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After-school interventions to increase physical activity among youth
  1. R R Pate,
  2. J R O’Neill
  1. Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
  1. Russell R Pate, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street Suite 212, Columbia, SC 29208; rpate{at}mailbox.sc.edu

Abstract

Most children and adolescents do not meet the recommended 60 minutes or more of moderate to vigorous physical activity per day. One attractive approach to increasing physical activity in young people is providing activity through structured after-school programmes. This paper provides a review of the scientific literature on the effects of after-school programmes on physical activity in children and adolescents. After-school physical activity interventions provided mixed results; some increased children’s physical activity, others did not. Although after-school programmes have the potential to help children and adolescents engage in regular, enjoyable physical activity, the research on these programmes is limited and, in some cases, methodologically weak. Additional, well-controlled studies are needed to identify the components of after-school programmes that promote physical activity and to determine the level of activity that can be attained when children and adolescents participate in these programmes.

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Current public health guidelines for physical activity call for children and youth to engage in 60 minutes or more of moderate to vigorous physical activity per day.13 Available evidence indicates that most youth in the economically developed nations do not meet that standard,46 and it is likely that their physical activity levels have declined significantly in recent decades. Expert panels have recommended that policies be implemented to increase physical activity in young persons through school-based initiatives. However, resource limitations and public pressure to optimise academic achievement limit opportunities for students to be physically active during the traditional school day.

One attractive approach to increasing physical activity in young people is providing activity through structured after-school programmes. Very large numbers of students at the elementary and middle school levels transition to supervised programmes at the conclusion of the formal school day. Many of these programmes focus on supporting academic goals and/or provide unstructured and often sedentary recreation. However, some after-school programmes have emphasised opportunities for physical activity. Because such large numbers of children and youth are exposed to structured after-school programmes, providing physical activity through such programmes is an attractive public health strategy. We review the scientific literature on the effects of after-school programmes on physical activity in children and adolescents. The relevant studies are organised on the basis of the method used for measurement of physical activity; some studies used objective measures while others used self-report instruments.7

SEARCH STRATEGY

A literature search was conducted using Medline and Psyc-Info to identify studies of after-school physical activity interventions among youth. Keywords included after-school, physical activity, and intervention. The search was restricted to articles in the English language and to those with children and adolescents. Studies were classified by the method of physical activity measurement: accelerometry, self-report, heart rate monitoring, and direct observation; the studies are summarised in table 1.

Table 1 After-school physical activity interventions

STUDIES USING OBJECTIVE MEASURES OF PHYSICAL ACTIVITY

The Stanford Sports to Prevent Obesity Randomized Trial (SPORT) was a 6 month soccer intervention for overweight children from a low-income community in California.8 Participants were 21 4th and 5th graders (intervention, n = 9; control, n = 12). For the first 4 months, the intervention was offered 3 days per week, but for the 5th and 6th months it was offered 4 days per week at the request of the parents and participants. Each session was approximately 75 minutes long, and included a warm-up, stretching exercises, and soccer skills practice. Control group participants attended weekly after-school meetings that emphasised healthy diet and physical activity behaviours. Physical activity was assessed using accelerometry over a 6 day period. Children in the intervention group, compared with children in the control group, had significantly greater physical activity levels at 3 months, differences of 10.57 minutes and 4.37 minutes for moderate physical activity and vigorous physical activity, respectively.

Vizcaino et al implemented a group randomised controlled trial in 20 elementary schools.9 Participants were 1044 children aged 9 and 10 years (intervention, n = 465; control, n = 579). The intervention was a non-competitive physical activity programme that consisted of three 90 minute sessions per week for 24 weeks, administered by physical education teachers. Physical activity was assessed with the RT3 accelerometer in a random sample of 75 children from the intervention group. In those children, mean counts per minute per session were 1345.58 counts/minute on days when the programme was offered and 527.38 counts/minute on non-programme days. The physical activity levels of children in the control group were not measured.

The Stanford GEMS Pilot Study was a 12 week after-school programme implemented 5 days per week for 2.5 h per session and included a family component aimed at reducing television viewing.10 Participants were 61 African American girls, aged 8 to 10 years (intervention, n = 28; control, n = 33). Each session included a 45 minute dance session, homework time, a healthy snack, and an educational component. The control group received educational materials to promote healthy diet and physical activity behaviours. Physical activity was assessed with accelerometry and the GEMS Activity Questionnaire. Girls in the intervention group demonstrated trends toward increased after-school physical activity (adjusted difference of 55.1 counts/min), and reduced television viewing (adjusted difference of −4.96 h/week), compared with girls in the control group. Results from the GEMS Activity Questionnaire indicated that girls in the intervention group reported 12% more minutes of moderate-to-vigorous physical activity (MVPA) than girls in the control group.

The Stanford GEMS phase 2 obesity prevention trial11 is an ongoing study that builds on the Stanford GEMS pilot study.10 The intervention is a 2 year after-school dance programme and a family-based television reduction programme offered to 8–10-year-old African American girls. The after-school sessions are offered 5 days per week at local community centres for 2.5 h, and consist of 45–60 minute dance lessons, homework time, and a snack. Transportation is provided from the school to the community centres. Physical activity is measured with accelerometry. Girls and parents in the control group receive monthly letters and quarterly health lectures. Researchers successfully recruited 261 girls and their families.

The Minnesota GEMS Pilot Study was a 12 week after-school programme for African American girls.12 Participants were 54 girls aged 8 to 10 years (intervention, n = 26; control, n = 28). The programme was administered 2 days per week for 1 h per session. Sessions provided physical activity opportunities and taught healthy eating habits. The control group received three monthly meetings that were not related to physical activity or nutrition during the 12 week period. Physical activity was assessed with accelerometry and the GEMS Activity Questionnaire. Physical activity preference was measured with a scale. Girls also reported their preference for 37 specific activities (e.g., “I’ve never done it”; “Don’t like it”; “Like it a little”; or “Like it a lot”). Girls in the intervention group increased their physical activity levels compared with girls in the control group (adjusted differences of 57.4 counts/min for total physical activity and 2.9 minutes for after-school MVPA), although this difference was not statistically significant. Girls in the intervention group also improved their preferences for the 37 activities compared with girls in the control group.

Kien and Chiodo administered and evaluated an after-school programme without a control group.13 The intervention was offered 4 days per week for 3 h per day over a 4 month period, and consisted of gardening and landscaping activities for 30–45 minutes and group games for 60 minutes. A total of 216 sixth graders were invited to participate; 22% of those attended at least one session, and only 6% attended at least half. Eight children attended approximately 75% of the sessions and wore an accelerometer for 2 h during the intervention and for 2 h while at home. Researchers determined that the children had significantly higher accelerometer counts per minute (4578) during the after-school session compared with time at home (2345 counts/min).

The Medical College of Georgia FitKid Project was a 3 year after-school group randomised trial designed to improve body composition and aerobic fitness.14 Although 617 children (8 years old at baseline) consented to participate, the results are based on 206 participants (intervention, n = 42; control, n = 164). These children completed all six measurements, and children in the intervention group attended 40% of sessions for each of the 3 years. After-school sessions lasted 120 minutes and were offered 5 days per week. Children participated in 80 minutes of physical activity (of which half was vigorous intensity), homework time, and a healthy snack. Activities were non-competitive and were designed to improve aerobic fitness, strength, and flexibility. The mean heart rates (beats/min) during the entire activity portion and vigorous-intensity portion were 151 and 156, respectively.

The CATCH Kids Club was an after-school quasi-experimental intervention study in 16 elementary schools designed to improve children’s physical activity and nutrition behaviours.15 Participants were 157 kindergarteners through fifth graders (total sample, includes intervention and control groups). Intervention components included physical activity for at least 30 minutes, with at least 40% of the time spent in MVPA; health education to address knowledge, skills, self-efficacy, and intentions to make healthy eating and physical activity choices; and a snack. Physical activity was assessed using the direct observation system SOFIT. Among intervention schools, the proportion of time spent in MVPA during recess increased, and a greater amount of physical education time was spent in MVPA (56.8% vs. 13.3%), compared with control schools. The CATCH Kids Club provided evidence for significant effects for the physical activity component.

Farley and colleagues administered an environmental physical activity intervention, which focused on accessibility to a safe playground in low-income neighbourhoods.16 One neighbourhood playground received the intervention, and the other playground was locked. The playground was open after school from 3:00 to 5:30, on Saturdays from 10:00 to 3:00, and on Sundays from 12:00 to 3:00 (although Sunday hours were discontinued due to low attendance). The direct observation system SOPLAY was administered on randomly selected days to capture physical activity levels of children using the playground. Children also self-reported their television viewing habits. Mean playground use on weekdays and weekends was 71 children and 26 children, respectively, and a total of 66% of the children on the playground were physically active.

Summary of the studies using objective measures

Of the five randomised controlled trials that reported follow-up data, three studies were effective in increasing physical activity.8 9 14 In addition, the GEMS interventions with African American girls reported that the intervention group showed trends toward increased physical activity, compared with the control group.10 12 The CATCH Kids Club demonstrated an increase in physical activity for the intervention group,15 and the playground intervention resulted in reduced television viewing time for children in the intervention group.16 Also, four interventions were well-received by participants and their parents.810 12 In addition, three interventions reported moderate to high attendance rates,9 10 12 14 15 and the GEMS Phase 2 study (which is ongoing) reported that 83% of the eligible families completed baseline assessments.11

STUDIES WITH PHYSICAL ACTIVITY MEASURED BY SELF-REPORT

Barbeau and colleagues conducted a 10 month randomised trial to evaluate an after-school programme for African American girls.17 Participants were 201 girls ages 8 to 12 years (intervention, n = 118; control, n = 83). The intervention was offered every school day for the school year, and was implemented by classroom teachers. Each session lasted 110 minutes, with 80 minutes for physical activities (including skill development, sustained aerobic activity, and toning and stretching) and 30 minutes for homework time. Physical activity was assessed with the Seven-Day Physical Activity Recall, and heart rate monitors were worn during the physical activity sessions. The intervention group had significant increases in moderate physical activity (adjusted difference of 0.21 h/day), vigorous physical activity (adjusted difference of 0.15 h/day), and MVPA (adjusted difference of 0.37 h/day), compared with the control group.

Active Winners was a community-based quasi-experimental study of an 18 month physical activity intervention implemented in two communities.18 Participants were 436 5th and 6th graders (intervention, n = 175; control, n = 261). After-school sessions were offered 5 days per week for 2 h per session, and summer programmes were offered (three 2 week camps in Summer I and one 4 week camp in Summer II). The sessions included opportunities to engage in non-competitive and enjoyable physical activities, and to practice social and academic skills. Physical activity was assessed with three consecutive administrations of the Previous Day Physical Activity Recall (PDPAR). Researchers found no significant differences in physical activity between the children in the intervention and control communities. The process evaluation provided evidence that the after-school and summer physical activity components were implemented as designed, but the home, school, and community components were not, due to resource and time limitations.

The Kids Living Fit programme was a quasi-experimental physical activity intervention. Participants were 185 2nd–5th graders (intervention, n = 80; control, n = 105).19 The programme was implemented 1 day per week after school for 12 weeks, with a 12 week follow-up. During each session, children participated in activities such as aerobic dance, strengthening, stretching, balancing, yoga, and relaxation. The children completed physical activity diaries for 5 weeks and recorded counts obtained from their pedometers, but researchers did not report these findings. Unlike the other studies in this review, children in the intervention group paid a registration fee ($100) to participate.

Summary of the studies using self-report measures

The results of the three interventions that used self-report measures were mixed. The randomised controlled trial reported significant increases in physical activity in the intervention group compared with the control group,17 one of the quasi-experimental studies reported no significant increases in physical activity between the intervention and control groups,18 and the other quasi-experimental study did not report its physical activity findings.19 Mean attendance also varied; 54% attendance was reported in the randomised controlled trial,17 but only 5% of Active Winners participants attended half the sessions.18

SUMMARY AND CONCLUSIONS

Findings of the after-school physical activity intervention studies were mixed with regard to their effectiveness in increasing children’s physical activity. Four of the six randomised controlled trials were effective in producing significant increases in physical activity among children in the intervention group,8 9 14 17 and the other two randomised controlled trials demonstrated trends toward increasing physical activity among African American girls.10 12 Of the three quasi-experimental interventions, two were effective in increasing children’s after-school activity.15 16 In general, after-school interventions were well-received by children and parents810 12 and had high attendance rates.9 10 12 17 Accordingly, available evidence indicates that after-school physical activity interventions can be both enjoyable to children and effective in increasing their physical activity levels.

There are several advantages to after-school programmes. They have the potential to provide children and adolescents with significant amounts of physical activity that can help them accumulate the recommended 60 minutes or more of daily moderate-to-vigorous physical activity.3 After-school sessions can provide a safe place for youth to spend their after-school hours, particularly in communities where parents perceive the neighbourhood as being unsafe for children to play outside. In addition, after-school programmes allow children to spend time with their friends and adults who are positive role models, learn and practise physical activity skills, be active, and, perhaps most important for children, have fun. Children also can be given an opportunity to do homework; the academic enrichment portion of the KidFit programme was well-received by parents and school personnel.14

However, providers of after-school programmes may need to help children overcome barriers to attending. Children from low-income families may not be able to participate in traditional fee-based activity classes or lessons and may need assistance with transportation.13 Robinson and colleagues, for example, provided transportation for participants from schools to community centres.10 11

Although research suggests that after-school programmes have the potential to help children and adolescents engage in regular, enjoyable physical activity, the volume of research on such programmes is limited. In some cases, the studies have methodological weaknesses. Additional, well-controlled studies are needed to identify specific programme strategies that best promote physical activity and to determine the amount of activity provided when children and adolescents participate in these programmes. Further, after-school programmes may be a cost-effective and time-efficient way to help young people meet physical activity guidelines, and future studies should examine the economic aspects of the programmes.

REFERENCES

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Footnotes

  • Competing interests: None.

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