- Title
- Evaluation of a school-based physical activity and fundamental movement skill intervention for children living in low-income communities: the Supporting Children’s Outcomes using Rewards, Exercise and Skills (SCORES) cluster randomised controlled trial
- Creator
- Cohen, Kristen Emilie
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Many Australian children are insufficiently active to accrue the associated health benefits. Physical activity levels are also consistently lower among children of low socio-economic status (SES) than children of middle- and high-SES. Physical activity levels decline dramatically during adolescence and evidence suggests that competency in a range of fundamental movement skills (FMS) may serve as a protective factor against this trend. Schools offer an ideal setting to promote physical activity and increase FMS competency in children. However, previous school-based interventions have had small effects on increasing children’s physical activity, which may be attributed to the lack of a theoretical framework for guiding behaviour change, failure to address the multiple components that influence physical activity behaviour in and beyond the school setting, and methodological weaknesses. Currently, an evidence gap exists for effective, theoretically framed, multi-component school-based physical activity and FMS interventions for children located in low-income communities. Objectives: This thesis by publication presents a series of studies that were conducted to address this gap in the literature. Overall, these studies relate to: i) the utility of FMS for promoting physical activity in children and the effectiveness of FMS interventions; and ii) the development of the primary school-based Supporting Children’s Outcomes using Rewards, Exercise and Skills (SCORES) intervention and its evaluation via a cluster randomised controlled trial (RCT). The primary aim of this thesis was to evaluate the impact of the SCORES intervention on moderate-to-vigorous physical activity (MVPA), cardiorespiratory fitness and FMS competency among children attending primary schools located in low-income communities. Further, the thesis presents a series of studies investigating four key secondary aims, which are briefly described below. As these studies provide important context for the primary aim, the thesis is presented in the following order: Secondary Aim 1: To systematically review the evidence of interventions designed to improve FMS competency in typically developing children and adolescents. A literature search with no date restrictions was conducted across seven databases. Studies included any school-, home-, or community-based intervention for typically developing youth with clear intent to improve FMS competency and that reported statistical analysis of FMS competence at both pre-intervention and at least one other post-intervention time-point. Study designs included RCTs using experimental and quasi-experimental designs and single group pre-post trials. Risk of bias was independently assessed by two reviewers. Twenty-two articles (six RCTs, 13 quasi-experimental trials, three pre-post trials) describing 19 interventions were included. All but one intervention were evaluated in primary/elementary schools. All studies reported significant intervention effects for ≥ one FMS. Meta-analyses revealed large effect sizes for overall gross motor proficiency (standardized mean difference [SMD] = 1.42, 95% confidence interval [CI] 0.68 to 2.16, Z = 3.77, p < .0002) and locomotor skill competency (SMD = 1.42, 95% CI 0.56 to 2.27, Z = 3.25, p = .001). A medium effect size for object control skill competency was observed (SMD = 0.63, 95% CI 0.28 to 0.98, Z = 3.53, p = .0004). Risk of bias was high among the majority of studies. Secondary Aim 2: To examine the association between FMS competency and objectively measured MVPA during time periods of the day that represent key physical activity opportunities (i.e., lunchtime, recess and after-school) among children attending primary schools located in low-income communities. Using baseline data from the SCORES cluster RCT, multilevel linear mixed models were used to assess the cross-sectional associations between FMS and objectively measured MVPA. After adjusting for age, sex, BMI and SES (measured at the individual level), locomotor skill competency was positively associated with total MVPA (p = 0.002, r = 0.15) and after-school MVPA (p = 0.014, r = 0.13). Object-control skill competency was positively associated with total MVPA (p < 0.001, r = 0.20), lunchtime MVPA (p = 0.03, r = 0.10), recess (p = 0.006, r = 0.11) and after-school MVPA (p = 0.022, r = 0.13). Primary Aim: To evaluate the impact of the Supporting Children’s Outcomes using Rewards, Exercise and Skills (SCORES) intervention on MVPA, cardiorespiratory fitness and FMS competency among children attending primary schools located in low-income communities. The SCORES intervention, which was a multi-component physical activity and FMS intervention for primary schools located in low-income communities, was evaluated using a cluster RCT. The socio-ecological model provided a framework for the 12-month intervention, which included the following components: teacher professional learning, student leadership workshops, physical activity policy review, equipment packs, parental engagement via newsletters, FMS homework and a parent evening, and community partnerships with local sporting organisations. The sample included 25 classes from eight primary schools located in low-income communities. Participants were 460 children (54.1% girls) aged 8.5 ± 0.6 years. Primary outcomes were objectively measured MVPA (ActiGraph GT3X and GT3X+ accelerometers), FMS competency (TGMD-2; six locomotor and six object-control skills), and cardiorespiratory fitness (20 meter multistage fitness test) assessed at baseline, mid-program (6-months) and posttest (12-months). Linear mixed models, adjusted for sex, age, BMI-z score, SES, ethnicity and school class (as a random factor), were used to assess the impact of the intervention. At mid-program, there were no significant intervention effects for any of the outcomes. At posttest, (study’s primary time point), there were intervention effects for daily MVPA (adjusted mean difference, 12.7 MVPA mins/day; 95% CI 5.0 to 20.5), overall FMS competency (4.9 units; 95% CI -0.04 to 9.8), and cardiorespiratory fitness (5.4 laps; 95% CI 2.3 to 8.6). Secondary Aim 3: To determine if changes in FMS competency and perceived competence mediate the effect of the SCORES intervention on MVPA and cardiorespiratory fitness among children attending primary schools located in low-income communities. Mediation analyses were conducted using multilevel linear analysis in MPlus. There were significant treatment effects for locomotor skills (A = 1.76, SE = 0.88, p = 0.044) and overall FMS (A = 4.09, SE = 2.08, p = 0.049). Changes in MVPA were associated with changes in object-control skills (B = 0.86, SE = 0.15, p < 0.001), overall FMS (B = 0.51, SE = 0.10, p < 0.001) and perceived competence (B = 0.48, SE = 0.36, p = 0.027). Overall FMS had a significant mediating effect on MVPA (AB = 2.09, 95% CI 0.01 to 4.55). Overall FMS (AB = 1.19, 95% CI 0.002 to 2.79) and locomotor skills (AB = 0.74, 95% CI 0.01 to 1.69) had a significant mediating effect on cardiorespiratory fitness. Secondary Aim 4: To determine if changes in individual, social and physical environmental constructs mediate the effect of the SCORES intervention on MVPA among children attending primary schools located in low-income communities. Hypothesised mediators measured in children via questionnaire were enjoyment of physical activity, perceived sport competence, and perceived social support. Hypothesised mediators measured in parents via questionnaire were social support from family, access to physical activity facilities and equipment at home, and perceived access to physical activity opportunities in the local community. Mediation analyses were conducted using multi-level linear analysis in MPlus. There were significant intervention effects for social support from teachers (A = 1.73, SE = 0.88, p = 0.048) and perceived access to physical opportunities in the local community (A = 2.69, SE = 1.12, p = 0.016). There were significant associations between changes in perceived sport competence (B = 0.48, SE = 0.36, p = 0.027), perceived access to physical activity opportunities in the local community (B = 0.60, SE = 0.26, p = 0.021), and changes in total MVPA. Perceived access to physical activity opportunities in the local community was found to have a significant mediating effect on total MVPA (AB = 1.61, 95% CI 0.06 to 3.95). Discussion: The studies included in this thesis contribute to the growing body of evidence for the utility of FMS to promote physical activity in children and the effectiveness of FMS and physical activity interventions. This thesis revealed that school- and community-based programs that include developmentally appropriate FMS learning experiences delivered by physical education (PE) specialists or highly trained classroom teachers significantly improve FMS competency in young people. In addition, object-control skill competency was found to be a better predictor of children’s MVPA during school-based physical activity opportunities than locomotor skill competency. In contrast, both object-control and locomotor skill competency were important for engagement in after-school MVPA. The SCORES intervention maintained daily MVPA, improved overall FMS competency and increased cardiorespiratory fitness among children attending primary schools in low-income communities. Of note, these effects were achieved without allocating additional curriculum time to PE or school sport. This provides evidence for the effectiveness of theoretically-framed, multi-component school-based physical activity and FMS interventions for children. Further, this was the first study to explore the mediating effects of FMS competency in a physical activity intervention in children. Improvements in overall FMS competency acted as a causal mechanism for physical activity behaviour change and subsequent improvements in cardiorespiratory fitness among children. Perceived access to physical activity opportunities in the local community was also identified as a mechanism of physical activity behaviour change in children. Additional research is needed to replicate the novel findings in this thesis and follow-up assessments beyond the post-intervention time point are needed to determine any sustained or long-term effects of future physical activity and FMS interventions.
- Subject
- fundamental movement skills; children; mediation; locomotor; object-control; perceived competence; school; thesis by publication; systematic review; motor skills; intervention; physical activity; low income; primary school; cardiorespiratory fitness; socioecological
- Identifier
- http://hdl.handle.net/1959.13/1316801
- Identifier
- uon:23269
- Rights
- Copyright 2016 Kristen Emilie Cohen
- Language
- eng
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