An overview of “The Active by Choice Today” (ACT) trial for increasing physical activity

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Abstract

Background

Although school-based behavioral interventions for increasing physical activity (PA) in children and adolescents have been conducted, little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days. The overall goal of the “Active by Choice Today” (ACT) trial is to expand the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents (low socioeconmic status, minorities) during their middle school years.

Design and setting

An overview of the ACT study design, theoretical framework, process evaluation, and primary hypotheses is presented. The trial involves twenty-four middle schools (1560 6th graders) in South Carolina that are randomly assigned to one of two after-school programs (motivational and life skills intervention, or general health education).

Intervention

The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA. The intervention targets skill development for PA outside of program days and the after-school program social environment (autonomy, choice, participation, belongingness, fun, enjoyment, support) is designed to positively impact cognitive mediators (self-efficacy, perceived competence), and motivational orientation (intrinsic motivation, commitment, positive self-concept).

Main hypotheses/outcomes

It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA (based on 7-day accelerometry estimates) at post-intervention as compared to the general health education program.

Conclusions

Implications of this innovative school-based trial are discussed.

Section snippets

Introduction and rationale for the ACT trial

There have been a relatively large number of studies examining the prevalence of physical activity (PA) in children and adolescents. Only a limited number of studies, however, have examined the prevalence of PA in underserved adolescent populations (e.g., minorities and those of low socioeconomic status (SES)) [1], [2], [3]. Previous research indicates that only 50% of youth are currently meeting the national guidelines of engaging in regular PA and that underserved adolescents are less

Study design and recruitment approach

The ACT trial is a group-randomized cohort design (see Fig. 1) with three intervention and three comparison schools per cohort (year). The schools are paired prior to recruitment and randomization to condition to avoid possible bias or confounding by socio-demographic differences. The criteria on which the schools are paired includes 1) school size, 2) white versus non-white ethnicity 3) proportion of free and reduced lunch in the school and 4) urban or rural community setting. Baseline

Integration of motivational and behavioral theories in the ACT intervention

A novel aspect of the ACT trial is the integration of theoretical constructs from SDT and SCT to enhance intrinsic motivation and behavioral skills for increasing long-term PA behavior specifically in underserved adolescents. A formative evaluation of the theoretical elements was developed during year 1 of the ACT trial [15]. All of the theoretically-based elements of the ACT intervention are summarized into the ACT essential elements, which are listed and defined in Table 1. Collectively, the

Approach to process evaluation and assessment of mediators and outcomes

The ACT logic model is presented in Fig. 1 as an integrative framework for process and outcome evaluation [38], [39] by illustrating how program inputs (resources) and program activities are designed to create a motivation-enhancing environment and PA behavior skill development, and how this is expected to lead to changes in mediators and PA behavior. The logic model in Fig. 2 also presents the associated measurement components for each of these elements. Note that activities in the “Inputs”

Data analyses plan for primary outcome

The primary aim of this study is to demonstrate an increase in moderate to vigorous physical activity (MVPA) in students assigned to the PA intervention after the completion of the after-school program. Data analysis for the main aims of this study involves two steps. The first step utilizes approaches for dealing with missing data. These analyses follow the general methodology proposed for dealing with missing accelerometer data in a previous national trial [62], in which multiple imputation

Study implications

During the past several years our research team has conducted a series of preliminary studies that demonstrate the feasibility of the ACT intervention [15], [21], [22]. Process evaluation data reveal that the program elements were acceptable to 6th grade students and promote increases in PA and participation. Thus, the next step in our program of research is to test the efficacy of this innovative intervention as part of the group randomized trial. This trial allows us to more clearly document

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    This article was supported by a grant (R01 HD 045693) funded by the National Institutes of Child Health and Human Development to Dawn K. Wilson, Ph.D.

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