Evaluation of Skipping Rope and Informational Pamphlet Among Adolescents in South Africa

Impact of Skipping Rope and Informational Pamphlet on Physical Activity Among Adolescents in South Africa

The purpose of the study is to evaluate the impact of providing a skipping rope and informational pamphlet to adolescents aged 10-14 years on their physical activity intentions and behaviors from baseline to 12-month follow-up when compared with adolescents of the same age who are not provided with any intervention. This study comprises a two-arm randomized controlled trial nested within an adolescent cohort, i.e. a 'randomized trial-within-cohort'. The intervention will include providing each participant with a skipping rope and a pamphlet with general instructions for skipping the rope and messages about the importance of physical activity. The investigators hypothesize that adolescents in a South African community who are provided with a skipping rope and an informational pamphlet on physical activity will engage in more physical activity behaviors and will report greater intentions to be physically active at a 12-month follow-up, compared to a control group of adolescents who do not receive the intervention.

Study Overview

• Status: Recruiting
• Conditions: Moderate-vigorous Physical Activity (MVPA)
• Intervention / Treatment: Other: Skipping rope and informational pamphlet

Detailed Description

Adolescence is a key period of life during which important physical and psychosocial changes happen. With adolescents comprising about 16% of the world population and 23% of the population in Sub-Saharan Africa (SSA), it is critical to address their health needs to ensure their present wellbeing, as well as healthier trajectories across the life course. One of the most important aspects of a healthy lifestyle during adolescence is physical activity. Regular physical activity improves several physical and mental health outcomes among adolescents. This includes improving muscular strength and flexibility, bone mass, cardiovascular health, lung function, and reducing the risk of obesity and related diseases, such as type 2 diabetes or heart diseases. Additionally, physical activity can improve energy levels, mood, sleep, academic attainment, and social behavior, and it provides an opportunity to connect with peers, by reducing feelings of isolation and fostering friendships.

The World Health Organization (WHO) recommends that adolescents do at least 60 minutes of moderate-to-vigorous physical activity (MVPA) per day, incorporating vigorous-intensity aerobic activities at least three days a week, and limiting the amount of time spent being sedentary. Despite this, research found that adolescents in SSA tend to be largely inactive, with about 82-90% of adolescents reporting low physical activity levels. Similarly, studies suggest that a large proportion of adolescents in South Africa does not meet the physical activity recommendations, with about 93% of males and 95% of females reporting a decrease in physical activity outside of school or sports clubs over adolescence, compared to childhood, and with only 50% of children and adolescents meeting the recommended one hour of MVPA per day.

Skipping, or jumping rope, is a type of physical activity practiced among adolescents across the world. It requires a simple rope and involves the simultaneous rotation of arms and vertical jumping. Skipping rope is an ideal way to promote physical activity among adolescents in South Africa, as it is an easy-to-implement, whole body exercise that has been associated with increased cardiorespiratory fitness and improved bone density. Providing education on the importance of physical activity and instructions on how to skip rope, in addition to the rope itself, can help increase awareness about the benefits of being active and skipping rope, and can help adolescents develop physical activity skills. While there is substantial evidence for short-term positive effects of skipping rope and of successful implementation in schools, there is limited evidence on long-term effects and on implementation in community settings outside of school. Additionally, to the investigators' knowledge, there is limited evidence on skipping rope interventions for adolescents in South Africa.

To address these gaps, the investigators propose to implement a parallel arm randomized controlled trial (1:1 allocation) to promote physical activity among adolescents aged 10-14 years in a community setting in South Africa. This trial will focus on the provision of a skipping rope and informational pamphlet on physical activity and examine their impact on measures of physical activity intentions and behaviors among adolescents over 12 months from baseline. The trial, described in this protocol, will be nested within the Design and Evaluation of Adolescent Health Interventions and Policies (DASH) project, aimed at boosting adolescent health in the SSA region through rigorous population-based intervention and policy research. The DASH project involves the establishment of a cohort of adolescents and young adults, who will be followed up over four waves of data collection in four years. The trial is not invasive.

For the intervention group, the provision of rope and informational pamphlet will happen during the participant interview within the overall DASH cohort study. The fieldworker conducting the survey interview will provide each participant in the intervention group with a rope and pamphlet and will read a short script explaining how to use the rope, outlining the benefits of physical activity for adolescents, and asking participants to read the pamphlet in their own time. The control group will not receive any intervention.

• Study Type: Interventional
• Enrollment (Estimated): 700
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jabulani Ncayiyana, Ph.D.; Phone Number: +27 (031) 260 4459; Email: ncayiyanaj@ukzn.ac.za
• Study Contact Backup: Name: Elisabetta Ferrero, MPH; Email: eferrero@hsph.harvard.edu

Study Locations

• South Africa
  • KwaZulu-Natal
    • Durban, KwaZulu-Natal, South Africa, 4091
      • Recruiting
      • University of KwaZulu-Natal
      • Contact: Jabulani Ncayiyana, Ph.D; Phone Number: +27 031-260-4459; Email: NcayiyanaJ@ukzn.ac.za
      • Contact: Jabulani Ncayiyana, Ph.D.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Study participant is between ages 10 and 14 years;
• Minors (i.e. less than 18 years of age): the parents or guardians provide written informed consent;
• Minors: the minor participant provides informed assent;
• Study participant is a resident of the study area and intends to stay in the study area for the duration of the study;

Exclusion Criteria:

• Participants with physical disabilities that prevent them from doing physical activity will be excluded;
• Those participants whose capacity to make meaningful decisions is in question because they are "cognitively impaired" will be excluded;
• Individuals with communication difficulties will be excluded.
• Study participants who report suicidal behaviors during baseline data collection will be excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Skipping rope and informational pamphlet; The intervention group will be provided with a skipping rope and pamphlet with information on the importance of physical activity and ways to engage in physical activity. Both the skipping rope and pamphlet will be provided only once after completing the baseline interview.	Other: Skipping rope and informational pamphlet; The provision of a skipping rope and an informational pamphlet to the intervention arm participants will happen during the participant interview within the overall DASH cohort study. The enumerator conducting the survey interview will provide each participant in the intervention group with a skipping rope and pamphlet and will read a short script explaining how to use the rope, outlining the main benefits of physical activity for adolescents, and asking participants to read the pamphlet in their own time.
No Intervention: Control; The control arm will not receive provision of intervention (no skipping rope or informational pamphlet).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of moderate to vigorous physical activity (MVPA) per week	Total minutes of MVPA/week. This will be calculated by multiplying the minutes of MVPA on the most recent day participant did MVPA by the number of days MVPA was done.	Baseline and follow up at 12 months after baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of adolescents who meet the MVPA recommendations over the 7 days preceding the interview	Percentage of adolescents who meet the WHO MVPA recommendations of at least 60 minutes/day of MVPA across the week (>=420 minutes/week)	Baseline and follow up at 12 months after baseline
Intention to engage in physical activity compared to the 7 days preceding the interview	Intention to engage in physical activity compared to previous 7 days. This will be evaluated by asking participants if they intend to change the amount of physical activity they do in the 7 days following the interview, compared to the 7 days preceding the interview.	Baseline and follow up at 12 months after baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Utilization of rope, process outcome	Utilization modality of skipping rope, that is alone or with friends, among intervention group	At the 12-month follow up assessment after baseline

Collaborators and Investigators

• Sponsor: University of KwaZulu
• Collaborators: Heidelberg University; Technical University of Munich; Harvard School of Public Health (HSPH); Africa Academy for Public Health; USINGA Health and Demographic Surveillance System
• Investigators: Principal Investigator: Jabulani Ncayiyana, Ph.D., University of KwaZulu; Principal Investigator: Mosa Moshabela, University of KwaZulu; Principal Investigator: Mary Mwanyika-Sando, Africa Academy of Public Health; Principal Investigator: Michael Laxi, Technical University of Munich; Principal Investigator: Till Bärnighausen, Heidelberg University; Principal Investigator: Jacob Burns, Technical University of Munich

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2024
• Primary Completion (Estimated): December 30, 2025
• Study Completion (Estimated): December 30, 2025

Study Registration Dates

• First Submitted: July 17, 2024
• First Submitted That Met QC Criteria: July 17, 2024
• First Posted (Actual): July 24, 2024

Study Record Updates

• Last Update Posted (Estimated): November 22, 2024
• Last Update Submitted That Met QC Criteria: November 21, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: Physical activity; South Africa; Community; Young adolescents; Skipping rope; Informational pamphlet
• Other Study ID Numbers: BREC000064592023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

IPD Plan Description

It is not yet known if there will be a plan to make IPD available. There are ethical concerns about data privacy and confidentiality that require careful consideration before sharing individual-level data as the trial is embedded with the large DASH Project.

A detailed statistical plan will be developed in due course and made available on this registry.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No