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1.
Experiential Learning Interventions and Healthy Eating Outcomes in Children: A Systematic Literature Review.
Varman, SD, Cliff, DP, Jones, RA, Hammersley, ML, Zhang, Z, Charlton, K, Kelly, B
International journal of environmental research and public health. 2021;(20)
Abstract
Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0-12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children's knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.
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2.
'Jump start' childcare-based intervention to promote physical activity in pre-schoolers: six-month findings from a cluster randomised trial.
Okely, AD, Stanley, RM, Jones, RA, Cliff, DP, Trost, SG, Berthelsen, D, Salmon, J, Batterham, M, Eckermann, S, Reilly, JJ, et al
The international journal of behavioral nutrition and physical activity. 2020;17(1):6
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Australian national guidelines recommend children have at least 180 minutes of physical activity per day. But many do not reach this, especially those in low socio-economic areas. There is a lack of evidence on effective interventions to increase movement in children. This 6-month randomised control trial aimed to assess the promotion of physical activity in 658 children from disadvantaged areas. The results showed that daily physical activity was not increased in children who participated in a structured exercise programme. When further analysis was performed it was shown that overweight and obese children did marginally increase their daily physical activity whilst on a structured exercise programme. It was concluded that six-month intervention of a structured exercise programme did not increase a child’s overall daily physical activity.; six months may not be an adequate amount of time to embed this type of regime. Healthcare professionals could use this study to understand that although a structured exercise programme may not be the answer for children with low activity levels, participating in movement and exercise is important from a young age.
Abstract
BACKGROUND Participation in adequate levels of physical activity during the early years is important for health and development. We report the 6-month effects of an 18-month multicomponent intervention on physical activity in early childhood education and care (ECEC) settings in low-income communities. METHODS A cluster randomised controlled trial was conducted in 43 ECEC settings in disadvantaged areas of New South Wales, Australia. Three-year-old children were recruited and assessed in the first half of 2015 with follow-up 6 months later. The intervention was guided by Social Cognitive Theory and included five components. The primary outcome was minutes per hour in total physical activity during ECEC hours measured using Actigraph accelerometers. Intention-to-treat analysis of the primary outcome was conducted using a generalized linear mixed model. RESULTS A total of 658 children were assessed at baseline. Of these, 558 (85%) had valid accelerometer data (mean age 3.38y, 52% boys) and 508 (77%) had valid accelerometry data at 6-month follow-up. Implementation of the intervention components ranged from 38 to 72%. There were no significant intervention effects on mins/hr. spent in physical activity (adjusted difference = - 0.17 mins/hr., 95% CI (- 1.30 to 0.97), p = 0.78). A priori sub-group analyses showed a greater effect among overweight/obese children in the control group compared with the intervention group for mins/hr. of physical activity (2.35mins/hr., [0.28 to 4.43], p = 0.036). CONCLUSIONS After six-months the Jump Start intervention had no effect on physical activity levels during ECEC. This was largely due to low levels of implementation. Increasing fidelity may result in higher levels of physical activity when outcomes are assessed at 18-months. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614000597695.
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Compliance with the 24-Hour movement guidelines for the early years: Cross-sectional and longitudinal associations with executive function and psychosocial health in preschool children.
McNeill, J, Howard, SJ, Vella, SA, Cliff, DP
Journal of science and medicine in sport. 2020;(9):846-853
Abstract
OBJECTIVE To examine whether meeting the Australian 24-Hour Movement Guidelines was associated with cognitive and psychosocial health in preschoolers. DESIGN Prospective observational study. METHODS Cross-sectional (n=247) and 12-month longitudinal (n=185) data from the PATH-ABC study were examined. Physical activity was assessed by accelerometry. Parents reported children's screen time and sleep. Children were categorised at baseline as meeting: i) none/one guideline, ii) two guidelines, or iii) 24-Hour Movement Guidelines. Associations with executive functions and psychosocial health were examined using linear regression, adjusting for covariates and preschool clustering. Longitudinal associations were additionally adjusted for baseline levels of development. RESULTS High proportions of children met the physical activity (94.3%) and sleep (89.9%) guidelines, 17.8% and 17.4% met screen time and 24-Hour Movement Guidelines, respectively. Cross-sectionally, children meeting both sleep and physical activity guidelines displayed better phonological working memory (p=0.026) and shifting (p= 0.034) scores compared to children who did not. Meeting two (p=0.037) and three (p=0.017) guidelines were associated with better phonological working memory and shifting scores, respectively (vs. meeting 0/1 guideline). Longitudinally, children meeting the physical activity guideline at baseline displayed better shifting performance 12-months later compared to those who did not (p<0.002). No associations with remaining cognitive outcomes, and no associations with psychosocial outcomes were evident. CONCLUSIONS Null associations suggest that meeting the recommendations may not be adequate for broad cognitive and psychosocial health outcomes in preschoolers. However, supporting preschool children to meet the physical activity and sleep guidelines, may be beneficial for aspects of cognitive health.
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4.
Energy expenditure associated with posture transitions in preschool children.
Downing, KL, Janssen, X, Cliff, DP, Okely, AD, Reilly, JJ
PloS one. 2019;(4):e0215169
Abstract
BACKGROUND Despite growing scientific interest in the benefits of breaking up sedentary time with intermittent standing or walking, few studies have investigated the energy cost of posture transitions. This study aimed to determine whether posture transitions are associated with increased energy expenditure in preschool children. METHODS Forty children (mean age 5.3 ± 1.0y) completed a ~150-min room calorimeter protocol involving sedentary, light, and moderate- to vigorous-intensity activities. This study utilised data from ~65-min of the protocol, during which children were undertaking sedentary behaviours (TV viewing, drawing/colouring in, and playing with toys on the floor). Posture was coded as sit/lie, stand, walk, or other using direct observation; posture transitions were classified as sit/lie to stand/walk, sit/lie to other, stand/walk to other, or vice versa. Energy expenditure was calculated using the Weir equation and used to calculate individualised MET and activity energy expenditure (AEE) values. Spearman's rank correlations were used to compare the number of posture transitions, in the individual activities separately and combined, with corresponding MET and AEE values. Participants were divided into tertiles based on the number of posture transitions; MET and AEE values of children in the lowest and highest tertiles of posture transitions were compared using unpaired t-tests. Effect sizes (Cohen's d) were calculated. RESULTS There was a positive correlation between the total number of posture transitions and average METs (rs = 0.42, p = 0.02) and AEE (rs = 0.43, p = 0.02). MET differences between the lowest and highest tertiles of posture transitions resulted in a small effect size for playing with toys (d = 0.27), and moderate effect sizes for TV viewing, drawing and all three activities combined (d = 0.61, 0.50 and 0.64 respectively). Similar results were found for AEE. CONCLUSIONS Results from this study showed that variation in posture transitions may be associated with variation in energy expenditure in preschool children. The findings suggest that the concept that variation in posture transitions may have meaningful biological or health effects in early childhood is worth investigating further.
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5.
The Acute Effects of a "Reduced Sitting Preschool Day" on Executive Function and Musculoskeletal Health in Preschoolers: A Randomized Cross-Over Study.
Ellis, YG, Cliff, DP, Howard, SJ, Okely, AD
Pediatric exercise science. 2019;(4):505-513
Abstract
PURPOSE To examine the acute effects of a reduced sitting day on executive function (EF) and musculoskeletal health in preschoolers. METHODS A sample of 29 children (54% boys; 4-5 y) participated in a randomized cross-over trial. Each child completed 2 protocols, which simulate a day at childcare in random order for 2.5 hours; a typical preschool day (50% sitting) and a reduced preschool day (25% sitting) where most sitting activities were replaced with standing activities. Sitting, standing, and stepping time were objectively assessed using an activPAL accelerometer. EF was evaluated using tablet-based EF assessments (inhibition, working memory, and task shifting). Musculoskeletal health was assessed using a handheld dynamometer and goniometer. RESULTS Compared with the typical preschool day, the reduced sitting day showed no significant differences for EF scores. Effect sizes for inhibition (d = 0.04), working memory (d = 0.02), and shifting (d = 0.11) were all small. For musculoskeletal health, no significant differences were reported after the reduced preschool day. The effect sizes for the hip extension force, hamstring flexibility, gastrocnemius length, and balancing on 1 leg were all small (d = 0.21, d = 0.25, d = 0.28, and d = 0.28). CONCLUSIONS This study suggests that reducing sitting time is unlikely to result in acute changes in EF and musculoskeletal health among preschoolers.
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Compliance with the Australian 24-hour movement guidelines for the early years: associations with weight status.
Santos, R, Zhang, Z, Pereira, JR, Sousa-Sá, E, Cliff, DP, Okely, AD
BMC public health. 2017;(Suppl 5):867
Abstract
BACKGROUND For effective public health and surveillance it is important to document the proportion of young children who meet the new Australian Integrated 24 h Movement Guidelines for the Early Years and how these associate with health outcomes. We aimed to (i) assess compliance with the new Integrated 24 h Movement Guidelines for the Early Years in a sample of Australian toddlers; and (ii) ascertain whether compliance with the guidelines associates with weight status. METHODS The sample comprised 202 toddlers (104 girls) aged 19.74 ± 4.07 months from the GET UP! STUDY Participants wore accelerometers (Actigraph GT3X+) for 24 h over 7 consecutive days to assess physical activity, sedentary time and sleep. Parents reported participants' screen time. Weight and height were measured and body mass index (BMI) z-scores by age and sex were calculated. Analysis of Covariance (ANCOVA) was performed to test differences in BMI z-scores between participants complying with (i) none or any individual guideline, (ii) any combination of meeting two guidelines, and (iii) those who met all three guidelines, adjusting for child age, gender and socioeconomic status. RESULTS Only 8.9% of the sample met the overall 24 h movement guidelines. Most of the sample met the physical activity (96.5%) and sleep (79.7%) guidelines but only 11.4% met the sedentary behavior guideline. Average BMI Z-scores did not significantly differ between children who complied with none or any individual guideline, any combination of meeting two guidelines, and those who met all three guidelines (p > 0.05). Although the lack of significant differences, participants who accomplished any combination of two guidelines or all three guidelines appear to have had a lower BMI Z-score than those complying with one of the guidelines or none. CONCLUSIONS Just under 9% of our sample met the overall Australian 24 h Movement Guidelines for the Early Years. BMI was not associated with the accomplishment of any of the 24-h Movement Guidelines. Strategies to promote adherence to the 24-h movement guidelines in toddlers, particularly for screen time, are necessary, as promoting health-related behaviors in early childhood has the potential to provide children a strong foundation for lifelong physical and mental health.
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7.
Acute effects of reducing sitting time in adolescents: a randomized cross-over study.
Penning, A, Okely, AD, Trost, SG, Salmon, J, Cliff, DP, Batterham, M, Howard, S, Parrish, AM
BMC public health. 2017;(1):657
Abstract
BACKGROUND Levels of sitting among adolescents are high, especially during the school day. The acute cognitive and health consequences associated with prolonged sitting are poorly understood in adolescents. This randomized crossover design study examined the acute effects of a simulated school day with reduced sitting or usual sitting on adolescents' cognitive function and cardiometabolic biomarkers. METHODS Eighteen healthy school aged adolescents were recruited from the community to the study (11 males; 7 females; mean age [SD] = 13.5 ± 0.9 years). Two protocols were developed to simulate an adolescent school day, the amount of time spent sitting was manipulated reflecting: a 'typical' day (65% of the time spent sitting with two sitting bouts sitting >20 min) and a 'reduced sitting' day (adolescents sat for 50% less time with no bouts of sitting >20 mins). The order that participants were exposed to each condition was randomized (via random number generator). Participants were not fully blinded as they could observe the difference between conditions. Energy intake and moderate to vigorous physical activity (MVPA) were standardized for both conditions and monitored for 48 h post-condition for compensatory effects. Cognitive (working memory) and cardiometabolic outcomes (lipids, glucose, insulin, IL-6, apo-A1, apo-B, blood pressure,) were assessed pre and post for both conditions, BMI and body fat were assessed on the morning of the intervention. Data were analyzed using linear mixed models. Standardised effect sizes were calculated. RESULTS Compared with the typical school day, the reduced sitting day demonstrated significant positive effects for apoB/apoA-1 ratio (adjusted difference ± SD) -0.02 ± 0.03; P = 0.03; effect size [Cohen's d] = -0.67. Findings for total cholesterol -0.19 ± 0.27; P = 0.28; d = -0.71; HDL cholesterol -0.23 ± 0.50; P = 0.12 d = -0.66; and total cholesterol/HDL ratio 0.25 ± 0.53; P = 0.25; d = 0.51 and for cognition 0.64 ± 0.15; P = 0.15; d = 0.54 were non-significant. There were no compensatory changes in participant energy expenditure or energy intake for 48 h post intervention. CONCLUSION Reducing school day sitting time in adolescents' resulted in significant improvements in apoB/apoA-1 ratio with medium effect sizes for total cholesterol, HDL cholesterol and total cholesterol/HDL ratio. Cognitive function results showed the equivalent of a 6 month improvement in effective mental-attentional capacity. TRIAL REGISTRATION The trial was registered as a clinical trial with the Australian and New Zealand Clinical Trials Registry ( ACTRN12614001064695 ) on the 3rd of October 2014 - registered retrospectively.
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Comparability and feasibility of wrist- and hip-worn accelerometers in free-living adolescents.
Scott, JJ, Rowlands, AV, Cliff, DP, Morgan, PJ, Plotnikoff, RC, Lubans, DR
Journal of science and medicine in sport. 2017;(12):1101-1106
Abstract
OBJECTIVE To determine the comparability and feasibility of wrist- and hip-worn accelerometers among free-living adolescents. DESIGN 89 adolescents (age=13-14years old) from eight secondary schools in New South Wales (NSW), Australia wore wrist-worn GENEActiv and hip-worn ActiGraph (GT3X+) accelerometers simultaneously for seven days and completed an accelerometry behavior questionnaire. METHODS Bivariate correlations between the wrist- and hip-worn out-put were used to determine concurrent validity. Paired samples t-test were used to compare minutes per day in moderate-to-vigorous physical activity (MVPA). Group means and paired sample t-tests were used to analyze participants' perceptions of the wrist- and hip-worn monitoring protocols to assist with determining the feasibility. RESULTS Wrist-worn accelerometry compared favorably with the hip-worn in average activity (r=0.88, p<0.001) and MVPA (r=0.84 p<0.001, mean difference=3.54min/day, SD=12.37). The wrist-worn accelerometer had 50% fewer non-valid days (75 days, 12%) than the hip-worn accelerometer (n=152, 24.4%). Participants reported they liked to wear the device on the wrist (p<0.01), and that it was less uncomfortable (p=0.02) and less embarrassing to wear on the wrist (p<0.01). Furthermore, that they would be more willing to wear the device again on the wrist over the hip (p<0.01). CONCLUSIONS Our findings reveal there is a strong linear relationship between wrist- and hip-worn accelerometer out-put among adolescents in free-living conditions. Adolescent compliance was significantly higher with wrist placement, with participants reporting that it was more comfortable and less embarrassing to wear on the wrist.
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Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis.
Cliff, DP, Hesketh, KD, Vella, SA, Hinkley, T, Tsiros, MD, Ridgers, ND, Carver, A, Veitch, J, Parrish, AM, Hardy, LL, et al
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2016;(4):330-44
Abstract
Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.
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10.
The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion.
Beets, MW, Okely, A, Weaver, RG, Webster, C, Lubans, D, Brusseau, T, Carson, R, Cliff, DP
The international journal of behavioral nutrition and physical activity. 2016;(1):120
Abstract
BACKGROUND Physical activity interventions targeting children and adolescents (≤18 years) often focus on complex intra- and inter-personal behavioral constructs, social-ecological frameworks, or some combination of both. Recently published meta-analytical reviews and large-scale randomized controlled trials have demonstrated that these intervention approaches have largely produced minimal or no improvements in young people's physical activity levels. DISCUSSION In this paper, we propose that the main reason for previous studies' limited effects is that fundamental mechanisms that lead to change in youth physical activity have often been overlooked or misunderstood. Evidence from observational and experimental studies is presented to support the development of a new theory positing that the primary mechanisms of change in many youth physical activity interventions are approaches that fall into one of the following three categories: (a) the expansion of opportunities for youth to be active by the inclusion of a new occasion to be active, (b) the extension of an existing physical activity opportunity by increasing the amount of time allocated for that opportunity, and/or (c) the enhancement of existing physical activity opportunities through strategies designed to increase physical activity above routine practice. Their application and considerations for intervention design and interpretation are presented. The utility of these mechanisms, referred to as the Theory of Expanded, Extended, and Enhanced Opportunities (TEO), is demonstrated in their parsimony, logical appeal, support with empirical evidence, and the direct and immediate application to numerous settings and contexts. The TEO offers a new way to understand youth physical activity behaviors and provides a common taxonomy by which interventionists can identify appropriate targets for interventions across different settings and contexts. We believe the formalization of the TEO concepts will propel them to the forefront in the design of future intervention studies and through their use, lead to a greater impact on youth activity behaviors than what has been demonstrated in previous studies.