- Title
- The Fit-4-Fun study: promoting physical activity and physical fitness in primary school-aged children
- Creator
- Eather, Narelle
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2014
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Physical fitness is an important predictor of physical and psychological health in children and adolescents, yet evidence confirms that a large proportion of children are unfit and do not participate in physical activity of sufficient volume and intensity to accrue the associated health benefits. Given that children’s fitness levels also decline with age, there is an urgent need to develop and evaluate interventions that promote high intensity physical activity, that are appealing to children and adolescents and contribute to the development and maintenance of high levels of physical fitness. Objective: The primary aim of this thesis was to evaluate an eight-week school-based physical fitness education intervention (Fit-4-Fun) for improving the physical activity and physical fitness levels of Grades 5 and 6 primary school children. The secondary aim of this thesis was to explore potential mediators of physical activity in the Fit-4-Fun program. Methods: Study type and participants: 1) In 2010, a pilot randomized controlled trial (RCT) with a three-month wait-list control group was conducted in two primary schools, in the Hunter Region, NSW, Australia. Children from Grades 5 and 6 were recruited for the studies (n = 49; mean age 10.9 years ± 0.7) and were randomized by school into the Fit-4-Fun intervention (n = 32) or the control (n = 17) conditions. 2) In 2011, a cluster RCT with a six-month wait-list control group was conducted in four primary schools in the Hunter Region, NSW, Australia. Children from Grades 5 and 6 were recruited for the studies (n = 213; mean age = 10.72 years ± 0.6) and were randomized by school into the Fit-4-Fun intervention (n = 118 students) or the control (n = 95) conditions. Treatment conditions: The Fit-4-Fun intervention was a theoretically grounded eight-week physical fitness education program that included: 8 x 60 min Health and Physical Education (HPE) lessons (theory and practical – replacing the existing HPE program), a daily break-time activity program (recess and lunch) and a home fitness program. The control group participated in their usual weekly 60min health and physical education lesson. Measures and statistical analysis: 1)In the pilot study, assessments were taken at baseline and immediate post-intervention todetermine changes in health-related fitness levels (cardiorespiratory fitness, muscular fitness, flexibility, and body composition), physical activity and changes in constructs from Social Cognitive Theory and Competence Motivation Theory. Intervention effects in the pilot study were assessed using analysis of covariance (ANCOVA). 2)In the cluster RCT, assessments were taken at baseline, immediate post-intervention and atsix-months to determine changes in health-related fitness levels, physical activity and changes in constructs from Social Cognitive Theory and Competence Motivation Theory. Intervention effects were assessed using linear mixed models and mediation analysis was conducted using Preacher and Hayes’ multiple mediation regression SPSS macro. Process evaluation measures of recruitment, retention, adherence and satisfaction were also assessed in both trials to determine program feasibility. Results: Pilot RCT: children in the intervention group improved in all health-related fitness measures with significant group x time effects (p <.05) observed in the seven-stage sit-up test (d = 0.9), the sit and reach tests (right leg d = 1.0, left leg d = 0.9, both legs d = 1.1) and the wall squat tests (right leg d = 0.9, left leg d = 0.6). No significant group x time effect was found in the beep test, basketball throw, physical activity measure or psychological measures. Process evaluation findings demonstrated high levels of recruitment, retention, adherence and satisfaction. Minor changes were made to the home activity program and program components based on feedback provided by participants and process evaluation results. Cluster RCT: After six-months, significant treatment effects were found for cardiorespiratory fitness (20mSRT adjusted mean difference, 1.14 levels, 95% CI = 0.74 to 1.55 p < 0.001), body composition (BMI adjusted mean difference -0.96kg/m², 95% CI = -1.42 to -0.5, p < 0.001 and BMI-Z adjusted mean difference -0.47 Z-scores, 95% CI = -0.70 to -.25, p < 0.001), flexibility (sit and reach adjusted mean difference 1.52cm, 95% CI = -0.65 to 3.68, p = 0.0013), muscular fitness (sit-ups) (adjusted mean difference 0.62 stages, 95% CI = -0.97 to -0.27, p = 0.003) and physical activity (mean, 3253 steps/day, 95% CI = 1776 to 4730, p < 0.001). There were no significant treatment effects for three of the muscular fitness measures. Mediation Analysis: Teacher social support was found to have a significant mediating effect on physical activity in the cluster RCT (AB = 445, 95% CI = 77 to 1068 steps, proportion = 13%), and perceived school environment approached significance (AB = 434, 95% CI = -415 to 1507 steps, proportion = 13%). The targeted constructs of enjoyment, social support from parents and friends, and self-efficacy did not meet the criteria for mediation. Process Evaluation: Measures of recruitment, retention, adherence and satisfaction were very high. In both trials all invited schools’ principals and teachers agreed to participate in the Fit-4-Fun study. 1)In the pilot RCT, 85.7% of children invited to participate in the trial gained informed consent,all program sessions were delivered and 94% of participants were retained in follow-up assessments. Scores for the evaluation surveys ranged from 4.63 to 5.62 of a possible 6 for the 14 items in the evaluation survey, implying high-to-very high satisfaction rates for the Fit-4-Fun program. 2)In the cluster RCT, 93.8% of the 226 eligible participants completed all baseline assessments,86.7% completed the 10-week follow-up measures and 90.7% completed the six-month assessments. All eight curriculum sessions were presented at the treatment schools with an attendance rate of 94% and mean scores for the evaluation survey categories ranged from 4.29 to 5.33 of a possible 6 for the 14 items in the evaluation survey – also indicating high to very high overall satisfaction rates for the Fit-4-Fun program. In both trials, students reported difficulties with adhering to the home component which relied on parent/family involvement in the program with a mean score of 2.84 (pilot RCT) and 3.33 (cluster RCT) of a possible 6 for perceived parental and family involvement. Conclusion: A multi-component, curriculum-based health-related fitness intervention for primary school children that targeted the three areas of a health promoting school and targeted teacher social support for participation in physical fitness activities is feasible and efficacious in improving health-related fitness and physical activity levels in children.
- Subject
- fitness; physical activity; adolescents; children; school; health; physical education; curriculum; social support; intervention; primary school
- Identifier
- http://hdl.handle.net/1959.13/1051068
- Identifier
- uon:15245
- Rights
- Copyright 2014 Narelle Eather
- Language
- eng
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