Study protocol for a comparative randomized controlled trial of Tai Chi and conventional exercise training on alleviating depression in older insomniacs.

Background: Insomnia and depression are prevalent mental disorders that are often comorbid among older adults. Lifestyle intervention strategies incorporating Tai Chi or conventional exercise have been shown to alleviate symptoms of insomnia and depression. However, the comparative efficacy of these exercise modalities in individuals with both disorders has yet to be determined. Therefore, the aim of this study is to examine the efficacy of Tai Chi and conventional exercise for reducing depressive symptoms in older adults with chronic insomnia and depressive symptoms, when compared to a health education control. Methods: This study is a prospective, assessor-blinded, three-arm, parallel group, randomized controlled trial. Older adults aged ≥60 years with a diagnosis of chronic insomnia and depressive symptoms will be randomly assigned to a Tai Chi, conventional exercise or health education control condition on a 1:1:1 basis. Interventions will last for 3 months, with a 6-month follow-up period. The primary outcome is depressive symptoms, assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes include subjective sleep quality, 7-day actigraphy, 7-day sleep diary, anxiety symptoms, quality of life, medication usage and physical function. All measurements will be conducted at baseline, 3 months and 9 months by outcome assessors who are blinded to group allocation. Discussion: This study will compare the efficacy of Tai Chi and conventional exercise in improving depression outcomes in older adults with chronic insomnia and depressive symptoms. Our results will shed light on the clinical potential of these interventions for combating insomnia and depression in older adults.

The effectiveness of a positive psychological intervention for promoting preschool teachers' well-being and professional competence: EASP intervention program.

The present study investigated the effectiveness of the Early Advancement in Social-Emotional Health and Positivity (EASP) program, a positive psychological intervention promoting preschool teachers' well-being and the motivational aspect of professional competence. Participants were 273 in-service preschool teachers (Mage = 34.56 years, SD = 9.52, range = 22-58; female = 98.90%) who participated in a 2-month randomized controlled trial. Participants were randomly assigned to the intervention group (n = 143) receiving 1) four online workshops, 2) a smartphone app, and 3) an online activity, or to the wait-list control group (n = 130), which received the intervention materials after all the data collection. Participants reported their well-being dimensions, teaching self-efficacy, and autonomous motivation for teaching before and after the intervention. Results from a path analytic model exhibited excellent fit with the data, χ2 = 37.62, df = 33, CFI = .99, TLI = .98, RMSEA = .02 [90% CI = 0.00, 0.05], SRMR = .02. The intervention had direct effects on changes in well-being dimensions, including positivity, outcome, strength, engagement, and resilience (ß = .14 to .26, ps = .00 to .04), and indirect intervention effects on changes in teaching self-efficacy and autonomous motivation for teaching (ß = .14 to .15, ps = .00 to .01). These findings highlighted the potential value of implementing positive psychological interventions in educational settings to promote the well-being and professional competence among preschool teachers.

Tracking and predicting the treatment adherence of patients under rehabilitation: a three-wave longitudinal validation study for the Rehabilitation Adherence Inventory.

This study aimed to develop and validate a new measurement tool, the Rehabilitation Adherence Inventory (RAI), to measure patients' rehabilitation adherence. We recruited 236 patients with anterior cruciate ligament (ACL) ruptures from the United Kingdom (Mage = 33.58 ± 10.03, range = 18 to 59; female = 46.2%). Participants completed a survey, that measured their rehabilitation adherence, rehabilitation volume, psychological needs support, autonomous motivation, and intention at baseline, and at the 2nd and 4th month. Factorial, convergent, discriminant, concurrent, predictive, ecological validity and test-retest reliability of the RAI were tested via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modelling (SEM). All the EFAs, CFAs, and SEMs yielded acceptable to excellent goodness-of-fit, χ2 = 10.51 to 224.12, df = 9 to 161, CFI > 0.95, TLI > 0.95, RMSEA <0.09 [90%C I < 0.06 to 0.12], SRMR <0.04. Results fully supported the RAI's factorial, convergent, discriminant, and ecological validity, and test-retest reliability. The concurrent and predictive validity of the RAI was only partially supported because the RAI scores at baseline was positively associated with rehabilitation frequency at all time points (r = 0.34 to 0.38, p < 0.001), but its corresponding associations with rehabilitation duration were not statistically significant (p = 0.07 to 0.93). Overall, our findings suggest that this six-item RAI is a reliable and valid tool for evaluating patients' rehabilitation adherence.

Effectiveness of a theory-driven mHealth intervention in promoting post-surgery rehabilitation adherence in patients who had anterior cruciate ligament reconstruction: A randomized clinical trial.

RATIONALE: Patients with anterior cruciate ligament (ACL) reconstruction often have poor adherence to post-surgery rehabilitation. OBJECTIVE: This study applied the integrated model of self-determination theory and the theory of planned behavior to examine the effects of a smartphone-delivered intervention on the recovery outcomes of patients with an ACL rupture during post-surgery rehabilitation period. Additionally, we explored the effects of the intervention on participants with different beliefs toward rehabilitation at baseline. METHODS: The randomized control trial recruited 96 eligible participants (M age = 27.82 years, SD = 8.73; female = 39%) who underwent ACL reconstruction surgery. Participants were randomly assigned to an intervention group (n = 41), which received standard post-surgical treatment (usual-care) and smartphone application ("ACL-Well"), or a usual-care control group (n = 55). The primary outcomes were recovery outcomes from ACL surgery measured by knee muscle strength and laxity, and subjective knee evaluation completed 4-month post-intervention. Secondary outcomes were the psychological and behavioral outcomes measured at baseline, at 2- and 4-month post-intervention. RESULTS: ANCOVA indicated no significant between-group differences in primary outcomes: knee muscle strength, knee laxity and subjective knee evaluation, Fs(1, 27 to 55) = 0.01 to 1.36, p = .25 to .99, η2 = 0.01 to 0.03. For the secondary outcomes, growth mixture modelling revealed self-determined treatment motivation declined significantly over the intervention period in the control group (M slope = -0.39 to -0.12, p = .01 to .04), but not in the intervention group (M slope = -0.19 to -0.08, p = .06 to .38). CONCLUSIONS: The smartphone application fell short in promoting orthopedic outpatients' recovery outcomes. Yet, it shows some promises as a mean to maintain patients' motivation and adherence to treatment.

Significant others and students' leisure-time physical activity intention: A prospective test of the social influence in sport model.

This two-wave prospective study applied the Social Influence in Sport Model to investigate whether the social influences of parents, physical education (PE) teachers, and peers were predictive of students' intention to engage in leisure-time physical activity (PA). Participants were 2,484 secondary school students (11-18 years old) who completed a questionnaire assessing positive influence, punishment, and dysfunction from the three social agents (parents, PE teachers, and peers) at baseline, and PA intention at a 1-month follow-up. Structural equation modelling (SEM) yielded excellent goodness-of-fit and consistent pathways between the three social agents. Students' leisure-time PA intention (R2 = .103 to 0.112) was positively associated with positive influence (ß = .223 to 0.236, p < .001) and punishment (ß = .214 to 0.256, p < .01), and negatively associated with dysfunction (ß = - 0.281 to -.335, p < .001). Multi-group SEM showed that the predictions were invariant between parents, PE teachers, and peers. Furthermore, no significant differences in students' gender were found between perceived social influence and PA intention. The findings supported the application of the Social Influence in Sport Model in explaining the role of significant others on students' intention to take part in leisure-time PA.

Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents: A Systematic Review and Meta-analysis.

Importance: Depression is the second most prevalent mental disorder among children and adolescents, yet only a small proportion seek or receive disorder-specific treatment. Physical activity interventions hold promise as an alternative or adjunctive approach to clinical treatment for depression. Objective: To determine the association of physical activity interventions with depressive symptoms in children and adolescents. Data Sources: PubMed, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched from inception to February 2022 for relevant studies written in English, Chinese, or Italian. Study Selection: Two independent researchers selected studies that assessed the effects of physical activity interventions on depressive symptoms in children and adolescents compared with a control condition. Data Extraction and Synthesis: A random-effects meta-analysis using Hedges g was performed. Heterogeneity, risk of bias, and publication bias were assessed independently by multiple reviewers. Meta-regressions and sensitivity analyses were conducted to substantiate the overall results. The study followed the PRISMA reporting guideline. Main Outcomes and Measures: The main outcome was depressive symptoms as measured by validated depression scales at postintervention and follow-up. Results: Twenty-one studies involving 2441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years) were included. Meta-analysis of the postintervention differences revealed that physical activity interventions were associated with a reduction in depressive symptoms compared with the control condition (g = -0.29; 95% CI, -0.47 to -0.10; P = .004). Analysis of the follow-up outcomes in 4 studies revealed no differences between the physical activity and control groups (g = -0.39; 95% CI, -1.01 to 0.24; P = .14). Moderate study heterogeneity was detected (Q = 53.92; df = 20; P < .001; I2 = 62.9% [95% CI, 40.7%-76.8%]). The primary moderator analysis accounting for total physical activity volume, study design, participant health status, and allocation and/or assessment concealment did not moderate the main treatment effect. Secondary analyses demonstrated that intervention (ie, <12 weeks in duration, 3 times per week, unsupervised) and participant characteristics (ie, aged ≥13 years, with a mental illness and/or depression diagnosis) may influence the overall treatment effect. Conclusions and Relevance: Physical activity interventions may be used to reduce depressive symptoms in children and adolescents. Greater reductions in depressive symptoms were derived from participants older than 13 years and with a mental illness and/or depression diagnosis. The association with physical activity parameters such as frequency, duration, and supervision of the sessions remains unclear and needs further investigation.

Physical activity and exercise for cancer-related cognitive impairment among individuals affected by childhood cancer: a systematic review and meta-analysis.

BACKGROUND: Individuals affected by childhood cancer can have cognitive dysfunction that persists into adulthood and negatively affects quality of life. In this study, we aimed to evaluate the effects of physical activity and exercise on cognitive function among individuals affected by childhood cancer. METHODS: In this systematic review and meta-analysis, we searched seven databases (CINAHL Plus, Cochrane Library, Embase, MEDLINE, PsycINFO, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) for randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) published (or registered) from database inception to Jan 30, 2022, with no language restrictions. We included studies that compared the effects of physical activity or exercise interventions with controls (no intervention or usual care) on cognitive function among individuals diagnosed with any type of cancer at age 0-19 years. Two reviewers (JDKB and FR) independently screened records for eligibility and searched references of the selected studies; extracted study-level data from published reports; and assessed study risk of bias of RCTs and NRSIs using the Cochrane risk of bias tool for randomised trials (RoB 2) and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) tools, certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and any adverse events. We used intention-to-treat data and unpublished data if available. Cognitive function was assessed by standardised cognitive performance measures (primary outcome) and by validated patient-reported measures (secondary outcome). A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates (Hedges' g) and 95% CI values. We estimated the heterogeneity variance by the restricted maximum likelihood method and calculated I2 values to measure heterogeneity. We examined funnel plots and used Egger's regression test to assess for publication bias. This study is registered with PROSPERO, CRD42021261061. FINDINGS: We screened 12 425 titles and abstracts, which resulted in full-text assessment of 131 potentially relevant reports. We evaluated 22 unique studies (16 RCTs and six NRSIs) with data on 1277 individuals affected by childhood cancer and low-to-moderate risk of bias. Of the 1277 individuals, 674 [52·8%] were male and 603 [47·2%] were female; median age at study start was 12 (IQR 11-14) years, median time since the end of cancer treatment was 2·5 (IQR -1·1 to 3·0) years, and median intervention period was 12 [IQR 10-24] weeks. There was moderate-quality evidence that, compared with control, physical activity and exercise improved cognitive performance measures (five RCTs; Hedges' g 0·40 [95% CI 0·07-0·73], p=0·027; I2=18%) and patient-reported measures of cognitive function (13 RCTs; Hedges' g 0·26 [0·09-0·43], p=0·0070; I2=40%). No evidence of publication bias was found. Nine mild adverse events were reported. INTERPRETATION: There is moderate-certainty evidence that physical activity and exercise improves cognitive function among individuals affected by childhood cancer, which supports the use of physical activity for managing cancer-related cognitive impairment. FUNDING: Research Impact Fund of Research Grants Council of the Hong Kong University Grants Committee (R7024-20) and Seed Fund for Basic Research of the University of Hong Kong. COPYRIGHT: © 2022 Published by Elsevier Ltd. All rights reserved.

Effects of Tai Chi and cognitive behavioral therapy for insomnia on improving sleep in older adults: Study protocol for a non-inferiority trial.

Background: Insomnia is a prevailing health problem among older adults. Tai Chi, a popular mind-body exercise practiced by older people in various oriental communities, has been shown to improve sleep. However, Tai Chi has not been directly compared to cognitive behavioral therapy for insomnia (CBT-I), which is the first-line non-pharmacological treatment for insomnia in older adults. This study aims to examine whether Tai Chi is non-inferior to CBT-I as a treatment for insomnia in older adults. Methods: This is a single-center, assessor-blinded, non-inferiority randomized controlled trial comparing Tai Chi and CBT-I in 180 older adults aged ≥50 years with chronic insomnia according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Participants will be randomly assigned to either the Tai Chi or CBT-I group. Interventions will last for 3 months with a 12-month follow-up. The primary outcome is self-perceived insomnia severity measured by Insomnia Severity Index (ISI) at 3 months and at 15 months. The secondary outcomes include the remission rate of chronic insomnia, insomnia treatment response, subjective sleep quantity and quality, 7-day actigraphy, 7-day sleep diary, sleep medication, health-related quality of life, mental health, body balance and lower extremity function, adverse events, habitual physical activity, and dietary intake. Measurements will be conducted at baseline, 3 months, and 15 months by outcome assessors who are blinded to the group allocation. Discussion: This will be the first non-inferiority randomized controlled trial to compare the efficacy and long-term outcomes of Tai Chi versus CBT-I for treating insomnia in older adults. This study will be of clinical importance as it supports the use of Tai Chi as an alternative non-pharmacological approach for insomnia treatment and sustainable management.

Parental Influence on Child and Adolescent Physical Activity Level: A Meta-Analysis.

Parents are often regarded as one of the significant social agents who are important to the participation of physical activity (PA) among children and adolescents. However, within the literature, the relationships between parental influences and child and adolescent PA have been inconclusive and discordant. The purpose of this meta-analysis was to quantify and synthesize the associations between parental social influences (positive parental influence, punishment, and discouragement) and the PA level of children and adolescents. Through a systematic literature search using PsycINFO, Web of Science, PubMed, ProQuest, and SPORTDiscus databases, we identified 112 eligible studies and subsequently extracted 741 effect sizes for our analysis. Multilevel meta-analysis showed that the corrected zero-order correlation of positive parental influence was positive and statistically significant, r = 0.202, SE = 0.014, t = 14.975, p < 0.001, 95% confidence interval (CI) = [0.176, 0.228]. Further moderation analysis also found that this was significantly moderated by parental gender (maternal vs. paternal), respondent of influence measure (parent-reported vs. child-reported), and type of PA measure (subjective vs. objective). The corrected zero-order correlations of negative parental influences (i.e., punishment and discouragement) were not statistically significant, and no significant moderation effects were observed. The findings of our meta-analysis showed that children and adolescents had higher PA levels when their parents supported PA participation by exerting positive social influence. Punishment and discouragement against PA by parents did not appear to be significantly associated with the PA level of children and adolescents. The findings of negative parental social influence were mixed and required further investigations.

Effects of exercise intensity and frequency on improving cognitive performance in middle-aged and older adults with mild cognitive impairment: A pilot randomized controlled trial on the minimum physical activity recommendation from WHO.

Background: The World Health Organization physical activity guidelines recommend adults and older adults to accumulate at least 150-300 min of moderate or 75-150 min of vigorous aerobic-type physical activity weekly for health benefits including improvements of cognitive performance. However, the optimal exercise intensity and frequency for maximizing the cognitive benefits remain unclear. Purpose: We conducted a parallel, assessor-blinded, pilot randomized controlled trial to evaluate the effectiveness of different intensities and frequencies of the WHO-recommended minimal volume of aerobic-type physical activity on improving cognitive performance in middle-aged and older adults with mild cognitive impairment (MCI). Methods: Participants were randomly allocated to the stretching exercise control group (CON), once-a-week and thrice-a-week moderate-intensity walking groups (M1 and M3), and once-a-week and thrice-a-week vigorous-intensity walking groups (V1 and V3). Intervention duration was 12 weeks. The primary outcome was global cognitive performance assessed by the Hong Kong version of Montreal Cognitive Assessment. Secondary outcomes were self-report and objective cognitive performances, mental health, sleep quality, and cardiorespiratory fitness. Results: Thirty-seven participants completed the study (CON: n = 7, M1: n = 7, M3: n = 7, V1: n = 8, V3: n = 8). Participants in all four walking exercise groups demonstrated significant improvements in global cognitive performance assessed by the Hong Kong version of the Montreal Cognitive Assessment after the intervention when compared to CON (p < 0.001). The walking exercise interventions also significantly mitigated the anxiety severity (p < 0.005) and improved the cardiorespiratory fitness (p < 0.05) of the participants in the walking exercise groups. Conclusion: 150-min moderate- or 75-min vigorous-intensity walking exercise performed once- or thrice-weekly showed similar effects on improving cognitive performance in middle-aged and older adults with MCI. The 12-week walking exercise interventions also reduced anxiety severity and improved cardiorespiratory fitness of the participants. Clinical Trial Registration: clinicaltrials.gov, identifier NCT04515563.

Protecting children from COVID-19: examining U.S. parents motivation and behaviour using an integrated model of self-determination theory and the theory of planned behaviour.

OBJECTIVES: This longitudinal study applied the integrated model of self-determination theory (SDT) and the theory of planned behaviour (TPB) to explain COVID-19 preventive behaviours among parents of young children in the United States. DESIGN: The study adopted a two-wave longitudinal study design. Parents (N = 681) completed self-report questionnaires related to measures of SDT and the TPB constructs and behavioural adherence at baseline and after one month. We used standardised residual change scores to test the structural relationships of the integrated model. RESULTS: The parameter estimates of the model (CFI > .96, TLI > .86, RMSEA = .05, SRMR = .03) fit acceptably well to the data. Psychological need support was positively and significantly linked to autonomous and controlled motivation and amotivation. Autonomous motivation was positively and significantly correlated with TPB factors, and intention. Intention was a significant and positive predictor of behavioural adherence. CONCLUSION: The integrated model of SDT and the TPB appeared to be applicable to the explanation of COVID-19 prevention among the U.S. parents. Longitudinal data showed that a psychological need supportive social environment was related to favourable motivation, social cognition beliefs, intention and behavioural adherence to the preventive behaviours of parents protecting their young children from COVID-19.

Effects of one-year once-weekly high-intensity interval training on body adiposity and liver fat in adults with central obesity: Study protocol for a randomized controlled trial.

Objective: This study aims to examine the effects of one-year, once-weekly high-intensity interval training (HIIT) on body adiposity and liver fat in adults with central obesity. Methods: One-hundred and twenty adults aged 18-60 years with central obesity (body mass index ≥25, waist circumference ≥90 cm for men and ≥80 cm for women). This is an assessor-blinded randomized controlled trial. Participants will be randomly assigned to the HIIT group or the usual care control group. Each HIIT session will consist of 4 × 4-min bouts at 85%-95% maximal heart rate, interspersed with 3-min bouts at 50%-70% maximal heart rate. The HIIT group will complete one session per week for 12 months, whereas the usual care control group will receive health education. The primary outcomes of this study are total body adiposity and intrahepatic triglyceride content. The secondary outcomes include abdominal visceral adipose tissue, subcutaneous adipose tissue, body mass index, waist circumference, hip circumference, cardiorespiratory fitness, lean body mass, bone mineral density, blood pressure, fasting blood glucose, insulin, triglycerides, glycated hemoglobin, cholesterol profile, liver function enzymes, medications, adherence to exercise, adverse events, quality of life, and mental health. Outcome measure will be conducted at baseline, 12 months (post-intervention), and 24 months (one-year follow-up). Impact of the project: This study will explore the benefits of long-term once-weekly HIIT with a follow-up period to assess its effectiveness, adherence, and sustainability. We expect this intervention will enhance the practical suitability of HIIT in inactive adults with central obesity, and provide insights on low-frequency HIIT as a novel exercise option for the management of patients with central obesity and liver fat. Trial registration: ClinicalTrials.gov (NCT03912272) registered on 11 April 2019.

Wearing Compression Garment Enhances Central Hemodynamics? A Systematic Review and Meta-Analysis.

ABSTRACT: Lee, DCW, Ali, A, Sheridan, S, Chan, DKC, and Wong, SHS. Wearing compression garment enhances central hemodynamics? a systematic review and meta-analysis. J Strength Cond Res 36(8): 2349-2359, 2022-Compression garments (CG) are believed to enhance exercise performance and recovery by improving central hemodynamic responses. However, evidence is inconclusive. We performed a systematic review and meta-analysis to determine the effect of wearing CG at rest or after a physiological challenge on central hemodynamic responses, including cardiac output, stroke volume (SV), heart rate (HR), systolic blood pressure, diastolic blood pressure (DBP), and systemic vascular resistance in healthy individuals. The English language searches of the electronic databases SPORTDiscus, MEDLINE, and Web of Science were conducted from November 2018-February 2019. The studies involved were limited to the following: (a) original articles; (b) randomized controlled trials; (c) monitoring of central hemodynamic responses (either at rest or after a physiological challenge: maximal exercise or orthostatic challenge); and (d) healthy individuals. Of the 786 studies identified, 12 were included in the systematic review and meta-analysis. Meta-analysis was performed by the restricted maximum likelihood method. The results indicated that the effect size (ES) of wearing CG on improving central hemodynamic responses was large overall (Hedges' g = 0.55) and was large in SV (Hedges' g = 1.09) and HR (Hedges' g = 0.65). Subgroup analysis showed that the ESs in "post-physiological challenge" was large in overall (Hedges' g = 0.98), SV (Hedges' g = 1.78), HR (Hedges' g = 1.10), and DBP (Hedges' g = 0.75). Their ESs in "at rest" were not significant in all central hemodynamic responses, apart from a significant medium ES observed in SV (Hedges' g = 0.44). Healthy individuals who wear CG have marked improvement in central hemodynamic responses, particularly after a physiological challenge. More pronounced effects of CG are observed in increasing SV and reducing HR.

Applying the trans-contextual model to promote sport injury prevention behaviors among secondary school students.

The current study tested the effects of an intervention based on the trans-contextual model (TCM) on secondary school PE students' sport injury prevention behavior and on theory-based motivational and social cognition mediators. Participants were PE students (N = 1168; Mage  = 13.322 ± 1.045, range = 12-16; female = 51.721%) who participated in a 3-month cluster-randomized controlled trial. Schools were randomly assigned to a treatment group, in which PE teachers received training to be more supportive of psychological needs in teaching sport injury prevention, or a control group, in which PE teachers received no training. Participants completed survey measures of TCM variables and self-reported sport injury prevention behavior at baseline and at 3-month post-intervention follow-up. The proposed TCM model exhibited adequate fit with the data, χ2  = 143.080 (df = 19), CFI = 0.956, TLI = 0.916, RMSEA = 0.078 (90% CI = 0.066-0.090), and SRMR = 0.058. We found positive, statistically significant direct intervention effects on changes in perceived psychological need support (ß = 0.064, p = 0.020). We also found positive, significant direct (ß = 0.086-0.599, p < 0.001) and indirect (ß = 0.002-0.027, p = 0.020-0.032) intervention effects on changes in TCM variables and behaviors to prevent sport injuries. Our findings support the TCM as a useful framework for building an intervention for promoting sport injury prevention behaviors among secondary school students.

Strategies for Teachers to Promote Physical Activity in Early Childhood Education Settings-A Scoping Review.

Recent evidence has emphasized the importance of the early childhood years for developing lifelong physical activity patterns. As such, evidence-informed programs that create opportunities for young children to engage in physical activity are needed and education settings present an important context. This review aimed to identify strategies that are implemented by teachers to promote physical activity in early childhood education and care settings. This is a scoping review that followed the framework proposed by the Joanna Briggs Institute. Searches were conducted using the databases of PubMed, SCOPUS, PsycINFO, SPORT Discus, ERIC and Web of Science for publications up to September 2020. From a total of 8974 articles, 19 were deemed eligible. Ten types of strategies, performed by teachers with the intention to improve physical activity-related primary outcomes, were identified. Physical activity promotion by teachers in early childhood settings is recommended to take a multi-strategy approach, in conjunction with professional development training opportunities and continuous follow-up support for teachers. Future work is warranted to fill the evidence gap in other regions (e.g., Asia, Africa and South America) and strengthen the evidence base to establish best practice standards.

Predictors of in-school and out-of-school sport injury prevention: A test of the trans-contextual model.

The current study aimed to predict secondary school students' motivation toward sport injury prevention in "in-school" and "out-of-school" contexts, and their sport injury prevention behavior at 3-month follow-up using the trans-contextual model (TCM). Hong Kong secondary school students (N = 1566; mean age = 13.34 years, range = 11 to 19; female = 49.42%) were recruited. Participants were asked to complete a survey comprising previously validated scales measuring TCM constructs at baseline and a measure of sport injury prevention behavior at follow-up three months later. Structural equation modeling (SEM) was used to examine the hypothesized paths among TCM constructs. A SEM specifying hypothesized paths among TCM variables showed acceptable fit with the data (χ2 (29) = 418.55, CFI = .93, TLI = .90, and RMSEA = .09, 90% CI [.09, .10], and SRMR = .05). Findings supported tenets of the TCM: the effects of perceived autonomy support from PE teachers on in-school autonomous motivation toward injury prevention, the trans-contextual relationship between students' "in-school" and "out-of-school" autonomous motivation toward injury prevention, and the effects of autonomous motivation toward injury prevention on social cognitive variables and subsequent sport injury prevention behaviors. Results supported the tenets proposed within the TCM in predicting students' "in-school" and "out-of-school" autonomous motivation toward sport injury prevention. Findings underscore the potential importance of autonomy support from PE teachers in facilitating students' sport injury prevention behaviors. Further longitudinal and intervention research is warranted to establish temporal and causal effects of TCM variables in sport injury prevention.

Validation of the swimming competence questionnaire for children.

Two studies were employed to test the reliability and validity of the Swimming Competence Questionnaire (SCQ) among primary school children. Study 1 was a cross-sectional survey in 4959 primary school children. Study 2 was a pre-post-test quasi-experiment among 1609 primary school children who underwent a 20-lesson learn-to-swim programme. In Study 1, exploratory structural equation modelling revealed excellent goodness-of-fit and scale reliability for a two-factor model comprising distance and skill factors, which supported the construct and convergent validity. SCQ scores were significantly and positively correlated with swimming outcomes (i.e., self-efficacy, intention, swimming frequency), which supported SCQ's concurrent and criterion validity. Average variance extracted for the SCQ factors exceeded cut-off criteria supporting discriminant validity. In Study 2, pre-test SCQ scores correlated significantly and positively with the SCQ scores, self-efficacy, intention, and swimming frequency at post-test, which supported SCQ's test-retest reliability and predictive validity. Positive intraclass correlation between SCQ scores and coach ratings at post-test provided evidence for SCQ's inter-rater reliability. SCQ scores significantly improved at post-test, which supported SCQ's ecological validity. In conclusion, findings indicate that the SCQ is a valid and reliable measure to assess primary school children's swimming competence, in terms of swimming distance and basic water survival skills.

Low-Frequency HIIT Improves Body Composition and Aerobic Capacity in Overweight Men.

BACKGROUND: The relationship between the frequency of high-intensity interval training (HIIT) and the resultant adaptations is largely unclear. PURPOSE: This study compared the effects of different frequencies of HIIT with those of moderate-intensity continuous training (MICT) on body composition in overweight or obese adults. METHODS: Fifty-six overweight or obese (body mass index = 26.4 ± 2.9) men between 18 and 30 yr old (age = 22.8 ± 3.1 yr) were randomly assigned to the following groups: no-intervention control (CON; n = 14), MICT performed thrice weekly (MICT×3/wk; n = 9), HIIT performed thrice weekly (HIIT×3/wk; n = 14), HIIT performed twice weekly (HIIT×2/wk; n = 10), and HIIT performed once weekly (HIIT×1/wk; n = 9). Each HIIT session consisted of 12 × 1-min bouts at 90% heart rate reserve, interspersed with 11 × 1-min bouts at 70% heart rate reserve. Aerobic capacity, body composition, resting heart rate, vascular function, insulin resistance, and biomarkers of metabolic syndrome risk factor were examined at baseline, after 4 wk, and after 8 wk of intervention. RESULTS: Aerobic capacity and percent fat-free mass significantly increased in all exercise groups compared with those in the CON group (CON vs all exercise groups, P < 0.05), whereas body fat mass and systolic blood pressure significantly decreased after 8 wk of intervention in all exercise groups compared with those in the CON group (CON vs all exercise groups, P < 0.05). Body fat mass significantly decreased after 4 wk in all HIIT groups compared with those in the CON group (CON vs all HIIT groups, P < 0.05) but not in the MICT×3/wk group. CONCLUSION: These novel results demonstrated that performing HIIT once weekly, even with a lower weekly volume of exercise, improved cardiorespiratory fitness, body composition, and blood pressure in overweight/obese adults. Low-frequency HIIT might be a feasible and effective strategy for the prescription of an initial exercise program for inactive, overweight, or obese young men.

Psychological processes of ACL-patients' post-surgery rehabilitation: A prospective test of an integrated theoretical model.

OBJECTIVES: The aim of this prospective study was to examine the utility of an integrated model comprising constructs from self-determination theory (SDT) and the theory of planned behavior (TPB) in predicting adherence to a post-surgery rehabilitation program in patients receiving anterior cruciate ligament (ACL) reconstruction. Constructs of the integrated model measured at baseline were expected to predict patients' rehabilitation adherence two months later. METHOD: Patients (N = 121, M age = 27.62, range = 18-53; 36.66% female) scheduled to have ACL reconstruction surgery within two months were recruited from a Hong Kong public hospital. At baseline and two-month follow-up, patients completed measures of perceived autonomy support from doctors and physiotherapists and treatment motivation from SDT, social cognition constructs from the TPB factors, and adherence to the postsurgery rehabilitation program recommended by their surgeon. RESULTS: Path analysis displayed good goodness-of-fit of the proposed model with the data (χ2 = 11.47 (df = 9), CFI = 0.98, TLI = 0.93, RMSEA = 0.06 [90% CI = 0.00; 0.10]) after controlling for age, gender, time of surgery, post-surgery rehabilitation, and injury severity. Consistent with hypotheses, perceived autonomy support from physiotherapist and autonomous treatment motivation directly and indirectly predicted the TPB constructs and treatment adherence. However, there was no association between perceived autonomy support from doctors and autonomous motivation. CONCLUSION: The integrated model was effective in explaining the psychological processes that relate to medical adherence. Findings also highlight the importance of the autonomy support from physiotherapists and provide evidence for potential intervention targets.