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Objectives Participation in physical activity can improve mental health and well-being, but effects are mixed. This consensus statement from Sports Medicine Australia and the Australian Psychological Society aims to provide guidance to practitioners on the ways that physical activity can be promoted to maximise benefits to mental health. Method Following the Clinical Consensus Statement protocol, an expert group comprised of eight members with expertise in physical activity and mental health articulated recommendations regarding five physical activity contextual factors: type, physical environment, delivery, domain, and social environment. Results To optimise the mental health benefits of physical activity, we recommend: i) activity selection be guided by factors associated with adherence and enjoyment as opposed to any specific type (type); ii) facilitators (i.e., teachers, coaches, instructors, practitioners) deliver organised physical activity sessions using an instructional style that satisfies individuals' basic needs for autonomy, competence and social connection (delivery); iii) participation in physical activity with others who provide support, facilitate positive interactions, or make people feel valued, so long as it does not undermine a preference to be active alone (social environment); iv) where possible and appropriate, some physical activity should be undertaken outside in pleasant natural environments (physical environment); and, v) at least some physical activity be undertaken during leisure-time or via active travel, where possible prioritising activities one personally chooses to undertake (domain). Conclusions The type, domain, physical and social environment of physical activity, as well as the way in which it is delivered, will determine mental health outcomes. Practitioners can use these recommendations to optimise the effects of physical activity on mental health. peerReviewed

The population of adults living with congenital heart disease (CHD) has grown rapidly in recent decades due to major advances in surgical and medical care. Although the benefits of physical activity (PA) and exercise are well recognised in the management of chronic diseases, the therapeutic role of exercise for the CHD population has been under-studied and under-recognised. In fact, people living with complex CHD have traditionally been advised against participation in moderate or vigorous PA due to safety concerns. However, a small but growing body of literature has demonstrated that PA and exercise are safe and beneficial for the vast majority of people with CHD following appropriate screening. Exercise training (ET) is a potent therapy to improve well-being and cardiorespiratory fitness, which likely has important implications for prognosis. This has led to ET becoming an increasingly important adjunct to medical therapy in the management of this group who frequently have significant exercise limitation and complex medical issues. However, there is currently limited evidence-based guidance that has been published regarding appropriate exercise prescription in adults with CHD. This article aims to provide an overview of different congenital heart conditions, their impact on the exercise response, and to provide considerations and recommendations for ET in adolescents and adults living with CHD based on the available literature.

Young people aged 10-24 years constitute 24% of the world's population; investing in their health could yield a triple benefit-eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10-14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. In this Series paper, we present the most up-to-date global evidence on adolescent physical activity and discuss directions for identifying potential solutions to enhance physical activity in the adolescent population. Adolescent physical inactivity probably contributes to key global health problems, including cardiometabolic and mental health disorders, but the evidence is methodologically weak. Evidence-based solutions focus on three key components of the adolescent physical activity system: supportive schools, the social and digital environment, and multipurpose urban environments. Despite an increasing volume of research focused on adolescents, there are still important knowledge gaps, and efforts to improve adolescent physical activity surveillance, research, intervention implementation, and policy development are urgently needed.

Objectives While outdoor gyms are being rapidly installed around the globe, little is known about their implications on physical activity, and fitness and other health-related outcomes. The primary objective of this systematic review was to examine the effects of outdoor gyms on physical activity, fitness and other health-related outcomes. Secondary objectives were to describe outdoor gym characteristics, user characteristics, and outdoor gym usage. Design Systematic review. Methods Peer-reviewed papers published in English were obtained through online database searches of the following databases; EBSCO, SPORTdiscus, Medline, PsycINFO, Web of Science, Scopus and Informit. Searches covered the periods from database inception to January 2019. Studies that reported on the efficacy of outdoor gym use for physical activity, health-related outcomes or descriptive aspects of outdoor gyms and their users were eligible for inclusion. Results There was some support that outdoor gyms may improve physical activity, fitness and other health-related outcomes, however few experimental studies have been conducted. There was no consistency between outdoor gyms in terms types and number of installed equipment for each facility. Further, this review found discrepancies of whom were the most likely users of outdoor gyms and when they were mainly used. Conclusions This review contributes to the limited evidence on the impact and characteristics of outdoor gyms on physical activity and fitness and health-related outcomes.

This study aims to explore associations between physical activity intensity and well-being (i.e., positive and negative affect) in adolescents. A secondary aim was to determine if associations were moderated by sex. Grade 8 students from 14 government-funded secondary schools in low socio-economic areas of Western Sydney (Australia) were assessed. Data from three timepoints (baseline, 7–8 months, and 14–15 months) were combined to increase the sample size. Physical activity was objectively assessed for 1-week at each timepoint using Actigraph accelerometers. Time (minutes/day) in light, moderate and vigorous physical activity was estimated. The short form Positive and Negative Affect Scale for Children was used to measure well-being. Quantile regression was used to analyse the data. A total of 3140 observations were collected from 1223 students (mean age at baseline: 12.9(0.54); 55.1% male). Light and moderate physical activity was not associated with well-being. Higher levels of vigorous physical activity were associated with more positive affect [β(SE) = 0.307 (0.06), p < 0.001], to an estimated vigorous physical activity turning point [Point(95%CI) = 36.48 min/day (31.39–41.59)]. Similarly, higher levels of vigorous physical activity were associated with less negative affect [β(SE) = −0.250 (0.06), p < 0.001] up to the estimated vigorous physical activity turning point [Point(95%CI) = 37.35 min/day (31.27–43.44)]. The negative association between vigorous physical activity and negative affect was more pronounced in females than in males. Our findings highlight the importance of adolescents engaging in vigorous physical activity to improve positive affect and reduce negative affect.

Objectives The primary aim of this study was to evaluate the preliminary efficacy and feasibility of an 8-week high-intensity interval training program (Uni-HIIT) for young adult students in a university setting. Design Randomised controlled trial. Method Uni-HIIT was conducted at the University of Newcastle, Australia (February-June, 2017). Participants were university students 18-25yrs (n = 53; 20.38 ± 1.88yrs) randomized into the Uni HIIT program (n = 26) or wait-list control (n = 27) condition. Participants were required to attend up to three HIIT sessions/week for 8-weeks which included a variety of aerobic and muscular fitness exercise combinations lasting 8–12 minutes (using 30:30 sec rest:work intervals). The primary outcome was cardio-respiratory fitness (CRF) (20mSRT), and secondary outcomes included muscular fitness (standing jump, push-ups), body composition (InBody), executive function (Trail Making Test), anxiety levels (State Trait Anxiety Inventory) and perceived stress (Perceived Stress Scale). Linear mixed models were used to analyse outcomes and Cohen’s d effect sizes were calculated. Process evaluation measures of recruitment, retention, attendance and satisfaction were conducted. Results A large significant group-by-time effect resulted for CRF [8.4 shuttles (95% CI(2.9-13.9), P = 0.004,d = 1.08] and muscular fitness [4.0 repetitions (95% CI(1.2-6.8), P = 0.006,d = 0.99], and moderate effect size was observed for Trail B [-5.9 seconds (95% CI(-11.8-0.1.0), P = 0.052, d = 0.63]. No significant intervention effects were found for body composition, standing jump, anxiety or perceived stress (P > 0.05). High ratings of participant satisfaction (4.73), enjoyment (4.54) and perceived value (4.54) were observed. Conclusion This study demonstrates the efficacy and feasibility of delivering a novel HIIT program in the university setting.

Objective To examine the impact of a school-based physical activity intervention on adolescents' self-esteem and subjective well-being, and to explore moderators and mediators of intervention effects. Methods Resistance Training for Teens was evaluated using a cluster RCT in 16 schools located in New South Wales, Australia. Adolescents (N = 508; 14.1 ± 0.5 years; 49.6% female) completed measures of global self-esteem, subjective well-being, and hypothesized mediators (i.e., perceived fitness, resistance training self-efficacy, and autonomous motivation) at baseline (April–June, 2015) and post-intervention (October–December). The school-based physical activity program was delivered by teachers over 10-weeks via Physical Education, co-curricular school sport, or an elective subject known as Physical Activity and Sport Studies, and involved once-weekly fitness sessions and additional lunch-time sessions. Intervention effects and moderator analyses were tested using multi-level linear regression analyses with interaction terms. Multi-level mediation analyses were used to explore potential mediators of changes in well-being outcomes. Results Intervention effects for self-esteem (β = 0.05, p = .194) and wellbeing (β = 0.03, p = .509) were not statistically significant. Moderator analyses showed effects for self-esteem were greater for the overweight/obese subgroup (p = .069 for interaction), and resistance training self-efficacy was a significant mediator of changes in self-esteem (product-of-coefficients [AB] = 0.021, SE = 0.010, 95% CIs = 0.002 to 0.040). No other significant indirect effects were observed. Conclusion Overall, Resistance Training for Teens did not improve adolescents' self-esteem or subjective well-being. However, our mediation findings lend support to resistance training self-efficacy as a mechanism explaining the positive effect of resistance training on self-esteem.

Many adults without a diagnosed sleep disorder report poor sleep health, which is defined by dissatisfactory levels of sleep duration, sleep quality, or the timing of sleep. No previous review has summarized and described interventions targeting poor sleep health in this population. This meta-analysis aimed to quantify the efficacy of behavioral and cognitive sleep interventions in adults with poor sleep health, who do not have a sleep disorder. Electronic databases (Medline, Embase, PsycInfo, Cinahl) were searched with restrictions for age (18-64 y) and English language full-text, resulting in 18,009 records being screened and 592 full-texts being assessed. Eleven studies met inclusion criteria, seven of which reported a measure of overall sleep health (Pittsburgh sleep quality index [PSQI]). Following appraisal for risk of bias, extracted data were meta-analyzed using random-effects models. Meta-analyses showed interventions had a medium effect on sleep quality (Hedge's g = -0.54, [95% confidence interval (CI)] -0.90 to -0.19, p 0.01). Baseline sleep health was the only significant effect moderator (p = 0.01). The most frequently used intervention components were stress management and relaxation practice, stimulus control, sleep hygiene, and exercise. Interventions targeting cognitive and behavioral self-regulation improve sleep quality in adults without clinical sleep disorder.

Objective The present study examined the effect of a school-based multicomponent physical activity intervention on aggression in adolescent males from low-income areas, and explored potential mediators of change in aggression. Methods Participants were adolescent males (N = 361; 12.7 ± 0.5 years) enrolled in the ‘Active Teen Leaders Avoiding Screen-time’ cluster RCT. Self-report measures for aggression, perceived strength and recreational screen-time were collected at baseline and 8-months. The effect of the intervention on aggression was tested using multi-level linear regression and potential mediators (i.e., screen-time and perceived strength) were explored using a product-of-coefficients test. Results There was no significant intervention effects for aggression (C [SE] = -0.038 [0.044], p = .384) or perceived strength (A [SE] = -0.0 [0.0], p = .884). However, a statistically significant effect was found for screen-time (A [SE] = -0.160 [0.04], p= Conclusion Limiting recreational screen-time may help to reduce aggression in adolescent boys. Interventions targeting adolescents' recreational screen-time should examine their ‘flow-on’ effects on externalising behaviours in adolescent populations.

This study explored the impact of a university teacher education course on preservice and inservice teachers’ attitudes towards gender equity in physical activity and sport. Preservice teachers (n = 40) completed an Implicit Association Test and explicit attitude measures pre- and post-course. Focus group interviews were conducted with preservice and inservice teachers (n = 24). Preservice teachers reduced their negative implicit and explicit attitudes towards girls and activity. Preservice and inservice teachers also improved their awareness and gained skills to address gender-related issues in schools. Targeted teacher education courses have the potential to improve gender equity in schools.

Objective: To determine the comparability and feasibility of wrist- and hip-worn accelerometers among free-living adolescents. Design: 89 adolescents (age = 13-14. years old) from eight secondary schools in New South Wales (NSW), Australia wore wrist-worn GENEActiv and hip-worn ActiGraph (GT3X+) accelerometers simultaneously for seven days and completed an accelerometry behavior questionnaire. Methods: Bivariate correlations between the wrist- and hip-worn out-put were used to determine concurrent validity. Paired samples t-test were used to compare minutes per day in moderate-to-vigorous physical activity (MVPA). Group means and paired sample t-tests were used to analyze participants' perceptions of the wrist- and hip-worn monitoring protocols to assist with determining the feasibility. Results: Wrist-worn accelerometry compared favorably with the hip-worn in average activity (r = 0.88, p.

Robust evidence of the effectiveness of professional development for teachers is limited. This study tested a pedagogy-based, collaborative PD approach for impact on the quality of teaching. A cluster randomised controlled trial involving eight teachers at each of 24 schools found significant positive effects on teaching quality (d = 0.4), independent of school type (primary/secondary), school location (urban/rural), and years of teaching experience. These effects were sustained six months later. Qualitative data are used to illustrate mechanisms underpinning the success of the intervention. This study illuminates how to support teacher learning for measurable positive impacts on teaching quality and teacher morale.

Introduction The primary aim was to examine longitudinal associations between changes in screen-time and mental health outcomes among adolescents. Methods Adolescents (N = 322, 65.5% females, mean age = 14.4 ± 0.6 years) reported screen-time and mental health at two time points over a school year. Multi-level linear regression analyses were conducted after adjusting for covariates. Results Changes in total recreational screen-time (β = −0.09 p = 0.048) and tablet/mobile phone use (β = −0.18, p Conclusion Changes in recreational screen-time were associated with changes in a range of mental health outcomes.

The primary objective was to evaluate the impact of the 'Switch-off 4 Healthy Minds' (S4HM) intervention on recreational screen-time in adolescents.Cluster randomized controlled trial with study measures at baseline and 6-months (post-intervention). Eligible participants reported exceeding recreational screen-time recommendations (i.e.,2h/day). In total, 322 adolescents (mean age=14.4±0.6years) from eight secondary schools in New South Wales, Australia were recruited. The S4HM intervention was guided by Self-Determination Theory and included: an interactive seminar, eHealth messaging, a behavioral contract and parental newsletters. The primary outcome was recreational screen-time. Secondary outcomes included mental health (i.e., well-being, psychological distress, self-perceptions), objectively measured physical activity, and body mass index (BMI). Outcome analyses were conducted using linear mixed models and mediation was examined using a product-of-coefficients test.At post-intervention, significant reductions in screen-time were observed in both groups, with a greater reduction observed in the intervention group (-50min/day versus -29min, p0.05 for both). However, the adjusted difference in change between groups was not statistically significant (mean=-21.3min/day, p=0.255). There were no significant intervention effects for mental health outcomes, physical activity or BMI. Significant mediation effects for autonomous motivation were found.Participants in both the S4HM intervention and control groups significantly reduced their screen-time, with no group-by-time effects. Enhancing autonomous motivation might be a useful intervention target for trials aimed at reducing adolescents' recreational screen-time.ACTRN12614000163606.

Objectives To investigate the effectiveness of the CrossFit™ Teens resistance training program for improving mental health outcomes in adolescents, and to explore potential moderators and mediators. Design Assessor-blinded randomized controlled trial. Methods Ninety-six students (15.4 (0.5) years, 51.5% female) from one NSW secondary school, Australia 2013, were randomized into the 8-week CrossFit™ Teens intervention (n = 51) or control conditions (n = 45). Measures of mental health (psychological distress and self-esteem) were assessed using the Strength and Difficulties Questionnaire and Physical Self-Description Questionnaire. Hypothesized mediators were perceived body fat, strength and appearance; and general physical self-concept. Mediation was assessed using Preacher and Hayes’ multiple mediation regression SPSS macro. Hypothesized moderators (sex and baseline levels of psychological distress) were assessed using linear mixed models and Cohen’s d effect sizes were evaluated. Results There were no significant intervention effects on mental health or potential mediators in the full study sample. Intervention participants categorized as ‘at risk’ of psychological distress demonstrated improvements in self-esteem (d = 1.35); perceived body fat (d = 1.05), perceived appearance (d = 0.95); physical self-concept (d = 1.96); and total difficulties score (d = 0.70). A medium-large positive effect on perceived body fat was also observed in boys. Conclusions Participation in the CrossFit™ Teens resistance training program did not improve mental health outcomes in the full study sample. However, the results from this study provides preliminary evidence for improving mental health in adolescents ‘at risk’ of developing psychological disorders. Trial Registration No: ACTRN12611000976987.

Introduction The prevalence and risk of Type 2 Diabetes (T2D) has dramatically increased over the past decade. Physical activity (PA) has significant benefits for the treatment and prevention of T2D. The aim of this study is to develop, implement and evaluate a community-based PA intervention to improve aerobic and muscular fitness among adults at risk of, or diagnosed with T2D. Research design and methods The eCoFit pilot intervention will be evaluated using a randomized controlled trial (RCT) design. The 20-week (Phases 1 and 2) multi-component intervention was guided by Social Cognitive Theory, Health Action Process Approach Model, and Cognitive Behavior Therapy strategies. Phase 1 (Weeks 1–10) includes: i) 5 group face-to-face sessions consisting of outdoor training and cognitive mentoring; and ii) the use of the eCoFit smartphone application with a description of where and how to use the outdoor environment to be more physically active. Phase 2 (Weeks 11–20) includes the use of the eCoFit smartphone application only. Assessments are to be conducted at baseline, 10-weeks (primary end-point) and 20-weeks (secondary end-point) post-baseline. Primary outcomes are cardio-respiratory fitness and muscular fitness (lower body). Secondary outcomes include physical, behavioral, mental health and quality of life, and social–cognitive outcomes. Discussion eCoFit is an innovative, multi-component intervention, which integrates smartphone technology, social support and the outdoor physical environment to promote aerobic and resistance training PA among adults at risk of, or diagnosed with T2D. The findings will be used to guide future interventions and to develop and implement effective community-based prevention programs. Trial registration Australian New Zealand Clinical Trials Registry No: ACTRN12615000990527.

Background School-based trials to prevent and reduce prevalence of pediatric obesity in low-income countries are necessary. In Brazil, addressing adolescent obesity is a public health priority. Objective To evaluate the impact of a group randomized controlled trial involving a 6-month multicomponent school-based obesity prevention program targeting adolescent girls. Methods The Healthy Habits, Healthy Girls–Brazil program recruited participants (n = 253; 16.05 ± 0.05 years) from ten eligible public technical schools in Sao Paulo, Brazil. The program was adapted from an Australian intervention study, which is based on the Social Cognitive Theory. The primary outcome measure was body mass index (BMI), and secondary outcomes included BMI z score, waist circumference, and various sedentary and dietary health-related behaviours. Results Although changes in BMI were not statistically significant, differences favored the intervention group (adjusted mean difference, − 0.26 kg/m2,se SE = 0.018, p = 0.076). Statistically significant intervention effects were found for waist circumference (− 2.28 cm; p =, p = 0.01), computer screen time on the weekends (0.63 h/day, p; p = 0.02), total sedentary activities on the weekends (− 0.92 h/day, p Conclusion These findings provide some evidence for the benefit of a school-based intervention to prevent unhealthy weight gain in adolescent girls living in low-income communities.

Objective To examine elementary school students' moderate-to-vigorous physical activity (MVPA) levels during physical education (PE) lessons. Methods A systematic search of nine electronic databases was conducted (PROSPERO2014:CRD42014009649). Studies were eligible if they were in English; published between 2005–April 2014; assessed MVPA levels in PE lessons of elementary school children (aged four–12 years); and used an objective MVPA measure. Two reviewers retrieved articles, assessed risk of bias, and performed data extraction. The findings were synthesised using a meta-analysis. Results The search yielded 5132 articles. Thirteen studies from nine countries met the inclusion criteria. Eight studies measured MVPA through observational measures, five used accelerometry and one used heart rate monitoring. The percentage of PE lesson time spent in MVPA ranged between 11.4–88.5%. Meta-analysis of seven studies (4 direct observations; 4 accelerometers) found that children spent a mean (95% CI) 44.8 (28.2–61.4)% of PE lesson time in MVPA. When measured using direct observation and accelerometers, children spent 57.6 (47.3–68.2) and 32.6 (5.9–59.3)% of PE lesson time in MVPA, respectively. The review has limitations; the search strategy was restricted to studies in English; theses, dissertations and conference abstracts were excluded; and six studies that provided insufficient data were excluded from the meta-analysis. Conclusion MVPA levels during elementary school PE lessons do not meet the United States Centre for Disease Control and Prevention and the United Kingdom's Association of Physical Education recommendation (50% of lesson time), but is higher than estimated in the previous review (34.2%). Interventions to increase MVPA in PE lessons are needed.

Purpose The aim of this study was to explore the effect of the Active Teen Leaders Avoiding Screen-time (ATLAS) intervention on psychological well-being in adolescent boys and to examine the potential mediating mechanisms that might explain this effect. Methods ATLAS was evaluated using a cluster randomized controlled trial in 14 secondary schools located in low-income communities (N = 361 adolescent boys, mean age = 12.7 ± .5 years). The 20-week intervention was guided by self-determination theory and involved: professional development for teachers, provision of fitness equipment to schools, enhanced school sport sessions, researcher-led seminars, a smartphone application, and parental strategies for reducing screen time. Assessments were conducted at baseline and immediately post intervention (8 months). Psychological well-being was measured using the Flourishing Scale. Motivational regulations (intrinsic, identified, introjected, controlled, and amotivation) and basic psychological needs (autonomy, competence, and relatedness) in school sport, muscular fitness, resistance training skill competency, and recreational screen time were examined as potential mediating mechanisms of the intervention effect. Results The intervention effect on well-being was small but statistically significant. Within a multiple mediator model, changes in autonomy needs satisfaction, recreational screen time, and muscular fitness significantly mediated the effect of the intervention on psychological well-being. Conclusions In addition to the physical health benefits, targeted physical activity programs for adolescent boys may have utility for mental health promotion through the mechanisms of increasing autonomy support and muscular fitness and reducing screen time.

Objectives Physical education (PE) plays an important role in contributing to students’ physical activity (PA); however, moderate-to-vigorous PA (MVPA) within PE is lower than recommended. Little is known about the PA levels of students from disadvantaged schools within PE. This study aimed to describe: (i) the PA levels of students from disadvantaged secondary schools during PE lessons, (ii) the lesson context and teacher interactions occurring during PE, and (iii) the associations between teacher, school or PE lesson characteristics with student physical activity levels in PE. Design Cross-sectional study of 100 Grade 7 PE lessons across 10 secondary schools. Methods System for observing fitness instruction time (SOFIT) was used to assess student PA, lesson context, and teacher interaction. Teacher and school characteristics were collected via survey. Mean proportion of lesson time was used to describe PA, lesson context and teacher interaction. Associations between each outcome variable and each characteristic were examined using 2-sample t-tests, ANOVAs and linear regression. Results Thirty-nine percent of PE lesson was spent in MVPA, and less than 10% spent in VA. Lessons in schools in urban areas included significantly more MVPA than rural areas (P = 0.04). Male teachers and more experienced teachers conducted lessons with significantly more VA than female and less experienced teachers (P = 0.04 and 0.02). MVPA was also higher in lessons conducted by more experienced teachers. Conclusions PA during PE lessons within disadvantaged secondary schools is below international recommendations. Male teachers, more experienced teachers and schools in urban regions teach more active lessons.

Exercise in natural environments can improve cognition, positive affect, and reduce psychological stress. However, it remains unclear whether these benefits are subject to a gradient effect, whereby more natural features confer greater cognitive and psychological benefits. This study examined the influence of the exercise environment (i.e., the degree of nature) on cognition, and psychological outcomes in a sample of adolescents (n = 90; mean age = 14.3 ±.05 years). Four groups were randomised to one of the following experimental conditions: a non-exercise indoor control, indoor exercise, park exercise, and exercise in a nature reserve. Participants’ self-reported their stress, affect, and vitality and completed two measures of cognition (‘Rapid Visual Information Processing’ and ‘Spatial Working Memory’) immediately before and ~6 min after exercise. All exercise conditions participated in a group-based circuit lasting ~20 min, which included a mixture of aerobic and body-weight resistance activities. Linear mixed models were used to examine changes within and between groups. The indoor group increased sustained attention accuracy compared to the park group. There were no between-group differences in working memory. The indoor and nature groups increased cognitive arousal compared to control. The park group improved in state-level vitality compared to control. The mixed-results of this research do not support our ‘nature gradient’ hypothesis, whereby cognitive and psychological outcomes would improve in accordance with the degree of nature present in the exercise environment.

This study examines the impact of a classroom-based physical activity intervention on primary school students’ academic outcomes and physical activity levels. Students (N = 283) from nine primary schools located in New South Wales, Australia were randomly allocated to a control (n = 5 schools) or Thinking while Moving in English (TWM-E) (n = 4 schools) conditions. Teachers delivered three 40-min physically active English lessons per week for six weeks. The control condition continued with the usual lessons. For both conditions, assessments occurred at baseline and post-test. The TWM-E group displayed improved on-task behaviour, and improved grammar and punctuation scores. Despite minimal effect on overall physical activity levels, active lessons have important benefits for students’ on-task behaviour and literacy.

Objectives This study evaluated the feasibility of the ‘Encouraging Activity to Stimulate Young (EASY) Minds' programme, a school-based intervention for integrating physical activity (PA) into mathematics lessons. Design Randomised controlled trial. Methods Two classes from a single school ( n =54) were randomised to receive either the 6-week EASY Minds intervention ( n =27) or follow their usual school programme ( n =27). The intervention involved the embedding of PA across the pre-existing mathematics programme for 3×60min sessions per week. Changes in PA were measured using accelerometers and ‘on task' behaviour was measured using momentary time sampling observation. Results Using intention-to-treat analysis, significant intervention effects were found for MVPA (9.7%, 95%CI=7.6, 11.8, p ≤0.001) and sedentary time (−22.4%, CI=−24.9, −12.2, p ≤0.001) for the intervention group during Mathematics lessons (9.30am–10.30am). Significant intervention effects were also shown for MVPA 8.7% (95% CI=5.8, 11.6, p ≤0.001 and sedentary time −18.6% (95% CI=−24.9, −12.2, p ≤0.001) across the whole school day. Furthermore, children displayed significantly greater ‘on-task' behaviour across the intervention period with a 19.9% (95%CI=2.4, 37.4, p ≤0.03) mean difference between groups. Conclusions The EASY Minds programme demonstrated that integrating movement across the primary mathematics syllabus is feasible and efficacious in enhancing school based-PA and improving on-task behaviour in mathematics lessons.

Professional development is widely considered important for enhancing the quality of teaching for enhanced student learning. Yet few studies have demonstrated such impacts. This protocol for a cluster randomised controlled trial involving 24 schools tests a structured collaborative approach to professional development called Quality Teaching Rounds. The study seeks to establish: which features of Quality Teaching Rounds are fundamental to its effectiveness; how, why, and for whom participation in Quality Teaching Rounds supports improvement in teaching practice; and, to what extent the Quality Teaching Rounds intervention can be implemented to build and sustain teacher capacity. The primary outcome measure, quality of teaching, will be analysed using linear mixed models and the quantitative modelling will be complemented with qualitative evidence.

Objectives The study aim was to assess rater agreement of the Resistance Training Skills Battery (RTSB) for adolescents. The RTSB provides an assessment of resistance training skill competency and includes six exercises. The RTSB can be used to assess performance and progress in adolescent resistance training programmes and to provide associated feedback to participants. Individual skill scores are based on the number of performance criteria successfully demonstrated and an overall resistance training skill quotient (RTSQ) is created by summing the six skill scores. Design/methods The eight raters had varying experience in movement skill assessment and resistance training and completed a 2–3 h training session in how to assess resistance training performance using the RTSB. The raters then completed an assessment on six skills for 12 adolescents (mean age = 15.1 years, SD = 1.0, six male and six female) in a randomised order. Results Agreement between seven of the eight raters was high (20 of the 21 pairwise correlations were greater than 0.7 and 13 of the 21 were greater than 0.8). Correlations between the eighth rater and each of the other seven raters were generally lower (0.45–0.78). Most variation in the assigned RTSB scores (67%) was between cases, a relatively small amount of the variation (10%) was between raters and the remainder (23%) was between periods within raters. The between-raters coefficient of variation was approximately 5%. Conclusions The RTSB can be used reliably by those with experience in movement skill assessment and resistance training to assess the resistance skill of adolescents.

The primary aim of this study was to examine a range of potential behavioral and maternal/paternal correlates of adiposity in children. Secondary aims were to examine (a) correlates of screen-time, diet and physical activity and (b) if there were differences in maternal and paternal physical activity- and dietary-related parenting practices. Cross-sectional analysis was conducted using 70 families with children (59% boys (41/70), mean age 8.4 (±2.4) years). Parenting practices were measured using the Parenting Strategies for Eating and Activity Scale. Children's outcomes included: 7-day pedometry (physical activity), screen-time, percent energy from core foods (Food frequency questionnaire) and BMI z-score. Multiple regression models were generated to examine the associations between maternal and paternal parenting practices and children's variables. In the regression analyses, fathers' BMI (p < .01) and mothers' control (p < .001) were significantly associated with child weight status. Fathers' reinforcement (p < .01) was significantly associated with child physical activity. For screen-time, mothers' monitoring (p < .001) and child characteristics [age (p = .01), sex (p = .01), BMI z-score (p = .03)] were significant predictors. Mothers' parenting practices [limit setting (p = .01), reinforcement (p = .02)] and child screen-time (p = .02) were significantly associated with intake of core foods. Despite some similarities within families, three out of five parenting constructs were significantly different between mothers and fathers. Mothers and fathers have different parental influences on their children's weight status and lifestyle behaviors and both should be included in lifestyle interventions targeting children. A focus on maternal parenting specifically relating to screen-time and diet, and father's physical activity parenting and weight status may support their children in developing more healthy behaviors.

To evaluate the effectiveness of the 'Healthy Dads, Healthy Kids (HDHK)' program when delivered by trained facilitators in community settings.A two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age=40.3 [5.3] years; BMI=32.5 [3.8] kg/m(2)) and their primary school-aged children (n=132) from the Hunter Region, Australia. In 2010-2011, families were randomized to either: (i) HDHK intervention (n=48 fathers, n=72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors.Linear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P.001, d=0.24), with HDHK fathers losing more weight (-3.3 kg; 95%CI, -4.3, -2.4) than control fathers (0.1 kg; 95%CI, -0.9,1.0). Significant treatment effects (P.05) were also found for fathers' waist (d=0.41), BMI (d=0.26), resting heart rate (d=0.59), energy intake (d=0.49) and physical activity (d=0.46) and for children's physical activity (d=0.50) and adiposity (d=0.07).HDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting.

Poor dietary habits and obesity are more prevalent in lower socio-economic status (SES) communities. The NEAT Girls cluster randomized controlled trial was a school-based obesity prevention program targeting adolescent girls in low SES schools in NSW, Australia. The aim was to evaluate the 12-month impact of key nutrition program messages on dietary intake and food behaviors. Diet was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Individual foods were categorized into nutrient-dense or energy-dense, nutrient-poor food groups and the percentage contribution to total energy intake calculated. Participants were aged 13.2±0.5years (n=330). There were no statistically significant group-by-time effects for dietary intake or food related behaviors, with 12-month trends suggesting more intervention group girls had improved water intakes (59% consuming⩽three glasses per day to 54% at 12 months vs. 50% to 61% in controls, p=0.052), with a greater proportion consumingone sweetened beverage per day (24-41% vs. 34-37% in controls, p=0.057). Further research including more intensive nutrition intervention strategies are required to evaluate whether dietary intake in adolescent girls attending schools in low SES communities can be optimized.

Objective To evaluate the impact of a 12-month school-based multi-component program on adolescent girls’ physical activity and sedentary behaviors, and hypothesized mediators of physical activity behavior change. Design Group randomized controlled trial with 12-month follow-up. Methods The intervention, guided by Social Cognitive Theory, involved 357 adolescent girls (13.2 ± 0.5 years) from 12 secondary schools (6 intervention schools, 6 control schools) in low-income communities in the Hunter and Central Coast regions of New South Wales, Australia. The intervention included enhanced school sport, lunchtime physical activity sessions, interactive seminars, student handbooks, nutrition workshops, pedometers, parent newsletters and text messages to encourage physical activity and healthy eating, and a decrease in sedentary behavior. Outcomes were assessed at baseline and 12-months and included: physical activity (accelerometers), sedentary behaviors (questionnaire and accelerometers), and social-cognitive mediators of physical activity (questionnaire). Results There were significant between group differences in favor of the intervention group for self-reported recreational computer use (−26.0 min; 95% CI, −46.9 to −5.1), and sedentary activities summed (−56.4 min; 95% CI, −110.1 to −2.7), however objective sedentary behavior showed no differences. There were no group-by-time effects for any of the physical activity outcomes or hypothesized mediators. Conclusions A school-based intervention tailored for adolescent girls from schools located in low-income communities significantly reduced time spent in sedentary activities. However, improvements in physical activity and hypothesized mediators of physical activity behavior were not observed. Future studies are encouraged to explore alternative mechanisms of behavior change derived from integrated and socio-ecological theories.

Objectives A limited understanding of the mechanisms of behavior change has hindered the development of more effective interventions. The aim of this study was to identify potential mediators of objectively measured physical activity (PA) behavior change in women with type 2 diabetes (T2DM). Design Mediation test of a randomized controlled trial. Method Women with T2DM (n = 93) from the control group (standard PA materials, n = 44) and the full intervention group (control + stage-matched printed material and telephone counseling, n = 49) of a larger PA intervention trial were included. PA outcomes were minutes of MET weighted moderate and vigorous PA/week (self-report) and steps/3-days (objective) recorded at baseline and 12-months. Social-cognitive constructs were measured and tested in a mediating variable framework. Results Perceived behavioral control and barrier self-efficacy mediated intervention effects on objective PA (proportion of intervention effect mediated = 18% and 24% respectively). Intention was a mediator of objective PA (23%). Conclusion Perceived behavior control, barrier self-efficacy, and intention are effective mechanisms of PA behavior change in women with T2DM.

Objective Physical education (PE) programs aim to promote physical activity (PA) and reach most school-aged youth. However, PA levels within PE lessons are often low. In this cluster-randomized controlled trial, we examined the effects of three self-determination theory-based motivational strategies on PA and sedentary behavior, as well as their hypothesized antecedents during PE lessons. Methods Data were collected in Sydney, Australia (October–December 2011). After baseline testing, teachers (n = 16) and their classes (n = 288 students; M = 13.6 years, 50.4% male) were randomly assigned to one of four teaching strategy conditions: (1) explaining relevance; (2) providing choice; (3) complete free choice; or (4) usual practice. Teachers then delivered the assigned strategy. Primary outcomes were accelerometer-assessed PA and student motivation during lessons. Secondary outcomes included sedentary behavior, perceptions of teachers' support and psychological needs satisfaction. Results The ‘free choice’ intervention increased PA (p < .05). ‘Providing choice’ and ‘free choice’ interventions decreased sedentary behavior (p < .05). The interventions did not influence motivation, but students' autonomy increased during both choice-based interventions (p < .05). Conclusions Promoting choice can produce short-term increases in PA and decreases in sedentary behavior, as well as increased perceived autonomy during PE lessons.

Background Obesity prevention among youth of low SES is a public health priority given the higher prevalence of youth obesity in this population subgroup. Purpose To evaluate the 24-month impact of a school-based obesity prevention program among adolescent girls living in low-income communities. Design The study was a school-based group RCT, the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) intervention. Setting/participants The study involved 12 secondary schools located in low-income communities in New South Wales, Australia. Participants were 357 adolescent girls (aged 13.2±0.5 years). Intervention The 12-month multicomponent intervention was guided by social cognitive theory and involved strategies to promote physical activity, reduce sedentary behaviors, and improve dietary outcomes. Main outcome measures The primary outcome was BMI, and secondary outcomes were BMI z -score; percentage body fat (bioelectrical impedance analysis); physical activity (accelerometers); dietary intake; and recreational screen-time (self-report). Data were collected in 2010–2012 and analyzed in 2012. Results After 24 months, there were no intervention effects on BMI (adjusted mean difference −0.33, 95% CI=−0.97, 0.28, p =0.353) and BMI z -score (−0.12, 95% CI=−0.27, 0.04, p =0.178). However, there was a group-by-time interaction for percentage body fat (−1.96%, 95% CI=−3.02, −0.89, p =0.006). Intervention effects for physical activity, screen time, and dietary intake were not significant. Conclusions The NEAT Girls intervention did not result in effects on the primary outcome. Further study of youth who are "at risk" of obesity should focus on strategies to improve retention and adherence in prevention programs. Trial registration This study is registered at Australian New Zealand Clinical Trials ACTRN1261000033004.

Purpose To systematically review and examine the explanatory power of key social-cognitive theories used to explain physical activity (PA) intention and behavior, among adolescents. Methods A systematic review and meta-analysis of the literature was performed using the electronic databases Medline, Cumulative Index to Nursing and Allied Health Literature, SPORTdiscus, EBSCO and Education Resources Information Center, Proquest Education Journals Collection, Science Direct, Web of Science and Scopus for social-cognitive theories (i.e., Health Promotion Model, Theory of Planned Behavior, Theory of Reasoned Action, Protection Motivation Theory, Social Cognitive Theory/Self-Efficacy Theory, Health Belief Model, Self-Determination Theory, Transtheoretical Model) used to explain PA intention and behavior. Related keywords in titles, abstracts, or indexing fields were searched. Results Twenty-three studies satisfied the inclusion criteria and were retained for data extraction and analysis; 16 were cross-sectional studies and seven were longitudinal studies. Most studies employed self-report measures. In general, the models explained greater proportions of variance for intention compared to behavior. The meta-analyses revealed 33% and 48% of the variance respectively for PA and intention were explained by social cognitive models. Conclusions Few studies have tested the predictive capacity of social cognitive theories to explain objectively measured PA. The majority of PA variance remains unexplained and more theoretical research is needed.

Background Excessive time spent in sedentary behavior is associated with a range of physiological, psychosocial and behavioral health concerns in youth. Objective The primary aim of this study was to examine the association between sedentary behavior and self-esteem among adolescent girls living in low-income communities. Methods Participants were 357 girls [mean age (standard deviation) = 13.2 (0.5) years] from 12 secondary schools located in low-income communities in New South Wales, Australia. Height, weight, body fat (bio-electrical impedance analysis) and physical activity (accelerometers), self-esteem were assessed. Results Significant inverse associations were found between self-esteem and time spent watching DVDs and using the computer for non-school purposes, but no relationship was found between TV viewing and self-esteem. The relationship between sedentary time (%) from accelerometers and self-esteem was not significant. Conclusions Sedentary behavior is a pervasive public health concern and time spent in specific screen-based recreation was associated with self-esteem in adolescent girls living in low-income communities. Our findings are indicative of the complex nature of these relationships and reveal a need for further longitudinal and intervention-based research in the field.

To evaluate the impact of a multi-component school-based physical activity intervention (Fit-4-Fun) on health-related fitness and objectively measured physical activity in primary school children.Four Hunter primary schools were recruited in April, 2011 and randomized by school into treatment or control conditions. Participants included 213 children (mean age = 10.72 years ± 0.6; 52.2% female) with the treatment group (n = 118) completing the 8-week Fit-4-Fun Program. Participants were assessed at baseline and 6-month follow-up, with a 91% retention rate. Cardio-respiratory fitness (CRF) (20 m shuttle run) was the primary outcome, and secondary outcomes included body composition (BMI, BMI(Z)), muscular fitness (7-stage sit-up test, push-up test, basketball throw test, Standing Jump), flexibility (sit and reach) and physical activity (7 days pedometry).After 6-months, significant treatment effects were found for CRF (adjusted mean difference, 1.14 levels, p0.001), body composition (BMI mean, -0.96 kg/m(2), p0.001 and BMI z-score mean -0.47 z-scores, p0.001), flexibility (sit and reach mean, 1.52 cm, p = 0.0013), muscular fitness (sit-ups) (mean 0.62 stages, p = 0.003) and physical activity (mean, 3253 steps/day, p0.001). There were no group by time effects for the other muscular fitness measures.A primary school-based intervention focusing on fitness education significantly improved health-related fitness and physical activity levels in children.

Objectives The purpose of this study was to explore potential moderators and mediators of intervention effects in the Physical Activity Leaders (PALs) obesity prevention program for adolescent boys from disadvantaged secondary schools. Design Group randomized controlled trial. Methods One hundred adolescent boys (mean age = 14.3 (0.6) years) from four schools were randomized to the PALs intervention or a control group for the 6-month study period. The primary outcome was change in BMI and secondary outcomes were physical activity assessed using pedometers and constructs from Social Cognitive Theory (SCT) assessed using a questionnaire. Results Moderation analyses revealed a significant weight status interaction for BMI (p = 0.04), indicating stronger intervention effects for youth classified as overweight/obese at baseline. The intervention had a significant effect on resistance training self-efficacy (p