Search

Emerging evidence suggests that the accuracy of a child's perceived physical competence (PPC) impacts participation in physical activity. We examined differences in active physical recreation (APR) participation based on clusters of high and low motor competence and perceptions from grades 3-5. Participants were a longitudinal sample ( n = 155; 85 girls) of grade three, four, and five children. Fundamental motor skills (FMSs) were assessed using the TGMD-2, perceptions were assessed using the Self-Perception Profile for Children, and APR was measured using the Children's Assessment of Participation and Enjoyment. K-means cluster analysis was used to create four clusters per grade based on participants' FMSs and PPC z -scores. Differences in FMSs, PPC, and APR with cluster group as a factor were examined using a series of factorial ANOVAs. In each grade, participants in the high-high cluster participated in significantly more APR than those in the low-low cluster ( p = 0.002 in grades three and four; p < 0.001 in grade five). Among the less accurate clusters (e.g., low FMSs with high PPC) was a trend toward positive FMSs growth among the children with higher perceptions. Results show that combinations of FMSs and PPC influence patterns of engagement or disengagement in active physical recreation persistently across middle childhood.

Background: Teachers are recognized as 'key agents' for the delivery of physical activity programs and policies in schools. The aim of our study was to develop and evaluate a tool to assess teachers' capability, opportunity, and motivation to deliver school-based physical activity interventions., Methods: The development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS) involved three phases. In Phase 1, we invited academic experts to participate in a Delphi study to rate, provide recommendations, and achieve consensus on questionnaire items that were based on the Capability, Opportunity, and Motivation Behavior (COM-B) model. Each item was ranked on the degree to which it matched the content of the COM-B model, using a 5-point scale ranging from '1 = Poor match' to '5 = Excellent match'. In Phase 2, we interviewed primary and secondary school teachers using a 'think-aloud' approach to assess their understanding of the items. In Phase 3, teachers (n = 196) completed the COM-PASS to assess structural validity using confirmatory factor analysis (CFA)., Results: Thirty-eight academic experts from 14 countries completed three rounds of the Delphi study. In the first round, items had an average rating score of 4.04, in the second round 4.51, and in the third (final) round 4.78. The final tool included 14 items, which related to the six constructs of the COM-B model: physical capability, psychological capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation. In Phase 2, ten teachers shared their interpretation of COM-PASS via a 20-min interview, which resulted in minor changes. In Phase 3, CFA of the 3-factor model (i.e., capability, opportunity, and motivation) revealed an adequate fit to the data (χ 2  = 122.6, p < .001, CFI = .945, TLI = .924, RMSEA = .066). The internal consistencies of the three subscale scores were acceptable (i.e., capability: α = .75, opportunity: α = .75, motivation: α = .81)., Conclusion: COM-PASS is a valid and reliable tool for assessing teachers' capability, opportunity, and motivation to deliver physical activity interventions in schools. Further studies examining additional psychometric properties of the COM-PASS are warranted., (© 2024. The Author(s).)

Background: Early childhood educators play a critical role in promoting physical activity and reducing sedentary time in childcare centres. However, early childhood educators receive limited specialised pre- and in-service learning opportunities relating to these behaviours and may lack the capacity to effectively engage children in healthy movement behaviours. This study aimed to examine the efficacy of an e-Learning course on increasing early childhood educators' physical activity and sedentary behaviour-related capacities., Methods: A two-group parallel randomized controlled trial was conducted with early childhood educators in Canada (M age = 41.78, 97% female). Participants randomized to the intervention group were asked to complete a physical activity and sedentary behaviour e-Learning course within a 4-week period. Participants randomized to the waitlist control condition were assigned to a waitlist to receive the intervention after the testing period. Participants reported on their self-efficacy, knowledge, intentions, and perceived behavioural control relating to physical activity and sedentary behaviours at baseline, post-intervention, and 3 months follow-up. Linear mixed effects models were estimated to determine difference in changes in outcomes from baseline to post-intervention, and follow-up., Results: A total of 209 early childhood educators participated in the study (intervention n = 98; control n = 111). The TEACH e-Learning course was found to be efficacious at improving all of the examined outcomes, with standardized effect sizes ranging from d = 0.58 to d = 0.65 for self-efficacy outcomes, d = 0.66 to d = 1.20 for knowledge outcomes, d = 0.50 to d = 0.65 for intention outcomes, and d = 0.33 to d = 0.69 for perceived behavioural control outcomes post-intervention. The intervention effects were sustained at follow-up for all outcomes apart from perceived behavioural control to limit screen time. Additionally, the magnitude of the effect for knowledge outcomes decreased at follow-up, with standardized effect sizes ranging from d = 0.49 to d = 0.67., Conclusions: The e-Learning course was highly successful at improving early childhood educators' capacity pertaining to physical activity and sedentary behaviours. Providing training content through e-Learning may be an efficacious approach to providing continual professional learning opportunities relating to physical activity and sedentary time to early childhood educators on a large scale., (© 2024. The Author(s).)

Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.

Background: Governments internationally have invested hugely in the implementation and scale-up of school-based physical activity interventions, but have little evidence of how to best sustain these interventions once active implementation support ceases. This study will assess the effectiveness of a multi-strategy sustainability intervention on classroom teachers' sustainment of energisers (short 3-5 min physical activity breaks during class-time) scheduled across the school day from baseline to 12 and 24-month follow-up., Methods: A cluster randomised controlled trial will be conducted in 50 primary schools within the Hunter New England, Illawarra Shoalhaven, Murrumbidgee and Northern New South Wales (NSW) Local Health Districts of NSW Australia. Schools will be randomly allocated to receive either usual support or the multi-strategy sustainability intervention that includes: centralised technical assistance from a trained project officer; formal commitment and mandated change obtained from school principals; training in-school champions; reminders for teachers; educational materials provided to teachers; capturing and sharing local knowledge; and engagement of parents, carers and the wider school community. The primary trial outcome will be measured via a teacher logbook to determine the between-group difference in the change in mean minutes of energisers scheduled across the school day at 12 and 24-month follow-up compared to baseline. Analyses will be performed using an intention to treat framework. Linear mixed models will be used to assess intervention effects on the primary outcome at both follow-up periods., Discussion: This study will be one of the first randomised controlled trials to examine the impact of a multi-strategy sustainability intervention to support schools' sustainment of a physical activity intervention. The proposed research will generate new evidence needed for the partnering organisations to protect their considerable investments to date in physical activity promotion in this setting and will provide seminal evidence for the field globally., Trial Registration: ACTRN12620000372987 version 1 registered 17 th March 2020. Version 3 (current version) updated 4 th August 2023., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Physically Active Children in Education (PACE) is an effective implementation intervention for increasing the number of minutes classroom teachers schedule physical activity each week. To date, evaluations of PACE have included a smaller number of schools from only one region in New South Wales Australia. If PACE is to have population-wide benefits we must be able to deliver this support to a larger number of schools across multiple regions. This study aimed to evaluate the scale-up of PACE., Methods: An uncontrolled before and after study, with 100 schools from three regions was conducted. Participating schools received PACE for approximately 12 months. We assessed the following outcomes: delivery of the evidence-based intervention (EBI) (i.e. minutes of physical activity scheduled by classroom teachers per week); delivery of the implementation strategies (i.e. reach, dose delivered, adherence and indicators of sustainability); and key determinants of implementation (i.e. acceptability of strategies and cost). Data were collected via project officer records, and principal and teacher surveys. Linear mixed models were used to assess EBI delivery by evaluating the difference in the mean minutes teachers scheduled physical activity per week from baseline to follow-up. Descriptive data were used to assess delivery of the implementation strategies and their perceived acceptability (i.e. PACE). A prospective, trial-based economic evaluation was used to assess cost., Results: Delivery of the EBI was successful: teachers increas their average minutes of total physical activity scheduled across the school week by 26.8 min (95% CI: 21.2, 32.4, p < 0.001) after receiving PACE. Indicators for delivery of implementation strategies were high: 90% of consenting schools received all strategies and components (reach); 100% of strategies were delivered by the provider (dose); >50% of schools adhered to the majority of strategies (11 of the 14 components); and acceptability was > 50% agreement for all strategies. The incremental cost per additional minute of physical activity scheduled per week was $27 per school (Uncertainty Interval $24, $31)., Conclusions: PACE can be successfully delivered across multiple regions and to a large number of schools. Given the ongoing and scalable benefits of PACE, it is important that we continue to extend and improve this program while considering ways to reduce the associated cost., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: In 2016-17, the government of British Columbia (BC) enacted a mandatory policy outlining Active Play Standards (AP Standards) alongside a capacity building initiative (Appetite to Play) focused on implementing policies and practices to support physical activity in childcare centres. We aimed to identify factors at the provider and organizational levels as well as attributes of the Standards hypothesized to influence implementation (i.e., changes in policies and practices)., Methods: We conducted surveys before (2016-2017) and after (2018-2019) enforcement of the AP Standards among 146 group childcare centres across BC. The 2018-19 surveys measured theoretically based constructs associated with implementation of policies and practices (9 childcare- and 8 provider- level characteristics as well as 4 attributes of the licensing standards). Characteristics that were associated in simple regression models were entered in multivariable regression models to identify factors associated with policy and practice changes related to fundamental movement skills (FMS), screen time, total amount of active play (AP) and total amount of outdoor AP from baseline to follow-up., Results: In multivariable analyses, higher staff capacity (OR = 2.1, 95% 1.2, 3.7) and perceived flexibility of the standards (OR: 3.3, 95% 1.5, 7.1) were associated with higher odds of a policy change related to FMS. Higher staff commitment to the AP standards was associated with a higher odds of policy changes related to screen time (OR = 1.6, 95% CI: 1.1, 2.4) and amount of AP (OR: 1.5, 95% 1.0, 2.3). Higher institutionalization of PA policies was associated with a higher odds of policy changes related to the amount of AP (OR: 5.4, 95% CI: 1.5, 20). Higher self-efficacy was associated with a higher odds of policy changes related to outdoor AP (OR = 2.9, 95% 1.1, 7.8). Appetite to Play training was a positively associated with practice changes related to FMS (β = 0.5, 95% CI: 0.1, 0.9)., Conclusions: A hierarchy of theoretically defined factors influenced childcare providers' implementation of the AP Standards in BC. Future research should test the feasibility of modifying these factors to improve the implementation of PA policy and practice interventions in this setting., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: Physical activity (PA), sedentary time (SED), and energy intake (EI) are associated with fat mass accrual in children and youth. Previous studies relied primarily on cross-sectional designs and proxy measures of body composition such as body mass index. We aimed to prospectively investigate associations between PA, SED, EI, and total body fat mass accrual using dual-energy x-ray absorptiometry., Methods: This analysis of the mixed longitudinal Healthy Bones III Study included data from 312 participants (138 boys age 9 to 21 yr at baseline). For each participant, we acquired a maximum of four annual total body dual-energy x-ray absorptiometry scans from which we determined fat mass (in kilograms; n = 748 observations). We assessed total PA, moderate-to-vigorous PA (MVPA) and SED with accelerometers (ActiGraph GT1M) and measured EI via 24-h dietary recall. We fit sex-specific multilevel models adjusting for maturity (years from age at peak height velocity (APHV)), weight status, ethnicity, total PA, MVPA, SED, and EI., Results: Boys and girls demonstrated divergent trajectories of fat mass accrual; rate of fat mass accrual in girls was four times greater than boys at APHV and increased across adolescence, whereas boys' fat mass plateaued after APHV. In boys, within-person change in MVPA negatively predicted fat mass independent of SED; each annual increase in MVPA of 6 min·d -1 was associated with a 0.21-kg lower fat mass. In girls, between-person average MVPA negatively predicted fat mass accrual independent of SED; greater MVPA of 4 min·d -1 across adolescence was associated with a 0.31-kg lower fat mass., Conclusions: MVPA demonstrates an independent and negative effect on fat mass in boys and girls. Given different trajectories of fat mass accrual and movement behaviors between boys and girls, PA interventions aimed at preventing obesity in youth may benefit from a sex and gendered approach., (Copyright © 2022 by the American College of Sports Medicine.)

Background: Physically Active Children in Education (PACE) is composed of eight implementation strategies that improves schools' implementation of a government physical activity policy. A greater understanding of each discrete implementation strategy could inform improvements to PACE for delivery at-scale. This study aimed to: (A) measure the dose delivered, fidelity, adoption and acceptability of each strategy using quantitative data; (B) identify implementation barriers and facilitators using qualitative data; and (C) explore the importance of each strategy by integrating both data sets (mixed methods)., Methods: This study used data from a cluster randomised noninferiority trial comparing PACE with an adapted version (Adapted PACE) that was delivered with reduced in-person external support to reduce costs and increase scalability. Data were collected from both trials arms for between-group comparison. Descriptive statistics were produced using surveys of principals, in-school champions and teachers; and project records maintained by PACE project officers (objective A). Thematic analysis was performed using in-school champion and project officer interviews (objective B). Both data sets were integrated via a triangulation protocol and findings synthesized in the form of meta-inferences (objective C)., Results: Eleven in-school champions and six project officers completed interviews; 33 principals, 51 in-school champions and 260 teachers completed surveys. Regardless of group allocation, implementation indicators were high for at least one component of each strategy: dose delivered =100%, fidelity ≥95%, adoption ≥83%, acceptability ≥50%; and several implementation barriers and facilitators were identified within three broad categories: external policy landscape, inner organizational structure/context of schools, and intervention characteristics and processes. All strategies were considered important as use varied by school, however support from a school executive and in-school champions' interest were suggested as especially important for optimal implementation., Conclusion: This study highlights the importance of both executive support and in-school champions for successful implementation of school physical activity policies. In particular, identifying and supporting an in-school champion to have high power and high interest is recommended for future implementation strategies. This may reduce the need for intensive external support, thus improving intervention scalability., (© 2022. The Author(s).)

Background: Early childhood educators (ECEs) influence young children's early uptake of positive health behaviours in childcare settings and serve as important daytime role models. As such, it is imperative that post-secondary early childhood education programs provide students with the foundational knowledge and professional training required to confidently facilitate quality active play opportunities for young children. The primary objective of the Training pre-service EArly CHildhood educators in physical activity (TEACH) study is to develop and implement an e-Learning course in physical activity and sedentary behaviour to facilitate improvements in: pre-service ECEs' self-efficacy and knowledge to lead physical activity and outdoor play opportunities and minimize sedentary behaviours in childcare. This study will also explore pre-service ECEs' behavioural intention and perceived control to promote physical activity and outdoor play, and minimize sedentary behaviour in childcare, and the implementation of the e-Learning course., Methods/design: A mixed-methods quasi-experimental design with three data collection time points (baseline, post-course completion, 3-month follow-up) will be employed to test the e-Learning course in early childhood education programs ( n = 18; 9 experimental, 9 comparison) across Canada. Pre-service ECEs enrolled in colleges/universities assigned to the experimental group will be required to complete a 4-module e-Learning course, while programs in the comparison group will maintain their typical curriculum. Pre-service ECEs' self-efficacy, knowledge, as well as behavioural intention and perceived behavioural control will be assessed via online surveys and module completion rates will be documented using website metrics. Group differences across timepoints will be assessed using linear mixed effects modelling and common themes will be identified through thematic analysis., Discussion: The TEACH study represents a novel, evidence-informed approach to address the existing gap in physical activity and sedentary behaviour-related education in Canadian post-secondary early childhood education programs. Moreover, e-Learning platforms, can be employed as an innovative, standardized, and scalable way to provide ECEs with consistent training across jurisdictions.

Family-based physical activity (PA) interventions have proven effective in modifying PA; yet, the underlying mechanisms are currently unclear. In this study, we follow-up upon prior trial data that showed changes to child moderate-to-vigorous PA (MVPA) as a result of a family education+planning intervention compared to an education-only condition. We examined parents' perceived family PA frequency, family PA social cognitions, and family PA habit over 26 weeks between the two conditions. One hundred and two parents (of children aged 6 to 12 yrs), were recruited through advertisements and randomized to either the planning + education condition (n = 52) or an education-only condition (n = 50). Self-reported family PA, and measures of theory of planned behaviour, planning intention, and habit were completed by the contact parent at baseline, six-week, 13-week, and 26-week time-periods. The education+planning intervention increased planning intention ( p <.01) and family PA ( p =.06) compared to the© education-only group. The effect of condition on the putative mediators did not explain these changes (all 95% CIs crossed 0), and family PA was associated with child MVPA only at 13 weeks ( p <.01). Intervention 20 assignment had a small indirect effect on family PA (favouring©the education+planning group) via Habit. Perceived behavioural©control and habit were consistent predictors of family PA ( p <.05), but not PA intention or planning intention ( p >.05). The planning+education intervention showed improved family PA and planning intention, yet null mediation results suggest that other variables from the family system (e.g., child motivation, other parent's motivation and plans) are likely needed to fully understand the intervention effects. The promotion of perceived behavioural control and habit to assist in family PA is recommended for future research in this population.

Background:  The aim of this study was to examine the lived experiences of teachers and administrators at two schools (one elementary Kindergarten-Grade 5 and one middle school, grades 6-8) following the 'naturalizing' of a portion of their schoolyard. Methods : A qualitative case study design was used. Focus groups and interviews allowed participants to express their rationale, identify implementation facilitators and barriers and critical processes/steps for realizing their naturalization goals. Researcher questions explored (1) factors which led to naturalizing the schoolyard, (2) key planning and process steps (3) challenges and successes experienced, and, (4) lessons learned. Findings : Six themes were identified as rationale for naturalizing including: re-integration of outdoor play into children's daily lives, pro-active mental health, opportunity for inclusion, nature as a positive space for learning, it fit with our values and principles, we had a need. Implementation was facilitated by having champions and support from multiple levels, adopting a phased approach, resources and having the buy-in to persevere over time. Significant challenges and 'how to' steps were also identified. Conclusions : Naturalizing schoolyards does not happen without a supportive context, significant time and effort. Implementation steps and issues were those commonly found in other school-based health promotion efforts.

Background: Beyond the often examined perceptions of competence and motor skill proficiency, perceived value and children's expectations for success are thought to affect engagement in physical activities. We used parallel mediation models to examine the direct effect of motor skill proficiency on participation in physical activities, as well as whether children's beliefs and value for physical activities mediated this relationship., Methods: The participants in this cross-sectional study were a total of 398 grade 3 children (201 girls) from 8 schools. Motor skills were assessed using the Test of Gross Motor Development-2, the Value Expectancy Questionnaire measured the psychological variables, and the Children's Assessment of Participation and Enjoyment measured physical activities., Results: Motor skill proficiency predicted all 3 psychological constructs for the boys and the girls, and boys' participation in physical activities. However, the psychological variables did not mediate the relationship between motor skills and participation among the boys. For the girls, task value mediated the relationship between motor skills and physical activity participation., Conclusion: It is possible that the girls are further along in their ability to reflect on their competence, successes, and failures; it is also possible that the lower motor skill levels of girls had a deleterious effect on their feelings about participating.

Background: The 'scale-up' of effective physical activity interventions is required if they are to yield improvements in population health. The purpose of this study was to systematically review the effectiveness of community-based physical activity interventions that have been scaled-up. We also sought to explore differences in the effect size of these interventions compared with prior evaluations of their efficacy in more controlled contexts, and describe adaptations that were made to interventions as part of the scale-up process., Methods: We performed a search of empirical research using six electronic databases, hand searched reference lists and contacted field experts. An intervention was considered 'scaled-up' if it had been intentionally delivered on a larger scale (to a greater number of participants, new populations, and/or by means of different delivery systems) than a preceding randomised control trial ('pre-scale') in which a significant intervention effect (p < 0.05) was reported on any measure of physical activity. Effect size differences between pre-scale and scaled up interventions were quantified ([the effect size reported in the scaled-up study / the effect size reported in the pre-scale-up efficacy trial] × 100) to explore any scale-up 'penalties' in intervention effects., Results: We identified 10 eligible studies. Six scaled-up interventions appeared to achieve significant improvement on at least one measure of physical activity. Six studies included measures of physical activity that were common between pre-scale and scaled-up trials enabling the calculation of an effect size difference (and potential scale-up penalty). Differences in effect size ranged from 132 to 25% (median = 58.8%), suggesting that most scaled-up interventions typically achieve less than 60% of their pre-scale effect size. A variety of adaptations were made for scale-up - the most common being mode of delivery., Conclusion: The majority of interventions remained effective when delivered at-scale however their effects were markedly lower than reported in pre-scale trials. Adaptations of interventions were common and may have impacted on the effectiveness of interventions delivered at scale. These outcomes provide valuable insight for researchers and public health practitioners interested in the design and scale-up of physical activity interventions, and contribute to the growing evidence base for delivering health promotion interventions at-scale., Trial Registration: PROSPERO CRD42020144842 .

Purpose: Limited research has measured the effect of physical activity (PA) interventions on health-related quality of life (HRQoL) among pre-school-aged children. This study evaluates the effect of the Activity Begins in Childhood (ABC) cluster-randomized controlled trial designed to increase PA in the ages 3-5 years on HRQoL., Methods: This was a cluster-randomized controlled trial where the intervention group included PA education delivered to daycare providers only, or daycare providers and parents. In the current study, the two PA intervention groups were combined. The comparator group received standard daycare curriculum (COM). A total of 215 children were included (PA n = 161, COM n = 54). Parents completed the proxy Pediatric Quality of Life Inventory Generic Core Scale (PedsQL™ 4.0) to measure HRQoL at baseline and the end of the 6-month trial. HRQoL scores were analyzed as physical, psychosocial, and total domains. Baseline and 6-months measurements were compared for PA and COM groups, and mean changes in scores (95% confidence intervals) were measured using absolute values., Results: No between-group differences were observed for the physical (p = 0.17), psychosocial (p = 0.95) or total scores (p = 0.20). Paired comparisons showed that only the PA group improved psychosocial- (PA mean difference = 2.18 (0.20, 4.15), p = 0.03; COM mean difference = 2.05 (- 1.03, 5.13), p = 0.19) and total-HRQoL scores (PA mean difference = 2.83 (1.83, 3.84), p < 0.001; COM mean difference = 0.19 (- 1.78, 2.16), p = 0.84) after 6 months., Conclusion: Although the within-PA group analysis showed an improvement in psychosocial and total HRQoL scores from baseline, no between-group differences were observed in the HRQoL over time among children aged 3-5 years.

The transition to parenthood is associated with declines in moderate to vigorous physical activity (MVPA) and increases in light PA (LPA). One potential mechanism for this change in PA that occur at the onset of parenthood is housework. We examined housework load and PA levels of three cohorts of couples across 12 months recruited from Victoria, British Columbia, Canada between January 2007 and December 2011. Participants (N = 314; 102 not expecting a child, 136 expecting first-child, 76 expecting second child) completed baseline demographics and 7-day accelerometry, followed by assessments at 6 and 12 months. Hierarchical linear regression assessed the association between PA, housework, and perceptions of partner's workload. New fathers' but not new mothers' housework was positively related to their LPA at 12 months. Perceptions of partners' workload were positively related to new mothers LPA, and negatively related to new fathers MVPA at 12 months. Mediation analysis determined if perceived behavioral control accounts for the relationship between the discrepancy in housework between partners' PA. Results suggest that if a woman perceives their partner to do more housework their own PA increases, whereas for men their PA decreases. These findings highlight the importance of the division of housework on PA for both mothers and fathers.

Objective: To examine older adult physical activity (PA) intervention studies that evaluated implementation and/or scale-up. Research question 1: What implementation and/or scale-up indicators (specific, observable and measurable characteristics that show the progress of implementation) were reported? Research question 2: What implementation and/or scale-up frameworks were reported? Research question 3: Did studies evaluate the relationship between implementation or scale-up of the intervention and individual level health/behaviour outcomes? If yes, how?, Design: Systematic review., Data Sources: Publications from electronic databases and hand searches (2000 to December 2019)., Eligibility Criteria for Selecting Studies: Any PA intervention studies with community-dwelling older adult participants (mean age ≥60 years). Required indicators: (a) Must report amount of PA as an outcome, with validated self-report or objective measures, and (b) Must have reported at least one implementation or scale-up framework and/or one implementation or scale-up indicator., Results: 137 studies were included for research question 1, 11 for question 2 and 22 for question 3. 137 studies reported an implementation indicator: 14 unique indicators. None were specified as indicators for scale-up evaluation. 11 studies were guided by an implementation or scale-up framework. 22 studies described a relationship between an implementation indicator and an individual-level health outcome., Conclusion: There is need for implementation research that extends beyond analysis at the individual level, includes clearly defined indicators and provides a guiding framework to support PA initiatives in older adults. Such implementation studies should evaluate factors in the broader context (eg,political, environmental) that influence scale-up., Prospero Registration: CRD42018091839., Competing Interests: Competing interests: Professor Heather McKay is married to BJSM Editor-in-Chief Karim Khan. Professor Khan was blinded to the submission and the manuscript was handled for the BJSM by Editor Professor Babette Pluim., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

The transition from elementary to secondary school is an emotionally and socially complex time when adverse behaviors appear, such as decreased levels of physical activity (PA). Behavioral and environmental factors that influence PA during this time are poorly understood. Therefore, we aimed to identify factors that influence PA as adolescents transition to secondary school. Qualitative interviews were conducted with a sample of 27 ethnically diverse child-parent dyads within the public-school system in British Columbia, Canada (50% boys, 68% mothers, 25% White). The interviews probed for environmental and behavioral factors in school, family, and social contexts that potentially initiated changes in PA, specifically related to the adolescents' transitions. Interviews were recorded and transcribed verbatim. Thematic analyses identified factors at the individual, social, familial, and school levels that may trigger adolescents to change their participation in PA as they transition from elementary to secondary school. Twenty-two factors emerged from the qualitative analysis including school factors (8), household factors (3), social factors (4), and intrapersonal factors (7). These findings contribute to a better understanding of adolescents' PA behaviors and highlight the influence of changing environments as they transition from elementary school to secondary school.

Background: Physical activity (PA) is critical to early child development, and child care is a key setting for promotion. The authors investigated differences in daily PA and sedentary behavior practices as well as physical environments between family child care (FCC) and group child care (GCC) settings for children aged 3-5 years in Canada., Methods: Group child care (n = 581) and FCC (n = 357) managers completed surveys assessing the implementation of PA promoting practices and description of their environments. Crosstabulation and chi-square tests of association were used to examine differences between GCC and FCC., Results: The prevalence of facilities implementing 120 minutes of active play (odds ratio [OR] 2.23; 95% confidence interval [CI], 1.58-3.15), <30 minutes on screens (OR 1.35; 95% CI, 1.02-1.80), and 60-minute outdoors daily (OR 1.99; 95% CI, 1.4-2.9) was more likely in FCC compared with GCC. However, implementation of fundamental movement skill activities (OR 1.40; 95% CI, 1.01-1.92), breaking up prolonged sitting (OR 1.86; 95% CI, 1.36-2.5), and outdoor space for large group running games (OR 1.74; 95% CI, 1.07-2.83) were more likely in GCC., Conclusions: Child care setting was associated with daily PA and sedentary practices and outdoor space for PA. Interventions to support PA in child care should be tailored to different settings and the facilitators explored.

The purpose of this study was to examine the effect of two family interventions targeting inactive children on their parents' MVPA. Correlates of MVPA across the trial in the form of theory of planned behavior (TPB) and multi-process action control (M-PAC) were examined as exploratory outcomes. Parents (of children aged 6-12 years) were randomized to either a planning + education (n = 52) or an education only condition (n = 50) designed to improve child MVPA. Parental MVPA (accelerometry, self-report) was assessed at baseline, 6-week, 13-week, and 26-week time-periods. Parental MVPA increased from baseline to 26 weeks (p < .05), but there were no group differences. The TPB was unable to predict MVPA and application of M-PAC showed this was because nearly all participants possessed the intention to be active. Successful-compared to unsuccessful-intenders had stronger habit in four of the six tests employed (p < .05). Parent MVPA may benefit during a family-based intervention but the putative mediators of this increase are unclear.Registered trial clinicaltrials.gov #NCT01882192.

Childcare is a critical target for promoting children's physical activity (PA) and physical literacy (PL). With emerging evidence about the efficacy of policy and capacity-building strategies, more information about how to bring these strategies to scale is needed. This paper describes implementation at scale of Appetite to Play (ATP), a capacity-building intervention for childcare providers, and examines the implementation and impact on early years providers' capacity to address PA. The ATP implementation evaluation was a natural experiment that utilized a mixed methods concurrent parallel design framed within the Reach, Effectiveness, Adoption, Implementation, Maintenance framework (RE-AIM). Workshop and website tracking assessed reach and adoption. Surveys and interviews with workshop participants and stakeholders assessed satisfaction, implementation, and maintenance. Training reached 60% of British Columbia municipalities and 2700 early years providers. Significant changes in participants' knowledge and confidence to promote PA and PL were achieved (p >0.01-0.001). Childcare level implementation facilitators as reported by early years providers included appropriate resources, planning, indoor space, and equipment, whereas weather and space were reported barriers. The stakeholder advisory group viewed the stakeholder network and Active Play policy as facilitators and adjustments to recent shifts in childcare funding and previous initiatives as barriers to implementation. ATP was scalable and impacted provider knowledge, confidence, and intentions. The impact on actual policies and practices, and children's PA needs to be assessed along with sustainability., Competing Interests: The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Physical activity (PA) is critical to early childhood health and development, and childcare is a key setting for establishing physically active play. In British Columbia (BC), a provincial standard for active play in childcare was enacted, identified here as the Active Play (AP) standard. Pragmatic constraints limit real-world data collection for evaluating policy impact. We explored whether information about policies, practices, and the environment varied when it was collected from managers or staff. Surveys were distributed to BC childcare centers before AP standard enactment to ascertain current PA and fundamental movement skill policies and practices. The full sample ( n = 1037 from 625 facilities) and a subsample of paired managers and staff ( n = 261 centers) were used to explore agreement across managers and staff in reported prevalence and relationships among indicators. The policy prevalence and relationships for active play and outdoor play variables were relatively similar for manager and staff data, although the matched data had modest agreement and less than optimal intraclass correlations. The prevalence of manager-reported PA policies ranged from 47% for screen-time limits to 77% for fundamental movement skill activities. The manager and staff data highlighted indoor and outdoor space as a primary factor in AP standard adherence. With reliance on sampling staff unfeasible, it appears that the manager data may adequately describe the policies and practices of childcare providers with some notable issues.

Background: Ineffective research-practice translation is a major challenge to population health improvement. This paper presents an international perspective on the barriers and facilitators associated with the uptake of and engagement in Dissemination and Implementation (D&I) research in the fields of physical activity and nutrition., Methods: A mixed methods study involving participants from the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) network. Participants completed an online survey (May-July 2018) and/or participated in a focus group during the annual ISBNPA conference (June 2018). Descriptive statistics were generated for quantitative online and pre-focus group survey data. Fisher's exact tests investigated associations of (i) length of time in academia, (ii) career stage and (iii) country of work, and agreement with 'perceptions of D&I'. Qualitative data were analysed thematically., Results: In total, 141 participants responded to the survey (76% female, 21% aged 35-39 years, 14 countries represented) and 25 participated in focus groups (n = 3). Participants self-identified as having knowledge (48%), skills (53%) and experience supporting others (40%) to conduct D&I research. The majority (96%) perceived D&I was important, with 66% having organizational support for D&I, yet only 52% reported prioritizing D&I research. Perceptions of D&I differed by length of time in academia, career stage and country of work. Barriers included: (i) lack of D&I expertise; (ii) lack of organisational support/value for D&I; (iii) embedded scientific beliefs/culture; (iv) methodological challenges with D&I research; (v) funding/publishing priorities and; (vi) academic performance structures. Facilitators included: (i) increased presence/value of D&I; (ii) collective advocacy; (iii) organisational support for D&I; (iv) recruitment of D&I scientists and; (v) restructure of academic performance models, funding/publishing criteria., Conclusions: Individual, organisational and system-wide factors hindered academics' engagement with and support for D&I research, which was perceived to reduce opportunities for research-practice translation. Factors were mostly consistent across countries and individual career stages/time spent in academia. Embedding D&I early within academic training, and system-wide reorientation of academic performance and funding structures to promote and facilitate D&I research, are some of the necessary actions to reduce the research-practice gap. Consistent with public health more broadly, these changes are long overdue in the fields of physical activity and nutrition.

Background: Globally, many children fail to meet the World Health Organization's physical activity and sedentary behaviour guidelines. Schools are an ideal setting to intervene, yet despite many interventions in this setting, success when delivered under real-world conditions or at scale is limited. This systematic review aims to i) identify which implementation models are used in school-based physical activity effectiveness, dissemination, and/or implementation trials, and ii) identify factors associated with the adoption, implementation and sustainability of school-based physical activity interventions in real-world settings., Methods: The review followed PRISMA guidelines and included a systematic search of seven databases from January 1st, 2000 to July 31st, 2018: MEDLINE, EMBASE, CINAHL, SPORTDiscus, PsycINFO, CENTRAL, and ERIC. A forward citation search of included studies using Google Scholar was performed on the 21st of January 2019 including articles published until the end of 2018. Study inclusion criteria: (i) a primary outcome to increase physical activity and/or decrease sedentary behaviour among school-aged children and/or adolescents; (ii) intervention delivery within school settings, (iii) use of implementation models to plan or interpret study results; and (iv) interventions delivered under real-world conditions., Exclusion Criteria: (i) efficacy trials; (ii) studies applying or testing school-based physical activity policies, and; (iii) studies targeting special schools or pre-school and/or kindergarten aged children., Results: 27 papers comprising 17 unique interventions were included. Fourteen implementation models (e.g., RE-AIM, Rogers' Diffusion of Innovations, Precede Proceed model), were applied across 27 papers. Implementation models were mostly used to interpret results (n = 9), for planning evaluation and interpreting results (n = 8), for planning evaluation (n = 6), for intervention design (n = 4), or for a combination of designing the intervention and interpreting results (n = 3). We identified 269 factors related to barriers (n = 93) and facilitators (n = 176) for the adoption (n = 7 studies), implementation (n = 14 studies) and sustainability (n = 7 studies) of interventions., Conclusions: Implementation model use was predominately centered on the interpretation of results and analyses, with few examples of use across all study phases as a planning tool and to understand results. This lack of implementation models applied may explain the limited success of interventions when delivered under real-world conditions or at scale., Trial Registration: PROSPERO (CRD42018099836).

Background: Interventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (> 60) that guide design and evaluation of implementation and scale-up processes. Therefore, we sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. We also sought to recommend a minimum data set of implementation outcome and determinant variables (indicators) as well as measures and tools deemed most relevant for PA and nutrition researchers., Methods: We adopted a five-round modified Delphi methodology. For rounds 1, 2, and 3 we administered online surveys to PA and nutrition implementation scientists to generate a rank order list of most commonly used; i) implementation and scale-up frameworks, ii) implementation indicators, and iii) implementation and scale-up measures and tools. Measures and tools were excluded after round 2 as input from participants was very limited. For rounds 4 and 5, we conducted two in-person meetings with an expert group to create a shortlist of implementation and scale-up frameworks, identify a minimum data set of indicators and to discuss application and relevance of frameworks and indicators to the field of PA and nutrition., Results: The two most commonly referenced implementation frameworks were the Framework for Effective Implementation and the Consolidated Framework for Implementation Research. We provide the 25 most highly ranked implementation indicators reported by those who participated in rounds 1-3 of the survey. From these, the expert group created a recommended minimum data set of implementation determinants (n = 10) and implementation outcomes (n = 5) and reconciled differences in commonly used terms and definitions., Conclusions: Researchers are confronted with myriad options when conducting implementation and scale-up evaluations. Thus, we identified and prioritized a list of frameworks and a minimum data set of indicators that have potential to improve the quality and consistency of evaluating implementation and scale-up of PA and nutrition interventions. Advancing our science is predicated upon increased efforts to develop a common 'language' and adaptable measures and tools.

Introduction: Family-based behavioural weight management interventions are efficacious and widely used to address childhood obesity. Curriculum and strategies vary extensively and scale-up often depends on ensuring that the intervention fits the adoption context., Aims and Objectives: To evaluate the impact and implementation of a 'made in British Columbia' (BC) family-based early intervention programme (EIP) for 8-12 years old with overweight and obesity and their families., Methods and Analysis: A randomised waitlist-control trial will assess a 10-week interactive, family-based lifestyle intervention followed by four maintenance sessions, in BC, Canada. We aim to enrol 186 families. The blended intervention includes at least 26 contact hours between participants and programme providers, including interactive activities and educational materials through weekly 90-min group sessions, an online family portal, and self-directed family activities. Curricular content includes information and activities related to healthy eating, physical activity (PA), positive mental health, parenting practices and sleep hygiene. The waitlist control group will receive a modified programme with the same 10-week sessions in the family portal, and four group sessions. Families participate in data collection at baseline, postintervention (week 10) and follow-up (week 18). The primary outcome is to assess changes in child body mass index z-score at 10 weeks between the groups. Secondary outcomes include changes at 10 weeks between the groups in child and parent PA behaviour and skills, healthy eating behaviour, and mental health. Process evaluation will address reach, implementation and maintenance (baseline, 10-week and 18-week) using recruitment tracking forms, parent questionnaire, programme attendance tracking forms, leader feedback surveys, parents and children satisfaction surveys and postprogramme interviews with facilitators, stakeholders and parents. Intention-to-treat analyses will be conducted. Process evaluation will be analysed thematically., Ethics and Dissemination: Study procedures were designed to address research and community needs and will follow ethical standards., Trial Registration Number: NCT03643341., Competing Interests: Competing interests: P-JN is on the Board of Childhood Obesity Foundation and had course release to oversee the implementation of the evaluation of the EIP. P-JN reports grants from Childhood Obesity Foundation, during the conduct of the study. KS, GM, TS, JW and MAP report personal fees from Childhood Obesity Foundation, during the conduct of the study., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Regular moderate-to-vigorous physical activity and high physical fitness are extremely important to the health of children and track to positive health profiles in adulthood. Family-based interventions to improve moderate-to-vigorous physical activity are essential given that children live within a structure of parental influence. The purpose of this study was to examine the effect of a parent planning skills intervention to support child physical activity on the subsequent moderate-to-vigorous physical activity (primary outcome) and fitness of their children across 26 weeks (primary endpoint)., Study Design: Two-arm randomized trial with physical activity assessment at baseline 6 weeks, 13 weeks, and 26 weeks and fitness and BMI tests at baseline and 26 weeks from 2012 and 2017., Setting/participants: One hundred and two children (aged 6-12 years) who were below international physical activity recommendations at baseline were recruited through advertisements., Intervention: Participants received a planning plus education intervention (n=52) or an education-only intervention (n=50)., Main Outcome Measures: Moderate-to-vigorous physical activity was assessed via accelerometry and fitness tests included aerobic fitness, muscular strength, flexibility. BMI was calculated by objectively assessed height and weight., Results: Generalized linear mixed modeling conducted in 2019 showed that the patterns varied by condition over time (β=-0.05, p<0.05), where children in the planning intervention significantly increased moderate-to-vigorous physical activity compared with the education condition at 6 weeks and 13 weeks but not at 26 weeks. Aerobic fitness (p=0.04, d=0.26) was the only significant health-related physical fitness change between the two groups and favored the planning group over the education group., Conclusions: There was initial efficacy of the planning intervention, but effectiveness waned by 26 weeks. These changes appeared to be sufficient for modest changes in aerobic fitness. Future research should aim to improve the maintenance of these early positive changes and assist parents in planning for activities that also include opportunities to improve child musculoskeletal fitness., Trial Registration: This study is registered at www.clinicaltrials.gov NCT01882192., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: In an attempt to improve children's physical activity levels governments have introduced policies specifying the minimum time schools are to schedule physical activity each week. Despite this, the majority of schools in many jurisdictions fail to implement these policies. This study will assess the effectiveness of a multi-component implementation strategy on increasing the minutes of planned physical activity scheduled by primary school teachers each week., Methods: A cluster randomised controlled trial will be conducted in 62 primary schools in the Hunter New England region of New South Wales, Australia. Schools will be randomly allocated to receive either a multi-component implementation strategy that includes; obtaining executive support, training in-school champions, provision of tools and resources, implementation prompts, reminders and feedback; or usual practice. The study will employ an effectiveness-implementation hybrid design, assessing both policy implementation and individual (student) behavioural outcomes. The primary trial outcome of mean minutes of physical activity scheduled by classroom teachers across the school week will be measured via teacher log-book at baseline and approximately 12 and 18 months post baseline. A nested evaluation of the impact of policy implementation on child physical activity will be undertaken of students in Grades 2 and 3. Analyses will be performed using an intention to treat framework. Linear mixed effects regression models will be used to assess intervention effects on the primary outcome at both follow-up periods., Discussion: This study will be the one of the first well powered randomised trials internationally to examine the impact of an implementation strategy for a physical activity policy in primary schools and will address a fundamental research translation gap. Given the dearth of research, the findings will be important in informing future implementation efforts in this setting., Trial Registration: ANZCTR ACTRN12617001265369 version 1 registered 1st September 2017.

Background: Early childhood educators greatly influence young children's physical activity and screen-viewing behaviours in childcare. However, educators have requested additional training in physical activity programming, and one logical place to provide this education is during their pre-service schooling. This study explored the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education (ECE) candidates across Canada, to determine their confidence and ability to facilitate physical activity opportunities and limit screen-viewing among young children in childcare., Methods: Key program personnel at 61 (of 110) Canadian colleges/universities offering an ECE program agreed to participate in this cross-sectional study. An online survey (112 items; 9 domains), developed by experts using the Tailored Design Method, was administered via Qualtrics© to a sample of 1292 ECE candidates. Descriptive statistics, Mann-Whitney U-tests, and chi-square tests were used to report participant demographics and physical activity and screen-viewing-related knowledge (i.e., of physical activity and screen-viewing concepts), training (i.e., physical activity and screen-viewing courses/content received), and self-efficacy (i.e., to facilitate physical activity and limit screen-viewing in childcare) of candidates., Results: ECE candidates exhibited the least amount of knowledge regarding the impact of screen-viewing on physiological outcomes (i.e., blood pressure) in young children. Further, only 32.2 and 26.7% of candidates reported completing physical activity or screen-viewing courses during their post-secondary training, respectively. Candidates who completed one or more physical activity or screen-viewing courses exhibited significantly greater (p <.05) self-efficacy than those without such training related to ensuring children were engaging in adequate moderate-to-vigorous physical activity (MVPA). Confidence to limit screen time did not differ. Candidates reporting meeting national physical activity recommendations (i.e., 150+ minutes of MVPA/week) exhibited significantly greater (p <.05) physical activity-related self-efficacy than those not meeting these guidelines., Conclusions: Findings from this work highlight both the need for and the potential of supplementary physical activity and screen-viewing content in post-secondary ECE programs to benefit candidates' knowledge and self-efficacy in these areas. Introducing this content at the post-secondary level will ensure that all early childhood educators are appropriately trained regarding physical activity and screen-viewing before entering a childcare-based profession, where they can positively influence young children's health behaviours.

Objectives: To assess the effect of a physical activity intervention delivered in the childcare centres (CC), with or without a parent-driven home physical activity component, on children's fundamental motor skills (FMS)., Design: Six-month 3-arm cluster randomized controlled trial., Methods: Preschoolers were recruited from 18 licensed CC. CC were randomly assigned to a typical curriculum comparison group (COM), childcare intervention alone (CC), or childcare intervention with parental component (CC+HOME). FMS was measured with the Test of Gross Motor Development-2. Linear mixed models were performed at the level of the individual while accounting for clustering., Results: Raw locomotor skills score increased significantly in the CC group (mean difference=2.5 units, 95% Confidence Intervals, CI, 1.0-4.1, p<0.001) and the CC+HOME group (mean difference=2.4 units, 95% CI, 0.8-4.0, p<0.001) compared to the COM group. No significant (p>0.05) between group differences were observed in the raw object control skills, sum of raw scores, or gross motor quotient. No significant sex differences were found in any of the measured outcomes., Conclusions: A physical activity intervention delivered in childcare with or without parents' involvement was effective in increasing locomotor skills in preschoolers., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate the effect of a preschool physical activity intervention program delivered in licensed childcare settings, with or without a parent-facilitated home component, on children's daily physical activity, sedentary time, and body composition., Study Design: For this cluster randomized controlled trial, 18 childcare centers were randomly allocated in equal numbers to the typical curriculum comparison group, childcare intervention alone (CC), or childcare intervention with parental involvement. Accelerometers were used to asses physical activity and sedentary time, and body composition was measured by bioelectrical impedance., Results: Linear mixed model regression analyses showed no differences between the CC, the childcare intervention with parental involvement, and the comparison groups in changes from baseline to 6 months in total physical activity (P for time × group interaction = .665) or moderate-to-vigorous physical activity (P for time × group interaction = .164) when adjusted for baseline physical activity levels. Furthermore, no group differences were found for changes in light physical activity, sedentary time, or anthropometric variables., Conclusions: An affordable and easily scalable preschool intervention program delivered in licensed childcare settings, with or without the addition of a parent-driven home physical activity promotion, seems to have no significant effect on physical activity, sedentary time, or body composition., Trial Registration: ISRCTN: ISRCTN94022291., (Copyright © 2017 Elsevier Inc. All rights reserved.)

From 4 to 7 April 2016, 24 researchers from 8 countries and from a variety of academic disciplines gathered in Snekkersten, Denmark, to reach evidence-based consensus about physical activity in children and youth, that is, individuals between 6 and 18 years. Physical activity is an overarching term that consists of many structured and unstructured forms within school and out-of-school-time contexts, including organised sport, physical education, outdoor recreation, motor skill development programmes, recess, and active transportation such as biking and walking. This consensus statement presents the accord on the effects of physical activity on children's and youth's fitness, health, cognitive functioning, engagement, motivation, psychological well-being and social inclusion, as well as presenting educational and physical activity implementation strategies. The consensus was obtained through an iterative process that began with presentation of the state-of-the art in each domain followed by plenary and group discussions. Ultimately, Consensus Conference participants reached agreement on the 21-item consensus statement., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Introduction: This study evaluated whether intervening with child care providers would increase physical activity (PA) and reduce adiposity in preschoolers., Methods: This was a two-arm, parallel group, cluster RCT whereby six child care centers were randomly assigned in equal numbers to intervention (n=40 children) or control (n=43 children). Participants were aged 3-5 years and attended licensed child care centers. Child care providers received two 3-hour train-the-trainer workshops and a training manual at program initiation aimed at increasing structured and unstructured PA through active play. Control child care centers implemented their standard curriculum. PA and sedentary behavior were measured by accelerometry, and body composition was measured using bioelectrical impedance at baseline and 6 months. Data were collected in 2011-2012 and analyzed in April 2015., Results: Linear mixed-effects modeling showed that at 6 months, children in the intervention group demonstrated greater increases in minutes per preschool day spent in overall PA (22.5 minutes, 95% CI=8.9, 36.1, p=0.002), and light-intensity PA (16.1 minutes, 95% CI=5.2, 26.7, p=0.004), but changes between groups in moderate to vigorous PA did not differ. The intervention group showed greater reductions in body fat percentage (-1.9%, 95% CI=-3.5, -0.3, p=0.023) and fat mass (-0.3 kg, 95% CI=-0.7, -0.1, p=0.018), but groups did not differ on fat-free mass, BMI, or z-BMI., Conclusions: Provider-led intervention in child care centers increased preschoolers' PA and reduced adiposity, therefore may represent a viable approach to promoting PA and related health benefits in preschool-aged children., Trial Registration: This study is registered at www.clinicaltrials.gov NCT02293278., (Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Knowing that motor skills will not develop to their full potential without opportunities to practice in environments that are stimulating and supportive, we evaluated the effect of a physical activity (PA)-based intervention targeting childcare providers on fundamental movement skills (FMS) in preschoolers attending childcare centers., Methods: In this two-arm cluster-randomized controlled trial, six licensed childcare centers in Ottawa, Canada, were randomly allocated into one of two groups (three controls, n = 43; three interventions, n = 40). Participants were between the ages of 3 and 5 yr. Childcare providers in the experimental condition received two 3-h workshops and a training manual at program initiation aimed at increasing PA through active play and several in-center "booster" sessions throughout the 6-month intervention. Control childcare centers implemented their standard curriculum. FMS were measured at baseline and 6 months using the Test of Gross Motor Development-2., Results: Groups did not differ on sociodemographic variables. Compared with control, children in the intervention group demonstrated significantly greater improvement in their standardized gross motor quotient (score, 5.70; 95% confidence interval [95% CI], 0.74-10.67; P = 0.025 and gross motor quotient percentile, 13.33; 95% CI, 2.17-24.49; P = 0.020). Over the 6-month study period, the intervention group showed a significantly greater increase in locomotor skills score (1.20; 95% CI, 0.18-2.22; P = 0.022) than the control group. There was a significant decrease in the object control scores in the control group over the study period., Conclusions: A childcare provider-led PA-based intervention increased the FMS in preschoolers, driven by the change in locomotor skills. The childcare environment may represent a viable public health approach for promoting motor skill development to support future engagement in PA.

Purpose: Patterns of physical activity (PA) and sedentary time, including volume of bouted activity, are important health indicators. However, the effect of accelerometer epoch length on measurement of these patterns and associations with health outcomes in children remain unknown., Method: We measured activity patterns in 308 children (52% girls, age range = 8-11 years) using ActiGraph GT1M accelerometers with 15-s epochs and reintegrated to 60-s epochs. We calculated the volume (minutes per day) of moderate-to-vigorous PA (MVPA), sedentary time, light, moderate, and vigorous PA, as well as bouted MVPA and sedentary time (0-5 min, 5-10 min, 10-20 min, and > 20 min)., Results: The difference between 15-s and 60-s epochs was statistically significant for all outcomes; however, effect sizes were small or negligible in 30% of comparisons. Bias ranged from 1.9 min/day (total MVPA) to 102.7 min/day (0-5 min sedentary bouts). Regression-based estimates of bias and 95% limits of agreement illustrated that the magnitude, and in some cases, the direction, of between-epoch differences varied with activity level. Correlations with body mass index and cardiovascular fitness were similar for 15-s (r = -.19 to .20) and 60-s (r = -.16 to .29) epochs. Estimated 15-s data (predicted from 60-s) were similar to measured data and had similar relationships with health outcomes., Conclusion: Epoch length influences measurement of PA and sedentary patterns and the effect is modified by activity level. However, associations with health outcomes were similar and epoch differences can be adjusted. Future research should clarify the accuracy of different epoch lengths for measuring bouted activity and evaluate whether epoch length alters relationships with additional health outcomes.

Background: Physical activity is associated with the reduction of several chronic conditions in adults. Additionally, physical activity is extremely important for children for their development and cognitive functioning and also to create a physically active lifestyle that continues into adulthood. Despite the known benefits of physical activity, only one in five adults are achieving the public health recommendations of 150 minutes of moderate-to-vigorous physical activity per week and only 13 % of boys and 6 % of girls between the ages of 5 and 17 years are meeting the guidelines of 60 minutes per day. This study aims to evaluate whether a planning condition improves adherence to regular physical activity compared to an education-only control condition among families. Families are eligible if there is at least one child between the ages of 6 and 12 years who is not meeting the Canadian Physical Activity Guidelines., Methods/design: A six-month longitudinal randomized controlled trial will be used to compare the two conditions. Materials will be delivered at baseline with 'booster' sessions at six weeks and three months. Participants will be assessed at baseline and at six months with a fitness test, as well as questionnaires and accelerometery at baseline, six weeks, three months and six months. A total of 137 families have been recruited thus far from Greater Victoria. This study is ongoing and recruitment will continue until December 2015 with the target goal of reaching 160 families., Discussion: This protocol describes the implementation of a randomized controlled trial that utilizes planning strategies to try and increase physical activity among families. Research findings could be useful in public health in providing effective strategies to families to help decrease sedentary lifestyles. Additionally, findings may help to inform future interventions aimed at increasing physical activity among families., Trial Registration: This trial was registered on June 5, 2012 with the Clinical Trials Registry maintained by the National Library of Medicine at the National Institutes of Health. The registration ID is NCT01882192.

Background: Perceptions of competence mediate the relationship between motor skill proficiency and physical activity among older children and adolescents. This study examined kindergarten children's perceptions of physical competence as a mediator of the relationship between motor skill proficiency as a predictor variable and physical activity levels as the outcome variable; and also with physical activity as a predictor and motor skill proficiency as the outcome., Methods: Participants were 116 children (mean age = 5 years 7 months, 58% boys) from 10 schools. Motor skills were measured using the Test of Gross Motor Development-2 and physical activity was monitored through accelerometry. Perceptions of physical competence were measured using The Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, and the relationships between these variables were examined using a model of mediation., Results: The direct path between object control skills and moderate-vigorous physical activity (MVPA) was significant and object control skills predicted perceived physical competence. However, perceived competence did not mediate the relationship between object control skills and MVPA., Conclusion: The significant relationship between motor proficiency and perceptions of competence did not in turn influence kindergarten children's participation in physical activity. These findings support concepts of developmental differences in the structure of the self-perception system.

Objective: Implementation science is an emerging area in physical activity (PA) research. We sought to establish the current state of the evidence related to implementation of school-based PA models to explore 1) the relationship between implementation and health outcomes, and 2) factors that influence implementation., Methods: We searched 7 electronic databases (1995-2014) and included controlled studies of school-based PA programmes for healthy youth (6-18 y) measuring at least one physical health-related outcome. For objective 1, studies linked implementation level to student-level health outcome(s). For objective 2, studies reported factors associated with implementation., Results: There was substantial variability in how health outcomes and implementation were assessed. Few studies linked implementation and health outcomes (n=15 interventions). Most (11/15) reported a positive relationship between implementation and at least one health outcome. Implementation factors were reported in 29 interventions. Of 22 unique categories, time was the most prevalent influencing factor followed by resource availability/quality and supportive school climate., Conclusions: Implementation evaluation supports scale-up of effective school-based PA interventions and thus population-level change. Our review serves as a call to action to 1) address the link between implementation and outcome within the school-based PA literature and 2) improve and standardize definitions and measurement of implementation., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To describe Action Schools! BC (AS! BC) from efficacy to scale-up., Participants/setting: Education and health system stakeholders and children in grades 4-6 from elementary schools in British Columbia, Canada., Intervention: At the provincial level, the AS! BC model reflected socioecological theory and a partnership approach to social change. Knowledge translation and exchange were embedded as a foundational element. At the school level, AS! BC is a comprehensive school health-based model providing teachers and schools with training and resources to integrate physical activity (PA) and healthy eating (HE) into the school environment. Our research team partnered with key community and government stakeholders to deliver and evaluate AS! BC over efficacy, effectiveness and implementation trials., Results: On the basis of significant increases in PA, cardiovascular fitness, bone and HE in AS! BC schools during efficacy trials, the BC government supported a provincial scale-up. Since its inception, the AS! BC Support Team and >225 trained regional trainers have delivered 4677 teacher-focused workshops (training approximately 81,000 teachers), reaching approximately 500,000 students. After scale-up, PA delivery was replicated but the magnitude of change appeared less. One (HE) and 4 (PA) years after scale-up, trained AS! BC teachers provided more PA and HE opportunities for students even in the context of supportive provincial policies., Conclusions: Whole school models like AS! BC can enhance children's PA and health when implemented in partnership with key stakeholders. At the school level, adequately trained and resourced teachers and supportive school policies promoted successful scale-up and sustained implementation. At the provincial level, multisectoral partnerships and embedded knowledge exchange mechanisms influenced the context for action at the provincial and school level, and were core elements of successful implementation., Trial Registration Number: Clinical Trials Registry NCT01412203., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Today's children are more overweight than previous generations and physical inactivity is a contributing factor. Modelling and promoting positive behaviour in the early years is imperative for the development of lifelong health habits. The social and physical environments where children spend their time have a powerful influence on behaviour. Since the majority of preschool children spend time in care outside of the home, this provides an ideal setting to examine the ability of an intervention to enhance movement skills and modify physical activity behaviour. This study aims to evaluate the efficacy of the Activity Begins in Childhood (ABC) intervention delivered in licensed daycare settings alone or in combination with a parent-driven home physical activity-promotion component to increase preschoolers' overall physical activity levels and, specifically, the time spent in moderate to vigorous physical activity., Methods/design: This study is a single site, three-arm, cluster-randomized controlled trial design with a daycare centre as the unit of measurement (clusters). All daycare centres in the National Capital region that serve children between the ages of 3 and 5, expressing an interest in receiving the ABC intervention will be invited to participate. Those who agree will be randomly assigned to one of three groups: i) ABC program delivered at a daycare centre only, ii) ABC program delivered at daycare with a home/parental education component, or iii) regular daycare curriculum. This study will recruit 18 daycare centres, 6 in each of the three groups. The intervention will last approximately 6 months, with baseline assessment prior to ABC implementation and follow-up assessments at 3 and 6 months., Discussion: Physical activity is an acknowledged component of a healthy lifestyle and childhood experiences as it has an important impact on lifelong behaviour and health. Opportunities for physical activity and motor development in early childhood may, over the lifespan, influence the maintenance of a healthy body weight and reduce cardiovascular disease risk. If successful, the ABC program may be implemented in daycare centres as an effective way of increasing healthy activity behaviours of preschoolers., Trial Registration: Current Controlled Trials: ISRCTN94022291. Registered in December 2012, first cluster randomized in April 2013.

The health benefits of regular moderate-vigorous intensity physical activity (MVPA) are well established, yet young adults, particularly parents, often show declines in MVPA and may represent a critical population for intervention. Theory-based correlates used to guide future interventions are scant in this population. The purpose of this study was to examine theory of planned behaviour (TPB) belief-level constructs as correlates of directly assessed MVPA across cohorts of couples without children and with their first child over the initial 12 months. Participants were 238 adults (102 not expecting a child, 136 expecting first child) who completed baseline demographics, belief measures of the TPB and seven-day accelerometry, followed by assessments at 6 and 12 months. Results showed select medium-sized belief-PA correlations with sex and cohort interactions. Overall, women had larger affect-based behavioural belief associations with MVPA than men (e.g. PA relieves stress), and among new parents, mothers showed larger associations with control over MVPA than fathers. Mothers also had larger associations between control beliefs and MVPA compared to women without children (e.g. domestic duties, bad weather). Extremely high means and low variability on the behavioural beliefs show limited room for possible changes in intervention while control beliefs had low means suggesting room for change. Interventions targeting control among new mothers may be paramount for increasing MVPA, yet the TPB yielded less insight into the targets for promoting MVPA among young men.

Purpose: Public policies targeting the school setting are increasingly being used to address childhood obesity; however, their effectiveness depends on their implementation. This study explores the factors which impeded or facilitated the implementation of publicly mandated school-based physical activity and nutrition guidelines in the province of British Columbia (BC), Canada., Methods: Semi-structured interviews were conducted with 50 school informants (17 principals - 33 teacher/school informants) to examine the factors associated with the implementation of the mandated Daily Physical Activity (DPA) and Food and Beverage Sales in Schools (FBSS) guidelines. Coding used a constructivist grounded theory approach. The first five transcripts and every fifth transcript thereafter were coded by two independent coders with discrepancies reconciled by a third coder. Data was coded and analysed in the NVivo 9 software. Concept maps were developed and current theoretical perspectives were integrated in the later stages of analysis., Results: The Diffusion of Innovations Model provided an organizing framework to present emergent themes. With the exception of triability (not relevant in the context of mandated guidelines/policies), the key attributes of the Diffusion of Innovations Model (relative advantage, compatibility, complexity, and observability) provided a robust framework for understanding themes associated with implementation of mandated guidelines. Specifically, implementation of the DPA and FBSS guidelines was facilitated by perceptions that they: were relatively advantageous compared to status quo; were compatible with school mandates and teaching philosophies; had observable positive impacts and impeded when perceived as complex to understand and implement. In addition, a number of contextual factors including availability of resources facilitated implementation., Conclusions: The enactment of mandated policies/guidelines for schools is considered an essential step in improving physical activity and healthy eating. However, policy makers need to: monitor whether schools are able to implement the guidelines, support schools struggling with implementation, and document the impact of the guidelines on students' behaviors. To facilitate the implementation of mandated guidelines/policies, the Diffusion of Innovations Model provides an organizational framework for planning interventions. Changing the school environment is a process which cannot be undertaken solely by passive means as we know that such approaches have not resulted in adequate implementation.

Background: Due to physiological and cognitive changes that occur with aging, accurate physical activity (PA) measurement in older adults represents a unique challenge. The primary purpose of this study was to systematically review measures of PA and their use and appropriateness with older adults. A secondary aim was to determine the level of agreement between PA measures in older adults., Methods: Literature was identified through electronic databases. Studies were eligible if they examined the correlation and/or agreement between at least 2 measures, either indirect and/or direct, of PA in older adults (> 65 years of age)., Results: Thirty-six studies met eligibility criteria. The indirect and direct measures of PA across the studies differed widely in their ability to address the key dimensions (i.e., frequency, intensity, time, type) of PA in older adults. The average correlation between indirect and direct measures was moderate (r=0.38). The correlation between indirect and other indirect measures (r=0.29) was weak, while correlations between direct measures with other direct measures were high (real world: r= 0.84; controlled settings: r=0.92). Agreement was strongest between direct PA measures with other direct measures in both real world and laboratory settings. While a clear trend regarding the agreement for mean differences between other PA measures (i.e., direct with indirect, indirect with indirect) did not emerge, there were only a limited number of studies that reported comparable units., Conclusions: Despite the lack of a clear trend regarding the agreement between PA measures in older adults, the findings underscore the importance of valid, accurate and reliable measurement. To advance this field, researchers will need to approach the assessment of PA in older adults in a more standardized way (i.e., consistent reporting of results, consensus over cut-points and epoch lengths, using appropriate validation tools). Until then researchers should be cautious when choosing measures for PA that are appropriate for their research questions and when comparing PA levels across various studies.

Background: Action Schools! BC (AS!BC) is a comprehensive school-based model that utilizes a socioecologic approach to provide children with opportunities for physical activity at school in British Columbia., Purpose: The hierarchy of factors associated with successful implementation of AS!BC was examined 4 years after it was scaled up., Methods: A cross-sectional multistage survey was administered to principals (n=133; 92% response rate) and Grade 4-7 teachers (n=587; 71% response rate) in 2008-2009. Constructs from the theories of organizational change, social cognitive theory and Rogers's diffusion of innovation model were used to examine characteristics of teachers and schools and attributes of the innovation associated with implementation. Multilevel mixed-effect logistic regression analyses were employed (analyzed in November 2011)., Results: Self-efficacy, outcome expectation, training received, organizational climate/support, level of institutionalization, environmental influence, and attributes of the innovation were associated with implementation. In multivariate analyses, self-efficacy, training, and level of institutionalization remained significant (all p<0.05)., Conclusions: Demonstrating that an intervention "works" is only the first step toward promoting enhanced health at the population level. For wide-scale implementation, teacher-level self-efficacy and ongoing technical support to train teachers were important. At the school level, policies and guidelines provided a necessary, supportive environment for implementation., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of the study was to determine the short-term impact of a 7-month whole-school physical activity and healthy eating intervention (Action Schools! BC) over the 2007-2008 school year for children and youth in 3 remote First Nations villages in northwestern British Columbia., Study Design: A pre-experimental pre/post design was conducted with 148 children and youth (77 males, 71 females; age 12.5±2.2 yrs)., Methods: We evaluated changes in obesity (body mass index [wt/ht(2)] and waist circumference z-scores: zBMI and zWC), aerobic fitness (20-m shuttle run), physical activity (PA; physical activity questionnaire and accelerometry), healthy eating (dietary recall) and cardiovascular risk (CV risk)., Results: zBMI remained unchanged while zWC increased from 0.46±1.07 to 0.57±1.04 (p<0.05). No change was detected in PA or CV risk but aerobic fitness increased by 22% (25.4±15.8 to 30.9±20.0 laps; p<0.01). There was an increase in the variety of vegetables consumed (1.10±1.18 to 1.45±1.24; p<0.05) but otherwise no dietary changes were detected., Conclusions: While no changes were seen in PA or overall CV risk, zWC increased, zBMI remained stable and aerobic fitness improved during a 7-month intervention.

Purpose: To describe physical activity (PA) intensity across a school day and assess the percentage of girls and boys achieving recommended guidelines., Methods: The authors measured PA via accelerometry in 380 children (8-11 years) and examined data representing (1) the whole school day, (2) regular class time, (3) recess, (4) lunch and (5) scheduled physical education (PE). Activity was categorised as sedentary (SED), light physical activity (LPA) or moderate to vigorous physical activity (MVPA) using age-specific thresholds. They examined sex differences across PA intensities during each time period and compliance with recommended guidelines., Results: Girls accumulated less MVPA and more SED than boys throughout the school day (MVPA -10.6 min; SED +13.9 min) recess (MVPA -1.6 min; SED +1.7 min) and lunch (MVPA -3.1 min; SED +2.9 min). Girls accumulated less MVPA (-6.2 min), less LPA (-2.5 min) and more SED (+9.4 min) than boys during regular class time. Fewer girls than boys achieved PA guidelines during school (90.9% vs 96.2%), recess (15.7% vs 34.1%) and lunch (16.7% vs 37.4%). During PE, only 1.8% of girls and 2.9% of boys achieved the PA guidelines. Girls and boys accumulated similar amounts of MVPA, LPA and SED., Conclusion: The MVPA deficit in girls was due to their sedentary behaviour as opposed to LPA. Physical activity strategies that target girls are essential to overcome this deficit. Only a very small percentage of children met physical activity guidelines during PE. There is a great need for additional training and emphasis on PA during PE. In addition schools should complement PE with PA models that increase PA opportunities across the school day.

Introduction: Aboriginal people who reside in rural and remote areas of Canada often have poorer health than other Canadians. For instance, the prevalence rate of type 2 diabetes is 3 to 5 times higher than for the general population. Chronic disease risk factors such as obesity are also more prevalent. Overweight and obesity have become major health challenges for all Canadian children, but for Aboriginal children, the numbers are 2 to 3 times higher. 'Action Schools! BC' (AS! BC) is a whole-school framework designed as a positive approach to addressing childhood inactivity and unhealthy eating patterns during the school day that was effective for children in a large urban center. The purpose of this study was to explore the feasibility and implementation of AS! BC in 3 remote Aboriginal communities in northern British Columbia., Methods: The AS! BC model provided tools for schools and teachers to create individualized 'action plans' to increase the opportunities for physical activity (PA) and healthy eating (HE) across 6 'action zones'. These zones included: (1) school environment; (2) scheduled physical education; (3) classroom action; (4) family and community; (5) extra-curricular; and (6) school spirit. Teachers (primarily generalists) were provided with the training and resources necessary to implement their action plan for their class. Schools had three visits from the AS! BC support team. Teachers received specialized training and support, a 'planning guide' and classroom-based resources. Gender- and skill-level-inclusive activities were prioritized. Although the model emphasized choice using a whole-school framework, 'classroom action' was a flagship component. Teachers were asked to provide students with a minimum of 15 additional minutes of PA each school day and at least one HE activity per month in the 'classroom action zone'. Information about implementation was gathered from weekly 'classroom logs' completed by teachers and focus groups with school staff., Results: The logs showed that all 3 schools implemented physical activities (mean = 140 min/week, range = 7-360 min/week) and HE activities (mean = 2.3 times/week, range = 0-10 times/week) but this varied by school and teacher. Adherence to logging was low (34% of eligible weeks). Focus group data showed that the program was well received and that support from the AS! BC master trainer and support team was crucial to delivery of the program. Staff highlighted challenges (eg time, high staff turnover at the schools and lack of financial resources), but felt that with continued support and cultural adaptations they would continue to implement AS! BC in their schools., Conclusions: The evaluation demonstrated that AS! BC was appropriate and feasible for use in the First Nations schools in these rural and remote communities with some cultural adaptations and ongoing support. Rural and remote locations have very specific challenges that need to be considered in broader dissemination strategies.

Physical activity interventions among youth have resulted in modest outcomes; thus, there is a need to increase the theoretical fidelity of interventions and hone pilot work before embarking on large scale trials. The purpose of this study was to examine the effect of a planning intervention in comparison to a standard condition on intergenerational physical activity in families with young children. Inactive families (N = 85) were randomized to either a standard condition (received physical activity guidelines and a local municipal healthy active living guide) or the intervention (physical activity guidelines, local municipal healthy active living guide + planning material) after completing a baseline questionnaire package. Sixty-five families (standard condition n = 34; intervention condition n = 31) completed the 4 week follow-up questionnaire package. Complete cases and intention to treat analyses showed that the planning intervention resulted in higher self-reported family physical activity compared to the standard condition and this was due to an increase in unstructured family activities over the 4 weeks. The results are promising and suggest that theoretical fidelity targeting parent regulation of family activity may be a helpful approach to increasing weekly energy expenditure.

Physical activity was monitored for 65 boys and girls, during family child care, using accelerometry. Average accelerometer wear time was 7.0 h (SD = 0.83), and average counts per epoch were 104.6 (SD = 31.6). Mean minutes per hour of moderate-vigorous physical activity and sedentary behaviour were 1.76 min (SD = 0.90) and 39.49 min (SD = 4.50), respectively. The very low levels of moderate-vigorous physical activity suggest that the young children in this study may be insufficiently active during child care.

Objective: To assess the impact of an active school model on children's physical activity (PA)., Design: 16-month cluster randomised controlled trial., Setting: 10 elementary schools in Greater Vancouver, BC., Participants: 515 children aged 9-11 years., Intervention: Action Schools! BC (AS! BC) is an active school model that provided schools with training and resources to increase children's PA. Schools implemented AS! BC with support from either external liaisons (liaison schools, LS; four schools) or internal champions (champion schools, CS; three schools). Outcomes were compared with usual practice (UP) schools (three schools)., Main Outcome Measurements: PA was measured four times during the study using pedometers (step count, steps/day)., Results: Boys in the LS group took 1175 more steps per day, on average, than boys in the UP group (95% CI: 97 to 2253). Boys in the CS group also tended to have a higher step count than boys in the UP group (+804 steps/day; 95% CI: -341 to 1949). There was no difference in girls' step counts across groups., Conclusions: The positive effect of the AS! BC model on boys' PA is important in light of the current global trend of decreased PA.