Individual- and Environmental- Level Predictors of Recess Activity and Sedentary Behavior: Findings from the I-CAN! study.

Introduction/Purpose: Recess represents a prime opportunity for physical activity during the school day. However, evidence is mixed with regard to factors associated with activity during recess. Methods: Data were collected as a part of the Texas Initiative for Children's Activity and Nutrition (I-CAN!) program from 14 elementary schools and 1,049 4th-grade students. Percent of time in moderate-to-vigorous physical activity (MVPA) and sedentary behavior during recess was measured using GT3X+ accelerometers. Students' demographics, aerobic fitness, and body mass index (BMI) were collected from school records and FITNESSGRAM® data. Aspects of the playground environment supporting activity (e.g. soccer goals) or sedentary behavior (e.g. benches) were calculated following the procedures of the System for Observing Play and Leisure Activity in Youth (SOPLAY), with recess spatial area calculated via the polygon measurement tool in Google™ Earth Pro software. Recess time was collected from school data. Weather during recess was determined using time-stamped archived weather data from Weather Underground. Two-level, linear mixed model regression examined associations between individual- and school-level characteristics and percent time in MVPA. Results: At the student-level, boys were more active than girls (effect size (ES)=0.50) and percent time in MVPA was directly associated with aerobic fitness (ES=0.35). At the school-level, recess infrastructure was associated with percent time in MVPA (ES=1.45), except for factors related to sedentary behavior, which were indirectly associated with percent time in MVPA (ES=-1.98). Patterns for sedentary behavior mirrored these effects. Conclusions: This is one of the few studies to test the associations of fitness and sedentary upgrades to play areas with MVPA and sedentary behavior. The results suggest that recess is most likely to support MVPA in boys and those who are already most fit (i.e., those who would not be the target of intervention). This is not surprising because the focus of recess is on free choice of play, and thus recess might be supported more for social and emotional benefits than the impact on physical activity.

Children's Enjoyment, Perceived Competency, and Vigorous Physical Activity During High-Intensity Interval Training in Physical Education.

Purpose: Little is known about children's experience with high-intensity interval training (HIIT) during elementary school. Perceptions of enjoyment, perceived competence, and motivation are likely to drive long-term adherence and are, therefore, critical to understanding how HIIT might be implemented in this setting. The purpose of this study was to describe children's vigorous physical activity (VPA), enjoyment, and perceived competency of HIIT activities within a Self-Determination Theory framework (autonomy) in elementary school physical education (PE) classes. Methods: Participants were 402 children from a single, diverse elementary school (49.4% female, 59.6% Non-Hispanic white). Student enjoyment and perceived competency were collected following teacher- (non-autonomous) and student-led (autonomous) conditions. A sub-set of 201 children wore accelerometers to measure percent of time in VPA during HIIT conditions. This mixed factorial design was assessed through a series of repeated measures ANOVAs. Results: While children reported generally positive enjoyment and perceived competence in both conditions (rating over 4.0 on a 5-point scale), children significantly enjoyed (d = 0.44) and felt more competent (d = 0.11) during the autonomous HIIT condition compared to the nonautonomous HIIT condition. In contrast, the percent of time in VPA (d = 0.94) was significantly lower in the autonomous condition. Conclusions: These data illustrate a challenging trade-off with the design of HIIT trials. Increasing autonomy through the inclusion of student choice increased enjoyment and perceived competence of HIIT, which are likely to improve adherence, but lowered VPA, which is likely to reduce cardiometabolic impact.Abbreviations: U.S.: United States; PA: Physical activity; MVPA; Moderate-to-vigorous physical activity; PE: Physical education; CDC: Centers for Disease Control and Prevention; Randomized control trial, RCT; SDT: Self-Determination Theory; HIIT: High-intensity interval training; RCT: Randomized control trial; VPA: Vigorous physical activity; IRB; Institutional Review Board; HFZ: Healthy Fitness Zone; PACES: Physical Activity Enjoyment Scale; M: Mean; SD: Standard deviation.

Implementation Quality Impacts Fourth Grade Students' Participation in Physically Active Academic Lessons.

It is important to assess implementation of active learning interventions to maximize their impact. Implementation quality, or how well one engages program participants, has been less studied than other implementation components (e.g., dose, fidelity). This cross-sectional, exploratory study examined associations between teacher engagement behaviors, quality of teacher engagement (i.e., teacher feedback), and student physical activity outcomes during active classroom lessons. This study used data from the Texas Initiatives for Children's Activity and Nutrition (I-CAN!) randomized controlled trial. Fixed effects regressions investigated the impact of teacher engagement behaviors on student physical activity outcomes. Bivariate correlations examined associations between teacher feedback and student physical activity outcomes. A latent profile analysis explored whether there were subsets of teachers with similar feedback profiles. The final analytic sample included 82 teachers. Teacher-directed changes and teacher participation in physical activity were each associated with higher ratings for how many and how often children were active during lessons. Teacher participation in physical activity was also significantly related to higher ratings for student physical activity intensity (all p < .05). Physical Activity Reinforcement and Technical Instruction feedback were positively associated with activity intensity (r = - .20, p < .05 and r = .34, p < .01, respectively). Technical Instruction feedback was positively associated with how many (r = .25, p < .01) and how often (r = .41, p < .01) students were active during lessons. Negative feedback was negatively associated with how often (r = - .25, p < .05) students were active and activity intensity (r = - .25, p < .05). Game Instruction was negatively related to how often students were active (r = -.23, p < .05). All teachers were represented by high levels of Game Instruction and Classroom Management feedback, moderate levels of Content Reinforcement and Content Instruction feedback, and low levels of Negative, Technical Instruction, and Physical Activity Reinforcement feedback. These data did not indicate the existence of multiple feedback profiles. Findings suggest that teacher engagement and feedback to students during active lessons can promote student physical activity. Teachers are primarily responsible for implementing school-based interventions, so it is critical to develop strategies that increase their ability to implement them successfully. Opportunities to maximize intervention delivery, such as co-designing with teachers, should be utilized when designing school-based, physical activity interventions.

Lessons Learned from a Physically Active Learning Intervention: Texas I-CAN!

Texas I-CAN! has focused on the development of interventions to provide physically active learning (PAL) to regular education, elementary classroom. This paper provides an overview of our approach and the iterations through which we have progressed the intervention. We adopt a framework that considers PAL along continuums of relatedness to and integration with the academic goals of the lessons. This provides a lens through which to view our iterations of I-CAN!, as we sought a version of PAL that is both acceptable to teachers and effective for physical activity and academic outcomes. As such, this provides an overview of the choices that must be made to translate theory to practice.

Active Learning Increases Children's Physical Activity across Demographic Subgroups.

PURPOSE: Given the need to find more opportunities for physical activity within the elementary school day, this study was designed to asses the impact of I-CAN!, active lessons on: 1) student physical activity (PA) outcomes via accelerometry; and 2) socioeconomic status (SES), race, sex, body mass index (BMI), or fitness as moderators of this impact. METHODS: Participants were 2,493 fourth grade students (45.9% male, 45.8% white, 21.7% low SES) from 28 central Texas elementary schools randomly assigned to intervention (n=19) or control (n=9). Multilevel regression models evaluated the effect of I-CAN! on PA and effect sizes were calculated. The moderating effects of SES, race, sex, BMI, and fitness were examined in separate models. RESULTS: Students in treatment schools took significantly more steps than those in control schools (ß = 125.267, SE = 41.327, p = .002, d = .44). I-CAN! had a significant effect on MVPA with treatment schools realizing 80% (ß = 0.796, SE =0.251, p = .001; d = .38) more MVPA than the control schools. There were no significant school-level differences on sedentary behavior (ß = -0.177, SE = 0.824, p = .83). SES, race, sex, BMI, and fitness level did not moderate the impact of active learning on step count and MVPA. CONCLUSION: Active learning increases PA within elementary students, and does so consistently across demographic sub-groups. This is important as these sub-groups represent harder to reach populations for PA interventions. While these lessons may not be enough to help children reach daily recommendations of PA, they can supplement other opportunities for PA. This speaks to the potential of schools to adopt policy change to require active learning.

A cluster randomized control trial to assess the impact of active learning on child activity, attention control, and academic outcomes: The Texas I-CAN trial.

BACKGROUND: Active learning is designed to pair physical activity with the teaching of academic content. This has been shown to be a successful strategy to increase physical activity and improve academic performance. The existing designs have confounded academic lessons with physical activity. As a result, it is impossible to determine if the subsequent improvement in academic performance is due to: (1) physical activity, (2) the academic content of the active learning, or (3) the combination of academic material taught through physical activity. METHODS/DESIGN: The Texas I-CAN project is a 3-arm, cluster randomized control trial in which 28 elementary schools were assigned to either control, math intervention, or spelling intervention. As a result, each intervention condition serves as an unrelated content control for the other arm of the trial, allowing the impact of physical activity to be separated from the content. That is, schools that perform only active math lessons provide a content control for the spelling schools on spelling outcomes. This also calculated direct observations of attention and behavior control following periods of active learning. DISCUSSION: This design is unique in its ability to separate the impact of physical activity, in general, from the combination of physical activity and specific academic content. This, in combination with the ability to examine both proximal and distal outcomes along with measures of time on task will do much to guide the design of future, school-based interventions.

Physically active vs. sedentary academic lessons: A dose response study for elementary student time on task.

BACKGROUND: Physically active academic lessons are an effective intervention to reduce sedentary time and increase student physical activity. They have also been shown to enhance task engagement, as indicated by observations of attention and behavior control, time on task (TOT). However, it is not clear if the improved TOT stems from the physical activity or if it is the result of an enjoyable break from traditional instruction. If it is due to physical activity, what dose of intensity is required for the effect? This study was designed to test these questions. METHODS: Participants were 320 children (7-9years) recruited from school districts in Central Texas in 2012. They were assigned by classroom (n=20) to one of four conditions: 1) sedentary, standard lesson (n=72); 2) sedentary academic game (n=87); 3) low to moderate intensity PA (LMPA), academic game (n=81); and 4) moderate to vigorous intensity PA (MVPA), academic game (n=76). Measures included PA via accelerometer and TOT. RESULTS: Mixed-method RMANOVA indicated TOT decreased following the standard lesson (p<0.001), showed no change following the sedentary academic game (p=0.68), and increased following the LMPA (p<0.01) and MVPA (p<0.001) academic games. CONCLUSIONS: While the sedentary, academic game prevented the reduction in TOT observed in the standard lesson, PA resulted in increased TOT. Future research should be designed to examine the potential academic benefits of the change in TOT.

Farm to Work: Development of a Modified Community-Supported Agriculture Model at Worksites, 2007-2012.

BACKGROUND: The Farm to Work program is a modified community-supported agriculture model at worksites in Texas. COMMUNITY CONTEXT: The objective of the Farm to Work program is to increase fruit and vegetable intake among employees and their households by decreasing cost, improving convenience, and increasing access while also creating a new market for local farmers at worksites. The objectives of this article were to describe the development, implementation, and outcome of a 5-year participation trend analysis and to describe the community relationships that were formed to enable the successful implementation of the program. METHODS: The Farm to Work program began in November 2007 as a collaborative effort between the nonprofit Sustainable Food Center, the Texas Department of State Health Services, the Web development company WebChronic Consulting LLC, and Naegelin Farm. The program provides a weekly or biweekly opportunity for employees to order a basket of produce online to be delivered to the worksite by a local farmer. A 5-year participation trend analysis, including seasonal variation and sales trends, was conducted using sales data from November 2007 through December 2012. OUTCOME: The total number of baskets delivered from November 2007 through December 2012 was 38,343; of these, 37,466 were sold and 877 were complimentary. The total value of sold and complimentary baskets was $851,035 and $21,925, respectively. Participation in the program increased over time and was highest in 2012. INTERPRETATION: The Farm to Work program increased access to locally grown fruits and vegetables for employees and created a new market for farmers. Increased program participation indicates that Farm to Work can increase employees' fruit and vegetable consumption and thus help prevent chronic diseases in this population.

Fruit and vegetable exposure in children is linked to the selection of a wider variety of healthy foods at school.

Schools often offer healthy fruits and vegetables (FV) and healthy entrées. However, children may resist these efforts due to a lack of familiarity with the offerings. While numerous exposures with a food increase its liking, it may be that an exposure to a variety of FV at home leads to greater willingness to select other foods - even those that are unrelated to those eaten at home. As an initial test of this possibility, this study was designed to examine how self-reports of exposure and consumption of various FV were associated with the selection of FV and lunch entrées at school. Participants (n = 59) were a convenience sample of elementary children. A median split was used to place students into high- and low-exposure groups for self-reports of both exposure and consumption at home. The primary dependent variables were self-reports of selecting FV at school; the children's absolute and relative ratings of eight 'healthier' lunch entrées; and self-reports of selecting these entrées. These entrées were recently added to the school menu and, therefore, tended to be less familiar to children. Food ratings were collected through taste exposures conducted at school. Results indicate that children who reported more frequent exposure to FV at home consumed a wider variety of FV at school and were more likely to report selecting 'healthier' entrées at school lunch. These data suggest that exposure to, and the consumption of, a variety of FV may make children more willing to select a wider range of FV and other healthy entrées.

Physically active academic lessons in elementary children.

BACKGROUND: Although schools are an ideal location to conduct interventions that target children, the emphasis on standardized testing makes it difficult to implement interventions that do not directly support academic instruction. In response, physically active academic lessons have been developed as a strategy to increase physical activity while also addressing core educational goals. Texas I-CAN! is one incarnation of this approach. METHODS: We will review the on-going research on the impact of these active lessons on: teacher implementation, child step count, child attention control, and academic performance. RESULTS: The collected studies support the impact of physically active academic lessons on each area of interest. CONCLUSIONS: If these data can be replicated, it suggests that teachers might find these lessons of benefit to their primary role as educators, which should ease dissemination of these and other physically active lessons in elementary schools.

Physically active academic lessons and time on task: the moderating effect of body mass index.

UNLABELLED: Physically active classroom lessons have been found to increase on-task behavior in children. Given that physical activity has been associated with an increased time on task (TOT) and that overweight children take fewer steps than normal weight children do, it was expected that benefits of the physical activity would differentially impact those children of higher weight status. PURPOSE: To examine the effects of a physically active classroom lesson and body mass index (BMI) category on TOT in a sample of elementary-aged children (N = 97). METHODS: Behavior was assessed through direct observations before and after a physically active classroom lesson and before and after a traditional inactive classroom lesson. TOT was calculated through momentary time sampling for each student by dividing the number of on-task observations by the total number of observations per student (interrater reliability = 94%). RESULTS: TOT decreased significantly from before to after the lesson for all BMI categories in the inactive control condition, with no change for the active condition. Post hoc analyses found a significant linear effect for the reduction in TOT with each level of BMI in the inactive condition, with the greatest magnitude of effect for the overweight group. CONCLUSIONS: Physically active classroom lessons provide a buffer to prevent the steep reduction in TOT experienced after a period of inactivity in all children, especially those who are overweight.

Increasing frequency of lower-fat entrees offered at school lunch: an environmental change strategy to increase healthful selections.

OBJECTIVE: A two-phase study was conducted to determine the effect of an environmental intervention aimed to increase the selection of low- and moderate-fat entrees at school. DESIGN: An evaluation of a school-wide intervention followed for two semesters. SUBJECTS: Two schools of similar size and demographic data were randomly assigned to either intervention or control. Participants were the children in these schools. INTERVENTION: In Phase 1, the rotation of existing entrees was modified such that one of three entree choices was low or moderate in fat. In Phase 2, the number of competing high-fat entrees was reduced from two choices to one. MAIN OUTCOME MEASURES: Data were: (a) entree fat content (determined by a registered dietitian) and (b) the aggregate entree selections compiled from daily selection reports. STATISTICAL ANALYSES PERFORMED: Frequency distributions were used to describe entree availability. Two-way analysis of variance indicated differences in the mean daily selection of low-, moderate-, and high-fat entrees. RESULTS: In Phase 1 in the intervention school, the number of days that a low-fat entree was offered increased by 70%, with no increase in the rate of selection of the low- or moderate-fat entrees. In Phase 2, both low- and moderate-fat entrees were selected at a higher rate in the intervention school (32.1% and 26.4%, respectively) than the control school (13.8% and 7.5%, respectively), P<0.01. CONCLUSIONS: Increasing the availability of low- and moderate-fat entrees is not sufficient to increase their rate of selection. However, their rate of selection is increased as the availability of high-fat entree choices is reduced.

The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era.

The use of highly active antiretroviral therapy (HAART) has served to significantly reduce the mortality of HIV-infected persons. However, this treatment is associated with a host of adverse effects: fatigue, nausea, pain, anxiety and depression. Rather than utilise traditional pharmacological treatments for these effects, many HIV/AIDS patients are utilising adjunct therapies to maintain their quality of life while they undergo treatment. Exercise has consistently been listed as one of the most popular self-care therapies and a small number of studies have been conducted to examine the impact of exercise on the most common self-reported symptoms of HIV and AIDS and the adverse effects of treatment. Although the results are generally positive, there are clear limitations to this work. The existing studies have utilised small samples and experienced high rates of attrition. In addition, the majority of the studies were conducted prior to the widespread use of HAART, which limits the ability to generalise these data. As a result, data from other chronic disease and healthy samples are used to suggest that exercise has the potential to be a beneficial treatment across the range of symptoms and adverse effects experienced by HIV-infected individuals. However, additional research is required with this population to demonstrate these effects.