Fitness promotion in college: the relationships among students' perceived physical literacy, knowledge, and physical fitness.

Purpose: The purpose of this study was to examine the relationships among perceived physical literacy (PPL), knowledge of physical activity and fitness (PAF knowledge), and physical fitness. Methods: Undergraduates (N = 968, female = 414; Mage = 18.64) from a public university in central China completed a simplified Chinese version of the PPL instrument, an online test for PAF knowledge, and seven health-related physical fitness tests. The PPL includes three dimensions: (a) confidence and physical competence, (b) motivation, and (c) interaction with the environment. The fitness tests measured lung capacity, body mass index (BMI), and performances in 800 (female)/1000 (male) meters run, 50 meters dash (50 M), sit-up (female) / pull-up (male), standing long jump (SLJ), and sit-and-reach. Results: PPL and its dimensions significantly predicted six fitness test performances both in male (ß: -0.42 - 0.37; p < 0.01-0.05; R2: 0.01-0.13) and female (ß: -0.59 - 0.49; p < 0.01-0.05; R2: 0.03-0.13) students. PAF knowledge (ß: -0.17 - 0.18; p < 0.01-0.05; R2: 0.01-0.05) significantly predicted BMI (males) and performances in 50 M (females) and SLJ (females) tests. Conclusion: To support college students' fitness development and maintenance, tailored physical activity and fitness promotion programs are needed to strengthen students' PPL and PAF knowledge.

The enhanced connectivity between the frontoparietal, somatomotor network and thalamus as the most significant network changes of chronic low back pain.

The prolonged duration of chronic low back pain (cLBP) inevitably leads to changes in the cognitive, attentional, sensory and emotional processing brain regions. Currently, it remains unclear how these alterations are manifested in the interplay between brain functional and structural networks. This study aimed to predict the Oswestry Disability Index (ODI) in cLBP patients using multimodal brain magnetic resonance imaging (MRI) data and identified the most significant features within the multimodal networks to aid in distinguishing patients from healthy controls (HCs). We constructed dynamic functional connectivity (dFC) and structural connectivity (SC) networks for all participants (n = 112) and employed the Connectome-based Predictive Modeling (CPM) approach to predict ODI scores, utilizing various feature selection thresholds to identify the most significant network change features in dFC and SC outcomes. Subsequently, we utilized these significant features for optimal classifier selection and the integration of multimodal features. The results revealed enhanced connectivity among the frontoparietal network (FPN), somatomotor network (SMN) and thalamus in cLBP patients compared to HCs. The thalamus transmits pain-related sensations and emotions to the cortical areas through the dorsolateral prefrontal cortex (dlPFC) and primary somatosensory cortex (SI), leading to alterations in whole-brain network functionality and structure. Regarding the model selection for the classifier, we found that Support Vector Machine (SVM) best fit these significant network features. The combined model based on dFC and SC features significantly improved classification performance between cLBP patients and HCs (AUC=0.9772). Finally, the results from an external validation set support our hypotheses and provide insights into the potential applicability of the model in real-world scenarios. Our discovery of enhanced connectivity between the thalamus and both the dlPFC (FPN) and SI (SMN) provides a valuable supplement to prior research on cLBP.

Dysregulated neural activity between the thalamus and cerebral cortex mediates cortical reorganization in cervical spondylotic myelopathy.

Neuroimaging research has revealed significant changes in brain structure and function in patients with cervical spondylotic myelopathy(CSM). The thalamus plays a crucial role in this process, although its mechanisms of action remain incompletely understood. This study aimed to investigate whether spinal cord compression leads to alterations in the functional connectivity between the thalamus and the cerebral cortex, and to determine if such changes are associated with structural and functional remodeling of the brain in patients with CSM, and to identify potential neuroimaging biomarkers for classification. The study included 40 patients with CSM and 34 healthy controls(HCs) who underwent resting-state functional magnetic resonance imaging(fMRI) and structural MRI scans. Brain structural and functional metrics were quantified using functional connectivity(FC), fractional amplitude of low-frequency fluctuations(fALFF), surface-based morphometry(SBM), and independent component analysis(ICA) based on functional and structural MRI. Patients with CSM exhibited significantly reduced fALFF in the bilateral lateral lingual gyrus, bilateral calcarine fissure, left precentral gyrus and postcentral gyrus, left middle and superior occipital gyrus, left superior marginal gyrus, left inferior parietal gyrus, and right Rolandic operculum. ICA results revealed weakened functional connectivity between the sensorimotor network (SMN) and the left and right frontoparietal network(FPN), and lateral visual network (lVN), along with decreased connectivity between lVN and rFPN, and increased connectivity between lFPN and rFPN. Patients with CSM also had decreased sulcus depth in the bilateral insula, left precentral and postcentral gyrus, and right lingual gyrus and calcarine fissure. Furthermore, cervical spondylotic myelopathy patients showed decreased functional connectivity between the left ventral posterolateral nucleus (VPL) of the thalamus and the right middle occipital gyrus (MOG). Finally,multimodal neuroimaging with support vector machine(SVM) classified patients with CSM and healthy controls with 86.00% accuracy. Our study revealed that the decrease in functional connectivity between the thalamus and cortex mediated by spinal cord compression leads to structural and functional reorganization of the cortex. Features based on neuroimaging markers have the potential to become neuroimaging biomarkers for CSM.

Temporal Changes in Energy-Balance Behaviors and Home Factors in Adolescents with Normal Weight and Those with Overweight or Obesity.

This study aimed to examine the temporal changes in energy-balance behaviors and home factors in adolescents with normal weight and those with overweight or obesity (OWOB). Adolescents or parent proxies completed survey assessments two to four years before (T0; n=82), ≤ six months before (T1; n=68), and ≤ three months after the COVID-19 pandemic outbreak (T2; n=82), to capture energy-balance behaviors (i.e., physical activity [PA], screen time, sleep) and home factors (i.e., food environment, food worry, parent support for PA). At T0 and T1 (before pandemic), participants visited our laboratory for anthropometric measurements. At T2, parent proxies also completed a survey to report the COVID-19 pandemic exposure and impact. The participating families experienced moderate levels of pandemic exposure and impact, although exposure was higher in the OWOB group F1,78=5.50,p<.05. Repeated-measure multivariate analyses of covariance (RM-MACOVAs) did not show significant time by weight status interaction effects (p>0.05; adjusted for race and sex). However, the models detected significant time (T0 vs. T2) by race (White vs. non-White) interaction effect λ7,66=0.81,p<0.05, with greater increase in food worry F1,72=4.36,p<.05 but less increase in screen time F1,72=4.54,p<.05 among the non-White group. Graphical visualization depicted some favorable change patterns in adolescents with normal weight (vs. those with OWOB) for certain behaviors and home factors (e.g., number of days per week ≥ 60 mins PA, food worry). These findings suggest that the COVID-19 pandemic exerted greater adverse effects on adolescents with OWOB and specifically on screen time and food worry among non-White adolescents.

MOF-derived nitrogen-doped porous carbon nanofibers with interconnected channels for high-stability Li+/Na+ battery anodes.

Heteroatom-doped porous carbon materials have been widely used as anode materials for Li-ion and Na-ion batteries, however, improving the specific capacity and long-term cycling stability of ion batteries remains a major challenge. Here, we report a facile based metal-organic framework (MOFs) strategy to synthesize nitrogen-doped porous carbon nanofibers (NCNFs) with a large number of interconnected channels that can increase the contact area between the material and the electrolyte, shorten the diffusion distance between Li+/Na+ and the electrolyte, and relieve the volume expansion of the electrode material during cycling; the doping of nitrogen atoms can improve the conductivity and increase the active sites of the carbon material, can also affect the microstructure and electron distribution of the electrode material, thereby improving the electrochemical performance of the material. As expected, the obtained NCNFs-800 exhibited excellent electrochemical performance with high reversible capacity (for Li+ battery anodes: 1237 mA h g-1 at 100 mA g-1 after 200 cycles, for Na+ battery anodes: 323 mA h g-1 at 100 mA g-1 after 150 cycles) and long-term cycling stability (for Li+ battery anodes: 635 mA h g-1 at 2 A g-1 after 5000 cycles, for Na+ battery anodes: 194 mA h g-1 at 2 A g-1 after 5000 cycles).

Remodeling of the brain correlates with gait instability in cervical spondylotic myelopathy.

Introduction: Cervical spondylotic myelopathy (CSM) is a common form of non-traumatic spinal cord injury (SCI) and usually leads to remodeling of the brain and spinal cord. In CSM with gait instability, the remodeling of the brain and cervical spinal cord is unclear. We attempted to explore the remodeling of these patients' brains and spinal cords, as well as the relationship between the remodeling of the brain and spinal cord and gait instability. Methods: According to the CSM patients' gait, we divided patients into two groups: normal gait patients (nPT) and abnormal gait patients (aPT). Voxel-wise z-score transformation amplitude of low-frequency fluctuations (zALFF) and resting-state functional connectivity (rs-FC) were performed for estimating brain changes. Cross-sectional area (CSA) and fractional anisotropy (FA) of the spinal cord were computed by Spinal cord toolbox. Correlations of these measures and the modified Japanese Orthopedic Association (mJOA) score were analyzed. Results: We found that the zALFF of caudate nucleus in aPT was higher than that in healthy controls (HC) and lower than that in nPT. The zALFF of the right postcentral gyrus and paracentral lobule in HC was higher than those of aPT and nPT. Compared with the nPT, the aPT showed increased functional connectivity between the caudate nucleus and left angular gyrus, bilateral precuneus and bilateral posterior cingulate cortex (PCC), which constitute a vital section of the default mode network (DMN). No significantly different FA values or CSA of spinal tracts at the C2 level were observed between the HC, nPT and aPT groups. In CSM, the right paracentral lobule's zALFF was negatively correlated with the FA value of fasciculus gracilis (FCG), and the right caudate zALFF was positively correlated with the FA value of the fasciculus cuneatus (FCC). The results showed that the functional connectivity between the right caudate nucleus and DMN was negatively correlated with the CSA of the lateral corticospinal tract (CST). Discussion: The activation of the caudate nucleus and the strengthening functional connectivity between the caudate nucleus and DMN were associated with gait instability in CSM patients. Correlations between spinal cord and brain function might be related to the clinical symptoms in CSM.

A cluster-randomized trial comparing two SWITCH implementation support strategies for school wellness intervention effectiveness.

BACKGROUND: The School Wellness Integration Targeting Child Health (SWITCH) intervention has demonstrated feasibility as an implementation approach to help schools facilitate changes in students' physical activity (PA), sedentary screen time (SST), and dietary intake (DI). This study evaluated the comparative effectiveness of enhanced (individualized) implementation and standard (group-based) implementation. METHODS: Twenty-two Iowa elementary schools participated, with each receiving standardized training (wellness conference and webinars). Schools were matched within region and randomized to receive either individualized or group implementation support. The PA, SST, and DI outcomes of 1097 students were assessed at pre- and post-intervention periods using the Youth Activity Profile. Linear mixed models evaluated differential change in outcomes by condition, for comparative effectiveness, and by gender. RESULTS: Both implementation conditions led to significant improvements in PA and SST over time (p < 0.01), but DI did not improve commensurately (p value range: 0.02‒0.05). There were no differential changes between the group and individualized conditions for PA (p = 0.51), SST (p = 0.19), or DI (p = 0.73). There were no differential effects by gender (i.e., non-significant condition-by-gender interactions) for PA (pfor interaction = 0.86), SST (pfor interaction = 0.46), or DI (pfor interaction = 0.15). Effect sizes for both conditions equated to approximately 6 min more PA per day and approximately 3 min less sedentary time. CONCLUSION: The observed lack of difference in outcomes suggests that group implementation of SWITCH is equally effective as individualized implementation for building capacity in school wellness programming. Similarly, the lack of interaction by gender suggests that SWITCH can be beneficial for both boys and girls. Additional research is needed to understand the school-level factors that influence implementation (and outcomes) of SWITCH.

Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: A Delphi study.

INTRODUCTION: As the frequency of infectious diseases rises, it's more important than ever to pay attention to the competency level of front-line nurses as the primary force in front-line rescue, which has an impact on the quality of anti-epidemic response. This paper aims to construct the competency evaluation index system for front-line nurses during the outbreak of major infectious diseases. MATERIALS AND METHODS: This study combined literature review, critical incident technique interviews, and semi-structured in-depth interviews, as well as two rounds of Delphi expert correspondence, to construct a competence evaluation index system for front-line nurses during the outbreak of major infectious diseases. The study used purposive sampling to select 26 experts from 11 provinces and cities across China to conduct two rounds of Delphi expert consultation, and the indicators were selected based on the mean importance score > 3.5 and the coefficient of variation < 0.25, and the weights of the indicators were calculated by the Analytic Hierarchy Process. The effective recovery rates of the two rounds of correspondence questionnaires were 93.1% and 96%. RESULTS: The effective recovery rates of the two rounds of correspondence questionnaires were 93.1% and 96%, the authority coefficients of experts were 0.96 and 0.98, the Kendall's coordination coefficients of the first, second, and third level indexes were 0.281, 0.132, and 0.285 (P < 0.001), 0.259, 0.158, and 0.415 (P < 0.001). The final index system includes 4 primary indicators (Knowledge System of Infectious Diseases, Nursing Skills for Infectious Diseases, Related Professional Abilities for Infectious Diseases, and Comprehensive Quality), 10 secondary indicators, and 64 tertiary indicators. CONCLUSION: The competency evaluation index system of front-line nurses during the outbreak of major infectious diseases is scientific, reasonable, and practical, which can provide a scientific basis for nursing managers to accurately understand, describe, analyze, and evaluate the competence level of nursing staff and scientifically implement the allocation of human resources in the future, as well as serve as a content framework for subsequent training programs.

Degeneration of the Sensorimotor Tract in Degenerative Cervical Myelopathy and Compensatory Structural Changes in the Brain.

Degenerative cervical myelopathy is a progressive neurodegenerative disease, that has become increasingly prevalent in the aging population worldwide. The current study determined the factors affecting degeneration in the sensorimotor tract with degenerative cervical myelopathy and its relationship with brain structure. We divided patients into hyperintensity (HS) and non-hyperintensity (nHS) groups and measured the fractional anisotropy and apparent diffusion coefficients of the lateral corticospinal tract (CST), fasciculus gracilis and fasciculus cuneatus (FGC). Voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) techniques were used to estimate brain structure changes. Correlation of the modified Japanese Orthopaedic Association (mJOA) score, light touch, pinprick, motor score, and fractional anisotropy (FA) ratios of the CST at different levels were analyzed. Compared to healthy controls, the FA ratios of CST in the HS and nHS groups were decreased at all levels, and the apparent diffusion coefficient (ADC) ratio was increased only at C4/5 levels in the HS group. The FA ratio of FGC was decreased at the C3/4 and C4/5 levels in the HS group and only decreased at the C4/5 level in the nHS group. The ADC ratio was decreased only at the C4/5 level in the HS group. VBM analysis revealed that the volume of the precentral gyrus, postcentral gyrus, and paracentral lobule increased in patients compared to controls. TBSS analysis found no statistical significance between the sensory and motor tracts in white matter. The volume of clusters in HS and nHS groups negatively correlated with the C1/2 FA ratio of the CST. The results showed that the degeneration distance of the CST was longer than the FGC, and the degeneration distance was related to the degree of compression and spinal cord damage. Structural compensation and the neurotrophin family may lead to enlargement of the brain.

Adolescents' Behaviors, Fitness, and Knowledge Related to Active Living before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Analysis.

BACKGROUND: Nearly all schools in the United States experienced shutdown followed by phased reopening during the COVID-19 pandemic, thereby limiting students' opportunities for physical activity (PA). This study aimed to examine adolescents' PA at school (PAS) and PA out-of-school (PAO), screen-based sedentary behaviors (SbSB), health-related fitness, and knowledge understanding about PA and fitness before and during the pandemic. METHODS: Three rounds of data were collected: Time 1 pre-pandemic (January 2020; n = 405), Time 2 schools partially reopened (February 2021; n = 412), and Time 3 schools fully reopened (March 2021; n = 450). Adolescents completed the Youth Activity Profile, the 20 m Progressive Aerobic Cardiovascular Endurance Run (PACER) test and Plank test, and a written test, to measure the behaviors (T1, T2, T3), fitness (T2-T3), and knowledge (T1, T2, T3), respectively. RESULTS: Inferential statistical analyses revealed a significant time effect for the behaviors and fitness. From T1 to T2 PAO decreased but PAS increased; whereas SbSB decreased at T3 compared to T1 and T2. Health-related fitness improved from T2 to T3. Further, the change patterns for SbSB varied by grade, and those for knowledge understanding varied by gender. CONCLUSION: The findings confirm the disruptive impact of the COVID-19 pandemic on adolescents' active living but varied by school grade and gender. The favorable changes from T2 to T3 observed for fitness and other constructs may be partially attributable to an interrupted fitness education intervention. The findings may guide the design and evaluation of future interventions addressing the physical inactivity pandemic during public health crises (e.g., COVID-19).

The Roles of Sex and Minority Status in Children's Motivation and Psychomotor Learning.

In this study, we had two inter-related goals: (a) to examine sex and minority status differences on children's motivation for physical education (PE; i.e., their expectancy beliefs, subjective task values, and situational interest) and their psychomotor learning outcomes (i.e., motor competence, cardiorespiratory fitness, and in-class physical activity); and (b) to examine the relationships between children's motivation and their psychomotor learning outcomes while testing the moderation effects of sex and minority status. We recruited 195 fourth and fifth-grade students (101 boys; 94 girls; Mage = 10.7, SD = 0.7 years) from three elementary schools in North Texas. Using multivariate analysis of variance, we identified a significant sex difference that favored boys in motivation and psychomotor learning outcomes, with no significant minority status difference in relation to these variables. Regression analysis revealed that children's expectancy beliefs were significantly associated with both motor competence (R2 = 11%) and cardiorespiratory fitness (R2 = 16%), while both situational interest and sex were associated with in-class physical activity (R2 = 18%). Thus, improving children's expectancy beliefs may be a means of enhancing psychomotor learning outcomes in PE, especially for girls. Enhancing children's beliefs in their own ability and offering diversified PE content so as to generate greater interest may facilitate psychomotor learning.

Learners' motivational response to the Science, PE, & Me! curriculum: A situational interest perspective.

BACKGROUND: The Science, PE, & Me! (SPEM) curriculum is a concept-based physical education curriculum that offers students coherent educational experiences for constructing health-related fitness knowledge through movement experiences. The purpose of this study was to evaluate students' motivational response to the SPEM curriculum from the situational interest perspective. METHODS: The study used a cluster randomized controlled design in which 30 elementary schools in one of the largest metropolitan areas in the eastern United States were randomly assigned to an experimental or comparison condition. Although all students in the 3rd, 4th, and 5th grades in the targeted schools were eligible to participate in the study, a random sample of students from the experimental (n = 1749; 15 schools) and comparison groups (n = 1985; 15 schools) provided data. Students' motivational response to the SPEM curriculum or comparison curriculum was measured using the previously validated Situational Interest Scale-Elementary. Data were analyzed using structural mean modeling. RESULTS: The results demonstrated that the experimental group (as reference group) showed significantly higher enjoyment (z = -2.01), challenge (z = -6.54), exploration (z = -12.195), novelty (z = -8.80), and attention demand (z = -7.90) than the comparison group. CONCLUSION: The findings indicate that the SPEM curriculum created a more situationally interesting context for learning than the comparison physical education curriculum.

Characterizing Middle School Students' Physical Literacy Development: A Self-Determination Theory-Based Pilot Intervention in Physical Education.

Purpose: Positive youth development (PYD) can be achieved through effective and purposeful instructions in physical education (PE) and other relevant experiences both in and beyond schools. Students' PYD is associated with their physical literacy (PL) development, which has become a primary emphasis of PE, especially in the United States, in recent years. This study aimed to (a) characterize middle school students' physical literacy (PL) and (b) capture their PL developing trajectories in light of receiving a self-determination theory (SDT)-based pedagogical workshop, with the long-term vision on PYD. Methods: Participants (N = 226) completed the Canadian Assessment of Physical Literacy (CAPL-2) in physical education (PE). A subsample (n = 49) received four workshop sessions over 8 weeks; and completed the CAPL-2 and participated in focus group interviews before and after the workshop. Results: Both boys and girls' CAPL-2 scores were in the "progressing" stage. Significant differences in PL and PL domains were observed by gender, grade, socioeconomic status (SES), body mass index (BMI), and race/ethnicity. The low PL group showed improvements in PL and PL domains. Interview data delineated positive PL developing trajectories for physical activity (PA) type, frequency, and intensity; perceived motives; and participation barriers. Conclusion: PL is a dynamic state that can be improved through purposeful PE. Future work should examine the effect (and implementation) of opportunities in (e.g., PE) and beyond schools (e.g., youth sports programs) to ultimately advance PYD.

The immediate and durable effects of yoga and physical fitness exercises on stress.

OBJECTIVE: This study aimed to examine the effects of yoga and physical fitness exercises on stress and the underlying mechanisms. Participants: Healthy undergraduates from four yoga and four fitness classes participated in Study 1 (n = 191) and Study 2 (n = 143), respectively (in 2017 Fall). Methods: Study 1 evaluated the immediate effect (a 60-minute practice) while Study 2 evaluated the durable effect (a 12-week intervention). Results: Results showed that immediate stress reduction was more salient in the yoga group than that in the fitness group in Study 1. Yoga group had a greater increase in mindfulness, which predicted stress reduction. Similar observations were made in Study 2 showing the durable effect of yoga on stress reduction through mindfulness. Conclusions: Yoga intervention is better than fitness exercises in helping undergraduates cultivate mindfulness and reduce stress. These findings may guide future interventions in stress management in college students.

Movement behaviors and health-related fitness among peripubertal adolescents: 2012 NHANES national youth fitness survey data.

BACKGROUND: Less than half of adolescents in the United States meet the recommended levels of moderate-to-vigorous physical activity (MVPA) and health-related fitness (HRF). Using the 2012 NHANES National Youth Fitness Survey data, this study aimed to examine the associations of movement behaviors (i.e., MVPA and screen-based sedentary behaviors) with HRF (i.e., cardiovascular and muscular fitness) among 11-16- year-old peripubertal boys and girls, respectively. METHODS: A total of 470 adolescents (227 boys, 243 girls; age: 13.59±1.12 years old) from the 2012 NHANES dataset were included. The study variables included movement behaviors (i.e., MVPA and screen-based sedentary behavior), anthropometric indices (i.e., waist circumference, Body Mass Index [BMI]), and HRF (i.e., cardiovascular fitness and muscular fitness). Correlational and hierarchical regression analyses were conducted for boys and girls, respectively. RESULTS: MVPA significantly predicted cardiovascular fitness for boys (ß=0.16, P<0.05) and girls (ß=0.15, P<0.05) regardless of weight status; screen-based sedentary behavior and waist circumference in girls significantly predicted muscular fitness (ß=-0.13 and ß=-0.42, P<0.05). CONCLUSIONS: To increase overall HRF in peripubertal girls and boys, it is important to help them maintain healthy weight status and to promote MVPA and limit screen-based sedentary behavior, especially in adolescent girls.

Comparing the Psychological Effects of Meditation- and Breathing-Focused Yoga Practice in Undergraduate Students.

OBJECTIVES: The present study aimed to compare the psychological effects of meditation- and breathing-focused yoga practice in undergraduate students. METHODS: A 12-weeks yoga intervention was conducted among a group of undergraduate students enrolled in four yoga classes at an academically prestigious university in Beijing, China. Four classes were randomized to meditation-focused yoga or breathing-focused yoga. A total of 86 participants finished surveys before and after the 12-weeks intervention, measuring work intention, mindfulness, and perceived stress. The repeated-measure multivariate analysis of covariance (MANCOVA) followed by univariate analyses were conducted to examine the differences in work intention, mindfulness, and stress between the two yoga intervention groups over the semester, after controlling for age and gender. RESULTS: The repeated-measure MANCOVA revealed significant group differences with a median effect size [Wilks' lambda, Λ = 0.90, F(3, 80) = 3.10, p = 0.031, η2 = 0.104]. Subsequent univariate analyses showed that students in the breathing-focused yoga group had significant higher work intentions [F (1, 82) = 5.22; p = 0.025; η2 p = 0.060] and mindfulness [F (1, 82) = 6.33; p = 0.014; η2 p = 0.072] but marginally lower stress [F (1, 82) = 4.20; p = 0.044; η2 p = 0.049] than students in the meditation-focused yoga group. CONCLUSION: Yoga practice with a focus on breathing is more effective than that with a focus on meditation for undergraduates to retain energy for work, keep attention and awareness, and reduce stress.

Evaluating the implementation of the SWITCH® school wellness intervention and capacity-building process through multiple methods.

BACKGROUND: School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming. METHODS: As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). RESULTS: Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed non-significant associations between implementation group and gains in school capacity (F [2, 24] = 1.63; p = .21), class capacity (F [2, 24]=0.20 p = .82), lunchroom capacity (F [2, 24]=0.29; p = .78), and physical education (F [2, 24]=1.45; p = .25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy. CONCLUSIONS: The results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.

Evaluating the Implementation and Effectiveness of the SWITCH-MS: An Ecological, Multi-Component Adolescent Obesity Prevention Intervention.

Background: The purpose of this study was to evaluate the implementation and effectiveness of an ecological, multi-component adolescent obesity prevention intervention called School Wellness Integration Targeting Child Health-Middle School (SWITCH-MS). Methods: Following the effectiveness-implementation hybrid type 3 quasi-experimental design, seven middle schools (377 students) in Iowa, United States, were stratified into "experienced" (n = 3; 110 students) or "inexperienced" (n = 4; 267 students) groups to receive the 12-week SWITCH-MS intervention. To evaluate implementation, school informants (n = 10) responded to a survey and students completed behavioral tracking in the classroom on a website. For effectiveness evaluation, students in 6th, 7th, and 8th grades completed a validated questionnaire before and after intervention, to measure behaviors of physical activity (PA; "Do"), screen-based activity ("View"), and fruits and vegetable consumption ("Chew"). Results: The two groups of schools showed similar levels of implementation for best practices, awareness, and engagement. Behavioral tracking rate favored the experienced schools early on (47.5% vs. 11.7%), but differences leveled off in weeks 3-12 (sustained at 30.1-44.3%). Linear mixed models demonstrated significant time effects for "Do" (at school and out of school; p < 0.01) and "View" behaviors (p = 0.02), after controlling for student- and school-level covariates. Conclusions: This study demonstrates that prior experience with SWITCH-MS may not be a prominent factor for implementation and effectiveness, although greater experience is associated with favorable behavioral tracking when the intervention is first launched.

Ethnic Disparities in Mental Health and Movement Behaviors During Childhood: Examining the Longitudinal Developmental Patterns.

PURPOSE: The purpose of this study was to examine the longitudinal developmental patterns of mental health (i.e., physical, psychosocial, and executive functioning) and movement behaviors (i.e., sedentary behavior and moderate-to-vigorous physical activity [MVPA]) between Hispanic and non-Hispanic children. METHOD: We tracked 153 children for 3 years from kindergarten (time 1) to third grade (time 2; 91 Hispanic; mean age = 5.36, SD = .48). Physical, psychosocial, and executive functioning was assessed using validated surveys, while school-based sedentary behavior and MVPA were assessed by accelerometers. RESULT: A 2 × 2 (time × ethnicity) factorial repeated measures MANCOVA (gender and SES as covariates) revealed significant ethnicity effect (p = .05) and time by ethnicity interaction effect (p < .05). Hispanic children reported lower physical (p < .05) and psychosocial functioning (p > .05) but higher executive functioning (p < .05) than non-Hispanic children in kindergarten, but the gaps narrowed in third grade. Results also revealed that children's sedentary behavior increased significantly (p < .05) and MVPA showed a declining trend (p > .05) over time. CONCLUSION: Ethnic disparities in mental health between Hispanic and non-Hispanic children exist but may reduce from early to middle childhood. The longitudinal changes relative to ethnicity highlight the need for tailored interventions to address health disparities in mental health and movement behaviors between Hispanic and non-Hispanic children.

School-Based Sedentary Behavior, Physical Activity, and Health-Related Outcomes among Hispanic Children in the United States: A Cross-Sectional Study.

The main purpose of this study was to examine the relationships between school-based sedentary behavior, physical activity, and health-related outcomes, including cardiorespiratory fitness, weight status, and health-related quality of life (HRQOL) among Hispanic children. The participants were 374 children (192 boys, 182 girls; Mage = 9.64) recruited from four elementary schools from 3rd grade through to 5th grade. Sedentary behavior and physical activity behaviors (light physical activity [LPA] and moderate-to-vigorous physical activity (MVPA)) during school were measured by accelerometers. Cardiorespiratory fitness and weight status were measured using the FITNESSGRAM®, while HRQOL was measured using the PedsQL 4.0TM Spanish version, a validated questionnaire. Sedentary behavior was negatively correlated with cardiorespiratory fitness and HRQOL but positively associated with weight status. MVPA was positively correlated with cardiorespiratory fitness and HRQOL, but negatively associated with weight status and sedentary behavior. Multiple regressions demonstrated that sedentary behavior significantly predicted cardiorespiratory fitness and weight status, whereas MVPA significantly predicted HRQOL. With the current public health priority aiming to reduce health disparities in minority populations, the findings of this study provide important insights. Educators, health care providers, or other professionals working with Hispanic children are encouraged to focus on reducing sedentary behavior and promoting physical activity to improve their health-related outcomes.