ObjectiveTo review and evaluate the impact of school-based, before-school physical activity (PA) programmes on children’s PA levels, health and learning-related outcomes.DesignSystematic review.Data sourcesPubMed, PsycINFO, Scopus, Embase and ERIC were searched in January 2021.Eligibility criteria for selecting studies(1) Original research published in English, (2) sample included typically developing school-age children and/or adolescents, (3) examined school-based PA programmes delivered before school, (4) included a comparator and (5) reported associations with PA, physical health, learning-related and/or psychosocial outcomes. Studies examining before-school active transport or sport were excluded.ResultsThirteen articles representing 10 studies were included (published 2012–2020); seven conducted in primary schools. Programmes ranged between 3 weeks and 6 months, primarily operating daily and for 25–40 min. One study examined a programme informed by theory; six incorporated fidelity measures. Data synthesis, considering consistency of findings, showed indeterminate associations for the domains of physical health, learning-related and psychosocial outcomes. Among subdomains, synthesis showed positive associations with before-school and daily PA, cardiorespiratory and muscular fitness, readiness to learn and an inverse association with adiposity. Risk of bias was high/serious or insufficiently detailed across studies and outcome domains, except PA, which included moderate-risk studies.ConclusionThere is limited available evidence on school-based, before-school PA programmes, with some positive associations at domain and subdomain levels. Continued research is justified to understand the role of before-school programmes for facilitating PA. Future research should follow recommended practice for intervention design and process evaluation, and address under-represented contexts, including secondary schools.PROSPERO registration numberCRD42020181108.
Objective To explore health professionals’ perspectives on physical activity and sedentary behaviour of hospitalised adults to understand factors that contribute to these behaviours in this environment. Data sources Five databases (PubMed, MEDLINE, Embase, PsycINFO and CINAHL) were searched in March 2023. Review methods Thematic synthesis. Included studies explored perspectives of health professionals on the physical activity and/or sedentary behaviour of hospitalised adults using qualitative methods. Study eligibility was assessed independently by two reviewers and results thematically analysed. Quality was assessed using the McMaster Critical Review Form and confidence in findings assessed using GRADE-CERQual. Results Findings from 40 studies explored perspectives of over 1408 health professionals from 12 health disciplines. The central theme identified was that physical activity is not a priority in this setting due to the complex interplay of multilevel influences present in the interdisciplinary inpatient landscape. Subthemes, the hospital is a place for rest, there are not enough resources to make movement a priority, everyone's job is no one's job and policy and leadership drives priorities, supported the central theme. Quality of included studies was variable; critical appraisal scores ranged from 36% to 95% on a modified scoring system. Confidence in findings was moderate to high. Conclusion Physical activity in the inpatient setting is not a priority, even in rehabilitation units where optimising function is the key. A shift in focus towards functional recovery and returning home may promote a positive movement culture that is supported by appropriate resources, leadership, policy, and the interdisciplinary team.
Physical activity (PA) among children and adolescents is often reported by time segments centered around the school day, including before school. However, there is no consistent approach to defining the before-school segment, to accurately capture PA levels and facilitate synthesis of results across studies. Therefore, this study aimed to (a) examine how studies with children and adolescents have defined the before-school segment, and (b) compare adolescents’ before-school PA using various segment definitions. We conducted a systematic search and review of literature from six databases, and subsequently analyzed accelerometer data from Australia (n = 472, mean age 14.9 years, 40% male), to compare PA across five before-school definitions. Our review found 69 studies reporting before-school PA, 59 of which used device-based measures. Definitions ranged widely, but justifications were rarely reported. Our empirical comparison of definitions resulted in a range of participants meeting wear time criteria (≥3 days at >50% of segment length) from the latest-starting definition (30 min prior to school; n = 443) to the earliest-starting definition (6:00 a.m.–school start; n = 155), implying that for many participants, accelerometer wear was low in the early hours due to sleep or noncompliance. Statistically significant differences in light and moderate-to-vigorous PA (mean minutes/school day, proportion of segment length, and proportion of wear time) were found between definitions, indicating that before-school PA could potentially be underestimated depending on definition choice. We recommend that future studies clearly report and justify segment definition, apply segment-specific wear time criteria, and collect wake time data to enable individualized segment start times and minimize risk of data misclassification.
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