Distribution - American College of Sports Medicineforms.acsm.org/_frm/acad/PDFs/6.pdfDistribution of...
44
Transcript of Distribution - American College of Sports Medicineforms.acsm.org/_frm/acad/PDFs/6.pdfDistribution of...
Distribution of the Metabolic Syndrome & Its Related Components
0
10
20
30
40
MS HDL-C TG Gluc CO BP
All Boys Girls
Prev
alen
ce (%
)
VariablesDuBose et al., Acta Paediatr, 2006
Distribution of the Metabolic Syndrome & Its Related Components By BMI Levels
0
10
20
30
4050
60
MS HDL-C TG Gluc CO BP
Normal At risk Overweight
Prev
alen
ce (%
)
VariablesDuBose et al., Acta Paediatr, 2006
Distribution of the Metabolic Syndrome & Its Related Components By Race
0
10
20
30
40
MS HDL-C TG Gluc CO BP
Cau AA Hisp
Prev
alen
ce (%
)
VariablesDuBose et al., Acta Paediatr, 2006
Number of Components of the Metabolic Syndrome
0
10
20
30
40
50
60
0 1 2 3 4 5
Prev
alen
ce (%
)
Number of ComponentsDuBose et al., Acta Paediatr, 2006
Schools are Sedentary
• Bus ride can be > 60 min each way• Recess and physical education has declined to levels that cannot provide adequate stimulus (energy expenditure) for fitness or to protect against fatness
• Motor time off task is discouraged and disciplined
• Traditional teaching paradigm‐ sit down and be quiet
Physical Activity Across the Curriculum (A+PAAC)
A 3‐year, randomized controlled trial of physical activity and academic
achievement for elementary school children in grades 2 & 3
DK61489 Donnelly, PI
Major Aims of PAAC
• Increase physical activity by using classroom teachers to teach existing lessons with using physical activityDiminish increases in BMIDetermine association between physically active lessons and academic achievementCharacterize metabolic syndrome
The PAAC Program
•A classroom‐based approach to reduce sedentary behavior while maintaining the focus on academics•NO DECREASE in academic instruction time•PAAC is a technique to deliver existing academic instruction through movement
Traditional VS. PAAC Classroom
Conceptual Framework
• Minimal intervention• Enhances learning• No additional teacher preparation time• No additional cost• Easily perpetuated and replicated• Desirable for both teacher and student (i.e., FUN)• Students “must” participate in classroom lessons
The PAAC Program
Integrate 10 minute periods of physical activity within academic lessons for a total of 90 min/wk (i.e. 1 ten min lesson in morning and afternoon.
• Language art• Math • Science• History
The Selling of PAAC
The All Important Link Between Academics +Physical Activity
Physically active children:
Achieve higher math and reading scores
Calmer in class
Less absenteeism
School Responsibilities• Enthusiastic support for ~100 min A+PAAC/wk & reporting data by teachers
• Provide time for recruitment of volunteers• Provide for observation by research assistants• Provide space & time for testing, ~2.5hr, fall & spring, volunteers only, N= 40 (20 2nd, 20 3rd)
• Participate in focus groups 2010‐2011 (participants paid by KU for attendance)
• Provide time for teachers for in‐service fall & spring for PAAC training for 3 years (participants paid by KU for attendance)
KU Responsibilities• Provide in‐service for teachers and A+PAAC notebook (examples of
physically active lessons). Provide ongoing teacher support• Recruit students for testing• Provide research assistants to collect observe classrooms and
collect data• Provide necessary instruments for testing volunteer participants in
fall and spring of each of 3 years• Provide incentives for volunteer participants who undergo testing
(small items‐ gift cards, bowling pass, water bottles, etc.)• Provide a stipend of $1,000 to each school upon completion of the
study• Provide training for control schools that are interested in
implementing A+PAAC upon study completion
Design
• Cluster randomized, controlled trial N=22• 3 year intervention• Grades 2&3• Target 90 minutes of mvpa/wk• Use classroom teachers to deliver existing academic lessons using physical activity
Methods
• Teacher in‐service for PAAC twice yr. 1, then 1 in yrs. 2&3
• BMI% calculated • Physical activity was measured using the SOFIT procedure
• Academic achievement was measured using WeschslerIndividual Achievement Test‐Second Edition (WIAT‐II; The Psychological Corporation, 2001).
• Blood chemistry by venipuncture• Daily physical activity by accelerometer
Active Lesson
Learning to Spell
Learning Math
Learning Spanish
SOFIT
• Observation of level of physical activity1 lying2 sitting3 standing4 walking5 running
McKenzie et al., 1991
MinuteStudent #1
Name:___________________Student #2
Name:____________________Student #3
Name:___________________
1 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
2 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
3 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
4 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
6 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
7 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
8 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
9 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
10 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
11 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
12 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
13 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
14 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
15 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
16 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
17 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
18 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
19 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
20 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
SOFIT CODE SHEETKEY:
1: Lying Down2: Sitting3: Standing4:Walking5: Very Active
School: ____________ Date: ____________ Teacher: ________ Start Time: _______ _
Activity Subject (check all that apply): Language Arts Math Science Social Studies Other
Duration: _______ minutes
Teacher Participation: None Somewhat Very Active
Overall Student Enjoyment: Activity was not enjoyable Neutral Activity was enjoyable
Comments/Notes:____________________________________________________________________________
___________________________________________________________________________________________
Level of Physical Activity Mean SOFIT by Semester
0
0.5
1
1.5
2
2.5
3
3.5
4
Spring 04 Fall 04 Spring 05 Fall 05 Spring 06
SOFI
T ControlIntervention
Energy Expenditure of PAAC Lessons with Cosmed
• 38 boys & girls• Grades 2‐5• PAAC lessons of ≥ 10 min duration
• Average MET = 3.4 (lower end of moderate to vigorous)
SOFIT Scores Across Grades
3.283.3
3.323.343.363.383.4
3.423.443.463.48
Grade2
Grade3
Grade4
Grade5
SOFIT Score
Typical Pattern of PAAC Minutes Across Semester
62
64
66
68
70
72
74
76
78
JanuaryFebruaryMarchAprilMay
BMI Change Across 3 Years for PAAC Schools Receiving 75+ min of PA or < 75
min PA
0
0.5
1
1.5
2
2.5
BMI Change
75+<75
P=0.0003
1.8±0.1
2.4±0.2
9 schools 75+ min5 school <75 min
Academic Achievement‐ Individual Categories
9698
100102104106108110112114
PAACCON
ReadingB 3yr
Math B 3yr
SpellingB 3yr
Donner Adjusted t for Each Category p ≤ 0.01
Activity Level Measured by Accelerometry
Accelerometer Period
Control(N=90)
Intervention(N=77)
P value
4‐d Ave 744 (183) 851 (233) 0.007
Weekend Day 750 (219) 901 (279) 0.001
During School 606 (205) 688 (199) 0.01
After School 946 (332) 1,017 (365) NS
Evening 812 (349) 891 (361) NS
Values are means (SD). * Controlling for gender, race, ethnicity, and cohort.
Relationship Between Teacher Modeling & Physical Activity Levels in Students
2
2.5
3
3.5
4
4.5
5
None Some what active Active
Level of Teacher Modeling
PA L
evel
by
SOFI
T Sc
ore
*P<0.0001; dose-response relationship between teacher modeling and PA levelGibson et al., IJBNPA, 2008
**
9‐Months Post Intervention Teacher Survey
0102030405060708090100
≥1 d 2‐4 d/wk most or every did not use
Percentage Use
CDC Review
• 43 articles reporting 50 unique studies• Coded by physical activity context• Investigated increasing time spent in physical education or physical activity
www.cdc.gov/HealthyYouth, April, 2010
Results of CDC Review
• General findingsPositive or no relationship between time in physical education/recess/sports and academic achievement and indicators of cognitive functionPositive relationships between classroom physical activity and indicators of academic achievement, classroom behavior, and cognitive function
Level of Evidence
• Few randomized controlled trials with adequate statistical power
• It is difficult to know if it is fitness or physical activity that drives potential improvements in academic achievement
• Many related factors may be responsible for any potential effect of physical activity on academic achievement such as attention‐to‐task, absenteeism, SES, and others
• It is difficult to know for whom active lessons may have the greatest benefits
Which Test to Choose
• Cognitive function• Individual or group achievement tests• Grades• Teacher judgment• *State administered standard tests
*Likely considered important by school officials
A+PAAC Design‐ Emphasis on Academic Achievement
• Adequately powered, cluster randomized trial• 17 elementary schools, (9 intervention, 8 control)
• ~ 20 children from 2nd & 3rd grades followed 3 yrs. to 4th and 5th grades (~40/school, 682 children total)
• 20 minutes of A+PAAC lessons/day
DK85317, Donnelly PI
Theoretical Model to Improve Health & Academic Achievement
Adapted from Lambourne
Outcomes
• Academic achievement measured by Wechsler Individual Achievement Test III
• State administered achievement tests• Cognitive function‐ Stroop, XXXX• Anthropometrics, fitness (Pacer), blood sample, blood pressure, attention‐to‐task, energy expenditure of A+PAAC lessons (indirect calorimetry via CosMed)
