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Background UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies all components of a whole-school PA approach. The study’s aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA). Methodology Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder ( n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed ( n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one ‘initial’ framework. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire. Results Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers’ capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA. Summary To the authors’ knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

Physical activity tracking wearable devices have emerged as an increasingly popular method for consumers to assess their daily activity and calories expended. However, whether these wearable devices are valid at different levels of exercise intensity is unknown. The objective of this study was to examine heart rate (HR) and energy expenditure (EE) validity of 3 popular wrist-worn activity monitors at different exercise intensities. A total of 62 participants (females: 58%, 36/62; nonwhite: 47% [13/62 Hispanic, 8/62 Asian, 7/62 black/ African American, 1/62 other]) wore the Apple Watch, Fitbit Charge HR, and Garmin Forerunner 225. Validity was assessed using 2 criterion devices: HR chest strap and a metabolic cart. Participants completed a 10-minute seated baseline assessment; separate 4-minute stages of light-, moderate-, and vigorous-intensity treadmill exercises; and a 10-minute seated recovery period. Data from devices were compared with each criterion via two-way repeated-measures analysis of variance and Bland-Altman analysis. Differences are expressed in mean absolute percentage error (MAPE). For the Apple Watch, HR MAPE was between 1.14% and 6.70%. HR was not significantly different at the start (P=.78), during baseline (P=.76), or vigorous intensity (P=.84); lower HR readings were measured during light intensity (P=.03), moderate intensity (P=.001), and recovery (P=.004). EE MAPE was between 14.07% and 210.84%. The device measured higher EE at all stages (P<.01). For the Fitbit device, the HR MAPE was between 2.38% and 16.99%. HR was not significantly different at the start (P=.67) or during moderate intensity (P=.34); lower HR readings were measured during baseline, vigorous intensity, and recovery (P<.001) and higher HR during light intensity (P<.001). EE MAPE was between 16.85% and 84.98%. The device measured higher EE at baseline (P=.003), light intensity (P<.001), and moderate intensity (P=.001). EE was not significantly different at vigorous (P=.70) or recovery (P=.10). For Garmin Forerunner 225, HR MAPE was between 7.87% and 24.38%. HR was not significantly different at vigorous intensity (P=.35). The device measured higher HR readings at start, baseline, light intensity, moderate intensity (P<.001), and recovery (P=.04). EE MAPE was between 30.77% and 155.05%. The device measured higher EE at all stages (P<.001). This study provides one of the first validation assessments for the Fitbit Charge HR, Apple Watch, and Garmin Forerunner 225. An advantage and novel approach of the study is the examination of HR and EE at specific physical activity intensities. Establishing validity of wearable devices is of particular interest as these devices are being used in weight loss interventions and could impact findings. Future research should investigate why differences between exercise intensities and the devices exist.

Background Few whole-school physical activity programmes integrate implementation science frameworks within the design, delivery, and evaluation. As a result, knowledge of the key factors that support implementation at scale is lacking. The Creating Active Schools (CAS) programme was co-designed and is underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Consolidated Framework for Implementation Research (CFIR). The study aims to understand the initial impact and implementation of CAS in Bradford over 9 months using McKay’s et al.’s (2019) implementation evaluation roadmap. Methods Focus groups and interviews were conducted with school staff (n = 30, schools = 25), CAS Champions (n = 9), and the CAS strategic lead (n = 1). Qualitative data were analysed both inductively and deductively. The deductive analysis involved coding data into a priori themes based on McKay et al’s implementation evaluation roadmap, using a codebook approach to thematic analysis. The inductive analysis included producing initial codes and reviewing themes before finalising. Results Identified themes aligned into three categories: (i) key ingredients for successful adoption and implementation of CAS, (ii) CAS implementation: challenges and solutions, and (iv) the perceived effectiveness of CAS at the school level. This included the willingness of schools to adopt and implement whole-school approaches when they are perceived as high quality and aligned with current school values. The programme implementation processes were seen as supportive; schools identified and valued the step-change approach to implementing CAS long-term. Formal and informal communities of practice provided “safe spaces” for cross-school support. Conversely, challenges persisted with gaining broader reach within schools, school staff’s self-competence and shifting school culture around physical activity. This resulted in varied uptake between and within schools. Conclusions This study provides novel insights into the implementation of CAS, with outcomes aligning to the adoption, reach, and sustainability. Successful implementation of CAS was underpinned by determinants including acceptability, intervention complexity, school culture and school stakeholders’ perceived self-efficacy. The combination of McKay’s evaluation roadmap and CFIR establishes a rigorous approach for evaluating activity promotion programmes underpinned by behavioural and implementation science. Resultantly this study offers originality and progression in understanding the implementation and effectiveness of whole-school approaches to physical activity.

Background Incorporating physical movement in the teaching of academic content (active learning) is a promising approach to improve children’s health and academic performance. Despite documented benefits, implementation of active learning remains challenging for schools. The aims of this study are to develop an implementation strategy to support the delivery of active learning in elementary schools and examine the impact of the developed implementation strategy on the implementation and effectiveness of active learning. Methods Aim 1 will use Implementation Mapping, which is a multi-step approach that guides the use of theory, stakeholder input, and existing literature to develop a scientifically based implementation strategy for active learning in elementary schools. Aim 2 will feature a feasibility study to examine the impact of the implementation strategy on both implementation and effectiveness outcomes, consistent with a Hybrid Type 2 design. Acceptability and implementation fidelity will be the primary implementation outcomes, and student physical activity levels will be the primary effectiveness outcome. We will recruit two elementary schools within our partner district, and one will be randomly assigned to receive usual support while the other will receive the newly developed implementation strategy. Participants from each school will complete baseline, 6-, and 12-month assessments. Bayesian statistical approaches will quantitatively examine preliminary effectiveness outcomes. We will also use an embedded mixed methods approach to triangulate findings. Discussion This study’s innovative overarching conceptual framework (centered on Implementation Mapping) will inform the development and testing of the implementation strategy. This study also uses methodological approaches optimal for feasibility studies, including mixed methods and Bayesian statistics. As a result, we will be able to gain a thorough understanding about the feasibility and preliminary effectiveness of the implementation strategy, which will inform subsequent research and practice for implementing active learning in schools. Trial registration ClinicalTrials.gov, NCT05048433 , registered on September 8, 2021.

Bibeau, WS, Moore, JB, Mitchell, NG, Vargas-Tonsing, T, and Bartholomew, JB. Effects of acute resistance training of different intensities and rest periods on anxiety and affect. J Strength Cond Res 24(8)2184-2191, 2010-The affective benefits associated with aerobic exercise are well documented. However, literature concerning resistance exercise has suggested a more variable response (i.e., a short duration increase in state anxiety, which eventually is reduced below baseline) and thus may play an important role in the adoption and maintenance of a resistance training program. The purpose of the current study was to examine the effects of different intensities and rest period during resistance exercise on anxiety, positive affect, and negative affect while holding volume constant and controlling for self-efficacy. Using an experimental design, individuals enrolled in a weight training class (n = 104) were randomly assigned 1 of 5 exercise conditions (control, low-long, low-short, high-long, and high-short), varying intensities, and rest time. Anxiety and positive and negative affect measurements were collected immediately following the exercise workouts. Data from separate analyses of covariance revealed a significant main effect for condition on positive affect (p = 0.026), in which the low-long group reported significantly higher positive affect than the control group, at 5-minute postexercise. Similar analysis indicated a significant main effect for time on anxiety (p = 0.003), with the highest anxiety detected at 5-minute postexercise, and significant reductions in anxiety at both 20-minute and 40-minute postexercise. In conclusion, these results suggest that the variation of intensity and rest time had a modest short-term effect on psychological states, following an acute bout of resistance exercise. Personal trainers and health professionals may want to emphasize light-intensity resistance programs for novice clients to maximize psychological benefits, which in turn, may positively affect compliance and adherence.

Purpose The purpose of this study is to translate laboratory-based research on beverage-based supplements to a naturalistic, field setting in adolescent athletes. To this end, we tested the effects of two commercially-available drinks on strength in a field-based setting with both male and female high school athletes completing a summer training program. Methods One hundred and three high school athletes completed the study ( M age = 15.3, SD  = 1.2; 70.9% male; 37.9% Afr. Amer.). Measures included a composite strength score (bench press + squat). Participants completed 1 week of pre- and post-testing, and 4 days per week of strength and conditioning training for 5 weeks. Participants were randomly-assigned to receive either CM or CHO immediately post-exercise. Results A 2 (group) × 2 (time) repeated measures ANOVA showed there was a significant main effect on time for increase in the composite strength score ( p  = .002, ŋp2  = .18). There was a significant interaction of composite strength score between groups, ( p  = .04, ŋp2  = .08). The CM group (12.3% increase) had significantly greater improvements in composite strength from pre- to post-test than CHO (2.7% increase). There were no differences in these results based on demographic variables. Conclusion This is the first study comparing the impact of CM and CHO on athletic outcomes in an adolescent population in a field-based environment. CM had a more positive effect on strength development and should be considered an appropriate post-exercise recovery supplement for adolescents. Future research will benefit from longer study durations with larger numbers of participants.

Background Classroom-based approaches are an evidence-based way to improve children’s physical activity; however, they are inconsistently implemented in schools. We developed MAGIC (Movement for Academic Growth In Classrooms), a multifaceted implementation strategy that consists of leadership training, teacher training, and a monthly newsletter to improve use of classroom-based physical activity approaches. The purpose of this study is to examine the feasibility and acceptability of MAGIC among elementary school teachers and leaders. Methods We used an embedded, convergent mixed methods design. We provided the MAGIC implementation strategy to a partner elementary school. We then administered surveys to teachers to quantitatively examine feasibility and acceptability. The surveys included questions about training attendance, receipt of newsletters, and acceptability based on a theoretical framework of acceptability. We used descriptive statistics to understand feasibility and acceptability trends. We also conducted semi-structured group and individual interviews with teachers and school leaders to understand perspectives about MAGIC components. We used rapid assessment procedures to analyze qualitative data, and multiple integration strategies, including joint displays, to compare quantitative and qualitative findings. Results A total of 35 teachers (kindergarten-5 th grade) completed study surveys and 27 teachers and school leaders participated in interviews. As an indicator of feasibility, all leaders attended leadership training sessions 1 ( n  = 13/13), 2 ( n  = 13/13), and 4 ( n  = 7/7); and 57% attended session 3 ( n  = 7/13); 93% ( n  = 28/30) of teachers attended training session 1, 90% ( n  = 27/20) attended session 2, and 87.5% ( n  = 21/24) attended session 3; and 67–75% of teachers received respective newsletters. The trainings and newsletters had high acceptability levels as indicated by survey results and interview data. Trainings included flexible scheduling integrated into existing meetings, which participants reported helped improve feasibility. Participants also highlighted the importance of incorporating classroom-based approaches into trainings and the simplicity of the newsletter, which contributed to their acceptability. Conclusions This study provides evidence supporting the feasibility and acceptability of the MAGIC implementation strategy among elementary school teachers and leaders. Future research should test MAGIC among more elementary schools to examine its impact on teacher implementation outcomes and students’ physical activity levels. Trial registration ClinicalTrials.gov, NCT05048433, registered 9/8/2021, https://clinicaltrials.gov/ct2/show/NCT05048433

Background: National and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School’s (CAS) programme on organisational changes to physical activity provision. Methods: In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. Results: >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. Conclusions: This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.

Background: Pain catastrophizing is a maladaptive cognitive strategy that is associated with increased emotional responses and poor pain outcomes. Total knee replacement procedures are on the rise and 20% of those who have the procedure go on to have ongoing pain. Pain catastrophizing complicates this pain and management of this is important for recovery from surgery and prevention of chronic pain. This study examines the effect of interventions on PC for patients undergoing total knee replacement (TKR). Methods: Multiple search engines were searched from inception up to March 2021 for relevant studies measuring PC in adults who have undergone TKR. Studies were screened using the Downs and Black Checklist. We included 10 studies (n = 574) which recruited peri surgical TKR participants. Effect sizes were calculated and compared on effect of intervention on PC. Results: Five studies examined the effect of cognitive behavioral therapy-based intervention on PC with low to moderate effects. Two studies examined the effect of a pain neuroscience education on PC with small effects short term. One study examined the effect of hypnotic therapy on PC with small, short-term effect (1 month) but large effect at 6 months. One study compared the effect of an isometric quadricep exercise with auditory and visual feedback on PC to treatment as usual with small, short-term effects. One study compared the effects of an activity and goal setting diary on PC with a moderate effect at 4 weeks. Conclusion: PC is a modifiable characteristic. Several interventions show modest benefit, however more research is needed to aid in clinical decision-making for this population. Interventions are most likely to produce benefits when they are targeted to people with high levels of PC. Keywords: pain catastrophizing, fear-avoidance, fear of pain, psychological, psychosocial, treatment

It is important to assess implementation of active learning interventions to maximize their impact. Implementation quality, or how well one engages program participants, has been less studied than other implementation components (e.g., dose, fidelity). This cross-sectional, exploratory study examined associations between teacher engagement behaviors, quality of teacher engagement (i.e., teacher feedback), and student physical activity outcomes during active classroom lessons. This study used data from the Texas Initiatives for Children’s Activity and Nutrition (I-CAN!) randomized controlled trial. Fixed effects regressions investigated the impact of teacher engagement behaviors on student physical activity outcomes. Bivariate correlations examined associations between teacher feedback and student physical activity outcomes. A latent profile analysis explored whether there were subsets of teachers with similar feedback profiles. The final analytic sample included 82 teachers. Teacher-directed changes and teacher participation in physical activity were each associated with higher ratings for how many and how often children were active during lessons. Teacher participation in physical activity was also significantly related to higher ratings for student physical activity intensity (all p < .05). Physical Activity Reinforcement and Technical Instruction feedback were positively associated with activity intensity (r = − .20, p < .05 and r = .34, p < .01, respectively). Technical Instruction feedback was positively associated with how many (r = .25, p < .01) and how often (r = .41, p < .01) students were active during lessons. Negative feedback was negatively associated with how often (r = − .25, p < .05) students were active and activity intensity (r = − .25, p < .05). Game Instruction was negatively related to how often students were active (r = -.23, p < .05). All teachers were represented by high levels of Game Instruction and Classroom Management feedback, moderate levels of Content Reinforcement and Content Instruction feedback, and low levels of Negative, Technical Instruction, and Physical Activity Reinforcement feedback. These data did not indicate the existence of multiple feedback profiles. Findings suggest that teacher engagement and feedback to students during active lessons can promote student physical activity. Teachers are primarily responsible for implementing school-based interventions, so it is critical to develop strategies that increase their ability to implement them successfully. Opportunities to maximize intervention delivery, such as co-designing with teachers, should be utilized when designing school-based, physical activity interventions.