What is the meaning and nature of active play for today's children in the UK?

<p>Abstract</p> <p>Background</p> <p>Preventing the decline in physical activity which occurs around 10-11 years of age is a public health priority. Physically active play can make unique contributions to children's development which cannot be obtained from more structured forms of physical activity. Encouraging active play in children's leisure time has potential to increase physical activity levels while promoting optimal child development. Aspired wisdom states that contemporary British children no longer play outdoors, but systematic evidence for this is lacking. We need to build a more informed picture of contemporary children's play before we consider interventions to increase it.</p> <p>Methods</p> <p>Eleven focus groups were conducted with 77, 10-11 year old children from four primary schools in Bristol, UK. Focus groups examined: 1) children's perceptions of 'play'; 2) how much of their play is active play; and 3) contexts of children's active play. All focus groups were audio-taped and transcribed verbatim. Data were analysed using a thematic approach.</p> <p>Results</p> <p>Children's perceptions of play were broad and included both physically active and sedentary behaviours. Children reported that they frequently engaged in active play and valued both the physical and social benefits it provided. Whereas boys frequently reported having a 'kick about' or riding bikes as their preferred forms of active play, girls were less likely to report a specific activity. Additionally, boys reported greater independent mobility in their active play compared to girls. Finally, boys were more likely to report playing with neighbourhood friends but girls more frequently reported playing with family members.</p> <p>Conclusions</p> <p>Promoting active play in children's leisure time may increase the physical activity of children, but interventions may need to be tailored according to gender.</p

Physical activity and sedentary behaviour typologies of 10-11 year olds

<p>Abstract</p> <p>Background</p> <p>Targeted interventions may be more effective at increasing children's physical activity. The aim of this study was to identify clusters of children based on physical activity and sedentary patterns across the week.</p> <p>Methods</p> <p>Participants were 761, 10-11 year old children. Participant's self-reported time spent in eight physical activity and sedentary contexts and wore an accelerometer. Cluster analysis was conducted on the time spent in the self-reported physical activity and sedentary contexts. Mean minutes of accelerometer derived of moderate to vigorous physical activity (MVPA) and sedentary time were derived for the entire week, weekdays only, weekend days and four different time periods across each type (weekend or weekday) of days. Differences in the physical activity patterns of the groups derived from the cluster analysis were assessed for overall physical activity as well as for the four time periods on weekdays and weekend days.</p> <p>Results</p> <p>Three clusters emerged: 1) High active/Low sedentary; 2) Low active/Moderate sedentary; and 3) High Active/High sedentary. Patterns of activity differed across the week for each group and the High Active/High sedentary obtained the most minutes of MVPA.</p> <p>Conclusions</p> <p>Patterns of physical activity and sedentary time differed across the week for each cluster. Interventions could be targeted to the key periods when each group is inactive.</p

Development of scales to assess children's perceptions of friend and parental influences on physical activity

<p>Abstract</p> <p>Background</p> <p>Many children do not meet physical activity guidelines. Parents and friends are likely to influence children's physical activity but there is a shortage of measures that are able to capture these influences.</p> <p>Methods</p> <p>A new questionnaire with the following three scales was developed: 1) <it>Parental influence on physical activity</it>; 2) <it>Motives for activity with friends </it>scale; and 3) <it>Physical activity and sedentary group normative values</it>. Content for each scale was informed by qualitative work. One hundred and seventy three, 10-11 year old children completed the new questionnaire twice, one week apart. Participants also wore an accelerometer for 5 days and mean minutes of moderate to vigorous physical activity, light physical activity and sedentary time per day were obtained. Test-retest reliability of the items was calculated and Principal Component analysis of the scales performed and sub-scales produced. Alphas were calculated for main scales and sub-scales. Correlations were calculated among sub-scales. Correlations between each sub-scale and accelerometer physical activity variables were calculated for all participants and stratified by sex.</p> <p>Results</p> <p>The Parental influence scale yielded four factors which accounted for 67.5% of the variance in the items and had good (α > 0.7) internal consistency. The Motives for physical activity scale yielded four factors that accounted for 66.1% and had good internal consistency. The Physical activity norms scale yielded 4 factors that accounted for 67.4% of the variance, with good internal consistency for the sub-scales and alpha of .642 for the overall scale. Associations between the sub-scales and physical activity differed by sex. Although only 6 of the 11 sub-scales were significantly correlated with physical activity there were a number of associations that were positively correlated >0.15 indicating that these factors may contribute to the explanation of children's physical activity.</p> <p>Conclusion</p> <p>Three scales that assess how parents, friends and group normative values may be associated with children's physical activity have been shown to be reliable and internally consistent. Examination of the extent to which these new scales improve our understanding of children's physical activity in datasets with a range of participant and family characteristics is needed.</p

Friendship groups and physical activity: qualitative findings on how physical activity is initiated and maintained among 10–11 year old children

<p>Abstract</p> <p>Background</p> <p>Many youth physical activity interventions have minimal effect. To design better interventions we need to understand more about the factors that influence youth activity. Application of self-determination theory to youth physical activity, particularly the relatedness and competence, might suggest that friends and friendship groups influence the initiation and maintenance of youth physical activity. In this study we examined this issue.</p> <p>Methods</p> <p>Seventeen focus groups were conducted with 113, 10–11 year old children, from 11 primary schools in Bristol, UK. Focus groups examined: 1) the nature of children's friendship groups; 2) associations between physical activity and social group status; and 3) how friendship groups affect the initiation and maintenance of physical activity. All focus groups were audio-taped and transcribed verbatim. Data were analyzed using content analysis.</p> <p>Results</p> <p>Participants reported that there were three different types of friendship groups; School friends; Neighborhood friends; and Other Friends who were friends from organized activities or children of their parents' friends. Participants had multiple groups of friends and engaged in different activities with the different groups. Possessing several groups of friends was desirable as it kept the friendships fresh and interesting. Physical activity was perceived as a positive attribute and linked to social status among boys. Among girls the association between physical activity ability and social status was more complex, appearing to differ by the norms of the group to which participants belonged. Some participants reported that low activity ability could be perceived as desirable in some social groups. Participants reported that friends provide support to initiate physical activity via co-participation (i.e. engaging in activity together); modeling of being active; and providing verbal support to engage in activity. Enjoyment was the most important factor in maintaining activity participation with participating in activity with friends a key factor influencing enjoyment.</p> <p>Conclusion</p> <p>Friendship groups affect both the initiation and maintenance of youth physical activity. Children belong to several groups and engage in different activities with different groups. Simple strategies that aim to promote physical activity via the different friendship groups could be an effective means of promoting increased physical activity in young people.</p

Associations between children's social functioning and physical activity participation are not mediated by social acceptance: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Physical activity (PA) during childhood often occurs in social contexts. As such, children's ability to develop and maintain friendship groups may be important in understanding their PA. This paper investigates the associations among children's social functioning, and physical activity and whether perceptions of social acceptance mediate any social functioning-PA association.</p> <p>Methods</p> <p>A cross sectional survey in which 652 10-11 year olds self-reported their peer (e.g. difficulties with friends) and conduct (e.g. anger/aggression) problems, prosocial behaviours (e.g. being kind to others) and perceptions of social acceptance. Physical activity was objectively assessed by Actigraph GT1M accelerometers to estimate counts per minute, (CPM) and minutes of moderate-to-vigorous physical activity (MVPA). Linear regression analyses were conducted to investigate associations between social functioning and PA. Indirect effects were analysed to explore mediation by social acceptance.</p> <p>Results</p> <p>Among boys, peer problems were negatively associated with CPM and MVPA and conduct problems were positively associated with CPM and MVPA. Prosocial behaviour was unrelated to PA in boys. Social functioning was not associated with PA among girls. Social acceptance did not mediate the social functioning-PA relationship.</p> <p>Conclusions</p> <p>Boys' conduct and peer problems were associated positively and negatively respectively with their PA but this relationship was not mediated by perceptions of social acceptance. Future research should study alternative mediators to understand the processes underpinning this relationship.</p

NAP SACC UK:protocol for a feasibility cluster randomised controlled trial in nurseries and at home to increase physical activity and healthy eating in 2-4 year olds

Introduction: Systematic reviews have identified the lack of intervention studies with young children to prevent obesity. This feasibility study examines the feasibility and acceptability of adapting the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention in the UK to inform a full-scale trial. Methods and analysis: A feasibility cluster randomised controlled trial in 12 nurseries in England, with 6 randomly assigned to the adapted NAP SACC UK intervention: nursery staff will receive training and support from an NAP SACC UK Partner to review the nursery environment (nutrition, physical activity, sedentary behaviours and oral health) and set goals for making changes. Parents will be invited to participate in a digital media-based home component to set goals for making changes in the home. As this is a feasibility study, the sample size was not based on a power calculation but will indicate the likely response rates and intracluster correlations. Measures will be assessed at baseline and 8–10 months later. We will estimate the recruitment rate of nurseries and children and adherence to the intervention and data. Nursery measurements will include the Environmental Policy Assessment and Observation score and the nursery staff's review of the nursery environment. Child measurements will include height and weight to calculate z-score body mass index (zBMI), accelerometer-determined minutes of moderate-to-vigorous physical activity per day and sedentary time, and diet using the Child and Diet Evaluation Tool. Questionnaires with nursery staff and parents will measure mediators. A process evaluation will assess fidelity of intervention delivery and views of participants. Ethics and dissemination: Ethical approval for this study was given by Wales 3 NHS Research Ethics Committee. Findings will be made available through publication in peer-reviewed journals, at conferences and to participants via the University of Bristol website. Data will be available from the University of Bristol Research Data Repository

Process evaluation protocol for a cluster randomised controlled trial of an intervention to improve the mental health support and training available to secondary school teachers– the Wellbeing in Secondary Education (WISE) project

Background: Secondary school teachers have low levels of wellbeing and high levels of depression compared with the general population. Teachers are in a key position to support students, but poor mental health may be a barrier to doing so effectively. The Wellbeing in Secondary Education (WISE) project is a cluster randomised controlled trial (RCT) of an intervention to improve the mental health support and training available to secondary school teachers through delivery of the training package Mental Health First Aid and a staff peer support service. We will conduct a process evaluation as part of the WISE trial to support the interpretation of trial outcomes and refine intervention theory. The domains assessed will be: the extent to which the hypothesised mechanisms of change are activated; system level influences on these mechanisms; programme differentiation and usual practice; intervention implementation, including any adaptations; intervention acceptability; and intervention sustainability. Methods: Research questions will be addressed via quantitative and qualitative methods. All study schools (n = 25) will provide process evaluation data, with more detailed focus group, interview and observation data being collected from a subsample of case study schools (4 intervention and 4 control). Mechanisms of change, as outlined in a logic model, will be measured via teacher and student surveys and focus groups. School context will be explored via audits of school practice that relate to mental health and wellbeing, combined with stakeholder interviews and focus groups. Implementation of the training and peer support service will be assessed via training observations, training participant evaluation forms, focus groups with participants, interviews with trainers and peer support service users, and peer supporter logs recording help provided. Acceptability and sustainability will be examined via interviews with funders, head teachers, trainers and peer support services users, and focus groups with training participants. Discussion: The process evaluation embedded within the WISE cluster RCT will illuminate how and why the intervention was effective, ineffective or conferred iatrogenic effects. It will contribute to the refinement of the theory underpinning the intervention, and will help to inform any future implementation. Trial registration: International Standard Randomised Controlled Trial Number: ISRCTN95909211 registered on 24 March 2016. Keywords: Mental health, Wellbeing, Schools, Children, Adolescents, Teachers, Process evaluation, Cluster Randomised Controlled Tria

An intervention to improve teacher well-being support and training to support students in UK high schools (the WISE study): A cluster randomised controlled trial.

Funder: Public Health WalesFunder: Bristol City CouncilFunder: Public Health EnglandBACKGROUND: Teachers are at heightened risk of poor mental health and well-being, which is likely to impact on the support they provide to students, and student outcomes. We conducted a cluster randomised controlled trial, to test whether an intervention to improve mental health support and training for high school teachers led to improved mental health and well-being for teachers and students, compared to usual practice. We also conducted a cost evaluation of the intervention. METHODS AND FINDINGS: The intervention comprised (i) Mental Health First Aid training for teachers to support students; (ii) a mental health awareness session; and (iii) a confidential staff peer support service. In total 25 mainstream, non-fee-paying secondary schools stratified by geographical area and free school meal entitlement were randomly allocated to intervention (n = 12) or control group (n = 13) after collection of baseline measures. We analysed data using mixed-effects repeated measures models in the intention-to-treat population, adjusted for stratification variables, sex, and years of experience. The primary outcome was teacher well-being (Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were teacher depression, absence, and presenteeism, and student well-being, mental health difficulties, attendance, and attainment. Follow-up was at months 12 (T1) and 24 (T2). We collected process data to test the logic model underpinning the intervention, to aid interpretation of the findings. A total of 1,722 teachers were included in the primary analysis. Teacher well-being did not differ between groups at T2 (intervention mean well-being score 47.5, control group mean well-being score 48.4, adjusted mean difference -0.90, 95% CI -2.07 to 0.27, p = 0.130). The only effect on secondary outcomes was higher teacher-reported absence among the intervention group at T2 (intervention group median number of days absent 0, control group median number of days absent 0, ratio of geometric means 1.04, 95% CI 1.00 to 1.09, p = 0.042). Process measures indicated little change in perceived mental health support, quality of relationships, and work-related stress. The average cost of the intervention was £9,103 per school. The study's main limitations were a lack of blinding of research participants and the self-report nature of the outcome measures. CONCLUSIONS: In this study, we observed no improvements to teacher or student mental health following the intervention, possibly due to a lack of impact on key drivers of poor mental health within the school environment. Future research should focus on structural and cultural changes to the school environment, which may be more effective at improving teacher and student mental health and well-being. TRIAL REGISTRATION: www.isrctn.com ISRCTN95909211

Licence to be active: parental concerns and 10–11-year-old children's ability to be independently physically active

Background Physical activity independent of adult supervision is an important component of youth physical activity. This study examined parental attitudes to independent activity, factors that limit licence to be independently active and parental strategies to facilitate independent activity. Methods In-depth phone interviews were conducted with 24 parents (4 males) of 10–11-year-old children recruited from six primary schools in Bristol. Results Parents perceived that a lack of appropriate spaces in which to be active, safety, traffic, the proximity of friends and older children affected children’s ability to be independently physically active. The final year of primary school was perceived as a period when children should be afforded increased licence. Parents managed physical activity licence by placing time limits on activity, restricting activity to close to home, only allowing activity in groups or under adult supervision. Conclusions Strategies are needed to build children’s licence to be independently active; this could be achieved by developing parental self-efficacy to allow children to be active and developing structures such as safe routes to parks and safer play areas. Future programmes could make use of traffic-calming programmes as catalysts for safe independent physical activity