Implementation of physical activity interventions for children and young people with intellectual and developmental disabilities: an international modified Delphi study

Aims Children and adolescents with cerebral palsy (CP) are at heightened risk for mental health problems. Physical activity is an effective strategy to promote quality of life (QoL) and reduce mental health symptoms along with evidence-based therapies. This study described existing literature examining the mental health outcomes (e.g., QoL, well-being, anxiety, and depression) of physical activity interventions in children and adolescents with CP to help inform the implementation of physical activity interventions for this population. Methods Ascoping review framework was used to map the existing quantitative literature. Results The search returned 243 articles; after titles, abstracts, and full manuscripts were reviewed, 21 articles were included. The association between physical activity and QoL was examined in most studies (n = 17) with mixed findings. Eight studies documented at least one significant positive association between physical activity and QoL, and four found that physical activity interventions were highly enjoyable. Only one study assessed anxiety and/or depression following a PA intervention. Conclusions Physical activity may benefit aspects of QoL and mental health symptoms; however, this was not a consistent finding in the existing literature. Along with other therapies, physical activity interventions may be valuable in improving QoL, and in turn, the mental health symptoms of children with CP.

The effects of regular physical activity on energy intake in obese adolescents are unknown. The objective is to determine how physical activity interventions affect energy and macronutrient intake in overweight/obese youth. Databases were searched from December 2014 to December 2015 for studies that measured energy and/or macronutrient consumption in response to physical activity intervention in overweight/obese youth. The review comprises primary source articles published in English in peer-reviewed journals. Articles that presented data on energy and/or macronutrient intake before and after a physical activity intervention (without dietary restriction) in overweight or obese children and teenagers (up to 18 years old) were included. Of the initial 307 references found, nine were included. The nine included studies analysed the effect of 15 different physical activity interventions. Nine showed a decrease and six unchanged energy intakes. The effect size for total energy intake ranged from -2.108 to -0.207 (n = 14). Results of the meta-analysis revealed a mean effect of physical intervention to reduce intake of -1.003 (95% confidence interval = -1.261 to -0.745, p < 0.001). Results for heterogeneity among these studies were I2 = 67.421; Q = 39.903; df = 13, p < 0.001. The mean energy intake reduction was -323 ± 286 kcal. Macronutrient intake was assessed in 11 interventions. Protein intake was found decreased in five (reduction of -26.8 ± 19.2 g), seven reported fat decrease (reduction of -26.4 ± 17.8 g) and five a decrease in CHO (reduction of -72.5 ± 22.8 g). The meta-analysis revealed significant decreases of each macronutrient (p < 0.001). Structured physical activity interventions favour decreased daily energy intake in obese adolescents.

Part of the Physical Activity Intervention Series, Physical Activity Interventions in Children and Adolescents provides information on current levels of youth physical activity and presents a basic understanding of the issues associated with it. The book offers a clear and reader-friendly overview of theories of behavior change that have been used in developing physical activity interventions in a variety of settings and methods for program evaluation. Specific recommendations for physical activity from various professional and health organizations are included as well. The book also provides – descriptive epidemiology of youth physical activity that helps identify the changes in activity as children age; – insights into the potential role of the family and the community in providing physical activity opportunities for youth; – guidance for the development of collaborative relationships among agencies and organizations to promote physical activity in the community; and – a review of available instruments for measuring physical activity in youth populations, including self-report instruments and step counters. Practical application of the information covered in Physical Activity Interventions in Children and Adolescents is demonstrated through real-world interventions that have been implemented in various settings. The programs were selected based on their demonstrated effectiveness, potential for success, or unique features. Strengths and weaknesses of each intervention are highlighted. In addition to the presentation of existing programs, guidelines for the development of new programs are presented. Sample worksheets serve as valuable tools in evaluating and designing interventions in areas where proven programs are not yet available. The text follows a three-part progression. Part I provides an orientation to activity in young people, describing how to change behavior and introducing the settings in which such behavior change programs might be developed. In Part II, documented interventions are examined for programs in schools, community organizations, and home and health care settings. Part III explores intervention design, assisting those who want to design their own interventions for specific populations. Descriptions of program evaluation, including useful measurement instruments, are detailed as well.

Status and Potential of Community-Engaged Research to Investigate Physical Activity Interventions for Children with Autism Spectrum Disorder in Chinese-American Communities

Dropout from physical activity interventions in children and adolescents with attention deficit hyperactivity disorder: A systematic review and meta-analysis

Little is known about the factors that influence implementation of physical activity interventions undertaken in youth-serving settings, and this lack of information impedes the development of effective implementation strategies. This study convened a panel of experts to identify factors that are most important in achieving successful implementation of physical activity interventions in youth-serving organizations. Five recognized experts participated in a four-round, modified Delphi consensus process. The panelists were asked to achieve consensus on a list of potential factors that are most important in predicting successful implementation and on the descriptions of these factors. They also provided estimates regarding the individual contributions each of the identified factors make in predicting a successful implementation. These estimates were then translated into Bayesian predictive models for factor selection. The expert panel achieved consensus on 23 factors. Results from the factor selection procedures indicated that a final model containing 15 factors yielded the greatest contributions in predicting successful implementation of youth physical activity interventions. In this final model, five factors were classified as organizational characteristics, six factors as implementation processes, two factors as provider characteristics, and two factors as program characteristics and community-level factors, respectively. In conclusion, this is the first study to identify factors that are important in achieving a successful implementation of youth physical activity interventions through systemically gathering information from a panel of experts. The 15 factors identified in this study provide important information to inform implementation planning and evaluation of future interventions.

IntroductionChildren with juvenile arthritis (JA) experience pain, stiffness, fatigue, and decreased motion leading to difficulties with daily activities and low physical activity (PA). PA is critical to improve health and function and mitigate JA-associated symptoms. This study evaluated the evidence for PA interventions in children with JA.Materials and MethodsA systematic review of randomized controlled trials (RCTs) of PA interventions in children with JA was conducted. Ovid (Medline), Cochrane Library, EMBASE, and CINAHL databases were searched for papers published in English between 1/1/1946 and 9/1/2021. Studies which concurrently assessed medical interventions were excluded. Participant and intervention characteristics and outcomes were extracted. Study internal validity and intervention attributes were assessed.ResultsA total of 555 studies were identified, with 13 studies from 10 countries included. Data from 672 children diagnosed with juvenile idiopathic arthritis (JIA) (range of mean ages, 8.7 to 16.1 years) were analyzed. Fifty-two percent of intervention arms incorporated strengthening exercise alone or combined with other exercise, with 61.9% performed 3x/week. About 43.5% of sessions lasted >45 to ≤60 minutes and 65.2% of programs were ≥12 to <28 weeks. PA interventions improved function and symptoms without adverse events. Intervention details were missing especially regarding PA intensity, reasons for dropouts, and adherence. Only two studies incorporated strategies to promote adherence.DiscussionRCTs of PA interventions in JA only include JIA. Available RCTs used mixed modes of interventions. Reporting of PA interventions lacks sufficient detail to discern the dose-response relationship. Strategies to motivate engagement in PA and to support families to promote PA are lacking, as are studies of long-term outcomes.ConclusionThere are limited RCTs of PA interventions in JIA. Adherence was better with low intensity programs. PA interventions for JIA yield positive health benefits but better reporting of PA intervention details is needed to generate more high-quality evidence and inform clinical practice.Prospero RegistrationMaura Iversen, Johan von Heideken, Marie Andre. Physical Activity in Children with Rheumatic Diseases: a systematic review. PROSPERO 2021 CRD42021274634 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021274634.

Evaluation of physical activity interventions in children via the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework: A systematic review of randomized and non-randomized trials

Rx Exercise: Physical Activity Is Good Medicine

Physical Activity Interventions Improve Quality of Life of Children With Obesity: Should We Expect Them to Also Decrease Body Mass Index?

BackgroundPeople with severe mental illness (SMI) often suffer from long-lasting symptoms that negatively influence their social functioning, their ability to live a meaningful life, and participation in society. Interventions aimed at increasing physical activity can improve social functioning, but people with SMI experience multiple barriers to becoming physically active. Besides, the implementation of physical activity interventions in day-to-day practice is difficult. In this study, we aim to evaluate the effectiveness and implementation of a physical activity intervention to improve social functioning, mental and physical health.MethodsIn this pragmatic stepped wedge cluster randomized controlled trial we aim to include 100 people with SMI and their mental health workers from a supported housing organization. The intervention focuses on increasing physical activity by implementing group sports activities, active guidance meetings, and a serious game to set physical activity goals. We aim to decrease barriers to physical activity through active involvement of the mental health workers, lifestyle courses, and a medication review. Participating locations will be divided into four clusters and randomization will decide the start of the intervention. The primary outcome is social functioning. Secondary outcomes are quality of life, symptom severity, physical activity, cardiometabolic risk factors, cardiorespiratory fitness, and movement disturbances with specific attention to postural adjustment and movement sequencing in gait. In addition, we will assess the implementation by conducting semi-structured interviews with location managers and mental health workers and analyze them by direct content analysis.DiscussionThis trial is innovative since it aims to improve social functioning in people with SMI through a physical activity intervention which aims to lower barriers to becoming physically active in a real-life setting. The strength of this trial is that we will also evaluate the implementation of the intervention. Limitations of this study are the risk of poor implementation of the intervention, and bias due to the inclusion of a medication review in the intervention that might impact outcomes.Trial registrationThis trial was registered prospectively in The Netherlands Trial Register (NTR) as NTR NL9163 on December 20, 2020. As the The Netherlands Trial Register is no longer available, the trial can now be found in the International Clinical Trial Registry Platform via: https://trialsearch.who.int/Trial2.aspx?TrialID=NL9163.

AimsTo synthesize evidence from randomized and non-randomized studies of physical activity interventions in children and young people with Type 1 diabetes so as to explore clinically relevant health outcomes and inform the promotion of physical activity.MethodWe conducted a search of CINAHL Plus, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, SCOPUS, SportDiscus and Web of Science between October and December 2012. Eligible articles included subjects aged ≤18 years with Type 1 diabetes and a physical activity intervention that was more than a one-off activity session. Physiological, psychological, behavioural or social outcomes were those of interest.ResultsA total of 26 articles (10 randomized and 16 non-randomized studies), published in the period 1964–2012, were reviewed. Although there was heterogeneity in study design, methods and reporting, 23 articles reported at least one significant beneficial health outcome at follow-up. Meta-analyses of these studies showed potential benefits of physical activity on HbA1c (11 studies, 345 participants, standardized mean difference -0.52, 95% CI -0.97 to -0.07; P = 0.02), BMI (four studies, 195 participants, standardized mean difference -0.41, 95% CI -0.70 to -0.12; P = 0.006) and triglycerides (five studies, 206 participants, standardized mean difference -0.70, 95% CI -1.25 to -0.14; P = 0.01).The largest effect size was for total cholesterol (five studies, 206 participants, standardized mean difference -0.91, 95% CI -1.66 to -0.17; P = 0.02).ConclusionsPhysical activity is important for diabetes management and has the potential to delay cardiovascular disease, but there is a lack of studies that are underpinned by psychological behaviour change theory, promoting sustained physical activity and exploring psychological outcomes. There remains a lack of knowledge of how to promote physical activity in people with Type 1 diabetes.

Creativity outcomes of physical activity interventions for children and adolescents: A systematic review

Children with developmental disabilities often face barriers to engaging in physical activity (PA), impacting their health and quality of life. Parent-mediated interventions (PMIs) have shown promise to reduce these barriers, but little research explores online PMIs for parents of children with developmental disabilities. Thus, the purpose of this study was to assess the feasibility and impact of a multi-site collaborative online parent-mediated PA intervention on stress levels and self-efficacy among parents of children with developmental disabilities over a 12-week period. Participants (n=55) were parents of children with developmental disabilities, randomly assigned to intervention (n=27) or control (n=28) groups. Recruitment rate was 58%, with an 80% retention rate. The feasibility of online delivery was demonstrated, allowing participation from various locations. An analyses of covariance (ANCOVA) with parental sex and education level as covariates revealed no significant interaction effect between group and time for parenting self-efficacy score (PSE), F(1, 104)=0.118, P=0.732, or PSI, F(1, 104)=0.196, P=0.659. The mean PSI difference (pre-post) was -0.38 (CI: -10.57 to 9.80) for the experimental group and 2.64 (CI: -9.61 to 14.91) for the control group, while the mean PSE difference was -4.41 (CI: -29.33 to 20.49) and 4.75 (CI: -23.22 to 32.73), respectively. Future research should explore the integration of hybrid PMIs in conjunction with qualitative measures to facilitate a deeper understanding of the multifaceted factors influencing parental engagement in PA interventions for children with developmental disabilities.

Children with Autism Spectrum Disorder (ASD) commonly have difficulties with executive function abilities and motor skills that might complicate their learning. Literatures have shown on the possible role of physical activity to intervene the effects on the executive functions and motor skills. The present study is proposed to examine the executive functions (EF) and motor skills (MS) of children with ASD, and the possible role of physical activity intervention to affect the EF and MS of children with ASD. The relevant domains of EF which include working memory, planning, inhibition and cognitive flexibility will be examined and compared between children with ASD who receive the physical activity intervention and those who do not. In addition, differences in gross motor skills will be compared between children with ASD who receive the physical activity intervention and those who do not. The data will be collected from children with ASD from the Department of Special Education under Ministry of Education Malaysia and Special Needs NGO centres in Selangor and Klang Valley, Malaysia (N=60). The children with the age range of 6-10 years old, bilingual in English and Malay and able to participate in physical activity or physical education class age range 6-10 years old will be targeted. All participants will be randomly and equally assigned into an experimental and a control group. The pre-intervention scores of executive functions will be obtained for both groups based on the Colour-Word Interference Test, Tower of Hanoi task and Number-Letter Sequencing Test. The scores of gross motor skills will be obtained from the Test of Gross Motor Development (TGMD-2). Then, the children in the experimental group will receive the physical activity intervention which is 15-20 minutes of jogging that will be conducted twice a week for a 12 weeks period. Meanwhile, the children in the control group will be shown an exercise-related video for the same duration. After 12 weeks, the post-intervention scores for the executive functions and motor skills will be recorded again for both groups. Statistical analyses testing the effect of physical activity on EF will be conducted separately by using a 2 (Group: experimental vs control) x2 (time: pre-test vs post- test) mixed ANOVA and testing the effect of physical activity on MS will be conducted by using a 2 (Group: experimental vs control) x2 (time: pre-test vs post- test) mixed ANOVA as well. It is expected that children with ASD who undergo physical activity intervention will demonstrate significant increase in the executive function scores and motor skills scores compared to those who do not undergo the physical activity intervention. The study is expected to add to the current literatures on understanding the potential role of physical activity intervention for children with ASD in improving their executive function and gross motor skills and mechanisms to optimise their learning experience. &#x0D; &#x0D; Keywords: Executive function, motor skills, physical activity intervention, ASD, children.