Arnold School of Public Health, University of South Carolina, 921 Assembly St, 1st Flr Suite, RM 131, Columbia, SC, 29208, USA.
Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA.
BMC Public Health. 2018 Jul 3;18(1):819. doi: 10.1186/s12889-018-5737-6.
In 2015, YMCA afterschool programs (ASPs) across South Carolina, USA pledged to achieve the YMCA physical activity standard calling for all children to accumulate 30 min of moderate-to-vigorous physical activity (MVPA) while attending their ASPs. This study presents the final two-year outcomes from the dissemination and implementation efforts associated with achieving this MVPA standard.
Twenty ASPs were sampled from all South Carolina YMCA-operated ASPs (N = 97) and visited at baseline (2015) and first (2016) and second year (2017) follow-up. All ASPs were provided training to increase MVPA during the program by extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Intent-to-treat (ITT) models were conducted summer 2017. Programs were also classified, based on changes in MVPA from 2015 to 2016 and 2016-2017, into one of three categories: gain, maintain, or lost. Implementation, within the three groups, was evaluated via direct observation and document review.
Adoption during the first year was 45% of staff attending training, with this increasing to 67% of staff during the second year. ITT models indicated no increase in the odds of accumulating 30 min of MVPA after the first year for either boys (odds ratio [OR] 1.06, 95CI 0.86-1.31) or girls (OR 1.14, 95CI 0.87-1.50), whereas an increase in the odds was observed during the second year for boys (OR 1.31, 95CI 1.04-1.64) and girls (OR 1.50 95CI 1.01-1.80). Programs that lost MVPA (avg. - 5 to - 7.5 min/d MVPA) elected to modify their program in a greater number of non-supportive ways (e.g., reduce time for activity opportunities, less time spent outdoors), whereas ASPs that gained MVPA (avg. + 5.5 to + 10.1 min MVPA) elected to modify their program in more supportive ways.
The statewide study demonstrated minimal improvements in overall MVPA. However, child MVPA was dramatically influenced by ASPs who elected to modify their daily program in more supportive than non-supportive ways, with no one program modifying their program consistently across the multi-year initiative. These findings have important implications for organizations seeking to achieve the MVPA standard.
Clinical Trial Registration: NCT02394717 .
2015 年，美国南卡罗来纳州的基督教青年会（YMCA）课后项目承诺达到 YMCA 体育活动标准，要求所有儿童在参加课后项目时累计进行 30 分钟的中等至剧烈强度的身体活动（MVPA）。本研究介绍了为实现这一 MVPA 标准而进行的传播和实施工作的最后两年结果。
从所有南卡罗来纳州 YMCA 运营的课后项目中抽取了 20 个课后项目（N=97）进行抽样，并在基线（2015 年）和第一年（2016 年）和第二年（2017 年）随访时进行了访问。所有课后项目都接受了培训，通过延长活动机会的预定时间和修改常见的游戏来增加 MVPA，从而增加项目中的 MVPA。使用 RE-AIM 框架评估全州范围的干预措施。加速度计衍生的 MVPA 是主要结果。2017 年夏季进行意向治疗（ITT）模型。根据 2015 年至 2016 年和 2016 年至 2017 年期间 MVPA 的变化，课程也分为以下三类之一：获得、维持或丧失。通过直接观察和文件审查评估了三组内的实施情况。
第一年有 45%的员工参加了培训，第二年增加到 67%。IT 模型表明，无论是男孩（比值比 [OR] 1.06，95%置信区间 [CI] 0.86-1.31）还是女孩（OR 1.14，95%CI 0.87-1.50），在第一年之后，积累 30 分钟 MVPA 的几率都没有增加，而男孩（OR 1.31，95%CI 1.04-1.64）和女孩（OR 1.50 95%CI 1.01-1.80）在第二年的几率有所增加。在第二年，失去 MVPA（平均减少 5 到 7.5 分钟/天的 MVPA）的课程选择以更多不支持的方式修改课程（例如，减少活动机会的时间，减少户外活动时间），而获得 MVPA（平均增加 5.5 到 10.1 分钟/天的 MVPA）的课程选择以更多支持的方式修改课程。
全州范围的研究表明，整体 MVPA 仅略有改善。然而，儿童的 MVPA 受到课后项目的显著影响，这些课后项目选择以更支持而不是不支持的方式修改他们的日常课程，没有一个课程在整个多年倡议中始终一致地修改他们的课程。这些发现对寻求达到 MVPA 标准的组织具有重要意义。
临床试验注册：NCT02394717。
