An overview of "The Active by Choice Today" (ACT) trial for increasing physical activity.

BACKGROUND: Although school-based behavioral interventions for increasing physical activity (PA) in children and adolescents have been conducted, little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days. The overall goal of the "Active by Choice Today" (ACT) trial is to expand the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents (low socioeconomic status, minorities) during their middle school years. DESIGN AND SETTING: An overview of the ACT study design, theoretical framework, process evaluation, and primary hypotheses is presented. The trial involves twenty-four middle schools (1560 6th graders) in South Carolina that are randomly assigned to one of two after-school programs (motivational and life skills intervention, or general health education). INTERVENTION: The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA. The intervention targets skill development for PA outside of program days and the after-school program social environment (autonomy, choice, participation, belongingness, fun, enjoyment, support) is designed to positively impact cognitive mediators (self-efficacy, perceived competence), and motivational orientation (intrinsic motivation, commitment, positive self-concept). MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA (based on 7-day accelerometry estimates) at post-intervention as compared to the general health education program. CONCLUSIONS: Implications of this innovative school-based trial are discussed.

Results of the "Active by Choice Today" (ACT) randomized trial for increasing physical activity in low-income and minority adolescents.

OBJECTIVE: This study reports the results of the "Active by Choice Today" (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents. DESIGN: The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program. MAIN OUTCOME MEASURE: The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention. RESULTS: At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention. CONCLUSIONS: Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA.

Perceptions of Neighborhood Sidewalks on Walking and Physical Activity Patterns in a Southeastern Community in the US.

BACKGROUND: The purpose of this study was to examine the relationships between perceptions of neighborhood sidewalks and race, and walking and physical activity (PA) patterns in a southeastern US community. METHODS: A telephone survey was administered to a stratified sample of adults (N = 1148). Physical activity was categorized according to the CDC/ACSM recommendations. Respondents were also asked if they walked for at least 10 min at a time for recreation, exercise, transportation, or while at work. RESULTS: A greater proportion (44%) of respondents who reported having neighborhood sidewalks were irregular walkers (OR = 1.88; 95% CI = 1.13, 3.11). For whites, (but not for non-whites) the perceived presence of sidewalks increased the odds for meeting recommended PA levels (P < 0.05; OR = 3.59, 95% CI = 1.05, 12.24). CONCLUSIONS: Presence of neighborhood sidewalks was related to irregular walking levels of respondents. Sidewalk presence was related to PA in whites, but was not related to activity patterns of non-whites.

Formative evaluation of a motivational intervention for increasing physical activity in underserved youth.

The present study was designed to develop an innovative motivational intervention (based on Self-Determination Theory and Social Cognitive Theory) to increase physical activity (PA) in underserved adolescents. Sixty-four adolescents (35 females, 29 males; 50% minority; 65% on reduced lunch program; ages 11-13 yr) participated in either an 8-week motivational intervention after-school (n = 32) or a typical after-school program (n = 32). The conceptual framework for the intervention targeted the social environment (perceived autonomy, perceived social support, participation, fun), cognitive mediators (perceived choice, self-efficacy, and relatedness/belongingness), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program. The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention. The data revealed information regarding the importance of the cognitive appropriateness of the PA and motivational activities, the environmental climate for promoting nurturing relationships, developing specific strategies for increasing intrinsic rather than extrinsic reinforcement, and developing methods for preventing social "cliques" and gender conflicts to maintain an appropriate level of support in the social climate. Themes for training staff included focusing on team building, leadership, and nurturing. This formative evaluation is being used to formalize a randomized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th graders.

Brief report: a qualitative study of gender preferences and motivational factors for physical activity in underserved adolescents.

OBJECTIVE: This study used focus groups to identify preferences for physical activity (PA) and motivational themes for increasing PA in underserved adolescents. METHODS: Fifty-one adolescents, on the free lunch program (25 males and 26 females; ages 10-13 years; 72% African-American, 19% white, and 9% other minorities) participated in focus groups (6-10 children per group; same gender). The data were transcribed and coded into themes. A content analysis was performed using QSR NVivo. RESULTS: Boys rated their favorite activities as playing basketball, football, soccer, and baseball. Girls rated their favorite activities as playing basketball, swimming, and roller-skating. For motivational themes, boys and girls most frequently stated that they would participate in PA if it was a fun, provided a health benefit, and if there were a variety of choices offered. Being involved with friends was also identified as important to both boys and girls. CONCLUSIONS: The findings from this qualitative study suggest that including components of choice and a variety of physical activities may be important elements for intervention programs in underserved adolescents.

A preliminary test of a student-centered intervention on increasing physical activity in underserved adolescents.

BACKGROUND: Previous studies have shown that choice and self-initiated behavior change are important for increasing intrinsic motivation and physical activity (PA), however, little of this research has focused on underserved adolescents. PURPOSE: This study examined the effects of a 4-week student-centered intervention on increasing PA in underserved adolescents. METHODS: Twenty-eight students in the intervention school were matched (on race, percentage on free or reduced-price lunch program, gender, and age) with 20 students from another school who served as the comparison group (30 girls, 18 boys; ages 10-12 years; 83% African American; 83% on free or reduced-price lunch). The student-centered intervention was consistent with self-determination (motivation) theory and social cognitive theory in that it emphasized increasing intrinsic motivation and behavioral skills for PA. Intervention adolescents took ownership in selecting a variety of PA activities in which to participate, and they generated coping strategies for making effective PA behavior changes. RESULTS: Intervention participants showed greater increases in accelerometer estimates of time spent in moderate PA, moderate-to-vigorous PA, and vigorous PA from baseline to Week 4 of the intervention than the comparison group. Intervention participants also showed greater increases in PA motivation and positive self-concept for PA than comparison adolescents. CONCLUSIONS: This study provides preliminary evidence that increasing adolescent involvement and choice of activities may be important in developing future PA interventions for underserved adolescents.

Awareness and use of community walking trails.

BACKGROUND: Community trail development is an emerging strategy to increase physical activity (PA) among community residents. The purpose of this study was to assess awareness and use of trails and compare perceptions to objective data. METHODS: A telephone survey was administered to a stratified sample of adults (N = 1,112) in a southeastern county in the United States. Respondents' home addresses and the locations of trails were entered into a GIS database. A kappa statistic was used to measure agreement between awareness and presence of trails. Differences in reported trail use patterns by sex, race, education, and PA levels were evaluated. RESULTS: There was no agreement between the awareness and presence of trails (kappa = 0.07). Fifty-six percent of the respondents reported having trails; however, only 33% reported using the trails. Of the trail users, 42% reported being regularly active in moderate-to-vigorous PA (30+ min/day for 5+ days/week), and 51% reported being less active (P < 0.003). Among walkers (> or =30 min/day for > or =5 days/week), 49% of regular walkers and 35% of irregular walkers (< walkers) reported using the trails (P < 0.04). CONCLUSIONS: Awareness of existing trails in this community and levels of use were low. Marketing programs should promote awareness and use of trails among older adults and irregularly active adults.