BackgroundOverweight and obesity among adolescents may have consequences, with potentially lasting effects on health and health-related quality of life (HRQoL). Excess weight is also associated with decreases in physical activity and cardiorespiratory fitness. The aim of the current study was to investigate the short-term effects of a 12-week Internet intervention in a primary care setting intended to increase cardiorespiratory fitness and HRQoL among overweight and obese adolescents.MethodsIn this controlled trial, participants (13–15 years) were non-randomly allocated to an intervention- or a control group. The intervention group received 12-weeks access to an online program providing tailored physical activity counseling based on principles from Self-determination Theory and Motivational Interviewing. The control group received standard follow-up by the school nurses. The primary outcome measure of cardiorespiratory fitness was determined using a shuttle run test. The secondary outcomes: HRQoL, leisure time exercise, body image and self-determined motivation for physical activity and exercise, were assessed by self-report measures. Age- and gender-adjusted body mass index (BMI) was calculated based on measurements of height and weight. To compare pre-to post intervention differences within groups, a paired samples t-test was used while crude differences between groups were analyzed with an independent samples t-test.ResultsOf the 120 participants, 108 completed the study, 75 in the intervention group and 33 in the control group. Exposure to the intervention had a small effect on cardiorespiratory fitness (0.14; 95% CI [0.01;0.28]; P = 0.04), and a moderate effect on HRQoL (5.22; 95% CI [0.90; 9.53]; P = 0.02). Moreover, the control group increased significantly in BMI, yielding a moderate preventive effect on BMI (−0.39; 95% CI [−0.74;−0.03]; P = 0.03) for the intervention group.ConclusionThe results suggest that the Internet intervention with tailored physical activity counseling can have beneficial short-term effect on cardiorespiratory fitness, HRQoL and BMI among adolescents with overweight and obesity.Trial RegistrationClinicalTrials.gov NCT01700309

BackgroundInternet interventions may provide opportunities for low threshold counseling using feedback to guide and support health behavior, including increased physical activity. Research shows that overweight and obese adolescents are less physically active than their peers of normal weight. There are good reasons to believe that Internet-based interventions may be particularly suitable for motivating adolescents to increase physical activity, but we need to gain further knowledge of what features are effective and how to design such interventions.ObjectiveTo describe the process of development and evaluation of usability of a Web-based program for increasing physical activity in overweight adolescents.MethodsInformed by the self-determination theory, motivational interviewing, and perspectives on self-regulation, this intervention was developed in a stepwise process by an interdisciplinary team of researchers, designers, developers, and representatives from the target group. An iterative qualitative usability testing approach (observation, survey, and interview) was applied in 2 sequences, first in the lab and second in the field, to assess how adolescents (aged 12-16 years) used and experienced the program and to make adjustments to the program based on evaluation of their response.ResultsThe following components were included in the program: self-monitoring through planning and registration of physical activity and graphical response on progress, autonomy supportive individual Web-based counseling, forum for social support, and relevant age-adjusted information about physical activity. The first usability test resulted in adjustments related mainly to making the content and aim of the different features more visible and explicit. The second test evaluated the program with adjustments from the first test, revealing that the program was well accepted by the participants and only small aesthetic adjustments had to be made to complete the final version of the Internet program, Young & Active.ConclusionsThorough preparation, with clear theory foundation and close monitoring in the developmental phase, as well as contribution and iterative evaluation from the target group, is essential to create a user-friendly and engaging program. The efficacy of the program will be evaluated in a controlled trial.

BACKGROUND After‐school programs (ASP) provide opportunities to influence children's physical activity (PA). However, little is known about the PA levels of the youngest schoolchildren. The aim of the study was to describe the level of PA intensity and sedentary time among first graders attending ASP in Norway, and to investigate factors that are associated with PA in the ASP. METHODS First graders from 14 ASPs were invited to participate in the study and 426 children were included. The children wore an accelerometer for five consecutive days during their stay in the ASP. Light, moderate, and vigorous PA and sedentary time were registered and analyzed. RESULTS On average, the children accumulated 25.8 minutes of moderate and vigorous physical activity (MVPA) during their ASP‐stay. However, there was considerable variation within the sample. Sex, as well as body mass, were associated with MVPA. The activity level increased substantially when the children had to be outside. CONCLUSIONS The findings show that on average, the children were quite physically active in the ASP. However, it seems critical to devote increased attention to the least active children and to include extensive outdoor play‐time in the ASP schedule.

This file was dowloaded from the institutional repository Brage NIH -brage.bibsys.no/nih Riiser, K., Ommundsen, Y., Småstuen, M. C., Løndal, K., Misvaer, N., Helseth, S. (2014). The relationship between fitness and health-related quality of life and the mediating role of self-determined motivation in overweight adolescents. The relationship between fitness and health-related quality of life and the mediating role of self-determined motivation in overweight adolescentsAim: To examine the relationship between cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) among overweight adolescents and to test whether this relationship is mediated by body image (BI) and self-determined motivation for physical activity (PA) and exercise. Methods: 120 adolescents identified as overweight or obese were recruited through the school health service. The participants completed self-report instruments measuring HRQoL, BI and self-determined motivation for physical activity and exercise in addition to a 20-m shuttle-run test, and body mass index was calculated. Confirmatory factor analysis was conducted to evaluate the hypothesized fivedimensional structure of the Behavioural regulation in exercise questionnaire-2 (BREQ-2) used to measure self-determined motivation. Associations between the study variables were explored using univariate linear regression. Mediation was tested by a multistage regression approach. Results: The five-dimensional model of BREQ-2 showed acceptable fit for the data. We revealed a statistically significant association between cardiorespiratory fitness and HRQoL (4.16 [0.3-8.02]; p <0.05). CRF failed to affect BI in the first mediation equation, hence body image was excluded from further analyses. However, self-determined motivation proved to mediate the relationship between CRF and HRQoL. Conclusions: The results of this study suggest that the motivational mechanisms related to fitness can contribute to explain the association between CRF and HRQoL in adolescents with overweight. The findings are important from a public health point of view and should be taken into account in the development of PA-interventions for adolescents with overweight and obesity for the potential enhancement of their physical and psychosocial well-being.

IntroductionInterventions delivered in after-school programmes (ASPs) have the potential to become a means of ensuring adequate physical activity among schoolchildren. This requires a motivational climate, allowing for self-determined play. If trained, ASP staff may represent a valuable resource for supporting such play. Increasing knowledge and supportive skills among ASP staff may also potentially increase their motivation for work. The purpose of this article is to describe the development of the ‘Active Play in ASP’ intervention, which aims to promote physical activity among first graders attending ASP, and to present a protocol for a matched-pair cluster-randomised trial to evaluate the intervention.Methods and analysisInformed by experiences from practice, evidence-based knowledge and theory, the intervention was developed in a stepwise process including focus group meetings and a small-scale pilot test. The intervention contains a course programme for ASP staff to increase their skills in how to support physical activity through play. In a cluster randomised controlled trial, the ASPs will be matched and randomly allocated to receive the 7-month intervention or to a control group. Outcomes will be assessed at baseline, after 7 and 19 months. First graders attending the ASPs included are eligible. The primary outcome will be accelerometer-determined minutes in moderate to vigorous physical activity in the ASP. The study uses a mixed methods approach including observations and interviews to provide rich descriptions of the concept of children's physical activity in ASP. Moreover, the trial will assess whether the ASP staff benefits from participation in the intervention in terms of increased work motivation. Lastly, process evaluations of programme fidelity, satisfaction and suggestions on improvement will be performed.Ethics and disseminationThe study is approved by the Data Protection Official for Research (reference no 46008). Results will be presented in conferences and peer-reviewed journals.Trial registration numberClinical Trials (NCT02954614), pre-results.