Youth who participated in the SHCP decreased time spent in sedentary activity and increased very vigorous physical activity from pre- to post-intervention, while these changes were not observed at the control school. The overall small physical activity intensity pattern shift supports that physical activity is an important area to target within a multicomponent nutrition intervention aimed at preventing childhood obesity.

Background. Research remains inconclusive about the most effective frame for encouraging health preventative behaviors. Aims. To examine the impact of gain- and loss-framed health messages on nutrition and physical activity (PA) knowledge in fourth-grade youth participating in the Shaping Healthy Choices Program (SHCP), a multicomponent nutrition program. Methods. Youth were recruited to participate in this 9-month quasi-experimental study and divided into 3 groups: (1) comparison (n = 50), (2) loss-framed (n = 76), and (3) gain-framed (n = 67). All youth participated in the SHCP, and the gain- and loss-framed groups also viewed weekly health messages. Paired t tests or Wilcoxon signed-rank test, ANOVA (analysis of variance), and Bonferroni for multiple comparisons were used for analysis. Results. Youth who participated in the SHCP improved nutrition knowledge (+2.0 points; P < .01) and PA knowledge (+1.8 points; P < .01). Nutrition knowledge improved in the comparison group (+1.3 points; P = .04), loss-framed group (+1.9 points; P = .01), and gain-framed group (+2.6 points; P = .01). Improvements in PA knowledge were also demonstrated in the comparison group (+1.6 points; P < .01), the loss-framed group (+1.3 points; P < .01), and the gain-framed group (+2.5 points; P = .01). There were no significant differences between groups. Youth in the loss-framed group reported a decrease in self-efficacy (−1.2; P = .05), while this was not observed in the other groups. Discussion. The SHCP improves nutrition and PA knowledge, and the positive reinforcement further strengthens some of these improvements, while loss-framed messaging can contribute to undesirable outcomes. Conclusions. Incorporating positive reinforcement through gain-framed messages can be a relatively low-cost avenue for supporting beneficial outcomes.

Background: Research has shown that engaging in regular physical activity supports physiologic, metabolic, and immunologic processes, as well as quality of life. However, few youth in the United States meet the U.S. Department of Health and Human Services recommendation of 60 min of moderate-to-vigorous physical activity every day. School-based programs can be an effective avenue for engaging youth in physical activity, particularly when the design of the health education is based on theory, research, and practice. The purpose of this study was to design, implement, and evaluate a theory-driven physical activity curriculum for the Shaping Healthy Choices Program (SHCP) using a systematic approach. Methods: The experiential, inquiry-based physical activity curriculum, Healthy Choices in Motion (HCIM), was developed with an optional technology enhancement using Backward Design. A questionnaire to assess the curriculum's effect on physical activity knowledge was developed and assessed for content validity, internal consistency (α = 0.84), and test-retest reliability (r = 0.73). The curriculum was piloted in two phases among upper elementary-aged youth: to ensure the learning goals were met (Pilot I) and to determine the curriculum's impact on physical activity knowledge, behavior, and self-efficacy (Pilot II). Pilot II was implemented among eight 4th and 5th-grade classrooms participating in the UC CalFresh Nutrition Education Program: (1) Comparison (no intervention) (n = 25); (2) SHCP only (n = 22); (3) SHCP + HCIM (n = 42); (4) SHCP + HCIM with technology enhancement (n = 47). Analyses included unadjusted ANOVA and Bonferroni for multiple comparisons and paired t-test (p < 0.05). Results: Through the use of a methodical design approach, a comprehensive physical activity curriculum, called HCIM, was developed. Youth participating in HCIM improved physical activity knowledge compared to youth receiving no intervention (+2.8 points, p = 0.009) and youth only in the SHCP (+3.0 points, p = 0.007). Youth participating in Fetter et al. Development of Healthy Choices in Motion HCIM with technology enhancement demonstrated improvements compared to youth only in the SHCP (+2.3 points, p = 0.05). Conclusion: Improvements in physical activity knowledge in youth participating in HCIM may contribute to improvements in physical activity and should be further explored in conjunction with behavioral measurements.

Engaging in regular activity during childhood leads to better cardiorespiratory fitness and a greater likelihood of being active in adulthood. To encourage 4th–6th grade students to be more active, a physical activity curriculum, called Healthy Choices in Motion, was developed to complement the school‐based, multi‐component nutrition program, the Shaping Healthy Choices Program (SHCP). The curriculum was designed with an optional technology‐enhancement component utilizing wearable activity monitoring devices. Relying upon the principles of the Social Cognitive Theory and constructivism, the Backward Design approach was used to develop the experiential, inquiry‐based curriculum. Through this process, five primary learning objectives were identified, each to be developed into a lesson: (1) the benefits of physical activity; (2) recommendations across the lifespan; (3) the five components of physical fitness; (4) the importance of a variety of physical activity; (5) what being physically active means. A journal was created with take‐home activities for the learner to complete after each lesson. The lessons underwent an extensive development phase where the lessons were implemented among learners in the intended age group. This allowed the research team to ascertain whether children would be capable of understanding the intended concepts, if the evidence of learning was sufficient, and that the activity design was appropriate. To ensure the technology component contributed to the learning objectives, the lessons were facilitated once with pedometers and then with accelerometers. As each lesson was facilitated, two observers used a plus/delta form to record what worked well on the “plus” side and what needed to be improved on the “delta” side. The research team later met to review observations and make revisions to the lesson. To determine whether the lessons improved physical activity knowledge for future research, a 20‐item assessment tool was created. The questionnaire was assessed for content validity, internal consistency reliability, and test‐retest reliability. Analyses were conducted using STATA 14.0. Pearson's correlations were used to assess test‐retest reliability by comparing total scores and scores between the test and retest administration with significance set at P<0.05. Cronbach's α was used to determine internal consistency, with a minimum acceptable level of α>0.7. Results showed the questionnaire to have acceptable total reliability (r=0.73) and internal consistency (Cronbach's α=0.84). Nutrition education experts reviewed the questionnaire for content validity. For future SHCP implementation, the inclusion of Healthy Choices in Motion may strengthen the improvement seen in physical activity pattern from the initial intervention.

Regular physical activity (PA) has been shown to aid with weight control and improve physiologic, metabolic, and immunologic processes, along with quality of life. The objective of this study was to determine whether intensity of PA improved in 4th‐graders participating in the multi component intervention Shaping Healthy Choices Program (SHCP). At pre‐ and post‐intervention assessments, students at the control and intervention schools were asked to wear a PolarActive monitor on their non‐dominant wrist 24 h/d for 5 consecutive days. The PolarActive used accelerometer technology to measure 3 dimensions of motion capturing time (minutes) spent in different activity intensity levels (very vigorous, vigorous, moderate, easy, and very easy). A total of 54 students at the intervention school and 38 students at the control school used the accelerometers for at least 2 days during both the pre‐ and post‐assessments. Analyses were conducted using STATA 14.0. Tests performed were Student's t‐test and paired t‐test, as appropriate. Mean moderate to vigorous physical activity (MVPA) significantly increased at the intervention school from 81.43 ± 29.36 min/d at pre to 103.70 ± 40.76 min/d at post (P=0.01) and at the control school from 70.10 ± 29.42 min/d at pre to 100.03 ± 63.15 min/d at post (P=0.01). There were no significant differences for the change in MVPA between the intervention and control schools. Students at the intervention school significantly decreased mean time performing very easy activity from pre to post by 78.53 ± 119.12 minutes compared to the controls (16.55 ± 138.42 minutes; P=0.02). While there was no significant difference in the change of very vigorous PA between the control and intervention schools, mean very vigorous PA significantly increased in students at the intervention school from 5.57 ± 4.37 min/d at pre to 7.80 ± 9.23 min/d at post (P=0.04). This significant increase in very vigorous PA was not observed at the control school (P=0.44). Taken together, these results suggest students at the intervention school decreased very easy PA and increased very vigorous PA from pre to post; while these changes were not observed at the control school. These improvements in PA, concomitant with other positive behavioral outcomes, may have contributed to the significant decrease in BMI percentile observed in students participating in the SHCP. Due to the small sample size, significant changes in intensity of PA for those students that improved their BMI percentile were not evaluated. These data support that PA is an important area to target within a multi‐component nutrition intervention aimed at preventing childhood obesity.Support or Funding InformationFunding was provided by UCANR competitive grant #11‐1018, USDA 2011‐38420‐20082, and USDA NIFA Hatch project 221082.