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Physical fitness is an important marker of current and future health status, yet the association between physical fitness and indicators of mental health in youth has not been systematically reviewed and meta-analyzed. The aim of this work was to systematically review and meta-analyze the association between physical fitness components (i.e. cardiorespiratory fitness, muscular fitness, speed-agility, flexibility and fitness composite) and mental health indicators (i.e. psychological well-being and psychological ill-being) in preschoolers, children and adolescents. Systematic review and meta-analysis. Systematic searches were conducted in PubMed, Web of Science and Scopus from database inception to May 2020. Studies (cross-sectional, longitudinal and intervention designs) were included if they measured at least one physical fitness component and one mental health indicator in healthy youth (2–18 years). A total of 58 unique studies (52 cross-sectional, 4 longitudinal and 4 intervention studies) met all eligibility criteria and were included. There was a significant positive overall association between physical fitness and mental health in children and adolescents (pooled r = 0.206, p

Highlights • Cardiorespiratory fitness was associated with older adolescents’ cognitive control. • Muscular fitness was not associated with older adolescents’ cognitive control. • Cardiorespiratory fitness selectively influences cognition in late adolescence., Background Participation in physical activity supports greater cardiorespiratory fitness (CRF), a correlate of cognitive control. However, the relationship between muscular fitness (MF) and cognitive control is less clear. The present study investigated the differential relationship of CRF and MF with cognitive control in older adolescents. Methods This cross-sectional study involved students (15–17 years old, n = 541, 43% female) from 20 secondary schools who completed tests of inhibition (modified flanker task), working memory (n-back task), CRF (Progressive Aerobic Cardiovascular Endurance Run), and MF (standing long jump and push-up test). Multilevel analyses tested the association between CRF or MF and cognitive outcomes while accounting for the influence of the other fitness variable and relevant demographic factors. Results CRF predicted response accuracy during incongruent flanker trials, the condition requiring greater inhibition. For the working memory task, CRF predicted greater target accuracy and greater d' scores on the 1-back task, requiring lesser amounts of working memory. In the 2-back task, which requires greater amounts of working memory, CRF also predicted greater target and non-target accuracy and d' scores. Comparatively, MF did not predict any cognitive outcomes after adjustment for CRF. Conclusion CRF was selectively related to better performance during task conditions that require greater amounts of inhibition and working memory. This finding suggests that CRF, but not MF, may benefit cognitive control in older adolescents. This selective influence of CRF on older adolescents’ cognition highlights the value of aerobic physical activity., Graphical Abstract Image, graphical abstract

The purpose of this study was to assess the feasibility and preliminary efficacy of a high-intensity interval training (HIIT) intervention integrated into the workplace on physical and mental health outcomes in a sample of adults. The Work-HIIT intervention was evaluated at the University of Newcastle (March-July 2019). University employees (18+ years) who self-identified as predominantly sedentary at work (n = 47, 43.0 ± 10.7 years; 41 female) were recruited, screened, and randomized after baseline assessments into Work-HIIT (n = 24) or wait-list control (n = 23) conditions. Participants were asked to attend 2-3 researcher-facilitated HIIT sessions/week (weeks 1-8). Sessions included a 2-minute gross-motor warm-up, followed by various combinations of aerobic and muscular fitness exercises lasting 8 minutes (using 30:30 second work: rest intervals). Program feasibility was assessed using measures of satisfaction, compliance, adherence, fidelity, and retention. Physiological and psychological outcomes were measured at baseline and 9 weeks. Feasibility data were investigated using descriptive statistics and efficacy outcomes determined using linear mixed models and Cohen's d effect sizes. Participant ratings showed high levels of satisfaction (4.6/5); 71% of participants attended ≥2 sessions/wk and averaged 85.9% HRmax across all sessions (including rest and work intervals). Small-to-medium positive effects resulted for cardiorespiratory fitness [+2.9 laps, 95% CI (-4.19-10.14); d = 0.34] and work productivity [+0.26, d = 0.47]. Large positive effects resulted for muscular fitness [push-ups +3.5, d = 0.95; standing jump +10.1 cm, d = 1.12]; HIIT self-efficacy [+16.53, d = 1.57]; sleep [weekday +0.76 hours, d = 1.05]; and autonomous motivation [+0.23, d = 0.76]. This study supports the feasibility and preliminary efficacy of facilitator-led Work-HIIT as a time-efficient, enjoyable, and convenient workplace exercise option for adults.

Background Six core behavioural risk factors (poor diet, physical activity, sedentary behaviour, alcohol misuse, smoking and unhealthy sleep patterns) have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers. Smartphones have the potential to provide a real-time, pervasive, unobtrusive and cost-effective way to measure health behaviours and deliver instant feedback to users. Despite this, validity of using smartphones to measure these six key behaviours is largely unknown. The proposed systematic review aims to address this gap by identifying existing smartphone-based approaches to measure these health behaviours and critically appraising, comparing and summarizing the quality of their measurement properties. Methods A systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsychINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost) and IEEE Xplore Digital Library databases will be conducted from January 2007 to March 2020. Eligible studies will be those written in English that measure at least one of the six health behaviours of interest via a smartphone and report on at least one measurement property. The primary outcomes will be validity, reliability and/or responsiveness of these measurement approaches. A secondary outcome will be the feasibility (e.g. user burden, usability and cost) of identified approaches. No restrictions will be placed on the participant population or study design. Two reviewers will independently screen studies for eligibility, extract data and assess the risk of bias. The study methodological quality (or bias) will be appraised using an appropriate tool. Our results will be described in a narrative synthesis. If feasible, random effects meta-analysis will be conducted where appropriate. Discussion The results from this review will provide important information about the types of smartphone-based approaches currently available to measure the core behavioural risk factors for chronic disease and the quality of their measurement properties. It will allow recommendations on the most suitable and effective measures of these lifestyle behaviours using smartphones. Valid and reliable measurement of these behaviours and risk factor opens the door to targeted and real-time delivery of health behaviour interventions, providing unprecedented opportunities to offset the trajectory toward chronic disease. Systematic review registration PROSPERO: CRD42019122242

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.

PURPOSE High-intensity interval training (HIIT) has emerged as a time-efficient strategy to improve children's and adolescents' health-related fitness in comparison to traditional training methods. However, little is known regarding the effects on cognitive function and mental health. Therefore, the aim of this systematic review was to evaluate the effect of HIIT on cognitive function (basic information processing, executive function) and mental health (well-being, ill-being) outcomes for children and adolescents. METHODS A systematic search was conducted, and studies were eligible if they 1) included a HIIT protocol, 2) examined cognitive function or mental health outcomes, and 3) examined children or adolescents (5-18 yr). Separate meta-analyses were conducted for acute and chronic studies, with potential moderators (i.e., study duration, risk of bias, participant age, cognitive demand, and study population) also explored. RESULTS A total of 22 studies were included in the review. In acute studies, small to moderate effects were found for executive function (standardized mean difference [SMD], 0.50, 95% confidence interval [CI], 0.03-0.98; P = 0.038) and affect (SMD, 0.33; 95% CI, 0.05-0.62; P = 0.020), respectively. For chronic studies, small significant effects were found for executive function (SMD, 0.31; 95% CI, 0.15-0.76, P < 0.001), well-being (SMD, 0.22; 95% CI, 0.02-0.41; P = 0.029), and ill-being (SMD, -0.35; 95% CI, -0.68 to -0.03; P = 0.035). CONCLUSIONS Our review provides preliminary review evidence suggesting that participation in HIIT can improve cognitive function and mental health in children and adolescents. Because of the small number of studies and large heterogeneity, more high-quality research is needed to confirm these findings.

Background A healthy lifestyle program that appeals to, and supports, obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. In Scotland, Football Fans in Training (FFIT), a weight management and healthy lifestyle program for overweight and obese men aged 35–65 years , delivered by community coaching staff at professional football clubs, has been shown to be beneficial and cost-effective. A pilot program inspired by FFIT but delivered by professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, improved physiological outcomes, and adherence to healthy lifestyle behaviors in overweight and obese men. The objective of this trial is to determine the effectiveness and cost-effectiveness of the Rugby Fans in Training New Zealand (RUFIT-NZ) program. Methods A pragmatic, two-arm, multi-center, randomized controlled trial involving 308 overweight and obese men aged 30–65 years, randomized to either an intervention group (n = 154) or a wait-list control group (n = 154). The intervention-group participated in the 12-week RUFIT-NZ program, a gender-sensitized, healthy lifestyle intervention adapted to the environment and cultural diversity of NZ and delivered through professional rugby clubs. Participants in the intervention group undergo physical training sessions, in addition to workshop-based sessions to learn about nutrition, physical activity, sleep, sedentary behavior, and a range of behavior-change strategies for sustaining a healthier lifestyle. The control group receives the program after 52 weeks. The primary outcome is change in body weight from baseline to 52 weeks. Secondary outcomes include change in body weight at 12 weeks; waist circumference, blood pressure, fitness, and lifestyle behaviors at 12 and 52 weeks; and cost-effectiveness. A process evaluation informed by the RE-AIM framework will evaluate potential implementation of RUFIT-NZ as an ongoing program in NZ after the trial. Discussion This trial will investigate the effectiveness and cost-effectiveness of the RUFIT-NZ program in overweight and obese NZ men. Trial registration Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered on 18 January 2019, according to the World Health Organization Trial Registration Data Set. Universal Trial Number, U1111-1245-0645.

Funder: Sue and Bob O'Donnell, Summary: Biases introduced in early���stage studies can lead to inflated early discoveries. The risk of generalizability biases (RGBs) identifies key features of feasibility studies that, when present, lead to reduced impact in a larger trial. This meta���study examined the influence of RGBs in adult obesity interventions. Behavioral interventions with a published feasibility study and a larger scale trial of the same intervention (e.g., pairs) were identified. Each pair was coded for the presence of RGBs. Quantitative outcomes were extracted. Multilevel meta���regression models were used to examine the impact of RGBs on the difference in the effect size (ES, standardized mean difference) from pilot to larger scale trial. A total of 114 pairs, representing 230 studies, were identified. Overall, 75% of the pairs had at least one RGB present. The four most prevalent RGBs were duration (33%), delivery agent (30%), implementation support (23%), and target audience (22%) bias. The largest reductions in the ES were observed in pairs where an RGB was present in the pilot and removed in the larger scale trial (average reduction ES ���0.41, range ���1.06 to 0.01), compared with pairs without an RGB (average reduction ES ���0.15, range ���0.18 to ���0.14). Eliminating RGBs during early���stage testing may result in improved evidence.

Background Physical activity guidelines recommend young people engage in regular muscle-strengthening activities (e.g., resistance training [RT]). However, few school-based physical activity interventions have been delivered at-scale or promoted RT. The aim of this study was to evaluate the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens (RT for Teens) program. Methods Data were collected between August 2015 and October 2020. RE-AIM was operationalized as: (i) Reach: number and characteristics of students estimated to be exposed to the program; (ii) Effectiveness: impact of the program on student-level outcomes measured in a subsample of 750 students from 17 schools; (iii) Adoption: number and representativeness of schools with one or more teachers trained to deliver the program; (iv) Implementation: extent to which the program was delivered as intended; and (v) Maintenance: extent to which the program was sustained in schools. Results The estimated program reach was ~ 10,000 students, out of a total student population of ~ 200,000 (~ 5%). Students were from diverse socioeconomic and ethnic backgrounds. Improvements in muscular fitness, RT self-efficacy, perceived cardiorespiratory fitness and flexibility, and participation in muscle-strengthening physical activities were documented. A total of 30 workshops were delivered, involving 468 teachers from 249 schools from diverse geographical regions. Implementation varied considerably, with teachers adapting the program to suit the context of their school and student cohorts. However, RT skill development and the promotion of muscular fitness were the session components delivered most during sessions. Teachers’ adherence to the SAAFE (Supportive, Active, Autonomous, Fair and Enjoyable) teaching principles was high. Approximately 30% of teachers (144/476) registered to use the RT for Teens app. At the school-level, 37% (93/249) of schools had at least one registered user (teacher and/or student). A total of 2,336 workouts and 3,116 fitness tests were completed by registered users. Of the 249 schools represented, 51 (20.5%) sent an additional (previously untrained) teacher to a second workshop. Conclusions The RT for Teens program had broad reach and adoption. However, intervention delivery varied considerably across schools and additional support strategies are required to optimize intervention implementation and maintain program delivery over time. Future studies will benefit from the utilization of accepted frameworks, recommendations and guidelines for implementation research. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12621000352808), retrospectively registered 1st February 2021.

Background Physical inactivity, poor diet, sedentary recreational screen time, poor sleep, alcohol use and smoking (the “Big 6”) are key lifestyle risk factors for chronic disease. The Big 6 typically emerge during adolescence, co-occur and continue into adulthood. To improve short- and long-term health, early and effective prevention is critical. Methods A cluster randomised controlled trial (ACTRN12619000431123) is being conducted in 71 schools across NSW, QLD and WA. Schools are randomised to the Health4life intervention or health education as usual. The intervention has three components: 1) An online, school-based program delivered to all Year 7 students; 2) An accompanying smartphone application (all students); 3) Booster content, delivered to at-risk students in Years 8 and 9. Students complete questionnaires on five occasions over three years. Results Preliminary analyses including 6716 students (49% female) indicated that 22% of participants met national guidelines for physical activity, 27% reported drinking 2+ cups of sugar-sweetened beverages/week, 3% had consumed a standard alcoholic drink in the prior 6 months, 2% had tried smoking, 86% engaged in excessive recreational screen time, and 32% had inadequate sleep. The final dataset will be analysed for the conference. Conclusions Many Australian adolescents are engaging in lifestyle behaviours that put them at risk of chronic disease. Effective and scalable preventive interventions that simultaneously target these behaviours are needed. Key messages This is the first trial of an eHealth intervention to concurrently target the Big 6 among adolescents. Health4Life has the potential to improve physical and mental health in adolescence and beyond.

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.

Aim This study examined the effects of different types of classroom physical activity breaks on children's on-task behaviour, academic achievement and cognition. Methods Participants were 87 Australian primary school students (mean age 9.11 ± 0.62 years), recruited from one school. Three classes were randomly assigned either to activity breaks only (n = 29), activity breaks and mathematics combined (n = 29), or control conditions involving only mathematical content (n = 29). Students were engaged in five minutes of classroom physical activity breaks, three times per week, for four weeks (divided into two minutes at the beginning of the usual mathematics curriculum lesson and three minutes in the middle of the lesson). Assessments were conducted at baseline and post-test. Results Significant group-by-time effects were found for on-task behaviour (active engagement: activity breaks and mathematics combined versus control, p ≤ 0.001; activity breaks versus control, p ≤ 0.001; activity breaks and mathematics combined versus activity breaks, p = 0.037; passive engagement: activity breaks and mathematics combined versus control, p ≤ 0.001) and mathematics scores (activity breaks versus control, p = 0.045). Conclusion Physical activity breaks with and without integrated mathematics content were effective in improving children's on-task behaviour and learning scores.

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ≥ 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-to-treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (-3.6 kg, 95% confidence interval: -4.3, -2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.

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.

Introduction: Secondary schools have the potential to promote health-related fitness (HRF) and physical activity within and outside school hours. As such, schools are often chosen as the setting to implement child and adolescent physical activity programs. School-based programs often utilise teachers as delivery agents, but few studies examine effects on teacher-level outcomes.\ud Purpose: The primary aim of this study was to determine the impact of teacher training embedded within a physical activity intervention on teacher-level outcomes. The secondary aim of this study was to evaluate process data, including implementation, satisfaction and fidelity.\ud Methods: Resistance Training for Teens (RT for Teens) was evaluated using a cluster randomised controlled trial in 16 secondary schools. Teachers (N=44; 48% female/52% male; mean±SD years teaching experience=10.6±8.0) from 16 secondary schools were assessed at baseline. Intervention group teachers (i.e., from eight schools) delivered a structured school-based physical activity program over 10-weeks. Teacher outcomes included confidence to teach health-related fitness (HRF) activities, perceived barriers to teaching HRF activities, and perceived fitness. Detailed process evaluation data were also collected. Assessments were conducted at baseline and 6-months (post-program), and outcomes were assessed using repeated measures analysis of variance.\ud Results: There was a positive group-by-time effect for the confidence composite score (p = .010, partial eta squared = 0.29), but no effects for the two (contextual, interpersonal) barrier composite scores. Also, there was a significant effect for perceived ‘general fitness’ (p = 0.044, partial eta squared = 0.13), but not for specific fitness subdomains. Teachers were highly satisfied with both the training and the program, believing it was beneficial for students. Resource usage and adherence to the SAAFE (Supportive, Active, Autonomous, Fair, Enjoyable) delivery principles was high.\ud Conclusion: RT for Teens improved teachers’ confidence and perceived fitness. These findings highlight the potential for high-quality teacher training and program delivery to positively influence teacher-level outcomes. This may provide support for the use of teacher professional development to improve HRF-related pedagogy.

Background Adolescents with disability are less active and have lower levels of physical fitness than their typically developing peers. Schools are ideal settings to address this; however, few school-based interventions have been designed and evaluated among this group. Therefore, the aim of this pilot study was to determine the feasibility of a time-efficient school-based physical activity intervention for adolescents with disability. Methods A non-randomized pilot trial was conducted with adolescents in the special education unit at one secondary school in New South Wales, Australia. Sixteen grade 11 and 12 students (aged 17.3 ± 0.7 years) participated in the 2-month physical activity intervention. Two classroom teachers were trained to facilitate the delivery of a high-intensity interval training (HIIT) program, known as Burn 2 Learn adapted (B2La). Teachers were asked to deliver 2–3 weekly HIIT sessions for a period of 2 months. Four domains of feasibility (acceptability, implementation, adaptability, and practicality) were assessed using quantitative measures at the student and teacher levels (e.g., observations, process evaluation questionnaires, and heart rate [HR] monitoring). Data were also collected from three learning and support teachers who assisted classroom teachers with intervention delivery. Preliminary efficacy of the intervention on measures of adolescents’ functional capacity (6-min walk/run test) and muscular fitness (sit-to-stand test and modified push-up test) were analyzed using paired sample t-tests. Results Moderate-to-high levels of program satisfaction were reported by both students (80% rated “Good” or “Excellent”) and teachers (100% rated “Good” or “Excellent”). Teachers reported delivering 2.5 ± 0.7 sessions per week during the study. Based on researcher session observations, the program was delivered effectively by teachers (14/20). However, HR data indicated session intensity was lower than intended. The program was considered “adaptable” by teachers, with several observed modifications to HIIT sessions to cater for the needs of adolescents with disability. No adverse events were reported. We observed improvements in preliminary efficacy measures. Conclusions Our findings suggest it is feasible to train teachers to deliver a school-based HIIT program for adolescents with disability. Evaluation of B2La within a larger-scale effectiveness trial is warranted. Trial registration ACTRN12621000219886.

Background: Pilot/feasibility studies play an important role in the development and refinement of behavioral interventions by providing information about feasibility, acceptability, and potential efficacy. Despite their importance and wide-spread use, the approaches taken by behavioral scientists to scale-up early-stage studies to larger-scale trials has received little attention. The aim of our study was to understand the role that pilot studies play in the development and execution of larger-scale trials.Methods: We conducted interviews with behavioral interventionists identified in a systematic review as the lead author of a published pilot study that had also published larger-scale trial on a topic related to childhood obesity. Questions were asked about the role of pilot studies in developing larger-scale trials and the challenges encountered when scaling-up an intervention based upon pilot findings. Data were coded and analyzed using an inductive analytic approach to identify themes.Results: 24 Interventionists (54% women, 37-70 yrs old, mean 20 years since terminal degree) completed a total of 148 pilot studies across their careers (mean 6.4, range 1-20), of which 59% were scaled-up. Scaling was described as resource intensive and pilot work was considered essential to successfully competing for funding by 63% of the sample (n=15). When asked to define a high-quality pilot study, interventionists described studies that allowed them to evaluate components of their intervention (e.g., acceptability, feasibility) and study parameters (e.g., sample size, measures). Interventionists expressed that more process implementation measures, different study designs, and additional iterations could improve decisions to scale-up. Most agreed that pilot studies were likely to produce inflated estimates of potential efficacy though only nine interventionists provided potential solutions for decreasing inflated measures of efficacy. Suggested major causes of inflated effects included high levels of oversight in pilot studies (e.g., researcher support), reliance on subjective measures, and utilizing convenience or highly motivated samples. Potential solutions included designing pilots for real-world implementation, only conducting randomized controlled pilot studies, and pre-registering pilot studies. Conclusions: Pilot studies purposes are multifaceted and deemed essential to obtaining funding for larger-scale trials. Clarifying the form and function of preliminary, early-stage research may enhance the productive utilization of early-stage studies and reduced “voltage drop”.

Importance Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. Objective To evaluate the effect of an internet-based intervention on children’s cardiorespiratory fitness across a large number of schools. Design, Setting, and Participants In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. Interventions The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). Main Outcomes and Measures Multistage 20-m shuttle run test for cardiorespiratory fitness. Results Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). Conclusions and Relevance In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level. Trial Registration http://anzctr.org.au Identifier: ACTRN12616000731493

Participation in regular physical activity has significant physical, psychological, and social benefits, including the prevention and treatment of Type 2 Diabetes (T2D). The primary aim of this paper was to evaluate the impact of theeCoFit physical activity intervention on depression and anxiety symptoms among adults at risk of, or diagnosed with, T2D. The primary outcomes were assessed using Patient Health Questionnaire-9, and Generalised Anxiety Disorder-7. The secondary aim was to test for the potential mediators for the intervention effect on mental health. The 20-week intervention was evaluated using a two-arm randomised controlled trial with await list control group. The intervention included two phases: Phase 1 integrated group face-to-face sessions and the use of the eCoFit smartphone application (app); and Phase 2 that included the use of the app only. Participants (n = 84) were assessed at baseline and 10- and 20-weeks post-baseline. Social support, self-efficacy, nature-relatedness, and perceived sleep quality were examined as potential mechanisms for the intervention effects on mental health. A significant interaction for depression severity was observed at 20-weeks (-1.76, CI -3.48, -05, p= .044, d= -0.35). There were no significant intervention effects for anxiety or any of the potential mechanisms.

Objectives To determine the impact of bushfires on children’s physical activity. Design Natural experiment comparing device-measured physical activity and air quality index data for schools exposed and not exposed to the Australian bushfires. Methods Participants were drawn from 22 schools participating in a cluster randomised controlled trial of a school-based physical activity intervention that coincided with the 2019 Australian bushfires. Students in Years 3 and 4 (8–10 years old) provided data. We used propensity score matching to match 245 exposed and 344 control participants. Main outcome measures Minutes of moderate and vigorous physical activity. Results The bushfires had minimal effect on children’s average weekly physical activity. Analysis of acute effects showed children maintained their levels of physical activity up to an estimated turning point of air quality index of 737.08 (95% CI = 638.63, 835.53), beyond which daily physical activity levels dropped sharply. Similar results were found for girls and boys and for children from low-to-average and higher socio-economic backgrounds. Conclusions Children’s physical activity was not strongly influenced by the presence of smoke and targeted public health advice during the bushfires might not have had the intended effect of reducing children’s outdoor physical activity. Only when air quality deteriorated to approximately 3.5 times the Air Quality index threshold (>200) deemed ‘hazardous’ by the Australian Department of Health did children’s physical activity decline. Public health agencies should re-evaluate the effectiveness of health messages during bushfires and develop strategies to mitigate risks to children’s health.

usc Estimations of time spent sedentary and in various physical activity intensities may vary according to data reduction methods applied. This study compared associations between children's accelerometer data and adiposity and fitness markers using open source (mean amplitude deviation, MAD) and proprietary (counts) data reduction methods. Complete-case accelerometer, adiposity (Body Mass Index z-score, waist circumference), and fitness (cardiorespiratory, musculoskeletal) data from 118 children (10.4 ± 0.6 years, 49% girls) were analyzed. Estimates of sedentary behavior, light-, moderate-, vigorous- (VPA), and moderate- to vigorous-intensity (MVPA) physical activity were calculated using count- and MAD-based data reduction methods. Linear regression models between time in movement behaviours and fitness and adiposity markers were conducted. Significant differences in estimates of time spent in all intensities were observed between MAD-based and count-based methods. Both methods produced evidence to suggest that sedentary behavior was detrimentally, and physical activity(any intensity) was beneficially, associated with waist circumference. MVPA and VPA were beneficially associated with fitness markers using both data reduction measures. Overall, findings suggest that estimates of sedentary time and physical activity were not comparable. However, the strength and direction of the associations obtained between the different data reduction methods and adiposity and fitness outcomes were fairly comparable, with both methods finding stronger associations for VPA compared to MVPA. This suggests that future studies maybe able to pool data using different data reduction approaches when examining associations between activity and health risk factors, albeit with caution. Refereed/Peer-reviewed

The authors thank the study participants and collaborators on the individual studies that provided data for this pooled IPD analysis., Objectives To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. Design Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. Participants Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. Main outcome measures Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. Results Interventions modestly improved students’ cardiorespiratory fitness by 0.47 mL/kg/min (95% confidence interval 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. Conclusions Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity, and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Purpose: The aim of this study was to determine the feasibility of generalist school teachers delivering curriculum connected high-intensity interval training in a school’s physical education class time. Method: Two schools volunteered to participate. A total of 84 students (11.9 [0.5] y, M = 64 and F = 19) volunteered to participate. Four classes from 2 schools were randomized to either intervention (n = 53) or control (n = 31) for one school term (8 wk). Intervention class teachers participated in a 1-day workshop instructing them how to deliver twice weekly, high-intensity interval training sessions. The control classes continued with their usual physical education curriculum. Recruitment, intervention fidelity, and program satisfaction were assessed. Preliminary efficacy (primary outcome cardiorespiratory fitness) was quantified using generalized linear mixed models, expressed as effect size. A range of secondary outcomes was also assessed. Results: The recruitment rate was 88%. About 84% of the sessions were delivered. The heart rate peak over all sessions was 89.6% (13%) of the predicted maximum. The intervention teachers reported high levels of satisfaction. Almost all student participants were positive about participating. No adverse events occurred. The adjusted between-group difference for cardiorespiratory fitness was trivial (effect size 0.02). Conclusions: This teacher-delivered high-intensity interval training program was feasible and acceptable to both teachers and student participants. It is therefore potentially scalable.

Process evaluations can help to optimise the implementation of school-based physical activity interventions., The purpose of this paper is to describe the process evaluation of a school-based high-intensity interval training (HIIT) program for older adolescent students, known as Burn 2 Learn (B2L). B2L was evaluated via a cluster randomised controlled trial in 20 secondary schools (10 intervention, 10 control) in New South Wales, Australia., Teachers (n = 22 (55% female)) from the 10 intervention schools, delivered the program over three phases (Phases 1 and 2, 6 months, Phase 3, 6 months) to older adolescent students (n = 337 (50% female), mean &plusmn, standard deviation (SD) age = 16.0 &plusmn, 0.4 years)., Process evaluation data were collected across the 12-month study period. Teachers delivered 2.0 &plusmn, 0.8 and 1.7 &plusmn, 0.6 sessions/week in Phases 1 and 2 respectively (mean total 25.9 &plusmn, 5.2), but only 0.6 &plusmn, 0.7 sessions/week in Phase 3., Observational data showed that session quality was high, however heart rate (HR) data indicated that only half of the students reached the prescribed threshold of &ge, 85% predicted HRmax during sessions., Over 80% of teachers reported they intended to deliver the B2L program to future student cohorts., Almost 70% of students indicated they intended to participate in HIIT in the future., Teachers considered the program to be adaptable, and both students and teachers were satisfied with the intervention., B2L was implemented with moderate-to-high fidelity in Phases 1 and 2, but low in Phase 3., Our findings add to the relatively scant process evaluation literature focused on the delivery of school-based physical activity programs.

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory and respiratory systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. CRF is an important marker of physical and mental health and academic achievement in youth. However, only 40% of US youth are currently believed to have healthy CRF. In this statement, we review the physiological principles that determine CRF, the tools that are available to assess CRF, the modifiable and nonmodifiable factors influencing CRF, the association of CRF with markers of health in otherwise healthy youth, and the temporal trends in CRF both in the United States and internationally. Development of a cost-effective CRF measurement process that could readily be incorporated into office visits and in field settings to screen all youth periodically could help identify those at increased risk.

The feasibility requirements of administering field-based cognitive assessments are rarely reported. We examined the feasibility of administering a group-based cognitive test battery in a school setting with older adolescents. Several types of reliability were also assessed in the control group. Preliminary efficacy and the relationship between changes in fitness and changes in cognitive control were also explored following a 14-week HIIT intervention (3 sessions/week). Participants completed a cognitive test battery measuring inhibition (flanker), and working memory (n-back) at baseline and post-test. Health-related fitness assessments were also conducted. Test administration took approximately 30.8 ± 1.5 minutes to complete with up to six participants simultaneously. The test battery demonstrated acceptable reliability (ICC = 0.5-0.81), with significant changes observed for flanker incongruent accuracy, and 2-back non-target accuracy from baseline to post-test. Regarding efficacy, small-to-moderate effects were observed for accuracy outcomes, while several small associations were found between changes in fitness and changes in cognition. Findings from the current study suggest a cognitive test battery can be administered with older adolescents in a school setting. However, there remains a lack of adequate reporting of administration requirements for field-based cognitive assessments. Efficacy findings should be confirmed with a larger and more representative sample of older adolescents.

This chapter aims to provide an overview of the research literature regarding exercise for children and adolescents. It outlines seminal and contemporary research evidence of the benefits of aerobic, resistance, and flexibility training, as well as recommendations for exercise prescription in this population. The chapter focuses on the ways in which various forms of exercise can be utilized to improve health-related fitness in young people. It also provides detail regarding the application of the principles to aerobic, resistance, and flexibility training, and examine an overview of prior research related to each of the specific forms of exercise conducted with children and adolescents. Children and adolescents have a greater capacity than adults to recover when performing resistance training, and it has been suggested that a 1-minute rest period between sets is sufficient for most youth. There is growing recognition of the importance of structured exercise programs for children and adolescents, which is reflected in national and international physical activity guidelines.

Background ecofit is an evidence-based multi-component physical activity intervention that integrates smartphone technology, the outdoor environment, and social support. In a previous efficacy trial, significant improvements were found across several clinical, fitness, and mental health outcomes among adults at risk of (or with) type 2 diabetes. Methods The aim of the present pilot study was to evaluate a number of patient-centered and feasibility outcomes of the ecofit intervention in a “real-world” setting, using a scalable implementation model. ecofit was adapted and implemented by a rural municipal council in the Upper Hunter Shire, New South Wales, Australia, and evaluated using a single-group pre-post design. Inactive middle-aged and older adults (N=59) were recruited and assessed at 6 (primary time-point) and 20 weeks (follow-up). Results Improvements were found in this predominantly overweight and obese sample for aerobic fitness, functional mobility, upper and lower body muscular fitness, systolic blood pressure, and waist circumference at 6 weeks. At 20 weeks, effects were found for aerobic fitness, functional mobility, upper and lower body muscular fitness, and systolic blood pressure. Overall, participants were satisfied with the ecofit program. Participants attended the 6-week primary time-point (66.1%) and follow-up at 20 weeks (41.6%). Conclusions Our findings support the preliminary effectiveness and feasibility of the ecofit intervention delivered by municipal council staff following a brief training from the research team. This study provides valuable preliminary evidence to support a larger implementation trial.

Background Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. “Risk of generalizability biases (RGB)” in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity. Methods We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes. Results A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of − 0.325 (95CI − 0.556 to − 0.094), − 0.346 (− 0.640 to − 0.052), − 0.342 (− 0.498 to − 0.187), and − 0.360 (− 0.631 to − 0.089), respectively. Conclusions Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.

Physical activity interventions that promote cardiorespiratory (CRF) and muscular fitness (MF) may improve mental health in young adolescents. However, less is known about the links between fitness and mental health in older adolescents, as they are an understudied population. In addition, the association between MF and adolescents' mental health is less clear than it is for CRF. Our primary aim was to investigate whether MF is independently associated with mental health in a sample of older adolescents. Our secondary aim was to determine if the association between fitness and mental health was moderated by sex, socio-economic status (SES) or weight status. Participants were 670 students (16.0 [0.4] years, 44.6% female) from 20 secondary schools in New South Wales, Australia. Mental health (well-being and internalizing problems) was self-reported using the Short Warwick-Edinburgh Mental Wellbeing Scale and the Strengths and Difficulties Questionnaire. We assessed CRF using the Progressive Aerobic Cardiovascular Endurance Run and MF using the push-up and standing long jump tests. After controlling for CRF, MF was not associated with mental health. CRF was associated with well-being (β = 0.20, p < .001) and internalizing problems (β = −0.27, p < .001). The strength of association between CRF and mental health was stronger in girls, than boys. No interaction effects were observed for SES or weight status. Although cross-sectional, our findings provide further evidence of the potential benefits of CRF for adolescents' mental health (i.e., well-being and internalizing problems), particularly girls. However, MF may be less relevant for mental health among this population.

Background Poor diet, alcohol use, and tobacco smoking have been identified as strong determinants of chronic diseases, such as cardiovascular disease, diabetes, and cancer. Smartphones have the potential to provide a real-time, pervasive, unobtrusive, and cost-effective way to measure these health behaviors and deliver instant feedback to users. Despite this, the validity of using smartphones to measure these behaviors is largely unknown. Objective The aim of our review is to identify existing smartphone-based approaches to measure these health behaviors and critically appraise the quality of their measurement properties. Methods We conducted a systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsycINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library databases in March 2020. Articles that were written in English; reported measuring diet, alcohol use, or tobacco use via a smartphone; and reported on at least one measurement property (eg, validity, reliability, and responsiveness) were eligible. The methodological quality of the included studies was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Outcomes were summarized in a narrative synthesis. This systematic review was registered with PROSPERO, identifier CRD42019122242. Results Of 12,261 records, 72 studies describing the measurement properties of smartphone-based approaches to measure diet (48/72, 67%), alcohol use (16/72, 22%), and tobacco use (8/72, 11%) were identified and included in this review. Across the health behaviors, 18 different measurement techniques were used in smartphones. The measurement properties most commonly examined were construct validity, measurement error, and criterion validity. The results varied by behavior and measurement approach, and the methodological quality of the studies varied widely. Most studies investigating the measurement of diet and alcohol received very good or adequate methodological quality ratings, that is, 73% (35/48) and 69% (11/16), respectively, whereas only 13% (1/8) investigating the measurement of tobacco use received a very good or adequate rating. Conclusions This review is the first to provide evidence regarding the different types of smartphone-based approaches currently used to measure key behavioral risk factors for chronic diseases (diet, alcohol use, and tobacco use) and the quality of their measurement properties. A total of 19 measurement techniques were identified, most of which assessed dietary behaviors (48/72, 67%). Some evidence exists to support the reliability and validity of using smartphones to assess these behaviors; however, the results varied by behavior and measurement approach. The methodological quality of the included studies also varied. Overall, more high-quality studies validating smartphone-based approaches against criterion measures are needed. Further research investigating the use of smartphones to assess alcohol and tobacco use and objective measurement approaches is also needed. International Registered Report Identifier (IRRID) RR2-https://doi.org/10.1186/s13643-020-01375-w

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: 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.

The aim of this study is to examine the prevalence and correlates of adolescents' resistance training (RT) skill competence. Participants were 548 adolescents (14.1 ± 0.5 years) from 16 schools in New South Wales, Australia. RT skills were assessed using the Resistance Training Skills Battery. Demographics, BMI, muscular fitness, perceived strength, RT self-efficacy, and motivation for RT were also assessed. The proportion demonstrating "competence" and "near competence" in each of the six RT skills were calculated and sex differences explored. Associations between the combined RT skill score and potential correlates were examined using multi-level linear mixed models. Overall, the prevalence of competence was low (range = 3.3% to 27.9%). Females outperformed males on the squat, lunge and overhead press, whereas males performed better on the push-up (p .05). Significant associations were seen for a number of correlates, which largely differed by sex. Muscular fitness was moderately and positively associated with RT skills among both males (β = 0.34, 95%CIs = 0.23 to 0.46) and females (β = 0.36, 95%CIs = 0.23 to 0.48). Our findings support a link between RT skills and muscular fitness. Other associations were statistically significant but small in magnitude, and should therefore be interpreted cautiously.

Background Slowing the decline in participation in physical activity among adolescent girls is a public health priority. This study reports the outcomes from a multi-component school-based intervention (Girls in Sport), focused on promoting physical activity among adolescent girls. Methods Group randomized controlled trial in 24 secondary schools (12 intervention and 12 control). Assessments were conducted at baseline (2009) and at 18 months post-baseline (2010). The setting was secondary schools in urban, regional and rural areas of New South Wales, Australia. All girls in Grade 8 in 2009 who attended these schools were invited to participate in the study (N = 1769). Using a Health Promoting Schools and Action Learning Frameworks, each school formed a committee and developed an action plan for promoting physical activity among Grade 8 girls. The action plan incorporated strategies in three main areas – i) the formal curriculum, ii) school environment, and iii) home/school/community links – based on the results of formative data from target girls and staff and on individual needs of the school. A member of the research team supported each school throughout the intervention. The main outcome measure was accelerometer-derived total physical activity (TPA) spent in physical activity. Data were analyzed from December 2011 to March 2012. Results 1518 girls (mean age 13.6y ±0.02) were assessed at baseline. There was a significant decline in TPA from baseline to 18-month follow-up with no differences between girls in the intervention and control schools. Only one-third of schools (4/12) implemented the intervention as per their action plan. Per-protocol analyses on these schools revealed a smaller decline in percentage of time spent in MVPA among girls in the intervention group (adjusted difference 0.5%, 95% CI = -0.01, 0.99, P = 0.05). Conclusions The Girls in Sport intervention was not effective in reducing the decline in physical activity among adolescent girls. Lack of implementation by most intervention schools was the main reason for a null effect. Identifying strategies to enhance implementation levels is critical to determining the true potential of this intervention approach. Trial registration This study was retrospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12610001077055. Date of registration: 7 December 2010. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0535-6) contains supplementary material, which is available to authorized users.

Objective Regular participation in resistance training (RT) is critical to health and recommended in most international physical activity guidelines. Few people, however, participate in RT. The purpose of this review was to assess the demographic, behavioural, intrapersonal, interpersonal and environmental factors associated with participating in RT. Data sources Eligible studies were from English peer-reviewed published articles that examined correlates or determinants of RT in adult samples. Searches were performed from August 2015 to April 2016 in six databases. Results We identified 51 independent data sets, from nine countries, primarily of moderate to high quality, and 23 factors related to participating in RT. Education, perceived health status, quality of life, affective judgements, self-efficacy, intention, self-regulation behaviours, subjective norm and programme leadership were associated with RT. Conclusion Low education levels and poor health status were associated with low participation rates in RT. Intrapersonal factors including affective judgements, self-efficacy, and self-regulation behaviours, and interpersonal factors including subjective norms and programme leadership may be important for promoting RT behaviours.

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.

Refereed/Peer-reviewed The directionality of the relationship between children's physical activity and sleep is unclear. This study examined the temporal and bidirectional associations between objectively measured physical activity, energy expenditure, and sleep in primary school-aged children. A subgroup of children (n = 65, aged 8-11 years) from the Fitness, Activity and Skills Testing Study conducted in Melbourne, Australia, had their sleep and physical activity assessed using the SenseWear Pro Armband for 8 consecutive days. Outcome measures included time spent in light-intensity physical activiy (LPA), moderate-to vigorousintensity physical activity (MVPA), activity energy expenditure (AEE), time in bed, total sleep time, and sleep efficiency. Multilevel analyses were conducted using generalized linear latent mixed models to determine whether physical activity on 1 day was associated with sleep outcomes that night, and whether sleep during 1 night was associated with physical activity the following day. No significant associations were observed between time in bed, total sleep time, and sleep efficiency with LPA, MVPA, and AEE in either direction. This study found no temporal or bidirectional associations between objectively measured physical activity, AEE, and sleep. Future research is needed to understand other sleep dimensions that may impact on or be influenced by physical activity to provide potential intervention targets to improve these outcomes. usc

SummaryObjective The aims of this systematic review and meta-analysis are (i) to determine the impact of school-based interventions on objectively measured physical activity among adolescents and (ii) to examine accelerometer methods and decision rule reporting in previous interventions. Methods A systematic search was performed to identify randomized controlled trials targeting adolescents (age: ≥10 years), conducted in the school setting, and reporting objectively measured physical activity. Random effects meta-analyses were conducted to determine the pooled effects of previous interventions on total and moderate-to-vigorous physical activity. Potential moderators of intervention effects were also explored. Results Thirteen articles met the inclusion criteria, and twelve were included in the meta-analysis. The pooled effects were small and non-significant for both total physical activity (standardized mean difference = 0.02 [95% confidence interval = −0.13 to 0.18]) and moderate-to-vigorous physical activity (standardized mean difference = 0.24 [95% confidence interval = −0.08 to 0.56]). Sample age and accelerometer compliance were significant moderators for total physical activity, with a younger sample and higher compliance associated with larger effects. Conclusion Previous school-based physical activity interventions targeting adolescents have been largely unsuccessful, particularly for older adolescents. There is a need for more high-quality research using objective monitoring in this population. Future interventions should comply with best-practice recommendations regarding physical activity monitoring protocols.

Introduction: Regular physical activity can significantly reduce the risk of numerous chronic diseases, and improve bone density and mental health. Yet, only 50% of Australian adults meet the aerobic physical activity guidelines and 9–19% meet the resistance-based physical activity guidelines. The aim of this study is to enhance community-based aerobic and resistance-based physical activity through the use of publicly available outdoor exercise equipment, social support and smartphone technology. Research design and methods: The ecofit intervention will be evaluated using a two-arm randomized controlled trial. A total of 240 adults (aged 18–80) will be recruited and randomly allocated to either the ecofit intervention or a ‘wait-list’ control group. Both groups will have access to the two types of outdoor park exercise equipment, but the intervention group will be given access to the purpose-built ecofit app and a 90-min introductory group training session. To promote social support, participants can enrol in a group of up to four individuals and access the ecofit Facebook group. The ecofit app include workout plans that can be tailored to different locations, difficulty levels and workout-types (i.e., resistance-only or combined resistance and aerobic workouts). Outcome assessments will be conducted at baseline, 3- (primary-end point) and 9-months follow-up. The primary outcomes are upper and lower body muscular fitness. The secondary outcomes include physical activity, body composition, aerobic fitness, body mass index, self-report resistance-based physical activity, and mental health outcomes. The cost-effectiveness of the study will also be evaluated. Discussion: ecofit is an innovative, multi-component physical activity intervention that integrates smartphone technology, social support and the outdoor built environment to promote community-based aerobic and resistance-based physical. The findings will be used to guide future interventions and to support councils to promote community-based physical activity through the use of local outdoor exercise equipment. Trial registration: ACTRN12619000868189. Keywords: Resistance training, Aerobic exercise, Physical activity, Behavioral change

The study aim was to examine the mechanisms of physical activity behaviour change in the multi-component eCoFit randomised controlled trial (RCT) among adults diagnosed with, or at risk of, T2D. The RCT included two phases: phase 1 (weeks 1–10) integrated group sessions (outdoor physical activity and cognitive mentoring) and the use of the eCoFit smartphone application (app), and phase 2 (weeks 11–20), which included the use of the eCoFit smartphone application only. Participants (n = 84) were assessed at baseline and 10 and 20 weeks from baseline. Physical activity was assessed using pedometers, and the following mediators were tested: action self-efficacy, barrier self-efficacy, recovery self-efficacy, implementation intentions, intention to have regular physical activity, outcome expectations, risk perception and implicit associations related to physical activity. The PROCESS INDIRECT Macro was used to perform mediation analyses. Significant mediation pathways were found for implementation intention measured at 10 weeks, AB (95% CI = 486.04 [128.19, 1073.42]). No significant pathways were found for the other social–cognitive and implicit attitudinal mediators. Increased daily steps among the intervention participants were explained by increased implementation intentions. The eCoFit study successfully operationalised implementation intentions in the smartphone app designed to promote outdoor physical activity. The trial was approved by a University Human Research Committee and is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000990527).

Background The implementation of interventions at-scale is required to maximise population health benefits. ‘Physical Activity 4 Everyone (PA4E1)’ was a multi-component school-based program targeting adolescents attending secondary schools in low socio-economic areas. An efficacy trial of the intervention demonstrated an increase in students’ mean minutes of moderate-to-vigorous physical activity (MVPA) per day and lower weight gain at low incremental cost. This study aims to assess the effectiveness and cost effectiveness of a multi-component implementation support intervention to improve implementation, at-scale, of the evidence based school physical activity (PA) practices of the PA4E1 program. Impact on student PA levels and adiposity will also be assessed, in addition to the cost of implementation. Methods A cluster randomised controlled trial, utilising an effectiveness-implementation hybrid design, will be conducted in up to 76 secondary schools located in lower socio-economic areas across four health districts in New South Wales (NSW), Australia. Schools will be randomly allocated to a usual practice control arm or a multi-component implementation support intervention to embed the seven school PA practices of the PA4E1 program. The implementation support intervention incorporates seven strategies including executive support, in-School Champion, teacher training, resources, prompts, audit and feedback and access to an external Support Officer. The primary trial outcome will be the proportion of schools meeting at least four of the seven physical activity practices of the program, assessed via surveys with Head Physical Education teachers at 12 and 24-months. Secondary outcomes will be assessed via a nested evaluation of student PA and adiposity at 12-months (Grade 8 students) and 24 months (Grade 9 students) undertaken in 30 schools (15 per group). Resource use associated with the implementation intervention will be measured prospectively. Linear mixed effects regression models will assess program effects on the primary outcome at each follow-up period. Discussion This study is one of few evidence-based multi-component PA programs scaled-up to a large number of secondary schools and evaluated via randomised controlled trial. The use of implementation science theoretical frameworks to implement the evidence-based program and the rigorous evaluation design are strengths of the study. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12th May 2017. Protocol Version 1. Electronic supplementary material The online version of this article (10.1186/s12889-019-6965-0) contains supplementary material, which is available to authorized users.

Evidence suggests that participation in physical activity may support young people’s current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects. The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2–5 years of age), children (6–11 years of age) and adolescents (12–18 years of age). A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents. A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6–18 years (effect size 0.173, 95% confidence interval 0.106–0.239, p

Background The current and declining physical activity levels of children is a global concern. Integrating physical activity into the school curriculum may be an effective way not only to improve children’s physical activity levels but also enhance educational outcomes. Given the recent national focus in Australia on improving the literacy levels of children in primary school, and an increasing proportion of time spent on explicitly teaching these skills, integrating physical activity into English could be a viable strategy to improve literacy levels and physical activity at the same time. The aim of this study is to evaluate the impact of the ‘Thinking While Moving in English’ (TWM-E) program on children’s physical activity, on-task behavior in the classroom, academic achievement, and executive function. Methods Grade 3–4 children from 10 public schools in New South Wales, Australia will be randomly allocated to intervention (n = 5) or control (n = 5) groups. All teachers will receive 1-day workshop of registered professional learning and a TWM-E equipment pack (e.g., chalk, lettered bean bags). Intervention schools will be asked to adapt their English lessons to embed movement-based learning in their daily program for three 40-min lessons per week, over a six-week period. The primary outcome is children’s physical activity levels across the school day (measured using accelerometry). Secondary outcomes are children’s on-task behavior during English lessons, academic achievement in English, and executive function. A detailed process evaluation will be undertaken including questionnaires, fidelity checks, and teacher and student interviews. Discussion The TWM-E program has the potential to improve primary school children’s physical activity levels, along with academic outcomes (on-task behavior, cognition, and academic achievement), and provide stakeholders with exemplar lessons and guidelines which illustrate how to teach English to children whilst they are moving. Trial registration Australian and New Zealand Clinical trial Register ACTRN12618001009202 Date registered: 15/06/2018 retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-019-6635-2) contains supplementary material, which is available to authorized users.

Background Both high-intensity interval training and moderate-intensity continuous training demonstrate beneficial physiological outcomes for active and insufficiently active populations. However, it remains unclear whether compliance to exercise in supervised settings translates to long-term adherence to physical activity in real-world, unstructured environments. To our knowledge, no comprehensive review is available on compliance and/or adherence rates to either modes of exercise for insufficiently active individuals. Furthermore, it is unclear which training modality insufficiently active individuals comply and/or adhere more readily to. Based on these gaps, the following two questions will be addressed: (1) What are compliance and adherence rates to high-intensity interval training for insufficiently active adults aged 18–65 years and (2) How do compliance and adherence rates differ between high-intensity interval training and moderate-intensity continuous training? Methods Both observational and experimental studies that report on compliance and/or adherence rates to high-intensity interval training will be included. Relevant studies will be retrieved from Medline, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science using a pre-specified search strategy. Pre-defined inclusion and exclusion criteria will be used by two independent researchers to determine eligible studies. Of those meeting the inclusion criteria, data extraction and narrative synthesis will be completed, and where applicable, random-effects meta-analyses will be computed to compare compliance and adherence rates between high-intensity interval training and moderate-intensity continuous training. Meta-regressions and sensitivity analyses will be used to further explore factors that could influence aggregate effect sizes. Risk of bias will be assessed using established tools by the Cochrane association, and quality assessment of the cumulative evidence will be assessed using the GRADE approach. Discussion Results from this study may have the potential to inform future physical activity recommendations and guidelines on the ideal mode of exercise for the general population. This review will add to the body of literature on the feasibility of high-intensity interval training for an insufficiently active population, conclusively addressing the ongoing debate of whether it is an appropriate exercise choice for this demographic. With this new information, individuals working towards a healthier lifestyle through physical activity engagement may be better equipped to make an evidence-based decision. Systematic review registration This review has been registered in the PROSPERO database and assigned the identifier CRD42019103313.

Muscular fitness (MF) is considered a powerful marker of health, but the extent to which common health behaviors are associated with MF during childhood and adolescence is currently unclear. We conducted a systematic review of studies investigating associations between MF (i.e., strength/power, local muscular endurance) and physical activity, sedentary behaviors, and sleep in children and adolescents. A systematic search of six electronic databases was performed on 8 March, 2017. Search results were screened for relevance and studies conducted with children and adolescents (3–18 years) that explored associations between MF and physical activity, sedentary behavior, or sleep were considered eligible. Data were extracted and checked by a second author. The proportion of studies reporting a statistically significant association between each MF component and behavioral variables was calculated, and additional coding was conducted to account for risk of bias. There was consistent evidence for a positive association between MF and physical activity. For both MF components, there was support for objectively measured physical activity, particularly for activity of vigorous intensity. Sports participation was also consistently linked with both MF components, whereas the association with active transport was inconsistent. For both MF components, associations with sedentary behaviors were inconsistent irrespective of measurement method, and the association between MF and sleep was considered uncertain. The available evidence supports a link between MF and physical activity, particularly for vigorous intensity activity and organized sports participation. Conversely, there is limited support for an association with sedentary behaviors, and more research exploring MF and sleep is required.

CONTEXT: Advances in neuroimaging techniques have resulted in an exponential increase in the number of studies investigating the effects of physical activity on brain structure and function. Authors of studies have linked physical activity and fitness with brain regions and networks integral to cognitive function and scholastic performance in children and adolescents but findings have not been synthesized. OBJECTIVE: To conduct a systematic review of studies in which the impact of physical activity on brain structure and function in children and adolescents is examined. DATA SOURCES: Six electronic databases (PubMed, PsychINFO, Scopus, Ovid Medline, SportDiscus, and Embase) were systematically searched for experimental studies published between 2002 and March 1, 2019. STUDY SELECTION: Two reviewers independently screened studies for inclusion according to predetermined criteria. DATA EXTRACTION: Two reviewers independently extracted data for key variables and synthesized findings qualitatively. RESULTS: Nine studies were included (task-based functional MRI [n = 4], diffusion tensor imaging [n = 3], arterial spin labeling [n = 1], and resting-state functional MRI [n = 1]) in which results for 5 distinct and 4 similar study samples aged 8.7 ± 0.6 to 10.2 ± 1.0 years and typically of relatively low socioeconomic status were reported. Effects were reported for 12 regions, including frontal lobe (n = 3), parietal lobe (n = 3), anterior cingulate cortex (n = 2), hippocampus (n = 1), and several white matter tracts and functional networks. LIMITATIONS: Findings need to be interpreted with caution as quantitative syntheses were not possible because of study heterogeneity. CONCLUSIONS: There is evidence from randomized controlled trials that participation in physical activity may modify white matter integrity and activation of regions key to cognitive processes. Additional larger hypothesis-driven studies are needed to replicate findings.

Physical activity (PA) is beneficial to people’s physical and psychological health. Physically active children are likely to become active adults; thus, active lifestyles should be promoted from childhood. Parents are crucial for shaping their children’s behaviors, but many lack the knowledge and skills to provide optimal support for PA. The “Active 1 + FUN” intervention was designed to enhance PA of the whole family, and improve parenting methods of both fathers and mothers. “Active 1 + FUN” is a family-based intervention designed using the tenets of self-determination theory. The intervention was designed to help parents support their children’s basic psychological needs for competence (by providing informational feedback and optimal challenges), autonomy (by exploring a variety of activities and reducing controlling behaviors), and relatedness (by increasing co-PA between parents and child). The intervention components include interactive workshops, activity sessions, physical activity homework, activity planning consultations, easy sports equipment, and online materials. A randomized controlled trial will be conducted to evaluate the intervention. A target sample of 204 Primary three to five students (8 to 11 years) and their parents will be randomly allocated to the experimental group or a wait-list control group. The experimental group will receive a ten-session intervention which spans approximately six months. The control group will receive intervention one year later. Children’s accelerometer-based leisure-time physical activity (primary outcome) and secondary outcomes will be assessed at baseline, at end of intervention period (6 months after baseline), and at follow-up (12 months after baseline). Qualitative interviews will be conducted to determine effective intervention components from the perspective of children and parents. We hypothesize that the intervention will increase parents’ and children’s activity behaviors and that children will experience higher levels of needs satisfaction with regard to physical activity participation. Physical activity interventions often target children only, but ones that also involve parents may be more beneficial. The “Active 1 + FUN” intervention will be organized and delivered by trained trainers. Consequently, this intervention could be scaled to a larger number of Hong Kong schools in the future and could impact a wider population of schoolchildren. ANZCTR ACTRN12618001524280 . Registered 11 September 2018.