Combinations of Physical Activity, Sedentary Behavior, and Sleep Duration and Their Associations With Physical, Psychological, and Educational Outcomes in Children and Adolescents: A Systematic Review.

We conducted a systematic review to evaluate combinations of physical activity, sedentary behavior, and sleep duration (defined as "movement behaviors") and their associations with physical, psychological, and educational outcomes in children and adolescents. MEDLINE, CINAHL, PsychInfo, SPORTDiscus, PubMed, EMBASE, and ERIC were searched in June 2020. Included studies needed to 1) quantitatively analyze the association of 2 or more movement behaviors with an outcome, 2) analyze a population between 5 and 17 years of age, and 3) include at least an English abstract. We included 141 studies. Most studies included the combination of physical activity and sedentary behavior in their analyses. Sleep was studied less frequently. In combination, a high level of physical activity and a low level of sedentary behavior were associated with the best physical health, psychological health, and education-related outcomes. Sleep was often included in the combination that was associated with the most favorable outcomes. Sedentary behavior had a stronger influence in adolescents than in children and tended to be associated more negatively with outcomes when it was defined as screen time than when defined as overall time spent being sedentary. More initiatives and guidelines combining all 3 movement behaviors will provide benefit with regard to adiposity, cardiometabolic risk factors, cardiorespiratory fitness, muscular physical fitness, well-being, health-related quality of life, mental health, academic performance, and cognitive/executive function.

Socioeconomic position as a predictor of youth's movement trajectory profiles between ages 10 and 14 years.

BACKGROUND: Combinations of movement behaviors (i.e., physical activity, sedentary behavior, sleep) are associated with health and developmental outcomes in youth. Youth vary in how they accumulate these behaviors, both in volume and specific domains (e.g., sedentary time spent on recreational screen activities vs homework). The aim of this study was to examine how youth's combined general and domain-specific movement trajectories differ by socioeconomic position. METHODS: We conducted a longitudinal, group-based multi-trajectory analysis to identify general and domain-specific movement trajectory profiles for 2457 youth from age 10 to 14 years from the Longitudinal Study of Australian Children from 2014-2018. We used multinomial logistic regression to test if socioeconomic position predicted profile membership. RESULTS: We identified three general movement trajectory profiles for both sexes, four domain-specific profiles for males, and five for females. For general movement trajectories, females from lower socioeconomic positions were more likely to be a combination of less active and more sedentary than females from higher socioeconomic positions. Males across socioeconomic positions spend similar amounts of time in physical activity, sedentary time, and sleep. For domain-specific movement trajectories, youth from lower socioeconomic positions were likely to spend a combination of less time in education-based sedentary behavior and more time in recreational screen activities than their higher socioeconomic position peers. CONCLUSION: Our results indicate that socioeconomic position predicted in which domains youth accumulate their movements. Future observational research and interventions targeting different socioeconomic groups should therefore consider domain-specific movement trajectories.

Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses.

BACKGROUND: To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT). METHODS: Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis. RESULTS: One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge's g = 0.015 (95%CI: - 0.088-0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge's g = - 0.313 (95%CI: - 0.681-0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence. CONCLUSIONS: Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints. REGISTRATION: This review was registered in the PROSPERO database and given the identifier CRD42019103313.

Impact of adapted bicycle riding on outcomes for children and adolescents with disabilities: A systematic review.

AIM: To review the evidence for the effects of adapted bicycle riding on body structures and functions, activity, participation, and quality of life outcomes in children with disabilities, along with family-level participation outcomes. METHOD: A systematic review with searches of nine electronic databases to identify studies involving participants with a developmental disability aged 4 to 18 years who used a dynamic adapted bicycle was completed in August 2021. Risk of bias was assessed based on individual study designs. A narrative synthesis integrated the findings of the included studies. Certainty of evidence was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Ten studies were included with 234 participants. Five studies reported outcomes at the body structures and functions level, ten reported activity-level outcomes, two reported participation-related outcomes, and none assessed quality of life or family participation in social and recreational activities. INTERPRETATION: Adapted bicycle riding interventions may improve gross motor function, enhance lower-limb muscle strength, and promote physical activity; however, certainty of evidence of effects was rated very low using GRADE. Further research is required to understand the impact of adapted bicycle riding on the participation outcomes of children and adolescents with disabilities and on family-level participation in social and recreational activities. WHAT THIS PAPER ADDS: Adapted bicycle riding interventions may improve motor functions and physical activity. Evidence about participation outcomes after adapted bicycle riding is limited. Research on adapted bicycle riding interventions in natural settings is needed.

Reliability of GENEActiv accelerometers to estimate sleep, physical activity, and sedentary time in children.

BACKGROUND: Reliable estimates of habitual sleep, physical activity, and sedentary time are essential to investigate the associations between these behaviours and health outcomes. While the number of days needed and hours/day for estimates of physical activity and sedentary time are generally known, the criteria for sleep estimates are more uncertain. The objective of this study was to identify the number of nights needed to obtain reliable estimates of habitual sleep behaviour using the GENEActiv wrist worn accelerometer. The number of days to obtain reliable estimate of physical activity was also examined. METHODS: Data was used from a two-year longitudinal study. Children wore an accelerometer for up to 8 days 24 h/day across three timepoints. The sample included 2,745 children (51 % girls) between the ages of 7-12-years-old (mean = 9.8 years, SD = 1.1 year) with valid accelerometer data from any timepoint. Reliability estimates were calculated for sleep duration, sleep efficiency, sleep onset, wake time, time in bed, light physical activity, moderate physical activity, moderate-to-vigorous physical activity, vigorous physical activity, and sedentary time. RESULTS: Intraclass correlations and the Spearman Brown prophecy formula were used to determine the nights and days needed for reliable estimates. We found that between 3 and 5 nights were needed to achieve acceptable reliability (ICC = 0.7) in sleep outcomes, while physical activity and sedentary time outcomes required between 3 and 4 days. CONCLUSIONS: To obtain reliable estimates, researchers should consider these minimum criteria when designing their studies and prepare strategies to ensure sufficient wear time compliance.

Improving children's fundamental movement skills through a family-based physical activity program: results from the "Active 1 + FUN" randomized controlled trial.

BACKGROUND: Physical activity is related to many positive health outcomes, yet activity levels of many children are low. Researchers have suggested that family-based interventions may improve physical activity behaviors of both children and their parents. In this study, we evaluated the "Active 1 + FUN" program, which was designed based on tenets of self-determination theory. Intervention components included free sporting equipment, ten coach-led workshops and activity sessions, and one booster session. METHODS: We evaluated the intervention program using a randomized controlled trial. One hundred seventy-one families were randomly allocated to either an experimental group or a wait-list control group. Participants were exposed to program contents over a nine-month period, while families in the control did not receive any form of intervention. Measured constructs included moderate-to-vigorous physical activity, co-physical activity behaviors, fundamental movement skills, BMI, and several self-reported questionnaire outcomes. Hierarchical linear modeling was used to compare changes in measured outcomes across the two groups. RESULTS: No significant intervention effects were found for children's and parents' accelerometer-measured moderate-to-vigorous physical activity, or their co-physical activity. However, in terms of children's fundamental movement skills, a significant Time*Group interaction (B = 0.52, 95% CI [0.07, 0.96] for Times 1 to 2; B = 0.24, 95% CI [0.01, 0.48] for Times 1 to 3) in favor of the experimental group was found. CONCLUSIONS: Results suggested that the "Active 1 + FUN" program was effective in improving children's fundamental movement skills. Additional research is needed to examine how family-based initiatives could effectively improve physical activity behaviors too. TRIAL REGISTRATION: ANZCTR, ACTRN12618001524280. Registered 11 September 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375660 .

Interventions for improving medical students' interpersonal communication in medical consultations.

BACKGROUND: Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES: To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS: We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS: We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence).  Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported.  AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.

Effectiveness of a coordinated support system linking public hospitals to a health coaching service compared with usual care at discharge for patients with chronic low back pain: protocol for a randomised controlled trial.

BACKGROUND: Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge. METHODS: Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making. DISCUSSION: This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes. CONCLUSION: Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia. TRIAL REGISTRATION: Prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12620000889954 ) on 10/09/2020.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

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

Time-efficient intervention to improve older adolescents' cardiorespiratory fitness: findings from the 'Burn 2 Learn' cluster randomised controlled trial.

BACKGROUND: Cardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents' CRF. METHODS: Two-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering. RESULTS: We observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol. CONCLUSIONS: Implementing HIIT during curricular time improved adolescents' CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12618000293268).

Validity and reliability evidence for motor competence assessments in children and adolescents: A systematic review.

Valid and reliable tests of motor competence are necessary to allow researchers and practitioners to quantify levels of motor competence, identify skill deficiencies, and determine the effectiveness of motor skill interventions. The primary study aim was to systematically review the validity and reliability of scores derived from gross motor competence tests for typically developing child and adolescent populations. The secondary aim of this review was to identify the most prevalent motor skills assessed across all instruments. A search of seven electronic databases identified 57 different skill assessment tools from 107 studies. Construct validity was the most common measurement property examined (60 studies; 56%). Content validity (21 studies; 20%) was the least commonly explored measurement property. Scores derived from the Test of Gross Motor Development - second and third edition had the most support for validity and reliability. The most common skills included in these skill batteries were the overhand throw (n = 33), catch (n = 32), jump (n = 31) and hop (n = 26). Research efforts should focus on: (1) further investigation of measurement properties of existing tools rather than developing new assessments and (2) further investigation of existing tools and their measurement properties in adolescent populations.

Type of screen time moderates effects on outcomes in 4013 children: evidence from the Longitudinal Study of Australian Children.

BACKGROUND: Excessive engagement with digital screens is harmful to children's health. However, new evidence suggests that exposure at moderate levels may not be harmful and may even provide benefit. Therefore, our objective was to determine if there are curvilinear relationships between different types of screen time and a diverse set of outcomes, including health and education. METHODS: We address our objective using a repeated measures design. Children (N = 4013), initially aged 10-11 were assessed every 2 years between 2010 and 2014. Children's screen time behavior was measured using time-use diaries, and categorized into five types: social, passive, interactive, educational, or other. We used measures of children's physical health, health-related quality of life, socio-emotional outcomes, and school achievement. The analysis plan was pre-registered. Models were adjusted for gender, socio-economic status, ethnicity, number of siblings, and housing factors. RESULTS: There were linear associations between total screen time and all outcomes, such that more screen time was associated with worse outcomes. However, there was variability when examined by screen time type. Passive screen time (e.g., TV) was associated with worse outcomes, educational screen time (e.g., computer for homework) was associated with positive educational outcomes and had no negative relations with other outcomes. Interactive screen time (e.g., video games) had positive associations with educational outcomes but negative associations with other outcomes. In all instances, these significant associations were small or very small, with standardised effects < 0.07. We found little evidence of curvilinear relationships. CONCLUSIONS: The small effects of screen time on children's outcomes appear to be moderated by the type of screen time. Policy makers, educators, and parents should consider the type of screen time when considering the benefits and harms of use.

Joint physical-activity/screen-time trajectories during early childhood: socio-demographic predictors and consequences on health-related quality-of-life and socio-emotional outcomes.

BACKGROUND: Understanding the early roots of physical activity and sedentary behaviors is critical to developing intervention programs that promote healthy lifestyle habits in infants and children. There is, however, no evidence on how these behaviors cluster and develop together during early childhood. The aim of this study was to identify single and joint longitudinal trajectories in physical activity and screen time amongst children aged 0 to 9 years, their social-demographic predictors and their prospective health-related quality-of-life and socio-emotional outcomes. METHODS: Three waves of data from The Longitudinal Study of Australian Children, a national study tracking two cohorts every 2 years (B-cohort, 0-5 years, n = 4,164; K-cohort, 4-9 years, n = 3,974) were analysed. Growth mixture modelling was applied to longitudinal time-use diary data to identify joint trajectories in children's physical activity and screen time over Waves 1-3. Key socio-demographic variables measured at Wave 1 were used to predict membership in different trajectories. The prospective consequences (at Wave 3) of time-use trajectories on health-related quality-of-life and socio-emotional outcomes were assessed. RESULTS: Three physical-activity/screen-time trajectories were identified for both cohorts: Cluster-A-children who maintained low levels of physical activity and screen time (∽50% of the sample), Cluster-B-children who progressively increased physical activity and maintained low screen-time levels (∽25%), and Cluster-C-children who maintained low physical-activity levels and increased screen time (∽25%). Children in Cluster-B experienced the best health-related quality-of-life and socio-emotional outcomes, while those in Cluster-C experienced the worst. Children who were female, Indigenous, from non-English-speaking backgrounds, not living with two biological parents, in more affluent households and neighbourhoods, without siblings and with parents with poor mental health were at greater risk of falling into Cluster-A or Cluster-C. CONCLUSION: Our findings identified which children are most at-risk of falling into time-use trajectories that lead to poor health-related quality-of-life and socio-emotional outcomes later in life, increasing our ability to monitor, detect and prevent these suboptimal behaviours prior to their onset.

Associations between physical activity intensity and well-being in adolescents.

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

Toward a better assessment of perceived social influence: The relative role of significant others on young athletes.

The purpose of this three-study paper was to develop and validate the Perceived Social Influence in Sport Scale-2 (PSISS-2) that aimed to resolve the limitations of PSISS-1 in assessing the relative social influence of significant others in youth sport. In Study 1, a pool of 60 items generated from revisiting a qualitative dataset about significant others of young athletes were examined by two expert panel reviews in terms of content validity, clarity, coverage, and age-appropriateness, leading to the development of 16 items of the PSISS-2. In Study 2, multi-group exploratory structural equation model for PSISS-2 was conducted among 904 young athletes, and the results supported a model comprising positive influence (ie, conditional and unconditional positive influence combined), punishment (ie, conditional negative influence), and dysfunction (ie, unconditional negative influence) as three factors. The goodness of fit of the three-factor model was acceptable and invariant across the coach-, father-, mother-, and teammates-versions of PSISS-2. In support of the criterion validity of PSISS-2, the three factors explained substantial variance of young athletes' perceived competence, effort, enjoyment, and trait anxiety in sport. Study 3 examined the relationship between PSISS-2 factors, psychological need support, and controlling behaviors in a subsample of 452 young athletes, and the findings supported the concurrent validity and discriminant validity of the scale. In conclusion, the data are supportive of PSISS-2. The three factors of the scale (ie, positive influence, punishment, and dysfunction) may form a new framework for understanding and comparing the relative role of significant others in youth sport.

A monitoring system to provide feedback on student physical activity during physical education lessons.

School-based physical education (PE) provides opportunities to accumulate moderate-to-vigorous physical activity (MVPA), but many students are insufficiently active during PE lessons. Providing teachers with feedback regarding their students' physical activity may increase the effectiveness of PE for achieving MVPA goals, but existing physical activity monitoring technologies have limitations in class environments. Therefore, the purpose of this study was to develop and validate a system capable of providing feedback on PE lesson MVPA. Equations for translating step counts to %MVPA were derived from measures in 492 students who concurrently wore an ActiGraph GT3X+ (ActiGraph) and Yamax pedometer (Yamax) during a PE lesson. To enhance feedback availability during PE lessons, we then developed a bespoke monitoring system using wireless tri-axial pedometers (HMM) and a smart device app. After developing and testing the monitoring system, we assessed its validity and reliability in 100 students during a PE lesson. There was a strong correlation of 0.896 between step counts and accelerometer-determined %MVPA and quantile regression equations showed good validity for translating step counts to %MVPA with a mean absolute difference of 5.3 (95% CI, 4.4-6.2). The physical activity monitoring system was effective at providing %MVPA during PE lessons with a mean difference of 1.6 ± 7.1 compared with accelerometer-determined %MVPA (7% difference between the two measurement methods). Teachers and students can use a smart device app and wireless pedometers to conveniently obtain feedback during PE lessons. Future studies should determine whether such technologies help teachers to increase physical activity during PE lessons.

Promoting physical activity in children through family-based intervention: protocol of the "Active 1 + FUN" randomized controlled trial.

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

Integrating physical activity into the primary school curriculum: rationale and study protocol for the "Thinking while Moving in English" cluster randomized controlled trial.

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

An internet-supported school physical activity intervention in low socioeconomic status communities: results from the Activity and Motivation in Physical Education (AMPED) cluster randomised controlled trial.

OBJECTIVE: Quality physical education (PE) is the cornerstone of comprehensive school physical activity (PA) promotion programmes. We tested the efficacy of a teacher professional learning intervention, delivered partially via the internet, designed to maximise opportunities for students to be active during PE lessons and enhance adolescents' motivation towards PE and PA. METHODS: A two-arm cluster randomised controlled trial with teachers and Grade 8 students from secondary schools in low socioeconomic areas of Western Sydney, Australia. The Activity and Motivation in Physical Education (AMPED) intervention for secondary school PE teachers included workshops, online learning, implementation tasks and mentoring sessions. The primary outcome was the proportion of PE lesson time that students spent in moderate-to-vigorous physical activity (MVPA), measured by accelerometers at baseline, postintervention (7-8 months after baseline) and maintenance (14-15 months). Secondary outcomes included observed PE teachers' behaviour during lessons, students' leisure-time PA and students' motivation. RESULTS: Students (n=1421) from 14 schools completed baseline assessments and were included in linear mixed model analyses. The intervention had positive effects on students' MVPA during lessons. At postintervention, the adjusted mean difference in the proportion of lesson time spent in MVPA was 5.58% (p<0.001, approximately 4 min/lesson). During the maintenance phase, this effect was 2.64% (p<0.001, approximately 2 min/lesson). The intervention had positive effects on teachers' behaviour, but did not impact students' motivation. CONCLUSIONS: AMPED produced modest improvements in MVPA and compares favourably with previous interventions delivered exclusively face-to-face. Online teacher training could help facilitate widespread dissemination of professional learning interventions. TRIAL REGISTRATION NUMBER: ACTRN12614000184673.

Domain-specific physical activity and affective wellbeing among adolescents: an observational study of the moderating roles of autonomous and controlled motivation.

BACKGROUND: Abundant evidence demonstrates a relationship between physical activity and mental wellbeing. However, the strength of the relationship is not consistent. Factors contributing to variation in the strength of association are not well understood and, therefore, it remains difficult to optimize physical activity to ensure the strongest possible relationship with mental health. Self-determination theory suggests that more autonomously motivated behaviors lead to better mental health outcomes, when compared to more controlled behaviors. Therefore, we examined whether autonomous and controlled motivation moderated the relationships between physical activity and affective wellbeing within two domains (i.e., leisure-time and active travel). METHODS: Between February and April 2014, adolescents (N = 1632, M age = 12.94 years, SD = 0.54, 55% male) wore an accelerometer across seven-days and completed self-report measures of leisure-time physical activity and active travel. They also completed two measures of motivation (towards leisure-time physical activity and active travel) and an affective wellbeing measure. RESULTS: Structural equation modeling revealed that greater self-reported leisure-time physical activity was associated with greater positive affect (ß = .29) and less negative affect (ß = -.19) and that motivation did not moderate these relationships. Self-reported active travel had no linear relationship with affective wellbeing, and motivation did not moderate these relationships. Accelerometer-measured leisure-time physical activity had no relationship with positive affect but, had a weak inverse association with negative affect (ß = -.09), and neither relationship was moderated by motivation. Accelerometer-measured active travel had no association with positive affect; however, autonomous motivation significantly moderated this association such that active travel had a positive association with positive affect when autonomous motivation was high (ß = .09), but a negative association when autonomous motivation was low (ß = -.07). Accelerometer-measured active travel had no association with negative affect. Despite some significant moderation effects, motivation did not consistently moderate the relationship between all physical activity variables (leisure-time and active travel, and self-report and accelerometer) and affective outcomes. CONCLUSIONS: Tailoring physical activity interventions and guidelines to prioritize leisure-time ahead of other life domains could benefit wellbeing. Promoting autonomous participation in active travel may also be associated with increased wellbeing among adolescents.