Development of a multi-wear-site, deep learning-based physical activity intensity classification algorithm using raw acceleration data.

BACKGROUND: Accelerometers are widely adopted in research and consumer devices as a tool to measure physical activity. However, existing algorithms used to estimate activity intensity are wear-site-specific. Non-compliance to wear instructions may lead to misspecifications. In this study, we developed deep neural network models to classify device placement and activity intensity based on raw acceleration data. Performances of these models were evaluated by making comparisons to the ground truth and results derived from existing count-based algorithms. METHODS: 54 participants (26 adults 26.9±8.7 years; 28 children, 12.1±2.3 years) completed a series of activity tasks in a laboratory with accelerometers attached to each of their hip, wrist, and chest. Their metabolic rates at rest and during activity periods were measured using the portable COSMED K5; data were then converted to metabolic equivalents, and used as the ground truth for activity intensity. Deep neutral networks using the Long Short-Term Memory approach were trained and evaluated based on raw acceleration data collected from accelerometers. Models to classify wear-site and activity intensity, respectively, were evaluated. RESULTS: The trained models correctly classified wear-sites and activity intensities over 90% of the time, which outperformed count-based algorithms (wear-site correctly specified: 83% to 85%; wear-site misspecified: 64% to 75%). When additional parameters of age, height and weight of participants were specified, the accuracy of some prediction models surpassed 95%. CONCLUSIONS: Results of the study suggest that accelerometer placement could be determined prospectively, and non-wear-site-specific algorithms had satisfactory accuracies. The performances, in terms of intensity classification, of these models also exceeded typical count-based algorithms. Without being restricted to one specific wear-site, research protocols for accelerometers wear could allow more autonomy to participants, which may in turn improve their acceptance and compliance to wear protocols, and in turn more accurate results.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis.

BACKGROUND: The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers. OBJECTIVE: This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness. METHODS: We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. RESULTS: Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes. CONCLUSIONS: eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions. TRIAL REGISTRATION: PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

Barriers and facilitators to physical activity for young adult women: a systematic review and thematic synthesis of qualitative literature.

BACKGROUND: Physical activity (PA) has many benefits in preventing diseases and maintaining physical and mental health. Women, in particular, can benefit from regular PA. However, women's PA did not increase over the past decade globally, and the situations faced by women are often gender-specific. Healthy young adult women's PA does not receive as much attention as older women and adolescent girls, yet, they face the same situation of low level of PA. This review aims to explore and synthesise the self-identified barriers and facilitators to young adult women's participation in PA from qualitative research studies and offer suggestions for future studies and programs designed for this population. METHODS: A systematic search was conducted in Pubmed, Web of Science, Scopus, Medline, and SPORTDiscus for studies published between January 2000 to February 2022 to identify qualitative studies on the barriers and facilitators of young adult women's PA between ages 18 to 40. The search yielded 694 studies initially, of which 23 were included. The research quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) tool. Data were extracted and thematically analysed based on the tenets of the social-ecological model (SEM). RESULTS: Identified barriers and facilitators were grouped into different levels of the SEM, with the most frequently cited factors being time, body image and societal beauty standards, family duty and social support, religious and cultural norms, organisation and community facilities and environment, safety issues and physical environment. Descriptive data were thematically analysed and synthesised in line with the five levels: body image, health and beauty; multiple roles, support, and PA; religious identity, cultural identity, and PA; safety issues and women's fears. CONCLUSIONS: This qualitative synthesis revealed in-depth information on barriers and facilitators influencing young adult women's PA. It highlighted that the factors young adult women face are diverse at different levels yet holistic and intertwined. Future studies on young adult women's PA should address the social-cultural influence and would benefit from applying multilevel strategies employing the SEM model. It is critical to create an open and inclusive environment and offer more opportunities for women. TRIAL REGISTRATION: PROSPERO CRD42021290519.

Acceptability of a parent-focused program for physical literacy development among parents and children during the COVID-19 pandemic: A qualitative study.

Background: A 3-month parent education program was designed and implemented in Hong Kong to improve physical literacy (PL) among primary school children and their parents during the COVID-19 pandemic. This study aims to probe into the acceptability of the intervention from parental perspectives, providing more insights for future implementation. Methods: Following the 3-month parent-focused PL program, 16 parents (mean age = 43.73 years, 15 mothers) were recruited to participate in semi-structured individual interviews in June 2021. Interviews were analyzed using thematic analysis in NVivo 12. Two coders analyzed interview transcripts deductively based on the interview guide and social cognitive theory (SCT). Results: Three themes were identified that captured the acceptability of the program: (1) Addressing needs through appropriate delivery enhances acceptability of intervention; (2) Positive behavioral and psychological changes to families; (3) Appropriate support of environmental factors can enhance the sustainability of program effects. The high levels of acceptability were attributable to the fact that parents were able to learn and be a gatekeeper to impact their children positively. Moreover, the design and contents of the program were appropriate for the participating parents because the program provided adequate learning resources and interactive learning support without being overly rigid, and the online learning mode was feasible and convenient. Consequent to their participation in the program, parents expressed that they became more aware of the importance of PL, established physical activity routines with their children, and modified their parenting styles which resulted in improved parent-child relationships. Conclusions: The current study provided evidence that engaging parents in the intervention was feasible and acceptable approach in supporting both parents and children to establish physically active routines in the family setting. The insights gained regarding the appropriateness and acceptability of the program in this specific context may be used to inform the design, implementation and sustainability of other parent-focused PL programs.

Examining the criterion validity of two scalable, information technology-based systems designed to measure the quantity and quality of movement behaviours of children from Hong Kong primary schools: a cross-sectional validation study.

OBJECTIVES: Research has shown that having adequate quantity and quality of physical activity can contribute to the health and well-being of children. Nonetheless, existing tools to measure these constructs in children have limitations in terms of their objectivity and scalability. In this study, we provide criterion validity evidence of two systems built on commercially available sensors (ie, gyroscopes and infrared cameras), designed to measure children's moderate-to-vigorous physical activity and fundamental movement skill proficiencies. DESIGN: Cross-sectional. SETTING: Primary schools in Hong Kong. PARTICIPANTS: Data from 30 (age=8.55±1.25 years) and 1174 (age=9.15±1.63 years) children were included for the validation of physical activity and fundamental movement skills measures, respectively. Children's outcomes were simultaneously measured using the developed systems and existing, well-established measures (accelerometers and expert ratings). RESULTS: We found a strong correlation between physical activity outcomes measured using our developed system and accelerometers (Pearson r=0.795). Motor skill proficiency scored using our real-time rating system had strong agreement with expert ratings (percentage agreement=84%-94%, kappa=0.661 to 0.859). DISCUSSION: Results of the current study supported the application of the respective systems in physical education and large-scale research studies. Collection of such data at mass levels could help researchers depict the complex relation between children's quantity and quality of physical activity.

Parent-focused online intervention to promote parents' physical literacy and support children's physical activity: results from a quasi-experimental trial.

BACKGROUND: The development of physical literacy (PL) early in life may influence children's subsequent physical activity (PA) participation and consequent health benefits across the life course. Interventions designed for parents are lacking, but such efforts can potentially enhance the PL of parents and their children's PA participation. Additionally, there is insufficient evidence to support the feasibility of delivering a PL intervention using an online format. Therefore, the purpose of this study was to examine the feasibility and effectiveness of a parent-focused, theory-driven, online-delivered intervention designed to improve the parents' PL and children's PA behaviors. METHODS: A non-randomized trial was conducted to evaluate the effects of the program. 224 Hong Kong families (primary school-aged children and their parents) registered to the program were considered the experimental group and were exposed to an online intervention over three months. Another 220 families in Hong Kong were considered the comparison group and did not receive any intervention. Outcome measures included PA behaviors (daily steps and moderate-to-vigorous PA), parent-child co-activity behaviors, family PA routines, and parent perceived PL. Linear mixed models were used to analyze the differences in terms of changes in measured outcomes between groups over time. RESULTS: No significant group-by-time effects were found for children's or parents' PA behaviors. In terms of the family Co-PA routines, a small positive effect size in favor of the experimental group was found (p = .44, d = 0.2). Group-by-time effects favorable to the experimental group was detected for parent-child co-activity (p < .001, d = 0.7) and parental PL (p < .001, d = 0.9) at post-intervention. The results demonstrated that the intervention was acceptable and that there was potential for scale up. CONCLUSIONS: Findings indicated that the intervention was effective in increasing parent-child co-activity and parent perceived PL. During the pandemic, online intervention delivery was found to be feasible. Using this mode of delivery, the intervention has the potential to reach a wide population in the local context. TRIAL REGISTRATION: The study was prospectively registered at the Chinese Clinical Trial Registry, Registration number: ChiCTR2100041903, Registered 09 January 2021.

Parental Support, Children's Physical Activity, Dietary Behaviors and Health-Related Quality of Life: Evidence From Three Asian Cities.

BACKGROUND: Parental support is crucial for children's healthy lifestyle formation. The present study examined the relations between parental support (i.e., encouragement and praise), children's perceived autonomy support and behaviors in the domains of physical activity (PA) and diet, and health-related quality of life (HRQoL) simultaneously in Asia. METHOD: Children aged 9 to 12 years and their parents (2065 dyads) in three Asian cities completed the respective questionnaires. Children reported perceived PA and dietary autonomy support, PA frequency, dietary behaviors, and HRQoL. Parents reported their PA and dietary support. The relations between parental support, children's perceived autonomy support an behaviors in the PA, and dietary domains as well as HRQoL were examined using multigroup path analyses. RESULTS: Among three cities, the indirect effects of parental support on children's self-report PA or HRQoL via children's perceived PA autonomy support were significant. A hypothetical sequential indirect effect from parental PA support to children's HRQoL via children's perceived PA autonomy support and self-report PA was observed in Hong Kong. In Hong Kong and Taipei samples, the indirect effect of parental PA support on children's HRQoL via children's self-report PA and the indirect effect of children's perceived PA autonomy support on HRQoL via children's self-report PA were significant. In Hong Kong and Shanghai samples, children's perceived dietary autonomy support showed positive effect on HRQoL via healthy food consumption. CONCLUSIONS: Congruent findings across three cities suggest that parents should provide support via encouragement and praise to facilitate children's perceived autonomy support and further increase PA and HRQoL. Our study adds to the literature by examining relations of parental support and children's healthy lifestyle in Asia and provides insights to parents and researchers.

Effect of family income and physical activity on children's quality of life.

It is unclear whether gender differences exist in the relationship between maternal physical activity (PA) and children's quality of life (QoL). We also know relatively little about the potential role of PA in mitigating the adverse impact of family financial hardship. This study examined the interaction effect of PA with social and demographic factors on QoL among 272 primary school children and their mothers in Hong Kong. Children self-reported their QoL, whereas mothers reported their own and children's PA levels. Mothers also reported their family demographics including monthly household income. Moderated multiple regression models were calculated to examine 1) the relationship between maternal PA and child QoL based on child gender and 2) the relationship between family income status and child QoL based on maternal-child PA level status. The relationship between maternal PA and child QoL varied by child gender (ß = .21, p = .049), with boys of active mothers showing higher QoL. Compared to active families, when both mothers and boys were inactive, there were bigger income differences in child QoL scores (ß = .37, p = .041). No significant differences were observed in girls. The findings have implications for family-based PA interventions and highlights the benefits of PA toward the QoL of male children in disadvantaged families.

Examining the relationship between children's health-related quality of life and their perception of parental support toward physical activity: A longitudinal study.

This study investigated how health-related quality of life (HRQOL) affected perception of parental support for physical activity (PA) in 529 children from the "Fun to Move@JC Project." They self-reported their HRQOL, PA enjoyment and motivation, barriers to PA, and attachment to parents in the first semester (Time 1) and perceived parental PA support in the second semester (Time 2). Mediation analyses were performed to examine the underlying mechanisms. Greater Time 1 HRQOL scores predicted higher Time 2 perceived parental PA support through PA enjoyment and motivation, barriers to PA, and attachment to parents at Time 1. The specific indirect effect via attachment to parents was particularly strong in girls, whereas the association of PA enjoyment with perceived parental PA support was stronger in boys. Our findings suggest that children with poor HRQOL may not perceive parents to be supportive of their PA. Interventions promoting parental PA support should emphasize PA enjoyment and benefits to attachment security for parents of boys and girls, respectively.

The Impact of COVID-19 on Preschool-Aged Children's Movement Behaviors in Hong Kong: A Longitudinal Analysis of Accelerometer-Measured Data.

During the COVID-19 pandemic, many preschool-aged children were forced to remain indoors due to social distancing measures and school closures. In this study, we examined how children's movement behaviors (sedentary behaviors, physical activity, and sleep) were affected by the pandemic. Children's (N = 25, age = 4.4 years, SD = 0.3) movement behaviors were measured before and after the COVID outbreak, respectively. Data collected using accelerometers were analyzed using compositional data analyses. A significant change in the overall time-use composition (F = 5.89, p = 0.002) was found. Results suggested that children spent more time sleeping (8% increase) and in moderate-to-vigorous physical activity (16% increase), with less time spent in sedentary behaviors (9% decrease). However, parent reports suggested that children were less active and had more screen time. In conclusion, the current evidence suggests that children's physical activity is not negatively impacted by the pandemic. However, the continuous surveillance of movement behaviors of young children during the pandemic is needed.

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

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

Association between Physical Activity and Fundamental Movement Skills in Preschool-Aged Children: Does Perceived Movement Skill Competence Mediate This Relationship?

OBJECTIVES: The purpose of this research is to examine whether perceived fundamental movement skills (FMS) competence mediated the relationship between actual FMS and physical activity (PA) in Hong Kong preschool-aged children. DESIGN: A cross-sectional study. METHODS: 148 preschool-aged children (43% girls; mean age = 4.52 ± 0.67 years) from five preschools/childcare centres completed all assessments. Actual FMS was rated using the Test of Gross Motor Development-2, whilst perceived FMS was assessed via the Pictorial Scale for Perceived Movement Skill Competence. PA was measured through accelerometry. A bootstrap method was used to assess the potential mediating effect of perceived movement skill competence on the relationship between actual FMS and PA. All mediation models were adjusted for sex and age. RESULTS: Mediation analyses showed that the direct path between actual FMS and moderate-to-vigorous physical activity (MVPA) was significant (b = 0.228, p = 0.008), as was the path between MVPA and actual FMS (b = 0.214, p = 0.008). However, perceived FMS competence did not mediate the association between actual FMS and MVPA in the models. CONCLUSIONS: Our results showed evidence of reciprocal pathways between actual FMS and MVPA, reinforcing the need to simultaneously target both domains as part of broader developmental strategies, initiated in early childhood. Unlike emergent adolescence, perceptions of movement skill competence do not play a significant role in influencing the relationship between actual FMS proficiency and MVPA in this developmental period.

A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health.

There are no literature reviews that have examined the impact of health-domain interventions, informed by self-determination theory (SDT), on SDT constructs and health indices. Our aim was to meta-analyse such interventions in the health promotion and disease management literatures. Studies were eligible if they used an experimental design, tested an intervention that was based on SDT, measured at least one SDT-based motivational construct, and at least one indicator of health behaviour, physical health, or psychological health. Seventy-three studies met these criteria and provided sufficient data for the purposes of the review. A random-effects meta-analytic model showed that SDT-based interventions produced small-to-medium changes in most SDT constructs at the end of the intervention period, and in health behaviours at the end of the intervention period and at the follow-up. Small positive changes in physical and psychological health outcomes were also observed at the end of the interventions. Increases in need support and autonomous motivation (but not controlled motivation or amotivation) were associated with positive changes in health behaviour. In conclusion, SDT-informed interventions positively affect indices of health; these effects are modest, heterogeneous, and partly due to increases in self-determined motivation and support from social agents.

Relation between Perceived Barrier Profiles, Physical Literacy, Motivation and Physical Activity Behaviors among Parents with a Young Child.

Objectives: to reveal distinct subgroups of parents by their perception of 6 types of physical activity barriers and challenges (i.e., lack of time, poor health, lack of company, lack of facilities, childcare responsibility, lack of motivation), and examine its relation with related constructs. Design: cross-sectional survey data. Method: the sample consisted of 424 parents who had at least 1 child of primary school age. Latent profile analysis was conducted to identify latent subgroups within participants. Group differences on physical literacy, autonomous motivation, and self-report physical activity (PA) levels were explored. Results: a four-profile solution was obtained from latent profile analysis, labelled as: "Struggling" (29.0%), "Family burden" (41.3%), "Lazy" (13.0%), and "Barriers free" (16.7%). The "Barriers free" profile experienced the least difficulties with physical activity, but the "Struggling" profile suffered the most severe barriers and challenges. "Family burden" and "Lazy" profiles demonstrated qualitative differences on one or two given challenges. Significant group differences on physical literacy, autonomous motivation, and PA levels were found, showing the "Barriers free" profile as the most robust and adaptive group of parents. Conclusions: the findings suggest that it is common for a substantial portion of parents to experience multiple barriers and challenges to a relatively high degree. Intervention on raising parent's physical literacy to reduce barriers and sustain their motivation may be a target for intervention.

Increasing Students' Activity in Physical Education: Results of the Self-determined Exercise and Learning For FITness Trial.

PURPOSE: To examine the effects of the Self-determined Exercise and Learning For FITness (SELF-FIT) intervention on students' moderate-to-vigorous physical activity (MVPA) and motivation in physical education (PE). METHODS: In a clustered randomized controlled trial, 667 students (mean age, 14.4 yr; SD, 0.78) from 26 schools (i.e., clusters) were randomized into either an experimental group or a waitlist control group. Students in the experimental group received the SELF-FIT intervention, a school-based intervention designed to infuse fitness and game-like elements into PE using self-determination theory principles, whereas those in the control continued their classes using usual practices. Intervention content was provided by teachers who received training from the research team. The primary outcome was percentage of time spent in MVPA during PE. Secondary outcomes included basic psychological need satisfaction, motivation toward PE, leisure-time MVPA, and mental well-being. Data were analyzed using multilevel regression analyses and prespecified interactions were tested (i.e., group-time-sex). RESULTS: Positive intervention effects were found on MVPA during PE (B, 4.00; 95% confidence interval, 2.96-5.04; d = 0.36). Regarding the participants' competence and autonomy need satisfaction, and autonomous motivation, the intervention effects were stronger in girls, compared with boys. CONCLUSIONS: Fitness infusion and game-like elements, used according to self-determination theory principles, can enhance students' physical activity and motivation toward PE. This low-cost intervention has the potential to be scaled up and disseminated in secondary schools.

The A+FMS cluster randomized controlled trial: An assessment-based intervention on fundamental movement skills and psychosocial outcomes in primary schoolchildren.

OBJECTIVES: To evaluate the effectiveness of an assessment-based intervention that emphasizes fun, mastery, and support (A+FMS) on primary schoolchildren's fundamental movement skills (FMS), perceptions of physical and movement skill competence, teacher support and enjoyment. DESIGN: Cluster randomized controlled trial. METHODS: Ten clusters (classes) (n=282; mean age 8.4 years, SD 0.56) were randomised to the A+FMS or wait-list control group in a 1:1 ratio. Teachers in the A+FMS group were required to attend six hours of training and integrate 550min of assessment for learning strategies into their PE lessons for up to a maximum of 13 weeks. FMS competence in jump, skip, hop, overhand throw, dribble and catch was the primary outcome assessed using the Test of Gross Motor Development-3rd Edition. Secondary outcome measures included perceptions of physical and FMS competence, teacher support, and student enjoyment using questionnaires. Multilevel modelling for the analysis of clustered data was used to determine the effectiveness of the intervention. RESULTS: Significant intervention effects were found for locomotor skills (adjusted mean difference, 2.47 units; Cohen's d=0.76), overall FMS competence (3.72 units; Cohen's d=0.93) and perceived teacher support (0.21 units; Cohen's d=0.05). However, there was a group-by-time effect for perceived physical competence (-0.16 units; Cohen's d=-0.07) in favouring of the control group. CONCLUSIONS: An assessment-based teacher-led FMS intervention was effective in improving FMS proficiency in primary schoolchildren. The results highlight the need for increased teacher support to develop positive self-perceptions of competence while promoting children's FMS. Trial registration CUHK_CCRB00479.

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

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

Associations between fundamental movement skill competence, physical activity and psycho-social determinants in Hong Kong Chinese children.

Associations between fundamental movement skills (FMS), perceived competence, enjoyment and physical activity (PA) have not been widely investigated among Chinese school children. We hypothesised that FMS would be directly related to self-reported and objectively measured PA, and indirectly related to these outcomes via perceived physical and movement skill competence, and enjoyment. Participants were 763 primary school children (age = 9.3 ± 1.7 years; 474 girls) across grades. FMS were measured for a subsample (n = 603) using Test of Gross Motor Development-2. PA using accelerometers was obtained from this subgroup (n = 238). All participating children completed a questionnaire measuring their PA participation, enjoyment, and perceived physical and movement skill competence. Structural equation modelling revealed positive associations between locomotor skills and perceived movement skill competence (ß = .11, 95% CI [.001, .22]), and between perceived movement skill competence and objectively measured PA (ß = .59, 95% CI [.04, 1.14]). Perceived physical competence and enjoyment mediated the association between locomotor skills and self-reported PA (ß = .08, 95% CI [.02, .12]), but not objectively measured PA. Given inconsistent findings for subjective and objective measures of PA, further mediation analyses of the association between FMS and PA may be warranted.

Rope skipping increases bone mineral density at calcanei of pubertal girls in Hong Kong: A quasi-experimental investigation.

Bone mineral accrual during puberty is important, especially in girls, because it is related to reduced risks of osteoporosis in adulthood. Previous research has shown that jumping or plyometric exercises may be effective in increasing bone mineral density in adolescents. Rope skipping is a form of activity that involves jumping, thus regular skipping may also increase bone mineral density in pubertal girls. To this end, we conducted a quasi-experimental to examine the effects of rope skipping on girls' bone mineral density and cardiovascular fitness. 176 Hong Kong girls (age = 12.23 ± 1.80 years at baseline) were recruited to take part in the study. Bone density at their forearms and calcanei were measured twice over two academic years (mean time between visits was 10.3 months). Using multilevel modeling analyses and adjusting for participants' height and physical activity, we found that girls who participated in weekly rope skipping activities, compared to those who did not, had higher levels of bone density at the calcanei (B = 0.023, p < .01). However, no differences were found for bone density at forearms or participants' cardiovascular fitness. The rates of change of these variables across time were also not significantly different. Results suggest that regular rope skipping may increase girls' bone density at the lower extremities, irrespective of the amount of self-report physical activity. However, further research is required to examine the potential dose-response relation between skipping behaviors and the measured outcomes.

Increasing students' physical activity during school physical education: rationale and protocol for the SELF-FIT cluster randomized controlled trial.

BACKGROUND: The Self-determined Exercise and Learning For FITness (SELF-FIT) is a multi-component school-based intervention based on tenets of self-determination theory. SELF-FIT aims to increase students' moderate-to-vigorous physical activity (MVPA) during physical education lessons, and enhance their autonomous motivation towards fitness activities. Using a cluster randomized controlled trial, we aim to examine the effects of the intervention on students' MVPA during school physical education. METHODS: Secondary 2 students (approximately aged 14 years) from 26 classes in 26 different schools will be recruited. After baseline assessments, students will be randomized into either the experimental group or wait-list control group using a matched-pair randomization. Teachers allocated to the experimental group will attend two half-day workshops and deliver the SELF-FIT intervention for 8 weeks. The main intervention components include training teachers to teach in more need supportive ways, and conducting fitness exercises using a fitness dice with interchangeable faces. Other motivational components, such as playing music during classes, are also included. The primary outcome of the trial is students' MVPA during PE lessons. Secondary outcomes include students' leisure-time MVPA, perceived need support from teachers, need satisfaction, autonomous motivation towards physical education, intention to engage in physical activity, psychological well-being, and health-related fitness (cardiorespiratory and muscular fitness). Quantitative data will be analyzed using multilevel modeling approaches. Focus group interviews will also be conducted to assess students' perceptions of the intervention. DISCUSSION: The SELF-FIT intervention has been designed to improve students' health and well-being by using high-intensity activities in classes delivered by teachers who have been trained to be autonomy needs supportive. If successful, scalable interventions based on SELF-FIT could be applied in physical education at large. TRIAL REGISTRATION: The trial is registered at the Australia New Zealand Clinical Trial Registry (Trial ID: ACTRN12615000633583 ; date of registration: 18 June 2015).