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Background Engaging in no moderate-to-vigorous physical activity (MVPA) has been recognized as an important indicator in physical activity (PA) surveillance, as any engagement in MVPA confers health benefits compared to none. Studying the prevalence of no MVPA can provide valuable insights into physical inactivity patterns and inform public health intervention efforts. While some cross-sectional studies have examined this issue, no research has analysed year-to-year trends. Therefore, the aim of this study was to assess trends of no MVPA among adolescents and key subgroups using a nationally representative US sample. Methods Data from 2005 to 2021 cycles of the Youth Risk Behavior Surveillance System were used, with 115,926 US adolescents aged 14–17 years included (female: unweighted sample size = 58,582, 50.5%; weighted%=49.4%). Participants self-reported their demographic (sex, age, race/ethnicity, body mass index) and behavioural information (days of ≥ 60 min of MVPA over the past week, and recreational screen time). No MVPA was operationalized as reporting 0 days of ≥ 60 min of MVPA. Trend analysis was performed to assess temporal variations from 2005 to 2021 using a series of binary logistic regression models after controlling for demographic and screen time related variables. Results Declining trends in no MVPA were observed among adolescents from 2005 (weighted: 24.3%) to 2021 (weighted: 15.5%). After stratifying by sex, age, race/ethnicity, body mass index and recreational screen time, similar downward trends were shown across all adolescent subgroups consistently ( p for trend < 0.001). Girls, older adolescents, those who identified as non-White, adolescents with excess weight, and those engaging in more than 2 h of recreational screen time per day tended to report no MVPA at higher rates (all p  < 0.001) compared to their counterparts. Conclusions No MVPA has declined among the US adolescents, especially after 2009. Notably, sociodemographic disparities were observed in no MVPA among different population subgroups. PA promotion strategies targeting girls and older adolescents should be prioritized to further reduce the prevalence of no MVPA.

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 To examine the efficacy of providing free summer day camp (SDC) to children from low-income families on changes in physical activity, time spent sedentary, and screentime. Methods Across three summers (2021–2023), we randomized 422 children (8.2 ± 1.5yrs, 48% female, 51% Black, 69% at or below 200% Federal Poverty Level, 30% food insecure) from seven elementary schools to one of two conditions: summer as usual (control, n  = 199) or free SDC for 8-10wks (intervention, n  = 223). Accelerometry measured activity (moderate-to-vigorous PA [MVPA] and time spent sedentary) and parent daily report of screentime were measured using a 14-day in April/May (school) and July (summer). Intent-to-treat analysis examined changes in behaviors between school and summer. Exposure models examined differences in behaviors during summer on days when children attended vs. did not attend a SDC in both intervention and control children. Results Intent-to-treat models indicated in the summer children in the intervention group accumulated + 15.0 min/day (95CI 12.0 to 18.0) more MVPA and spent − 29.7 min/day (-37.7 to -21.8) less time sedentary and − 14.1 min/day (-23.9 to -4.3) on screens, compared to children in the control group. Exposure models indicated, on days children attended SDCs, they accumulated more MVPA (+ 26.1 min/day, 22.5 to 29.7), and spent less time sedentary (-63.5 min/day, -72.9 to -54.1) and on screens (-9.5 min/day, -20.1 to 1.2), compared to days when children did not attend SDC. Conclusions Policies targeting upstream structural factors, such as universal access to existing community SDCs during summer, could lead to improvements in health behaviors among children from low-income households. Clinical trials.Gov NCT04072549

Although moderate-to-vigorous physical activity (MVPA) is a widely used construct in physical activity (PA) research, the lack of standardized assessment methods– particularly with the growing use of consumer-grade wearable activity trackers– poses challenges for comparability. Consumer-grade devices tend to rely on heart rate (HR)-based estimation methods to classify PA intensity, which contrasts with traditional research-grade accelerometers that use count- or raw-acceleration metrics. Comparability issues are particularly salient across individuals with varying weight status. In this commentary, we discuss systematic discrepancies between HR-based (relative intensity) and acceleration-based (absolute intensity) classifications of MVPA among individuals with differing weight statuses. Using Fitbit data from the Adolescent Brain Cognitive Development Study, we illustrate how HR-based PA intensity classification may indicate higher MVPA in youth with greater adiposity despite lower step counts and light PA levels. We highlight implications for research design, public health surveillance, messaging, policy, and interventions. We also call for greater transparency, standardized methodologies, and integrative measurement approaches to ensure more accurate assessment of PA behavior.

The aim of this meta-meta-analysis was to systematically review randomised controlled trial (RCT) evidence examining the effectiveness of e- and m-Health interventions designed to improve physical activity, sedentary behaviour, healthy eating and sleep. Nine electronic databases were searched for eligible studies published from inception to 1 June 2023. Systematic reviews with meta-analyses of RCTs that evaluate e- and m-Health interventions designed to improve physical activity, sedentary behaviour, sleep and healthy eating in any adult population were included. Forty-seven meta-analyses were included, comprising of 507 RCTs and 206,873 participants. Interventions involved mobile apps, web-based and SMS interventions, with 14 focused on physical activity, 3 for diet, 4 for sleep and 26 evaluating multiple behaviours. Meta-meta-analyses showed that e- and m-Health interventions resulted in improvements in steps/day (mean difference, MD = 1329 [95% CI = 593.9, 2065.7] steps/day), moderate-to-vigorous physical activity (MD = 55.1 [95% CI = 13.8, 96.4] min/week), total physical activity (MD = 44.8 [95% CI = 21.6, 67.9] min/week), sedentary behaviour (MD = −426.3 [95% CI = −850.2, −2.3] min/week), fruit and vegetable consumption (MD = 0.57 [95% CI = 0.11, 1.02] servings/day), energy intake (MD = −102.9 kcals/day), saturated fat consumption (MD = −5.5 grams/day), and bodyweight (MD = −1.89 [95% CI = −2.42, −1.36] kg). Analyses based on standardised mean differences (SMD) showed improvements in sleep quality (SMD = 0.56, 95% CI = 0.40, 0.72) and insomnia severity (SMD = −0.90, 95% CI = −1.14, −0.65). Most subgroup analyses were not significant, suggesting that a variety of e- and m-Health interventions are effective across diverse age and health populations. These interventions offer scalable and accessible approaches to help individuals adopt and sustain healthier behaviours, with implications for broader public health and healthcare challenges.

Background Schools are recommended to use a whole-of-school (WOS) approach to promote physical activity opportunities before, during, and after school. Yet, the barriers and facilitators to implementing a WOS approach successfully are not well understood. The R = MC 2 heuristic, which defines readiness for implementation as a combination of an organization’s motivation and capacity to implement, can enhance our understanding of implementation in the school setting. This study examines associations between constructs from the R = MC 2 heuristic and schools’ implementation of a WOS approach. Methods We conducted a secondary analysis of cross-sectional data from U.S. elementary schools participating in the NFL PLAY60 FitnessGram Project during the 2022–23 school year. From surveys administered to school staff, we created a WOS index (range = 0–12) comprising six physical activity practices: physical education, recess, before and after-school programs, classroom-based approaches, and active transport. We also assessed how six constructs from the R = MC 2 heuristic (i.e., culture, implementation climate, leadership, priority, resources utilization, resource availability) impact physical activity implementation using a series of questions measured on a 5-point Likert scale. We used linear regression models to determine associations between R = MC 2 constructs (independent variables) and WOS index scores (dependent variable), controlling for school-level characteristics (student enrollment, percentage of race/ethnicity and economically disadvantaged students served) and state-level clustering. Results The analytic sample consisted of 132 schools across 18 states. On average, school staff rated leadership (mean = 4.1, range = 1.5–5) and organizational culture (mean = 4.0, range = 2.25–5) the highest. The mean WOS index score was 6.1. Partially adjusted models indicated significant positive associations between each R = MC 2 construct and WOS index scores. Fully adjusted regression models revealed priority ( b  = 0.88; p  = 0.010; 95% CI = 0.19–1.56) and implementation climate ( b  = 0.69; p  = 0.047; 95% CI = 0.07–1.32) were positively and significantly associated with WOS index scores. Conclusions Our study provides insights into key implementation constructs associated with providing school-based physical activity opportunities. These findings can support the development of resources and implementation strategies which, in turn, can help schools address implementation-related disparities. This will help schools improve the quality and accessibility of opportunities for physical activity provided to students across the United States.

Preliminary studies play a key role in developing large-scale interventions but may be held to higher or lower scientific standards during the peer review process because of their preliminary study status. Abstracts from 5 published obesity prevention preliminary studies were systematically modified to generate 16 variations of each abstract. Variations differed by 4 factors: sample size (n = 20 vs. n = 150), statistical significance (P < 0.05 vs. P > 0.05), study design (single group vs. randomized 2 groups), and preliminary study status (presence/absence of pilot language). Using an online survey, behavioral scientists were provided with a randomly selected variation of each of the 5 abstracts and blinded to the existence of other variations. Respondents rated each abstract on aspects of study quality. Behavioral scientists (n = 271, 79.7% female, median age 34 years) completed 1,355 abstract ratings. Preliminary study status was not associated with perceived study quality. Statistically significant effects were rated as more scientifically significant, rigorous, innovative, clearly written, warranted further testing, and had more meaningful results. Randomized designs were rated as more rigorous, innovative, and meaningful. Findings suggest reviewers place a greater value on statistically significant findings and randomized control design and may overlook other important study characteristics.

Purpose During summer vacation, many children in households with low income lose access to federally-funded, healthful school meals. Summer day camps (SDCs) provide access to healthful meals and a structured environment; yet low-income families often cannot afford SDCs which may influence food/beverage consumption. This study examined the impact of receiving a free SDC versus experiencing summer as usual (SAU) on dietary intake during summer among children from low-income families. Methods Parent-child dyads ( N  = 422; child age: 8.2 ± 1.5 yrs; 48% female; 51% Black) were recruited over 3 years (2021–2023) from schools serving families with low-income. Children were randomized to receive 8–10 weeks of free SDC (intervention) or SAU (control). Parents completed daily diaries for 14 days during school (April/May) and summer (July) which captured child consumption of healthful (e.g., fruit, vegetables, milk) and unhealthful (e.g., soda, fast food, snacks/chips) foods/beverages. Mixed-effects intent-to-treat (ITT) models examined the odds of consuming different foods/beverages during summer, controlling for school year consumption, in the SDC group compared to SAU. Secondary as-treated analyses examined the impact of attending structured summer programming versus not attending on the odds of consuming different food/beverages, regardless of randomization. Results A total of 2,931 daily diaries were completed for intervention ( n  = 232) and control ( n  = 201) children. ITT analyses showed the SDC group had decreased odds of consuming frozen desserts (OR 0.68, 95%CI 0.49–0.94), compared to SAU, during summer weekdays. No other differences were observed. As-treated analyses showed children had increased odds of consuming fruit (1.77, 1.30–2.41), milk (1.97, 1.44–2.69), and chips/snacks (1.49, 1.17–1.90), and decreased odds of consuming soda (0.53, 0.34–0.84), fast food (0.57, 0.45–0.73), and frozen desserts (0.58, 0.45–0.74) on weekdays when they attended structured summer programming, compared to days they did not attend. Conclusions Providing free SDC alone did not promote more healthful food/beverage consumption during summer vacation compared to SAU. However, on days children attended a structured program, children experienced more dietary benefits compared to days they did not. Thus, structured environments may positively impact children’s diet during summer; yet, identifying strategies to address barriers beyond cost to improve attendance and enrollment may enhance the impact of summer programming.

Background Summer vacation is a time when youth gain excessive weight. A key driver of unhealthy weight gain is poor dietary quality. The absence of consistent structure (e.g., school), is hypothesized to be one of the reasons for lower diet quality during summer. This study examined differences in school and summer dietary quality among a diverse cohort of children across three years. We also examined the impact of attending structured programs on children’s diets. Methods Parents of 1,032 children (age 5–14 years, 48% girls) completed a time use diary each day for 14-days during school (April/May) and again in summer (July) from 2021 to 2023, for a total of 6 timepoints. The daily diary collected information on the child’s location and dietary intake for that day. Mixed-effects models examined the odds (OR) of consuming a food/beverage (e.g., fruit, vegetable, soda, salty snacks) on a given day during school vs. summer, overall and by income. Models also examined the impact of attending structured programming during summer (e.g., summer day camp) on the likelihood of consumption. Results A total of 39,983 time use diaries were completed. Overall, children were less likely to consume fruit, vegetables, milk, 100% juice, and salty snacks (OR range 0.63 to 0.87), and they were more likely to consume non-carbonated sweetened beverages, soda, frozen desserts, and fast food (OR range 1.17 to 1.63) during the summer compared to school. On summer days with structured programming, children were more likely to consume fruits, vegetables, milk, salty snacks, sweetened beverages (OR range 1.13 to 1.45), and they were less likely to consume frozen desserts, fast food, and soda (OR range 0.63 to 0.90). Few differences were observed between income groups. Conclusions Children were less likely to report consumption of healthier foods/beverages and more likely to report consumption of unhealthier foods/beverages during summer compared to school. Attending structured programming during summer is associated with improved diet– suggesting such settings have potential to modify dietary intake.

s Background Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status. Methods Searches were to identify systematic reviews that conducted meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from January 2016 to October 2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size but not a pilot/feasibility study ( N  ≤ 100, N  > 100, and N  > 370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance of summary ES between the four categories of studies was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N  ≤ 100 studies on the estimated summary ES. Results A total of 1602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 studies per meta-analysis, range 2–108) and included 227,217 participants. Pilot/feasibility and N  ≤ 100 studies comprised 22% (0–58%) and 21% (0–83%) of studies included in the meta-analyses. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES ranged from 0.20 to 0.46 depending on the proportion of studies comprising the original ES were either mostly small (e.g., N  ≤ 100) or mostly large ( N  > 370). Concordance was low when removing both pilot/feasibility and N  ≤ 100 studies (kappa = 0.53) and restricting analyses only to the largest studies ( N  > 370, kappa = 0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES. Conclusions When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N  ≤ 100 studies, summary ES can be affected markedly and should be interpreted with caution.