounds. The purpose of this study was to evaluate the impact of a PA intervention guided by the socio-ecological model, known as SCORES (Supporting Children’s Outcomes using Rewards, Exercise and Skills). Methods: The SCORES intervention was evaluated using a cluster randomized controlled trial. Participants were 460 children (54.1% girls) aged 8.5 ± 0.6 years from 8 primary schools (25 classes) located in low-income communities. The socio-ecological model provided a framework for the 12-month intervention, which included the following components: teacher professional learning, student leadership workshops (including leadership accreditation and rewards, such as stickers and water bottles), PA school policy review, equipment packs, parental engagement via newsletters, PA homework and a parent evening, and community partnerships with local sporting organizations. Primary outcomes were objectively measured minutes per day of moderate-to-vigorous physical activity (MVPA)(GT3X + accelerometers) and cardiorespiratory fitness (20 meter multistage fitness test). Outcomes were assessed at baseline, mid-program (6-months) and posttest (12-months). Analyses were conducted using linear mixed models, adjusted for sex, age and school class (included as a random factor). A detailed process evaluation was also conducted. Results: Eighty-four percent of participants were retained in the study after 12-months. At mid-program, there were no statistically significant between-group differences for PA or cardiorespiratory fitness. At posttest, there were statistically significant group-bytime effects for PA (adjusted mean difference, 12.2 MVPA mins/day; 95% CI, 4.4–19.9, p = 0.011) and cardiorespiratory fitness (adjusted mean difference 5.3 laps; 95% CI, 2.1–8.5, p = 0.004). Overall, teachers were satisfied with the intervention (mean [SD], 4.9 [0.3]; rating scale, 1 = strongly disagree to 5 = strongly agree), as were children (mean [SD], 2.7 [0.6]; rating scale, 1 = not really to 3 = a lot). On average, teachers at the intervention schools adhered to 62.9% of the recommended PE lesson structure at observation 1, 70.5% at observation 2, and 79.0% at observation 3. Discussion: The SCORES multi-component school-based intervention improved PA and fitness in children attending primary schools in low-income communities, without increasing physical education curriculum time. Implementation of the SCORES program may help to improve the health and fitness of children and prevent the onset of lifestyle-related diseases. Trial registration: Australian New Zealand Clinical Trials Registry No: ACTRN12611001080910. http://dx.doi.org/10.1016/j.jsams.2014.11.090