Ha, ASC

Johns, DP

Macfarlane, DJ

Hong Kong Medical Journal

HKU Scholars Hub

Title Raising activity levels as a health risk reduction intervention inHong Kong childrenAuthor(s) Johns, DP; Ha, ASC; Macfarlane, DJCitation Hong Kong Medical Journal, 2006, v. 12 n. 2 Supp 1, p. 42-44Issued Date 2006URL http://hdl.handle.net/10722/45521Rights Creative Commons: Attribution 3.0 Hong Kong License42      Hong Kong Med J Vol 12 No 2 Supplement 1 April 2006RESEARCH DISSEMINATION REPORT—WOMEN AND CHILDRENHong Kong Med J 2006;12 (Suppl 1):S42-4Raising activity levels as a health riskreduction intervention in Hong Kongchildren○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○Department of Sports Science and PhysicalEducation, The Chinese University of HongKongDP JohnsASC HaInstitute of Human Performance, TheUniversity of Hong KongDJ MacfarlaneHCPF project number: 278109Principal applicant and corresponding author:DP JohnsDepartment of Sports Science and PhysicalEducationThe Chinese University of Hong KongShatin, NTHong Kong SAR, ChinaTel: (852) 2609 6080Fax: (852) 2603 5781E-mail: djohns@cuhk.edu.hkDP Johns  ASC Ha  DJ Macfarlane  IntroductionThere is a large body of research that underscores the importance of physicalactivity in a wide range of psychological and physical processes that influencehealth and well-being. Of particular interest to health professionals is thecompelling evidence of the role of physical activity in the primary preventionof cardiovascular disease and, in particular, coronary heart disease. In addition,regular physical activity has been linked to the reduction of risk in morbidityand mortality resulting from chronic ailments such as non-insulin diabetesmellitus, hypertension, osteoporosis, and certain types of cancer. Although theamount of physical activity that benefits health is not known, there aresuggestions that with every increase comes an added benefit. However, thisdoes not mean that activity of vigorous intensity is necessary to improvehealth. What seems to be required is habitual moderate-to-vigorous physicalactivity that can be sustained throughout the life cycle. According to USresearchers, an intervention that focuses on increasing the activity of youngpeople is urgently needed.1In Hong Kong, the habitual physical activity patterns of school age childrenare similar to those found in industrialised countries in the West. Macfarlane2found less than 4% of Hong Kong primary-aged children maintained a single20-minute period of low-to-medium physical activity per day. Wong andMacfarlane3 found that during each 35-minute class in physical education (PE)in Hong Kong schools, only 3.4 (10%) minutes of student time is devoted tovigorous activity. Moderate-to-vigorous physical activity levels are seldomattained by Hong Kong pupils. Moreover, existing instruction in PE fails toprovide adequate systematic learning about the body and the benefits of regularexercise. Nevertheless, school PE programmes in general have been identifiedas the site most likely to provide opportunities to investigate the potentialscope and possible impact of modified PE.Aims and objectivesThe purpose of this study was to implement and evaluate the efficacy of anintervention to increase students’ habitual physical activity.MethodsThis study was conducted from August 1998 to February 2000.The interventionTwenty Hong Kong secondary schools that obtained informed consent from theparents of enrolled students were invited to participate. Ten schools employingin-service PE teachers registered in a university curriculum design and planningcourse in PE were recruited for the experimental group. These teachers, as partof their term assignment, were asked to examine and modify the PE curriculumat their school to enhance the opportunities for students to improve their fitnesslevels. The invitation to in-service teachers to modify their PE curriculum wasan attempt to allow them to actively participate in the design and implementationof the intervention and to reduce the effect of a ‘top-down’ approach.Key Messages1. Physical activity behavioursare known to be beneficial inreducing health risk. However,behavioural change in youngpeople in the Hong Kong schoolpopulation has been difficult toachieve.2. Schools remain one of the mostappropriate institutions in whichto introduce wide-scale changesin health behaviour. Becauseteachers are often required tobecome involved in schoolresearch, care should be taken toassess the ability and willingnessof consenting teachers and toprovide them with adequatesupport in order to carry out theintervention.Hong Kong Med J Vol 12 No 2 Supplement 1 April 2006      43Raising activity levels: easier said than doneThe design focused on three aspects. First, learningexperiences that were likely to improve fitness by raisingthe intensity level of physical activity during sportskills training were included. Second, to increase activityat home teachers provided students with informationand encouragement in selecting activities that theycould perform with their parents and siblings. Third, aportfolio was designed to motivate the participants topractise a healthy lifestyle and to provide a record oftheir involvement in the programme was distributed tostudents after the pre-test.DesignTwo PE classes involving Form 1 and 2 boys and girls (age,11-13 years) were selected in each of the experimentaland control schools. A pre-test involving severalbehavioural measures was conducted at the beginningof the project. A post-test was conducted at the end of the4-month intervention period. Five students were randomlyselected from each PE class for the experimental andcontrol groups. A modified Academic Learning Time inPhysical Education (ALT-PE) instrument was used todirectly observe student and teacher behaviour duringthe PE class. In addition, the five participants wore aheart rate monitor (Polar Electro PE4000) and a three-dimensional accelerometer (Tritrac R3D) to measuretheir levels of physical activity over 8 continuous hours.Data acquisition began once the student arrived atschool and was performed over one school day thatincluded a 1-hour PE class, and one day that did not.The Tritrac data were reported as the mean ‘VectorMagnitude’ score (in counts⋅min-1), whilst the heartrates were reported as the time each student spent inmild exercise (heart rates above 139 beats⋅min-1), and inmoderate-to-vigorous exercise (heart rates above 159beats⋅min-1). A Youth Risk Surveillance Survey question-naire was administered during the pre-test and post-testto all study participants. A total of 1383 Form 1 and 2students participated in the pre-test and 1231 in the post-test. Vigorous physical activity, moderate physical activity,stretching exercise, and strengthening exercises scoreswere analysed.ResultsHeart rate monitors and motion sensorsThe results from the 3-D Tritrac motion sensor showedthat the intervention had little effect on improving activityscores either on days involving a PE lesson or on thosewithout a PE lesson. On days with a PE lesson both thecontrol and experimental groups produced similar averagevector magnitude scores around 290-300 counts⋅min-1, whilstthe non-PE days produced scores around 210-220counts⋅min-1. The only positive intervention result was asmall non-significant increase of 4.5% in the averagevector magnitude scores after intervention in the experimen-tal group, whilst the control group showed a small non-significant decrease of 5.0%.The heart rate data also showed no improvement ineither mild activity or moderate-to-vigorous activity. Ondays involving a PE lesson, both the control andexperimental groups accumulated about 45 minutes ofmild activity, and 18 minutes of moderate-to-vigorousactivity. However, on non-PE lesson days, both groupshalved their discretionary activity levels from about 20minutes of mild exercise before the intervention, to around10 minutes after the intervention. In addition, the time spentin moderate-to-vigorous activity also dropped fromaround 8 minutes preceding the intervention, to 3 minutesafter the intervention, with no significant differencesbetween the control and experimental groups. Evenduring the 60-minute PE lesson, no improvements in theexperimental group were seen after intervention, withlevels of accumulated mild exercise (18 minutes) oraccumulated moderate-to-vigorous activity (7 minutes)remaining unchanged throughout the study.The youth risk surveillance surveyParticipation patterns for both groups in vigorous, moderate,stretching and strength exercises were not significantlydifferent. While boys were more vigorously active than girlsin both control and experimental groups, girls were moreactive than boys in the moderate-level, stretching andstrengthening categories. Form 1 boys and girls in both theexperimental groups and control groups were less active atthe end of the study than at the beginning.In general, the participation patterns provided noindication that the intervention had any effect, as therewere no discernable changes in activity patterns in eitherthe control or experimental groups during the intervention.The direct observations and survey data were in agreementwith the heart rate and body motion data, this indicatedthat no significant improvements in activity patternsoccurred over the intervention, and, if anything, discretion-ary activity decreased.Teacher behavioursAlthough these data indicate that the intervention to raiselevels of activity was ineffectual, they do not explain whythe intervention failed or what can be learned from the studythat can be addressed in future studies. What was of benefitwas a follow-up procedure that allowed the teachers to sharetheir subjective experiences making it possible to understandwhy pedagogies recommended in the intended curriculumare often not used.We found that a considerable gap exists between theassumptions of the researchers and the daily practicalrealities of PE teaching. Teachers are not simply passiverecipients of change but make decisions, within theconstraints of the institution, about what is possible andwhat is not. During their debriefing the teachers explainedthat they were required to establish a curriculum planbefore the school year commenced that included informa-tion on scheduling units of PE, teaching assignments andJohns et al44      Hong Kong Med J Vol 12 No 2 Supplement 1 April 2006most important, the facility requirements for each activity.Once established, teachers rigidly adhered to it for the restof the year and found the intervention to be obtrusive andupsetting because it did not fit into the curriculum that theyhad put into effect. Although the lesson plans to be usedas an intervention were prepared by the teachers, theythemselves were not willing to deviate from their ownplan because it did not fit.DiscussionWhile this study was unsuccessful in raising the activityrates of young people, it provided an excellent illustrationof the difficulties of implementing change. Moreover, thestudy identified the importance of the role of the PE teacherand demonstrated that strategies are easier to design thanto implement. In school-based interventions, the teacherbecomes the last and most important link betweenstatements of intention and classroom reality. To increasethe intensity and volume of activity in school PEprogrammes requires much more consideration of theschool setting and the engagement of teachers in a discourseto design practical strategies to change the emphasis andmanagement of the PE class. Consideration must be givento the ‘situational and personal–social factors’ that preventthe transformation of untested ideas into effective strategies.4Large classes, resistance of other staff to change, no timefor planning and little opportunity for reflection coupledwith the lack of support, release time and assistance tosustain the pedagogical changes have already been widelyobserved among teachers.In retrospect, what the study lacked was the foresightto invest in teacher development and to confront ratherthan ignore the situational forces that would constrain thetransformation of ideas into action. This study has provideda clearer focus for future action research by suggesting thatit is not enough for teachers to design and own the plan forchange. Teachers must also be supported to a point wheretheir beliefs and values can be allowed to transform intopractice and where benefits for the teacher can be identified.Their inability to apply the effort and time that was neededto control the intervention was not due to indifference to theresearch but to the work environment and the consequencesthat influenced their good intentions. Researchers would dowell to pay attention to what McLaughlin termed “localcapacity and will” before attempting change.5 Accurateassessment of the will and capacity of teachers to embracethe proposed changes is essential if the project is to beenacted. Too often, as in this case, what is planned ascurriculum innovation and improvement may be far fromthe realities of everyday practices in schools.AcknowledgementsThis study was supported by the Health Care and Promo-tion Fund (#278109). The authors thank the participatingschools and PE teachers who were willing to participate inthe study.References1. Sallis JF, McKenzie TL. Physical education’s role in public health.Res Q Exerc Sport 1991;62:124-37.2. Macfarlane DJ. Some disturbing trends in the levels of habitualphysical activity in Hong Kong primary school children: preliminaryfindings. Hong Kong J Sports Med Sports Sci 1991;5:42-6.3. Wong TK, Macfarlane D. Levels of habitual physical activity andexercise intensity during physical education class among 8-13 yearold Hong Kong primary school children. Res Q Exerc Sport 1997;68:A24.4. Doutis P, Ward P. Teachers’ and administrators’ perceptions of theSaber-tooth project reform and of their changing workplaceconditions. J Teach Phys Educ 1999;18:417-27.5. McLaughlin MW. Listening and learning from the field: tales ofpolicy implementation and situated practice. In: HargreavesA, Leiberman A, Fullan M, Hopkins D, editors. Internationalhandbook of educational change. London: Kluwer AcademicPublishers; 1998.

Raising activity levels as a health risk reduction intervention in Hong Kong children

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Raising activity levels as a health risk reduction intervention in Hong Kong children

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