Protocol paper for the Movimente school-based program: A cluster-randomized controlled trial targeting physical activity and sedentary behavior among Brazilian adolescents

Kelly Samara Silva, Jaqueline Aragoni da Silva, Valter Cordeiro Barbosa Filho, Priscila Cristina Dos Santos, Pablo Magno da Silveira, Marcus V V Lopes, Jo Salmon, “Movimente Program” Working Group, Kelly Samara Silva, Jaqueline Aragoni da Silva, Valter Cordeiro Barbosa Filho, Priscila Cristina Dos Santos, Pablo Magno da Silveira, Marcus V V Lopes, Jo Salmon, “Movimente Program” Working Group

Abstract

Background: A better understanding of how multicomponent school-based interventions work and their effects on health and education outcomes are needed. This paper described the methods of the Movimente Program, a school-based intervention that aims to increase physical activity (PA) and decrease sedentary behavior (SB) among Brazilian students.

Methods: This is a cluster randomized controlled trial with adolescents from 7th to 9th grade in public schools from Florianopolis, Southern Brazil. After agreement, 6 schools were randomly selected to intervention or control groups (3 schools each), and all eligible students were invited to the study. The Movimente intervention program was performed during a school year and included 3 main components: Teacher training (including face-to-face meeting, social media platform, and handbook with lesson plans); improvements in the PA environment in school; and educational strategies. Control schools continued with their traditional schedule. Baseline (March/April 2017), postintervention (November/December 2017), and maintenance (June/July 2018) evaluations included PA and SB as primary outcomes (assessed by self-report and accelerometry). Secondary outcomes included psychosocial factors related to PA and SB (e.g., social support and self-efficacy), as well as health (e.g., quality of life and nutritional status) and education (e.g., academic achievement) outcomes. A program evaluation was performed based on the RE-AIM framework. Participants, intervention staffs, and evaluators were not blinded to group assignment, but a standardized evaluation protocol was applied independently of the trial allocation.

Results: Statistical analyses will include a multilevel approach for repeated measurements and mediation analysis. Any side effects of the intervention will be recorded. The sample size close to that expected (n = 1090) was reached (n = 999). The results of this trial will involve valuable information about the effect and the evaluation of a multicomponent intervention carried out in a middle-income country.

Conclusion: By creating opportunities for adolescents to be active at school using multicomponent strategies, the Movimente program has the potential to enhance students health and academic performance which may encourage the school community (e.g., teachers, principals) to adopt the program. Also, this trial will provide evidence for practitioners, policy makers, and researchers on how multicomponent program may be implemented in a school setting.

Trial registration: The trial is registered at the Clinical Trial Registry (Trial ID: NCT02944318; date of registration: 18 October 2016).

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Logic model of the Movimente Program. PA (physical activity), SB (sedentary behavior), PE (physical education).
Figure 2
Figure 2
Description of the timeline of Movimente Program.

References

    1. World Health Organization. The global strategy for women's, children's and adolescents’ health (2016–2030).
    1. NCDs | Global action plan on physical activity 2018–2030: more active people for a healthier world. WHO, Available at: (accessed October 4, 2018).
    1. Arena R, McNeil A, Street S, et al. Let us talk about moving: reframing the exercise and physical activity discussion. Curr Probl Cardiol 2017;43:154–79.
    1. Silva KS, Garcia LMT, Rabacow FM, et al. Physical activity as part of daily living: moving beyond quantitative recommendations. Prev Med 2017;96:160–2.
    1. World Health Organization. Review of best practice in interventions to promote physical activity in developing countries. Available at: (2008). Accessed in March 20, 2016.
    1. Nagata JM, Ferguson BJ, Ross DA. Research priorities for eight areas of adolescent health in low- and middle-income countries. J Adolesc Health 2016;59:50–60.
    1. Barbosa Filho VC, Minatto G, Mota J, et al. Promoting physical activity for children and adolescents in low- and middle-income countries: an umbrella systematic review. Prev Med 2016;88:115–26.
    1. van Stralen MM, Yildirim M, te Velde SJ, et al. What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms. Int J Obes (Lond) 2011;35:1251–65.
    1. van Sluijs EMF, Kriemler S. Reflections on physical activity intervention research in young people—dos, don’ts, and critical thoughts. Int J Behav Nutr Phys Act 2016;13:25.
    1. Langford R, Bonell C, Komro K, et al. The health promoting schools framework: known unknowns and an agenda for future research. Health Educ Behav 2016;44:463–75.
    1. Dobbins M, Husson H, DeCorby K, et al. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2009. CD007651.
    1. Langford R, Bonell CP, Jones HE, et al. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014. CD008958.
    1. Lubans DR, Foster C, Biddle SJH. A review of mediators of behavior in interventions to promote physical activity among children and adolescents. Prev Med 2008;47:463–70.
    1. Maniccia DM, Davison KK, Marshall SJ, et al. A meta-analysis of interventions that target children's screen time for reduction. Pediatrics 2011;128:e193–210.
    1. Barbosa Filho VC, Lopes A da S, Lima AB, et al. Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian students: the “Fortaleça sua Saúde” program. BMC Public Health 2015;15:1212.
    1. Silva KS, de Barros MVG, Barbosa Filho VC, et al. Implementation of the “Saúde na Boa”Intervention: process evaluation and characteristics of participants and dropouts. Rev Brasileira Cineantropometria Desempenho Humano 2014;16:1–2.
    1. US Department of Health and Human Services. Physical Activity Evaluation Handbook. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2002.
    1. Nahas MV, de Barros MV, de Assis MAA, et al. Methods and participant characteristics of a randomized intervention to promote physical activity and healthy eating among Brazilian high school students: the Saude na Boa project. J Phys Act Health 2009;6:153–62.
    1. Dean A, Sullivan K, Soe M. OpenEpi: Open Source Epidemiologic Statistics for Public Health [internet]. Available at: . Accessed in May 10, 2016.
    1. Fritz MS, MacKinnon DP. Required sample size to detect the mediated effect. Psychol Sci 2007;18:233–9.
    1. UNDP. Atlas of human development in the Brazilian metropolitan regions.
    1. QEdu: Florianópolis: Ideb 2015 [Internet].
    1. IBGE. Census 2010 – Cidades, Available at: (2010). Accessed in January 18, 2017.
    1. IBGE. Pesquisa Nacional da Saúde do Escolar -PeNSE.
    1. Municipal Secretary of Education. Data from the 2014 school census.
    1. Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot 1996;10:282–98.
    1. Stokols D. Establishing and maintaining healthy environments: toward a social ecology of health promotion. Am Psychol 1992;47:6–22.
    1. Bandura A. Health promotion by social cognitive means. Health Educ Behav 2004;31:143–64.
    1. Marcus BH, Simkin LR. The transtheoretical model: applications to exercise behavior. Med Sci Sports Exerc 1994;26:1400–4.
    1. Brazil. Parâmetros Curriculares Nacionais.
    1. Brazil. Base Nacional Comum Curricular (BNCC). Educação é a base. Available at: (2017). Accessed December 18, 2018.
    1. Gabriel KKP, Morrow JR, Woolsey A-LT. Framework for physical activity as a complex and multidimensional behavior. J Phys Act Health 2012;9:S11–8.
    1. Shankar V, Bangdiwala SI. Observer agreement paradoxes in 2x2 tables: comparison of agreement measures. BMC Med Res Methodol 2014;14:100.
    1. Gwet KL. Handbook of Inter-Rater Reliability: The Definitive Guide to Measuring the Extent of Agreement Among Raters. Edição: 4Gaithersburg, MD: Advanced Analytics, LLC; 2014.
    1. ABEP. Critério de classificação econômica Brasil.
    1. Farias Júnior JC, Lopes AS, Mota J, et al. Validade e reprodutibilidade de um questionário para medida de atividade física em adolescentes: uma adaptação do Self-Administered Physical Activity Checklist. Rev Brasileira Epidemiol 2012;15:198–210.
    1. Silva KS, Lopes AS, Hoefelmann LP, et al. Health risk behaviors Project (COMPAC) in youth of Santa Catarina State, Brazil: ethics and methodological aspects. Rev Bras Cineantropom Desempenho Hum 2013;15:1–5.
    1. ActiGraph [Internet], Available at: (accessed July 27, 2018).
    1. Migueles JH, Cadenas-Sanchez C, Ekelund U, et al. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med 2017;47:1821–45.
    1. Trost SG, Loprinzi PD, Moore RA, et al. Comparison of accelerometer cut points for predicting activity intensity in youth. Med Sci Sports Exerc 2011;43:1360–8.
    1. Evenson KR, Catellier DJ, Gill K, et al. Calibration of two objective measures of physical activity for children. J Sports Sci 2008;26:1557–65.
    1. ActiLife | ActiGraph [Internet, Available at: (accessed August 11, 2018).
    1. de Farias Júnior JC, da Silva Lopes A, Reis RS, et al. Development and validation of a questionnaire measuring factors associated with physical activity in adolescents. Rev Bras Saúde Materno Infantil 2011;11:301–12.
    1. Barbosa Filho VC, Rech CR, Mota J, et al. Validity and reliability of scales on intrapersonal, interpersonal and environmental factors associated with physical activity in Brazilian secondary students. Braz J Kinanthropometry Hum Performance 2016;18:207.
    1. Fonseca PN, Sousa DMF, Gouveira RSV, et al. Escala de Hábitos de estudo: evidências de validade de construto. Avaliação Psicológica 2013;12:71–9.
    1. Álvarez-Bueno C, Pesce C, Cavero-Redondo I, et al. The effect of physical activity interventions on children's cognition and metacognition: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2017;56:729–38.
    1. Hodapp V, Henneberger A. Test anxiety, study habits and academic performance. Adv Test Anxiety Res 1983;3:119–27.
    1. KIDSCREEN – Health Related Quality of Life Questionnaire for Children and Young People and their Parents., Available at: (2014). Accessed in November 5, 2016.
    1. Ravens-Sieberer U, Gosch A, Erhart M, et al. The kidscreen questionnaires: handbook-quality of life questionnaires for children and adolescents/2006. Available . Accessed in November 5 2016.
    1. Júnior F, De JC, Loch MR, et al. Reprodutibilidade, consistência interna e validade de construto do KIDSCREEN-27 em adolescentes brasileiros. Cad Saúde Pública 2017;33:e00131116.
    1. Lohman TiG, Roche AF, Martorell R. Antropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books; 1988.
    1. Leger LA, Mercier D, Gadoury C, et al. The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci 1988;6:93–101.
    1. Batista MB, Romanzini CLP, Castro Piñero J, et al. Validity of field tests to estimate cardiorespiratory fitness in children and adolescents: a systematic review. Revista Paulista de Pediatria 2017;35:222–33.
    1. Artero EG, España-Romero V, Castro-Piñero J, et al. Criterion-related validity of field-based muscular fitness tests in youth. J Sports Med Phys Fitness 2012;52:263–72.
    1. Stunkard AJ, Sørensen T, Schulsinger F. Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 1983;60:115–20.
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 1999;89:1322–7.
    1. Logiciel Sphinx Declic | Le Sphinx [Internet]. Available at: . (2018). Accessed in March 3, 2016.
    1. StataCorp. Stata Statistical Softwares. Release 13. College Station, TX: StataCorp LP; 2013.
    1. R: The R Project for Statistical Computing [Internet]. [cited 2018 Aug 11]. Available at: . Accessed in April 10, 2020.
    1. MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu Rev Psychol 2007;58:593–614.
    1. Hynynen S-T, van Stralen MM, Sniehotta FF, et al. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents. Int Rev Sport Exerc Psychol 2016;9:22–44.
    1. Kaushal N, Rhodes R. The home physical environment and its relationship with physical activity and sedentary behavior: a systematic review. Prev Med 2014;67:221–37.
    1. Friedrich RR, Polet JP, Schuch I, et al. Effect of intervention programs in schools to reduce screen time: a meta-analysis. J Pediatr (Rio J) 2014;90:232–41.
    1. Schmidt ME, Haines J, O’Brien A, et al. Systematic review of effective strategies for reducing screen time among young Children. Obesity 2012;20:1338–54.
    1. Buchanan LR, Rooks-Peck CR, Finnie RKC, et al. Reducing recreational sedentary screen time a community guide systematic review. Am J Prev Med 2016;50:402–15.
    1. Hardman CM, de Barros MVG, Lopes AS, et al. Effectiveness of a school-based intervention regarding screen time in high school students. Rev Bras Cineantropometria Desempenho Humano 2014;16:25.
    1. Leme ACB, Lubans DR, Guerra PH, et al. Preventing obesity among Brazilian adolescent girls: six-month outcomes of the Healthy Habits, Healthy Girls-Brazil school-based randomized controlled trial. Prev Med 2016;86:77–83.
    1. Guimarães RdF, da Silva MP, San Martini MC, et al. The effects of an after-school intervention program on physical activity level, sedentary time, and cardiovascular risk factors in adolescents. Motriz: Rev Educ Fís 2017;23:
    1. Smith JJ, Morgan PJ, Plotnikoff RC, et al. Rationale and study protocol for the ‘Active Teen Leaders Avoiding Screen-time’ (ATLAS) group randomized controlled trial: an obesity prevention intervention for adolescent boys from schools in low-income communities. Contemp Clin Trials 2014;37:106–19.
    1. Cohen KE, Morgan PJ, Plotnikoff RC, et al. Psychological, social and physical environmental mediators of the SCORES intervention on physical activity among children living in low-income communities. Psychol Sport Exercise 2017;32:1–1.
    1. Trudeau F, Shephard RJ. Physical education, school physical activity, school sports and academic performance. Int J Behav Nutr Phys Act 2008;5:10.
    1. Singh A, Uijtdewilligen L, Twisk JWR, et al. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatr Adolesc Med 2012;166:49–55.
    1. United Nation Development Program (UNDP). Sustainable Development Goals, Available at: (accessed September 5, 2018).
    1. Center for Disease Control. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance.
    1. Marques A, Gómez F, Martins J, et al. Association between physical education, school-based physical activity, and academic performance: a systematic review. Retos nuevas tendencias en educacion fisica deporte y recreacion 2017. 319–20.
    1. Haapala EA, Väistö J, Lintu N, et al. Physical activity and sedentary time in relation to academic achievement in children. J Sci Med Sport 2017;20:583–9.
    1. Ardoy DN, Fernández-Rodríguez JM, Jiménez-Pavón D, et al. A Physical Education trial improves adolescents’ cognitive performance and academic achievement: the EDUFIT study. Scand J Med Sci Sports 2014;24:e52–61.
    1. Käll LB, Nilsson M, Lindén T. The impact of a physical activity intervention program on academic achievement in a Swedish elementary school setting. J Sch Health 2014;84:473–80.
    1. Campbell R, Rawlins E, Wells S, et al. Intervention fidelity in a school-based diet and physical activity intervention in the UK: Active for Life Year 5. Int J Behav Nutr Phys Act 2015;12:141.

Source: PubMed

3
Se inscrever