Mid-way and post-intervention effects on potential determinants of physical activity and sedentary behavior, results of the HEIA study - a multi-component school-based randomized trial

International Journal of Behavioral Nutrition and Physical Activity

Yngvar Ommundsen³  Sigmund A Anderssen¹  Knut-Inge Klepp²  Lene F Andersen²  Nanna Lien²  May Grydeland²  Mona Bjelland²  Ingunn H Bergh³ 

[1] Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway;Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway

关键词: Randomized controlled trial;    Effect;    Social-ecological model;    Intervention;    Obesity prevention;    Adolescents;    Moderation;   

Others  :  824895
DOI  :  10.1186/1479-5868-9-63

 received in 2011-07-07, accepted in 2012-05-29,  发布年份 2012

【 摘 要 】

Background

There is limited knowledge as to whether obesity prevention interventions are able to produce change in the determinants hypothesized to precede change in energy balance-related behaviors in young people. The aim of this study was to evaluate the effect of a multi-component intervention on a wide range of theoretically informed determinants of physical activity (PA) and sedentary behavior (SB). Moderation effects of gender, weight status and parental education level and whether the perceived intervention dose received influenced the effects were also explored.

Methods

The HEIA study was a 20-month school-based, randomized controlled trial to promote healthy weight development. In total, 1418 11-year-olds participated at baseline and post-intervention assessment. Enjoyment, self-efficacy, perceived social support from parents, teachers and friends related to PA, perceived parental regulation of TV-viewing and computer/game-use and perceived social inclusion at schools were examined by covariance analyses to assess overall effects and moderation by gender, weight status and parental education, mid-way and post-intervention. Covariance analyses were also used to examine the role of intervention dose received on change in the determinants.

Results

At mid-way enjoyment (p = .03), perceived social support from teachers (p = .003) and self-efficacy (p = .05) were higher in the intervention group. Weight status moderated the effect on self-efficacy, with a positive effect observed among the normal weight only. At post-intervention results were sustained for social support from teachers (p = .001), while a negative effect was found for self-efficacy (p = .02). Weight status moderated the effect on enjoyment, with reduced enjoyment observed among the overweight. Moderation effects for parental education level were detected for perceived social support from parents and teachers. Finally, positive effects on several determinants were observed among those receiving a high as opposed to a low intervention dose.

Conclusion

The intervention affected both psychological and social-environmental determinants. Results indicate that social support from teachers might be a potential mediator of PA change, and that overweight adolescents might be in need of specially targeted interventions to avoid reducing their enjoyment of PA. Further studies should continue to assess how intervention effectiveness is influenced by the participants’ self-reported dose of intervention received.

【 授权许可】

   
2012 Bergh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Though SC: Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with "best practice" recommendations. Obes Rev 2006, 7(Suppl 1):7-66.
• [2]Brown T, Summerbell C: Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev 2009, 10:110-141.
• [3]Baranowski T, Jago R: Understanding the mechanisms of change in children's physical activity programs. Exerc Sport Sci Rev 2005, 33:163-168.
• [4]Bryan AD, Magnan RE, Nilsson R, Marcus BH, Tompkins SA, Hutchison KE: The big picture of individual differences in physical activity behavior change: A transdisciplinary approach. Psychology of Sport and Exercise 2011, 12:20-26.
• [5]Van Stralen MM, Yildirim M, te Velde SJ, Brug J, Van Mechelen W, Chinapaw MJ: What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms. Int J Obes 2011, 35:10.
• [6]Lubans DR, Foster C, Biddle SJH: A review of mediators of behvaiour in interventions to promote physical activity among children and adolescents. Preventive Medicine 2008, 47:463-470.
• [7]Baranowski T, Anderson C, Carmack C: Mediating variable framework in physical activity interventions - How are we doing? How might we do better? American Journal of Preventive Medicine 1998, 15:266-297.
• [8]Baranowski T, Lin LS, Wetter DW, Resnicow K, Hearn MD: Theory as mediating variables: Why aren't community interventions working as desired? Ann Epidemiol 1997, 7:S89-S95.
• [9]Lewis BA, Marcus BH, Pate RR, Dunn AL: Psychosocial mediators of physical activity behavior among adults and children. Am J Prev Med 2002, 23:26-35.
• [10]van Sluijs EMF, van Poppel MNM, Twisk JWR, Brug J, Van Mechelen W: The positive effect on determinants of physical activity of a tailored, general practice-based physical activity intervention. Heal Educ Res 2005, 20:345-356.
• [11]Salmon J, Brown H, Hume C: Effects of strategies to promote children's physical activity on potential mediators. Int J Obes (Lond) 2009, 33(Suppl 1):S66-S73.
• [12]Hume C, Jorna M, Arundell L, Saunders J, Crawford D, Salmon J: Are children's perceptions of neighbourhood social environments associated with their walking and physical activity? J Sci Med Sport 2009, 12:637-641.
• [13]Kraemer HC, Wilson GT, Fairburn CG, Agras WS: Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 2002, 59:877-883.
• [14]Kremers SP, De Bruijn GJ, Droomers M, van Lenthe F, Brug J: Moderators of environmental intervention effects on diet and activity in youth. Am J Prev Med 2007, 32:163-172.
• [15]Yildirim M, Van Stralen MM, Chinapaw MJBJ, Van Mechelen W, Twisk J, te Velde S: For Whom and Under What Circumstances Do School-based Interventions Aimed at Energy Balance Behaviour Work? Systematic Review on Moderators. Int J Pediatr Obes 2011.
• [16]Bauman AE, Sallis JF, Dzewaltowski DA, Owen N: Toward a better understanding of the influences on physical activity - The role of determinants, correlates, causal variables, mediators, moderators, and confounders. American Journal of Preventive Medicine 2002, 23:5-14.
• [17]Saunders RP, Evans MH, Joshi P: Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promottion Practice 2005, 6:134-147.
• [18]van Sluijs EMF, Mcminn AM, Griffin S: Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. Br Med J 2007, 335:703-707.
• [19]Summerbell CD, Waters E, Edmunds L, Kelly SAM, Brown T, Campbell KJ: Interventions for preventing obesity in children (Review). Cochrane Database of Systematic Reviews 2009, 2:1-86.
• [20]Lien N, Bjelland M, Bergh IH, Grydeland M, Anderssen SA, Ommundsen Y, Andersen LF, Henriksen HB, Randby JS, Klepp K-I: Design of a 20-month comprehensive, multicomponent school-based randomised trial to promote healthy weight development among 11–13 year olds: the health in adolescents study. Scandinavian Journal of Public Health 2010, 38:38-51.
• [21]Sallis JF, Prochaska JJ, Taylor WC: A review of correlates of physical activity of children and adolescents. Medicine and Science in Sports and Exercise 2000, 32:963-975.
• [22]Bergh IH, Grydeland M, Bjelland M, Lien N, Andersen LF, Klepp K-I, Anderssen SA, Ommundsen Y: Personal and social-environmental correlates of objectively measured physical activity in Norwegian pre-adolescent children. Scand J Med Sci Sports 2011.
• [23]Bjelland M, Bergh IH, Grydeland M, Klepp KI, Andersen LF, Anderssen SA, Ommundsen Y, Lien N: Changes in adolescents' intake of sugar-sweetened beverages and sedentary behaviour: Results at 8 month mid-way assessment of the HEIA study - a comprehensive, multi-component school-based randomized trial. Int J Behav Nutr Phys Act 2011, 8:63. BioMed Central Full Text
• [24]Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Faucette N, Hovell MF: The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids. Am J Public Health 1997, 87:1328-1334.
• [25]Brustad RJ: Who Will Go Out and Play - Parental and Psychological Influences on Childrens Attraction to Physical-Activity. Pediatr Exerc Sci 1993, 5:210-223.
• [26]Motl RW, Dishman RK, Trost SG, Saunders RP, Dowda M, Felton G, Ward DS, Pate RR: Factorial validity and invariance of questionnaires measuring social-cognitive determinants of physical activity among adolescent girls. Prev Med 2000, 31:584-594.
• [27]Lytle LA: Examining the Etiology of Childhood Obesity: The IDEA Study. Am J Community Psychol 2009, 44:338-349.
• [28]Sallis JF, Prochaska JJ, Taylor WC, Hill JO, Geraci JC: Correlates of physical activity in a national sample of girls and boys in Grades 4 through 12. Heal Psychol 1999, 18:410-415.
• [29]Riddoch C, Edwars D, Page A, Froberg K, Andressen SA, Wedderkopp N, Brage S, Cooper AR, Sardinha LB, Harro M, Klasson-Heggbø L, Van Mechelen W, Boreham C, Ekelund U, Andersen LB: Europena Youth Heart Study Team: The European Youth Heart Study - Cardivascular Diseaes Risk Factors in Children: Rationale, Aims, Study Design, and Validation of Methods. J Phys Act Heal 2005, 2:115-129.
• [30]Hardy LL, Baur LA, Garnett SP, Crawford D, Campbell KJ, Shrewsbury VA, Cowell CT, Salmon J: Family and home correlates of television viewing in 12–13 year old adolescents: the Nepean Study. Int J Behav Nutr Phys Act 2006, 3:24. BioMed Central Full Text
• [31]Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 2000, 320:1240-1243.
• [32]Bjelland M, Lien N, Bergh IH, Grydeland M, Anderssen SA, Klepp KI, Ommundsen Y, Andersen LF: Overweight and waist circumference among Norwegian 11-year-olds and associations with reported parental overweight and waist circumference: The HEIA study. Scandinavian Journal of Public Health 2010, 38:19-27.
• [33]Ernst MP, Pangrazi RP: Effects of a physical activity program on children's activity levels and attraction to physical activity. Pediatr Exerc Sci 1999, 11:393-405.
• [34]Weiss MR, Kimmel LA, Smith AL: Determinants of Sport Commitment Among Junior Tennis Players: Enjoyment as a Mediating Variable. Pediatr Exerc Sci 2001, 13:131-144.
• [35]Dishman RK, Motl RW, Saunders R, Felton G, Ward DS, Dowda M, Pate RR: Enjoyment mediates effects of a school-based physical-activity intervention. Medicine and Science in Sports and Exercise 2005, 37:478-487.
• [36]McKenzie TL, Sallis JF, Prochaska JJ, Conway TL, Marshall SJ, Rosengard P: Evaluation of a two-year middle-school physical education intervention: M-SPAN. Med Sci Sports Exerc 2004, 36:1382-1388.
• [37]Scanlan TK, Lewthwaite R: Social Psychological-Aspects of Competition for Male Youth Sport Participants .4. Predictors of Enjoymen. Journal of Sport Psychology 1986, 8:25-35.
• [38]Wiersma LD: Conceptualization and Development of the Sources of Enjoyment in Youth Sport Questionnaire. Meas Phys Educ Exerc Sci 2001, 5:153-177.
• [39]Strauss RS, Pollack HA: Social marginalization of overweight children. Archives of Pediatrics & Adolescent Medicine 2003, 157:746-752.
• [40]Haerens L, Cerin E, Maes L, Cardon G, Deforche B, De Bourdeaudhuij I: Explaining the effect of a 1-year intervention promoting physical activity in middle schools: a mediation analysis. Public Health Nutrition 2008, 11:501-512.
• [41]Lytle LA, Murray DM, Evenson KR, Moody J, Pratt CA, Metcalfe L, Parre-Medina D: Mediators Affecting Girls' Levels of Physical Activity Outside of School: Findings from the Trial of Activity in Adolescent Girls. Ann Behav Med 2009, 38:124-136.
• [42]Stalsberg R, Pedersen AV: Effects of socioeconomic status on the physical activity in adolescents: a systematic review of the evidence. Scand J Med Sci Sports 2010, 20:368-383.
• [43]Edmundson E, Parcel GS, Feldman HA, Elder J, Perry CL, Johnson C, Williston BJ, Stone EJ, Yang MS, Lytle L, Webber L: The effects of the child and adolescent trial for cardiovascular health upon psychosocial determinants of diet and physical activity behavior. Preventive Medicine 1996, 25:442-454.
• [44]Craggs C, Corder K, van Sluijs EMF, Griffin SJ: Determinants of Change in Physical Activity in Children and Adolescents A Systematic Review. American Journal of Preventive Medicine 2011, 40:645-658.
• [45]Bjelland M: Obesity prevention targeting Norwegian adolescents: prevalence rates, determinants and intervention effects by gender, parental education and parent–child associations. Unipub, Oslo; 2011.