Combinations of Physical Activity, Sedentary Behavior, and Sleep Duration and Their Associations With Physical, Psychological, and Educational Outcomes in Children and Adolescents: A Systematic Review.

We conducted a systematic review to evaluate combinations of physical activity, sedentary behavior, and sleep duration (defined as "movement behaviors") and their associations with physical, psychological, and educational outcomes in children and adolescents. MEDLINE, CINAHL, PsychInfo, SPORTDiscus, PubMed, EMBASE, and ERIC were searched in June 2020. Included studies needed to 1) quantitatively analyze the association of 2 or more movement behaviors with an outcome, 2) analyze a population between 5 and 17 years of age, and 3) include at least an English abstract. We included 141 studies. Most studies included the combination of physical activity and sedentary behavior in their analyses. Sleep was studied less frequently. In combination, a high level of physical activity and a low level of sedentary behavior were associated with the best physical health, psychological health, and education-related outcomes. Sleep was often included in the combination that was associated with the most favorable outcomes. Sedentary behavior had a stronger influence in adolescents than in children and tended to be associated more negatively with outcomes when it was defined as screen time than when defined as overall time spent being sedentary. More initiatives and guidelines combining all 3 movement behaviors will provide benefit with regard to adiposity, cardiometabolic risk factors, cardiorespiratory fitness, muscular physical fitness, well-being, health-related quality of life, mental health, academic performance, and cognitive/executive function.

Socioeconomic position as a predictor of youth's movement trajectory profiles between ages 10 and 14 years.

BACKGROUND: Combinations of movement behaviors (i.e., physical activity, sedentary behavior, sleep) are associated with health and developmental outcomes in youth. Youth vary in how they accumulate these behaviors, both in volume and specific domains (e.g., sedentary time spent on recreational screen activities vs homework). The aim of this study was to examine how youth's combined general and domain-specific movement trajectories differ by socioeconomic position. METHODS: We conducted a longitudinal, group-based multi-trajectory analysis to identify general and domain-specific movement trajectory profiles for 2457 youth from age 10 to 14 years from the Longitudinal Study of Australian Children from 2014-2018. We used multinomial logistic regression to test if socioeconomic position predicted profile membership. RESULTS: We identified three general movement trajectory profiles for both sexes, four domain-specific profiles for males, and five for females. For general movement trajectories, females from lower socioeconomic positions were more likely to be a combination of less active and more sedentary than females from higher socioeconomic positions. Males across socioeconomic positions spend similar amounts of time in physical activity, sedentary time, and sleep. For domain-specific movement trajectories, youth from lower socioeconomic positions were likely to spend a combination of less time in education-based sedentary behavior and more time in recreational screen activities than their higher socioeconomic position peers. CONCLUSION: Our results indicate that socioeconomic position predicted in which domains youth accumulate their movements. Future observational research and interventions targeting different socioeconomic groups should therefore consider domain-specific movement trajectories.

Outdoor time, screen time and sleep reported across early childhood: concurrent trajectories and maternal predictors.

BACKGROUND: Understanding the developmental trajectories of outdoor time, screen time and sleep is necessary to inform early interventions that promote healthy behaviours. This study aimed to describe concurrent trajectories of outdoor time, screen time and sleep across the early childhood period and their maternal predictors. METHODS: Data across five time points at child age 4, 9, 19, 42 and 60 months from the INFANT intervention were analysed. Mothers reported their child's usual outdoor time, screen time and sleep duration, in addition to a range of maternal beliefs, attitudes, expectations and behaviours. Group-based multi-trajectory modelling was used to model concurrent trajectories of children's behaviours. Multinomial logistic regression models determined the associations of maternal predictors with trajectory groups, adjusting for child sex and baseline age, intervention allocation, and clustering by recruitment. RESULTS: Of the 542 children recruited, 528 had data for outdoor time, screen time and sleep at one or more time points and were included in trajectory analyses Four trajectories were identified: 'unstable sleep, increasing outdoor time, low screen' (~ 22% of sample), 'high outdoor time, low screen, high sleep' (~ 24%), 'high sleep, increasing outdoor time, low screen' (~ 45%), 'high screen, increasing outdoor time, high sleep' (~ 10%). The 'high sleep, increasing outdoor time, low screen' group, comprising the largest percentage of the sample, demonstrated the healthiest behaviours. Predictors of group membership included: views of physically active children, screen time knowledge, screen time use, self-efficacy, physical activity optimism, future expectations for children's physical activity and screen time, perceptions of floor play safety, and maternal physical activity, screen time, and sleep quality. CONCLUSIONS: Four distinct trajectories of outdoor time, screen time and sleep were identified, with the most common (and healthiest) characterized by high levels of sleep. Maternal beliefs, attitudes, expectations and behaviours are important in the development of movement behaviour trajectories across early childhood. Future interventions and public policy may benefit from targeting these factors to support healthy movement behaviours from a young age.

Reliability of GENEActiv accelerometers to estimate sleep, physical activity, and sedentary time in children.

BACKGROUND: Reliable estimates of habitual sleep, physical activity, and sedentary time are essential to investigate the associations between these behaviours and health outcomes. While the number of days needed and hours/day for estimates of physical activity and sedentary time are generally known, the criteria for sleep estimates are more uncertain. The objective of this study was to identify the number of nights needed to obtain reliable estimates of habitual sleep behaviour using the GENEActiv wrist worn accelerometer. The number of days to obtain reliable estimate of physical activity was also examined. METHODS: Data was used from a two-year longitudinal study. Children wore an accelerometer for up to 8 days 24 h/day across three timepoints. The sample included 2,745 children (51 % girls) between the ages of 7-12-years-old (mean = 9.8 years, SD = 1.1 year) with valid accelerometer data from any timepoint. Reliability estimates were calculated for sleep duration, sleep efficiency, sleep onset, wake time, time in bed, light physical activity, moderate physical activity, moderate-to-vigorous physical activity, vigorous physical activity, and sedentary time. RESULTS: Intraclass correlations and the Spearman Brown prophecy formula were used to determine the nights and days needed for reliable estimates. We found that between 3 and 5 nights were needed to achieve acceptable reliability (ICC = 0.7) in sleep outcomes, while physical activity and sedentary time outcomes required between 3 and 4 days. CONCLUSIONS: To obtain reliable estimates, researchers should consider these minimum criteria when designing their studies and prepare strategies to ensure sufficient wear time compliance.

Maternal Judgments of Child Numeracy and Reading Ability Predict Gains in Academic Achievement and Interest.

In a representative longitudinal sample of 2,602 Australian children (52% boys; 2% Indigenous; 13% language other than English background; 22% of Mothers born overseas; and 65% Urban) and their mothers (first surveyed in 2003), this article examined if maternal judgments of numeracy and reading ability varied by child demographics and influenced achievement and interest gains. We linked survey data to administrative data of national standardized tests in Year 3, 5, and 7 and found that maternal judgments followed gender stereotype patterns, favoring girls in reading and boys in numeracy. Maternal judgments were more positive for children from non-English speaking backgrounds. Maternal judgments predicted gains in children's achievement (consistently) and academic interest (generally) including during the transition to high school.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Type of screen time moderates effects on outcomes in 4013 children: evidence from the Longitudinal Study of Australian Children.

BACKGROUND: Excessive engagement with digital screens is harmful to children's health. However, new evidence suggests that exposure at moderate levels may not be harmful and may even provide benefit. Therefore, our objective was to determine if there are curvilinear relationships between different types of screen time and a diverse set of outcomes, including health and education. METHODS: We address our objective using a repeated measures design. Children (N = 4013), initially aged 10-11 were assessed every 2 years between 2010 and 2014. Children's screen time behavior was measured using time-use diaries, and categorized into five types: social, passive, interactive, educational, or other. We used measures of children's physical health, health-related quality of life, socio-emotional outcomes, and school achievement. The analysis plan was pre-registered. Models were adjusted for gender, socio-economic status, ethnicity, number of siblings, and housing factors. RESULTS: There were linear associations between total screen time and all outcomes, such that more screen time was associated with worse outcomes. However, there was variability when examined by screen time type. Passive screen time (e.g., TV) was associated with worse outcomes, educational screen time (e.g., computer for homework) was associated with positive educational outcomes and had no negative relations with other outcomes. Interactive screen time (e.g., video games) had positive associations with educational outcomes but negative associations with other outcomes. In all instances, these significant associations were small or very small, with standardised effects < 0.07. We found little evidence of curvilinear relationships. CONCLUSIONS: The small effects of screen time on children's outcomes appear to be moderated by the type of screen time. Policy makers, educators, and parents should consider the type of screen time when considering the benefits and harms of use.

Joint physical-activity/screen-time trajectories during early childhood: socio-demographic predictors and consequences on health-related quality-of-life and socio-emotional outcomes.

BACKGROUND: Understanding the early roots of physical activity and sedentary behaviors is critical to developing intervention programs that promote healthy lifestyle habits in infants and children. There is, however, no evidence on how these behaviors cluster and develop together during early childhood. The aim of this study was to identify single and joint longitudinal trajectories in physical activity and screen time amongst children aged 0 to 9 years, their social-demographic predictors and their prospective health-related quality-of-life and socio-emotional outcomes. METHODS: Three waves of data from The Longitudinal Study of Australian Children, a national study tracking two cohorts every 2 years (B-cohort, 0-5 years, n = 4,164; K-cohort, 4-9 years, n = 3,974) were analysed. Growth mixture modelling was applied to longitudinal time-use diary data to identify joint trajectories in children's physical activity and screen time over Waves 1-3. Key socio-demographic variables measured at Wave 1 were used to predict membership in different trajectories. The prospective consequences (at Wave 3) of time-use trajectories on health-related quality-of-life and socio-emotional outcomes were assessed. RESULTS: Three physical-activity/screen-time trajectories were identified for both cohorts: Cluster-A-children who maintained low levels of physical activity and screen time (∽50% of the sample), Cluster-B-children who progressively increased physical activity and maintained low screen-time levels (∽25%), and Cluster-C-children who maintained low physical-activity levels and increased screen time (∽25%). Children in Cluster-B experienced the best health-related quality-of-life and socio-emotional outcomes, while those in Cluster-C experienced the worst. Children who were female, Indigenous, from non-English-speaking backgrounds, not living with two biological parents, in more affluent households and neighbourhoods, without siblings and with parents with poor mental health were at greater risk of falling into Cluster-A or Cluster-C. CONCLUSION: Our findings identified which children are most at-risk of falling into time-use trajectories that lead to poor health-related quality-of-life and socio-emotional outcomes later in life, increasing our ability to monitor, detect and prevent these suboptimal behaviours prior to their onset.

Associations between physical activity intensity and well-being in adolescents.

This study aims to explore associations between physical activity intensity and well-being (i.e., positive and negative affect) in adolescents. A secondary aim was to determine if associations were moderated by sex. Grade 8 students from 14 government-funded secondary schools in low socio-economic areas of Western Sydney (Australia) were assessed. Data from three timepoints (baseline, 7-8 months, and 14-15 months) were combined to increase the sample size. Physical activity was objectively assessed for 1-week at each timepoint using Actigraph accelerometers. Time (minutes/day) in light, moderate and vigorous physical activity was estimated. The short form Positive and Negative Affect Scale for Children was used to measure well-being. Quantile regression was used to analyse the data. A total of 3140 observations were collected from 1223 students (mean age at baseline: 12.9(0.54); 55.1% male). Light and moderate physical activity was not associated with well-being. Higher levels of vigorous physical activity were associated with more positive affect [ß(SE) = 0.307 (0.06), p < 0.001], to an estimated vigorous physical activity turning point [Point(95%CI) = 36.48 min/day (31.39-41.59)]. Similarly, higher levels of vigorous physical activity were associated with less negative affect [ß(SE) = -0.250 (0.06), p < 0.001] up to the estimated vigorous physical activity turning point [Point(95%CI) = 37.35 min/day (31.27-43.44)]. The negative association between vigorous physical activity and negative affect was more pronounced in females than in males. Our findings highlight the importance of adolescents engaging in vigorous physical activity to improve positive affect and reduce negative affect.

A monitoring system to provide feedback on student physical activity during physical education lessons.

School-based physical education (PE) provides opportunities to accumulate moderate-to-vigorous physical activity (MVPA), but many students are insufficiently active during PE lessons. Providing teachers with feedback regarding their students' physical activity may increase the effectiveness of PE for achieving MVPA goals, but existing physical activity monitoring technologies have limitations in class environments. Therefore, the purpose of this study was to develop and validate a system capable of providing feedback on PE lesson MVPA. Equations for translating step counts to %MVPA were derived from measures in 492 students who concurrently wore an ActiGraph GT3X+ (ActiGraph) and Yamax pedometer (Yamax) during a PE lesson. To enhance feedback availability during PE lessons, we then developed a bespoke monitoring system using wireless tri-axial pedometers (HMM) and a smart device app. After developing and testing the monitoring system, we assessed its validity and reliability in 100 students during a PE lesson. There was a strong correlation of 0.896 between step counts and accelerometer-determined %MVPA and quantile regression equations showed good validity for translating step counts to %MVPA with a mean absolute difference of 5.3 (95% CI, 4.4-6.2). The physical activity monitoring system was effective at providing %MVPA during PE lessons with a mean difference of 1.6 ± 7.1 compared with accelerometer-determined %MVPA (7% difference between the two measurement methods). Teachers and students can use a smart device app and wireless pedometers to conveniently obtain feedback during PE lessons. Future studies should determine whether such technologies help teachers to increase physical activity during PE lessons.

Ahead of the game protocol: a multi-component, community sport-based program targeting prevention, promotion and early intervention for mental health among adolescent males.

BACKGROUND: There is a recognised need for targeted community-wide mental health strategies and interventions aimed specifically at prevention and early intervention in promoting mental health. Young males are a high need group who hold particularly negative attitudes towards mental health services, and these views are detrimental for early intervention and help-seeking. Organised sports provide a promising context to deliver community-wide mental health strategies and interventions to adolescent males. The aim of the Ahead of the Game program is to test the effectiveness of a multi-component, community-sport based program targeting prevention, promotion and early intervention for mental health among adolescent males. METHODS: The Ahead of the Game program will be implemented within a sample drawn from community sporting clubs and evaluated using a sample drawn from a matched control community. Four programs are proposed, including two targeting adolescents, one for parents, and one for sports coaches. One adolescent program aims to increase mental health literacy, intentions to seek and/or provide help for mental health, and to decrease stigmatising attitudes. The second adolescent program aims to increase resilience. The goal of the parent program is to increase parental mental health literacy and confidence to provide help. The coach program is intended to increase coaches' supportive behaviours (e.g., autonomy supportive behaviours), and in turn facilitate high-quality motivation and wellbeing among adolescents. Programs will be complemented by a messaging campaign aimed at adolescents to enhance mental health literacy. The effects of the program on adolescent males' psychological distress and wellbeing will also be explored. DISCUSSION: Organised sports represent a potentially engaging avenue to promote mental health and prevent the onset of mental health problems among adolescent males. The community-based design, with samples drawn from an intervention and a matched control community, enables evaluation of adolescent males' incremental mental health literacy, help-seeking intentions, stigmatising attitudes, motivation, and resilience impacts from the multi-level, multi-component Ahead of the Game program. Notable risks to the study include self-selection bias, the non-randomised design, and the translational nature of the program. However, strengths include extensive community input, as well as the multi-level and multi-component design. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000709347 . Date registered 17 May 2017. Retrospectively registered.

Are changes in occupational physical activity level compensated by changes in exercise behavior?

Background: Physically active occupations with high-energy expenditure may lead to lower motivation to exercise during leisure time, while the reverse can be hypothesized for sedentary occupations. The aim of this study was to investigate the impact of changing occupational activity level on exercise behavior. Methods: Data on occupational physical activity and leisure time exercise were taken from a population-based cohort, with surveys completed in 2010 and 2014. Using data on those employed in both years, two trajectories were analyzed: (i) participants who changed from sedentary to active occupations and (ii) participants who changed from active to sedentary occupations. Exercise was reported in hours per week and changes from 2010 to 2014 were categorized as decreased, increased or stable. Associations were expressed as ORs and 95% CIs adjusting for age, gender and education. Results: Data were available for 12 969 participants (57% women, aged 45 ± 9 years, 57% highly educated). Relative to participants whose occupational activity was stable, participants who changed to active occupations (n = 549) were more likely to decrease exercise (OR = 1.22, 95% CI = 1.02-1.47) and those who changed to sedentary occupations (n = 373) more likely to increase exercise levels (OR = 1.21, 95% CI = 0.97-1.52). Conclusion: People changing from sedentary to active occupations compensate by exercising less, and those changing from physically active to sedentary occupations seem to compensate by exercising more in their leisure time. When developing and evaluating interventions to reduce occupational sedentary behavior or to promote exercise, mutual influences on physical activity of different contexts should be considered.

Scaling-up an efficacious school-based physical activity intervention: Study protocol for the 'Internet-based Professional Learning to help teachers support Activity in Youth' (iPLAY) cluster randomized controlled trial and scale-up implementation evaluation.

BACKGROUND: Despite the health benefits of regular physical activity, most children are insufficiently active. Schools are ideally placed to promote physical activity; however, many do not provide children with sufficient in-school activity or ensure they have the skills and motivation to be active beyond the school setting. The aim of this project is to modify, scale up and evaluate the effectiveness of an intervention previously shown to be efficacious in improving children's physical activity, fundamental movement skills and cardiorespiratory fitness. The 'Internet-based Professional Learning to help teachers support Activity in Youth' (iPLAY) study will focus largely on online delivery to enhance translational capacity. METHODS/DESIGN: The intervention will be implemented at school and teacher levels, and will include six components: (i) quality physical education and school sport, (ii) classroom movement breaks, (iii) physically active homework, (iv) active playgrounds, (v) community physical activity links and (vi) parent/caregiver engagement. Experienced physical education teachers will deliver professional learning workshops and follow-up, individualized mentoring to primary teachers (i.e., Kindergarten - Year 6). These activities will be supported by online learning and resources. Teachers will then deliver the iPLAY intervention components in their schools. We will evaluate iPLAY in two complementary studies in primary schools across New South Wales (NSW), Australia. A cluster randomized controlled trial (RCT), involving a representative sample of 20 schools within NSW (1:1 allocation at the school level to intervention and attention control conditions), will assess effectiveness and cost-effectiveness at 12 and 24 months. Students' cardiorespiratory fitness will be the primary outcome in this trial. Key secondary outcomes will include students' moderate-to-vigorous physical activity (via accelerometers), fundamental movement skill proficiency, enjoyment of physical education and sport, cognitive control, performance on standardized tests of numeracy and literacy, and cost-effectiveness. A scale-up implementation study guided by the RE-AIM framework will evaluate the reach, effectiveness, adoption, implementation, and maintenance of the intervention when delivered in 160 primary schools in urban and regional areas of NSW. DISCUSSION: This project will provide the evidence and a framework for government to guide physical activity promotion throughout NSW primary schools and a potential model for adoption in other states and countries. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ( ACTRN12616000731493 ). Date of registration: June 3, 2016.

The influence of neighbourhood green space on children's physical activity and screen time: findings from the longitudinal study of Australian children.

OBJECTIVE: It is often hypothesised that neighbourhood green space may help prevent well-known declines in physical activity and increases in sedentary behaviour that occur across childhood. As most studies in this regard are cross-sectional, the purpose of our study was to use longitudinal data to examine whether green space promotes active lifestyles as children grow older. METHODS: Data came from participants (n = 4983; age = 4-5) of the Longitudinal Study of Australian Children, a nationally representative study on health and child development. Physical activity and screen time were measured biennially (2004-2012) using questionnaires and time use diaries. Quantity of neighbourhood green space was objectively measured using Australian Bureau of Statistics mesh block data for each participant's statistical area level 2. Multilevel regression was used to test for associations between physical activity and screen time with green space quantity, adjusting for socio-economic confounders. RESULTS: Boys living in areas with 10% more neighbourhood green space had a: 7% (95% CI = 1.02, 1.13) greater odds of choosing physically active pastimes; 8% (95 % CI = 0.85, 1.00) lower odds of not enjoying physical activity; 2.3 min reduction in weekend television viewing (95% CI = -4.00, -0.69); and 7% (95% CI = 1.02; 1.12) and 9% (95% CI = 1.03; 1.15) greater odds of meeting physical activity guidelines on weekdays and weekends, respectively. No statistically (or practically) significant results were observed for girls. CONCLUSION: Current provisions of neighbourhood green space may be more amenable to promoting active lifestyles among boys than girls. Research is needed to explore what types of green space promote active lifestyles in all children.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens.

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.

OBJECTIVE: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN: Systematic review and network meta-analysis. METHODS: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018118040.

A cluster randomized controlled trial of strategies to increase adolescents' physical activity and motivation in physical education: results of the Motivating Active Learning in Physical Education (MALP) trial.

OBJECTIVE: Physical education (PE) programs aim to promote physical activity (PA) and reach most school-aged youth. However, PA levels within PE lessons are often low. In this cluster-randomized controlled trial, we examined the effects of three self-determination theory-based motivational strategies on PA and sedentary behavior, as well as their hypothesized antecedents during PE lessons. METHODS: Data were collected in Sydney, Australia (October-December 2011). After baseline testing, teachers (n=16) and their classes (n=288 students; M=13.6 years, 50.4% male) were randomly assigned to one of four teaching strategy conditions: (1) explaining relevance; (2) providing choice; (3) complete free choice; or (4) usual practice. Teachers then delivered the assigned strategy. Primary outcomes were accelerometer-assessed PA and student motivation during lessons. Secondary outcomes included sedentary behavior, perceptions of teachers' support and psychological needs satisfaction. RESULTS: The 'free choice' intervention increased PA (p<.05). 'Providing choice' and 'free choice' interventions decreased sedentary behavior (p<.05). The interventions did not influence motivation, but students' autonomy increased during both choice-based interventions (p<.05). CONCLUSIONS: Promoting choice can produce short-term increases in PA and decreases in sedentary behavior, as well as increased perceived autonomy during PE lessons.

School socioeconomic status context and social adjustment in children.

Social adjustment is critical to educational and occupational attainment. Yet little research has considered how the school's socioeconomic context is associated with social adjustment. In a longitudinal sample of Australian 4- to 8-year-olds (N = 9369; 51% boys) we tested the association between school average socioeconomic status and social skills (parent and teacher reported). Models controlled for age 4 social adjustment and additional covariates. Results showed that children from more advantaged schools are more likely to have better prosocial behavior and fewer peer and conduct problems. An interaction between family and school average socioeconomic status (SES) suggested that this association was mainly present for children from lower SES backgrounds. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Scaling up a school-based intervention to increase physical activity and reduce sedentary behaviour in children: protocol for the TransformUs hybrid effectiveness-implementation trial.

INTRODUCTION: Efficacious programmes require implementation at scale to maximise their public health impact. TransformUs is an efficacious behavioural and environmental intervention for increasing primary (elementary) school children's (5-12 years) physical activity and reducing their sedentary behaviour within school and home settings. This paper describes the study protocol of a 5-year effectiveness-implementation trial to assess the scalability and effectiveness of the TransformUs programme. METHODS AND ANALYSIS: A type II hybrid implementation-effectiveness trial, TransformUs is being disseminated to all primary schools in the state of Victoria, Australia (n=1786). Data are being collected using mixed methods at the system (state government, partner organisations), organisation (school) and individual (teacher, parent and child) levels. Evaluation is based on programme Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. RE-AIM domains are being measured using a quasi-experimental, pre/post, non-equivalent group design, at baseline, 12 and 24 months. Effectiveness will be determined in a subsample of 20 intervention schools (in Victoria) and 20 control schools (in New South Wales (NSW), Australia), at baseline, 12 and 24 months. Primary outcomes include TransformUs Reach, Adoption, Implementation and organisational Maintenance (implementation trial), and children's physical activity and sedentary time assessed using accelerometers (effectiveness trial). Secondary outcomes include average sedentary time and moderate to vigorous-intensity physical activity on weekdays and during school hours, body mass index z-scores and waist circumference (effectiveness trial). Linear mixed-effects models will be fitted to compare outcomes between intervention and control participants accounting for clustering of children within schools, confounding and random effects. ETHICS AND DISSEMINATION: The trial was approved by the Deakin University Human Research Ethics Committee (HEAG-H 28_2017), Victorian Department of Education, the NSW Department of Education, Australian Catholic University (2017-145R), Melbourne Archdiocese Catholic Schools and Catholic Schools NSW. Partners, schools/teachers and parents will provide an informed signed consent form prior to participating. Parents will provide consent for their child to participate in the effectiveness trial. Findings will be disseminated via peer-reviewed publications, scientific conferences, summary reports to schools and our partner organisations, and will inform education policy and practice on effective and sustainable ways to promote physical activity and reduce sedentary behaviours population-wide. TRIAL REGISTRATION NUMBER: Australian Clinical Trials Registration Registry (ACTRN12617000204347).

A cluster-randomized controlled trial of strategies to increase adolescents' physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial.

BACKGROUND: The physical activity (PA) levels of many children and adolescents in Australia are currently insufficient to promote health benefits. Physical education (PE) programs aim to promote PA and reach nearly all school-aged children, but PA levels within PE lessons are often low. PE teachers may influence children's motivation to be physically active in PE lessons, but little is known about teacher strategies that effectively motivate children to participate in PA, and few intervention studies have examined motivational strategies in PE. The purpose of this study was to compare the effect of three motivational strategies, each based on Self-Determination Theory (SDT), on PA levels, and their hypothesized antecedents, during year 8 PE lessons. METHODS/DESIGN: This study employed a cluster-randomized controlled trial design. Following a familiarization session, PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson. Teachers (n = 16) and their classes from five secondary schools in Sydney, Australia were randomly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions: (1) explaining the relevance of activities; (2) providing choice from PA options selected by the teacher; (3) providing equipment and free choice of activities; or (4) usual practice. The primary outcomes were lesson time spent in moderate-to-vigorous PA, and motivation towards the lesson. Secondary outcomes were perceptions of teacher behavior, psychological needs satisfaction, and lesson time spent in sedentary behavior. PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers. Teacher behavior, psychological needs satisfaction, and motivation were assessed via questionnaires at the end of each lesson. Linear mixed-model analyses will be run on all outcomes, with students nested within teachers as a random effect. DISCUSSION: Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students' psychological needs satisfaction, motivation, and PA levels. More effective teaching strategies may be identified that are capable of improving adolescents' PA levels, and thereby provide beneficial population health outcomes. TRIAL REGISTRATION: This trial is registered with Current Controlled Trials and is traceable as ISRCTN07038258.