Participation and physical activity in organized recess tied to physical education in elementary schools: An interventional study.

Maintaining physical activity habits is important for long-term health benefits. Many children do not achieve the World Health Organization (WHO) benchmark of 60 min Moderate-to-Vigorous Physical Activity (MVPA) daily. Comprehensive school physical activity programs (CSPAP) target all opportunities at school for children to be physically active. The purpose of this intervention study was to investigate boys' and girls' voluntary participation and MVPA in physical activity recess sessions during and after these were connected with the content of physical education. 147 (55 girls, 92 boys; mean age = 8 years) second grade children from seven different schools received a 10-lesson parkour unit in physical education and were concurrently offered five parkour recess sessions. After the parkour unit in physical education (i.e., maintenance) another five parkour sessions in which children could voluntarily participate were organized. Systematic observation tools were used to assess children's MVPA. Overall participation in parkour recess was 64% for both boys and girls. Participation decreased from intervention to maintenance phase for both boys (75% vs 54%; p < .001) and girls (80% vs 49%; p < .001). MVPA was higher for boys compared to girls in parkour recess (64% vs 58%; p = .002) and traditional recess (49% vs 39%; p = .006), but not in physical education (40% vs 37%). One aspect of physical activity promotion is to connect recess activities with the content taught in physical education, which could contribute up to 20% of the daily recommended MVPA. Positive effects maintained when the connection between physical education and recess stopped.

The Role of Content Knowledge in Influencing Student Physical Activity, On-Task Behavior, and Skill Performance.

Purpose: The purpose of this study was to compare the impact of interventions aimed at improving teacher's content knowledge on students' MVPA, on-task behavior, and skill performance. Differences between treatment and comparison groups were further examined by skill level and gender. Method: We conducted a retroactive analysis of teacher and student data from two randomly controlled trials and one well-controlled quasi-experimental trial measuring MVPA, student performance in badminton, and on-task behavior in lessons. We used descriptive and ANOVA analyses to determine our results. Results: The data show statistically significant effects for student performance and MVPA, and statistically significant effects for on-task performance between groups. Effect sizes for student performance exceed 1SD. MVPA for two of the three studies exceeded the 50% of the lesson criterion. Data are reported for high, average and low skilled students for each variable. Conclusions: This is the first study to examine three important outcomes of physical education, namely skill performance, MVPA, and on-task behavior in one investigation. Our results show that multiple objectives in physical education can be achieved. A strength of the study is that we did not sample any of our variables. The data represent a complete picture of every trial, and continuous interval recording for MVPA and on-task variables occurring in each lesson.

Leading the way together: a cluster randomised controlled trial of the 5R Shared Leadership Program in older adult walking groups.

BACKGROUND: With a rapidly ageing society, healthy ageing has become a key challenge. Engagement in physical activity, and particularly walking, is a key strategy that contributes to healthy ageing amongst older adults. The purpose of the present study was to evaluate the efficacy of a group walking program for older adults that incorporates the 5R Shared Leadership Program (5RS). By implementing a structure of shared leadership and strengthening peer leaders' identity leadership, 5RS aims to cultivate a shared social identity amongst participants, which has in other contexts been associated with greater performance and well-being. METHODS: A cluster randomised controlled trial was conducted to test the efficacy of the 5RS group walking program on group identification, group cohesion, walking activity, and well-being, compared to a regular group walking program for older adults. Nineteen older adult walking groups (i.e., the clusters; N = 503; Mage = 69.23 years, SD = 6.68) all participated in a 12-week structured group walking program. Nine walking groups (n = 304) were randomly assigned to the intervention in which participants received the 5RS program in addition to regular group walking. RESULTS: 5RS was successful in strengthening the identity leadership qualities of the appointed peer leaders. Multilevel regressions showed that 5RS succeeded in increasing group cohesion and walking activity to a greater extent than a regular group walking program, while participants' group identification and well-being increased to a similar extent in both conditions. Furthermore, structural equation modelling revealed that group identification mediated the impact of peer leaders' identity leadership on group cohesion and well-being (but not walking activity). CONCLUSION: By harnessing the capacity of the group and its peer leaders, the 5RS program offers a promising intervention to engage older adults in physical activity. TRIAL REGISTRATION: The study was retrospectively registered as clinical trial on 9 September 2021 ( NCT05038423 ).

The effect of content knowledge and repeated teaching on teaching and learning basic life support: a cluster randomised controlled trial.

BACKGROUND: Experimental research on the training of BLS instructors and how their performance evolves is scarce. This study investigated the role of content knowledge and repeated teaching trials for improving teaching and learning Basic Life Support (BLS). METHODS: A cluster randomised controlled trial. Six secondary school teachers were assigned to either a common content knowledge (CCK) or specialised content knowledge (SCK) training. In the CCK group, teachers were taught to perform BLS technically correct. In the SCK group, teachers were additionally taught to detect and correct common errors students would make. Following the training, teachers taught two BLS lessons to two different classes of secondary school students (n = 216, age 12-14). Teachers' lesson organisation in terms of cognitive (e.g. task presentations), motor (e.g. practice time), and general (e.g. getting organised) activities was assessed. Students' BLS and CPR performance was assessed as the primary outcomes. RESULTS: BLS performance was significantly higher in the second lesson for students taught by SCK versus CCK teachers (73% vs 63%). No significant difference was detected between lesson one and two across conditions and teachers. For cardiopulmonary resuscitation (CPR) variables, significant differences in favour of the SCK condition were found for chest compression depth after lesson one, and the amount and volume of ventilations after lesson two. CONCLUSION: Students' BLS and CPR performance was positively impacted by the SCK training. BLS performance varied greatly by teachers with averages ranging from 53% to 83% across conditions. Results suggest teaching experience alone is not sufficient to improve teaching effectiveness.

Comparing student nurse knowledge and performance of basic life support algorithm actions: An observational post-retention test design study.

This study aims to identify which basic life support skills of student nurses deteriorate in a period of four months. Secondly, it investigates the link between a specific cognitive skill and its corresponding motor skill in BLS. The population for this study consisted of 169 general nursing students within the first year cohort of a three-year undergraduate nursing education program. Following a BLS course, a multiple-choice questionnaire and a BLS performance test on a manikin was administered two weeks (post) and four months (retention) after the course. Seven BLS subcomponents were compared. In both the post and retention test, knowledge was better than the corresponding motor skill for five of the seven subcomponents. Two weeks after training, more than 50% of the students failed to perform 'time to check respiration', 'ventilation volume', 'compression depth' and 'compression frequency' correctly. Four months after training, significantly more students reached a correct 'ventilation volume' but performed it incorrectly. Nurse educators are recommended to spend more time on hands-on skills practice than on theory. Special attention should be given to the performance of a correct ventilation technique, a sufficiently deep chest compression and a correct compression frequency.

Mastery versus self-directed blended learning in basic life support: a randomised controlled trial.

Background: Blended learning combines online learning with face-to-face learning. Research investigating the effect of different blended learning models to teach basic life support (BLS) is lacking.Objectives: To investigate the effect of a mastery learning (ML) versus a self-directed learning (SDL) blend on students' BLS performance. In ML, students learn BLS as a linear sequence meaning each step should be 'mastered' prior to advancing to the next. In SDL, students' autonomy is increased for his or her learning trajectory leading to non-linear, user driven learning paths.Methods: A randomised controlled trial. Four conditions were created by combining two learning models (SDL and ML) in two learning phases (online and face to face). Bachelor students (n = 145) were randomised over these four conditions. In all blends, an online learning module was available for one week prior to a face-to-face learning component of which the duration was 45 minutes. All learners' BLS performance was assessed individually and unannounced one week following blended learning. An individual BLS score was calculated combining cardiopulmonary resuscitation (CPR) variables reported by a Laerdal ResusciAnne Manikin and qualitative observations by two trained researchers.Results: Students' CPR performance adhered to international 2015 guidelines for all groups. Median BLS-performance was 83.0% (interquartile range 13.2%). No statistical differences between groups were found for BLS performance or CPR variables.Conclusions: All blended learning models were highly time-effective since the face-to-face component only took 45 minutes and learning outcomes adhered to guidelines.

Effects of Generalization of Engagement in Parkour from Physical Education to Recess on Physical Activity.

PURPOSE: To investigate the effect of generalization of engagement in parkour from physical education (PE) to organized and supervised recess on voluntary participation and moderate-to-vigorous physical activity (MVPA). METHOD: Children received a 6-day parkour unit in PE and every two lessons they could voluntarily participate in 20-min parkour recess. Fourteen elementary school classes constituting 281 children (8-10 years old) and 16 PE teachers were randomized to either three supervised or three organized parkour recess sessions. During supervised recess, PE teachers supervised to ensure safety, and children could play freely on the parkour landscape. During organized recess, PE teachers provided instructional tasks as well as supervision for safety on the parkour landscape. The parkour landscape in the gymnasium was identical in both recess conditions and similar to previous parkour landscape in PE. Participation and MVPA were measured using systematic observation. RESULTS: Significantly more children from organized compared to supervised recess participated in all three sessions (60% vs. 43%, p = .008, V = .16). Children showed significantly less sedentary behavior (24% vs. 30%, p = .013, η2 = .063) and more MVPA (76% vs. 70%, p = .012, η2 = .066) during organized compared to supervised recess. The proportion of total MVPA spent doing parkour was significantly higher in organized compared to supervised recess for low- (36% vs. 24%, p = .005, η2 = .082) and high-skilled children (33% vs. 26%, p = .034, η2 = .048). CONCLUSION: Generalization of engagement in parkour was higher in organized compared to supervised recess.

The Effect of Organized Versus Supervised Recess on Elementary School Children's Participation, Physical Activity, Play, and Social Behavior: A Cluster Randomized Controlled Trial.

BACKGROUND: Recess strategies that increase children's physical activity and contribute to the daily 60 minutes of moderate to vigorous physical activity (MVPA) are recommended. METHODS: A cluster randomized trial was conducted to examine the effect of supervised versus organized recess on children's participation, physical activity, play, and social behavior. In supervised recess, children were free to play, and physical education (PE) teachers ensured safety. In organized recess, PE teachers provided challenging tasks. Data were collected using systematic observation. Children (N = 281; 8-10 y) from 14 schools received a 6-day parkour unit in PE and three opportunities to participate in a 20-minute parkour recess. Schools were randomized over a supervised and organized parkour recess condition. RESULTS: The majority of children participated in parkour recess (range = 56%-85%), with more boys participating in all 3 organized versus supervised recess sessions (57% vs 35%, P = .01). Boys spent more time in MVPA during organized recess (79% vs 71%, P = .02). Boys and girls spent more time in activity games during organized recess (59% vs 46%, P = .01; 59% vs 47%, P = .001). CONCLUSION: Organized recess attracted more children and made the largest contribution to daily MVPA.

Children saving lives: Training towards CPR excellence levels in chest compression based on age and physical characteristics.

BACKGROUND: The World Health Organization's endorsement of the "Kids save lives" statement fosters the implementation of cardiopulmonary resuscitation (CPR) training for school children worldwide. However, not every child achieves and maintains the recommended chest compression depth of 5-6cm. PURPOSE: To investigate the variability in compression depth for three age groups (grade 1: 12-14; grade 2: 14-16; grade 3: 16-18 years) as a function of physical characteristics and to define minimal compression excellence levels for training. METHODS: Compression depth of 265 subjects (111 girls, 154 boys) aged 12-18 years from one secondary school was individually assessed and reported in percentiles per age group. Pearson correlations between physical characteristics and CPR variables were calculated. Excellence level was defined as the percentage compressions with depth 5-6cm. RESULTS: In grade 1 (12-14 years), achieved excellence levels were 1% for girls and 23% for boys at the 75th percentile. In grade 2 (14-16 years), it increased to 24% for girls and 80% for boys. In grade 3 (16-18 years) finally, it was 59% for girls and 87% for boys. Significant positive correlations were found between CPR and physical variables (p<0.05), especially weight >50kg (p<0.01). CONCLUSION: A minimal excellence level of 25% is achievable by boys 12-14year and girls 14-16year and can be gradually improved to 60% and 90% according to age and gender. This might necessitate more exertion and training for some younger children, especially girls, and will probably be more easily achieved for children weighing >50kg.

The effect of a specialized content knowledge workshop on teaching and learning Basic Life Support in elementary school: A cluster randomized controlled trial.

BACKGROUND: Research investigating the effect of specialised content knowledge (SCK) on teaching and learning Basic Life Support (BLS) is lacking. PURPOSE: To investigate the effect of a specialised content knowledge workshop on teaching behaviour, lesson context and student learning of BLS. Specialised content knowledge comprises knowledge of content progressions, skill analysis, and how to correct common errors. METHODS: A cluster randomized controlled trial. Ten elementary teachers from three schools were assigned to a common content knowledge (n=4) and specialized content knowledge condition (n=6). Common content knowledge teachers received a 50-min BLS workshop focused on learning BLS. Next to learning BLS, specialised content knowledge teachers also practised the teaching of BLS focussing on skill progressions, skill analysis and how to correct common errors children would likely make. Teachers then taught one BLS lesson and their behaviour together with lesson context was collected through direct observation. BLS performance of 203 children (mean age: 11.3 years) was individually assessed immediately after the lesson. RESULTS: Students taught by specialised content knowledge teachers spent more time practising BLS (57% vs 30%), were less engaged in cognitive activities (29% vs 55%) and achieved a significantly higher BLS performance (62% vs 57%) compared to students taught by common content knowledge teachers, P<.05. Specialised content knowledge teachers on average gave more feedback (31 vs 19). DISCUSSION AND CONCLUSION: This study demonstrates that a 50-min workshop with a focus on specialised content knowledge impacted teachers' in-class behaviour, which in turn significantly improved students' BLS performance.

Peer-assisted Learning in Cardiopulmonary Resuscitation: The Jigsaw Model.

BACKGROUND: Training a large cohort of the population could, over time, increase the rate of bystander cardiopulmonary resuscitation (CPR) and survival after out-of-hospital cardiac arrest. OBJECTIVES: This study investigates 1) the quality of peer-assisted learning (PAL) by means of the jigsaw method compared to direct teaching by an instructor for learning CPR, and 2) the extent to which acquired skills can be passed on from tutor to tutee without loss of learning. METHODS: One hundred thirty-seven master students were randomized into a jigsaw and a control group. In the jigsaw group, subjects were randomly split into a chest compression group (CC) and a ventilation group (VEN). After each group had learned the respective skill by an expert instructor, all students were randomized into pairs and taught their partner the acquired skill. In the control group, both skills were taught by the expert instructor. CPR assessment was individually conducted 1 week prior to intervention (baseline) and 2 weeks after (post) on a manikin using a PC-Skill Reporting System. RESULTS: At baseline, no significant differences were observed between the three groups. At post, all groups met the European Resuscitation Council (ERC) 2010 guidelines. No significant difference was observed between the jigsaw and control group. One significant difference was found between the VEN and CC group for chest compression depth (p < 0.01). CONCLUSION: This study demonstrated that the jigsaw model is as effective as expert instruction to achieve the ERC 2010 guidelines. Only one difference was found between the tutor and tutee group.

A multiple linear regression analysis of factors affecting the simulated Basic Life Support (BLS) performance with Automated External Defibrillator (AED) in Flemish lifeguards.

BACKGROUND: Research investigating lifeguards' performance of Basic Life Support (BLS) with Automated External Defibrillator (AED) is limited. AIM: Assessing simulated BLS/AED performance in Flemish lifeguards and identifying factors affecting this performance. METHODS: Six hundred and sixteen (217 female and 399 male) certified Flemish lifeguards (aged 16-71 years) performed BLS with an AED on a Laerdal ResusciAnne manikin simulating an adult victim of drowning. Stepwise multiple linear regression analysis was conducted with BLS/AED performance as outcome variable and demographic data as explanatory variables. RESULTS: Mean BLS/AED performance for all lifeguards was 66.5%. Compression rate and depth adhered closely to ERC 2010 guidelines. Ventilation volume and flow rate exceeded the guidelines. A significant regression model, F(6, 415)=25.61, p<.001, ES=.38, explained 27% of the variance in BLS performance (R2=.27). Significant predictors were age (beta=-.31, p<.001), years of certification (beta=-.41, p<.001), time on duty per year (beta=-.25, p<.001), practising BLS skills (beta=.11, p=.011), and being a professional lifeguard (beta=-.13, p=.029). 71% of lifeguards reported not practising BLS/AED. DISCUSSION: Being young, recently certified, few days of employment per year, practising BLS skills and not being a professional lifeguard are factors associated with higher BLS/AED performance. CONCLUSION: Measures should be taken to prevent BLS/AED performances from decaying with age and longer certification. Refresher courses could include a formal skills test and lifeguards should be encouraged to practise their BLS/AED skills.

Learning basic life support (BLS) with tablet PCs in reciprocal learning at school: are videos superior to pictures? A randomized controlled trial.

BACKGROUND: It is often assumed that animations (i.e., videos) will lead to higher learning compared to static media (i.e., pictures) because they provide a more realistic demonstration of the learning task. AIM: To investigate whether learning basic life support (BLS) and cardiopulmonary resuscitation (CPR) from video produce higher learning outcomes compared to pictures in reciprocal learning. METHODS: A randomized controlled trial. A total of 128 students (mean age: 17 years) constituting eight intact classes from a secondary school learned BLS in reciprocal roles of doer and helper with tablet PCs. Student pairs in each class were randomized over a Picture and a Video group. In the Picture group, students learned BLS by means of pictures combined with written instructions. In the Video group, BLS was learned through videos with on-screen instructions. Informational equivalence was assured since instructions in both groups comprised exactly the same words. BLS assessment occurred unannounced, three weeks following intervention. RESULTS: Analysis of variance demonstrated no significant differences in chest compression depths between the Picture group (M=42 mm, 95% CI=40-45) and the Video group (M=39 mm, 95% CI=36-42). In the Picture group significantly higher percentages of chest compressions with correct hand placement were achieved (M=67%, CI=58-77) compared to the Video group (M=53%, CI=43-63), P=.03, η(p)(2)=.03. No other significant differences were found. CONCLUSION: Results do not support the assumption that videos are superior to pictures for learning BLS and CPR in reciprocal learning.

Reciprocal learning with task cards for teaching Basic Life Support (BLS): investigating effectiveness and the effect of instructor expertise on learning outcomes. A randomized controlled trial.

BACKGROUND: Basic Life Support (BLS) education in secondary schools and universities is often neglected or outsourced because teachers indicate not feeling competent to teach this content. OBJECTIVE: Investigate reciprocal learning with task cards as instructional model for teaching BLS and the effect of instructor expertise in BLS on learning outcomes. METHODS: There were 175 students (mean age = 18.9 years) randomized across a reciprocal/BLS instructor (RBI) group, a reciprocal/non-BLS instructor (RNI) group, and a traditional/BLS instructor group (TBI). In the RBI and RNI group, students were taught BLS through reciprocal learning with task cards. The instructor in the RBI group was certified in BLS by the European Resuscitation Council. In the TBI, students were taught BLS by a certified instructor according to the Belgian Red Cross instructional model. Student performance was assessed 1 day (intervention) and 3 weeks after intervention (retention). RESULTS: At retention, significantly higher BLS performances were found in the RBI group (M = 78%), p = 0.007, ES = 0.25, and the RNI group (M = 80%), p < 0.001, Effect Size (ES) = .36, compared to the TBI (M = 73%). Significantly more students remembered and performed all BLS skills in the experimental groups at intervention and retention. No differences in BLS performance were found between the reciprocal groups. Ventilation volumes and flow rates were significantly better in the TBI at intervention and retention. CONCLUSION: Reciprocal learning with task cards is a valuable model for teaching BLS when instructors are not experienced or skilled in BLS.

The design of instructional tools affects secondary school students' learning of cardiopulmonary resuscitation (CPR) in reciprocal peer learning: a randomized controlled trial.

BACKGROUND: Research investigating design effects of instructional tools for learning Basic Life Support (BLS) is almost non-existent. AIM: To demonstrate the design of instructional tools matter. The effect of spatial contiguity, a design principle stating that people learn more deeply when words and corresponding pictures are placed close (i.e., integrated) rather than far from each other on a page was investigated on task cards for learning Cardiopulmonary Resuscitation (CPR) during reciprocal peer learning. METHODS: A randomized controlled trial. A total of 111 students (mean age: 13 years) constituting six intact classes learned BLS through reciprocal learning with task cards. Task cards combine a picture of the skill with written instructions about how to perform it. In each class, students were randomly assigned to the experimental group or the control. In the control, written instructions were placed under the picture on the task cards. In the experimental group, written instructions were placed close to the corresponding part of the picture on the task cards reflecting application of the spatial contiguity principle. RESULTS: One-way analysis of variance found significantly better performances in the experimental group for ventilation volumes (P=.03, ηp2=.10) and flow rates (P=.02, ηp2=.10). For chest compression depth, compression frequency, compressions with correct hand placement, and duty cycles no significant differences were found. CONCLUSION: This study shows that the design of instructional tools (i.e., task cards) affects student learning. Research-based design of learning tools can enhance BLS and CPR education.

Peer evaluation in reciprocal learning with task cards for acquiring Basic Life Support (BLS).

BACKGROUND: Research emphasises the need for instructional methods and tools which can improve Basic Life Support (BLS) performance or reduce instructional time. AIM: To investigate the effect of peer evaluation to improve reciprocal learning with task cards as instructional tools for acquiring BLS. METHODS: A total of 78 kinesiology students from a Belgian university were paired and randomised across two groups to learn BLS in 20min with task cards. In the control group, students worked together in a defined doer-helper relationship and switched roles every 5min. In the peer evaluation group, students followed the same co-operation procedure as in the control group. In addition, 1min before every switching of roles, the helper evaluated the doer's performance. All BLS skills were individually assessed on a Laerdal AED Resusci Anne mannequin (Laerdal Medical, Vilvoorde, Belgium) using the Laerdal PC-Skill reporting system. A total BLS score was calculated and performance was measured before training (baseline), immediately after training (intervention) and 2 weeks later (retention). RESULTS: Significantly more students from the evaluation group remembered and consequently performed all BLS skills at intervention (P=0.03). No significant differences were found between groups for main cardiopulmonary resuscitation (CPR) variables and total BLS scores at baseline, intervention and retention. Both groups achieved more than 70% of the maximum BLS score at intervention and retention. CONCLUSIONS: This study demonstrated that 20min reciprocal-learning setting with task cards is an effective method to learn BLS. The implementation of peer evaluation in this setting has an immediate, however small, positive impact on BLS skill learning.