Showing papers by "Gregory J. Welk published in 2022"

Estimation of Lower Body Muscle Power from Vertical Jump in Youth

Abstract: ABSTRACT Incorporation of the vertical jump (VJ) test in health-related fitness batteries is predicated on the availability of prediction equations to accurately estimate VJ power. The purpose was to develop and validate a generalizable equation to estimate VJ power from VJ height, body mass, age, and sex in 10- to 18-year-olds. The sample (N = 529) performed a VJ test and had VJ power assessed via mechanography. Validation and cross-validation groups were randomly formed to assess accuracy. Results indicated that estimates of VJ power from VJ height and body mass were accurate (R = .93, SEE = 275 Watts). Age and sex did not add substantially to the model. Upon cross-validation, accuracy was maintained. The newly developed model was more accurate than previously published equations. The following equation provides accurate and feasible estimates of VJ power (Watts) = −1354.820 + (35.455*VJ[cm]) + (43.942*body mass[kg]). This equation provides a feasible way to estimate power in field-based settings.

Development of Criterion-Referenced Standards for Musculoskeletal Fitness in Youth: Considerations and Approaches by the FitnessGram Scientific Advisory Board

Abstract: ABSTRACT The FitnessGram program has prioritized the use of evidence-based, criterion-referenced standards to advance health-related fitness assessments in physical education. The Institute of Medicine (IOM)1 highlighted the importance of strength and power for youth fitness assessment and surveillance. The report specifically recommended the use of handgrip and long-jump, but a barrier to adoption was the lack of criterion-referenced standards to categorize and evaluate performance. The purpose of this paper is to provide an overview of a multi-faceted research initiative focused on advancing research on musculoskeletal fitness assessments in youth. The report chronicles the concepts, approaches, and considerations that shaped the plans for this large-scale research effort aimed at developing robust criterion-referenced fitness standards for these assessments.

Associations of Physical Activity Enjoyment and Physical Education Enjoyment With Segmented Daily Physical Activity in Children: Exploring Tenets of the Trans-Contextual Model of Motivation

Abstract: Purpose: This study examined the associations between physical activity enjoyment and physical education enjoyment with segmented physical activity in children. Method: Using student-level data from the School Wellness Integration Targeting Child Health project (N = 1,986), the Youth Activity Profile (YAP) assessed physical activity before school, during physical education, recess, after school, and evening. Segmented YAP scores were regressed onto two enjoyment variables using a seemingly unrelated regression system. Results: Physical activity enjoyment and physical education enjoyment significantly associated with YAP scores during all segments, but physical education enjoyment showed stronger associations during physical education. Older students had higher physical activity before school and in the evening, and physical education enjoyment was more influential for females before school. Conclusion: This study supports tenets of the trans-contextual model of motivation. Improving both physical activity and physical education enjoyment may yield improvements in physical activity behaviors during physical education and all other day segments.

Long Jump, Vertical Jump, and Vertical Jump Power Reference Curves for 10-18 Year Olds

Abstract: ABSTRACT We developed age- and sex-specific smoothed percentiles for vertical and long jump, as well as vertical jump power, in healthy 10–18 year olds (n = 529, 47.1% female). Jump height and distance were measured and vertical jump power was assessed via mechanography. LMS regression was used to create smoothed age-specific reference curves, separated by sex. Pearson correlations between the jumps ranged from r = 0.22 to 0.64, varying by age and sex. Comparing medians, younger males had slightly higher values for vertical and long jump compared to females. Vertical jump power was more comparable between the sexes. For all measures, differences between the sexes become more pronounced at ages associated with the transition into adolescence. Growth model coefficients are reported for calculation of Z-scores. The growth curves can be used to compare samples, track lower body power, and link tests of fitness to athletic performance or health-related outcomes.

Linking Vertical Jump and Standing Broad Jump Tests: A Testing Equating Application

Abstract: ABSTRACT This study evaluated test-equating methods to enable comparisons and conversions between the vertical jump (VJ) and standing long jump (SLJ) tests. A total of 528 youth (280 males) performed VJ and SLJ, and their scores were randomly split as the calibration (C) sample (n = 478) and cross-validation (CV) sample (n = 50). SLJ scores of the C sample were equated to the scale of VJ using linear and equipercentile equating, and established conversion between the tests was applied to SLJ scores of the CV sample. Overall, the correlations between VJ and equated VJ were moderately high to high and the absolute differences were small in both C and CV samples. There was little difference between the equating methods, but the results of the equipercentile method were used because it could provide a more robust conversion in theory. The conversion should be further crossly validated with large, more diverse samples.

Designing Health-referenced Standards for the Plank Test of Core Muscular Endurance

Abstract: ABSTRACT We developed plank test standards, based on trunk lean mass-to-fat mass (LM/FM) ratio, in a sample of healthy Portuguese 10–18 year olds (n = 474, 46.4% female). Height and weight were measured and muscular endurance was assessed using the prone plank test. Trunk LM/FM ratio was determined using dual-energy x-ray absorptiometry. Plank standards were derived using receiver operator characteristic curves. Approximately 90% of youth with sufficient trunk LM/FM ratio were categorized into the desirable zone of plank time. Roughly two-thirds of those with trunk LM/FM ratio ≤ 5th percentile were identified within the undesirable zone. The odds of low trunk LM/FM were 6.5 times greater for those in the undesirable zone of plank compared those scoring above the cutpoint (independent of age, sex, or weight status). The standards provided here can be used to identify low trunk LM/FM ratio, which may have implications for balance and spinal health in youth.

Facilitated Health Coaching Improves Activity Level and Chronic Low back Pain Symptoms

Abstract: ABSTRACT Introduction Behavioral treatments, like increasing physical activity (PA), are recommended for chronic low back pain (CLBP). Finding methods for promoting behavior change with potential for translatability as well as effective behavioral targets remains challenging. Purpose This randomized controlled pilot study evaluated the effectiveness of low-dose facilitated health coaching with activity monitors to improve PA and sedentary behaviors (SB), symptoms, and Patient Global Impression of Change (PGIC) in CLBP. A secondary purpose was identifying behaviors associated with symptom change to inform future trials. Methods Seventy-one adults with CLBP were randomized to receive a wearable activity monitor alone (WAM) or with one primary session of health coaching and two check-ins based on motivational interviewing (WAM + HC) or a wait-list control (WLC) condition for 12 wk. Moderate and vigorous PA (MVPA), light PA (LPA), total and prolonged SB (i.e., sedentary >60 min per bout), and pain (Short Form McGill Pain Questionnaire (MPQ)) were assessed before and after intervention along with PGIC. Regression analyses examined group differences in MVPA, LPA, total and prolonged SB, MPQ, and PGIC after intervention as well as behavioral predictors of symptom improvement (change in MPQ). Results WAM + HC improved MPQ scores (β = −0.25, P = 0.02), LPA (β = 0.23, P = 0.04), MVPA (β = 0.21, P = 0.03), and total SB (β = −0.24, P = 0.03) compared with WLC over time. Both WAM + HC and WAM had significantly higher PGIC compared with WLC (P < 0.05). Change in prolonged SB was the only significant predictor of change in MPQ (β = 0.48, P = 0.01). Conclusions WAM + HC may be effective for changing activity-related behaviors and improving CLBP. Furthermore, reducing prolonged SB may be a meaningful target for future interventions in CLBP. Research focused on reducing prolonged SB including larger samples, and examining changes in symptoms will be important for identifying optimal translational treatment strategies for CLBP.

Process and impact evaluation of a practicum in motivational interviewing

Abstract: A practicum course was designed to offer undergraduate students the opportunity to learn motivational interviewing (MI), a skill commonly used in health coaching (HC). The 16-week course included online video lectures, in-class activities, experiential training, and supervised practicum experiences. This study evaluated the process, impact, and outcomes of the course (n = 46; 74% female; age 21.9 ± 3.7). Surveys were administered pre- and post-training to assess participant satisfaction of the course and the impact of training on communication using 7-point Likert scales. Recorded MI conversations were obtained after initial training (Week 8) and again following the supervised practicum (Week 16) to assess the fidelity outcomes (n = 23). Recordings were independently coded using the Motivational Interviewing Treatment Integrity (MITI) Coding Manual 4.2.1, with inter-rater agreement calculated between two trained coders. Paired samples t-tests and post-hoc analyses examined differences in pre-post fidelity levels, followed by Cohen’s d effect sizes. Survey results demonstrated that students felt comfortable (5.0 ± 0.7) and confident (4.8 ± 0.6) using MI. Inter-rater reliability among coders was high (ICC = 0.92 [95% CI: 0.90–0.93]). MITI results showed that 97.5% of coaches met proficiency for technical and 90.0% for relational at week 8. At week 16, all trainees met proficiency levels for both technical and global ratings, with t-tests reporting improvements in fidelity scores. Behavior counts were much lower, with the majority of participants not meeting proficiency at either timepoint. Extended real-world practice enhanced MI fidelity levels, and trained students reported high likelihood of continued skill use 1 year after training completion.

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation

Abstract: Guidelines recommend primary care providers refer children with obesity to behavioral interventions, but given limited program availability, access, and parental engagement, referrals remain rare. We developed telehealth coaching interventions for families whose children received care at a health system in Pennsylvania, United States in 2019-2020. Intervention referrals were facilitated by the pediatrician and/or project team for 6–12-year-old children with obesity following well-child visits. Participants chose one of three 26-week interventions focused on healthy eating, physical activity, or a hybrid clinical/nutrition intervention. Interventions engaged parents as change agents, enhancing self-efficacy to model and reinforce behavior and providing resources to help create a healthy home environment. We enrolled 77 of 183 eligible parent/child dyads. We used mixed methods to evaluate the interventions. Repeated measures models among participants showed significant reductions in obesogenic nutrition behaviors post-intervention and at 1-year follow-up, including a reduction in sugar-sweetened beverage intake of 2.14 servings/week (95% confidence interval: −3.45, −0.82). There were also improvements in obesoprotective nutrition behaviors (e.g., frequency of family meals, parental self-efficacy related to meal management). One year post-baseline, we observed no significant differences in changes in body mass index (BMI) z-scores comparing child participants with matched controls. Given potential impacts of COVID-19 community restrictions on study outcomes, we conducted qualitative interviews with 13 participants during restrictions, which exemplified how disrupted routines constrained children’s healthy behaviors but that intervention participation prepared parents by providing cooking and physical activities at home. Findings support the potential of a telehealth-delivered nutrition intervention to support adoption of healthy weight behaviors.

SWITCH-ing Quality Physical Education to Multicomponent Comprehensive School Physical Activity Programs

Abstract: Abstract Comprehensive School Physical Activity Programs (CSPAP) coordinate physical activity opportunities for school-age children through physical education, programs offered before/after school and during the school day, and those facilitated through staff involvement and community engagement. An active school is considered to implement quality physical education and one additional CSPAP component. This paper aims to describe evidence-based school initiatives that have used a multicomponent approach to integrating CSPAP in schools. Common themes will be summarized to provide strategies and suggestions on creating, implementing, and sustaining a CSPAP in schools. The Let’s Get Fit to Learn partnered with local underserved elementary schools to increase physical activity at school designed to improve or increase health and on-task behaviors. The Whole Communities-Whole Health is an equity-centered, community-engaged research project one outcome is to deeply integrate physical activity into the school curriculum. SWITCH (School Wellness Integration Targeting Child Health) is an evidence-based CSPAP designed to build capacity through a partnership with 4-H Youth Development. In Ireland, Active School Flag is a national initiative focused on self-reflection, action planning and collaboration at the school level and provides options for schools to achieve the “Flag.” Multicomponent CSPAP purposefully links multiple points of intervention to maximize physical activity opportunities for children. Given the implementation of culturally relevant and contextually grounded learning opportunities in and around schools, the potential for impact and sustainability is high.

The COVID-19 pandemic and changes in children’s physical activity in a rural US community: a mixed methods study

Abstract: Objectives To examine differences in rural community children’s moderate-to-vigorous physical activity (MVPA) and participation in out-of-school activities from fall 2019 to fall 2020 and explore enacted PA opportunity modifications post initial COVID-19 disruption. Design Mixed methods study using the validated Youth Activity Profile (YAP), administrator reports and stakeholder surveys and semistructured interviews. Setting Children and community stakeholders from one rural US Great Plains community in the state of Nebraska were recruited. Participants Third through fifth graders in fall 2019 (n=144) and fall 2020 (n=174) reported MVPA and participation in out-of-school activities using the YAP. School administrators reported weekly physical education (PE) and recess minutes. Community stakeholders reported pandemic-related changes in community social structures in semistructured interviews (n=4) and surveys (n=19). Results Average daily MVPA minutes increased from 2019 to 2020 (75.0 vs 81.3, SE=1.6, p<0.05). Minutes of MVPA increased during: school hours (MD=2.7, SE=0.5, p<0.5); out-of-school time on weekdays (MD=3.9, SE=1.3, p<0.5); and on weekends (MD=5.5, SE=2.4, p<0.5). On average, fewer children participated in youth sport (42.5% vs 47.2%), youth clubs (10.3% vs 16.0%) and other out-of-school activities (24.1% vs 38.2%) in 2020, compared with 2019. Weekly PE/recess minutes increased from 208.3 to 241.7 from 2019 to 2020. Stakeholder surveys revealed community-driven modifications to PA opportunities, and interviews suggested children played outside more frequently, especially when school was closed and out-of-school activities were shut down. Conclusions Increased minutes of PE and recess, and decreased out-of-school activity participation may have increased children’s overall free play and MVPA during the pandemic. Free play was an important contributor to children’s PA during the pandemic and should be prioritised by educators, coaches and other leaders of child PA opportunities. Trial registration number NCT03380143.

Comparing enhancements to well-child visits in the prevention of obesity: ENCIRCLE cluster-randomized controlled trial

Abstract: Obesity disproportionally impacts rural, lower-income children in the United States. Primary care providers are well-positioned to engage parents in early obesity prevention, yet there is a lack of evidence regarding the most effective care delivery models. The ENCIRCLE study, a pragmatic cluster-randomized controlled trial, will respond to this gap by testing the comparative effectiveness of standard care well-child visits (WCV) versus two enhancements: adding a patient-reported outcome (PRO) measure (PRO WCV) and PRO WCV plus Food Care (telehealth coaching and a grocery store tour).A total of 2,025 parents and their preschool-aged children (20-60 months of age) will be recruited from 24 Geisinger primary care clinics, where providers are randomized to the standard WCV, PRO WCV, or PRO WCV plus Food Care intervention arms. The PRO WCV includes the standard WCV plus collection of the PRO-the Family Nutrition and Physical Activity (FNPA) risk assessment-from parents. Parents complete the PRO in the patient-portal or in the clinic (own device, tablet, or kiosk), receive real-time feedback, and select priority topics to discuss with the provider. These results are integrated into the child's electronic health record to inform personalized preventive counseling by providers. PRO WCV plus Food Care includes referrals to community health professionals who deliver evidence-based obesity prevention and food resource management interventions via telehealth following the WCV. The primary study outcome is change in child body mass index z-score (BMIz), based on the World Health Organization growth standards, 12 months post-baseline WCV. Additional outcomes include percent of children with overweight and obesity, raw BMI, BMI50, BMIz extended, parent involvement in counseling, health behaviors, food resource management, and implementation process measures.Study findings will inform health care systems' choices about effective care delivery models to prevent childhood obesity among a high-risk population. Additionally, dissemination will be informed by an evaluation of mediating, moderating, and implementation factors.ClinicalTrials.gov identifier (NCT04406441); Registered May 28, 2020.

Telephonic Motivational Interviewing-based Health Coaching To Supplement Older Adult Walk With Ease Participation

Abstract: PURPOSE: Motivational interviewing (MI) is a commonly used method of promoting healthy lifestyles in clinical research. It is typically delivered in face-to-face interactions and is less commonly used with older adults. Thus, the purpose of this pilot study was to assess acceptability of telephonic delivery of MI with an older adult population. The study specifically tested the utility of pairing MI with an existing evidence-based program (Walk with Ease; WWE) to promote autonomy and intrinsic motivation for behavior change. METHOD: A subsample of participants enrolling in self-directed WWE (n = 10) were paired with student health coaches trained in MI for the six-week program. Coaches supported individual motivation and problem-solving but were explicitly not coaching to WWE activities. Motivation and autonomy were evaluated prior to the first coaching session and after program completion using the BREQ-3 motivation sub-scales and relative autonomy index. Changes in both indicators were evaluated using effect sizes with post WWE satisfaction ratings providing context. RESULTS: Participants attended 5.4 ± 1.4 sessions, lasting 15.7 ± 4.8 minutes and were overwhelmingly accepting of telephonic MI. Evaluations of behavioral correlates showed that WWE coupled with MI had a positive effect on intrinsic motivation (d = 0.47) and individual autonomy (d = 0.59). Participants reported that coaches positively impacted the program experience, and that telephonic delivery was convenient and presented minimal technical barriers. Common themes from the open-ended items revealed themes of developing connections with coaches who acted as a source of accountability, and provided support in developing a healthy relationship with PA. CONCLUSION: Participants were accepting of telephonic MI and viewed at as a positive enhancement to their program experience with WWE. Coaches provided an additional source of accountability and encouragement, and potential barriers due to delivery or coach training did not dissuade participants. When coupled with MI-based health coaching, WWE participants increased intrinsic motivation and autonomy, potentially increasing the likelihood of long-term behavior maintenance. Telephonic delivery may allow for greater access to health coaching and larger trials are warranted.