Professor Philip Morgan

The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109¿million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men¿s representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression.

Background:: Fathers are important in establishing healthy behaviors in their children, but are rarely engaged in lifestyle programs. Focusing on physical activity (PA) of both fathers and their children by engaging them together in PA (i.e. ¿co-PA¿) is therefore a promising novel strategy for interventions. The study aim was to investigate the effect of the ¿Run Daddy Run¿ on co-PA and PA of fathers and their children, and secondary outcomes such as weight status and sedentary behaviour (SB). Methods:: This study is a non-randomized controlled trial (nRCT), including 98 fathers and one of their 6 to 8 years old children (intervention = 35, control = 63). The intervention was implemented over a 14-week period, and consisted of six (inter)active father-child sessions and an online component. Due to COVID-19, only 2/6 sessions could be implemented as planned, the remaining sessions were delivered online. In November 2019-January 2020 pre-test measurements took place, and post-test measurements in June 2020. Additional follow-up test was conducted in November 2020. PA (i.e. LPA, MPA, VPA and volume) of fathers and children were objectively measured using accelerometry, co-PA and the secondary outcomes were questioned using an online questionnaire. Results:: Significant intervention effects were found for co-PA (+ 24¿min./day in the intervention compared to the control group, p = 0.002), and MPA of the father (+ 17¿min./day, p = 0.035). For children, a significant increase in LPA (+ 35¿min./day, p < 0.001) was found. However, an inverse intervention effect was found for their MPA and VPA (-15¿min./day, p = 0.005 and - 4¿min./day, p = 0.002, respectively). Also decreases in fathers¿ and children¿s SB were found (-39¿min./day, p = 0.022 and - 40¿min./day, p = 0.003, respectively), but no changes in weight status, the father-child relationship, and the PA-family health climate (all p > 0.05). Conclusion:: The Run Daddy Run intervention was able to improve co-PA, MPA of fathers and LPA of children, and decreasing their SB. Inverse intervention effects were however found for MPA and VPA of children. These results are unique given their magnitude and clinical relevance. Targeting fathers together with their children might be a novel and potential intervention strategy to improve overall physical activity levels, however, further efforts should however be made to target children¿s MPA and VPA. Last, replicating these findings in a randomized controlled trial (RCT) is recommended for future research. Trial registration number:: This study is registered as a clinical trial (clinicaltrials.gov, ID number: NCT04590755, date: 19/10/2020).

Background: There is a growing body of evidence showing the benefits to coaches and players in adopting a game-based pedagogical approach. Whilst the evidence in support of a game-based pedagogy continues to rise it is acknowledged that the complex art form of coaching is a uniquely personal one, where the coach may draw on previous first-hand experiences and traditional coaching practices regarding training methods rather than the use of current evidence-based best practice techniques. Purpose: The aim of this randomised control trial was to evaluate the impact of a coach development intervention (MASTER) on game-based coaching practices of football coaches. Methods: Four clubs were recruited, and 20 coaches were randomised to two groups, MASTER intervention (n = 10) and 10 usual practice (waitlist, n = 10); NSW Australia) which included 200 junior footballers (aged 8¿16years). Intervention coaches participated in an 8-week multi-component intervention (which included a coach education workshop focused on positive game-based pedagogy, mentoring, peer evaluations and an online discussion forum) underpinned by positive coaching and game-based coaching practices. Pre- and post-intervention assessments occurred at baseline and 10 weeks. The primary aim was to investigate if the MASTER intervention could increase playing form (PF) and active learning time within training sessions. Three coaching sessions per coach were filmed at baseline and follow-up and assessed using the MASTER assessment tool. Secondary aims investigation included coach confidence and competence to coach (assessed by questionnaire), player game play and decision making (videoed during structured game play using a Game Performance Assessment Instrument), a range of player well-being measures including enjoyment, self-perception, and various motivations (questionnaire) and the parent¿s perception of their child¿s enjoyment was assessed by the completion of a questionnaire. Intervention effects were analysed using linear mixed models. Findings: Significant effects were found for the primary outcome which was the percentage of training time devoted to playing-form activities (22.63%; 95% CI 9.07¿36.19; P = 0.002, d = 1.78). No significant effect was observed for ALT. Significant interventions effects were also observed for the secondary outcomes of coach perceptions of confidence and confidence; player game skills including defence, support and decision making, wellbeing, physical self-perceptions, enjoyment, learning and performance orientations and motivation; and parent¿s perception of child¿s enjoyment (P < 0.05). Conclusions: The MASTER programme was effective in improving game-based coaching practices of football coaches during training sessions, and in facilitating improvements in multiple coach and player outcomes.

Background: Depression and obesity are major health concerns and commonly co-exist, but men rarely seek help for these conditions. SHED-IT: Recharge was a gender-tailored eHealth program for men that generated clinically meaningful improvements in weight and depressive symptoms. Purpose: To evaluate behavioral and psychological outcomes from the SHED-IT: Recharge intervention designed for overweight/obese men with low mood. Methods: Overall, 125 men (18-70 years) with a BMI between 25 and 42 kg/m2 and depressive symptoms (PHQ-9 = 5) were randomly allocated to SHED-IT: Recharge (n = 62) or wait-list control (n = 63) groups. The self-directed program targeted key health behaviors combined with online mental fitness modules based on cognitive behavioral therapy. Behavioral (e.g., physical activity) and psychological outcomes (e.g., cognitive flexibility) were assessed with validated measures at baseline, 3 months (post-test) and 6 months (follow-up). Intention-to-treat linear mixed models examined treatment effects, which were adjusted for covariates, and effect size estimated (Cohen's d). Results: At post-test, intervention men achieved small-to-medium improvements in several health behavior outcomes including moderate-to-vigorous physical activity, light physical activity, sedentary behavior, sleep, energy intake, portion size, and risky alcohol consumption (range, d = 0.3-0.5), when compared with the control group. Intervention effects were also observed for perceived physical self-worth, perceived physical strength, cognitive flexibility, and behavioral activation (range, d = 0.3-0.8). No effects were found for fruit and vegetable intake, or mindful attention. Most effects were maintained at follow-up. Conclusions: This gender-tailored, eHealth program with integrated mental fitness support elicited meaningful improvements in health behaviors and psychological outcomes for men with low mood. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12619001209189).

Background: Children can internalise social and parental gender stereotypes and this may influence their perceived motor competence (PMC). This study aimed to examine the association between father and daughter gender-stereotyped attitudes/beliefs and girls¿ PMC. Methods: Girls (N = 68, M age = 8.9 years, SD = 1.7) and their fathers were recruited at baseline from a physical activity intervention. Girls¿ PMC was assessed using the pictorial scale of Perceived Movement Skill Competence. Gender-stereotyped attitudes/beliefs of girls and fathers were assessed using the Occupation, Activity, and Trait¿Attitude/Personal instrument. The girls¿ questions were interviewer administered to ensure comprehension, whilst fathers completed an online survey. Correlations were calculated, followed by linear regressions adjusted for girls¿ age and fathers¿ education. Regression models were used to investigate associations between father-daughter gender-stereotyped attitudes/beliefs, and whether these attitudes/beliefs were associated with girls¿ perceptions of their object control/locomotor, active play, and overall skill competence. Results: Girls¿ gender-stereotyped attitudes negatively correlated with overall PMC, r(60) = ¿.36, p =.004, and object control perception, r(60) = ¿.36, p =.004. These associations remained evident in linear regression analysis. No other associations were found. Conclusions: Girls with more gender-stereotyped attitudes have lower motor skill perceptions, which may impact negatively on physical activity and sport participation. Future interventions aimed at reducing sociocultural gender stereotypes in children may improve girls¿ motor skill perception and positively impact physical activity.

Background: The SHED-IT: Recharge study demonstrated that a gender-tailored eHealth program could improve the depressive symptoms of men with overweight or obesity and low mood. This study examined whether changes in key behaviours and cognitions acted as significant mediators of this treatment effect. Methods: The study was a randomised controlled trial (RCT) including 125 men with overweight or obesity (mean (SD) weight 103.8 (15.8) kg), and current depressive symptoms (Patient Health Questionnaire (PHQ-9) = 5; mean (SD) 9.2 (4.1) units). Assessments were held at baseline, 3 months (post-intervention), and 6 months (follow-up). Depressive symptoms were assessed using the validated PHQ-9 and Masculine Depressive Risk Scale (MDRS-22). Behavioural and cognitive mediators were assessed with validated measures. Intention-to-treat mediation analyses were conducted using the PROCESS macro in SPSS. Results: Single mediation analyses demonstrated that the intervention effect on both PHQ-9 and MDRS-22 scores was significantly mediated by changes in MVPA, energy-dense nutrient-poor foods, cognitive flexibility, and behavioural activation. In addition, changes in sleep quality mediated improvements in MDRS-22 scores. No mediation effects were observed for light physical activity, sedentary behaviour, fruit and vegetable intake, risky alcohol consumption or mindfulness. Limitations: The study was a secondary analysis with power to detect moderate-to-large mediation effects only. Conclusion: To prevent or treat depression in men with overweight or obesity, early evidence suggests MVPA, sleep quality, energy-dense nutrient-poor food intake, cognitive flexibility, and behavioural activation are important intervention targets.

Background: The 'Dads And Daughters Exercising and Empowered' (DADEE) program significantly improved physical activity levels of fathers and their daughters in an efficacy trial. However, the effectiveness of interventions when delivered in real-world settings needs to be established. Purpose: To evaluate the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. Methods: We conducted a two-arm RCT, (baseline and 3-months post-intervention assessments), in Newcastle, Australia. In 2016, 155 fathers (27-60 years) and 189 primary-school-aged daughters (4-12 years) (n = 344) were randomly allocated to the intervention (78 fathers, 95 daughters) or waitlist-control (77 fathers, 94 daughters) groups. Trained facilitators delivered the 9-week DADEE program (weekly sessions plus home-based tasks). Primary outcomes were fathers' and daughters' physical activity (steps/day). Secondary outcomes included screen-time, weight status, daughters' fundamental movement skill (FMS) proficiency, perceived sports competence, and fathers' parenting practices. Effects were assessed using linear mixed models. Results: Primary outcome follow-up data were collected from 88% of fathers and 89% of daughters. Significant group-by-time differences in mean daily steps were found for fathers' (adjusted difference = +1,638; 95% CI: 833, 2,443, d = 0.7) and daughters' (adjusted difference = +1,023 steps/day; 95% CI: 259, 1,787; d = 0.4) physical activity. Significant effects were observed for daughters' screen-time, FMS, and some parenting practices. No significant effects were identified for weight status, or fathers'screen-time or self-reported MVPA. Program attendance, satisfaction and fidelity were very high. Conclusion: This study established the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. Importantly, the findings were comparable to those of the efficacy RCT delivered by the research team. To maximize public health benefits, a larger-scale dissemination of the program appears warranted. Trial Registration Australian New Zealand Clinical Trial Registry: ACTRN12616001270404 Human Research Ethics Committee: H-2014-0330

Background: Physical Activity 4 Everyone (PA4E1) is an evidence-based program effective at increasing adolescent physical activity (PA) and improving weight status. This study aimed to determine a) the effectiveness of an adapted implementation intervention to scale-up PA4E1 at 24-month follow-up, b) fidelity and reach, and c) the cost and cost-effectiveness of the implementation support intervention. Methods: A cluster randomised controlled trial using a type III hybrid implementation-effectiveness design in 49 lower socio-economic secondary schools, randomised to a program (n = 24) or control group (n = 25). An adapted implementation intervention consisting of seven strategies was developed to support schools to implement PA4E1 over 24-months. The primary outcome was the proportion of schools implementing at least four of the 7 PA practices, assessed via computer assisted telephone interviews (CATI) with Head Physical Education Teachers. Secondary outcomes included the mean number of PA practices implemented, fidelity and reach, cost and cost-effectiveness. Logistic regression models assessed program effects. Results: At baseline, no schools implemented four of the 7 PA practices. At 24-months, significantly more schools in the program group (16/23, 69.6%) implemented at least four of the 7 PA practices than the control group (0/25, 0%) (p < 0.001). At 24-months, program schools were implementing an average of 3.6 more practices than control schools (4.1 (1.7) vs. 0.5 (0.8), respectively) (P < 0.001). Fidelity and reach of the implementation intervention were high (> 75%). The total cost of the program was $415,112 AUD (2018) ($17,296 per school; $117.30 per student). Conclusions: The adapted implementation intervention provides policy makers and researchers with an effective and potentially cost-effective model for scaling-up the delivery of PA4E1 in secondary schools. Further assessment of sustainability is warranted. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017.

Importance: Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. Objective: To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools. Design, Setting, and Participants: In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. Interventions: The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). Main Outcomes and Measures: Multistage 20-m shuttle run test for cardiorespiratory fitness. Results: Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). Conclusions and Relevance: In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level. Trial Registration: http://anzctr.org.au Identifier: ACTRN12616000731493.

Background: The effect of fathers on dietary intake in preschool-aged children is under-explored. The aims were to: (i) evaluate the efficacy of a family-based lifestyle intervention, Healthy Youngsters, Healthy Dads, on change in dietary intake in fathers and their preschool-aged children post-intervention (10 weeks) and at 9 months follow-up compared to a waitlist control group and (ii) investigate associations in father¿child dietary intakes. Methods: Linear mixed models estimated group-by-time effects for all dietary outcomes, measured by food frequency questionnaires. Cohen¿s d determined effect sizes, while correlation tests determined associations in father¿child dietary intakes. Results: For children, medium group-by-time effects sizes were identified at 10 weeks for sodium intake (d = 0.38) and percentage energy from core foods (d = 0.43), energy-dense, nutrient-poor (EDNP) foods (d = 0.43) and prepacked snacks (d = 0.45). These findings were sustained at 9 months follow-up. For fathers, medium to large, group-by-time effect sizes were identified at 10 weeks for energy intake (d = 0.55), sodium intake (d = 0.64) and percentage energy from core foods (d = 0.49), EDNP foods (d = 0.49), and confectionary (d = 0.36). For all of these dietary variables, except sodium, effects were sustained at 9 months. Moderate to strong associations existed in father¿child dietary intakes for some of the dietary variables. Conclusions: Although further research is required, this study provides preliminary support for targeting fathers as agents of change to improve dietary intakes in their preschool-aged children.

Background Cardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents' CRF. Methods Two-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering. Results We observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol. Conclusions Implementing HIIT during curricular time improved adolescents' CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12618000293268).

Objective: Qualitatively assess culturally adapted lifestyle intervention, Papás Saludables, Niños Saludables (PSNS; Healthy Dads, Healthy Kids), for Hispanic fathers and children. Methods: Semistructured interviews of parents and children after participation in 10-week PSNS program for Hispanic fathers and children. Qualitative data double-coded inductively and deductively until consensus reached. Results: Total of 26 fathers, 26 mothers, and 45 children interviewed. Parents and children had positive feedback about program content on culturally relevant nutrition and physical activity and reported improved father-child bonding. Mothers noted increased involvement among fathers in child's well-being. Participants suggested lengthening the program. Conclusions and Implications: Papás Saludables, Niños Saludables is an innovative approach with promise in engaging Hispanic fathers and children in a lifestyle program that emphasizes the role of fathers in children's lifestyle behaviors. Familism, respeto (respect), and promoting father-child relationships were important to engage fathers. Results from this study will inform future trials of PSNS and help identify ways to increase engagement of Hispanic men in other programs.

Background: Physical activity guidelines recommend young people engage in regular muscle-strengthening activities (e.g., resistance training [RT]). However, few school-based physical activity interventions have been delivered at-scale or promoted RT. The aim of this study was to evaluate the¿reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens (RT for Teens) program. Methods: Data were collected between August 2015 and October 2020. RE-AIM was operationalized as: (i) Reach: number and characteristics of students estimated to be exposed to the program; (ii) Effectiveness: impact of the program on student-level outcomes measured in a subsample of 750 students from 17 schools; (iii) Adoption: number and representativeness of schools with one or more teachers trained to deliver the program; (iv) Implementation: extent to which the program was delivered as intended; and (v) Maintenance: extent to which the program was sustained¿in schools. Results: The estimated program reach was ~ 10,000 students, out of a total student population of ~ 200,000 (~ 5%). Students were from diverse socioeconomic and ethnic backgrounds. Improvements in muscular fitness, RT self-efficacy, perceived cardiorespiratory fitness and flexibility, and participation in muscle-strengthening physical activities were documented. A total of 30 workshops were delivered, involving 468 teachers from 249 schools from diverse geographical regions. Implementation varied considerably, with teachers adapting the program to suit the¿context of their school and student cohorts. However, RT skill development and the promotion of muscular fitness were the session components delivered most during sessions. Teachers¿ adherence to the SAAFE (Supportive, Active, Autonomous, Fair and Enjoyable) teaching principles was high. Approximately 30% of teachers (144/476) registered to use the RT for Teens app. At the school-level, 37% (93/249) of schools had at least one registered user (teacher and/or student). A total of 2,336 workouts and 3,116 fitness tests were completed by registered users. Of the 249 schools represented, 51 (20.5%) sent an additional (previously untrained) teacher to a second workshop. Conclusions: The RT for Teens program had broad reach and adoption. However, intervention delivery varied considerably across schools and additional support strategies are required to optimize intervention implementation and maintain program delivery over time. Future studies will benefit from the utilization of accepted frameworks, recommendations and guidelines for implementation research. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12621000352808), retrospectively registered 1st February 2021.

Most family-based physical activity interventions have been modestly successful and failed to engage fathers. Also, program impact on family functioning and psychosocial outcomes are rarely measured. We explored the impact of an innovative father¿daughter physical activity program on family functioning and psychosocial outcomes for girls using qualitative methods. Of the 115 fathers who participated in the ¿Dads And Daughters Exercising and Empowered¿ (DADEE) pilot study, a random sample (stratified by baseline physical activity status) of 23 fathers (mean (SD) age: 41.4 (4.8) years) participated in semi-structured telephone interviews. Audio recordings were transcribed and analyzed by an independent researcher using a mixed inductive and deductive thematic approach. Seven themes were identified highlighting improvements in: (i) daughters¿ social-emotional well-being, (ii) father involvement and engagement with their daughter, (iii) fathers¿ parenting skills, (iv) the father¿daughter relationship, (v) co-parenting, (vi) family relationship dynamics, and (vii) knowledge and understanding of gender stereotypes and gender bias. A number of strategies were also identified as to how the program improved these outcomes. Engaging fathers and daughters in physical activity programs may have substantive benefits for daughters¿ mental health as well as broader outcomes for fathers and families. Enhancing fathers¿ and daughters¿ knowledge and skills through evidence-based strategies may be a useful approach to optimize the well-being of families.

Issue addressed: Supporting centre-based childcare services to create physical activity (PA) environments is a recommended strategy to improve child PA. This study aimed to describe the implementation of PA policies and practices by these services, and to examine the associations with service characteristics. Methods: Nominated supervisors of childcare services (n¿=¿309) in the Hunter New England region, New South Wales, Australia, completed a telephone interview. Using previously validated measures, the interview assessed the implementation of evidence-based practices shown to be associated with child PA. This includes: (a) provision of active play opportunities, (b) portable play equipment availability, (c) delivery of daily fundamental movement skills, (d) having at least 50% of staff trained in promoting child PA the past 5¿years and (e) having written PA and small screen recreation policies. Results: Although 98% (95% CI 96, 99) of childcare services provided active play opportunities for at least 25% of their daily opening hours, only 8% (95% CI 5, 11) of services fully implemented all policies and practices; with no service characteristic associated with full implementation. Long day care service had twice the odds of having a written PA policy (OR 2.0, 95% CI 0.7, 5.8), compared to preschools (adjusted for service size, socio-economic disadvantage and geographical location). Conclusions: Improvements could be made to childcare services¿ operations to support the promotion of child PA. So what?: To ensure the benefits to child health, childcare services require support to implement a number of PA promoting policies and practices that are known to improve child PA.

Objectives: Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55¿85 years. Design: A prospective cohort study of adults in Newcastle, New South Wales, Australia. Method: Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). Results: Higher step count (HR: 0.93, 95%CI: 0.88¿0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74¿0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for =3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78¿1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates. Conclusions: Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.

Aim: This study examined the effects of different types of classroom physical activity breaks on children¿s on-task behaviour, academic achievement and cognition. Methods: Participants were 87 Australian primary school students (mean age 9.11¿±¿0.62¿years), recruited from one school. Three classes were randomly assigned either to activity breaks only (n¿=¿29), activity breaks and mathematics combined (n¿=¿29), or control conditions involving only mathematical content (n¿=¿29). Students were engaged in five minutes of classroom physical activity breaks, three times per week, for four weeks (divided into two minutes at the beginning of the usual mathematics curriculum lesson and three minutes in the middle of the lesson). Assessments were conducted at baseline and post-test. Results: Significant group-by-time effects were found for on-task behaviour (active engagement: activity breaks and mathematics combined versus control, p¿=¿0.001; activity breaks versus control, p¿=¿0.001; activity breaks and mathematics combined versus activity breaks, p¿=¿0.037; passive engagement: activity breaks and mathematics combined versus control, p¿=¿0.001) and mathematics scores (activity breaks versus control, p¿=¿0.045). Conclusion: Physical activity breaks with and without integrated mathematics content were effective in improving children¿s on-task behaviour and learning scores.

Objective: To increase girls' well-being, strategies are needed to optimize their social-emotional competence during childhood. Although positive fathering is important for girls, many fathers discount their unique influence and few participate in interventions. The Dads And Daughters Exercising and Empowered (DADEE) program was developed to engage fathers and their daughters through shared physical activity experiences. This study examined the program's impact on girls' well-being and the father-daughter relationship. Method: Overall, 115 fathers (age range: 29-53 years) and 153 daughters (age range: 4-12 years) were randomized to (1) the DADEE program (9 weekly educational and practical sessions plus home-based challenges) or (2) a wait-list control. Assessments were baseline, 2 months (postintervention), and 9 months (94% retention). Daughters' social-emotional well-being was measured with the Devereux Student Strengths Assessment composite. Secondary outcomes included additional well-being indicators (e.g., global self-perception) plus validated measures of father involvement and father-daughter relationship quality. Results: At 2 months, intervention daughters showed a medium-to-large improvement in overall well-being (+24.9 units, 95% CI [8.6, 41.1], d = 0.6), when compared with controls. Intervention daughters were also more likely to show clinically meaningful improvements in well-being (54%) than controls (18%). Medium-to-large effects were observed for: seven of eight social-emotional competencies (e.g., personal responsibility, d = 0.4-0.9), father-daughter relationship quality (d = 0.8, father-report; d = 0.5, daughter-report), daughters' prosocial behavior (d = 0.3) and several indicators of father involvement. Most outcomes had improved by 9 months. No effects were observed for daughters' emotional difficulties or global self-perception. Conclusions: This study provided the first experimental evidence that father-daughter physical activity programs may improve girls' well-being and the father-daughter relationship.

Perceived and actual motor competence (MC) influence physical activity (PA) behaviour. Notably, both are lower in girls than in boys. This study aimed to investigate (i) whether a 12-week, teacher-led intervention that improves actual MC (Lander, N., Morgan, P. J., Salmon, J., & Barnett, L. M. (2017). Improving early-adolescent girls¿ motor skill: A cluster randomized controlled trial. Medicine and Science in Sports and Exercise. 49(12), 2498¿2505) could also improve adolescent girls¿ physical self-perception and perceived MC, and (ii) whether change in actual MC is associated with post-intervention perceptions A randomized controlled trial with 171 girls (mean age 12.48¿±¿0.34¿years), measured perception (i.e., physical self-perception profile (PSPP) and pictorial scale of perceived movement skill competence (PMSC)) and actual MC (i.e., Victorian FMS Teachers¿ Assessment Manual). Mixed models with post-intervention perception as the outcome, adjusting for baseline perception, group, and change in actual MC, as well as clustering, were performed. An interaction term between change in MC and intervention status was included to test the secondary aim. There were significant intervention effects on girls¿ physical self-perception as well as their perceived MC. However, there was no association between change in actual MC across the intervention and post intervention perception. While the intervention improved both actual MC and perceived MC, they were not associated.

The primary aim of this study was to assess the efficacy of a childcare-based intervention in increasing child physical activity by allowing children unrestricted access to outdoor areas for free-play when structured activity is not taking place. A randomized controlled trial was conducted in six childcare services. Intervention services provided children unrestricted access outdoors for active free-play, while control services provided their usual scheduled periods of outdoor play. Consent was obtained from 231 children. Child moderate to vigorous activity (MVPA), the primary trial outcome, was assessed via accelerometer at baseline and 3 months post baseline. Intervention effects were examined using Generalised Linear Mixed Models. Controlling for child age, gender and baseline outcome measure, at follow-up there were no significant differences between groups in minutes of MVPA in-care (mean difference: 4.85; 95% CI: -3.96, 13.66; P = 0.28), proportion of wear time in-care spent in MVPA (mean difference: 1.52%; 95% CI: -0.50, 3.53; P = 0.14) or total physical activity in-care (mean difference in counts per minute: 23.18; 95% CI: -4.26, 50.61; P = 0.10), nor on measures of child cognition (P = 0.45-0.91). It was concluded that interventions addressing multiple aspects of the childcare and home environment might provide the greatest potential to improve child physical activity.

Purpose: The development of a physical literacy definition and standards framework suitable for implementation in Australia. Method:Modified Delphi methodology. Results: Consensus was established on four defining statements: Core-Physical literacy is lifelong holistic learning acquired and applied in movement and physical activity contexts; Composition-Physical literacy reflects ongoing changes integrating physical, psychological, cognitive, and social capabilities; Importance-Physical literacy is vital in helping us lead healthy and fulfilling lives through movement and physical activity; and Aspiration-A physically literate person is able to draw on his/her integrated physical, psychological, cognitive, and social capacities to support health promoting and fulfilling movement and physical activity, relative to the situation and context, throughout the lifespan. The standards framework addressed four learning domains (physical, psychological, cognitive, and social), spanning five learning configurations/levels. Conclusion: The development of a bespoke program for a new context has important implications for both existing and future programs.

Background: Existing strategies to increase girls' physical activity levels have seen limited success. Fathers may influence their children's physical activity, but often spend more time with their sons and rarely participate in family-based programs. Purpose: To test a novel program designed to increase the physical activity levels of fathers and their daughters. Methods: In a two-arm RCT, 115 fathers (29-53 years) and 153 daughters (4-12 years) were randomized to (i) the "Dads And Daughters Exercising and Empowered" (DADEE) program, or (ii) a wait-list control. The 8-week program included weekly educational and practical sessions plus home tasks. Assessments were at baseline, 2 months (postintervention), and 9 months. The primary outcomes were father-daughter physical activity levels (pedometry). Secondary outcomes included screen-time, daughters' fundamental movement skill proficiency (FMS: perceived and objective), and fathers' physical activity parenting practices. Results: Primary outcome data were obtained from 88% of daughters and 90% of fathers at 9 months. Intentionto-treat analyses revealed favorable group-by-time effects for physical activity in daughters (p = .02, d = 0.4) and fathers (p < .001, d = 0.7) at postintervention, which were maintained at 9 months. At postintervention and follow-up, significant effects (p < .05) were also identified for daughters' FMS competence (objective: d = 1.1-1.2; perceived: d = 0.4-0.6), a range of fathers' physical activity parenting practices (d = 0.3-0.8), and screen-time for daughters (d = 0.5-0.8) and fathers (d = 0.4-0.6, postintervention only). Program satisfaction and attendance were very high. Conclusions: This study provided the first experimental evidence that efforts to increase physical activity behavior in preadolescent girls would benefit from a meaningful engagement of fathers.

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-Term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ? 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-To-Treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (?3.6 kg, 95% confidence interval: ?4.3, ?2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.

Objective: To explore young people¿s perceptions of pedometers and investigate behaviours exhibited while being monitored. Design: Qualitative design using six focus groups with participants (mean age 14.7 years). Setting: Study participants (n = 24) were randomly selected from a previous study of 123 young people aged 14¿15 years from three secondary schools in New South Wales (NSW), Australia. Methods: Participants wore pedometers (Yamax CW700) and accelerometers (ActiGraph GT3X+) simultaneously for 7 days. Accelerometer output was used to categorise participants into one of six focus groups (three boys groups and three girls groups): (1) low active (<30 minutes moderate to vigorous physical activity [MVPA]/day), (2) medium active (30¿60 minutes MVPA/day), and (3) high active (=60 minutes MVPA/day). Participants were questioned on their perceptions of the monitoring process and the behaviours that they exhibited while wearing pedometers. A hybrid approach to data analysis identified key concepts, which were thematically analysed. Results: The two main themes identified were (1) participants¿ perceptions of the monitoring process and (2) behaviour exhibited while being monitored. Overall, participants¿ attitudes towards objective monitoring were positive. A large proportion reported changing their levels of physical activity during the monitoring process, and 87.5% of focus group participants reported shaking their pedometers to increase their step counts. The medium and high active groups reported changing their activity patterns more than the low active groups. Conclusion: Our findings are consistent with previous quantitative studies that suggest reactivity and tampering are commonplace among young people. Pedometers may have more utility as an intervention strategy for increasing activity rather than as a method for assessing habitual activity levels.

Purpose: Guidelines recommend that young people engage in muscle-strengthening activities on at least 3 dIwkj1. The purpose of this study was to examine the effect of a school-based intervention focused on resistance training (RT) for adolescents. Methods: The ''Resistance Training for Teens'' intervention was evaluated using a cluster-randomized, controlled trial with 607 adolescents (50.1% girls; 14.1 T 0.5 yr) from 16 secondary schools. Teachers were trained to deliver the intervention, which included the following: (i) an interactive student seminar; (ii) a structured physical activity program, focused on RT; (iii) lunchtime fitness sessions; and (iv) Web-based smartphone apps. The primary outcome was muscular fitness (MF) and secondary outcomes included body mass index, RT skill competency, flexibility, physical activity, self-efficacy, and motivation. Assessments were conducted at baseline, 6 months (postprogram; primary end point), and 12 months (follow-up). Outcomes were assessed using linear mixed models, with three potential moderators tested using interaction terms (and subgroup analyses where appropriate). Results: For the primary outcome (MF), a group-time effect was observed at 6 months for the upper body (2.0 repetitions; 95% confidence interval (CI), 0.8-3.2), but not the lower body (j1.4 cm; 95% CI, j4.7-1.9). At 6 months, there were intervention effects for RT skill competency and self-efficacy, but no other secondary outcomes. Effects for upper body MF and RT skill competency were sustained at 12 months. Despite overall no effect for body mass index, there was a group-time effect at 12 months among students whowere overweight/obese at baseline (j0.55 kgImj2; 95% CI, j1.01 toj0.08). Conclusions: The school-based RT intervention resulted in immediate and sustained improvements in upper body MF and RT skill competency, demonstrating an effective and scalable approach to delivering RT within secondary schools.

Objectives: The majority of adolescent girls fail to meet public health guidelines for physical activity. Engaging mothers in the promotion of physical activity for their daughters may be an important strategy to facilitate behaviour change. The aim of this study was to use the behaviour change wheel (BCW) framework to design the components of an intervention to improve adolescent girls¿ physical activity. Study design: Cross-sectional study to inform intervention development. Methods: The BCW framework was used to (1) understand the behaviour, (2) identify intervention functions and (3) select content and implementation options. A circular development process was undertaken by the research team to collectively design the intervention in accordance with the steps recommended by the BCW. Results: The BCW design process resulted in the selection of six intervention functions (education, persuasion, incentivization, training, modelling, enablement) and 18 behaviour change techniques delivered via group-based, face-to-face mode. Behaviour change technique groupings include: goals and planning; feedback and monitoring; social support; shaping knowledge; natural consequences; comparison of behaviour; associations; comparison of outcomes; reward and threat; identity; and, self-belief. Conclusions: The BCW process allowed an in-depth consideration of the target behaviours and provided a systematic framework for developing the intervention. The feasibility and preliminary efficacy of the programme will be examined.

Evidence supports a positive association between competence in fundamental movement skills (e.g., kicking, jumping) and physical activity in young people. Whilst important, fundamental movement skills do not reflect the broad diversity of skills utilized in physical activity pursuits across the lifespan. Debate surrounds the question of what are the most salient skills to be learned which facilitate physical activity participation across the lifespan. In this paper, it is proposed that the term ¿fundamental movement skills¿ be replaced with ¿foundational movement skills¿. The term ¿foundational movement skills¿ better reflects the broad range of movement forms that increase in complexity and specificity and can be applied in a variety of settings. Thus, ¿foundational movement skills¿ includes both traditionally conceptualized ¿fundamental¿ movement skills and other skills (e.g., bodyweight squat, cycling, swimming strokes) that support physical activity engagement across the lifespan. A proposed conceptual model outlines how foundational movement skill competency can provide a direct or indirect pathway, via specialized movement skills, to a lifetime of physical activity. Foundational movement skill development is hypothesized to vary according to culture and/or geographical location. Further, skill development may be hindered or enhanced by physical (i.e., fitness, weight status) and psychological (i.e., perceived competence, self-efficacy) attributes. This conceptual model may advance the application of motor development principles within the public health domain. Additionally, it promotes the continued development of human movement in the context of how it leads to skillful performance and how movement skill development supports and maintains a lifetime of physical activity engagement.

Objective: To examine the impact of a school-based physical activity intervention on adolescents' self-esteem and subjective well-being, and to explore moderators and mediators of intervention effects. Methods: Resistance Training for Teens was evaluated using a cluster RCT in 16 schools located in New South Wales, Australia. Adolescents (N = 508; 14.1 ± 0.5 years; 49.6% female) completed measures of global self-esteem, subjective well-being, and hypothesized mediators (i.e., perceived fitness, resistance training self-efficacy, and autonomous motivation) at baseline (April¿June, 2015) and post-intervention (October¿December). The school-based physical activity program was delivered by teachers over 10-weeks via Physical Education, co-curricular school sport, or an elective subject known as Physical Activity and Sport Studies, and involved once-weekly fitness sessions and additional lunch-time sessions. Intervention effects and moderator analyses were tested using multi-level linear regression analyses with interaction terms. Multi-level mediation analyses were used to explore potential mediators of changes in well-being outcomes. Results: Intervention effects for self-esteem (ß = 0.05, p =.194) and wellbeing (ß = 0.03, p =.509) were not statistically significant. Moderator analyses showed effects for self-esteem were greater for the overweight/obese subgroup (p =.069 for interaction), and resistance training self-efficacy was a significant mediator of changes in self-esteem (product-of-coefficients [AB] = 0.021, SE = 0.010, 95% CIs = 0.002 to 0.040). No other significant indirect effects were observed. Conclusion: Overall, Resistance Training for Teens did not improve adolescents' self-esteem or subjective well-being. However, our mediation findings lend support to resistance training self-efficacy as a mechanism explaining the positive effect of resistance training on self-esteem.

Background: Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour. Methods: A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n¿=¿28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n¿=¿48; n¿=¿43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18¿months postpartum. Results: Mean PPWR decreased in the (I) group (-1.2¿kg) and the C2 group (-1.2¿kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3¿cm) and significantly for the (I) group (-6.4¿cm) compared to C1 (-1.1¿cm; P¿=¿0.002) and C2 (-3.3¿cm; P¿=¿0.001). Changes in diet, physical activity or sedentary behaviour were not significant. Conclusions: The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

Numerous skill batteries assess fundamental motor skill (e.g., kick, hop) competence. Few skill batteries examine lifelong physical activity skill competence (e.g., resistance training). This study aimed to develop and assess the content validity, test-retest and inter-rater reliability of the ¿Lifelong Physical Activity Skills Battery¿. Development of the skill battery occurred in three stages: i) systematic reviews of lifelong physical activity participation rates and existing motor skill assessment tools, ii) practitioner consultation and iii) research expert consultation. The final battery included eight skills: grapevine, golf swing, jog, push-up, squat, tennis forehand, upward dog and warrior I. Adolescents (28 boys, 29 girls; M¿=¿15.8¿years, SD¿=¿0.4¿years) completed the Lifelong Physical Activity Skills Battery on two occasions two weeks apart. The skill battery was highly reliable (ICC¿=¿0.84, 95% CI¿=¿0.72¿0.90) with individual skill reliability scores ranging from moderate (warrior I; ICC¿=¿0.56) to high (tennis forehand; ICC¿=¿0.82). Typical error (4.0; 95% CI 3.4¿5.0) and proportional bias (r¿=¿-0.21, p¿=¿.323) were low. This study has provided preliminary evidence for the content validity and reliability of the Lifelong Physical Activity Skills Battery in an adolescent population.

Fundamental movement skill (FMS) proficiency is positively associated with a range of health outcomes, and is a predictor of lifelong participation in physical activities and sport. Yet low FMS proficiency levels in children prevail, particularly among girls performing object-control skills (e.g., kicking, catching). To identify where girls require the most support and inform future teaching resources and interventions, this cross-sectional study investigated proficiency levels of object-control skills and their specific performance components (subskills) in girls; and aimed to determine whether patterns in subskill mastery were evident in girls from two different developmental stages. This study included 153 girls (aged 4¿12 years; mean age = 7.7, SD = 1.8) from the Hunter Region, Australia. Six object-control skills were video-assessed using the Test of Gross Motor Development (TGMD-2, TGMD-3); overall skill proficiency levels and mastery levels of subskills were determined. In summary, <5% (of the total group, 4¿8 years or 9¿12 years) demonstrated mastery or advanced skill level in the strike, stationary dribble, overhand throw or kick. Mastery levels were also poor for the majority of the 24 subskills, with mastery levels below 40% for the total group for 17 of the 24 subskills. Deficiencies in specific subskills were evident in the preparation, action and recovery phases of the six object-control skills. Only 6 of the 24 subskills mastery levels were significantly higher in the older age-group. Our investigation provides new evidence that may be useful for practitioners and researchers looking to support the optimal development of FMS proficiency among girls. Australian New Zealand Clinical Trials Registry: ACTRN12615000022561.

Participation in lifelong physical activities, such as yoga, golf, tennis, or running, are common endeavors in adolescence and adulthood. However, there is a lack of understanding of how competent individuals are in the skills needed for these activities and how competency in these skills relates to physical activity and fitness. This study aimed to determine the initial predictive validity of the Lifelong Physical Activity Skills Battery related to physical activity and health-related fitness. One-hundred and nine adolescents from four schools (55 males, 54 females; Mage = 15.82 years, SD = 0.37 years) completed: demographic information (survey), height (stadiometer), weight (digital scale), motor skill assessment (jog, grapevine, squat, push-up, upward dog, warrior one, tennis forehand, golf swing), health-related fitness (standing long jump, back-saver sit and reach, 3-min submaximal step test, 90° push-up test), and physical activity (GENEActiv accelerometers). Correlations and multiple regression models were conducted in SPSS version 24.0. Motor competence was associated with muscular fitness (standing long jump, ß = 0.24, p = .002; push-ups, ß = 0.42, p < .001), cardiorespiratory fitness (ß = 0.21, p = .031), and flexibility (ß = 0.23, p = .025), but not physical activity (ß = 0.17, p = .154) or body mass index (ß = -0.05, p = .622) Motor competence has a stronger association with health-relatedfitness parameters rather than physical activity.

Objectives Proficiency in fundamental movement skills (FMS) is positively correlated with cardiorespiratory fitness, healthy weight status, and physical activity. Many instruments have been developed to assess FMS in children. It is important to accurately measure FMS competency in adolescent populations, particularly in girls, who are less proficient than boys. Yet these tests have not been validated or tested for reliability among girls in this age group. Design The current study tested the concurrent validity and reliability of two FMS assessment instruments; the newly developed Canadian Agility and Movement Skill Assessment (CAMSA), against the Victorian FMS Assessment from Australia, among a sample of early adolescent girls. Methods In total, 34 Year 7 females (mean age 12.6 years) from Australia were tested and retested on each instrument in a school setting. Results Test-retest reliability was excellent for the overall CAMSA score (ICC¿=¿0.91) and for the isolated time and skill score components (time: ICC¿=¿0.80; skill: ICC¿=¿0.85). Test-retest reliability of the Victorian FMS Assessment was also good (ICC¿=¿0.79). There was no evidence of proportional bias in either assessment. There was evidence of strong concurrent validity (rs¿=¿0.68, p¿<¿0.05). Conclusions Both instruments were found to be reliable and valid. However, compared to the Victorian FMS instrument, the CAMSA has the advantage of both process and product assessment, less time needed to administer and higher authenticity, and so may be an attractive alternative to the more traditional forms of FMS assessment, for use with early adolescent girls, in school settings.

Young adult men are under-represented in health research, and little is known about how to reach and engage them in lifestyle interventions. This mixed-methods study aimed to explore young males¿ preferences for recruitment strategies, content, format (delivery mode and program duration and frequency), and facilitator characteristics for future physical activity and nutrition interventions. Ten focus groups involving 61 men (aged 18¿25 years) in the Hunter region, New South Wales, Australia and an online survey distributed within Australia were completed by 282 males (aged 18¿25 years). Key focus group themes included a preference for recruitment via multiple sources, ensuring images and recruiters were relatable; intervention facilitators to be engaging and refrain from discussing negative consequences of being unhealthy. Key program content preferences included skill development and individualized goals and feedback. Focus groups and the survey confirmed a preference for multiple delivery modes, including; face-to-face (group and individual), with support using eHealth technologies. Survey results confirmed the most favored program content as: ¿healthy eating on a budget,¿ ¿quick and easy meals,¿ and ¿resistance training.¿ Focus group responses suggested a program duration of =6 months, with 2¿3 combined face-to-face and supportive eHealth sessions per week. Survey intervention duration preference was 3 months with 4 face-to-face sessions per month. Findings can guide the design, conduct, and evaluation of relevant contemporary physical activity and or nutrition interventions for young men. There is a need to identify the most effective ways to address young men¿s individual preferences in intervention research.

This review aimed to determine the most popular physical activities performed by children, adolescents, and adults globally. Statistic bureau websites and article databases Scopus, ProQuest, SPORTDiscus, and Science Direct were searched between November 17th, 2014 and April 31st, 2015. Eligible studies were published in the last 10¿years with participation rates for specific physical activities among individuals five years or older. Data extraction for included articles (n¿=¿64) was assessed independently and agreed upon by two authors. A random-effects model was used to calculate participation rates in specific activities for each age group and region. In total 73,304 articles were retrieved and 64 articles representing 47 countries were included in the final meta-analysis. Among adults, walking was the most popular activity in the Americas (18.9%; 95% CI 10.2 to 32.5), Eastern Mediterranean (15.0%; 95% CI 5.8 to 33.6), Southeast Asia (39.3%; 95% CI 0.9 to 98.0) and Western Pacific (41.8%; 95% CI 25.2 to 60.6). In Europe and Africa, soccer (10.0%; 95% CI 6.5 to 15.1) and running (9.3%; 95% CI 0.9 to 53.9), respectively, were top activities. Child and adolescent participation results were highly dependent upon region. American youth team sport participation was high, while youth from the Eastern Mediterranean and Western Pacific were more likely to report participation in lifelong physical activities. Global data for adults reflects a consistent pattern of participation in running and walking. Among all age groups and regions soccer was popular. In children and adolescents, preferences were variable between regions.

Introduction The primary aim was to examine longitudinal associations between changes in screen-time and mental health outcomes among adolescents. Methods Adolescents (N¿=¿322, 65.5% females, mean age¿=¿14.4¿±¿0.6 years) reported screen-time and mental health at two time points over a school year. Multi-level linear regression analyses were conducted after adjusting for covariates. Results Changes in total recreational screen-time (ß¿=¿-0.09 p¿=¿0.048) and tablet/mobile phone use (ß¿=¿-0.18, p¿<¿0.001) were negatively associated with physical self-concept. Changes in total recreational screen-time (ß¿=¿-0.20, p¿=¿0.001) and computer use (ß¿=¿-0.23, p¿=¿0.003) were negatively associated with psychological well-being. A positive association was found with television/DVD use and psychological difficulties (ß¿=¿0.16, p¿=¿0.015). No associations were found for non-recreational screen-time. Conclusion Changes in recreational screen-time were associated with changes in a range of mental health outcomes.

Purpose: Competence in fundamental movement skills (FMSs) is positively associated with physical activity, fitness, and healthy weight status. However, adolescent girls exhibit very low levels of fundamental movement skill (FMS) proficiency. Method: In the current study, interviews were carried out with physical education teachers to investigate their perspectives of: (i) the importance and relevance of teaching FMSs to Year 7 girls, and (ii) the factors influencing effective FMS instruction. Results: There were two major findings in the data: Year 7 was perceived to be a critical period to instruct girls in FMSs; and current teaching practices were perceived to be suboptimal for effective FMS instruction. Conclusion: Apparent deficits in current FMS teaching practice may be improved with more comprehensive teacher training (both during physical education teacher education (PETE) and in in-service professional development) in pedagogical strategies, curriculum interpretation, and meaningful assessment.

Background: Schools play an important role in physical activity promotion for adolescents. The systematic review aimed to determine the proportion of secondary (middle and high) school physical education (PE) lesson time that students spend in moderate to vigorous physical activity (MVPA), and to assess if MVPA was moderated by school level (middle and high school), type of physical activity measurement and type of PE activities. Methods: A systematic search of nine electronic databases was conducted (PROSPERO2014:CRD42014009649). Studies were eligible if they were published between 2005 and 2014; written in English; assessed MVPA in PE lessons of secondary (middle and high) school students; and used a quantitative MVPA measure (i.e., accelerometry, heart rate monitoring, pedometers or observational measures). Two reviewers examined the retrieved articles, assessed risk of bias, and performed data extraction. Random effects meta-analysis was used to calculate a pooled estimate of the percent of PE lesson time spent in MVPA and to assess moderator effects where data allowed. Results: The search yielded 5,132 potentially relevant articles; 28 articles representing 25 studies (7 middle and 18 high school) from seven countries were included. Twelve studies measured MVPA through observational measures, seven used accelerometers, five used heart rate monitors and four used pedometers (including three studies using a mix of measures). Meta-analysis of 15 studies found that overall, students spent a mean (95% CI) of 40.5% (34.8-46.2%) of PE in MVPA. Middle school students spent 48.6% (41.3-55.9%) of the lesson in MVPA (n=5 studies) and high school students 35.9% (28.3-43.6%) (n=10 studies). Studies measuring MVPA using accelerometers (n=5) showed that students spent 34.7% (25.1-44.4%) of the lesson in MVPA, while 44.4% (38.3-50.5%) was found for lessons assessed via observation (n=9), 43.1% (24.3-61.9%) of the lesson for a heart rate based study, and 35.9% (31.0-40.8%) for a pedometer-measured study. Conclusions: The proportion of PE spent in MVPA (40.5%) is below the US Centre for Disease Control and Prevention and the UK Associations for Physical Education recommendation of 50%. Findings differed according to the method of MVPA assessment. Additional strategies and intervention research are needed to build more active lesson time in PE.

Background Physical activity (PA) levels decline substantially during adolescence and are consistently lower in girls. Competency in a range of fundamental movement skills (FMSs) may serve as a protective factor for the decline in PA typically observed in adolescent girls; yet, girls' mastery in FMS is low. Although interventions can improve FMS, there is a lack of interventions targeting girls, and very few are conducted in high schools. In addition, interventions are usually conducted by researchers, not teachers, and thus have little chance of being embedded into curricula. Purpose This study aimed to evaluate the effectiveness of a school-based intervention, delivered by teachers, in improving adolescent girls' FMS. Methods Four all-girls Australian secondary schools were recruited and randomized into intervention or control groups. In total, 190 year 7 girls (103 control/87 intervention; mean age, 12.4 ± 0.3 yr) completed baseline and posttest measures at 12 wk. Six FMS (i.e., catch, throw, kick, jump, leap, and dodge) were measured using the Victorian FMS Assessment instrument. Mixed models with posttest skill (i.e., locomotor, object control, and total skill) as the outcome, adjusting for baseline skill, intervention and control status, and relevant covariates, as well as accounting for clustering at school and class level, were used to assess the intervention impact. Results There were significant intervention effects, and large effect sizes (Cohen d) noted in locomotor (P = 0.04, t = 5.15, d = 1.6), object control (P < 0.001, t = 11.06, d = 0.83), and total skill (P = 0.02, t = 7.22, d = 1.36). Conclusions Teachers adequately trained in authentic assessment and student-centered instruction can significantly improve the FMS competency of early adolescent girls. Therefore, comprehensive teacher training should be viewed as an integral component of future school-based interventions.

Many Australian young men (18-25 years) fail to meet recommendations in national dietary or physical activity (PA) guidelines. However, there is a lack of understanding of their perspectives on PA and diet to inform intervention design. This study examined young men¿s motivators and barriers to healthy eating and PA, along with differences by demographic and behavioral factors. A cross-sectional online survey was completed by 282 men aged 18 to 25 years in Australia. Results identified the most common motivators for healthy eating included improving health (63.5%), body image (52.3%), and increasing energy (32.1%). Motivators for PA included improving body image (44.6%), fitness (44.2%), and health (41.0%). Common barriers to healthy eating were access to unhealthy foods (61.1%), time to cook/prepare healthy foods (55.0%), and motivation to cook healthy foods (50.7%). Barriers for PA included motivation (66.3%), time (57.8%), and cost of equipment/facilities (33.3%). Significant differences (p <.01) in motivators to healthy eating and/or PA were identified for BMI category, marital status, PA level, alcohol intake, and stress levels. Significant differences were identified for barriers to healthy eating and/or PA by BMI, PA level, stress, and fruit and vegetable intake, assessed using Pearson¿s chi-square test. Findings suggest that promotion of benefits related to health, appearance/body image, increased energy and fitness, and addressing key barriers including motivation, time, financial restraints, and accessibility of unhealthy foods, could engage young men in improving lifestyle behaviors. Differences by demographic and behavioral factors suggest development of tailored programs to address diversity among young men may be required.

Objective To determine the comparability and feasibility of wrist- and hip-worn accelerometers among free-living adolescents. Design 89 adolescents (age = 13¿14 years old) from eight secondary schools in New South Wales (NSW), Australia wore wrist-worn GENEActiv and hip-worn ActiGraph (GT3X+) accelerometers simultaneously for seven days and completed an accelerometry behavior questionnaire. Methods Bivariate correlations between the wrist- and hip-worn out-put were used to determine concurrent validity. Paired samples t-test were used to compare minutes per day in moderate-to-vigorous physical activity (MVPA). Group means and paired sample t-tests were used to analyze participants¿ perceptions of the wrist- and hip-worn monitoring protocols to assist with determining the feasibility. Results Wrist-worn accelerometry compared favorably with the hip-worn in average activity (r = 0.88, p < 0.001) and MVPA (r = 0.84 p < 0.001, mean difference = 3.54 min/day, SD = 12.37). The wrist-worn accelerometer had 50% fewer non-valid days (75 days, 12%) than the hip-worn accelerometer (n = 152, 24.4%). Participants reported they liked to wear the device on the wrist (p < 0.01), and that it was less uncomfortable (p = 0.02) and less embarrassing to wear on the wrist (p < 0.01). Furthermore, that they would be more willing to wear the device again on the wrist over the hip (p < 0.01). Conclusions Our findings reveal there is a strong linear relationship between wrist- and hip-worn accelerometer out-put among adolescents in free-living conditions. Adolescent compliance was significantly higher with wrist placement, with participants reporting that it was more comfortable and less embarrassing to wear on the wrist.

Although the transition to fatherhood is joyful and fulfilling for many men, becoming a father also exposes men to a series of new challenges and responsibilities that can negatively affect their well-being. As such, effective strategies that foster positive physical and mental health in fathers are required. Given the established links between regular physical activity and optimal health, strategies to reduce the substantial decline in physical activity typically observed during the early fatherhood may be particularly fruitful. In this commentary, we discuss the potential mediating role of physical activity on a series of important outcomes for fathers, including paternal and child health and the quality of the father-child relationship. We also present an argument that high-quality research studies testing physical activity interventions that meaningfully engage fathers are urgently required.

The mechanisms of behavior change in youth screen-time interventions are poorly understood. Participants were 361 adolescent boys (12¿14¿years) participating in the ATLAS obesity prevention trial, evaluated in 14 schools in low-income areas of New South Wales, Australia. Recreational screen-time was assessed at baseline, 8- and 18-months, whereas potential mediators (i.e., motivation to limit screen-time and parental rules) were assessed at baseline, 4- and 18-months. Multi-level mediation analyses followed the intention-to-treat principle and were conducted using a product-of-coefficients test. The intervention had a significant impact on screen-time at both time-points, and on autonomous motivation at 18-months. Changes in autonomous motivation partially mediated the effect on screen-time at 18-months in single and multi-mediator models [AB (95% CI)¿=¿-5.49 (-12.13, -.70)]. Enhancing autonomous motivation may be effective for limiting screen-time among adolescent males. Trial registration: Australian New Zealand Clinical Trials Registry No: ACTRN12612000978864.

Sex differences in weight loss are often seen despite using the same weight loss program. There has been relatively little investigation of physiological influences on weight loss success in males and females, such as energy homeostasis and appetite regulating hormones. The aims were to 1) characterise baseline plasma leptin, ghrelin and adiponectin concentrations in overweight and obese males and females, and 2) determine whether baseline concentrations of these hormones predict weight loss in males and females.Subjects were overweight or obese (BMI 25-40 kg/m2) adults aged 18-60 years. Weight was measured at baseline, and after three and six months participation in a weight loss program. Baseline concentrations of leptin, adiponectin and ghrelin were determined by enzyme-linked immunosorbent assay (ELISA). An independent t-test or non-parametric equivalent was used to determine any differences between sex. Linear regression determined whether baseline hormone concentrations were predictors of six-month weight change.Females had significantly higher baseline concentrations of leptin, adiponectin and unacylated ghrelin as well as ratios of leptin:adiponectin and leptin:ghrelin. The ratio of acylated:unacylated ghrelin was significantly higher in males. In males and females, a higher baseline concentration of unacylated ghrelin predicted greater weight loss at six months. Additionally in females, higher baseline total ghrelin predicted greater weight loss and a higher ratio of leptin:ghrelin predicted weight gain at six months.A higher pre-weight-loss plasma concentration of unacylated ghrelin is a modest predictor of weight loss success in males and females, while a higher leptin:ghrelin ratio is a predictor of weight loss failure in females. Further investigation is required into what combinations and concentrations of these hormones are optimal for weight loss success.

Youth participation in organised sport and physical activity is important for healthy development, growth and wellbeing. In 2014, Active Healthy Kids Australia released its inaugural Report Card on Physical Activity for Children and Young People, which synthesised the best available national- and state-level data for children and young people (<18 years). This paper provides a more detailed examination of the evidence informing the grade for Organised Sport from the 2014 Report Card, compares Australia's Organised Sport grade with other countries, identifies future directions for research and surveillance, and explores possible beneficial strategies. The Report Card highlighted that between 64% and 85% of Australians aged 5-17 years participate in organised sports, a rate higher than alternate forms of physical activity such as active transportation, active play and school based physical activity. This finding reflects Australia's position as one of the global leaders for participating in organised sport. Future research and surveillance methodologies however, need to incorporate standardised metrics that aim to capture more detailed data regarding organised sport participation. Facilitating access for all children and preventing dropout from organised sports are important initiatives to improve current levels of sport participation. However, given that 80% of Australians aged 5-17 years are not sufficiently physically active to achieve the daily recommendation, participation in sport alone is not enough to ensure that children can accrue the health benefits associated with being physically active. As such, there is a pressing need to develop strategies that engage children in other forms of physical activity such as active transportation and active play.

Background: Greater numbers of women are entering young adulthood overweight, but traditional weight loss programs do not appeal to them. This article describes the development and evaluation of an e-health weight loss intervention for young women (18-30 years of age). Materials and Methods: Young women's preferences for a targeted weight loss program were investigated via a cross-sectional online survey. A 3-month targeted weight loss program for young women was developed based on the formative research. A single-arm pre-post study was conducted to evaluate the acceptability of the intervention (process evaluation survey and objective usage data) and to estimate the treatments' effects on weight-related outcomes from baseline to 3 months. Results: Online survey respondents (n = 274) indicated preferences for various technologies (Web site, online quizzes with e-mail feedback and goal setting, an online discussion forum, smartphone application, e-mail newsletters, and text messages). Eighteen (mean ± standard deviation [SD] age, 22.8 ± 3.2 years; body mass index, 27.3 ± 1.6 kg/m2) women entered the pre-post study. Mean satisfaction was 3.4 ± 1.0 (maximum of 5), and 66.7% of participants completed the study. Significant reductions in mean ± SD weight (-1.5 ± 2.4 kg; p = 0.02) and waist circumference (-0.7 ± 1.4 cm; p = 0.04) were observed. Conclusions: Due to lower than anticipated participant satisfaction, modifications to the program content and modes of delivery are required to ensure a higher proportion of young women complete and actively engage with the program. The positive effects of treatment on weight-related outcomes supports further refinement and evaluation of targeted, e-health weight loss interventions for young women.

Background: Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent populations. As a result, few cost effectiveness analyses have been reported. The aim of this paper is to report the cost and cost effectiveness of the Physical Activity 4 Everyone (PA4E1) intervention which was a multi-component intervention implemented in secondary schools located in low-income communities. Cost effectiveness was assessed using both the physical activity and weight status trial outcomes. Methods: Intervention and Study Design: The PA4E1 cluster randomised controlled trial was implemented in 10 Australian secondary schools (5 intervention: 5 control) and consisted of intervention schools receiving seven physical activity promotion strategies and six additional strategies that supported school implementation of the intervention components. Costs associated with physical activity strategies, and intervention implementation strategies within the five intervention schools were estimated and compared to the costs of usual physical activity practices of schools in the control group. The total cost of implementing the intervention was estimated from a societal perspective, based on the number of enrolled students in the target grade at the start of the intervention (Grade 7, n = 837). Economic Outcomes: The economic analysis outcomes were cost and incremental cost effectiveness ratios for the following: minutes of moderate-to-vigorous physical activity (MVPA) per day gained, MET hours gained per person/day; Body Mass Index (BMI) unit avoided; and 10 % reduction in BMI z-score. Results: The intervention cost AUD $329,952 over 24 months, or AUD$394 per student in the intervention group. This resulted in a cost effectiveness ratio of AUD$56 ($35-$147) per additional minute of MVPA, AUD$1 ($0.6-$2.7) per MET hour gained per person per day, AUD$1408 ($788-$6,570) per BMI unit avoided, and AUD$563 ($282-$3,942) per 10 % reduction in BMI z-score. Conclusion: PA4E1 is a cost effective intervention for increasing the physical activity levels and reducing unhealthy weight gain in adolescence, a period in which physical activity typically declines. Additional modelling could explore the potential economic impact of the intervention on morbidity and mortality. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12612000382875.

Purpose: The aim of this study was to explore the effect of the Active Teen Leaders Avoiding Screen-time (ATLAS) intervention on psychological well-being in adolescent boys and to examine the potential mediating mechanisms that might explain this effect. Methods: ATLAS was evaluated using a cluster randomized controlled trial in 14 secondary schools located in low-income communities (N = 361 adolescent boys, mean age = 12.7 ±.5 years). The 20-week intervention was guided by self-determination theory and involved: professional development for teachers, provision of fitness equipment to schools, enhanced school sport sessions, researcher-led seminars, a smartphone application, and parental strategies for reducing screen time. Assessments were conducted at baseline and immediately post intervention (8 months). Psychological well-being was measured using the Flourishing Scale. Motivational regulations (intrinsic, identified, introjected, controlled, and amotivation) and basic psychological needs (autonomy, competence, and relatedness) in school sport, muscular fitness, resistance training skill competency, and recreational screen time were examined as potential mediating mechanisms of the intervention effect. Results: The intervention effect on well-being was small but statistically significant. Within a multiple mediator model, changes in autonomy needs satisfaction, recreational screen time, and muscular fitness significantly mediated the effect of the intervention on psychological well-being. Conclusions: In addition to the physical health benefits, targeted physical activity programs for adolescent boys may have utility for mental health promotion through the mechanisms of increasing autonomy support and muscular fitness and reducing screen time.

Objective To examine young Australian women's weight expectations, motivations for weight change and perceived factors influencing weight management, and to determine if these factors differ by age, BMI, marital status, education or income. Design Cross-sectional study. An online survey captured respondents' weight, height, ideal weight, main reasons for wanting to change their weight and challenges to managing their weight. Setting Online survey in Australia. Subjects Six hundred and twenty women aged 18-30 years currently living in Australia who completed the survey between 31 July and 30 September 2012. Results Approximately half of participants (53·1 %) were a healthy weight, 25·2 % overweight and 19·0 % obese. Women unhappy at their current weight (78·1 %) reported a median ideal weight -12·3 % less than their current weight. The key motivators for weight change were to improve health (24·4 %, ranked 1), feel better in oneself (22·3 %) and improve self-confidence (21·5 %). Lack of motivation, time constraints because of job commitments and cost were the most commonly reported factors influencing weight management. Age, BMI, marital status, education and income were found to influence weight expectations, motivations for weight change and/or factors perceived to influence weight management. Conclusions The findings suggest potential implications for weight management interventions and public health messaging targeting young women, to improve long-term health outcomes. Strategies that promote the health benefits of physical activity and healthy eating, feeling better about oneself and improved self-confidence, and address the main factors influencing weight management including lack of motivation, time constraints and cost, may be used to engage this target group.

Background: Gross motor competence confers health benefits, but levels in children and adolescents are low. While interventions can improve gross motor competence, it remains unclear which correlates should be targeted to ensure interventions are most effective, and for whom targeted and tailored interventions should be developed. Objective: The aim of this systematic review was to identify the potential correlates of gross motor competence in typically developing children and adolescents (aged 3¿18¿years) using an ecological approach. Methods: Motor competence was defined as gross motor skill competency, encompassing fundamental movement skills and motor coordination, but excluding motor fitness. Studies needed to assess a summary score of at least one aspect of motor competence (i.e., object control, locomotor, stability, or motor coordination). A structured electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Six electronic databases (CINAHL Complete, ERIC, MEDLINE Complete, PsycINFO®, Scopus and SPORTDiscus with Full Text) were searched from 1994 to 5 August 2014. Meta-analyses were conducted to determine the relationship between potential correlates and motor competency if at least three individual studies investigated the same correlate and also reported standardized regression coefficients. Results: A total of 59 studies were identified from 22 different countries, published between 1995 and 2014. Studies reflected the full range of age groups. The most examined correlates were biological and demographic factors. Age (increasing) was a correlate of children¿s motor competence. Weight status (healthy), sex (male) and socioeconomic background (higher) were consistent correlates for certain aspects of motor competence only. Physical activity and sport participation constituted the majority of investigations in the behavioral attributes and skills category. Whilst we found physical activity to be a positive correlate of skill composite and motor coordination, we also found indeterminate evidence for physical activity being a correlate of object control or locomotor skill competence. Few studies investigated cognitive, emotional and psychological factors, cultural and social factors or physical environment factors as correlates of motor competence. Conclusion: This systematic review is the first that has investigated correlates of gross motor competence in children and adolescents. A strength is that we categorized correlates according to the specific ways motor competence has been defined and operationalized (object control, motor coordination, etc.), which enables us to have an understanding of what correlates assist what types of motor competence. Indeed our findings do suggest that evidence for some correlates differs according to how motor competence is operationalized.

Introduction The primary objective was to evaluate the impact of the ¿Switch-off 4 Healthy Minds¿ (S4HM) intervention on recreational screen-time in adolescents. Methods Cluster randomized controlled trial with study measures at baseline and 6-months (post-intervention). Eligible participants reported exceeding recreational screen-time recommendations (i.e., >¿2¿h/day). In total, 322 adolescents (mean age¿=¿14.4¿±¿0.6¿years) from eight secondary schools in New South Wales, Australia were recruited. The S4HM intervention was guided by Self-Determination Theory and included: an interactive seminar, eHealth messaging, a behavioral contract and parental newsletters. The primary outcome was recreational screen-time. Secondary outcomes included mental health (i.e., well-being, psychological distress, self-perceptions), objectively measured physical activity, and body mass index (BMI). Outcome analyses were conducted using linear mixed models and mediation was examined using a product-of-coefficients test. Results At post-intervention, significant reductions in screen-time were observed in both groups, with a greater reduction observed in the intervention group (-¿50¿min/day versus -¿29¿min, p¿<¿0.05 for both). However, the adjusted difference in change between groups was not statistically significant (mean¿=¿-¿21.3¿min/day, p¿=¿0.255). There were no significant intervention effects for mental health outcomes, physical activity or BMI. Significant mediation effects for autonomous motivation were found. Conclusions Participants in both the S4HM intervention and control groups significantly reduced their screen-time, with no group-by-time effects. Enhancing autonomous motivation might be a useful intervention target for trials aimed at reducing adolescents' recreational screen-time. Trial registration ACTRN12614000163606.

Physical inactivity is a leading contributor to the burden of disease in men. Social¿cognitive theories may improve physical activity (PA) interventions by identifying which variables to target to maximize intervention impact. This study tested the utility of Bandura¿s social cognitive theory (SCT) to explain men¿s PA during a 3-month weight loss program. Participants were 204 overweight/obese men (M [SD] age = 46.6 [11.3] years; body mass index = 33.1 [3.5] kg/m2). A longitudinal, latent variable structural equation model tested the associations between SCT constructs (i.e., self-efficacy, outcome expectations, intention, and social support) and self-reported moderate-to-vigorous PA (MVPA) and examined the total PA variance explained by SCT. After controlling for Time 1 cognitions and behavior, the model fit the data well (¿2= 73.9, degrees of freedom = 39, p < .001; normed ¿2= 1.9; comparative fit index = 0.96; standardized root mean residual = 0.059) and explained 65% of the variance in MVPA at Time 2. At Time 2, self-efficacy demonstrated the largest direct and total effects on MVPA (ßdirect= .45, p < .001; ßtotal= .67, p = .002). A small-to-medium effect was observed from intention to MVPA, but not from outcome expectations or social support. This study provides some evidence supporting the tenets of SCT when examining PA behavior in overweight and obese men. Future PA and weight loss interventions for men may benefit by targeting self-efficacy and intention, but the utility of targeting social support and outcome expectations requires further examination.

Background: Obesity prevention interventions targeting 'at-risk' adolescents are urgently needed. The aim of this study is to evaluate the sustained impact of the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention program. Methods: Cluster RCT in 14 secondary schools in low-income communities of New South Wales, Australia. Participants were 361 adolescent boys (aged 12-14 years) 'at risk' of obesity. The intervention was based on Self-Determination Theory and Social Cognitive Theory and involved: professional development, fitness equipment for schools, teacher-delivered physical activity sessions, lunch-time activity sessions, researcher-led seminars, a smartphone application, and parental strategies. Assessments for the primary (body mass index [BMI], waist circumference) and secondary outcomes were conducted at baseline, 8- (post-intervention) and 18-months (follow-up). Analyses followed the intention-to-treat principle using linear mixed models. Results: After 18-months, there were no intervention effects for BMI or waist circumference. Sustained effects were found for screen-time, resistance training skill competency, and motivational regulations for school sport. Conclusions: There were no clinically meaningful intervention effects for the adiposity outcomes. However, the intervention resulted in sustained effects for secondary outcomes. Interventions that more intensively target the home environment, as well as other socio-ecological determinants of obesity may be needed to prevent unhealthy weight gain in adolescents from low-income communities. Trial registration: Australian Clinical Trial Registry ACTRN12612000978864.

Objective: To examine elementary school students' moderate-to-vigorous physical activity (MVPA) levels during physical education (PE) lessons. Methods: A systematic search of nine electronic databases was conducted (PROSPERO2014:CRD42014009649). Studies were eligible if they were in English; published between 2005-April 2014; assessed MVPA levels in PE lessons of elementary school children (aged four-12 years); and used an objective MVPA measure. Two reviewers retrieved articles, assessed risk of bias, and performed data extraction. The findings were synthesised using a meta-analysis. Results: The search yielded 5132 articles. Thirteen studies from nine countries met the inclusion criteria. Eight studies measured MVPA through observational measures, five used accelerometry and one used heart rate monitoring. The percentage of PE lesson time spent in MVPA ranged between 11.4-88.5%. Meta-analysis of seven studies (direct observations; 4 accelerometers) found that children spent a mean (95% CI) 44.8 (28.2-61.4)% of PE lesson time in MVPA. When measured using direct observation and accelerometers, children spent 57.6 (47.3-68.2) and 32.6 (5.9-59.3)% of PE lesson time in MVPA, respectively. The review has limitations; the search strategy was restricted to studies in English; theses, dissertations and conference abstracts were excluded; and six studies that provided insufficient data were excluded from the meta-analysis. Conclusion: MVPA levels during elementary school PE lessons do not meet the United States Centre for Disease Control and Prevention and the United Kingdom's Association of Physical Education recommendation (50% of lesson time), but is higher than estimated in the previous review (34.2%). Interventions to increase MVPA in PE lessons are needed.

This article presents a conceptual model illustrating a targeted approach to the design and delivery of health behavior interventions that focus on physical activity promotion. We hypothesize that researchers who i) enhance the sociocultural relevance of their core intervention components and ii) recognize the unique contributions of both intervention design and delivery will experience greater intervention engagement and improved outcomes.

To evaluate the impact of a primary school-based physical activity (PA) integration program delivered by teachers on objectively measured PA and key educational outcomes. Methods: Ten classes from 8 Australian public schools were randomly allocated to treatment conditions. Teachers from the intervention group were taught to embed movement-based learning in their students' (n = 142) daily mathematics program in 3 lessons per week for 6 weeks. The control group (n = 98) continued its regular mathematics program. The primary outcome was accelerometer-determined PA across the school day. Linear mixed models were used to analyze treatment effects. Results: Significant intervention effects were found for PA across the school day (adjusted mean difference 103 counts per minute [CPM], 95% confidence interval [CI], 36.5-169.7, P =.008). Intervention effects were also found for PA (168 CPM, 95% CI, 90.1-247.4, P =.008) and moderate-to-vigorous PA (2.6%, 95% CI, 0.9-4.4, P =.009) in mathematics lessons, sedentary time across the school day (-3.5%, 95% CI,-7.0 to-0.13, P =.044) and during mathematics (-8.2%, CI,-13.0 to-2.0, P =.010) and on-task behavior (13.8%, 95% CI, 4.0-23.6, P =.011)-but not for mathematics performance or attitude. Conclusion: Integrating movement across the primary mathematics syllabus is feasible and efficacious.

Introduction Self-administered lifestyle interventions have been suggested as an alternative to face-to-face delivery modes, although their efficacy remains uncertain. The aim of this study was to evaluate the efficacy of the Type 2 diabetes mellitus Prevention Using LifeStyle Education (PULSE) Program, a self-administered and gender-tailored lifestyle intervention for men at high risk for developing Type 2 diabetes mellitus. Design/setting A 6-month, assessor-blinded, parallel-group RCT was conducted at the University of Newcastle, Australia in 2012-2013. Participants Men (aged 18-65 years, BMI 25-40 kg/m2, high risk for developing Type 2 diabetes mellitus) were stratified by age (<50 and >50 years) and BMI category (25.0-29.9, 30.0-35.9, and 35.0-40 kg/m2) and individually randomized (1:1 ratio) to the intervention (n=53) or waitlist control groups (n=48). Intervention The intervention group received the PULSE Program, which contained print and video resources on weight loss (Self-Help, Exercise and Diet using Internet Technology [SHED-IT] Weight Loss Program), diet modification, and exercise for Type 2 diabetes mellitus prevention. The waitlist control group received no information until 6 months. Main outcome measures Data were collected from September 2012 to September 2013 and analyzed in 2014-2015. Linear mixed models (intention-to-treat) were used to determine group X time interactions (differences between groups in changes over time) at 6 months for the primary outcome (weight), glycated hemoglobin, and several secondary outcomes (significance level, p<0.05). Results Differences between groups in mean changes from baseline to 6 months (group × time interaction) favored the intervention over control group for weight loss (-5.50 kg, 95% CI=-7.40 kg, -3.61 kg, p<0.001, Cohen's d=1.15), glycated hemoglobin (-0.2%, 95% CI=-0.3%, -0.1%, p=0.002, d=0.64), and BMI, waist circumference, body fat percentage, aerobic fitness, and lower body muscular fitness (all p<0.05). No group × time effects were observed for fasting plasma glucose, upper body muscular fitness, physical activity, or energy intake. Conclusions The PULSE Program improved several Type 2 diabetes mellitus risk factors in men, including weight and glycated hemoglobin. These findings provide evidence for a self-administered and gender-tailored lifestyle intervention, which has potential for dissemination in community settings.

Objectives: To investigate the effectiveness of the CrossFit¿ Teens resistance training program for improving mental health outcomes in adolescents, and to explore potential moderators and mediators. Design: Assessor-blinded randomized controlled trial. Methods: Ninety-six students (15.4 (0.5) years, 51.5% female) from one NSW secondary school, Australia 2013, were randomized into the 8-week CrossFit¿ Teens intervention (n = 51) or control conditions (n = 45). Measures of mental health (psychological distress and self-esteem) were assessed using the Strength and Difficulties Questionnaire and Physical Self-Description Questionnaire. Hypothesized mediators were perceived body fat, strength and appearance; and general physical self-concept. Mediation was assessed using Preacher and Hayes' multiple mediation regression SPSS macro. Hypothesized moderators (sex and baseline levels of psychological distress) were assessed using linear mixed models and Cohen's d effect sizes were evaluated. Results: There were no significant intervention effects on mental health or potential mediators in the full study sample. Intervention participants categorized as 'at risk' of psychological distress demonstrated improvements in self-esteem (d = 1.35); perceived body fat (d = 1.05), perceived appearance (d = 0.95); physical self-concept (d = 1.96); and total difficulties score (d = 0.70). A medium-large positive effect on perceived body fat was also observed in boys. Conclusions: Participation in the CrossFit¿ Teens resistance training program did not improve mental health outcomes in the full study sample. However, the results from this study provides preliminary evidence for improving mental health in adolescents 'at risk' of developing psychological disorders.Trial Registration No: ACTRN12611000976987.

The purpose of this study was to examine the mediating effect of resistance training skill competency on percentage of body fat, muscular fitness and physical activity among a sample of adolescent boys participating in a school-based obesity prevention intervention. Participants were 361 adolescent boys taking part in the Active Teen Leaders Avoiding Screen-time (ATLAS) cluster randomised controlled trial: a school-based program targeting the health behaviours of economically disadvantaged adolescent males considered ¿at-risk¿ of obesity. Body fat percentage (bioelectrical impedance), muscular fitness (hand grip dynamometry and push-ups), physical activity (accelerometry) and resistance training skill competency were assessed at baseline and post-intervention (i.e., 8 months). Three separate multi-level mediation models were analysed to investigate the potential mediating effects of resistance training skill competency on each of the study outcomes using a product-of-coefficients test. Analyses followed the intention-to-treat principle. The intervention had a significant impact on the resistance training skill competency of the boys, and improvements in skill competency significantly mediated the effect of the intervention on percentage of body fat and the combined muscular fitness score. No significant mediated effects were found for physical activity. Improving resistance training skill competency may be an effective strategy for achieving improvements in body composition and muscular fitness in adolescent boys.

Fundamental movement skills (FMS) competence is low in adolescent girls. An assessment tool for teachers is needed to monitor FMS in this demographic. The present study explored whether the Canadian Agility and Movement Skill Assessment (CAMSA) is feasible for use by physical education (PE) teachers of Australian Year 7 girls in a school setting. Surveys, focus group interviews, and direct observation of 18 specialist PE teachers investigated teachers perceptions of this tool. Results indicated that the CAMSA was usable in a real-world school setting and was considered a promising means to assess FMS in Year 7 girls. However, future iterations may require minor logistical alterations and further training for teachers on how to utilize the assessment data to enhance teaching practice. These considerations could be used to improve future design, application, and training of the CAMSA in school-based PE.

Objectives: To investigate the effect of a weight-bearing physical activity program on foot structure and plantar pressures generated by overweight/obese children. Design: Descriptive study. Methods: Measurements were collected for a sample of children participating in an obesity treatment trial (mean±SD 8.5±1.1 y, 29.4% boys, 2.63±0.61 body mass index z-score). Children were randomised to physical activity (physical activity; n=24) and no physical activity (no physical activity; n=10) groups. Foot structure was characterised using anthropometry, an emed® AT-4 system quantified pressure distributions and Actigraph accelerometers objectively measured physical activity. Results: After 6 months there was a significant decrease in body mass index z-score (physical activity: p=0.002, no physical activity: p< 0.001), an increase in foot length (physical activity: p< 0.001, no physical activity: p< 0.001) and foot height (physical activity: p< 0.001, no physical activity: p=0.008), although no change in physical activity. Pressure-time integrals increased after 6 months (lateral midfoot; physical activity: p=0.036, medial forefoot; physical activity: p=0.002, no physical activity: p=0.013, middle forefoot; physical activity: p=0.044, lateral forefoot; physical activity: p=0.043) but there were no between-group differences in plantar pressures after the physical activity program. Conclusions: Although changes to foot structure and function in overweight/obese children could not be attributed to participating in the physical activity program, their developing feet may still be at risk of pain and discomfort due to higher plantar pressures and pressure-time integrals. Further research investigating ways to reduce plantar pressures generated by overweight/obese children while they are physically active is warranted.

Objectives: Physical education (PE) plays an important role in contributing to students' physical activity (PA); however, moderate-to-vigorous PA (MVPA) within PE is lower than recommended. Little is known about the PA levels of students from disadvantaged schools within PE. This study aimed to describe: (i) the PA levels of students from disadvantaged secondary schools during PE lessons, (ii) the lesson context and teacher interactions occurring during PE, and (iii) the associations between teacher, school or PE lesson characteristics with student physical activity levels in PE. Design: Cross-sectional study of 100 Grade 7 PE lessons across 10 secondary schools. Methods: System for observing fitness instruction time (SOFIT) was used to assess student PA, lesson context, and teacher interaction. Teacher and school characteristics were collected via survey. Mean proportion of lesson time was used to describe PA, lesson context and teacher interaction. Associations between each outcome variable and each characteristic were examined using 2-sample t-tests, ANOVAs and linear regression. Results: Thirty-nine percent of PE lesson was spent in MVPA, and less than 10% spent in VA. Lessons in schools in urban areas included significantly more MVPA than rural areas (P = 0.04). Male teachers and more experienced teachers conducted lessons with significantly more VA than female and less experienced teachers (P = 0.04 and 0.02). MVPA was also higher in lessons conducted by more experienced teachers. Conclusions: PA during PE lessons within disadvantaged secondary schools is below international recommendations. Male teachers, more experienced teachers and schools in urban regions teach more active lessons.

Background: Adolescence is a recognised period of physical activity decline, particularly among low-income communities. We report the 12-month (midpoint) effects of a 2-year multicomponent physical activity intervention implemented in disadvantaged secondary schools. Methods: A cluster randomised trial was undertaken in 10 secondary schools located in disadvantaged areas in New South Wales, Australia. Students in Grade 7 were recruited, with follow-up in Grade 8. The intervention was guided by socioecological theory and included seven physical activity strategies, and six implementation adoption strategies. The primary outcome was mean minutes of moderate-to-vigorous physical activity (MVPA) per day assessed using Actigraph GT3X accelerometers. Outcome data were analysed using repeated measures linear mixed models. Results: At baseline, 1150 (93%) students participated in the data collection (mean age 12 years, 48% boys) and 1050 (79%) students participated at 12-month follow-up. By the 12-month follow-up, the six implementation adoption strategies had been used to support schools to deliver four of the seven physical activity elements. There was a significant group-by-time interaction for mean minutes of MVPA per day in favour of the intervention group (adjusted difference between groups at follow-up=3.85 min, 95% CI (0.79 to 6.91), p=0.01), including significantly more vigorous physical activity (2.45 min, p=0.01), equating to 27 min more MVPA per week. Summary: At 12-month follow-up, the intervention had reduced the decline in physical activity among adolescents from disadvantaged schools. The intervention may assist students to meet physical activity guidelines.

© 2015 Dietitians Association of Australia. Aim: The 40-Something Randomised Controlled Trial (RCT) aimed to determine if a 12-month health professional-led intervention could improve dietary intake and increase physical activity for weight gain prevention in non-obese premenopausal women. Methods: Fifty-four women were randomised to a motivational interviewing intervention (MI) (n = 28; five health professional consultations) or a self-directed intervention (SDI; n = 26; written advice). Weight control behaviours including dietary intake (four-day weighed food record) and physical activity (pedometer steps; minutes spent in light, moderate and vigorous activity; sitting time) were measured at baseline, and at 3 and 12 months. Participants completed a questionnaire containing demographic questions, Short Form 36 and the International Physical Activity Questionnaire at baseline and 12 months. Linear mixed model analyses adjusting for baseline and 3-month behaviour, covariates and interactions were used to test for between-group differences. Results: At 12 months, the MI group had diets significantly more nutrient dense in iron (P = 0.01) and potassium (P = 0.04), and consumed more fruits (P = 0.02) than the SDI women. Women who achieved their weight control goals consumed significantly more daily fruit servings (+0.76 servings/day, P = 0.02) and less meat/meat alternatives (-0.34 servings/day, P < 0.01) than women who did not achieve weight control. The lack of changes in physical activity indicates that more emphasis may need to be placed on promoting physical activity. Conclusions: The findings demonstrated the effectiveness of the 40-Something RCT in improving iron and potassium nutrient density and fruit servings per day in women soon to commence menopause.

Objectives: Given the low levels of physical activity in girls, improving our understanding of the factors associated with girls¿ physical activity is important. In particular, exploring maternal correlates of girls¿ physical activity for both generations is important, given the paucity of research in this area. The primary aim of this study was to assess maternal correlates of objectively-measured physical activity in girls. Methods: A cross-sectional design was used to assess 40 girls [mean age 8.8¿years; mean body mass index (BMI) z-score¿=¿0.7] and their mothers (mean age 39.1¿years; mean BMI¿=¿27.6) prior to an intervention. Maternal correlates of daughters¿ accelerometer-assessed physical activity were evaluated. Daughters¿ outcomes included: % moderate-to-vigorous physical activity (MVPA), counts per minute (CPM) and % sedentary behavior (SED), screen time (mother-proxy) and BMI z-score (objectively measured). Maternal correlates included demographic, anthropometric, behavioral, activity-related parenting practices, and physical activity cognitions. Correlates were examined using regression models. Results: For daughters¿ % MVPA, mothers¿ beliefs was significant in the final model (R2¿=¿0.14; P¿=¿0.01). For daughters¿ CPM, mothers¿ logistic support (P¿=¿0.03), mothers¿ CPM (P¿=¿0.02) and outcome expectations (P¿=¿0.01) were all significant (R2¿=¿0.24). For daughters¿ % SED, mothers¿ logistic support (P¿=¿0.02) was significant (R2¿=¿0.11). Conclusions for Practice: A number of maternal behaviors, social¿cognitive and parenting correlates were found to be significantly associated with daughters¿ physical activity. Experimental studies are warranted, targeting mothers as the primary agents of change to increase physical activity among girls.

Background: Little is known about which behavioral strategies are most important to target in weight loss interventions for men. Purpose: The aim of the current study was to identify behavioral mediators of weight loss in the male-only Self-Help, Exercise, and Diet using Information Technology (SHED-IT) community weight loss study. Methods: A randomized controlled trial with 159 overweight/obese men [mean (SD) age = 47.5 (11.0) years; body mass index = 32.7 (3.5) kg/m2] assessed at baseline, 3¿months (post-test) and 6¿months (follow-up). Results: In an intention-to-treat, multiple-mediator model, the significant intervention effect on weight at 6¿months (-3.70¿kg; p < 0.001) was mediated by increases in physical activity (steps/day) and decreases in takeaway meals (kJ/day) and portion size at 3¿months. The largest mediation effect was for physical activity (-0.6¿kg; 95¿% confidence interval -1.4, -0.1). Overall, the targeted mediators accounted for 47.0¿% of the intervention¿s effect on weight. Conclusion: Step counts, takeaway food consumption, and portion sizes may be key areas to target in future weight loss programs for men (ACTRN12610000699066).

Purpose: Few efficacious child obesity interventions have been converted into ongoing community programs in the after-school setting. The aim of this study was to evaluate the impact of phase 2 of the Back to Basics cooking club on dietary behaviours and fruit and vegetable variety in a population at risk of obesity at a low income school with > 10% indigenous population. Methods: Baseline and 3-month dietary intake and social cognitive theory (SCT) constructs were collected in 51 children, mean age 9 years, 61% female. McNemar tests were used for comparison of proportions between categorical variables. Cohen's d was used to compare effect sizes across different measures. Results: Consumption of one or more fruit servings per day significantly increased from 41% to 67% (P = 0.02, d = 0.13) and there was a trend for increasing the weekly variety of fruit and vegetables. The SCT constructs assessed within the current study improved significantly (P < 0.05), with moderate to large effect sizes (d = 0.33-0.78). Conclusion: This study documents that a previous efficacious healthy lifestyle program can be adapted for use as an obesity prevention program addressing improvements in vegetable and fruit intakes in a low income community with a relatively high indigenous population.

Aims: The primary aim was to describe characteristics of men identified at high-risk for Type 2 diabetes mellitus (T2DM) using the Australian diabetes risk assessment (AUSDRISK) tool. Secondary aims were to determine the prevalence of pre-diabetes and metabolic syndrome in these men. Methods: Men (n = 209) completed the AUSDRISK tool, with 165 identified as high-risk for T2DM (score = 12, maximum 38). Demographic, anthropometric, physiological and behavioural outcomes were assessed for 101 men. Comparisons (one-way ANOVA) among three AUSDRISK score groups (12-15, 16-19, = 20) were performed (significance level, P < 0.05). Results: Common risk factors (percentages) among high-risk men were waist circumference (>90cm; 93%), age (>44 years; 79%), physical activity level (<150minwk-1; 59%), family history of diabetes (39%) and previously high blood glucose levels (32%). Men with AUSDRISK scores =20 had higher (mean±SD) HbA1C (6.0±0.4% [42±4.4mmol.mol-1], P<0.001), FPG (5.3±0.6mmol.L-1, P=0.001) and waist circumference (113.2±9.8cm, P=0.026) than men with scores of 12-15. Mean FPG for the sample was 5.0±0.6mmol.L-1, whereas mean HbA1C was 5.8±0.5% [40±5.5mmol.mol-1]. Pre-diabetes prevalence was 70% and metabolic syndrome prevalence was 62%. Conclusions: The AUSDRISK tool identified men who were mostly older than 44, and had large waist circumferences and elevated HbA1C. These findings provide evidence supporting the usefulness of the AUSDRISK screening tool for T2DM screening in clinical and research settings.

Background: It has been suggested that young people should develop competence in a variety of ¿lifelong physical activities¿ to ensure that they can be active across the lifespan. Objective: The primary aim of this systematic review is to report the methodological properties, validity, reliability, and test duration of field-based measures that assess movement skill competency in lifelong physical activities. A secondary aim was to clearly define those characteristics unique to lifelong physical activities. Data Sources: A search of four electronic databases (Scopus, SPORTDiscus, ProQuest, and PubMed) was conducted between June 2014 and April 2015 with no date restrictions. Study Selection: Studies addressing the validity and/or reliability of lifelong physical activity tests were reviewed. Included articles were required to assess lifelong physical activities using process-oriented measures, as well as report either one type of validity or reliability. Study Appraisal and Synthesis Methods: Assessment criteria for methodological quality were adapted from a checklist used in a previous review of sport skill outcome assessments. Results: Movement skill assessments for eight different lifelong physical activities (badminton, cycling, dance, golf, racquetball, resistance training, swimming, and tennis) in 17 studies were identified for inclusion. Methodological quality, validity, reliability, and test duration (time to assess a single participant), for each article were assessed. Moderate to excellent reliability results were found in 16 of 17 studies, with 71¿% reporting inter-rater reliability and 41¿% reporting intra-rater reliability. Only four studies in this review reported test¿retest reliability. Ten studies reported validity results; content validity was cited in 41¿% of these studies. Construct validity was reported in 24¿% of studies, while criterion validity was only reported in 12¿% of studies. Limitations: Numerous assessments for lifelong physical activities may exist, yet only assessments for eight lifelong physical activities were included in this review. Generalizability of results may be more applicable if more heterogeneous samples are used in future research. Conclusion: Moderate to excellent levels of inter- and intra-rater reliability were reported in the majority of studies. However, future work should look to establish test¿retest reliability. Validity was less commonly reported than reliability, and further types of validity other than content validity need to be established in future research. Specifically, predictive validity of ¿lifelong physical activity¿ movement skill competency is needed to support the assertion that such activities provide the foundation for a lifetime of activity.

Objectives: To investigate the effectiveness of Smoking, Nutrition, Alcohol, Physical activity and Obesity (SNAPO) interventions in young men exclusively. The secondary aim was to evaluate the recruitment, retention and engagement strategies. Methods: A search with no date restrictions was conducted across seven databases. Randomized controlled trials recruiting young men only (aged 18-35. years) into interventions targeting any SNAPO risk factors were included. Results: Ten studies were included (two nutrition, six alcohol use, two targeting multiple SNAPO risk factors). Six studies (two nutrition, three alcohol use and one targeting multiple SNAPO risk factors) demonstrated significant positive short-term intervention effects, but impact was either not assessed beyond the intervention (n = 3), had short-term follow-up (= 6 months) (n = 2) or not sustained beyond six months (n = 1). Overall, a high risk of bias was identified across studies. Only one study undertook a power calculation and recruited the required sample size. Adequate retention was achieved in three studies. Effectiveness of engagement strategies was not reported in any studies. Conclusions: Despite preliminary evidence of short-term effectiveness of SNAPO interventions in young men, few studies characterized by a high risk of bias were identified. High quality SNAPO interventions for young men are warranted.

Introduction: Excessive recreational screen time (i.e., screen use for entertainment) is a global public health issue associated with adverse mental and physical health outcomes. Considering the growing popularity of screen-based recreation in adolescents, there is a need to identify effective strategies for reducing screen time among adolescents. The aim of this paper is to report the rationale and study protocol for the 'Switch-off 4 Healthy Minds' (S4HM) study, an intervention designed to reduce recreational screen time among adolescents. Methods: The S4HM intervention will be evaluated using a cluster randomized controlled trial in eight secondary schools (. N=. 322 students) in New South Wales, Australia. The 6-month multi-component intervention will encourage adolescents to manage their recreational screen time using a range of evidence-based strategies. The intervention is grounded in Self-Determination Theory (SDT) and includes the following components: an interactive seminar for students, eHealth messaging, behavioral contract and parental newsletters. All outcomes will be assessed at baseline and at 6-months (i.e., immediate post-test). The primary outcome is recreational screen time measured by the Adolescent Sedentary Activity Questionnaire (ASAQ). Secondary outcomes include: self-reported psychological well-being, psychological distress, global physical self-concept, resilience, pathological video gaming and aggression, and objectively measured physical activity (accelerometry) and body mass index (BMI). Hypothesized mediators of behavior change will also be explored. Discussion: The S4HM study will involve the evaluation of an innovative, theory-driven, multi-component intervention that targets students and their parents and is designed to reduce recreational screen time in adolescents. The intervention has been designed for scalability and dissemination across Australian secondary schools.

Background and objective While weight loss has been shown to reduce obesity-related comorbidity, many weight loss treatments fail. Factors that enhance weight loss success are unknown, particularly in those with asthma. The aim of the study was to identify patient characteristics that predict weight loss success in adults with asthma. Methods Baseline and change in asthma characteristics and eating behaviours were investigated for relationships with weight loss and fat loss using multiple linear regression, in 38 overweight and obese adults with asthma randomized to dietary, exercise or combined interventions targeting weight loss for 10 weeks. Results Mean ± standard deviation weight loss was 6.6 ± 5.1 kg. Greater %weight loss and %fat loss was achieved in those with poorer asthma-related quality of life at baseline ((rs = 0.398, P = 0.015) and (rs = 0.455, P = 0.005) respectively), with 1.7% greater absolute weight loss at week 10 corresponding to each one unit reduction in the asthma-related quality of life score at baseline. Furthermore, a lower baseline forced expiratory volume in 1 s/forced vital capacity correlated with greater weight loss (rs = 0.398, P = 0.015). Male sex was associated with a 3.6 kg greater weight loss (P = 0.087). Reducing emotional eating during the programme was associated with greater weight loss in women (rs = 0.576, P = 0.010). Conclusions This study demonstrates that individuals with more severe asthma at baseline are more successful in achieving weight loss, which could be a consequence of greater motivation and could be used as a motivational tool within the clinical setting. Gender tailoring of weight loss programmes may be useful to enhance weight loss success. Future studies are urgently needed to establish predictors of long-term weight loss maintenance in those with asthma. See Editorial, page 179 This study is the first to demonstrate that more severe asthma at baseline, male sex, and improvements in eating behaviours during weight loss are associated with greater weight loss success in overweight and obese adults with asthma. Our findings may inform the development of asthma-specific weight management guidelines.

Background: Technical and Further Education (TAFE) colleges are the primary provider of vocational education in Australia. Most TAFE students are young adults, a period when health risk behaviours become established. Furthermore, high rates of smoking, risky alcohol consumption, inadequate fruit and vegetable intake and insufficient physical activity have been reported in TAFE students. There have been no intervention studies targeting multiple health risk behaviours simultaneously in this population. The proposed trial will examine the effectiveness of providing TAFE students with electronic feedback regarding health risk behaviours and referral to a suite of existing online and telephone services addressing smoking, risky alcohol consumption, fruit and vegetable intake, and physical activity levels. Methods/Design: A two arm, parallel, cluster randomised trial will be conducted within TAFE campuses in New South Wales (NSW), Australia. TAFE classes will be randomly allocated to an intervention or control condition (50 classes per condition). To be eligible, students must be: enrolled in a course that runs for more than 6 months; aged 16 years or older; and not meet Australian health guideline recommendations for at least one of the following: smoking, alcohol consumption, fruit and/or vegetable intake, or physical activity. Students attending intervention classes, will undertake via a computer tablet a risk assessment for health risk behaviours, and for behaviours not meeting Australian guidelines be provided with electronic feedback about these behaviours and referral to evidence-based online programs and telephone services. Students in control classes will not receive any intervention. Primary outcome measures that will be assessed via online surveys at baseline and 6 months post-recruitment are: 1) daily tobacco smoking; 2) standard drinks of alcohol consumed per week; 3) serves of fruit consumed daily; 4) serves of vegetables consumed daily; and 5) metabolic equivalent minutes of physical activity per week. Discussion: Proactive enrolment to existing online and telephone services has the potential to address modifiable determinants of disease. This trial will be the first to examine a potentially scalable intervention targeting multiple health risk behaviours among students in the vocational training setting.

Background: The aim of this study was to assess the beliefs and attitudes of preservice health and physical education (HPE) specialist and nonspecialist schoolteachers toward obese children. Methods: A total of 177 nonspecialist and 62 HPE specialist trainee teachers completed a series of pen-and-paper validated measures of attitudes and beliefs toward obese children. Results: Both groups of preservice teachers reported strong implicit and moderate explicit anti-fat bias. Enrollment in the HPE specialist degree was found to be a significant predictor of both implicit bad/good anti-fat bias (ß=3.97, p=.002) and implicit bias on the stupid/smart scale (ß=2.983, p=.016) of the IAT. Beliefs that obese children were less healthy, more self-conscious, and less satisfied with themselves were strongly endorsed by the majority of participants. HPE specialists were found to have significantly lower expectations for obese children in regard to "reasoning" (mean difference=0.21, p=.0107) and "cooperation" skills (mean difference=0.25, p=.0354) compared to nonspecialist trainees. Conclusions: This study is the first to document the strong anti-fat bias of both preservice nonspecialist and HPE specialist teachers. It is also the first to find that preservice HPE specialist teachers have stronger anti-fat biases and differential expectations regarding particular abilities of obese children, compared to nonspecialists.

Background: This study examined potential parenting-related mediators of children's physical activity and dietary behavior change in the Healthy Dads, Healthy Kids (HDHK) community program. Methods: A randomized controlled trial was conducted with 45 overweight/obese (mean [SD] age = 39.8 [5.4] years; BMI = 32.4 [3.8]) fathers and their children (n = 77; 58% boys; mean [SD] age = 7.7 [2.5] years). Families were randomized to either the HDHK program or wait-list control group. The program involved 7 sessions. Fathers and their children were assessed at baseline and at 14 weeks for physical activity (pedometery) and core food intake (Questionnaire). Fathers' lifestyle-related parenting practices included; self-efficacy, beliefs, modeling, logistic support, rules, cophysical activity, shared mealtime frequency and intentions. Results: Significant intervention effects were found for cophysical activity and modeling physical activity. Cophysical activity mediated children's physical activity in the intervention ('mediated effect,' AB = 653, 95% CI = 4-2050) and was responsible for 59.5% of the intervention effect. Fathers' beliefs mediated children's percent energy from core foods (AB = 1.51, 95% CI = 0.05-5.55) and accounted for 72.9% of the intervention effect. Conclusions: Participation in the HDHK program positively impacted on fathers' cophysical activity with their child and beliefs about healthy eating which mediated changes in children's diet and physical activity behaviors.

Objective: To describe children's physical activity levels during childcare and associations with modifiable characteristics. Methods: A cross-sectional study of 328 preschool children (43% girls; age 3-5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression. Results: Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four-year-olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06). Conclusions: Written physical activity policy, structured staff-led physical activity and staff joining in active play were associated with higher levels of physical activity. Implications: Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.

Background Evidence suggests that physical self-concept is associated with physical activity in children and adolescents, but no systematic review of this literature has been conducted. Objective The primary aim of this systematic review and meta-analysis was to determine the strength of associations between physical activity and physical self-concept (general and sub-domains) in children and adolescents. The secondary aim was to examine potential moderators of the association between physical activity and physical self-concept. Methods A systematic search of six electronic databases (MEDLINE, CINAHL, SPORTDiscus, ERIC, Web of Science and Scopus) with no date restrictions was conducted. Random effects meta-analyses with correction for measurement were employed. The associations between physical activity and general physical self-concept and sub-domains were explored. A risk of bias assessment was conducted by two reviewers. Results The search identified 64 studies to be included in the meta-analysis. Thirty-three studies addressed multiple outcomes of general physical self-concept: 28 studies examined general physical self-concept, 59 examined perceived competence, 25 examined perceived fitness, and 55 examined perceived appearance. Perceived competence was most strongly associated with physical activity (r = 0.30, 95 % CI 0.24-0.35, p < 0.001), followed by perceived fitness (r = 0.26, 95 % CI 0.20-0.32, p < 0.001), general physical self-concept (r = 0.25, 95 % CI 0.16-0.34, p < 0.001) and perceived physical appearance (r = 0.12, 95 % CI 0.08-0.16, p < 0.001). Sex was a significant moderator for general physical self-concept (p < 0.05), and age was a significant moderator for perceived appearance (p = 0.01) and perceived competence (p < 0.05). No significant moderators were found for perceived fitness. Conclusion Overall, a significant association has been consistently demonstrated between physical activity and physical self-concept and its various sub-domains in children and adolescents. Age and sex are key moderators of the association between physical activity and physical self-concept. © 2014 Springer International Publishing Switzerland.

The primary aim of this study was to examine the association between the types of video games played by adolescent boys and their participation in physical activity and recreational screen-time. Participants were 320 boys (mean age=12.7, ±0.5 years) from 14 secondary schools located in low-income areas of New South Wales, Australia. Outcomes included height, weight, physical activity (accelerometers), total screen-time, and video game genre preference. Significant differences in both weekday and weekend screen-time were found between video game genre groups. In addition, significant differences in overall activity and moderate-to-vigorous physical activity were found between genre groups on weekdays. Between-group differences in physical activity on weekends were not statistically significant. This cross-sectional study has demonstrated that video game genre preference is associated with physical activity and screen-time in adolescent boys from low-income communities.

Objective: To evaluate the effectiveness of the 'Healthy Dads, Healthy Kids (HDHK)' program when delivered by trained facilitators in community settings. Method: A two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age=40.3 [5.3] years; BMI=32.5 [3.8] kg/m2) and their primary school-aged children (n=132) from the Hunter Region, Australia. In 2010-2011, families were randomized to either: (i) HDHK intervention (n=48 fathers, n=72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors. Results: Linear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P < .001, d= 0.24), with HDHK fathers losing more weight (- 3.3. kg; 95%CI, - 4.3, - 2.4) than control fathers (0.1. kg; 95%CI, - 0.9,1.0). Significant treatment effects (P < .05) were also found for fathers' waist (d= 0.41), BMI (d= 0.26), resting heart rate (d= 0.59), energy intake (d= 0.49) and physical activity (d= 0.46) and for children's physical activity (d= 0.50) and adiposity (d= 0.07). Discussion: HDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting. © 2014 Published by Elsevier Inc.

Background: There is emerging evidence for positive associations between physical activity (PA), fitness, and fundamental movement skill (FMS) competence, for both children and adolescents. Current reviews of interventions to improve these variables note few studies conduct follow-up assessments to assess behavior maintenance. Objective: The aim of this systematic review was to determine whether typically developing children and adolescents (aged 3-18 years) who have participated in school-based interventions have sustained outcomes in PA, fitness, and/or FMS. Methods: A systematic search of six electronic databases (CINAHL® Plus with Full Text, Ovid MEDLINE®, SPORTDiscus¿, Scopus, PsycINFO® and ERIC) was conducted from 1995 to 26 July 2012. Included studies were school-based studies (including randomized controlled trials, longitudinal cohort, quasi-experimental, and experimental) that had a positive effect at post intervention in at least one variable and had a follow-up PA, fitness, or FMS assessment at least 6 months after the post-intervention assessment. Risk of bias assessment was guided by the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" statement. Results: The search identified 14 articles, and some studies addressed multiple outcomes: 13 articles assessed PA; three assessed fitness; and two assessed FMS. No study in this review met four key methodological criteria that have been shown to influence results, i.e., clarity on the randomization process, assessor blinding, analyzing participants in their original groups, and retaining sufficient participants through the entire study. Three-quarters (ten of 13) of the studies addressing PA, reported PA behavior change maintenance. The length of follow-up ranged from 6 months to 20 years, and the degree of PA difference reported was between 3 and 14 min per day. Only one of the three studies assessing fitness reported a sustained impact, whilst both studies that assessed FMS reported maintenance of effects. Conclusion: It is likely that PA is a sustainable outcome from interventions in children and adolescents, and there is reasonable evidence that interventions of longer than 1 year and interventions that utilize a theoretical model or framework are effective in producing this sustained impact. It would seem probable that FMS are a sustainable outcome in children and adolescents; however, this finding should be viewed with caution given the lack of studies and the risk of bias assessment. More research is needed to assess the sustainability of fitness interventions as this review only included a handful of studies that addressed fitness and only one of these studies found a sustained impact. © 2013 Springer International Publishing Switzerland.

The primary aim of this study was to examine a range of potential behavioral and maternal/paternal correlates of adiposity in children. Secondary aims were to examine (a) correlates of screen-time, diet and physical activity and (b) if there were differences in maternal and paternal physical activity- and dietary-related parenting practices. Cross-sectional analysis was conducted using 70 families with children (59% boys (41/70), mean age 8.4 (±2.4) years). Parenting practices were measured using the Parenting Strategies for Eating and Activity Scale. Children's outcomes included: 7-day pedometry (physical activity), screen-time, percent energy from core foods (Food frequency questionnaire) and BMI z-score. Multiple regression models were generated to examine the associations between maternal and paternal parenting practices and children's variables. In the regression analyses, fathers' BMI (p < .01) and mothers' control (p < .001) were significantly associated with child weight status. Fathers' reinforcement (p < .01) was significantly associated with child physical activity. For screen-time, mothers' monitoring (p < .001) and child characteristics [age (p = .01), sex (p = .01), BMI z-score (p = .03)] were significant predictors. Mothers' parenting practices [limit setting (p = .01), reinforcement (p = .02)] and child screen-time (p = .02) were significantly associated with intake of core foods. Despite some similarities within families, three out of five parenting constructs were significantly different between mothers and fathers. Mothers and fathers have different parental influences on their children's weight status and lifestyle behaviors and both should be included in lifestyle interventions targeting children. A focus on maternal parenting specifically relating to screen-time and diet, and father's physical activity parenting and weight status may support their children in developing more healthy behaviors. © 2014 Elsevier Ltd.

Objectives The aim was to evaluate the impact of the 'Healthy Dads, Healthy Kids' programme on fathers' and mothers' activity- and diet-related parenting practices. Methods Overweight/obese fathers (n = 87) and their primary school-aged children (56% boys) were randomized to either (i) 7-week programme (n = 45) or (ii) control group (n = 42). The programme involved four sessions for fathers only and three for fathers/children. Mothers were not directly involved. Parenting practices of both fathers and mothers were measured using the parenting strategies for eating and activity scale at baseline and 14-week follow-up. Results Intention-to-treat analysis using linear mixed models revealed significant group-by-time effects for fathers' limit setting (P = 0.048, d = 0.36) and reinforcement for multiple lifestyle behaviours (P = 0.001, d = 0.79). No significant intervention effects were found for fathers' control, monitoring, discipline or mothers' parenting practices (P > 0.05). Conclusions The Healthy Dads, Healthy Kids programme had a positive impact on some parenting practices for fathers but not mothers.

Objective: To evaluate the impact of a 12-month school-based multi-component program on adolescent girls' physical activity and sedentary behaviors, and hypothesized mediators of physical activity behavior change. Design: Group randomized controlled trial with 12-month follow-up. Methods: The intervention, guided by Social Cognitive Theory, involved 357 adolescent girls (13.2. ±. 0.5 years) from 12 secondary schools (6 intervention schools, 6 control schools) in low-income communities in the Hunter and Central Coast regions of New South Wales, Australia.The intervention included enhanced school sport, lunchtime physical activity sessions, interactive seminars, student handbooks, nutrition workshops, pedometers, parent newsletters and text messages to encourage physical activity and healthy eating, and a decrease in sedentary behavior. Outcomes were assessed at baseline and 12-months and included: physical activity (accelerometers), sedentary behaviors (questionnaire and accelerometers), and social-cognitive mediators of physical activity (questionnaire). Results: There were significant between group differences in favor of the intervention group for self-reported recreational computer use (-26.0. min; 95% CI, -46.9 to -5.1), and sedentary activities summed (-56.4. min; 95% CI, -110.1 to -2.7), however objective sedentary behavior showed no differences. There were no group-by-time effects for any of the physical activity outcomes or hypothesized mediators. Conclusions: A school-based intervention tailored for adolescent girls from schools located in low-income communities significantly reduced time spent in sedentary activities. However, improvements in physical activity and hypothesized mediators of physical activity behavior were not observed. Future studies are encouraged to explore alternative mechanisms of behavior change derived from integrated and socio-ecological theories. © 2013 Sports Medicine Australia.

Aim: Overweight and obesity prevalence is high among adolescent girls of low socioeconomic position and this increases their risk of cardiovascular disease and metabolic disorders in adulthood. The aim of this present study was to describe the dietary patterns of adolescent girls in terms of the relative contribution of core food groups to overall diet and by weight status category. Methods: Year 8 female students were recruited from schools in low-income communities. Weight status (i.e. underweight, healthy weight, overweight, obese) was determined using age- and sex-adjusted body mass index (BMI; z score). Dietary intakes were assessed using a validated semi-quantitative food frequency questionnaire. Individual foods were collated into core food group or energy-dense, nutrient-poor categories in line with the Australian Guide to Healthy Eating (AGHE) and the percentage contribution to total energy intake calculated. Results: Participants (n = 332) were (mean ± SD) 13.7 ± 0.4 years old with BMI z score 0.63 ± 1.22. Few girls met AGHE core food group recommendations for daily serves; meat and substitutes 69.3%, vegetables 28.6%, fruit 23.8%, dairy 15.7% and breads/cereals 5.7%. Total percentage energy derived from energy-dense, nutrient-poor foods was 46.6% (37.2-54.6%) (median (interquartile range)), with takeaways 9.8% (7.0-13.6%), confectionery 7.0% (4.1-10.9%) and packaged snacks 6.8% (4.0-10.7%), with no significant differences by weight status. Conclusions: Core food intakes are poor with excessive consumption of energy-dense, nutrient-poor foods in these adolescent girls. Nutrition education programs targeting this population are needed to address this imbalance. Strategies could include substitution of unhealthy snacks for core food items and greater inclusion of core foods within main meals. © 2013 Dietitians Association of Australia.

This review investigated three research questions (i) What is the utility of social cognitive theory (SCT) to explain physical activity (PA)?; (ii) Is the effectiveness of SCT moderated by sample or methodological characteristics? and (iii) What is the frequency of significant associations between the core SCT constructs and PA? Ten electronic databases were searched with no date or sample restrictions. Forty-four studies were retrieved containing 55 SCT models of PA. Methodological quality was assessed using a standardized tool. A random-effects meta-analysis revealed that SCT accounted for 31% of the variance in PA. However, methodological quality was mostly poor for these models. Methodological quality and sample age moderated the PA effect size, with increases in both associated with greater variance explained. Although self-efficacy and goals were consistently associated with PA, outcome expectations and socio-structural factors were not. This review determined that SCT is a useful framework to explain PA behaviour. Higher quality models explained more PA variance, but overall methodological quality was poor. As such, high-quality studies examining the utility of SCT to explain PA are warranted.

Introduction: The negative consequences of unhealthy weight gain and the high likelihood of pediatric obesity tracking into adulthood highlight the importance of targeting youth who are 'at risk' of obesity. The aim of this paper is to report the rationale and study protocol for the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention intervention for adolescent boys living in low-income communities. Methods/design: The ATLAS intervention will be evaluated using a cluster randomized controlled trial in 14 secondary schools in the state of New South Wales (NSW), Australia (2012 to 2014). ATLAS is an 8-month multi-component, school-based program informed by self-determination theory and social cognitive theory. The intervention consists of teacher professional development, enhanced school-sport sessions, researcher-led seminars, lunch-time physical activity mentoring sessions, pedometers for self-monitoring, provision of equipment to schools, parental newsletters, and a smartphone application and website. Assessments were conducted at baseline and will be completed again at 9- and 18-months from baseline. Primary outcomes are body mass index (BMI) and waist circumference. Secondary outcomes include BMI z-scores, body fat (bioelectrical impedance analysis), physical activity (accelerometers), muscular fitness (grip strength and push-ups), screen-time, sugar-sweetened beverage consumption, resistance training skill competency, daytime sleepiness, subjective well-being, physical self-perception, pathological video gaming, and aggression. Hypothesized mediators of behavior change will also be explored. Discussion: ATLAS is an innovative school-based intervention designed to improve the health behaviors and related outcomes of adolescent males in low-income communities. © 2013 Elsevier Inc.

OBJECTIVE: The goal of this study was to evaluate the impact of the Active Teen Leaders Avoiding Screen-time (ATLAS) intervention for adolescent boys, an obesity prevention intervention using smartphone technology.

Background: Obese men are more likely to have poor dietary patterns compared to women, increasing diet-related chronic disease risk. The impact of a male-only weight loss intervention on dietary intakes is under-evaluated. The aim was to deter-mine whether overweight/obese men randomised to self-help paper-based resources with or without online support, achieved greater improvements in diet compared with Wait-list controls at 3 and 6 months following a gender tailored weight-loss intervention.

Pediatric obesity continues to be a major public health concern. Once established it is difficult to treat, therefore well-designed and evaluated prevention interventions are vitally important. Schools have an important role in the prevention of childhood obesity, however, their involvement can be limited by a number of constraints and barriers, which need to be considered when designing interventions. Members of the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network have extensive experience in implementing and evaluating school-based obesity prevention initiatives. Based on their collective experience and evidence from implementation research, the aim of this paper was to highlight six areas to consider when designing, implementing and evaluating obesity prevention initiatives in schools. Further, this paper aimed to provide guidance for overcoming some of the challenges and barriers faced in school-based obesity prevention research. The six key areas discussed include: design and analysis; school-community engagement; planning and recruitment; evaluation; implementation; and feedback and sustainability.

Objective To examine associations of volumes and bouts of sedentary behavior (SED) and moderate-to-vigorous physical activity (MVPA) with individual and clustered cardio-metabolic outcomes in overweight/obese children. Methods Cross-sectional data from 120 overweight/obese children (8.3 ± 1.1 years, 62% girls, 74% obese) with SED and MVPA assessed using accelerometry. Children were categorized into quartiles of mean bouts per day of SED (10, 20, and 30 min) and MVPA (5, 10, and 15 min). Associations with triglycerides, HDL cholesterol, glucose, insulin, systolic/diastolic blood pressure, and clustered cardio-metabolic risk (cMet) were examined using linear regression, adjusted for confounders. Results Independent of MVPA, SED volume was inversely associated with HDL cholesterol (ß [95% CI] = -0.29 [-0.52, -0.05]). MVPA volume was inversely associated with diastolic blood pressure, independent of SED (ß = -0.22 [-0.44, -0.001]), and cMet (ß = -0.19 [-0.36, -0.01]) although not after adjustment for SED (ß = -0.14 [-0.33, 0.06]). Independent of MVPA and SED volumes, participants in the highest quartile of 30 min bouts per day of SED had 12% lower HDL cholesterol than those in the lowest quartile (d = 0.53, P = 0.046, Ptrend = 0.11). Conclusions In addition to increasing MVPA, targeting reduced SED and limiting bouts of SED to <30 min may contribute to improved HDL cholesterol levels and cardio-metabolic health in overweight/obese children. Copyright © 2014 The Obesity Society.

Current recommendations for the prevention of type 2 diabetes advise modification of diet and exercise behaviors including both aerobic and resistance training. However, the efficacy of multi-component interventions involving a combination of these three components has not been established. The aims of this review were to systematically review and meta-analyze the evidence on multi-component (diet + aerobic exercise + resistance training) lifestyle interventions for type 2 diabetes prevention. Eight electronic databases (Medline, Embase, SportDiscus, Web of Science, CINAHL, Informit health collection, Cochrane library and Scopus) were searched up to June 2013. Eligible studies 1) recruited prediabetic adults or individuals at risk of type 2 diabetes; 2) conducted diet and exercise [including both physical activity/aerobic and resistance training] programs; and 3) reported weight and plasma glucose outcomes. In total, 23 articles from eight studies were eligible including five randomized controlled trials, one quasi-experimental, one two-group comparison and one single-group pre-post study. Four studies had a low risk of bias (score = 6/10). Median intervention length was 12 months (range 4-48 months) with a follow-up of 18 months (range 6.5 - 48 months). The diet and exercise interventions varied slightly in terms of their specific prescriptions. Meta-analysis favored interventions over controls for weight loss (-3.79 kg [-6.13, -1.46; 95% CI], Z = 3.19, P = 0.001) and fasting plasma glucose (-0.13 mmol.L-1 [-0.24, -0.02; 95% CI], Z = 2.42, P = 0.02). Diabetes incidence was only reported in two studies, with reductions of 58% and 56% versus control groups. In summary, multi-component lifestyle type 2 diabetes prevention interventions that include diet and both aerobic and resistance exercise training are modestly effective in inducing weight loss and improving impaired fasting glucose, glucose tolerance, dietary and exercise outcomes in at risk and prediabetic adult populations. These results support the current exercise guidelines for the inclusion of resistance training in type 2 diabetes prevention, however there remains a need for more rigorous studies, with long-term follow-up evaluating program efficacy, muscular fitness outcomes, diabetes incidence and risk reduction. © 2014 Aguiar et al.; licensee BioMed Central Ltd.

Background: Although previous studies have demonstrated that children with high levels of fundamental movement skill competency are more active throughout the day, little is known regarding children's fundamental movement skill competency and their physical activity during key time periods of the school day (i.e., lunchtime, recess and after-school). The purpose of this study was to examine the associations between fundamental movement skill competency and objectively measured moderate-to-vigorous physical activity (MVPA) throughout the school day among children attending primary schools in low-income communities.Methods: Eight primary schools from low-income communities and 460 children (8.5 ± 0.6 years, 54% girls) were involved in the study. Children's fundamental movement skill competency (TGMD-2; 6 locomotor and 6 object-control skills), objectively measured physical activity (ActiGraph GT3X and GT3X + accelerometers), height, weight and demographics were assessed. Multilevel linear mixed models were used to assess the cross-sectional associations between fundamental movement skills and MVPA.Results: After adjusting for age, sex, BMI and socio-economic status, locomotor skill competency was positively associated with total (P = 0.002, r = 0.15) and after-school (P = 0.014, r = 0.13) MVPA. Object-control skill competency was positively associated with total (P < 0.001, r = 0.20), lunchtime (P = 0.03, r = 0.10), recess (P = 0.006, r = 0.11) and after-school (P = 0.022, r = 0.13) MVPA.Conclusions: Object-control skill competency appears to be a better predictor of children's MVPA during school-based physical activity opportunities than locomotor skill competency. Improving fundamental movement skill competency, particularly object-control skills, may contribute to increased levels of children's MVPA throughout the day.Trial registration: Australian New Zealand Clinical Trials Registry No: ACTRN12611001080910. © 2014 Cohen et al.; licensee BioMed Central Ltd.

Objective: To evaluate the impact of a multi-component school-based physical activity intervention (Fit-4-Fun) on health-related fitness and objectively measured physical activity in primary school children. Methods: Four Hunter primary schools were recruited in April, 2011 and randomized by school into treatment or control conditions. Participants included 213 children (mean age=10.72years±0.6; 52.2% female) with the treatment group (n=118) completing the 8-week Fit-4-Fun Program. Participants were assessed at baseline and 6-month follow-up, with a 91% retention rate. Cardio-respiratory fitness (CRF) (20m shuttle run) was the primary outcome, and secondary outcomes included body composition (BMI, BMIZ), muscular fitness (7-stage sit-up test, push-up test, basketball throw test, Standing Jump), flexibility (sit and reach) and physical activity (7days pedometry). Results: After 6-months, significant treatment effects were found for CRF (adjusted mean difference, 1.14 levels, p<0.001), body composition (BMI mean, -0.96kg/m2, p<0.001 and BMI z-score mean -0.47 z-scores, p<0.001), flexibility (sit and reach mean, 1.52cm, p=0.0013), muscular fitness (sit-ups) (mean 0.62 stages, p=0.003) and physical activity (mean, 3253 steps/day, p<0.001). There were no group by time effects for the other muscular fitness measures. Conclusions: A primary school-based intervention focusing on fitness education significantly improved health-related fitness and physical activity levels in children. © 2012 Elsevier Inc.

Background & aims: The aim of this study was to (i) to compare the accuracy of reporting for child's total energy intake from a food frequency questionnaire (FFQ) completed independently by the mother, father and child in comparison to total energy expenditure (TEE) measured using doubly labeled water (DLW) (ii) compare the accuracy of the weighed food record (WFR) and DLW. Methods: Healthy weight children (mean±SD age 9.8±1.3years, n=6 girls/3 boys) and their parents independently completed an FFQ about children's intake. A 4-day WFR of child intake was recorded simultaneously. The accuracy of energy intakes reports were determined by the absolute and percentage differences between estimated energy intake and TEE measured by DLW. Results: The mean difference (limits of agreement LOA, ±2SD) when compared to DLW was; child 130 (-1518, 1258)kcal or (113±35% of TEE); father 398 (0,796)kcal or (121±13%); mother 807 (-213, 1824)kcal or (144±26%) and for the WFR-153 (1089,-1395)kcal or 95±32%. Conclusions: Children were the most accurate reporters when compared to their parents, with fathers more accurate than mothers. The 4-day WFR was approximately equal to the child report FFQ in estimating EI in children 8-11 years. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Background Obesity prevention among youth of low SES is a public health priority given the higher prevalence of youth obesity in this population subgroup. Purpose To evaluate the 24-month impact of a school-based obesity prevention program among adolescent girls living in low-income communities. Design The study was a school-based group RCT, the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) intervention. Setting/participants The study involved 12 secondary schools located in low-income communities in New South Wales, Australia. Participants were 357 adolescent girls (aged 13.2±0.5 years). Intervention The 12-month multicomponent intervention was guided by social cognitive theory and involved strategies to promote physical activity, reduce sedentary behaviors, and improve dietary outcomes. Main outcome measures The primary outcome was BMI, and secondary outcomes were BMI z-score; percentage body fat (bioelectrical impedance analysis); physical activity (accelerometers); dietary intake; and recreational screen-time (self-report). Data were collected in 2010-2012 and analyzed in 2012. Results After 24 months, there were no intervention effects on BMI (adjusted mean difference -0.33, 95% CI= -0.97, 0.28, p=0.353) and BMI z-score (-0.12, 95% CI= -0.27, 0.04, p=0.178). However, there was a group-by-time interaction for percentage body fat (-1.96%, 95% CI= -3.02, -0.89, p=0.006). Intervention effects for physical activity, screen time, and dietary intake were not significant. Conclusions The NEAT Girls intervention did not result in effects on the primary outcome. Further study of youth who are "at risk" of obesity should focus on strategies to improve retention and adherence in prevention programs. Trial registration This study is registered at Australian New Zealand Clinical Trials ACTRN1261000033004. © 2013 American Journal of Preventive Medicine.

Movement skill competence is important to organised youth physical activity participation, but it is unclear how adolescents view this relationship. The primary aim of this study was to explore adolescents' perception of the relationship between movement skills, physical activity and sport, and whether their perceptions differed according to extent of participation in organised physical activities. We recruited 33 (17 male) Grade 11 and 12 students (aged 16 to 18) from two secondary schools in Australia. Focus groups were allocated according to whether or not students participated in organised physical activity, where 'organised activity' was defined as activity which involved regular classes, training or competition, was reasonably structured or formal, or had a teacher, instructor or coach. There were three all-male 'organised' groups, one mixed-gender 'organised' group and one all-female 'not-organised' group. Students were asked about their attitudes towards physical activity and sport, the relationship between childhood skill proficiency and later physical activity and their perceptions of the appropriate time taken to learn movement skills. Group discussions lasted for approximately 50 minutes, were recorded and were then transcribed verbatim. Transcripts were read using a constant comparison method, in which quotes were continually compared to other quotes. A thematic analysis was conducted in which the transcripts were analysed inductively. Participation in organised sport had no bearing on opinions regarding whether lack of childhood skill development would negatively impact latter participation. It did, however, subtly influence opinions regarding whether skill could be successfully acquired later in life. When asked whether not having well-developed skills as a child would negatively impact on participation in sport/physical activity later in life, the response was mixed, but this was not related to their involvement in organised sport or activities. Students who believed early skill proficiency related to subsequent activity thought this was due to skill ability and motivation. An alternate view was that subsequent activity did not need to be based on skill proficiency; also, one's environment might change, resulting in differing opportunities/constraints. Students felt skills could be learnt at any time in life (dependent on motivation), but that learning skills at a younger age would be easier and that skills learnt later would not be as developed. Fear of failure was identified as a barrier to learning when older. We conclude that motivation towards participation in sport and physical activity is affected by adolescents' perception of their own movement skill ability. Therefore, developing children's actual and perceived movement skills may help to increase adolescent physical activity. Since those with intrinsic achievement orientations were not as inclined towards organised activity, we may also need to provide physical activity options that resonate with intrinsic achievement motivations. © The Author(s) 2013.

Objective: To provide a user's guide for selecting an appropriate method to assess sedentary behaviours among children and adolescents. Design: While recommendations regarding specific instruments are not provided, the guide offers information about key attributes and considerations for objective (accelerometry; inclinometers; direct observation; screen monitoring devices) and subjective (self-report; parent report; and time use diaries/logs) approaches to assess sedentary behaviour Attributes of instruments and other factors to be considered in the selection of assessment instruments include: population (age); sample size; respondent burden; method/delivery mode; assessment time frame; physical activity information required (data output); data management; measurement error; cost (instrument and administration) and other limitations. Methods: Expert consensus among members of the Australasian Child and Adolescent Obesity Research Network's (ACAORN) Physical Activity and Sedentary Behaviour Special Interest Group. Results: We developed decision flow charts to assist researchers and practitioners select an appropriate method of assessing sedentary behaviour, identified attributes of each method and described five real-life scenarios to illustrate considerations associated with the selection of each method of measurement. Conclusions: It is important that researchers, practitioners and policy makers understand the strengths and limitations of different methods of assessing sedentary behaviour among youth, and are guided on selection of the most appropriate instrument/s to suit their needs. © 2012 .

Aim: The objective of the present study was to assess the feasibility and acceptability of an after-school obesity prevention strategy for families. Methods: Ten children aged 5-12 years and their parents/guardians from an economically disadvantaged area participated in an after-school healthy lifestyle program, which was run over a school term. It consisted of five face-to-face sessions that were run fortnightly with an additional social barbeque session at program completion. Results: Feasibility was demonstrated by successful recruitment, retention (80%) and collection of a high percentage of usable data (96% at baseline, 80% at follow up). Acceptability was demonstrated by a session attendance of 83%, 100% positive enjoyment response. There was no significant change in anthropometrics, child or adult fruit and vegetable intake with no or little effect on all other dietary variables. Conclusions: The present study illustrated an approach to the translation of a program used in an evidence-based efficacious clinical trial into a sustainable community setting. © 2013 Dietitians Association of Australia.

Background: This study aimed to develop and evaluate the construct validity and reliability of modernized social cognitive measures relating to physical activity behaviors in adolescents. Methods: An instrument was developed based on constructs from Bandura's Social Cognitive Theory and included the following scales: self-efficacy, situation (perceived physical environment), social support, behavioral strategies, and outcome expectations and expectancies. The questionnaire was administered in a sample of 171 adolescents (age = 13.6 ± 1.2 years, females = 61%). Confirmatory factor analysis was employed to examine model-fit for each scale using multiple indices, including chi-square index, comparative-fit index (CFI), goodness-of-fit index (GFI), and the root mean square error of approximation (RMSEA). Reliability properties were also examined (ICC and Cronbach's alpha). Results: Each scale represented a statistically sound measure: fit indices indicated each model to be an adequate-to-exact fit to the data; internal consistency was acceptable to good (a = 0.63-0.79); rank order repeatability was strong (ICC = 0.82-0.91). Conclusions: Results support the validity and reliability of social cognitive scales relating to physical activity among adolescents. As such, the developed scales have utility for the identification of potential social cognitive correlates of youth physical activity, mediators of physical activity behavior changes and the testing of theoretical models based on Social Cognitive Theory. © 2013 Human Kinetics, Inc..

Objective: This study examines the associations between objectively measured sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA), and plasma lipids in overweight and obese children. Design and Methods: Cross-sectional analyses were conducted among 126 children aged 5.5-9.9 years. Sedentary behavior, LPA, and MVPA were assessed using accelerometry. Fasting blood samples were analyzed for plasma lipids (high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], and triglycerides [TG]). Results: MVPA was not related to plasma lipids (P > 0.05). Independent of age, sex, energy intake, and waist circumference z-score, sedentary behavior and LPA were associated with HDL-C (ß = -0.23, 95% CI -0.42 to -0.04, P = 0.020; ß = 0.20, 95% CI 0.14 to 0.39, P = 0.036, respectively). The strength of the associations remained after additionally adjusting for MVPA (sedentary behavior: ß = -0.22, 95% CI -0.44 to 0.006, P = 0.056; LPA: ß = 0.19, 95% CI -0.005 to 0.38, P = 0.056, respectively). Conclusion: Substituting at least LPA for sedentary time may contribute to the development of healthy HDL-C levels among overweight and obese children, independent of their adiposity. Comprehensive prevention and treatment strategies to improve plasma HDL-C among overweight and obese children should target reductions in total sedentary time and promote the benefits of LPA, in addition to promoting healthy levels of adiposity, healthy dietary behaviors, and MVPA.