Professor David Lubans

Childhood and adolescence are particularly sensitive periods during which environmental factors may influence individuals' present and future mental health. A large and increasing number of studies have demonstrated that engaging in physical activity and reducing sedentary behaviour may enhance young people's mental health. However, updating and quantifying the current evidence is needed. Thereby, this chapter systematically reviews the available literature in order to (1) provide an updated synthesis of the literature in physical activity, sedentary behaviour and mental health in young people, (2) identify gaps in knowledge and (3) suggest directions for future research. From our review, a small but significant positive effect of physical activity on mental health among youths emerged. Furthermore, increased levels of sedentary behaviour, particularly excessive screen time (i.e. beyond 2 h/day in recreational time), were associated with poor mental health among young people. However, more studies are needed to better understand the specific mechanisms responsible for the effect of physical activity and sedentary behaviour on mental health in young people. The output from this chapter may assist in the development of evidence-based physical activity and sedentary behaviour guidelines for children and adolescents to enhance health and well-being.

The study aimed to develop and validate a tool that assessed students' foundational movement skills, for primary school teachers. The playground circuit, including 14 movement skills (e.g. functional, locomotor and object control), was developed through insights and recommendations from teachers (n = 36) and academic experts (n = 25). To validate the Best Start Foundational Movement Skill Assessment Tool (BS-FMAT), a sample of children (n = 340; 159 boys and 181 girls; mean age = 6.1 ± 0.9 years) completed the circuit. Then, n = 120 randomly selected children completed the Test of Gross Motor Development (TGMD-3) and BS-FMSAT to determine concurrent validity. Multiple linear results showed significant and positive association between TGMD-3 and BS-FMSAT for overall skill (ß = 0.043, p <.001), locomotor (ß = 0.457, p <.001) and object control skills (ß = 0.334, p <.001). Findings provide preliminary evidence that BS-FMSAT is an alternative assessment tool for children in a New South Wales, Australia (NSW) primary school.

Objective: The need for clear and actionable guidelines for the promotion and protection of mental health in organised community sport has previously been identified. This study aimed to provide guidelines to promote and protect mental health in organised community sport in Australia. Methods: Guideline development was informed by (1) systematic reviews of the evidence pertaining to existing mental health guidelines in sport and mental health interventions in community sport; (2) an expert Delphi consensus study and (3) key stakeholder input via focus groups. A Guideline Development Committee comprising experts and key stakeholder representatives articulated nine distinct guidelines. Results: These guidelines address the areas of: mental health literacy training; mental health support pathways and processes; responding to mental health emergencies; responding to major events that may impact mental health; having a mental health plan in place; reducing stigmatising attitudes; appointing a dedicated mental health champion; coach education and promoting well-being within the organisation. Conclusions: We provide guidance for promoting and protecting mental health in community sport. Monitoring uptake and measuring the effectiveness of the guidelines are important areas of future work to advance positive mental health for everybody involved in community sport.

Background: In a stepped wedge design, schools are randomised to a sequence of measurements, with each sequence transitioning to intervention status at a different time. There are several advantages to such designs, including increased statistical power, logistical benefits and the ability to explore change over time. However, stepped wedge designs have not previously been used to evaluate school-based physical activity interventions in children. This paper aimed to explore the feasibility of this design, by identifying school constraints, balancing these with statistical considerations and exploring the power of this chosen design under different scenarios. Methods: We conducted three interlinked studies, with the results from one informing the next. Study 1 was a qualitative study to identify school constraints that inform the choice of stepped wedge configuration. Study 2 used simulation to choose a configuration that balanced these school constraints and statistical properties. Study 3 explored the statistical power for the chosen design for different school and pupil sample sizes, using an open cohort design (a mixture of new and repeated pupils). Results: School staff considered the proposed data collection feasible, and supported a maximum of 3¿4 measurements per year and an implementation period of one school term. Study 2 therefore considered incomplete stepped wedge designs with five steps. Statistically, the best designs had a mix of control and intervention measurements in terms 2¿4 and a spread of measurements across the whole study duration. Power depended on a combination of the overall recruitment rate and the retention rate. For 20 schools with an eligible class size of 30 pupils, we would be able to detect a 6¿min difference in average weekday moderate-to-vigorous physical activity with 80% power, provided there were > 50% of pupils measured per school at each time. A similarly powered cluster randomised controlled trial would require 42 schools. Conclusion: Stepped wedge trials are a viable design for evaluating school-based physical activity interventions. Incomplete designs, where not all schools are measured at each point, offer the flexibility to work around practical constraints.

"Active 1 + FUN" is a family-based and self-determination theory-guided intervention program, designed to increase children's and parents' physical activity in leisure-time. In this qualitative study, we aimed to provide a comprehensive understanding of the intervention by exploring perceived behavioral and psychological changes, and implementation of the program from the perspective of facilitators and participants. The interviews and focus groups explored facilitators' and participants' (children and parents) perceptions of the intervention in terms of the theoretical basis, perceived behavioral changes, basic need satisfaction (i.e., competence, autonomy, and relatedness), and other aspects. The findings suggested that facilitators, children and parents perceived the theory-driven intervention to be effective in increasing family's leisure-time co-physical activity and basic psychological need satisfaction.

Background: Motor competence and executive functions co-develop throughout childhood and adolescence, and there is emerging evidence that improvements in motor competence may have cognitive benefits in these populations. There is a need to provide a quantitative synthesis of the cross-sectional, longitudinal and experimental studies that have examined the association between motor competence and executive functions in school-aged youth. Objectives: The primary aim of our systematic review was to synthesise evidence of the association between motor competence and executive functions in school-aged children and adolescents (5¿18¿years). Our secondary aim was to examine key moderators of this association. Methods: We searched the PubMed, PsycINFO, Scopus, Ovid MEDLINE, SPORTDiscus and EMBASE databases from inception up to 27 June 2023. We included cross-sectional, longitudinal and experimental studies that assessed the association between motor competence (e.g., general motor competence, locomotor skills, object control skills and stability skills) and executive functions (e.g., general executive functions, inhibition, working memory and cognitive flexibility) in children and adolescents aged 5¿18¿years. Results: In total, 12,117 records were screened for eligibility, and 44 studies were included. From the 44 included studies, we meta-analysed 37 studies with 251 effect sizes using a structural equation modelling approach in the statistical program R. We found a small positive association (r = 0.18, [95% confidence interval (CI) 0.13¿0.22]) between motor competence and executive functions. The positive associations were observed in cross-sectional (r = 0.17, [95% CI 0.13¿0.22]), longitudinal (r = 0.15, [95% CI 0.03¿0.28]) and experimental studies (r = 0.25, [95% CI 0.01¿0.45]). We also found that general motor competence (r = 0.25, [95% CI 0.18¿0.33]), locomotor (r = 0.15, [95% CI 0.09¿0.21]), object control (r = 0.14, [95% CI 0.08¿0.20]) and stability (r = 0.14, [95% CI 0.08¿0.20]) skills were associated with executive functions. We did not find any moderating effects for participants' age on the associations between motor competence and executive functions. Conclusions: Our findings suggest a small-to-moderate positive association between motor competence and executive functions in children and adolescents. The small number of experimental studies included in this review support the assertion that interventions targeting children's motor competence may be a promising strategy to improve their executive functions; however, more research is needed to confirm these findings. Future studies should explore the underlying mechanisms linking motor competence and executive functions as their comprehension may be used to optimise future intervention design and delivery. PROSPERO Registration: CRD42021285134.

Objectives: This study aimed to identify and synthesize online information/resources related to resistance training provided by governing bodies of the ten most popular youth sports in Australia. Design: A scoping review. Methods: The top 10 organised out-of-school sports were eligible for the review. A systematic search of national sporting organisation and associated websites was conducted, using key search terms. Data were extracted regarding information and/or resources aligning with current international youth muscle-and-bone strengthening activity guidelines (i.e., 5¿17 years, three days per week). Results: For all ten sports, information/resources on resistance training were provided for athletes or coaches, however the type of information and level of detail varied. There was lack of consistency between guidelines and information provided by sports. Age of commencement recommendations ranged from four years (athletics) to 14 years (Australian football), whilst others suggested resistance training for all ages (gymnastics) or did not provide an explicit age range (tennis and cricket). Regarding frequency, few sports organisations provided a recommendation for how many days per week resistance training should be performed. Some sports alluded to the need for youth to develop muscular fitness to enhance fitness and performance, whilst others focused primarily on the need for resistance training as an injury prevention tool. Conclusions: Our findings highlight the gap that exists in the provision of information in relation to resistance training in Australian sports. It is important that national sporting organisations look to educate athletes and coaches (and parents) from grassroots levels on the need for muscular fitness.

Background: The aim of our study was to evaluate the impact of the ActTeens Program on physical activity and health-related physical fitness among adolescents in Brazil. Methods: The "ActTeens Program" was conducted using a cluster-randomized controlled trial during 24-week school term. The sample consisted of 317 adolescents (52.7% girls; 13.61 ± 0.70 years) from four secondary schools that were randomly assigned to intervention group (N = 169) or control group (N = 148). This school-based physical activity (PA) intervention involved two components: (i) structured physical activity sessions delivered within physical education (PE) and (ii) healthy lifestyle guidance (mHealth). The primary outcome was PA assessed using Physical Activity Questionnaire for Adolescents (PAQ-A); secondary outcomes included muscular (MF) and cardiorespiratory fitness (CRF) assessed using 90-push-up, handgrip dynamometer, standing long jump, and 20¿m PACER shuttle run test. Assessments were conducted at baseline, 12- and 24-week. Intervention effects were assessed using linear mixed models (LMM). Results: For the primary outcome (PA), no significant group-by-time effects were observed for physical education based-PA (0.3 score; 95%CI: -0.1; 0.6; and - 0.01 score; 95%CI: -0.03; 0.03, at 12-wk and 24-wk respectively) and total PA (-0.02 score; 95%CI: -0.2; 0.2; and - 0.01score; 95%CI: -0.2; 0.2, at 12 and 24 weeks respectively). After 24 weeks, we observed a significant group by time effects for lower body muscular fitness (12.9¿cm; 95%CI, 3.2 to 22.2). Conclusion: The implementation of aerobic and muscle-strengthening exercises used in the ActTeens intervention did not lead to improvements in physical activity. The intervention resulted in improved lower body muscular fitness, however, we found no significant differences for upper body muscular and cardiorespiratory fitness.

Background: Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness. Objective: The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation. Methods: Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained. Results: Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles. Conclusion: While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained. Registration: PROSPERO (CRD42020169988).

Background: There has been an increase in the number of studies examining the effect of acute and chronic physical activity on academic outcomes in children and adolescents in the last two decades. We aimed to systematically determine the acute effects of physical activity on academic outcomes in school-aged youth and to examine possible moderators. Methods: We conducted a systematic search using PubMed, Web of Science, SPORTDiscus, and PsycINFO databases (from inception to 11th January 2023) for studies assessing the acute effects of physical activity on academic performance-related outcomes in school-aged youth. A univariate and multivariate meta-analysis was conducted based on a random-effects model with restricted maximum likelihood used to pool the academic outcomes results (Hedge's g). Results: We included 11 articles (803 children and adolescents [range: 6¿16 years]) in the systematic review. Overall, acute physical activity increased academic outcomes (Hedge's g = 0.35, 95% CI: 0.20¿0.50). Multivariate meta-analyses revealed that physical activity increased academic performance in mathematics (Hedge's g = 0.29, 95% CI: 0.16¿0.42) and language (Hedge's g = 0.28, 95% CI: 0.09¿0.47). Only behavior change techniques (Hedge's g = 0.54, 95% CI, 0.18¿0.90, p < 0.001) played a significant role in this relationship. Conclusions: A single bout of physical activity can improve academic outcomes in school-aged youth, which may serve as a complementary tool for the educational field. However, the observed heterogeneity in the results indicates that we should interpret the findings obtained with caution.

Objectives: To examine associations of movement behaviour compositions with health-related quality of life in children. Methods: Baseline data (2018) from the TransformUs study were used. Overall, 891 children aged 7¿12 years [69% of consented sample] recorded valid accelerometry data (ActiGraph GT3X+; 4 days, including =1 weekend day). Time spent sedentary, and in light-, moderate-, and vigorous-intensity physical activity were extracted. Health-related quality of life was assessed using five EQ-5D-Y health-related quality of life dimensions (mobility, looking after myself, doing usual activities, having pain/discomfort, and feeling worried/sad/unhappy [all dichotomized as no versus any problems]) and one continuous scale assessing overall perceived health. Regression models examined associations between waking movement behaviour compositions, including longer and shorter sedentary (<5 and = 5 min) and physical activity (<1 and = 1 min) bouts, and health-related quality of life. Results: The waking movement behaviour composition was associated with overall perceived health (whole sample, and boys and girls separately, but high socio-economic status only) and having pain/discomfort. More relative time in shorter versus longer sedentary bouts was associated with lower overall perceived health and higher odds of pain/discomfort. More relative time in shorter versus longer light-intensity and moderate-intensity bouts, were associated with decreased and increased odds of pain/discomfort, respectively. Finally, more time in shorter versus longer vigorous-intensity physical activity bouts was associated with better perceived health. Conclusions: Children's movement behaviours seem to be related to health-related quality of life. Longitudinal evidence from more diverse samples with 24-h wear protocols and context-specific measures are needed to better understand this association.

Physical activity (PA) is an effective and evidence-based intervention for the promotion of mental health, and prevention and treatment of mental health problems. However, little is known regarding the impact of contextual factors that may optimise the mental health benefits of PA. Contextual factors are the qualitative characteristics of PA that include its type, domain, physical and social environment, and delivery. We conducted an umbrella review of existing systematic reviews and meta-analyses of randomised controlled trials that evaluated the effect of contextual factors of PA on mental health outcomes. A total of 42 reviews were included, and covered the delivery (n = 8), social environment (n = 6), physical environment (n = 7), and type of PA (n = 33). There were no meta-analyses of randomised controlled trials pertaining to the domain of PA. Evidence showed beneficial effects for supervised PA (delivery), PA undertaken inside or outside (physical environment), PA undertaken individually or in groups (social environment), and many types of PA including aerobic and resistance training. This suggests that variations in contextual factors may play a role in enhancing the MH benefits of PA. However, few direct comparisons, and heterogenous control groups, precluded meaningful comparisons across and within contextual factors. Further, greater attention needs to be paid to the systematic testing and reporting of the contextual factors of PA to optimise mental health and wellbeing. (PROSPERO registration: BLINDED FOR REVIEW).

Background: Past Physical Activity Report Cards have indicated a minority of Australian children and young people are sufficiently active. The purpose of this paper is to summarise grades across 10 indicators of the 2022 Australian Physical Activity Report Card, to assess physical activity behaviours and supports. Methods: A development team consisting of research experts synthesised and evaluated national and state level data to inform grades for each indicator. Data were drawn from nationally and state/territory representative datasets spanning 2016¿2021. Results: Overall Physical Activity Levels and Screen Time were both assigned grades of D-, remaining the worst performing indicators. Australia's best performing indicator was Community and the Built Environment (A-), followed by Organised Sport and Physical Activity (B-). Remaining indicators were Family and Peers (C+), School (C+), Strategies and Investments (C-), Active Transport (D-) and Physical Fitness (D-). Active Play was unable to be graded, due to lack of consensus on a primary metric for this indicator and a lack of representative data. Conclusion: Evidence suggests that physical activity levels of Australian children remain consistently low, despite access to and availability of facilities and open spaces. There is a strong need for a National Physical Activity Plan to address this. The theme for the 2022 Australian Physical Activity Report Card, REBOOT! Reimagining physically active lives encourages us all to think more imaginatively about how we might engage all children and young people through diverse physical activity opportunities to be more active.

Introduction: The relationship between physical activity (PA) intensity and executive functions in older adolescents remains poorly understood. This study aimed to examine the associations between PA intensity, volume, attentional control, and working memory and the moderating effects of sex in older adolescents. Method: We analyzed baseline data from 418 participants (211 females, Mage¿=¿16.5 ± 0.40 years) from the Burn 2 Learn trial. Adolescents wore GT9X Link accelerometers on a non-dominant wrist for 7 days, 24-h·d-1. PA intensity was expressed as intensity gradient (IG) and moderate-to-vigorous PA (MVPA, Hildebrand cut-points); PA volume was expressed as average acceleration (AvACC). Attentional control was measured with a standard deviation (SDRT) and a coefficient of variation (CVRT) of the reaction time on the incongruent trials of a flanker task. Working memory was expressed as a d prime (a signal discrimination index) on the 2-back task. The moderating effects of sex on the PA-executive functions associations, adjusting for age, BMI z-score, and cardiorespiratory fitness, were tested using multilevel random intercept models. Results: After controlling for AvACC, sex moderated the relationships between IG and incongruent SDRT (B¿=¿0.53, 95% CI: 0.12, 0.94) and CVRT (B¿=¿0.63, 95% CI: 0.22, 1.05; ps = 0.002). Only girls with higher IG showed smaller incongruent SDRT and CVRT (Bs = -0.26, ps = 0.01). IG was not related to working memory. AvACC and MVPA were not associated with attentional control or working memory. Conclusion: Our findings reveal a novel association between higher-intensity PA and superior attentional control among adolescent girls.

Importance: Childhood obesity is a risk factor associated with type 2 diabetes, cardiovascular disease, and mental disorders later in life. Investigation of the parallel effects of a defined exercise program on cardiometabolic and mental health in children with overweight or obesity may provide new insights on the potential benefits of exercise on overall health. Objective: To investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity. Design, Setting, and Participants: This secondary analysis of a parallel-group randomized clinical trial was conducted in Granada, Spain, from November 1, 2014, to June 30, 2016. Data analyses were performed between February 1, 2020, and July 14, 2022. Children with overweight or obesity aged 8 to 11 years were eligible, and the study was performed in an out-of-school context. Intervention: The exercise program included 3 to 5 sessions/wk (90 min/session) of aerobic plus resistance training for 20 weeks. The wait-list control group continued with their usual routines. Main Outcomes and Measures: Cardiometabolic outcomes as specified in the trial protocol included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipid levels, glucose levels, insulin levels, and blood pressure). Cardiometabolic risk score (z score) was calculated based on age and sex reference values for levels of triglycerides, inverted high-density lipoprotein cholesterol, and glucose, the mean of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators. Results: The 92 participants included in the per-protocol analyses (36 girls [39%] and 56 boys [61%]) had a mean (SD) age of 10.0 (1.1) years. The exercise program reduced the cardiometabolic risk score by approximately 0.38 (95% CI, -0.74 to -0.02) SDs; decreased low-density lipoprotein cholesterol level by -7.00 (95% CI, -14.27 to 0.37) mg/dL (to convert to mmol/L, multiply by 0.0259), body mass index (calculated as weight in kilograms divided by height in meters squared) by -0.59 (95% CI, -1.06 to -0.12), fat mass index by -0.67 (95% CI, -1.01 to -0.33), and visceral adipose tissue by -31.44 (95% CI, -58.99 to -3.90) g; and improved cardiorespiratory fitness by 2.75 (95% CI, 0.22-5.28) laps in the exercise group compared with the control group. No effects were observed on mental health outcomes. Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, an aerobic plus resistance exercise program improved cardiometabolic health in children with overweight or obesity but had no effect on mental health. Trial Registration: ClinicalTrials.gov Identifier: NCT02295072.

Background: Outdoor gym installations have become a popular initiative by local government agencies globally to increase community-based physical activity. Despite their rapid spread, usage rates and user characteristics are not well described, particularly the mode/type of activity performed. This study aims to investigate the proportion and timing of outdoor gym use, and demographic characteristics of gym users across seven locations. Method: The current study employed a cross-sectional research design with observational measures to examine outdoor gym use across seven locations in a large regional area in New South Wales, Australia. An outdoor gym audit including the number of pieces and names of the equipment, and type of outdoor gym was undertaken in the month prior to data collection. Results: A total of 56¿h of observation periods were conducted, during which 2950 individuals were observed moving through the observation target areas. Across all parks, 3.8% of individuals (n = 112) were observed using the outdoor gyms for exercise purposes. Males (65%) were more likely to be observed using the equipment than females (35%) and there were more young-to-middle aged adult (83.9%) users than seniors (6.3%), adolescents (4.5%) and children (3.6%). Conclusion: Outdoor gyms have the potential to influence community-based physical inactivity rates as they appear to be a popular strategy by many government jurisdictions globally. To increase usage, local government agencies would benefit from working collaboratively with researchers to determine effective education and promotion strategies and in developing interventions to increase usage of outdoor gym equipment, particularly among women and older adults.

Background: Pilot/feasibility studies play an important role in the development and refinement of behavioral interventions by providing information about feasibility, acceptability, and potential efficacy. Despite their importance and wide-spread use, the approaches taken by behavioral scientists to scale-up early-stage studies to larger-scale trials has received little attention. The aim of our study was to understand the role that pilot studies play in the development and execution of larger-scale trials. Methods: We conducted interviews with childhood obesity researchers who had published pilot behavioral interventions and larger-scale trials of the same or similar interventions. Questions were asked about the role of pilot studies in developing larger-scale trials and the challenges encountered when scaling-up an intervention based upon pilot findings. Data were coded and analyzed using an inductive analytic approach to identify themes. Results: Twenty-four interventionists (54% women, 37¿70 years old, mean 20 years since terminal degree) completed a total of 148 pilot studies across their careers (mean 6.4, range 1¿20), of which 59% were scaled-up. Scaling was described as resource intensive and pilot work was considered essential to successfully competing for funding by 63% of the sample (n = 15). When asked to define a high-quality pilot study, interventionists described studies that allowed them to evaluate two independent factors: components of their intervention (e.g., acceptability, feasibility) and study parameters (e.g., sample size, measures). Interventionists expressed that more process implementation measures, different study designs, and additional iterations could improve decisions to scale-up. Most agreed that pilot studies were likely to produce inflated estimates of potential efficacy though only nine interventionists provided potential solutions for decreasing inflated measures of efficacy. Suggested major causes of inflated effects included high levels of oversight in pilot studies (e.g., researcher support), reliance on subjective measures, and utilizing convenience or highly motivated samples. Potential solutions included designing pilots for real-world implementation, only conducting randomized controlled pilot studies, and pre-registering pilot studies. Conclusions: Pilot studies purposes are multifaceted and deemed essential to obtaining funding for larger-scale trials. Clarifying the form and function of preliminary, early-stage research may enhance the productive utilization of early-stage studies and reduced drops in efficacy when transitioning to larger scale studies.

Type 2 diabetes mellitus (T2DM) accounts for approximately 90% of diabetes cases globally. Regular physical activity is regarded as one of the key components in T2DM management. Aerobic exercise was traditionally recommended; however, there is a growing body of research examining the independent effect of resistance training (RT) on glycemic control. This systematic review and meta-analysis aimed to conduct an update on the effects of RT on glycosylated hemoglobin (HbA1c) in adults with T2DM and examine the moderating effects of training effect (ie, muscular strength improvements), risk of bias and intervention duration. Peer-reviewed articles published in English were searched across MEDLINE, Embase, CINAHL, Scopus and SPORTDiscus from database inception until January 19, 2021. Each online database was systematically searched for randomized controlled trials reporting on the effects of RT on HbA1c in individuals with T2DM. Twenty studies (n=1172) were included in the meta-analysis. RT significantly reduced HbA1c compared with controls (weighted mean difference=-0.39, 95% CI -0.60 to -0.18, p<0.001, I 2 =69.20). Training effect significantly (p<0.05) moderated the results, with larger improvements in muscular strength leading to greater reductions in HbA1c (ß=-0.99, CI -1.97 to -0.01). Intervention duration and risk of bias did not significantly moderate the effects. As a secondary analysis, this study found no significant differences in HbA1c when comparing RT and aerobic training (p=0.42). This study demonstrates that RT is an effective strategy to decrease HbA1c in individuals with T2DM. Importantly, RT interventions that had a larger training effect appeared more effective in reducing HbA1c, compared with interventions producing medium and small effects. PROSPERO registration number CRD42020134046.

The provision of variety has been posited to influence motivation in physical education. Therefore, the aim of this 3-phase study was to design and evaluate a brief scale to assess ratings of variety-support in physical education. In Phase 1, 20 experts were invited to review the developed items of the Perceived Variety-Support in Physical Education (PVSPE) scale. In Phase 2, factorial validity of item responses was assessed in a sample of adolescents aged 12¿14¿years (n¿=¿265). In Phase 3, test-retest reliability was determined over a one-week period (n¿=¿100). A one-factor model resulted in "good" fit to the data (¿2(21)¿=¿43.265, p <¿0.001, CFI¿=¿0.968, TLI¿=¿0.952, RMSEA¿=¿0.089; factor loading estimates showed that indicators were highly related to the factor (range: 0.60 to 0.93); and ICC was 0.98, 95% CI [0.97 to 0.98]. Our results provide initial evidence for the validity, measurement invariance, and test-retest reliability of scores derived from the VSPE scale for use with adolescents.

The aim of our systematic review and meta-analysis was to quantitatively synthesise the effects of school-based peer-led interventions on leaders' academic, psychosocial, behavioural, and physical outcomes. Eligible studies were those that: (i) evaluated a school-based peer-led intervention using an experimental or quasi-experimental study design, (ii) included an age-matched control or comparison group, and (iii) evaluated the impact of the intervention on one or more leader outcomes. Medline, Sportdiscus, Psychinfo, Embase, and Scopus online databases were searched on the 24th of October, 2022 which yielded 13,572 results, with 31 included in the narrative synthesis and 12 in the meta-analysis. We found large positive effects for leaders' attitudes toward bullying (d = 1.02), small-to-medium positive effects for leaders' literacy (d = 0.39), and small positive effects for leaders' self-esteem (d = 0.18). There were mixed findings for behavioural outcomes and null effects for physical outcomes. Notable limitations of this research are the inclusion of a relatively small number of studies, and high heterogeneity in those included. Our findings have the potential to inform educational practice, but also highlight the need for further research examining the mechanisms that might account for the observed effects. Our systematic review was prospectively registered with PROSPERO (CRD42021273129).

Background: The primary aim of this pilot study was to evaluate the feasibility and preliminary efficacy of a school-based health and well-being program (Health and Well-being for Girls: HWBG) on adolescent girls' well-being, mindfulness, screen-time, and physical activity. Method: The HWBG program was evaluated using a group randomized controlled trial (RCT) in one secondary school. A convenience sample of female students in Grade 8 (mean age 14 ± 0.5 years) was recruited for the study (n=4 classes; 89 girls). The 20-week multi-component HWBG program, guided by Self-Determination Theory and Acceptance and Commitment Therapy, was designed and delivered by a member of the research team. Randomization occurred prior to baseline assessments at the class level (n=4 classes) into dose-matched treatment conditions (i.e., two classes received the HWBG intervention and two classes received an alternate elective course as a wait-list control group). Process evaluation measures of recruitment, retention, adherence, and satisfaction were used to determine program feasibility. This study was designed to assess feasibility (primary outcome) and preliminary efficacy (secondary outcomes), rather than effectiveness. Preliminary efficacy of HWBG for improving mental and social health, screen-time, and physical activity were measured and analyzed using linear mixed-models. Results: "The health and well-being program" targeting adolescent girls was found to be feasible for implementation as an elective course in a secondary school setting. Participants in the HWBG program reported high levels of satisfaction, the majority of lessons (45 out of 50), were implemented as planned and adherence to the planned HWBG program content was very high. Medium positive effects on mental health (d=0.45) and social health (d=0.50) were observed. Small effects were observed for physical activity, and no significant intervention effects were found for levels of recreational screen time. Participant ratings showed high levels of perceived benefit and enjoyment as indicated in the evaluation data (mean rating of 4.44 out of a possible 5.0) when asked whether the program was enjoyable. Conclusion: The study provides preliminary support for HWBG as a potentially feasible and enjoyable program suitable for use with adolescent girls in the secondary school setting. Potential of the study for facilitating improvements in pro-social and psychological well-being is also supported. Trial registration: ACTRN12617000157370. The trial was registered with the Australian New Zealand Clinical Trials Registry.

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

Objectives To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. Design Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. Participants Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. Main outcome measures Peak oxygen consumption (VO 2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. Results Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. Conclusions Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

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.

Background: Adolescents with disability are less active and have lower levels of physical fitness than their typically developing peers. Schools are ideal settings to address this; however, few school-based interventions have been designed and evaluated among this group. Therefore, the aim of this pilot study was to determine the feasibility of a time-efficient school-based physical activity intervention for adolescents with disability. Methods: A non-randomized pilot trial was conducted with adolescents in the special education unit at one secondary school in New South Wales, Australia. Sixteen grade 11 and 12 students (aged 17.3 ± 0.7 years) participated in the 2-month physical activity intervention. Two classroom teachers were trained to facilitate the delivery of a high-intensity interval training (HIIT) program, known as Burn 2 Learn adapted (B2La). Teachers were asked to deliver 2¿3 weekly HIIT sessions for a period of 2 months. Four domains of feasibility (acceptability, implementation, adaptability, and practicality) were assessed using quantitative measures at the student and teacher levels (e.g., observations, process evaluation questionnaires, and heart rate [HR] monitoring). Data were also collected from three learning and support teachers who assisted classroom teachers with intervention delivery. Preliminary efficacy of the intervention on measures of adolescents' functional capacity (6-min walk/run test) and muscular fitness (sit-to-stand test and modified push-up test) were analyzed using paired sample t-tests. Results: Moderate-to-high levels of program satisfaction were reported by both students (80% rated "Good" or "Excellent") and teachers (100% rated "Good" or "Excellent"). Teachers reported delivering 2.5 ± 0.7 sessions per week during the study. Based on researcher session observations, the program was delivered effectively by teachers (14/20). However, HR data indicated session intensity was lower than intended. The program was considered "adaptable" by teachers, with several observed modifications to HIIT sessions to cater for the needs of adolescents with disability. No adverse events were reported. We observed improvements in preliminary efficacy measures. Conclusions: Our findings suggest it is feasible to train teachers to deliver a school-based HIIT program for adolescents with disability. Evaluation of B2La within a larger-scale effectiveness trial is warranted. Trial registration: ACTRN12621000219886.

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 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).

Young people aged 10¿24 years constitute 24% of the world's population; investing in their health could yield a triple benefit¿eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10¿14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. In this Series paper, we present the most up-to-date global evidence on adolescent physical activity and discuss directions for identifying potential solutions to enhance physical activity in the adolescent population. Adolescent physical inactivity probably contributes to key global health problems, including cardiometabolic and mental health disorders, but the evidence is methodologically weak. Evidence-based solutions focus on three key components of the adolescent physical activity system: supportive schools, the social and digital environment, and multipurpose urban environments. Despite an increasing volume of research focused on adolescents, there are still important knowledge gaps, and efforts to improve adolescent physical activity surveillance, research, intervention implementation, and policy development are urgently needed.

Estimations of time spent sedentary and in various physical activity intensities may vary according to data reduction methods applied. This study compared associations between children's accelerometer data and adiposity and fitness markers using open source (mean amplitude deviation, MAD) and proprietary (counts) data reduction methods. Complete-case accelerometer, adiposity (Body Mass Index z-score, waist circumference), and fitness (cardiorespiratory, musculoskeletal) data from 118 children (10.4¿±¿0.6¿years, 49% girls) were analyzed. Estimates of sedentary behavior, light-, moderate-, vigorous- (VPA), and moderate- to vigorous-intensity (MVPA) physical activity were calculated using count- and MAD-based data reduction methods. Linear regression models between time in movement behaviours and fitness and adiposity markers were conducted. Significant differences in estimates of time spent in all intensities were observed between MAD-based and count-based methods. Both methods produced evidence to suggest that sedentary behavior was detrimentally, and physical activity (any intensity) was beneficially, associated with waist circumference. MVPA and VPA were beneficially associated with fitness markers using both data reduction measures. Overall, findings suggest that estimates of sedentary time and physical activity were not comparable. However, the strength and direction of the associations obtained between the different data reduction methods and adiposity and fitness outcomes were fairly comparable, with both methods finding stronger associations for VPA compared to MVPA. This suggests that future studies may be able to pool data using different data reduction approaches when examining associations between activity and health risk factors, albeit with caution.

PURPOSE: The aim of this study was to determine the feasibility of generalist school teachers delivering curriculum connected high-intensity interval training in a school's physical education class time. METHOD: Two schools volunteered to participate. A total of 84 students (11.9¿[0.5] y, M = 64 and F = 19) volunteered to participate. Four classes from 2 schools were randomized to either intervention (n = 53) or control (n = 31) for one school term (8 wk). Intervention class teachers participated in a 1-day workshop instructing them how to deliver twice weekly, high-intensity interval training sessions. The control classes continued with their usual physical education curriculum. Recruitment, intervention fidelity, and program satisfaction were assessed. Preliminary efficacy (primary outcome cardiorespiratory fitness) was quantified using generalized linear mixed models, expressed as effect size. A range of secondary outcomes was also assessed. RESULTS: The recruitment rate was 88%. About 84% of the sessions were delivered. The heart rate peak over all sessions was 89.6%¿(13%) of the predicted maximum. The intervention teachers reported high levels of satisfaction. Almost all student participants were positive about participating. No adverse events occurred. The adjusted between-group difference for cardiorespiratory fitness was trivial (effect size 0.02). CONCLUSIONS: This teacher-delivered high-intensity interval training program was feasible and acceptable to both teachers and student participants. It is therefore potentially scalable.

Background: ecofit is an evidence-based multi-component physical activity intervention that integrates smartphone technology, the outdoor environment, and social support. In a previous efficacy trial, significant improvements were found across several clinical, fitness, and mental health outcomes among adults at risk of (or with) type 2 diabetes. Methods: The aim of the present pilot study was to evaluate a number of patient-centered and feasibility outcomes of the ecofit intervention in a "real-world" setting, using a scalable implementation model. ecofit was adapted and implemented by a rural municipal council in the Upper Hunter Shire, New South Wales, Australia, and evaluated using a single-group pre-post design. Inactive middle-aged and older adults (N=59) were recruited and assessed at 6 (primary time-point) and 20 weeks (follow-up). Results: Improvements were found in this predominantly overweight and obese sample for aerobic fitness, functional mobility, upper and lower body muscular fitness, systolic blood pressure, and waist circumference at 6 weeks. At 20 weeks, effects were found for aerobic fitness, functional mobility, upper and lower body muscular fitness, and systolic blood pressure. Overall, participants were satisfied with the ecofit program. Participants attended the 6-week primary time-point (66.1%) and follow-up at 20 weeks (41.6%). Conclusions: Our findings support the preliminary effectiveness and feasibility of the ecofit intervention delivered by municipal council staff following a brief training from the research team. This study provides valuable preliminary evidence to support a larger implementation trial.

Background: Participation in physical activity supports greater cardiorespiratory fitness (CRF), a correlate of cognitive control. However, the relationship between muscular fitness (MF) and cognitive control is less clear. The present study investigated the differential relationship of CRF and MF with cognitive control in older adolescents. Methods: This cross-sectional study involved students (15¿17 years old, n = 541, 43% female) from 20 secondary schools who completed tests of inhibition (modified flanker task), working memory (n-back task), CRF (Progressive Aerobic Cardiovascular Endurance Run), and MF (standing long jump and push-up test). Multilevel analyses tested the association between CRF or MF and cognitive outcomes while accounting for the influence of the other fitness variable and relevant demographic factors. Results: CRF predicted response accuracy during incongruent flanker trials, the condition requiring greater inhibition. For the working memory task, CRF predicted greater target accuracy and greater d' scores on the 1-back task, requiring lesser amounts of working memory. In the 2-back task, which requires greater amounts of working memory, CRF also predicted greater target and non-target accuracy and d' scores. Comparatively, MF did not predict any cognitive outcomes after adjustment for CRF. Conclusion: CRF was selectively related to better performance during task conditions that require greater amounts of inhibition and working memory. This finding suggests that CRF, but not MF, may benefit cognitive control in older adolescents. This selective influence of CRF on older adolescents' cognition highlights the value of aerobic physical activity.

Background: Physical activity is related to many positive health outcomes, yet activity levels of many children are low. Researchers have suggested that family-based interventions may improve physical activity behaviors of both children and their parents. In this study, we evaluated the "Active 1 + FUN" program, which was designed based on tenets of self-determination theory. Intervention components included free sporting equipment, ten coach-led workshops and activity sessions, and one booster session. Methods: We evaluated the intervention program using a randomized controlled trial. One hundred seventy-one families were randomly allocated to either an experimental group or a wait-list control group. Participants were exposed to program contents over a nine-month period, while families in the control did not receive any form of intervention. Measured constructs included moderate-to-vigorous physical activity, co-physical activity behaviors, fundamental movement skills, BMI, and several self-reported questionnaire outcomes. Hierarchical linear modeling was used to compare changes in measured outcomes across the two groups. Results: No significant intervention effects were found for children's and parents' accelerometer-measured moderate-to-vigorous physical activity, or their co-physical activity. However, in terms of children's fundamental movement skills, a significant Time*Group interaction (B = 0.52, 95% CI [0.07, 0.96] for Times 1 to 2; B = 0.24, 95% CI [0.01, 0.48] for Times 1 to 3) in favor of the experimental group was found. Conclusions: Results suggested that the "Active 1 + FUN" program was effective in improving children's fundamental movement skills. Additional research is needed to examine how family-based initiatives could effectively improve physical activity behaviors too. Trial registration: ANZCTR, ACTRN12618001524280. Registered 11 September 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375660.

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.

Objectives: To determine the impact of bushfires on children's physical activity. Design: Natural experiment comparing device-measured physical activity and air quality index data for schools exposed and not exposed to the Australian bushfires. Methods: Participants were drawn from 22 schools participating in a cluster randomised controlled trial of a school-based physical activity intervention that coincided with the 2019 Australian bushfires. Students in Years 3 and 4 (8¿10 years old) provided data. We used propensity score matching to match 245 exposed and 344 control participants. Main outcome measures: Minutes of moderate and vigorous physical activity. Results: The bushfires had minimal effect on children's average weekly physical activity. Analysis of acute effects showed children maintained their levels of physical activity up to an estimated turning point of air quality index of 737.08 (95% CI = 638.63, 835.53), beyond which daily physical activity levels dropped sharply. Similar results were found for girls and boys and for children from low-to-average and higher socio-economic backgrounds. Conclusions: Children's physical activity was not strongly influenced by the presence of smoke and targeted public health advice during the bushfires might not have had the intended effect of reducing children's outdoor physical activity. Only when air quality deteriorated to approximately 3.5 times the Air Quality index threshold (>200) deemed 'hazardous' by the Australian Department of Health did children's physical activity decline. Public health agencies should re-evaluate the effectiveness of health messages during bushfires and develop strategies to mitigate risks to children's health.

The feasibility requirements of administering field-based cognitive assessments are rarely reported. We examined the feasibility of administering a group-based cognitive test battery in a school setting with older adolescents. Several types of reliability were also assessed in the control group. Preliminary efficacy and the relationship between changes in fitness and changes in cognitive control were also explored following a 14-week HIIT intervention (3 sessions/week). Participants completed a cognitive test battery measuring inhibition (flanker), and working memory (n-back) at baseline and post-test.¿Health-related fitness assessments were also conducted.¿Test administration took approximately 30.8¿±¿1.5¿minutes to complete with up to six participants simultaneously. The test battery demonstrated acceptable reliability (ICC¿=¿0.5¿0.81), with significant changes observed for flanker incongruent accuracy, and 2-back non-target accuracy from baseline to post-test. Regarding efficacy,¿small-to-moderate effects were observed for accuracy outcomes, while several small associations were found between changes in fitness and changes in cognition. Findings from the current study suggest a cognitive test battery can be administered with older adolescents in a school setting. However, there remains a lack of adequate reporting of administration requirements for field-based cognitive assessments. Efficacy findings should be confirmed with a larger and more representative sample of older adolescents.

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.

Objectives: Examining mediators of intervention efficacy in an m-health intervention targeting physical activity and sleep in 160 Australian adults. Design: Nationwide randomised controlled trial. Main outcome measures: Moderate- and vigorous-intensity physical activity (MVPA), assessed using the Active Australia Questionnaire; sleep quality (Pittsburgh Sleep Quality Index); and sleep hygiene practices (Sleep Hygiene Index). Hypothesised psychosocial (e.g. self-efficacy) and behavioural (i.e. MVPA, sleep quality, sleep hygiene) mediators were tested on primary endpoint data at 3 months using bias-corrected bootstrapping (PROCESS 2 for SPSS). All outcomes and mediators were assessed using self-report. Results: At three months, the intervention had significantly improved sleep quality (d = 0.48, 95% CI: -2.26, -0.33, p = 0.009) and sleep hygiene (d = 0.40, 95% CI: -3.10, -0.19, p = 0.027). Differences in MVPA were not significant (d = 0.24, 95% CI: -35.53, 254.67, p = 0.139). Changes in MVPA were mediated by self-efficacy, perceived capability, environment, social support, intentions and planning, some of which showed inconsistent mediation (suppression). None of the hypothesised psychosocial factors mediated sleep outcomes. Changes in sleep hygiene mediated changes in sleep quality. Conclusions: Several psychosocial factors mediated changes in physical activity but not in sleep outcomes. Mediation effects of sleep hygiene on sleep quality highlight the importance of providing evidence-based strategies to improve sleep quality.

The purpose of this study was to assess the feasibility and preliminary efficacy of a high-intensity interval training (HIIT) intervention integrated into the workplace on physical and mental health outcomes in a sample of adults. The Work-HIIT intervention was evaluated at the University of Newcastle (March-July 2019). University employees (18+¿years) who self-identified as predominantly sedentary at work (n¿=¿47, 43.0¿±¿10.7¿years; 41 female) were recruited, screened, and randomized after baseline assessments into Work-HIIT (n¿=¿24) or wait-list control (n¿=¿23) conditions. Participants were asked to attend 2-3 researcher-facilitated HIIT sessions/week (weeks 1-8). Sessions included a 2-minute gross-motor warm-up, followed by various combinations of aerobic and muscular fitness exercises lasting 8¿minutes (using 30:30¿second work: rest intervals). Program feasibility was assessed using measures of satisfaction, compliance, adherence, fidelity, and retention. Physiological and psychological outcomes were measured at baseline and 9¿weeks. Feasibility data were investigated using descriptive statistics and efficacy outcomes determined using linear mixed models and Cohen's d effect sizes. Participant ratings showed high levels of satisfaction (4.6/5); 71% of participants attended =2 sessions/wk and averaged 85.9% HRmax across all sessions (including rest and work intervals). Small-to-medium positive effects resulted for cardiorespiratory fitness [+2.9 laps, 95% CI (-4.19-10.14); d¿=¿0.34] and work productivity [+0.26, d¿=¿0.47]. Large positive effects resulted for muscular fitness [push-ups +3.5, d¿=¿0.95; standing jump +10.1¿cm, d¿=¿1.12]; HIIT self-efficacy [+16.53, d¿=¿1.57]; sleep [weekday +0.76¿hours, d¿=¿1.05]; and autonomous motivation [+0.23, d¿=¿0.76]. This study supports the feasibility and preliminary efficacy of facilitator-led Work-HIIT as a time-efficient, enjoyable, and convenient workplace exercise option for adults.

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory and respiratory systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. CRF is an important marker of physical and mental health and academic achievement in youth. However, only 40% of US youth are currently believed to have healthy CRF. In this statement, we review the physiological principles that determine CRF, the tools that are available to assess CRF, the modifiable and nonmodifiable factors influencing CRF, the association of CRF with markers of health in otherwise healthy youth, and the temporal trends in CRF both in the United States and internationally. Development of a cost-effective CRF measurement process that could readily be incorporated into office visits and in field settings to screen all youth periodically could help identify those at increased risk.

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.

The population of adults living with congenital heart disease (CHD) has grown rapidly in recent decades due to major advances in surgical and medical care. Although the benefits of physical activity (PA) and exercise are well recognised in the management of chronic diseases, the therapeutic role of exercise for the CHD population has been under-studied and under-recognised. In fact, people living with complex CHD have traditionally been advised against participation in moderate or vigorous PA due to safety concerns. However, a small but growing body of literature has demonstrated that PA and exercise are safe and beneficial for the vast majority of people with CHD following appropriate screening. Exercise training (ET) is a potent therapy to improve well-being and cardiorespiratory fitness, which likely has important implications for prognosis. This has led to ET becoming an increasingly important adjunct to medical therapy in the management of this group who frequently have significant exercise limitation and complex medical issues. However, there is currently limited evidence-based guidance that has been published regarding appropriate exercise prescription in adults with CHD. This article aims to provide an overview of different congenital heart conditions, their impact on the exercise response, and to provide considerations and recommendations for ET in adolescents and adults living with CHD based on the available literature.

Purpose To examine the effects of the Self-determined Exercise and Learning For FITness (SELF-FIT) intervention on students' moderate-to-vigorous physical activity (MVPA) and motivation in physical education (PE). Methods In a clustered randomized controlled trial, 667 students (mean age, 14.4 yr; SD, 0.78) from 26 schools (i.e., clusters) were randomized into either an experimental group or a waitlist control group. Students in the experimental group received the SELF-FIT intervention, a school-based intervention designed to infuse fitness and game-like elements into PE using self-determination theory principles, whereas those in the control continued their classes using usual practices. Intervention content was provided by teachers who received training from the research team. The primary outcome was percentage of time spent in MVPA during PE. Secondary outcomes included basic psychological need satisfaction, motivation toward PE, leisure-time MVPA, and mental well-being. Data were analyzed using multilevel regression analyses and prespecified interactions were tested (i.e., group-time-sex). Results Positive intervention effects were found on MVPA during PE (B, 4.00; 95% confidence interval, 2.96-5.04; d = 0.36). Regarding the participants' competence and autonomy need satisfaction, and autonomous motivation, the intervention effects were stronger in girls, compared with boys. Conclusions Fitness infusion and game-like elements, used according to self-determination theory principles, can enhance students' physical activity and motivation toward PE. This low-cost intervention has the potential to be scaled up and disseminated in secondary schools.

Background: To examine the extent to which group-based exercise programs, informed by self-categorisation theory, result in improvements in psychological flourishing and reductions in age- and gender-related stigma consciousness among older adults. Methods: In the study, older adults (N¿=¿485, = 65¿years) were randomised to similar age same gender (SASG), similar age mixed gender (SAMG), or "standard" mixed age mixed gender (MAMG) group-based exercise programs. Flourishing and stigma consciousness were assessed on six occasions during the 24-week intervention and represented secondary trial outcomes. Multilevel growth models examined the effects of the interventions on flourishing and stigma consciousness over time. Results: Participants in the SASG and SAMG conditions demonstrated, on average, higher levels of flourishing, relative to the MAMG condition, over the course of the 24¿weeks (p¿<.05). Additionally, participants demonstrated lower levels of age- and gender-related stigma consciousness in both the SASG and SAMG conditions relative to the MAMG condition (p¿<.05). No time by group interaction effects were observed for either flourishing or stigma consciousness. Conclusions: The results provide some support for the utility of group exercise programs, informed by self-categorisation theory, to enhance psychological flourishing and reduce stigma consciousness among older adults.

Background: The construct of physical literacy is gaining traction internationally and yet measurement of physical literacy is in its infancy. This paper describes the development of a pictorial child report scale of perceived physical literacy based on the comprehensive Australian Physical Literacy Framework, which includes 30 elements within four domains (physical, psychological, cognitive and social). Methods: An expert reference committee with academic and industry representatives from physical education, sport and education was formed to provide input to each stage of the process. Qualitative research methods were used to (a) determine a character that was gender neutral, not representative of a particular race or ethnicity and appealing to children, and (b) the content (i.e. relationship between item images, wording and format with the intended construct) and response processes (i.e. interpretation of items) of the Physical Literacy in Children Questionnaire (PL-C Quest). A total of 17 children aged 4¿12 years were interviewed as part of the study. Results: A 'bunny' character was preferred by children. Overall, children interpreted most images as intended by the researchers, and, in many cases, without having to hear the words that went with the images. Some of the image scenarios were amended and redrawn according to the suggestions received from children and the expert reference group. Discussion: This study has provided qualitative evidence based on the content of the PL-C Quest elements and domains, on the ways respondents understand, and interpret the items. This is the first step towards the development and testing of a pictorial instrument to comprehensively measure children's self-perceived physical literacy.

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.

School-based physical education (PE) provides opportunities to accumulate moderate-to-vigorous physical activity (MVPA), but many students are insufficiently active during PE lessons. Providing teachers with feedback regarding their students' physical activity may increase the effectiveness of PE for achieving MVPA goals, but existing physical activity monitoring technologies have limitations in class environments. Therefore, the purpose of this study was to develop and validate a system capable of providing feedback on PE lesson MVPA. Equations for translating step counts to %MVPA were derived from measures in 492 students who concurrently wore an ActiGraph GT3X+ (ActiGraph) and Yamax pedometer (Yamax) during a PE lesson. To enhance feedback availability during PE lessons, we then developed a bespoke monitoring system using wireless tri-axial pedometers (HMM) and a smart device app. After developing and testing the monitoring system, we assessed its validity and reliability in 100 students during a PE lesson. There was a strong correlation of 0.896 between step counts and accelerometer-determined %MVPA and quantile regression equations showed good validity for translating step counts to %MVPA with a mean absolute difference of 5.3 (95% CI, 4.4-6.2). The physical activity monitoring system was effective at providing %MVPA during PE lessons with a mean difference of 1.6¿±¿7.1 compared with accelerometer-determined %MVPA (7% difference between the two measurement methods). Teachers and students can use a smart device app and wireless pedometers to conveniently obtain feedback during PE lessons. Future studies should determine whether such technologies help teachers to increase physical activity during PE lessons.

Background: The study aim was to examine the mechanisms of physical activity behaviour change in the multi-component eCoFit randomised controlled trial (RCT) among adults diagnosed with, or at risk of, T2D. Method: The RCT included two phases: phase 1 (weeks 1¿10) integrated group sessions (outdoor physical activity and cognitive mentoring) and the use of the eCoFit smartphone application (app), and phase 2 (weeks 11¿20), which included the use of the eCoFit smartphone application only. Participants (n = 84) were assessed at baseline and 10 and 20¿weeks from baseline. Physical activity was assessed using pedometers, and the following mediators were tested: action self-efficacy, barrier self-efficacy, recovery self-efficacy, implementation intentions, intention to have regular physical activity, outcome expectations, risk perception and implicit associations related to physical activity. The PROCESS INDIRECT Macro was used to perform mediation analyses. Results: Significant mediation pathways were found for implementation intention measured at 10¿weeks, AB (95% CI = 486.04 [128.19, 1073.42]). No significant pathways were found for the other social¿cognitive and implicit attitudinal mediators. Conclusion: Increased daily steps among the intervention participants were explained by increased implementation intentions. The eCoFit study successfully operationalised implementation intentions in the smartphone app designed to promote outdoor physical activity. Trial Registration: The trial was approved by a University Human Research Committee and is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000990527).

Objectives: To evaluate the effectiveness of an assessment-based intervention that emphasizes fun, mastery, and support (A + FMS) on primary schoolchildren's fundamental movement skills (FMS), perceptions of physical and movement skill competence, teacher support and enjoyment. Design: Cluster randomized controlled trial. Methods: Ten clusters (classes) (n = 282; mean age 8.4 years, SD 0.56) were randomised to the A + FMS or wait-list control group in a 1:1 ratio. Teachers in the A + FMS group were required to attend six hours of training and integrate 550 min of assessment for learning strategies into their PE lessons for up to a maximum of 13 weeks. FMS competence in jump, skip, hop, overhand throw, dribble and catch was the primary outcome assessed using the Test of Gross Motor Development-3rd Edition. Secondary outcome measures included perceptions of physical and FMS competence, teacher support, and student enjoyment using questionnaires. Multilevel modelling for the analysis of clustered data was used to determine the effectiveness of the intervention. Results: Significant intervention effects were found for locomotor skills (adjusted mean difference, 2.47 units; Cohen's d = 0.76), overall FMS competence (3.72 units; Cohen's d = 0.93) and perceived teacher support (0.21 units; Cohen's d = 0.05). However, there was a group-by-time effect for perceived physical competence (-0.16 units; Cohen's d = -0.07) in favouring of the control group. Conclusions: An assessment-based teacher-led FMS intervention was effective in improving FMS proficiency in primary schoolchildren. The results highlight the need for increased teacher support to develop positive self-perceptions of competence while promoting children's FMS. Trial registration CUHK_CCRB00479.

Background: Evidence suggests that participation in physical activity may support young people's current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects. Objectives: The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2¿5¿years of age), children (6¿11¿years of age) and adolescents (12¿18¿years of age). Methods: A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents. Results: A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6¿18¿years (effect size 0.173, 95% confidence interval 0.106¿0.239, p < 0.001, percentage of total variability attributed to between-study heterogeneity [I2] = 11.3%). When the analyses were performed separately for children and adolescents, the results were significant for adolescents but not for children. Longitudinal and cross-sectional studies demonstrated significant associations between physical activity and lower levels of psychological ill-being (i.e. depression, stress, negative affect, and total psychological distress) and greater psychological well-being (i.e. self-image, satisfaction with life and happiness, and psychological well-being). Furthermore, significant associations were found between greater amounts of sedentary behavior and both increased psychological ill-being (i.e. depression) and lower psychological well-being (i.e. satisfaction with life and happiness) in children and adolescents. Evidence on preschoolers was nearly non-existent. Conclusions: Findings from the meta-analysis suggest that physical activity interventions can improve adolescents' mental health, but additional studies are needed to confirm the effects of physical activity on children's mental health. Findings from observational studies suggest that promoting physical activity and decreasing sedentary behavior might protect mental health in children and adolescents. PROSPERO Registration Number: CRD42017060373.

This study investigated if object control relates to children's game play competence, and examined these competencies as correlates of physical activity and cardiorespiratory fitness. Game play (Game Performance Assessment Instrument), object control (The Test Gross Motor Development-3), moderate-to-vigorous physical activity (Accelerometry), and cardiorespiratory fitness (20-metre shuttle) assessments were completed for 107 children (57% Female, 43% Male) aged 9¿12¿years (M 10.53, SD 0.65). Two-level regression of object control on game play competence, and object control and game play competence on physical activity and cardiorespiratory fitness assessed associations. Object control competence was positively associated with game play competence (Std. B¿=¿0.25, t (104.77)¿=¿2.38, p¿=¿0.001). Game play competence (Std. B¿=¿0.33, t (99.81)¿=¿5.21, p¿<¿0.000) was more strongly associated with moderate-to-vigorous physical activity than object control competence (Std. B¿=¿0.20, t (106.93)¿=¿2.96, p¿=¿0.003). Likewise, game competence (Std. B¿=¿0.39, t (104.41)¿=¿4.36, p¿<¿0.000) was more strongly associated with cardiorespiratory fitness than object control competence (Std. B¿=¿0.22, t (106.69)¿=¿2.63, p¿=¿0.002). Object control and game competence are both important as correlates of physical activity and cardiorespiratory fitness in children.

Introduction: Secondary schools have the potential to promote health-related fitness (HRF) and physical activity within and outside school hours. As such, schools are often chosen as the setting to implement child and adolescent physical activity programs. School-based programs often utilise teachers as delivery agents, but few studies examine effects on teacher-level outcomes. Purpose: The primary aim of this study was to determine the impact of teacher training embedded within a physical activity intervention on teacher-level outcomes. The secondary aim of this study was to evaluate process data, including implementation, satisfaction and fidelity. Methods:Resistance Training for Teens (RT for Teens) was evaluated using a cluster randomised controlled trial in 16 secondary schools. Teachers (N = 44; 48% female/52% male; mean ± SD years teaching experience = 10.6 ± 8.0) from 16 secondary schools were assessed at baseline. Intervention group teachers (i.e. from eight schools) delivered a structured school-based physical activity program over 10-weeks. Teacher outcomes included confidence to teach health-related fitness (HRF) activities, perceived barriers to teaching HRF activities, and perceived fitness. Detailed process evaluation data were also collected. Assessments were conducted at baseline and 6-months (post-program), and outcomes were assessed using repeated measures analysis of variance. Results: There was a positive group-by-time effect for the confidence composite score (p =.010, partial eta squared = 0.29), but no effects for the two (contextual, interpersonal) barrier composite scores. Also, there was a significant effect for perceived 'general fitness' (p = 0.044, partial eta squared = 0.13), but not for specific fitness subdomains. Teachers were highly satisfied with both the training and the program, believing it was beneficial for students. Resource usage and adherence to the SAAFE (Supportive, Active, Autonomous, Fair, Enjoyable) delivery principles was high. Conclusion:RT for Teens improved teachers' confidence and perceived fitness. These findings highlight the potential for high-quality teacher training and program delivery to positively influence teacher-level outcomes. This may provide support for the use of teacher professional development to improve HRF-related pedagogy.

Objectives: While outdoor gyms are being rapidly installed around the globe, little is known about their implications on physical activity, and fitness and other health-related outcomes. The primary objective of this systematic review was to examine the effects of outdoor gyms on physical activity, fitness and other health-related outcomes. Secondary objectives were to describe outdoor gym characteristics, user characteristics, and outdoor gym usage. Design: Systematic review. Methods: Peer-reviewed papers published in English were obtained through online database searches of the following databases; EBSCO, SPORTdiscus, Medline, PsycINFO, Web of Science, Scopus and Informit. Searches covered the periods from database inception to January 2019. Studies that reported on the efficacy of outdoor gym use for physical activity, health-related outcomes or descriptive aspects of outdoor gyms and their users were eligible for inclusion. Results: There was some support that outdoor gyms may improve physical activity, fitness and other health-related outcomes, however few experimental studies have been conducted. There was no consistency between outdoor gyms in terms types and number of installed equipment for each facility. Further, this review found discrepancies of whom were the most likely users of outdoor gyms and when they were mainly used. Conclusions: This review contributes to the limited evidence on the impact and characteristics of outdoor gyms on physical activity and fitness and health-related outcomes.

Associations between fundamental movement skills (FMS), perceived competence, enjoyment and physical activity (PA) have not been widely investigated among Chinese school children. We hypothesised that FMS would be directly related to self-reported and objectively measured PA, and indirectly related to these outcomes via perceived physical and movement skill competence, and enjoyment. Participants were 763 primary school children (age¿=¿9.3¿±¿1.7¿years; 474 girls) across grades. FMS were measured for a subsample (n¿=¿603) using Test of Gross Motor Development-2. PA using accelerometers was obtained from this subgroup (n¿=¿238). All participating children completed a questionnaire measuring their PA participation, enjoyment, and perceived physical and movement skill competence. Structural equation modelling revealed positive associations between locomotor skills and perceived movement skill competence (ß¿=¿.11, 95% CI [.001,.22]), and between perceived movement skill competence and objectively measured PA (ß¿=¿.59, 95% CI [.04, 1.14]). Perceived physical competence and enjoyment mediated the association between locomotor skills and self-reported PA (ß¿=¿.08, 95% CI [.02,.12]), but not objectively measured PA. Given inconsistent findings for subjective and objective measures of PA, further mediation analyses of the association between FMS and PA may be warranted.

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.

Objectives: The aim of the present study was to investigate the effects of specifically designed physical activities on primary school children's foreign language vocabulary learning and attentional performance. Design: A total of 104 children aged between 8 and 10 years were assigned to either (a) an embodied learning condition consisting of task-relevant physical activities, (b) a physical activity condition involving task-irrelevant physical activities, or (c) a control condition consisting of a sedentary teaching style. Within a 2-week teaching program, consisting of four learning sessions, children had to learn 20 foreign language words. Method: Children were tested on their memory performance (cued recall test) after completion of the program and on their focused attention (d2-R test of attention) immediately after one learning session. Results: Linear mixed model analyses revealed both the embodied learning (d = 1.12) and the physical activity condition (d = 0.51) as being more effective in teaching children new words than the control condition. Children's focused attention, however, did not differ between the three conditions. Conclusions: The results are discussed in the light of embodied cognition and cognitive load theory. Implications for the inclusion of specific physical activities during the school day are proposed.

This study aims to explore associations between physical activity intensity and well-being (i.e., positive and negative affect) in adolescents. A secondary aim was to determine if associations were moderated by sex. Grade 8 students from 14 government-funded secondary schools in low socio-economic areas of Western Sydney (Australia) were assessed. Data from three timepoints (baseline, 7¿8 months, and 14¿15 months) were combined to increase the sample size. Physical activity was objectively assessed for 1-week at each timepoint using Actigraph accelerometers. Time (minutes/day) in light, moderate and vigorous physical activity was estimated. The short form Positive and Negative Affect Scale for Children was used to measure well-being. Quantile regression was used to analyse the data. A total of 3140 observations were collected from 1223 students (mean age at baseline: 12.9(0.54); 55.1% male). Light and moderate physical activity was not associated with well-being. Higher levels of vigorous physical activity were associated with more positive affect [ß(SE) = 0.307 (0.06), p < 0.001], to an estimated vigorous physical activity turning point [Point(95%CI) = 36.48 min/day (31.39¿41.59)]. Similarly, higher levels of vigorous physical activity were associated with less negative affect [ß(SE) = -0.250 (0.06), p < 0.001] up to the estimated vigorous physical activity turning point [Point(95%CI) = 37.35 min/day (31.27¿43.44)]. The negative association between vigorous physical activity and negative affect was more pronounced in females than in males. Our findings highlight the importance of adolescents engaging in vigorous physical activity to improve positive affect and reduce negative affect.

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.

High Intensity Interval Training (HIIT) may be effective for accumulating VPA. However, the contribution of HIIT to overall physical activity is unknown. Our primary aim was to explore the impact of school-based HIIT on physical activity. The secondary aim was to explore within-individual changes in physical activity after participating in HIIT. Participants [n = 65; 15.8(0.6)years] were randomized to a HIIT or control group. Intervention groups participated in three HIIT sessions/week. GENEActiv accelerometers assessed objective physical activity at baseline and week-one, to detect changes in MPA and VPA. Intervention effects were examined using linear mixed models and evidence of a change in physical activity (i.e., compensation) were examined using multilevel linear regression models. The group-by-time interaction effects for MPA and VPA were small and moderate, respectively. Adjusted difference between groups for VPA was 1.70 min/day, 95%CI ¿1.96 to 5.36; p = 0.354; d = 0.55). Embedding HIIT within the school-day had a moderate effect on VPA compared to controls. Compensation analyses (i.e., individual level) suggested that adolescents were more active on days when they participated in HIIT. Further studies are needed to test the effects of HIIT on adolescents' physical activity over extended time periods.

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.

Little is known about whether physical activity compensation occurs and, if so, what are potential moderators of such responses. This study examined whether children's physical activity, sedentary time and energy expenditure on one day was associated with these behaviours the following day, and what factors may moderate observed associations. One hundred and twenty-seven children (8¿11¿years) wore an ActiGraph accelerometer for eight days. Time spent in sedentary time and physical activity was obtained. Daily energy expenditure was also assessed using a SenseWear Armband (n=98). Moderators examined were sex, age, BMI, fitness, and fundamental movement skills (FMS). Multilevel analyses were conducted using generalized mixed models. On any given day, every additional 10¿minutes spent in moderate-to-vigorous physical activity (MVPA) was associated with 9.3¿minutes less MVPA the following day. Every additional 10kcal expended on one day was associated with 2.9 fewer kcal expended the following day. Additional time spent sedentary on any given day was associated with less light physical activity the following day in children with lower FMS. The results are largely consistent with the compensation hypothesis, with children appearing to compensate their activity between days. Strategies to minimise potential compensatory changes may be needed for children overall rather than for specific population sub-groups.

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.

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.

This study aimed to examine the contribution of objective measures of physical fitness (musculoskeletal and cardiorespiratory), physical activity, and motor skill to motor perception. A total of 122 children (63 boys) aged 8-11 years were assessed. Independent t-tests assessed sex differences in all variables. Two linear mixed models adjusted for sex and age were performed with perceived object control and locomotor skills (Pictorial Scale of the Perceived Movement Skill Competence for Young Children) as outcomes. Aerobic (multi-stage fitness test) and muscular fitness (long jump, grip strength), moderate-to-vigorous physical activity (ActiGraph accelerometry), movement skill (Test of Gross Motor Development-2), age, and sex were predictors. Boys had higher object control skills (actual and perceived) and fitness. Age (decreasing) and long jump distance (positive) explained 16% of locomotor skill perception variance. Sex (boys) explained 13% of object control skill perception variance. Children's skill selfperception may be influenced by fitness attributes as these are more evident to them. The fact that girls have lower actual object control competence and fitness than boys suggests girls may be an intervention target.

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.

The aim of this study is to examine the prevalence and correlates of adolescents' resistance training (RT) skill competence. Participants were 548 adolescents (14.1¿±¿0.5¿years) from 16 schools in New South Wales, Australia. RT skills were assessed using the Resistance Training Skills Battery. Demographics, BMI, muscular fitness, perceived strength, RT self-efficacy, and motivation for RT were also assessed. The proportion demonstrating "competence" and "near competence" in each of the six RT skills were calculated and sex differences explored. Associations between the combined RT skill score and potential correlates were examined using multi-level linear mixed models. Overall, the prevalence of competence was low (range¿=¿3.3% to 27.9%). Females outperformed males on the squat, lunge and overhead press, whereas males performed better on the push-up (p¿<.05). Significant associations were seen for a number of correlates, which largely differed by sex. Muscular fitness was moderately and positively associated with RT skills among both males (ß¿=¿0.34, 95%CIs¿=¿0.23 to 0.46) and females (ß¿=¿0.36, 95%CIs¿=¿0.23 to 0.48). Our findings support a link between RT skills and muscular fitness. Other associations were statistically significant but small in magnitude, and should therefore be interpreted cautiously.

Objective The present study examined the effect of a school-based multicomponent physical activity intervention on aggression in adolescent males from low-income areas, and explored potential mediators of change in aggression. Methods Participants were adolescent males (N = 361; 12.7 ± 0.5 years) enrolled in the 'Active Teen Leaders Avoiding Screen-time' cluster RCT. Self-report measures for aggression, perceived strength and recreational screen-time were collected at baseline and 8-months. The effect of the intervention on aggression was tested using multi-level linear regression and potential mediators (i.e., screen-time and perceived strength) were explored using a product-of-coefficients test. Results There was no significant intervention effects for aggression (C [SE] = -0.038 [0.044], p =.384) or perceived strength (A [SE] = -0.0 [0.0], p =.884). However, a statistically significant effect was found for screen-time (A [SE] = -0.160 [0.04], p= <0.01). Changes in screen-time significantly mediated changes in aggression at post-test (AB [SE] = -0.021 [0.009], 95% CI = -0.042 to -0.005). Conclusion Limiting recreational screen-time may help to reduce aggression in adolescent boys. Interventions targeting adolescents' recreational screen-time should examine their 'flow-on' effects on externalising behaviours in adolescent populations.

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.

Context The mental health benefits of physical activity are well established. However, less is known about whether the relationship between physical activity and mental health is consistent across different life domains. It is important to understand how context may influence the relationship between physical activity and mental health so that interventions and policy guidelines can be tailored to maximize positive effects. Evidence acquisition In 2015, systematic searches of four databases identified 13,435 records, of which 98 studies met the inclusion criteria. Evidence synthesis Included studies were published between 1988 and 2015 and had a combined sample size of 648,726. Of the 98 included studies, 93 examined leisure-time physical activity, 14 examined work-related physical activity, 15 examined transport physical activity, 16 examined household physical activity, three examined school sport, and three examined physical education. Multi-level meta-analyses showed that leisure-time physical activity (r =0.13) and transport physical activity (r =0.13) both had a positive association with mental health. Leisure-time physical activity (r = ¿0.11) and school sport (r = ¿0.09) both had an inverse association with mental ill-health. However, physical activity was not consistently associated with lower mental ill-health across domains, as work-related physical activity was positively associated with mental ill-health (r =0.09). Household physical activity and participation in physical education had no relationship with mental health or mental ill-health. Conclusions The domain in which physical activity occurs influences the relationship between physical activity and mental health and should, therefore, be considered when developing interventions, treatment programs, and policy guidelines.

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.

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.

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.

The risk and prevalence of Type 2 Diabetes (T2D) has dramatically increased over the past decade. The aim of this study was to develop, implement and evaluate a physical activity intervention to improve aerobic and muscular fitness among adults at risk of, or diagnosed with T2D. A 20-week, assessor blinded, parallel-group randomized controlled trial (RCT) was conducted at the University of Newcastle (June¿December 2015). Adults were randomized to the intervention (n = 42) or wait-list control group (n = 42). The theory-based intervention included: Phase 1 (weeks 1¿10) integrated group sessions (outdoor physical activity and cognitive mentoring), and the eCoFit smartphone application (app). Phase 2 (weeks 11¿20) only included the eCoFit app. Participants were assessed at baseline, 10 weeks and 20 weeks. Linear mixed models (intention-to-treat) were used to determine group-by-time interactions at 10 weeks (primary time-point) and 20 weeks for the primary outcomes. Several secondary outcomes were also assessed. After 10 weeks, significant group-by-time effects were observed for aerobic fitness (4.5 mL/kg/min; 95% CI [1.3, 7.7], d = 0.68) and muscular fitness (lower body) (3.4 reps, 95% CI [2.7, 4.2], d = 1.45). Intervention effects for secondary outcomes included significant increased physical activity (1330 steps/week), improved upper body muscular fitness (5 reps; arm-curl test), improved functionality (- 1.8 s; timed-up and go test) reduced waist circumference (2.8 cm) and systolic blood pressure (- 10.4 mm Hg). After 20 weeks, significant effects were observed for lower body muscular fitness and health outcomes. eCoFit is an innovative lifestyle intervention which integrates smartphone technology, social support, and the outdoor environment to improve aerobic and muscular fitness.

Objective Regular participation in resistance training (RT) is critical to health and recommended in most international physical activity guidelines. Few people, however, participate in RT. The purpose of this review was to assess the demographic, behavioural, intrapersonal, interpersonal and environmental factors associated with participating in RT. Data sources Eligible studies were from English peer-reviewed published articles that examined correlates or determinants of RT in adult samples. Searches were performed from August 2015 to April 2016 in six databases. Results We identified 51 independent data sets, from nine countries, primarily of moderate to high quality, and 23 factors related to participating in RT. Education, perceived health status, quality of life, affective judgements, self-efficacy, intention, self-regulation behaviours, subjective norm and programme leadership were associated with RT. Conclusion Low education levels and poor health status were associated with low participation rates in RT. Intrapersonal factors including affective judgements, self-efficacy, and self-regulation behaviours, and interpersonal factors including subjective norms and programme leadership may be important for promoting RT behaviours.

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.

Objective: The aims of this systematic review and meta-analysis are (i) to determine the impact of school-based interventions on objectively measured physical activity among adolescents and (ii) to examine accelerometer methods and decision rule reporting in previous interventions. Methods: A systematic search was performed to identify randomized controlled trials targeting adolescents (age: =10¿years), conducted in the school setting, and reporting objectively measured physical activity. Random effects meta-analyses were conducted to determine the pooled effects of previous interventions on total and moderate-to-vigorous physical activity. Potential moderators of intervention effects were also explored. Results: Thirteen articles met the inclusion criteria, and twelve were included in the meta-analysis. The pooled effects were small and non-significant for both total physical activity (standardized mean difference¿=¿0.02 [95% confidence interval¿=¿-0.13 to 0.18]) and moderate-to-vigorous physical activity (standardized mean difference¿=¿0.24 [95% confidence interval¿=¿-0.08 to 0.56]). Sample age and accelerometer compliance were significant moderators for total physical activity, with a younger sample and higher compliance associated with larger effects. Conclusion: Previous school-based physical activity interventions targeting adolescents have been largely unsuccessful, particularly for older adolescents. There is a need for more high-quality research using objective monitoring in this population. Future interventions should comply with best-practice recommendations regarding physical activity monitoring protocols.