Exercise as it relates to Disease/Exploring strategies that influence children's physical activity self-efficacy

This is a critique of the research article by Merav Efrat: Exploring Strategies That Influence Children’s Physical Activity, from the contemporary issues in education research journal. This was written as an assignment for the unit Health, Disease and exercise at the University of Canberra.

What is the background to this research
Those who meet the physical activity guidelines during childhood are more likely to continue to meet them throughout adulthood, reducing the likelihood of morbidity and premature mortality. Despite this, only 24% of children aged 6 to 17 years in American schools meet the recommended guidelines. Interventions to improve habitual physical activity participation are necessary for long term adherence. Lack of equipment, minimal free time and poor socioeconomic status present barriers to physical activity in children. Unstructured recreational time (recess/lunch) provides an opportunity to acquire physical activity hours, however, only 33% of boys and 25% of girls spend recess time in moderate to vigorous physical activity.

Physical activity self efficacy (PASA), or the judgements of one's capability to accomplish a certain level of performance, is a strong predictor of school aged physical activity participation. Therefore, interventions should promote methods to enhance PASA through competent adult models (class time education on ways to be more active), and teacher encouragement. The purpose of this study is to compare if teachers encouragement alone, or modelling by a competent adult alone will have a similar impact on children's recess time physical activity self efficacy (RTPASE).

Where is the research from
The author of this study is Merav Efrat, who is an Associate Professor in the Department of Health Science at Cal State University, in North Ridge. She is a reputable researcher in the field of obesity and physical activity in children. This study is a followup to one she conducted in 2013, that used the same interventions, however measured MVPA levels during recess using accelerometer data, finding teachers encouragement more effective than adult modelling. The similarity between the two studies raises the question that do PASA increases matter independent of accelorometer measured behavioral changes. This followup study could be redundant, as she has already conducted a similar study showing objectivly measured increases in MVPA with identical interventions.

What kind of research was this
This study is a cluster randomized controlled trial, where predetermined groups are randomly presccribed an intervention, as opposed to individuals being randomly assigned to a group.

What did the research involve
The fourth grade cohort of three similar suburban Californian schools were each assigned a different intervention -Students were taught active recess games during six of their PE classes -A brief message to the students delivered before recess/lunch encouraging active choices - No intervention
 * Adult modelling (51 students)
 * Teachers encouragement (59 students)
 * Comparison (51 students)

By performing the study as a cluster randomised controlled trial, contamination of data through individuals of different groups interacting is minimised. Change to student lifestyle is also reduced, minisming undesirable behaivor changes. Differences in the schools, however, may impact the results and lead to correlative, but not causative data. Environmental differences (playground equipment, walking tracks, sport facilities), variation in teachers enthusiasm for physical activity, and prior recess time interventions are not accounted for in the data. Specifically, it was stated in the study that the teacher encouragement group already had an intervention in place to encourage students to be more active at recess. Therefore, it is unknown if the results obtained from this study could be replicated in a group without the prior intervention. The study is also only reflective of three schools in a similar region with similar characteristics. To improve the validity of this study, more schools should have been chosen with varying characteristics (teachers enthusiasm, other in place internvetions, environmental differences) and included urban and rural elementary schools to give greater data on factors influencing PASA across America.

Recess time physical activity self efficacy baseline data was collected using a questionnaire from a previously published study. The questionnaire used a 5 point scale from 1 (not confident) to 5 (definitely confident). This provided information on task self efficacy (level of confidence engaging in light, moderate and vigorous levels of PA) and adult encouragement self efficacy (confidence in engaging in PA even if an adult does not encourage them). Other measured barriers include confidence in overcoming personal, social and environmental barriers to physical activity. Practical techniques and demonstrations were implemented to ensure the children understood the questionnaire procedure. Pre and post treatment scores on this questionnaire are then compared across the interventions for this study.

What were the basic results
Encouragement from teachers was more effective at improving RTPASE scores (see figure 1). Children may internalize the encouragement, becoming less reliant on external motivation. The control group shows greater RTPASE scores compared to the adult modelling group, which had the lowest scores. These results are similar to the prior study conducted by Efrat, which found that encouragement was the most effective, and adult modelling least effective, at increasing recess time physical activity levels measured by accelerometer data.



What conclusions can we take from this research
According to this study, PASA sees greatest improvements with teacher encouragement when compared to adult modelling. This implies that a brief message to make active choices before recess is more effective than classtime education on physical activity behavior. Methodologies of the study, however, question the validity of this finding, mainly being that a prior intervention introduced by the school with the teacher encouragement group was not accounted for in the results. Therefore it is unclear if teachers encouragement on its own would yield similar results. Moreover, adult modelling has been shown to be effective, especially when done in the context of when the child will be active, rather than in class. Therefore, the lower scoring of adult modelling in this study is more reflective of weaknesses in the study rather than the intervention.

Further studies should investigate similar interventions, however across more schools in different regions. Other factors such as the influence of season (weather changes), organised sport activities, and the impact other adults such as principles and coaches may have, and how these factors can be manipulated, should be investigated.

Practical advice
Teachers encouragement is an effective strategy for increasing physical activity during recess at school by improving children's confidence in their ability to participate in activity, as demonstrated by this study. A brief, motivating statement right before recess and lunch can allow children to acquire more PA time. Education on physical activity in class, including ways to be more active during recess and lunch can also motivate students to be more active.Modifications to the environment and playground equipment to increase opportunities for physical activity can also be implemented. By improving physical activity self efficacy, long term adherence may increase through to adulthood based on the habits developed in early childhood.