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Objective - Accelerometer

791. Physical activity outcomes in afterschool programs: A group randomized controlled trial

Research Article
Michael W. Beets, R. Glenn Weaver, Gabrielle Turner-McGrievy, Jennifer Huberty, Dianne S. Ward, Russell R. Pate, Darcy Freedman, Brent Hutto, Justin B. Moore, Matteo Bottai, Jessica Chandler, Keith Brazendale, Aaron Beighle
September 2016

Commentary by Dr Jordan Smith, The University of Newcastle, Australia

After-school programs (ASPs) are delivered to millions of children in the United States throughout the school year. ASPs are often delivered every weekday for up to three hours at a time, and can therefore contribute significantly to children’s regular physical activity. Indeed, current standards dictate that all children attending ASPs accrue at least 30 minutes of moderate-to-vigorous physical activity (MVPA), which is half of the recommended daily total. Despite demonstrating promise, many ASPs fail to meet these standards, with insufficient staff training and high turnover being identified as barriers to success. This article describes the two year findings of an intervention delivered in 20 ASPs in the United States - the ‘Making Healthy Eating and Physical Activity Policy Practice’ trial. This is an interesting and novel trial which highlights both the potential of and inherent challenges in promoting physical activity within ASP settings.

Eligible ASPs were delivered in school, community or faith settings, served at least 30 children, and operated every day of the school year for at least 2 hours each day. The intervention was evaluated using a delayed group randomized controlled trial design. The ‘delayed’ group acted as a comparison group for the first year and received the intervention afterwards, whereas the ‘immediate’ group received two years of intervention over the entire study period. Physical activity was measured objectively using accelerometers.

To improve the proportion of children meeting the 30 min/day MVPA policy target the research team worked with site leaders to ensure they regularly scheduled PA opportunities and provided clear directions to frontline staff. In addition, ASP staff were trained in the LET US Play (Lines, Elimination, Team size, Uninvolved staff/children, Space, equipment, rules) principles, designed to maximize physical activity participation through effective modification of common games and activities. The trainings were provided once each year, and were supplemented with a number of booster sessions.

Overall, there were mixed findings. Boys in the ‘immediate’ group were significantly more likely to meet the 30 min/day MVPA standard after the first year, which was sustained at two years. Conversely, girls experienced initial improvements in meeting the standard, but these gains were not maintained long term. The opposite was found for the ‘delayed’ group, with girls achieving greater improvements than boys. Mixed findings for changes in MVPA and sedentary time were also reported.

Of interest, the authors note the substantial variability in findings between individual ASPs. For example, some ASPs continued to improve each year, whereas some experienced only short-term improvements. Other ASPs remained more or less stable from the outset, and some demonstrated poorer PA outcomes despite receiving the intervention. This study presented some encouraging findings and supports ASPs as worthwhile settings for PA promotion. However, it also highlights some ongoing challenges. For example, physical activity change among girls was not as large as for boys, which is both an unfortunate a consistent finding within the literature. In addition, the variability in outcomes between ASPs further demonstrates the need to investigate why interventions work in some settings and not others, despite the existence of common policies and procedures and the same exposure to intervention strategies.

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