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There are few examples of interventions designed to promote physical activity (PA) in adults with Cystic fibrosis (CF). Increasing levels of habitual PA may be more feasible and result in greater compliance than conventional exercise training inventions which give little or no attention to long-term PA behaviour. Despite this there is limited research exploring perceptions of PA among adults with CF. The study aimed to understand the ecological correlates of PA in adults with CF and to involve individuals with CF, their families (where applicable) and clinicians in a formative process to inform the development of an ecological approach to PA promotion in this population. An iterative approach was utilised, whereby findings from earlier phases of the research informed subsequent phases. Semi-structured interviews were conducted to explore patients' perceptions of PA, devised using the PRECEDE component of the PRECEDE-PROCEED model. Followed by, focus groups to discuss the perceived barriers, facilitators and opportunities for PA participation and how this information could inform the development and delivery of a PA intervention. Separate focus groups were conducted with individuals with CF (n = 11) and their families and CF MDT members. Thematic analysis was used to construct themes. Physical and mental wellbeing manifested as both barriers and facilitators of PA. CF is characterised by a progressive decline in physical function, which presents as a number of challenging symptoms and set-backs for an individual with CF. PA represents an opportunity for participants to slow the rate of this decline and manage the symptoms associated with the condition. Enjoyment was an important facilitator of PA. Exercise professionals and family reinforce PA behaviour, particularly during adolescence. PA promotion should form part of routine CF care with additional exercise professional support during adolescence.

In response to the adverse impacts of the COVID-19 lockdown measures Move Well, Feel Good (MWFG) was developed as a school intervention using improvement of motor competence as a mechanism for promoting positive mental health. Study objectives were to evaluate the feasibility and acceptability of MWFG and to describe changes in child-level outcomes. Five northwest England primary schools were recruited. MWFG was delivered over 10-weeks through physical education (PE) lessons, which were supplemented by optional class-time, break-time, and home activities. The intervention focused on development of 9-10 year-old children's motor competence in locomotor, object control, and stability skills, and psychosocial skills. Feasibility was evaluated against nine pre-defined criteria using surveys, interviews (teachers), and focus groups (children). Pre- and post-intervention assessments of motor competence, mental health, prosocial behaviour, wellbeing, and 24-hour movement behaviours were also completed. The five recruited schools represented 83% of the target number, 108 children consented (54% of target) with teachers recruited in all schools (100% of target). Intervention dose was reflected by 76% of the 45 scheduled PE lessons being delivered, and adherence was strong (>85% of children attending ≥75% of lessons). Positive indicators of acceptability were provided by 86% of children, 83% of PE teachers, and 90% of class teachers. Data collection methods were deemed acceptable by 91% of children and 80% of class teachers, and children spoke positively about participating in the data collection. Child-level outcome data collection was completed by 65%-97% of children, with a 3%-35% attrition rate at post-intervention, depending on measure. Favourable changes in motor competence (+13.7%), mental health difficulties (-8.8%), and prosocial behaviour (+7.6%) were observed. MWFG is an acceptable and feasible motor competence intervention to promote positive mental health. Content and delivery modifications could inform progression to a pilot trial with a more robust design.

Background Research to increase children’s physical activity and inform intervention design has, to date, largely underrepresented children’s voices. Further, research has been limited to singular qualitative methods that overlook children’s varied linguistic ability and interaction preference. The aim of this study was to use a novel combination of qualitative techniques to explore children’s current views, experiences and perceptions of out-of-school physical activity as well as offering formative opinion about future intervention design. Methods Write, draw, show and tell (WDST) groups were conducted with 35 children aged 10–11 years from 7 primary schools. Data were analysed through a deductive and inductive process, firstly using the Youth Physical Activity Promotion Model as a thematic framework, and then inductively to enable emergent themes to be further explored. Pen profiles were constructed representing key emergent themes. Results The WDST combination of qualitative techniques generated complimentary interconnected data which both confirmed and uncovered new insights into factors relevant to children’s out-of-school physical activity. Physical activity was most frequently associated with organised sports. Fun, enjoyment, competence, and physical activity provision were all important predictors of children’s out-of-school physical activity. Paradoxically, parents served as both significant enablers (i.e. encouragement) and barriers (i.e. restricting participation) to physical activity participation. Some of these key findings would have otherwise remained hidden when compared to more traditional singular methods based approaches. Conclusions Parents are in a unique position to promote health promoting behaviours serving as role models, physical activity gatekeepers and choice architects. Given the strong socialising effect parents have on children’s physical activity, family-based physical activity intervention may offer a promising alternative compared to traditional school-based approaches. Parents' qualitative input is important to supplement children’s voices and inform future family-based intervention design. The WDST method developed here is an inclusive, interactive and child-centred methodology which facilitates the exploration of a wide range of topics and enhances data credibility.

Background Over the past decade, there has been increased interest amongst researchers, practitioners and policymakers in physical literacy for children and young people and the assessment of the concept within physical education (PE). This systematic review aimed to identify tools to assess physical literacy and its physical, cognitive and affective domains within children aged 7–11.9 years, and to examine the measurement properties, feasibility and elements of physical literacy assessed within each tool. Methods Six databases (EBSCO host platform, MEDLINE, PsycINFO, Scopus, Education Research Complete, SPORTDiscus) were searched up to 10th September 2020. Studies were included if they sampled children aged between 7 and 11.9 years, employed field-based assessments of physical literacy and/or related affective, physical or cognitive domains, reported measurement properties (quantitative) or theoretical development (qualitative), and were published in English in peer-reviewed journals. The methodological quality and measurement properties of studies and assessment tools were appraised using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. The feasibility of each assessment was considered using a utility matrix and elements of physical literacy element were recorded using a descriptive checklist. Results The search strategy resulted in a total of 11467 initial results. After full text screening, 11 studies (3 assessments) related to explicit physical literacy assessments. Forty-four studies (32 assessments) were relevant to the affective domain, 31 studies (15 assessments) were relevant to the physical domain and 2 studies (2 assessments) were included within the cognitive domain. Methodological quality and reporting of measurement properties within the included studies were mixed. The Canadian Assessment of Physical Literacy-2 and the Passport For Life had evidence of acceptable measurement properties from studies of very good methodological quality and assessed a wide range of physical literacy elements. Feasibility results indicated that many tools would be suitable for a primary PE setting, though some require a level of expertise to administer and score that would require training. Conclusions This review has identified a number of existing assessments that could be useful in a physical literacy assessment approach within PE and provides further information to empower researchers and practitioners to make informed decisions when selecting the most appropriate assessment for their needs, purpose and context. The review indicates that researchers and tool developers should aim to improve the methodological quality and reporting of measurement properties of assessments to better inform the field. Trial registration PROSPERO: CRD42017062217

A significant proportion of youth in the United Kingdom fail to meet the recommended 60 minutes of moderate-to-vigorous physical activity every day. One of the major barriers encountered in achieving these physical activity recommendations is the perceived difficulty for youths to interpret physical activity intensity levels and apply them to everyday activities. Personalized physical activity feedback is an important method to educate youths about behaviors and associated outcomes. Recent advances in 3D printing have enabled novel ways of representing physical activity levels through personalized tangible feedback to enhance youths' understanding of concepts and make data more available in the everyday physical environment rather than on screen. The purpose of this research was to elicit youths' (children and adolescents) interpretations of two age-specific 3D models displaying physical activity and to assess their ability to appropriately align activities to the respective intensity. Twelve primary school children (9 boys; mean age 7.8 years; SD 0.4 years) and 12 secondary school adolescents (6 boys; mean age 14.1 years; SD 0.3 years) participated in individual semistructured interviews. Interview questions, in combination with two interactive tasks, focused on youths' ability to correctly identify physical activity intensities and interpret an age-specific 3D model. Interviews were transcribed verbatim, content was analyzed, and outcomes were represented via tables and diagrammatic pen profiles. Youths, irrespective of age, demonstrated a poor ability to define moderate-intensity activities. Moreover, children and adolescents demonstrated difficulty in correctly identifying light- and vigorous-intensity activities, respectively. Although youths were able to correctly interpret different components of the age-specific 3D models, children struggled to differentiate physical activity intensities represented in the models. These findings support the potential use of age-specific 3D models of physical activity to enhance youths' understanding of the recommended guidelines and associated intensities.

Background Low childhood physical activity levels are currently one of the most pressing public health concerns. Numerous school-based physical activity interventions have been conducted with varied success. Identifying effective child-based physical activity interventions are warranted. The purpose of this formative study was to elicit subjective views of children, their parents, and teachers about physical activity to inform the design of the CHANGE! (Children's Health, Activity, and Nutrition: Get Educated!) intervention programme. Methods Semi-structured mixed-gender interviews (group and individual) were conducted in 11 primary schools, stratified by socioeconomic status, with 60 children aged 9-10 years (24 boys, 36 girls), 33 parents (4 male, 29 female) and 10 teachers (4 male, 6 female). Questions for interviews were structured around the PRECEDE stage of the PRECEDE-PROCEDE model and addressed knowledge, attitudes and beliefs towards physical activity, as well as views on barriers to participation. All data were transcribed verbatim. Pen profiles were constructed from the transcripts in a deductive manner using the Youth Physical Activity Promotion Model framework. The profiles represented analysis outcomes via a diagram of key emergent themes. Results Analyses revealed an understanding of the relationship between physical activity and health, although some children had limited understanding of what constitutes physical activity. Views elicited by children and parents were generally consistent. Fun, enjoyment and social support were important predictors of physical activity participation, though several barriers such as lack of parental support were identified across all group interviews. The perception of family invested time was positively linked to physical activity engagement. Conclusions Families have a powerful and important role in promoting health-enhancing behaviours. Involvement of parents and the whole family is a strategy that could be significant to increase children's physical activity levels. Addressing various perceived barriers to such behaviours therefore, remains imperative. Trial Registration ISRCTN: ISRCTN03863885

Background Schools have been identified as key environments to promote child physical activity (PA). Implementation of multi-component PA interventions within schools is advocated but research has showed that they may not always be effective at increasing child PA. Results of the Active Schools: Skelmersdale (AS:Sk) multi-component pilot intervention indicated no significant positive change to child PA levels. Process evaluations can provide information on which aspects of an intervention were delivered and how. Therefore, the purpose of this study was to use a combination of methods to elicit child and teacher perceptions regarding the feasibility and acceptability of the AS:Sk intervention, alongside systematic researcher observations. The overarching study aim was to understand how schools implemented the AS:Sk intervention, with a specific focus on the frequency of intervention component implementation, and how the components were incorporated into the school day. Methods The study generated five data sets. Data elicited from 18 participating children via a write draw, show and tell task included, frequency counts of most enjoyable intervention components, drawings, and verbatim data. Teacher verbatim data was collected from 3 interviews, and 18 researcher observations were recorded using field notes. The data sources were pooled to produce the themes presented in the results section. Results The combination of data sources revealed four themes and 16 sub-themes. Implementation methods: how and when the components were implemented in schools. Child engagement: enjoyment and positive behaviour. Facilitators: peer influence, teacher influence, staggered implementation, incentives, rewards, challenges and competition, flexibility and adaptability, child ownership, routine. Barriers: time within an intense curriculum, space, sustaining child interest, parental support, school policies. Conclusions This study revealed that teachers believed classroom based activities were most feasible and acceptable due to the reduced implementation barriers of sufficient time and space. In contrast, children reported that the activities outside of the classroom were preferred. Future school-based PA interventions should aim to achieve a balance between routine PA at a set time and PA that is flexible and adaptable. Further process evaluations of multi-component school-based PA interventions are warranted to develop the limited evidence base.

Background Physical activity (PA) is associated with reduced hospitalisations and maintenance of lung function in patients with Cystic Fibrosis (CF). PA is therefore recommended as part of standard care. Despite this, there is no consensus for monitoring of PA and little is known about perceptions of PA monitoring among children and young people with CF. Therefore, the research aimed to explore patients’ perceptions of PA and the acceptability of using PA monitoring devices with children and young people with CF. Methods An action research approach was utilised, whereby findings from earlier research phases informed subsequent phases. Four phases were utilised, including patient interviews, PA monitoring, follow-up patient interviews and health care professional (HCP) interviews. Subsequently, an expert panel discussed the study to develop recommendations for practice and future research. Results Findings suggest that experiences of PA in children and young people with CF are largely comparable to their non-CF peers, with individuals engaging in a variety of activities. CF was not perceived as a barrier per se, although participants acknowledged that they could be limited by their symptoms. Maintenance of health emerged as a key facilitator, in some cases PA offered patients the opportunity to ‘normalise’ their condition. Participants reported enjoying wearing the monitoring devices and had good compliance. Wrist-worn devices and devices providing feedback were preferred. HCPs recognised the potential benefits of the devices in clinical practice. Recommendations based on these findings are that interventions to promote PA in children and young people with CF should be individualised and involve families to promote PA as part of an active lifestyle. Patients should receive support alongside the PA data obtained from monitoring devices. Conclusions PA monitoring devices appear to be an acceptable method for objective assessment of PA among children and young people with CF and their clinicians. Wrist-worn devices, which are unobtrusive and can display feedback, were perceived as most acceptable. By understanding the factors impacting PA, CF health professionals will be better placed to support patients and improve health outcomes.

Background Early childhood provides a window of opportunity for the promotion of physical activity. Given the limited effectiveness of interventions to date, new approaches are needed. Socio-ecological models suggest that involving parents as intervention targets may be effective in fostering healthier lifestyles in children. This study describes the effectiveness of a family-focused ‘Active Play’ intervention in decreasing sedentary time and increasing total physical activity in preschool children. Method Seventy-seven families were recruited from 8 randomly selected SureStart children’s centres in the North West of England. Centres were randomly assigned to either an intervention (n = 4) or a comparison group (n = 4). Parents and children in the intervention group received a 10-week active play programme delivered by trained active play professionals; this included an activity and educational component. Families in the comparison group were asked to maintain their usual routine. Each participating parent and child wore a uni-axial accelerometer for 7 days at baseline and post-test. Week and weekend day sedentary time and total physical activity adjusted for child- and home- level covariates were analysed using multilevel analyses. Results Significant intervention effects were observed for sedentary time and physical activity for both week and weekend days. Children in the intervention group engaged in 1.5% and 4.3% less sedentary time during week and weekend days, respectively and 4.5% and 13.1% more physical activity during week and weekend days, respectively than children in the comparison group. Parent’s participation in sport and their physical activity levels, child’s sex, availability of media in the home and attendance at organised activities were significant predictors of sedentary time and physical activity in this age group. Conclusion A 10-week family focused active play intervention produced positive changes in sedentary time and total physical activity levels in preschool children. Specific covariates were identified as having a significant effect on the outcome measures. Moreover, children whose parents were active engaged in less sedentary time and more physical activity suggesting that parent’s activity habits are mediators of physical activity engagement in this age group.