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$\textbf{Objective:}$ To systematically review and meta-analyse how physical activity (PA) changes from adolescence to early adulthood (13-30 years). $\textbf{Data sources:}$ Seven electronic databases were searched: Medline, Embase, PsycInfo, SCOPUS, ASSIA, SPORTdiscus and Web of Science. $\textbf{Eligibility criteria for selecting studies:}$ English-language, longitudinal studies (from 01/1980 to 01/2017) assessing PA ≥twice, with the mean age of ≥1 measurement in adolescence (13-19 years) and ≥1 in young adulthood (16-30 years) were included. Where possible, data were converted to moderate-to-vigorous physical activity (MVPA) min/day, and meta-analyses were conducted between weighted mean differences (WMDs) in adolescence and adulthood. Heterogeneity was explored using meta-regression. $\textbf{Results:}$ Of 67 included studies, 49 were eligible for meta-analysis. PA was lower during adulthood than adolescence WMD (95% CI) -5.2 (-7.3 to -3.1) min/day MVPA over mean (SD) 3.4 (2.6) years; heterogeneity was high (I(2) >99.0%), and no predictors explained this variation (all p>0.05). When we restricted analysis to studies with data for males (n=29) and females (n=30) separately, there were slightly larger declines in WMD (-6.5 (-10.6 to -2.3) and -5.5 (-8.4 to -2.6) min/day MVPA) (both I(2) >99.0%). For studies with accelerometer data (n=9), the decline was -7.4 (-11.6 to -3.1) and longer follow-up indicated more of a decline in WMD (95% CI) (-1.9 (-3.6 to -0.2) min/day MVPA), explaining 27.0% of between-study variation. Of 18 studies not eligible for meta-analysis, nine statistically tested change over time: seven showed a decline and two showed no change. $\textbf{Conclusion:}$ PA declines modestly between adolescence and young adulthood. More objective longitudinal PA data (eg, accelerometry) over this transition would be valuable, as would investigating how PA change is associated with contemporaneous social transitions to better inform PA promotion interventions. $\textbf{Registration:}$ PROSPERO ref:CRD42015030114.

The family environment is key in influencing children's health behaviours. Encouraging family co-participation in physical activity may therefore be an effective approach to increasing children's physical activity levels. Yet, little is known about how to best assess family co-participation in physical activity. This review summarizes methods to measure family co-participation in physical activity, which was defined as joint physical activities including at least one healthy child (0-18 years) and one other family member. Methods were identified through a systematic literature search, cross-referencing pre-selected reviews and contacting research groups. Thirty-seven measurement methods were included. Questionnaires were the most common method used, with the majority assessing frequency of co-participation and few also assessing duration and type. Reliability and internal consistency of scales were often reported, but rarely specified for the item(s) relevant to co-participation. Other methods of measuring co-participation included diaries, event history calendars, direct observations and accelerometry combined with diary, ecological momentary assessment or global positioning systems (GPS). Whilst a large number of measurement methods of family co-participation in physical activity exist, few are comprehensive and/or report acceptable psychometric properties. Future work should focus on reaching consensus in defining family co-participation in physical activity, and subsequently developing reliable and valid measures.

Introduction Adolescent physical activity promotion is rarely effective, despite adolescence being critical for preventing physical activity decline. Low adolescent physical activity is likely to last into adulthood, increasing health risks. The Get Others Active (GoActive) intervention is evidence-based and was developed iteratively with adolescents and teachers. This intervention aims to increase physical activity through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented using a tiered-leadership system. We previously established feasibility in one school and conducted a pilot randomised controlled trial (RCT) in three schools. Methods and analysis We will conduct a school-based cluster RCT (CRCT) in 16 secondary schools targeting all year 9 students (n=2400). In eight schools, GoActive will run for two terms: weekly facilitation support from a council-funded intervention facilitator will be offered in term 1, with more distant support in term 2. Tutor groups choose two weekly activities, encouraged by older adolescent mentors and weekly peer leaders. Students gain points for trying new activities; points are entered into a between-class competition. Outcomes will be assessed at baseline, interim (week 6), postintervention (week 14–16) and 10-month follow-up (main outcome). The primary outcome will be change from baseline in daily accelerometer-assessed moderate-to-vigorous physical activity. Secondary outcomes include accelerometer-assessed activity intensities on weekdays/weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness and cost-utility analyses; mixed-methods process evaluation integrating information from focus groups and participation logs/questionnaires. Ethics and dissemination Ethical approval for the conduct of the study was gained from the University of Cambridge Psychology Research Ethics Committee. Given the lack of rigorously evaluated interventions, and the inclusion of objective measurement of physical activity, long-term follow-up and testing of causal pathways, the results of a CRCT of the effectiveness and cost-effectiveness of GoActive are expected to add substantially to the limited evidence on adolescent physical activity promotion. Workshops will be held with key stakeholders including students, parents, teachers, school governors and government representatives to discuss plans for wider dissemination of the intervention. Trial registration number ISRCTN31583496. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/, This project is funded by the National Institute for Health Research Public Health Research (13/90/18). Intervention delivery costs will be borne by Essex and Cambridgeshire County Councils.

$\textbf{Objectives:}$ Assess the feasibility of implementing the GoActive intervention in secondary schools, to identify improvements, test study procedures, determine preliminary effectiveness to increase moderate-to-vigorous physical activity (MVPA), and inform power calculations to establish programme effectiveness. $\textbf{Setting:}$ Feasibility study (1 school) and pilot CRCT (2 intervention;1 control school(s)) $\textbf{Participants:}$ 460 participants (46.6% female; 13.2(0.4) years-old). $\textbf{Interventions:}$ 8-week intervention (2013) involved: classes choosing weekly activities encouraged by Mentors (older adolescents) and in-class peer-leaders. Students gain points for trying activities which are entered into an intra-mural competition. $\textbf{Primary and secondary outcome measures:}$ Planned quantitative (questionnaire) and qualitative (focus groups) process evaluation addressed enjoyment, confidence, participation, suggested improvements. Outcomes were assessed at baseline and follow-up (week 8) in pilot CRCT and included: accelerometer-assessed MVPA; adolescent-reported activity type, wellbeing, peer-support, shyness, sociability. ANCOVA was used to assess preliminary effectiveness as change in MVPA adjusted for baseline. $\textbf{Results:}$ All Year 9 students in intervention schools were exposed to the intervention; over all schools 77% of eligible students were measured. 71% boys and 74% girls found GoActive ‘fun’; 38% boys and 32% girls said it increased confidence and 64% boys and 59% girls said they would continue with a GoActive activity. Suggested improvements included more Mentorship; improved training; streamlined points recording. Pilot results indicated potential effectiveness ((adjusted mean difference (95%CI)p-value) (MVPA mins) 5.1(1.1,9.2)p=0.014)) and suggest recruitment of 16 schools (2400 adolescents) for a full trial. Compared to control, intervention students reported greater peer support 0.5(0.1,0.9)p=0.03, wellbeing 1.8(0.1, 3.4)p=0.04 but no difference in shyness/sociability. Participation in activity types approached significance (intervention group 2.3(-0.2,4.7)p=0.07 more activity types). $\textbf{Conclusions:}$ Results suggest feasibility and indicate potential effectiveness of GoActive to increase MVPA and support a fully-powered evaluation of effectiveness and cost-effectiveness. Process evaluation data was used to refine GoActive prior to a full trial. $\textbf{Trial Registration:}$ ISRCTN registry ISRCTN31583496.

Background Less than 20% of adolescents globally meet recommenced levels of physical activity, which comes with social disadvantage and rising disease risk at increasingly early ages. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school’s social environment likely plays an important role. We conducted a cluster-randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents. Methods/Findings Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (N=16), all Year 9 students were eligible and invited to participate. Participants were 2862 13-14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium (below/above county-specific median) and county (control: 8 schools, 1319 participants, mean (SD) participants per school: n=165 (62); intervention: 8 schools, 1543 participants, n=193 (43)). Measurement staff were blinded to allocation. The iteratively-developed, feasibility-tested 12-week intervention, aligned with Self-Determination Theory, trained older adolescent mentors and in-class-peer-leaders to encourage classes to conduct two new weekly activities. Students and classes gained points and rewards for engaging in any activity in- and out-of-school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2862 recruited participants (52.1% male), 2167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1874 participants (65.5%). At 10-months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] -1.91 minutes [-5.53 to 1.70], p=0.316). The programme cost £13 per student compared with control; it was not cost-effective. 62.9% of students and 87.3% of mentors reported that GoActive was fun. Deliverers commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample. Conclusions In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational setting-specific implementation challenges. School-leaders and authorities should be realistic about expectations of effect of school-based physical activity promotion strategies implemented at scale.

Little is known about the longitudinal association of familial socio-demographic factors, behaviours, attitudes, or home environment with meeting physical activity guidelines. Our objective was to a) describe 4-year change in the prevalence of meeting guidelines, and characteristics of participants across categories of physical activity maintenance, and b) identify familial factors in childhood that are longitudinally associated with meeting guidelines in adolescence. Data on 17 parent- and child-reported family variables and objectively measured physical activity (ActiGraph GT1M) were available from 406 children (10.3 ± 0.3 years, 53.5% female) participating in the SPEEDY study. Average duration of week- and weekend day moderate-to-vigorous physical activity (MVPA, ≥ 2000 cpm) at baseline and follow-up (14.3 ± 0.3 years) were calculated to determine whether participants met 60 min MVPA/day guidelines at each assessment. Descriptives were calculated across four MVPA change categories. Multi-level logistic regression examined the association of baseline familial factors with meeting guidelines at follow-up, adjusting for sex, baseline physical activity, family socio-economic position, and school clustering. At follow-up, 51.5% and 36.1% of adolescents met guidelines on weekdays and weekend days, respectively (baseline: 68.0%, 67.2%). Girls were less likely than boys to remain sufficiently active, particularly on weekdays. Family social support was positively associated with adolescents meeting guidelines at weekends (OR 1.2; 95% CI 1.0-1.4). The presence of play equipment at home was negatively associated with meeting guidelines on weekdays (OR 0.5; 95% CI 0.3-0.8). Interventions that foster parent's facilitation of physical activity may help to encourage the upkeep of healthy behaviours during the transition from childhood to adolescence., The SPEEDY study is funded by the National Prevention Research Initiative (G0501294) (http://www.npri.org.uk), consisting of the following Funding Partners: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Health and Social Care Research and Development Office for the Northern Ireland; Chief Scientist Office, Scottish Government Health Directorates; Welsh Assembly Government and World Cancer Research Fund. The work was also undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust. Kirsten Corder reports receiving the following grants: Lead Applicant - A cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the GoActive programme to increase physical activity among 13–14 year-old adolescents. Project: 13/90/18 National Institute for Health Research Public Health Research Programme Sept 2015 – Feb 2019. Co-Applicant - Opportunities within the school environment to shift the distribution of activity intensity in adolescents. Department of Health Policy Research Programme. Dec 2013 – Nov 2016. Kirsten Corder is a Director of Ridgepoint Consulting Limited, an operational improvement consultancy.

Background: There is a need for high-quality research aiming to increase physical activity in families. This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a child-led family-based physical activity intervention delivered online. Methods: In a two-armed randomised feasibility study 12 families (with an 8-10-year-old index child) were allocated to a ‘child-only’ (CO) or ‘family’ arm (FAM) of the theory-based FRESH intervention. Both received access to the FRESH website, allowing participants to select step challenges to ‘travel’ to target cities around the world, log their steps, and track their progress as they virtually globetrot. Only index children wore pedometers in CO; in FAM, all family members wore pedometers and worked toward collective goals. All family members were eligible to participate in the evaluation. Mixed-methods process evaluation (questionnaires and family focus groups) at 6-week follow-up consisted of completing questionnaires assessing acceptability of the intervention and accompanying effectiveness evaluation, focussed on physical (e.g., fitness, blood pressure), psychosocial (e.g., social support), and behavioural (e.g., objectively-measured family physical activity) measures. Results: All families were retained (32 participants). Parents enjoyed FRESH and all children found it fun. More FAM children wanted to continue with FRESH, found the website easy to use, and enjoyed wearing pedometers. FAM children also found it easier to reach goals. Most CO families would have preferred whole family participation. Compared to CO, FAM exhibited greater website engagement as they travelled to more cities (36 ± 11 vs. 13 ± 8) and failed fewer challenges (1.5 ± 1 vs. 3 ± 1). Focus groups also revealed that most families wanted elements of competition. All children enjoyed being part of the evaluation, and adults disagreed that there were too many intervention measures (overall: 2.4 ± 1.3) or that data collection took too long (overall: 2.2 ± 1.1). Conclusion: FRESH was feasible and acceptable to participating families, however, findings favoured the FAM group. Recruitment, intervention fidelity and delivery, and some measurement procedures are particular areas that require further attention for optimisation. Testing the preliminary effectiveness of FRESH on family physical activity is a necessary next step.

OBJECTIVE: The objective of the study is to evaluate the effectiveness of interventions to increase physical activity (PA) in 0-5 year olds and to determine what works, for whom, in what circumstances. DESIGN: Systematic review, meta-analysis and realist synthesis. DATA SOURCES: Embase and EBSCOhost (Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, SPORTDiscus with full text), up to and including April 2017. ELIGIBILITY CRITERIA: Published in a peer-reviewed English language journal; randomized or controlled trial design; aimed to increase children's PA levels; reported on objectively assessed PA in children between 0 and 5.9 years at baseline and post-intervention. RESULTS: Thirty-four studies were included in the review, mostly conducted in the preschool/childcare setting. Meta-analyses showed an overall non-significant (Z = 0.04, p = 0.97) mean difference of 0.03 (95% CI = -1.57, 1.63) minutes/day for light-intensity PA (n = 11). The overall mean difference for moderate-intensity to vigorous-intensity PA (n = 21) was 2.88 (95% CI = 1.54, 4.23) minutes/day, indicating a small but significant overall positive effect (Z = 4.20, p < 0.001). The realist synthesis provided insights into the key contexts and mechanisms that appeared to be effective at changing children's PA. CONCLUSION: Based on a quantitative and qualitative examination of the evidence, this review provides specific recommendations for effective early childhood PA interventions for practitioners and policymakers.