Introduction:Including children's perspectives developing health programs is a priority. This study gathered children's perspectives on outcomes in a Core Outcomes Set (COS), which they believe are important to measure in school-based healthy lifestyle behavioral interventions. Methods:Children aged 8-12 years from six countries across three continents participated in standardized interactive focus groups. An animation video was used to explain all relevant concepts (e.g., "intervention", "outcomes") and showed animated children engaging in a variety of lifestyle behaviors at school. Participating children then brainstormed and proposed outcomes they consider important to measure when evaluating a school-based "healthy lifestyle programme". Next, children individually rated the importance of the outcomes using a traffic light system (red, "not important"; orange, "important"; green, "very important"). Similar outcomes (across focus groups and countries) were merged, and an overall importance rating was given to each outcome (across countries and overall). An outcome was considered important for inclusion in a COS if ≥70% of children scored the outcome as "very important" and <15% scored it as "not important". Results:Children (n = 159) proposed 170 unique outcomes. Children proposed thirty-six outcomes in at least two countries, of which 20 outcomes received an overall rating of "very important" in all countries where the outcomes were reported. Of these 20, five outcomes were reported by children in at least four countries: being healthy, healthy diet, concentration, having fun, and feeling happy. Conclusion:Children reported a wide range of outcomes related to physical and mental health, as well as enjoyment and social skills, such as having fun and making friends. All outcomes reported by children in at least two countries and considered "very important" will be considered for inclusion in the consensus stage of developing a COS for school-based intervention studies aimed at childhood overweight and obesity prevention.

Background: Outdoor play supports physical and psychological health among children and early adolescents (EA; ages 10-14). However, most research to date has focused on younger children (under 10), leaving a gap in understanding the specific barriers and facilitators of outdoor play for EA.Objective: This study investigated parental perspectives on the barriers and facilitators of outdoor neighbourhood play for EA in the UK.Methods: Eleven parents (ages 30-50, 82% women) from diverse socioeconomic backgrounds participated in semi-structured online interviews. A content thematic analysis, guided by the socioecological model, was used to identify key themes.Results: Six key themes were developed: autonomy and independence, social connectedness, the built environment, social development, technology and parental behaviours. While parents recognised the importance of outdoor play for EA, concerns about neighbourhood safety, traffic and inadequate play and recreational facilities were significant barriers. Technology played a dual role: facilitating safety through regular communication but also contributing to sedentary behaviour. Parents also drew attention to lack of community cohesion, which limited their comfort about unsupervised outdoor play.Conclusion: Parents valued outdoor play but imposed restrictions due to safety concerns at a time at which EA should be developing independence and autonomy. Addressing these concerns by improved play and recreational facilities, fostering community trust and utilising safe technological solutions such as GPS trackers and apps providing location sharing could enhance outdoor play opportunities for EA. Future programmes and interventions should be tailored to meet the unique developmental needs of members of this age group.

Muscular fitness (MF) is an important modifiable factor to improve overall health. Schools offer a unique opportunity to deliver MF activity during physical education (PE) and develop competence to engage in various activities across the life course. However, the implementation of school-based MF activity may be impaired by some teachers reporting a lack of expertise and low confidence in the delivery of MF activity. Understanding teachers’ thoughts and perceptions regarding the delivery of MF in schools may help guide future research and policy to support MF delivery in UK schools. Following ethical approval, a survey of secondary school PE teachers across the UK was distributed via Twitter. Survey responses were analysed and reported descriptively and thematically. Completed surveys were returned by 194 teachers (61.9% male) from England, Scotland, Wales, and Northern Ireland. Relative to less experienced teachers, those with at least five years’ service were 2.2 times more likely to have completed continued professional development (CPD) in MF activity (OR = 2.16; ß = 0.77; 95% CI: 1.25-3.74; p < 0.01), and 1.8 times more likely to use assessments of MF to inform PE programme decision-making (OR = 1.83; ß = 0.60; 95% CI: 1.18-2.82; p < 0.01). Despite the promising contribution school-based PE may have to developing MF, we report a poor understanding of MF activity amongst UK-based PE teachers. CPD is warranted to deliver successful MF interventions in a school setting.

Although evidence for young children (<10) and older adults (>64) highlights an association between physical activity (PA) and executive functions (EFs), there is a paucity of research on adolescents aged 18–24 years. Thus, this study examined the associations between PA and EF and the difference in EF between individuals who achieve the moderate-to-vigorous (MVPA) guidelines and those who do not. Forty-seven participants engaged in a Stroop task, a reverse Corsi-block test, and a task-switching test, to measure inhibition, working memory, and cognitive flexibility, respectively. An ecological momentary assessment (EMA) was used to determine the participant’s MVPA and step count, through the “Pathverse” app. Multiple regressions were run to predict the task-switch cost, the Stroop effect, and the backward Corsi span from time spent in MVPA. A two-way ANCOVA examined the effects of achieving the MVPA guidelines on EF. MVPA and step count did not significantly predict EF. There were no significant differences in EF between participants achieving the MVPA guidelines and those that did not. Time spent in MVPA and step count were not significantly associated with working memory, cognitive flexibility, or inhibition in adolescents. Further research is warranted to understand other factors that may significantly affect EF, within and outside an individual’s control.

Schools provide an opportunity to enhance muscular fitness of English youth during physical education (PE). Continued professional development (CPD) among teachers may improve muscular fitness activity delivery in schools. This study sought to assess the feasibility and acceptability of an online CPD programme to enhance PE teachers’ knowledge of muscular fitness activity. Methods: Co-production of an online CPD platform was undertaken with five secondary school PE teachers. A quasi-experimental pre-post control group design for the CPD was adopted (CPD group n = 76, control n = 32). Upon CPD completion feedback was solicited for qualitative analysis. Results: Pre-and-post CPD knowledge quiz data were available from 65 participants (55.4% male). The median knowledge quiz change score was significantly higher in the CPD group than in the wait list control group (CPD score vs. control score; U =37, z = −5.96, p < 0.01). Three primary themes reflecting factors associated with the acceptability and feasibility were (1) practical application, (2) support and resources, and (3) knowledge and confidence. Conclusions: Co-production of an online CPD programme can improve knowledge and affect practice. PE teachers that completed the CPD reported the online platform was beneficial to overcoming the limitations of face-to-face CPD such as time and financial constraints and suggested the content covered was beneficial and appropriate to their teaching. Future work is required to establish links between teachers’ learning following CPD, the translation into PE practice and student MF outcomes.

We examined the compositional associations between the intensity spectrum derived from incremental acceleration intensity bands and the body mass index (BMI) z-score in youth, and investigated the estimated differences in BMI z-score following time reallocations between intensity bands. School-aged youth from 63 schools wore wrist accelerometers, and data of 1453 participants (57.5% girls) were analysed. Nine acceleration intensity bands (range: 0–50 mg to ≥700 mg) were used to generate time-use compositions. Multivariate regression assessed the associations between intensity band compositions and BMI z-scores. Compositional isotemporal substitution estimated the differences in BMI z-score following time reallocations between intensity bands. The ≥700 mg intensity bandwas strongly and inversely associated with BMI z-score (p < 0.001). The estimated differences in BMI z-score when 5 min were reallocated to and from the ≥700 mg band and reallocated equally among the remaining bands were −0.28 and 0.44, respectively (boys), and −0.39 and 1.06, respectively (girls). The time in the ≥700 mg intensity band was significantly associated with BMI z-score, irrespective of sex. When even modest durations of time in this band were reallocated, the asymmetrical estimated differences in BMI z-score were clinically meaningful. The findings highlight the utility of the full physical activity intensity spectrum over a priori-determined absolute intensity cut-point approaches.

Background: English youth typically do not sufficiently engage in the types and intensities of physical activity that develop muscular fitness. The aim of this study was to use a combination of qualitative techniques to explore adolescent boys’ understanding, perceptions, and experiences of physical activity and the role muscular fitness plays within boys’ physically active lifestyles. Methods: Focus group interviews with a write, draw, show, and tell activity were conducted with 32 adolescent boys aged 14–16 years from 3 secondary schools. Three separate sources of data (frequency counts, verbatim transcripts, and visual data) were generated and were pooled together and triangulated. Data were analysed deductively, first using the Youth Physical Activity Promotion model as a thematic framework, and then inductively. Results: Physical activity was frequently associated with organised sport, and most boys were unaware of current UK physical activity guidelines. Co-participation was frequently reported as a reinforcing factor to physical activity. Conclusions: There was a perceived lack of opportunity to participate in muscular fitness activities, particularly in school, and knowledge of how to conduct muscular fitness activities was limited. The contribution of physical education was highlighted as being key to facilitating exposure to muscular fitness activities.

Background: High Intensity Interval Training (HIIT) is a sustainable and effective method for improving Cardiorespiratory Fitness (CRF) in adolescents. HIIT is proven to produce equal or greater improvements in CRF when compared to moderate intensity continuous exercise (MICE) in adolescents. Methods: The studies included were considered eligible if: (1) Participants were adolescents (11–18 years old); (2) Examined changes in CRF measured either directly or indirectly; (3) Included a non-exercising control group or MICE comparison group; (4) Participants were matched at enrolment; (5) Reported HIIT protocol information; (6) Provided HIIT intensity. A meta-analysis was conducted to determine the effect of HIIT on CRF. Meta-regression and moderator analyses were performed out to quantitatively examine moderators of protocol design on CRF improvements. Results: HIIT displays a moderate effect to improve CRF (g = 0.86, 95% CI 0.518–1.106, p < 0.001). Neither study duration (weeks), nor total or weekly accumulated HIIT volume (min) displayed any significant moderation effect on pooled improvement on CRF (p > 0.05). Conclusions: HIIT is an effective method to improve CRF in adolescents, irrespective of body composition. Notably, meta regression analysis identified that prolonged high volume HIIT programs are similarly effective to short term low volume HIIT programs. This becomes of particular interest for those involved in school curricula, where short HIIT exercise may provide a pragmatic adjunct to the health benefits of Physical Education (PE) lessons.

Background It has been reported that boys’ and girls’ physical activity (PA) levels decline throughout adolescence. Boys are at risk of physical inactivity during adolescence; however, in intervention research, they are an under-represented group relative to girls. It is suggested that the school environment may be central to developing interventions that support adolescents in meeting the current PA guidelines. The aim of this systematic review and meta-analysis was to investigate the efficacy of school-based physical activity interventions for improving muscular fitness (MF) in adolescent males. Methods This systematic review and meta-analysis followed the preferred reporting systems for meta-analyses guidelines and was registered on PROSPERO (Registration number: CRD42018091023). Eligible studies were published in English within peer-reviewed articles. Searches were conducted in three databases, with an additional grey literature search in Google Scholar. Studies investigating MF outcomes were included. Results There were 43 data sets identified across 11 studies, from seven countries. Overall methodological quality of the studies was moderate-to-strong. Interventions targeting MF evidenced a small-to-medium effect ( g = 0.32, CI 0.17, 0.48, p < 0.00). Subgroup analyses of MF delivery method resulted in small-to-medium effects: upper limb MF measures ( g = 0.28, 95% CI − 0.02, 0.58, p = 0.07), lower limb MF measures ( g = 0.28, 95% CI 0.09, 0.68, p = 0.03), combined MF activities ( g = 0.24, 95% CI − 0.04 to 0.49, p = 0.05), plyometric activities ( g = 0.39, 95% CI 0.09, 0.68, p = 0.01), body weight ( g = 0.27, 95% CI − 0.10, 0.65, p = 0.15), and traditional MF methods ( g = 0.43, 95% CI 0.09, 0.78, p = 0.01). Conclusions School-based interventions which aimed to increase MF outcomes in adolescent boys demonstrated small-to-moderate effects. Traditional and plyometric methods of resistance training appear to be the most effective form of PA delivery in adolescent males. More quality research is required to assess the impact of MF delivered in the school environment to inform future intervention design.

Background: High Intensity Interval Training (HIIT) is a sustainable and effective method for improving Cardiorespiratory Fitness (CRF) in adolescents. HIIT is proven to produce equal or greater improvements in CRF when compared to moderate intensity continuous exercise (MICE) in adolescents. Methods: The studies included were considered eligible if: (1) Participants were adolescents (11–18 years old); (2) Examined changes in CRF measured either directly or indirectly; (3) Included a non-exercising control group or MICE comparison group; (4) Participants were matched at enrolment; (5) Reported HIIT protocol information; (6) Provided HIIT intensity. A meta-analysis was conducted to determine the effect of HIIT on CRF. Meta-regression and moderator analyses were performed out to quantitatively examine moderators of protocol design on CRF improvements. Results: HIIT displays a moderate effect to improve CRF (g = 0.86, 95% CI 0.518–1.106, p < 0.001). Neither study duration (weeks), nor total or weekly accumulated HIIT volume (min) displayed any significant moderation effect on pooled improvement on CRF (p > 0.05). Conclusions: HIIT is an effective method to improve CRF in adolescents, irrespective of body composition. Notably, meta regression analysis identified that prolonged high volume HIIT programs are similarly effective to short term low volume HIIT programs. This becomes of particular interest for those involved in school curricula, where short HIIT exercise may provide a pragmatic adjunct to the health benefits of Physical Education (PE) lessons.

Background: It has been reported that boys’ and girls’ physical activity (PA) levels decline throughout adolescence. Boys are at risk of physical inactivity during adolescence however, in intervention research they are an under-represented group relative to girls. It is suggested that the school environment may be central to developing interventions that support adolescents in meeting the current PA guidelines. The purpose of this systematic review and meta-analysis was to investigate the efficacy of school-based interventions to increase moderate to vigorous physical activity (MVPA) and muscle and bone strengthening exercise (MBSE) outcomes in adolescent males. Methods: This systematic review and meta-analysis followed the preferred reporting systems for meta-analyses guidelines and was registered on PROSPERO (Registration number: CRD42018091023). Eligible studies were published in English within peer-reviewed articles. Searches were conducted in three databases, with an additional grey literature search in Google Scholar. Studies with MVPA and MBSE as outcomes were included.Results: There were 51 data sets identified across 15 studies, from eight countries. Overall methodological quality of the studies was moderate to strong. Significant, small effect sizes were identified following a pooled analysis of all studies which aimed to increase MVPA and MBSE outcomes (g = 0.26, 95% CI = 0.15, 0.37, P = <.001). Interventions targeting MVPA were ineffective (g = -0.09, 95% CI -0.72, -0.53, P = 0.77). Interventions targeting MBSE evidenced a small to medium effect (g = 0.27, CI 0.16, 0.39, P = <.001). Sub-group analyses of MBSE delivery method resulted in small to medium effects: Upper limb MBSE (g = 0.23, 95% CI 0.03, 0.43, p = 0.02), lower limb MBSE (g = 0.21, 95% CI 0.09, 0.33, p <0.00), combined resistance activities (g = 0.22, 95% CI 0.05 – 0.39, p = <0.00), plyometric activities (g = 0.39, 95% CI 0.09, 0.68, p = 0.01), body weight (g = 0.21, 95% CI -0.00, 0.44, p = 0.05), and traditional MBSE methods (g = 0.43, 95% CI -0.09, 0.78, p = 0.01).Conclusions: School-based interventions which aim to increase MVPA in adolescent males were not effective. Interventions focused on MBSE demonstrated small to moderate effects. Traditional and plyometric methods of MBSE appear to be the most effective form of PA delivery in adolescent males. More quality research is required to assess the impact of MBSE delivered in the school environment in order to inform future intervention design.