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This is an analysis of the journal article "Implementation of a school environment intervention to increase physical activity in high school girls" by Epping, Felton, Pate, Ward and Williams (2006).

What is the background to this research?
Physical inactivity is a major risk facto disease not only in Australia but globally as well (reference). Participating in physical activity is a significant buffer against obesity and being overweight, which is a leading contributor to disease worldwide (reference). Furthermore, physical inactivity is a large contributor to health outcomes such as type II diabetes, cardiovascular disease and some cancers (reference), which are among some of the leading causes of mortality and morbidity in Australia (reference).

Leading a physically active lifestyle is not only crucial in regards to preventing against disease. but it is also important management and treatment strategy for disease. Physical activity not only increases physical health but mental wellbeing as well, thus also increasing overall quality of life (reference).

Physical inactivity is prevalent in adults however physical activity levels begin to decline in childhood and continue to decline through adolescence. Furthermore, the levels of physical inactivity are continuing to increase among adolescence throughout the years, with girls at all ages participating in less physical activity than boys. In addition, female high school students are less likely to participate in school sports teams and are less likely to elect to participate in physical education classes that are not mandatory (reference). Female high school students also generally report greater negative attitudes and beliefs towards physical education (reference).

Around 95% of the young population attend schools in first world countries (reference) therefore, schools have the potential to provide the "perfect" setting to develop and maintain a physically active lifestyle in school ages girls. Thus, this idea is investigated by Epping, Felton, Pate, Ward and Williams in this article.

Where is the research from?
The research from this study was undertaken by the following departments from these universities:


 * University of North Carolina
 * Department of Nutrition
 * University of South Carolina
 * Department of Health, Promotion, Education and Behaviour
 * College of Nursing
 * Department of Exercise Science

Furthermore the research data was collected from twenty-four high schools across the state of South Carolina.

What kind of research is this?
This study is a comprehensive school-based intervention study. Intervention studies involve exposing one group, known as the 'intervention group' to a condition and a second group known as the 'control group' to no condition or intervention. In addition this study also included the use of documentation, surveys as well as self reporting data regarding the implementation of the "Lifestyle Education for Activity Program" (LEAP).

Intervention studies can be an effective way of identifying key true differences between the intervention and control groups, however intervention based studies possess some limitations. For example, due to the long duration (of >2years) of this intervention compliance could be reduced as time progresses. Thus, has the potential to negatively impact the results and potentially not display the true results of the intervention.

What did the research involve?
This study involved the participation of twenty-four high schools across the state of South Carolina. These schools were matched based on their size and other contributing demographics, in order to allow for the schools to be compared against each other. From the twenty-four schools, twelve schools were randomly assigned to the intervention group and the remaining schools to the control group. The twelve within the intervention group were exposed to LEAP and the twelve schools in the control group received no intervention. The intervention was conducted over a period greater than two years across two different cohorts of ninth grade girls.

The intervention model took a facilitated model approach, rather than directed changes model in the participating schools, unlike most research in this area (reference). The LEAP intervention focused on changing personal, social and environmental factors that could increase physical activity levels as well as a program of physical activities set in gender-sensitive PE programs. The intervention involved providing educational information to teacher, families and the female students as well as different strategies to improve physical activity levels.

During the intervention LEAP staff were required to document throughout the intervention. This documentation included reporting orientation and training, communication information to classes and families, as well as PE activities and logs. Then as a part of the interventions evaluation at the end of the program, teachers were required to fill out a survey which reported the teachers opinions on how well they believed their school implemented the intervention and to identify any barriers they might have experienced throughout the intervention. There are potential issues regarding the survey conducted, as it is a subjective method of appraisal rather than a quantitative results. Furthermore, there could be issues regarding the re-call ability of the reporting teaching, thus potentially impacting the results collected. However, due to the large scale of the intervention both in duration and size surveys are an effective way to collect lots of data from a range of participants.

What were the basic results?
Results across the twelve intervention groups include:


 * 83% made changes to ensure PE was more enjoyable and fun
 * 75% made changes to the structure of their PE classes, resulting in female only classes
 * 80% had an increase in participation in PE classes
 * All schools reported the use of media messages to encourage physical activity such as physical activity school accountments
 * 75% of the instructional elements of the LEAP were implemented

Due to these changes and the implementation of LEAP the intervention was found to be successful. Due to an increase in the number of girls participating in an average of 1 or more 30 minute blocks of vigorous physical activity. This number increased to 45% in the intervention group compared to only 36% of girls in the control group reaching this same level of physical activity. However, only 50% of the schools in the study reported that they employed the components of LEAP consistently throughout the entire study period. Therefore, proposing the question that if all schools consistently employed the LEAP then these numbers have the potential to be higher thus possessing a greater impact on the health of the female students.

What conclusions can we take from this research?
This research enhances our understanding of different instructional and environmental components that we can implement in order to successively increase our physical activity levels in this population. It also further increases our understanding of the barriers that limit female students in reaching the necessary physical activity guidelines (reference).

This study takes a facilitated approach to the implementation of the program which was particularly successful in this study. However more research is needed in this area in order to be able to compare if this approach is more effective than traditional approaches such as a direct changes approach at increasing physical activity levels (reference).

In addition, this study takes a multi-faceted approach in the implementation of the program which is an effective health promotion strategy (reference). As it involves many different individuals and components working together to produce better health outcome (reference). Furthermore, multi-faceted health promotion approaches are more commonly implemented within health research and promotion (reference).

Lastly, the study had an issue with compliance, with only 50% of schools implementing LEAP consistently throughout the entire study (reference). This could be due to the numerous components which make it difficult to implement all strategies, due to the sheer number (reference). Therefore, a simpler approach could produce better outcomes, increasing the physical activity levels of more students (reference).

Practical advice
According to the authors alternating the structure of the typical PE classes is a crucial aspect to increasing physical activity levels in female high school students. These can include be inclusive, specifically addressing the needs and interest of the students when determining what physical activity they will engage in. Furthermore having the option of female only PE classes is suggested by the authors. Also when attempting to increase physical activity levels schools should take a multi-faceted approach, integrating multiple school components (e.g. families, PE classes, health education) in order to effectively increase physical activity. Lastly, it is suggested that schools specifically address the barriers experienced female students as identified by the students in order to successively overcome these and increase physical activity within this specific population.

Furthermore information and resources
For further information regarding this topic read below:


 * Physical inactivity risks and burden on society:
 * Barriers to overcoming exercise and different strategies to increase physical activity in women across all ages:
 * Considerations for program design for females: