Active play in ASP -a matched-pair cluster-randomized trial investigating the effectiveness of an intervention in after-school programs for supporting children's physical activity

Kirsti Riiser, Kåre Rønn Richardsen, Anders L H Haugen, Siv Lund, Knut Løndal, Kirsti Riiser, Kåre Rønn Richardsen, Anders L H Haugen, Siv Lund, Knut Løndal

Abstract

Background: Interventions directed at after school programs (ASPs) have the potential to support physical activity (PA) in young children. Research has indicated that interventions that emphasize competence building among the ASP staff can lead to increased PA among the children. The present study evaluates the effectiveness of the Active Play in ASP intervention-a program for ASP staff aimed at supporting physical activity among first graders in ASP.

Methods: We used a matched-pair cluster randomized design and included 456 first graders from 14 schools in Norway. From these, 7 ASPs received the intervention (N = 229), while 7 acted as controls (N = 227). Measurements were taken at baseline, immediately post intervention (7 month follow-up) and after a year (19 month follow-up). The primary outcome was moderate to vigorous physical activity (MVPA), which was estimated with predefined cut points of counts per minute (CPM) and expressed as minutes/hour. Secondary outcomes were vigorous and light intensity physical activity (VPA and LPA) and sedentary behavior. The analyses of intervention effects were based on between-group differences in outcome changes between the 3 measurement points and were conducted using a mixed-effects model for repeated measures using categorical time. In exploratory analyses, we investigated gender, baseline body mass index, and baseline CPM as potential effect modifiers.

Results: No significant intervention effects was observed on MVPA (0.55 min/hour [99% CI -0.55:1.64]) or on the secondary outcomes, min/hour of LPA, VPA or sedentary behavior. Exploratory analyses indicated that among the 50% least physically active children at baseline, children in intervention ASPs reduced sedentary time from baseline to 19 months follow up by 1.67 min/hour (95% CI -3.12:-0.21) compared to the controls.

Conclusions: Although the intervention did not significantly increase the mean MVPA among the children in the intervention ASPs compared to controls, it did seem to have a small effect by reducing sedentary behavior time among the least active children. An even stronger emphasis on how to identify less active children and support their activity may be needed in order to increase their PA and further reduce sedentary behavior time.

Trial registration: ClinicalTrials; NCT02954614, Registered 3 November 2016, -Retrospectively registered, first participant enrolled August 2016.

Keywords: Accelerometer; Activity support; After-school programs; Physical activity; Physical activity play; Sedentary behavior; Self-determination theory.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The flow of the participants in the study
Fig. 2
Fig. 2
a–d: Trajectories showing the mean MVPA, VPA, LPA, and sedentary behavior min/hour for both groups. T0: N = 426, T1: N = 383, T2: N = 313. §Modelled with an autoregressive (AR 1) residual covariance matrix because the unstructured covariance matrix did not converge
Fig. 3
Fig. 3
a–d Intervention effect on MVPA and sedentary behavior min/hour by activity level least vs most active. T0: N = 426, T1: N = 383, T2: N = 313

References

    1. World Health Organization (WHO). Global strategy on diet, physical activity and health. Available from: .
    1. Ommundsen Y, Løndal K, Loland S. Sport, children and well-being. In: Ben-Arieh A, Casas F, Frønes I, Korbin JE, editors. Handbook of child well-being. Dordrecht: Springer Reference; 2014.
    1. Telama R, Yang X, Viikari J, Valimaki I, Wanne O, Raitakari O. Physical activity from childhood to adulthood: a 21-year tracking study. Am J Prev Med. 2005;28(3):267–273. doi: 10.1016/j.amepre.2004.12.003.
    1. Gallahue DL, Ozmun JC. Understanding motor development : infants, children, adolescents, adults. 6th ed. Boston. London: McGraw Hill; 2006.
    1. Stodden DF, Goodway JD, Langendorfer SJ, Roberton MA, Rudisill ME, Garcia C, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest. 2008;60(2):290–306. doi: 10.1080/00336297.2008.10483582.
    1. Laukkanen A, Pesola A, Havu M, Saakslahti A, Finni T. Relationship between habitual physical activity and gross motor skills is multifaceted in 5- to 8-year-old children. Scand J Med Sci Sports. 2014;24(2):e102–e110. doi: 10.1111/sms.12116.
    1. Sigmundsson H, Haga M. Motor competence is associated with physical fitness in four- to six-year-old preschool children. Eur Early Child Educ. 2016;24(3):477–488.
    1. Luz C, Rodrigues LP, Meester A, Cordovil R. The relationship between motor competence and health-related fitness in children and adolescents. PLoS One. 2017;12(6):e0179993. doi: 10.1371/journal.pone.0179993.
    1. The Norwegian Directorate of Health . Norwegian guidelines on diet, nutrition and physical activity. Oslo: The Norwegian Directorate of Health; 2014.
    1. Laukkanen A. Physical activity and motor competence in 4–8-year old children : results of a family-based cluster-randomized controlled physical activity trial. Jyväskylä: University of Jyväskylä; 2016.
    1. Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013;2:CD007651.
    1. Lund S, Løndal K. Physical activity in “The activity school”. Barn. 2017;4:71–87.
    1. Riiser K, Haugen A, Lund S, Løndal K. Physical activity in young schoolchildren in after school programs. J Sch Health. 2019;89(9):752–758. doi: 10.1111/josh.12815.
    1. The Norwegian Directorate for Education and Training . The Education Mirror. Facts and analyses of kindergartens, primary and secondary education in Norway. Oslo: The Norwegian Directorate for Education and Training; 2016.
    1. Green K. Understanding physical education. London: SAGE Publications Inc; 2008.
    1. Wendelborg C, Caspersen J, Mordal S, Ljusberg A, Valenta M, Brunar N. Play, learning and non-pedagogy for all: national evaluation of the after-school program in Norway. Trondheim: NTNU Samfunnsforskning; 2018.
    1. The Norwegian Ministry of Education and Research. Norway: Education Act. 1998.
    1. Beets MW, Beighle A, Erwin HE, Huberty JL. After-school program impact on physical activity and fitness: a meta-analysis. Am J Prev Med. 2009;36(6):527–537. doi: 10.1016/j.amepre.2009.01.033.
    1. Cradock AL, Barrett JL, Giles CM, Lee RM, Kenney EL. deBlois ME, et al. promoting physical activity with the out of school nutrition and physical activity (OSNAP) initiative: a cluster-randomized controlled trial. JAMA Pediatr. 2016;170(2):155–162. doi: 10.1001/jamapediatrics.2015.3406.
    1. Gortmaker SL, Lee RM, Mozaffarian RS, Sobol AM, Nelson TF, Roth BA, et al. Effect of an after-school intervention on increases in children’s physical activity. Med Sci Sports Exerc. 2012;44(3):450–457. doi: 10.1249/MSS.0b013e3182300128.
    1. Hughey SM, Weaver RG, Saunders R, Webster C, Beets MW. Process evaluation of an intervention to increase child activity levels in afterschool programs. Eval Program Plann. 2014;45:164–170. doi: 10.1016/j.evalprogplan.2014.04.004.
    1. Riiser K, Helseth S, Ellingsen H, Fallang B, Londal K. Active play in after-school Programmes: development of an intervention and description of a matched-pair cluster-randomised trial assessing physical activity play in after-school programmes. BMJ Open. 2017;7(8):e016585. doi: 10.1136/bmjopen-2017-016585.
    1. Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behaviour change and its maintenance: interventions based on self-determination theory. The European Health Psychologist. 2008;10:2–5.
    1. Ryan R, Deci E. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78. doi: 10.1037/0003-066X.55.1.68.
    1. Evenson KR, Catellier DJ, Gill K, Ondrak KS, McMurray RG. Calibration of two objective measures of physical activity for children. J Sports Sci. 2008;26(14):1557–1565. doi: 10.1080/02640410802334196.
    1. Trost SG, Loprinzi PD, Moore R, Pfeiffer KA. Comparison of accelerometer cut points for predicting activity intensity in youth. Med Sci Sports Exerc. 2011;43(7):1360–1368. doi: 10.1249/MSS.0b013e318206476e.
    1. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240–1243. doi: 10.1136/bmj.320.7244.1240.
    1. Fitzmaurice G, Larid N, Ware J. Applied longitudinal analysis 2nd ed. Chichester: Wiley; 2011.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869. doi: 10.1136/bmj.c869.
    1. Davis S. Mixed models for repeated measures using categorical time effects (MMRM) In: O’Kelly M, Ratitch B, editors. Statistics in practice : clinical trials with missing data: a guide for practitioners. Wiley: New York, UK; 2014.
    1. StataCorp . In: Stata Statistical Software: Release: Release 15. TS LLC, editor. College Station: StataCorp LLC; 2017.
    1. Coffman C, Edelman D, Woolson R. To condition or not condition? Analysing ‘change’ in longitudinal randomised controlled trials. BMJ Open. 2016;6(12):e013096-e. doi: 10.1136/bmjopen-2016-013096.
    1. Enders CK, Hayes T, Du H. A comparison of multilevel imputation schemes for random coefficient models: fully conditional specification and joint model imputation with random covariance matrices. Multivariate Behav Res. 2019:1–19.
    1. Bowling A. Research methods in health : investigating health and health services. 2. Buckingham ; Philadelphia: Open University Press; 2002. p. 486.
    1. Øygardslia H. Interventions to increase physical activity in after-schhool programmes; a systematic review. master thesis. Oslo and Akershus University College of Applied Sciences: ODA Open Digital Archive; 2016.
    1. Smith WR, Moore R, Cosco N, Wesoloski J, Danninger T, Ward DS, et al. Increasing physical activity in childcare outdoor learning environments: the effect of setting adjacency relative to other built environment and social factors. Environ Behav. 2014;48(4):550–578. doi: 10.1177/0013916514551048.
    1. Trost SG, Rosenkranz RR, Dzewaltowski D. Physical activity levels among children attending after-school programs. Med Sci Sports Exerc. 2008;40(4):622–629. doi: 10.1249/MSS.0b013e318161eaa5.
    1. Løndal K, Greve A. Didactic approaches to child-managed play: analyses of teacher's interaction styles in kindergartens and after-school programmes in Norway. Int J Early Childhood. 2015;47(3):461–479. doi: 10.1007/s13158-015-0142-0.
    1. Løndal K. Places for child-managed bodily play at an after-school program. Child Youth Environ. 2013;23(2):103–126. doi: 10.7721/chilyoutenvi.23.2.0103.
    1. Cooper AR, Goodman A, Page AS, Sherar LB, Esliger DW, van Sluijs EMF, et al. Objectively measured physical activity and sedentary time in youth: the International children’s accelerometry database (ICAD) Int J Behav Nutr Phys Act. 2015;12:113. doi: 10.1186/s12966-015-0274-5.
    1. Hansen BH, Anderssen SA, Andersen LB, Hildebrand M, Kolle E, Steene-Johannessen J, et al. Cross-sectional associations of reallocating time between sedentary and active Behaviours on Cardiometabolic risk factors in young people: an international Children's Accelerometry database (ICAD) analysis. Sports Med. 2018;48(10):2401–2412. doi: 10.1007/s40279-018-0909-1.
    1. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activity for school-age youth. J Pediatr. 2005;146(6):732–737. doi: 10.1016/j.jpeds.2005.01.055.
    1. Pearson N, Braithwaite RE, Biddle SJH, van Sluijs EMF, Atkin AJ. Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis. Obes Rev. 2014;15(8):666–675. doi: 10.1111/obr.12188.
    1. The Norwegian Ministry of Health and Care Services. Norway: Health Research Act.. 2009.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi