Journal of Physical Activity and Health, 2015, 12, 1 -7 http://dx.doi.org/10.1123/jpah.2013-0135 © 2015 Human Kinetics, Inc.
Official Journal of ISPAH www.JPAH-Journal.com ORIGINAL RESEARCH
Physical Activity in After-School Programs: Comparison With Physical Activity Policies Michael W. Beets, Rohan Shah, Robert Glenn Weaver, Jennifer Huberty, Aaron Beighle, and Justin B. Moore Background: After-school programs (ASPs) across the nation have been asked to increase the amount of activity children accumulate during such programs. Policies/standards that benchmark the amount of total activity (light-to-vigorous physical activity, LVPA) and moderate-to-vigorous physical activity (MVPA) accumulated in an ASP have been developed. Little is known about the prevalence of children meeting these goals. Methods: Children (N = 812, 6 to 12 y old) attending 19 ASPs wore accelerometers for 4 days while attending an ASP. LVPA and MVPA were dichotomized according to existing ASP policies/standards. Data on whether a policy/standard was met were compared between gender, age, BMI, race/ethnicity, and ASP-type (faith-, school-, community-based) using mixed-model logistic-regression. Results: The prevalence of meeting an LVPA policy/standard ranged from 75.4% (National Afterschool Association [NAA], 20% of program time spent in LVPA) to 97.8% (NAA, 20% of time in attendance spent in LVPA), and meeting an MVPA policy/standard ranged from 0.3% (California, 60 min MVPA/d) to 26.9% (North Carolina, 20% of attendance spent in MVPA). Boys, younger children, nonwhites, and children attending faithor community-based ASPs were more likely to meet any policy/standard. Conclusion: Current practice in ASPs is sufficient to meet LVPA policies/standards but insufficient to meet MVPA policy/standards. Efforts must be directed toward identifying the most appropriate policy/standard and strategies to meet it. Keywords: moderate-to-vigorous physical activity, accelerometry, children, standards, guidelines Participation in regular physical activity has numerous health benefits for youth.1,2 Unfortunately, most children are not meeting recommended activity guidelines.3 A combination of reduced physical education and recess time, coupled with an increased focus on academic achievement, limits the opportunity for children to be physically active during the school day.4 With 8.4 million children attending after-school programs (ASPs) for an average of 8.1 hours per week, ASPs are emerging as a potentially useful and feasible location for physical activity promotion outside of the regular academic schedule of the school day.5–7 State and national organizations have called on ASPs to address childhood physical inactivity.8 To do so, they have developed policies and/or standards related to promoting physical activity in the ASP setting.8 Several states and organizations explicitly indicate the amount of PA that should be accumulated by each child during the course of an ASP. These policies range in scope, with differences in the focus on total physical activity (light to vigorous physical activity, LVPA) or moderate-to-vigorous physical activity (MVPA) and the amount of activity children should accumulate (eg, 20% of program length vs 30 to 60 min).8 Currently, a number of studies have quantified the amount of physical activity children accumulate while attending an ASP, yet little is known about the percentage of children that meet existing Beets ([email protected]), Shah, and Weaver are with the Dept of Exercise Science, University of South Carolina, Columbia, SC. Huberty is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Beighle is with the Dept of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY. Moore is with the Dept of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC.
physical activity policies for ASPs.9–14 To date, only a single study has examined the prevalence of children meeting physical activity policy benchmarks, but it was limited to 3 ASPs.9 Additional research is required to identify the effectiveness of current practice in ASPs with regard to meeting existing physical activity policies. Therefore, the purpose of this study was to evaluate the prevalence of children meeting existing ASP physical activity guidelines in a diverse sample of ASPs located in 2 metropolitan US cities.
Methods Participants and Setting A total of 812 children were recruited from 19 community-based ASPs (n = 10), faith-based ASPs (n = 3), and school-based ASPs (n = 6) in the Omaha, NE (n = 6), and Columbia, SC (n = 13), metropolitan areas between February 2010 and October 2011. The 19 sites served approximately 1235 children (an average of 65 per site). All 19 sites had a similar schedule that offered homework/ academic time, snack, enrichment (arts and crafts), structured PA led by staff, and free-play opportunities, and all served elementary age children (K through 5th or 6th grade). On average, ASPs lasted for 192 minutes each day (range, 60–240 min); an average of 68 minutes of their daily schedule were devoted to physical activity (range, 40–120 min). All children attending the ASPs were invited to take part in this study; the parents provided written consent and the children provided verbal consent. The only reason for exclusion from the study was if the child was unable to be physically active without an assistive device (eg, wheelchair, crutches). The protocol for this study was approved by the Institutional Review Board. Following a standardized protocol,9,10 height and weight measures were conducted (with the children dressed in light clothing 1
2 Beets et al
but no shoes), and age (years), gender, and race/ethnicity were recorded. Height was measured to the nearest 0.1 cm using a portable stadiometer (HM200P; Charder, Taichung City, Taiwan). Weight was measured to the nearest 0.1 lbs with high-precision electronic scales (HD-314; Tanita, Tokyo, Japan). Body mass index (BMI) was calculated as the body weight divided by height squared (kg/ m2) and then converted to a sex- and age-specific BMI percentile value using a computerized formula derived from the 2000 Centers for Disease Control (CDC) Growth Charts (http://www.cdc.gov/ growthcharts/cdc_charts.htm). On the basis of the BMI percentile value, each participant was assigned to a normal stratum (< 85th percentile) or an overweight/obese stratum (≥ 85th percentile). Table 1 presents age, gender, ethnicity (self-reported by the child), and BMI information on the children attending these ASPs.
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Assessment of Physical Activity Physical activity was collected via accelerometer (GT3X; ActiGraph, Pensacola, FL) using a standardized protocol.9,10 In brief, data were collected on 4 unannounced nonconsecutive week days (ie, Monday through Thursday). Children had the opportunity to wear an accelerometer for up to 4 days. Accelerometers were placed at the right hip of each child at the beginning of the ASP and removed as children left for home. Time of monitor placement and removal for each child was recorded, because children could leave the ASP at any time if accompanied by a parent/guardian. A valid day of data was a total wear time ≥ 60 minutes in attendance.8,10,14 Data were classified into intensity levels using the Evenson cutpoints.15 Total physical activity was defined as LVPA. Physical activity data were downloaded in 5-second epochs to account for the intermittent/sporadic nature of children’s physical activity and to improve the ability to capture the transitory physical activity patterns of children.16
Interpretation of PA Policies We used policies from 3 state and national organizations—California, North Carolina, and the National Afterschool Association—that explicitly state the amount of physical activity children should accumulate while attending an ASP. These “policy benchmarks” are described in Table 2. These recommendations were interpreted as (1) the proportion of days across the total number of days of observation for the entire sample a policy/standard was achieved and (2) the proportion of children who met a policy/standard based on their average amount of physical activity across assessment days.
Statistical Analysis Random intercept logistic models with measurement occasions (days) nested in each child nested within ASPs were calculated. Age, race (1 = other, 0 = non-Hispanic whites), sex (1 = boys, 0 = girls), and BMI of the child ≥ 85th percentile were included in the models. Because of the low number of children of Hispanic, Asian, or other ethnicities (< 5%), these race/ethnic groups were combined with African Americans to make up the Other group for analysis. In addition, comparisons were made across ASP program types—community-based (eg, YMCA, parks and recreation), school-based, and those located in churches (ie, faith-based). All estimates were adjusted for the length of time each child spent at the program. For policies in which the physical activity benchmark was defined as a percentage of time in attendance, total physical activity (LVPA) or MVPA were divided by the total amount of time a child was in attendance on each day of measurement. For policies in which the prevalence was less than 5%, no analytical models were performed because of nonconvergence of analytical models with the low number of children or days meeting the benchmarks. Stata
Table 1 Demographic Characteristics and Physical Activity Estimates of Youth (N = 812) Participating in After-School Programs in Columbia, SC, and Omaha, NE Girls (n = 382) Characteristic Age (y) Weight status (%)
Official Journal of ISPAH www.JPAH-Journal.com ORIGINAL RESEARCH
Physical Activity in After-School Programs: Comparison With Physical Activity Policies Michael W. Beets, Rohan Shah, Robert Glenn Weaver, Jennifer Huberty, Aaron Beighle, and Justin B. Moore Background: After-school programs (ASPs) across the nation have been asked to increase the amount of activity children accumulate during such programs. Policies/standards that benchmark the amount of total activity (light-to-vigorous physical activity, LVPA) and moderate-to-vigorous physical activity (MVPA) accumulated in an ASP have been developed. Little is known about the prevalence of children meeting these goals. Methods: Children (N = 812, 6 to 12 y old) attending 19 ASPs wore accelerometers for 4 days while attending an ASP. LVPA and MVPA were dichotomized according to existing ASP policies/standards. Data on whether a policy/standard was met were compared between gender, age, BMI, race/ethnicity, and ASP-type (faith-, school-, community-based) using mixed-model logistic-regression. Results: The prevalence of meeting an LVPA policy/standard ranged from 75.4% (National Afterschool Association [NAA], 20% of program time spent in LVPA) to 97.8% (NAA, 20% of time in attendance spent in LVPA), and meeting an MVPA policy/standard ranged from 0.3% (California, 60 min MVPA/d) to 26.9% (North Carolina, 20% of attendance spent in MVPA). Boys, younger children, nonwhites, and children attending faithor community-based ASPs were more likely to meet any policy/standard. Conclusion: Current practice in ASPs is sufficient to meet LVPA policies/standards but insufficient to meet MVPA policy/standards. Efforts must be directed toward identifying the most appropriate policy/standard and strategies to meet it. Keywords: moderate-to-vigorous physical activity, accelerometry, children, standards, guidelines Participation in regular physical activity has numerous health benefits for youth.1,2 Unfortunately, most children are not meeting recommended activity guidelines.3 A combination of reduced physical education and recess time, coupled with an increased focus on academic achievement, limits the opportunity for children to be physically active during the school day.4 With 8.4 million children attending after-school programs (ASPs) for an average of 8.1 hours per week, ASPs are emerging as a potentially useful and feasible location for physical activity promotion outside of the regular academic schedule of the school day.5–7 State and national organizations have called on ASPs to address childhood physical inactivity.8 To do so, they have developed policies and/or standards related to promoting physical activity in the ASP setting.8 Several states and organizations explicitly indicate the amount of PA that should be accumulated by each child during the course of an ASP. These policies range in scope, with differences in the focus on total physical activity (light to vigorous physical activity, LVPA) or moderate-to-vigorous physical activity (MVPA) and the amount of activity children should accumulate (eg, 20% of program length vs 30 to 60 min).8 Currently, a number of studies have quantified the amount of physical activity children accumulate while attending an ASP, yet little is known about the percentage of children that meet existing Beets ([email protected]), Shah, and Weaver are with the Dept of Exercise Science, University of South Carolina, Columbia, SC. Huberty is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ. Beighle is with the Dept of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY. Moore is with the Dept of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC.
physical activity policies for ASPs.9–14 To date, only a single study has examined the prevalence of children meeting physical activity policy benchmarks, but it was limited to 3 ASPs.9 Additional research is required to identify the effectiveness of current practice in ASPs with regard to meeting existing physical activity policies. Therefore, the purpose of this study was to evaluate the prevalence of children meeting existing ASP physical activity guidelines in a diverse sample of ASPs located in 2 metropolitan US cities.
Methods Participants and Setting A total of 812 children were recruited from 19 community-based ASPs (n = 10), faith-based ASPs (n = 3), and school-based ASPs (n = 6) in the Omaha, NE (n = 6), and Columbia, SC (n = 13), metropolitan areas between February 2010 and October 2011. The 19 sites served approximately 1235 children (an average of 65 per site). All 19 sites had a similar schedule that offered homework/ academic time, snack, enrichment (arts and crafts), structured PA led by staff, and free-play opportunities, and all served elementary age children (K through 5th or 6th grade). On average, ASPs lasted for 192 minutes each day (range, 60–240 min); an average of 68 minutes of their daily schedule were devoted to physical activity (range, 40–120 min). All children attending the ASPs were invited to take part in this study; the parents provided written consent and the children provided verbal consent. The only reason for exclusion from the study was if the child was unable to be physically active without an assistive device (eg, wheelchair, crutches). The protocol for this study was approved by the Institutional Review Board. Following a standardized protocol,9,10 height and weight measures were conducted (with the children dressed in light clothing 1
2 Beets et al
but no shoes), and age (years), gender, and race/ethnicity were recorded. Height was measured to the nearest 0.1 cm using a portable stadiometer (HM200P; Charder, Taichung City, Taiwan). Weight was measured to the nearest 0.1 lbs with high-precision electronic scales (HD-314; Tanita, Tokyo, Japan). Body mass index (BMI) was calculated as the body weight divided by height squared (kg/ m2) and then converted to a sex- and age-specific BMI percentile value using a computerized formula derived from the 2000 Centers for Disease Control (CDC) Growth Charts (http://www.cdc.gov/ growthcharts/cdc_charts.htm). On the basis of the BMI percentile value, each participant was assigned to a normal stratum (< 85th percentile) or an overweight/obese stratum (≥ 85th percentile). Table 1 presents age, gender, ethnicity (self-reported by the child), and BMI information on the children attending these ASPs.
Downloaded by Australian Catholic University on 09/24/16, Volume 12, Article Number 1
Assessment of Physical Activity Physical activity was collected via accelerometer (GT3X; ActiGraph, Pensacola, FL) using a standardized protocol.9,10 In brief, data were collected on 4 unannounced nonconsecutive week days (ie, Monday through Thursday). Children had the opportunity to wear an accelerometer for up to 4 days. Accelerometers were placed at the right hip of each child at the beginning of the ASP and removed as children left for home. Time of monitor placement and removal for each child was recorded, because children could leave the ASP at any time if accompanied by a parent/guardian. A valid day of data was a total wear time ≥ 60 minutes in attendance.8,10,14 Data were classified into intensity levels using the Evenson cutpoints.15 Total physical activity was defined as LVPA. Physical activity data were downloaded in 5-second epochs to account for the intermittent/sporadic nature of children’s physical activity and to improve the ability to capture the transitory physical activity patterns of children.16
Interpretation of PA Policies We used policies from 3 state and national organizations—California, North Carolina, and the National Afterschool Association—that explicitly state the amount of physical activity children should accumulate while attending an ASP. These “policy benchmarks” are described in Table 2. These recommendations were interpreted as (1) the proportion of days across the total number of days of observation for the entire sample a policy/standard was achieved and (2) the proportion of children who met a policy/standard based on their average amount of physical activity across assessment days.
Statistical Analysis Random intercept logistic models with measurement occasions (days) nested in each child nested within ASPs were calculated. Age, race (1 = other, 0 = non-Hispanic whites), sex (1 = boys, 0 = girls), and BMI of the child ≥ 85th percentile were included in the models. Because of the low number of children of Hispanic, Asian, or other ethnicities (< 5%), these race/ethnic groups were combined with African Americans to make up the Other group for analysis. In addition, comparisons were made across ASP program types—community-based (eg, YMCA, parks and recreation), school-based, and those located in churches (ie, faith-based). All estimates were adjusted for the length of time each child spent at the program. For policies in which the physical activity benchmark was defined as a percentage of time in attendance, total physical activity (LVPA) or MVPA were divided by the total amount of time a child was in attendance on each day of measurement. For policies in which the prevalence was less than 5%, no analytical models were performed because of nonconvergence of analytical models with the low number of children or days meeting the benchmarks. Stata
Table 1 Demographic Characteristics and Physical Activity Estimates of Youth (N = 812) Participating in After-School Programs in Columbia, SC, and Omaha, NE Girls (n = 382) Characteristic Age (y) Weight status (%)
