- Title
- A school-based program for improving muscular fitness in youth: evaluation of the resistance training for teens program from effectiveness to state-wide dissemination
- Creator
- Kennedy, Sarah Grace
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Despite the numerous physical and psychological benefits associated with participation, physical inactivity is a well-known global concern. It is estimated that only 20% of youth are meeting accepted physical activity guidelines of 60 minutes of mostly aerobic moderate-to-vigorous physical activity (MVPA) each day. In addition to the worrying statistics for aerobic activity, youth participation in muscle-strengthening activities (MSA) is also poor. Schools are an ideal setting to combat youth inactivity. Schools have the curriculum, staff and resources to provide students with the knowledge and skills to lead physically active lives, now and into the future. Over the years, numerous school-based programs have shown improvements in students’ physical activity levels. Despite this, few of the programs have progressed beyond efficacy or effectiveness trials. Furthermore, the majority of studies have not included strategies to promote muscular fitness (MF). As such, there is a need to test innovative programs that promote muscle-strengthening activity, and for these programs to be tested in real-world settings. Aims: This thesis by publication presents a body of research conducted to address a shortfall in the literature regarding the efficacy and impact of school-based resistance training (RT) programs. Research was conducted in two phases: (i) the Resistance Training for Teens (RT for Teens) cluster randomised controlled trial (RCT); and (ii) state-wide dissemination of the RT for Teens program, across New South Wales (NSW) secondary schools. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was utilised to evaluate program success. Given the importance of delivering effective interventions at-scale, and the relevance of the schooling system as a means to access children and adolescents, this thesis also addresses a key secondary aim of relevance to these topics. Primary aim: To explore the reach, effectiveness, adoption, implementation, and maintenance of the RT for Teens program in NSW secondary schools. The primary aim of this thesis was assessed via two phases. Pre-phases 1 and 2: design and development. To ensure suitability for at-scale delivery across NSW secondary schools, the RT for Teens intervention first had to be designed and developed. Based on feedback provided following evaluation of two prior school-based interventions delivered by the University of Newcastle research group - Nutrition and Enjoyable Activity for Teen (NEAT) Girls and Active Teen Leaders Avoiding Screen-time (ATLAS) interventions - the modified RT for Teens intervention was designed. Three major modifications to NEAT and ATLAS (resulting in RT for Teens) were (i) an increased focus on RT, (ii) reduction in program duration to fit within one school term (i.e., 10 weeks), and (iii) development of a smartphone app. These changes were made to increase the salience and scalability of the program. In addition to the modified intervention, numerous implementation strategies were included within RT for Teens to increase potential uptake, including (i) recruitment of school champions; (ii) professional learning workshop for teachers; (iii) provision of teacher handbook, session resources and fitness equipment; and (iv) physical activity session observation and feedback. Phase 1: RCT Student outcomes: This study aimed to evaluate the effectiveness of the revised RT for Teens intervention on student-level outcomes. RT for Teens was evaluated via a cluster RCT in 16 secondary schools across the Newcastle, Hunter, Central Coast and Sydney regions of NSW, Australia. A total of 607 adolescents were assessed at baseline and randomised to the intervention or control group (at the school level). Follow-up assessments were completed at 6-(post-program) and 12-months (follow-up). Analyses followed the intention-to-treat principle. At 6-months, statistically significant improvements were found for upper body MF (co-primary outcome; push-up repetitions and standing long jump), RT skill competency and RT self-efficacy. Effects for all other secondary outcomes were non-significant, as was lower body MF (co-primary outcome). During follow-up assessments, intervention effects for upper body MF and RT skill competency were sustained. There was also a statistically significant effect for body mass index (BMI), among students who were overweight or obese at baseline. Teacher outcomes: The aim of this study sought to investigate the effect of program training and delivery on teachers’ confidence to teach, barrier perception and perceived fitness, from the 16 schools involved in the RCT. A total of 44 teachers (27 intervention, 17 control) completed baseline surveys, prior to delivery of the 10-week program. Teachers then completed a follow-up survey at 6-months. Statistically significant group-by-time effects were found in favour of the intervention group for teachers’ confidence to teach fitness activities and perceived general fitness. No intervention effects were found for perceived barriers to teaching HRF. Intervention group teachers were also satisfied with the program, and intervention fidelity and delivery quality were high. Phase 2: Dissemination The primary aim of this thesis was to determine the public health impact of the RT for Teens program when delivered across NSW secondary schools. The RE-AIM framework was utilised to guide the evaluation process, with numerous data sources included in the mixed methods study. RT for Teens had wide potential reach, with students of varied cultural and socio-economic backgrounds enrolled at participating schools. Utilising a sub-sample (N = 17) to evaluate effectiveness, there were significant improvements in MF, RT self-efficacy, perceived cardiorespiratory fitness (CRF) and flexibility, and participation in muscle-strengthening physical activities. Adoption was also strong, with 468 teachers from 249 schools attending the RT for Teens professional learning workshop. This represents almost half of NSW secondary schools, and included those from various regions and with differing selective status. Implementation quality varied between schools; however, usage of resources (provided during the professional learning workshop) was high. The RT for Teens application (app) was used for over 2,000 workouts and over 3,000 fitness tests. Teachers indicated that they had shared program resources, with over one fifth of schools sending teachers to a second, third or fourth workshop to be trained. Secondary aim: to evaluate the extent to which school-based interventions have been delivered at-scale. A systematic search of the literature, including nine electronic databases and grey literature, was conducted. Eligible studies were those that evaluated a school-based physical activity intervention delivered at-scale. A total of 26 articles representing 14 studies were included, with data extracted across all dimensions of the RE-AIM framework. Reporting of outcomes across the RE-AIM domains was varied, with data described in numerous ways. Evidence gathered within this review provides a case for improving the reporting of evaluation metrics and findings in school-based studies delivered at-scale.
- Subject
- school-based program; muscular fitness; youth; resistance training; physical activity; students; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1506962
- Identifier
- uon:55940
- Rights
- Copyright 2021 Sarah Grace Kennedy
- Language
- eng
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