# Exercise as it relates to Disease/Physical activity interventions and high school female students

This is an analysis of the journal article "Implementation of a school environment intervention to increase physical activity in high school girls" by Epping, et al (2006).

## What is the background to this research?

Physical inactivity is a major risk factor for disease in Australia and globally. Participating in physical activity is a significant buffer against obesity and being overweight, which worldwide, is a leading contributor to disease. Furthermore, physical inactivity is a large contributor to health outcomes such as type II diabetes, cardiovascular disease and some cancers, which are among some of the leading causes of mortality and morbidity in Australia.
Leading a physically active lifestyle is not only crucial in regards to preventing against disease however is also an important management and treatment strategy for disease improving mental wellbeing, thus increasing overall quality of life.
Physical inactivity is prevalent in adults which begin to decline in childhood and continue to deteriorate through adolescence. Levels of physical inactivity continue to increase among adolescence, with girls at all ages participating in less physical activity than boys. In addition, female high school students are less likely to participate in school sports teams and are less likely to elect to participate in physical education classes that are not mandatory as they generally report greater negative attitudes and beliefs towards physical education.
Around 95% of the young population attend schools in first world countries therefore, highlighting them as an ideal setting to develop and maintain a physically active lifestyle. This idea is investigated by Epping, et al in this article.

## Where is the research from?

The research from this study was data collected from twenty four high schools across South Carolina and was undertaken by the following:
* University of North Carolina
** Department of Nutrition
* University of South Carolina
** Department of Health, Promotion, Education and Behaviour
** College of Nursing
** Department of Exercise Science

## What kind of research is this?

This study is a comprehensive school-based intervention study which involved exposing one group, known as the 'intervention group' to a condition and a second group known as the 'control group' to no condition or intervention. This study also included the use of documentation, surveys as well as self-reporting data regarding the implementation of the "Lifestyle Education for Activity Program" (LEAP).
Intervention studies can be an effective way of identifying key true differences between the intervention and control groups. There are however, some limitations which include the length of time which could be reduced as time progresses. Thus, has potential misrepresent the impact and outcomes of the intervention.

## What did the research involve?

Twenty-four high schools across the state of South Carolina were matched together based on their size and other contributing demographics. Twelve of the twenty four schools were randomly assigned to the intervention group and the remaining schools to the control group. Those schools in the intervention group were exposed to LEAP with the remaining receiving no intervention. The intervention was conducted over a period greater than two years across two different cohorts of ninth grade girls.
The intervention model took a facilitated model approach, rather than directed changes model in the participating schools, unlike most research in this area. The LEAP intervention focused on changing personal, social and environmental factors that could increase physical activity levels as well as including a program of physical activities set in gender-sensitive PE programs. The intervention involved providing educational information and different strategies to improve physical activity levels to teachers, families and female students.
LEAP staff were required to record data throughout the intervention which included orientation and training, communication information to classes and families, as well as PE activities and logs. An end of program evaluation was completed by teachers which reported their opinions on how well they believed their school implemented the intervention and to identify any barriers they experienced in the process. It is noteworthy this evaluation relies on recall accuracy and applies a subjective method of appraisal rather than a quantitative assessment However, due to the large scale of the intervention both in duration and size the surveys can be an effective way to collect extensive data from a range of participants.

## What were the basic results?

Results across the twelve intervention groups include:
* 83% made changes to ensure PE was more enjoyable and fun
* 75% made changes to provide female only PE classes
* 80% had an increase in participation in PE classes
* All schools reported using multimedia messaging encouraging physical activity
* 75% of the instructional elements of the LEAP were implemented
Due to the changes brought about by the implementation of LEAP the intervention was found to be successful. There was an increase in the female participation rate with an average of 1 or more 30-minute blocks of vigorous physical activity completed per day which increased to 45% in the intervention group compared to only 36% of girls in the control group. Only 50% of the schools in the study reported that they employed all the components of LEAP consistently therefore, indicating potential higher participation rates if all schools consistently employed the LEAP intervention strategies, creating a greater impact for female students overall.

## What conclusions can we take from this research?

This research enhances our understanding of different instructional and environmental components that we can implement to successively increase our physical activity levels for this population group. It also further increases our understanding of the barriers that limit female students in reaching the necessary physical activity guidelines.
This study takes a facilitated and multi-faceted approach to the implementation of the program which was particularly successful in this study and is an effective health promotion strategy. It involves a collaboration of efforts working together to produce better health outcome and are more commonly implemented within health research and promotion. However, more research is needed to be able to compare if these approaches are more effective than traditional approaches such as a direct change model at increasing physical activity levels.
Lastly, there were compliance issues with the study with only 50% of schools implementing LEAP consistently throughout the entire study. This could be due to the numerous components which make it difficult to implement all strategies. Therefore, a simpler approach could improve the physical activity outcomes for more students.

## Practical advice

According to the authors, alternating the structure of the typical PE classes is a crucial aspect to increasing physical activity levels in female high school students. It is important to specifically address the needs and interests of students when determining what physical activity they will engage in. Furthermore, including an option of female only PE classes is suggested by the authors.
When attempting to increase student physical activity levels, schools should take a multi-faceted approach, integrating multiple school components (e.g. families, PE classes, health education). Lastly, it is suggested that schools specifically address the barriers female students experienced to successively overcome these and increase physical activity within this specific population.

## Further information and resources

For further information regarding this topic read below:
* Physical activity for pre-teens and teenagers: https://raisingchildren.net.au/teens/healthy-lifestyle/physical-activity/physical-activity-teens
* Parent's guide for active girls: https://www.betterhealth.vic.gov.au/health/healthyliving/parents-guide-for-active-girls
* Considerations for program design for females: https://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/Physical%20activity/Female_participation_in_sport_Evidence_Aug15.pdf?la=en

## References

* 1 2 3 4 5 6 7 8 Epping, J. et al. (2006). 'Implementation of a school environment intervention to increase physical activity in high school girls'. Health Educational Research. 21(6): 896-910.
* 1 2 3 4 5 Australian Institute of Health and Welfare. (2017) 'Impact of physical inactivity for chronic conditions: Australian burden of disease study. Australian Institute of Health and Welfare. 15: 12-68.
* 1 2 Kappelides, P. et al. (2014). 'Female participation in sport and physical: a snapshot of the evidence'. Victorian Health.
* ↑ Brunton, G. et al. (2006). 'Young people and physical activity: a systematic review matching their views to effective interventions'. Health Educational Research. 21(6): 806-825.
* 1 2 3 4 5 Ecceles, M. et al. (2014). 'Are multi-faceted interventions more effective than single-component interventions in changing health care professionals behaviours? An overview of systematic reviews'. Implementation Science. 9(152): 152-156.
* 1 2 Barreto, P. (2013). 'Why ae we falling to promote physical activity globally'. Bulletin of the World Health Organisation. 91(6): 390-390A.