Centre for Physical Activity and Cardiometabolic Health in Youth Manitoba Increasing Physical Activity among Secondary Students: MIPASS An natural experiment

Centre for Physical Activity and Cardiometabolic Health in Youth

Manitoba Increasing Physical Activity among Secondary Students: MIPASS

An natural experiment evaluating the Manitoba Grade 11 and 12 PE Policy

Jonathan McGavock, PhDDepartment of Pediatrics, Faculty of Medicine

University of ManitobaManitoba Institute of Child Health

On Behalf of…• Steve Manske, PhD Propel – U of Waterloo• Erin Hobin, PhD Propel – U of Waterloo• Donna Murnaghan, PhD - UPEI• Catherine Casey, PhD - U of Manitoba• Jane Griffith, PhD - CancerCare MB• Paul Veugelers, PhD - U of Alberta

Presentation Overview1) Purpose and History of PE Policy

2) Epidemiology 101 and Policy Evaluation

3) Research Design and Methods

4) Results and Future Directions

Presentation Overview

1) Purpose and History of PE Policy




Physical Activity Status: Manitoba

• Only 22% of Manitoba youth aged 5-19 achieve the equivalent of 120 – 150 min/day of MVPA (CLFRI, 2009)

•>30% of Manitoba youth are overweight or obese (CHMS 2007)

Physical Activity Status: Manitoba

8000

9000

10000

11000

12000

13000

5-10 11-14 15-19

Average steps, by child age, Manitoba

2005-07 2007-09

(CLFRI, 2009)

Physical Activity Levels

F

Manitoba Context

Healthy Kids, Healthy Futures Task Force Report:

The task force recommends that the The task force recommends that the government mandate PE/HE from government mandate PE/HE from

kindergarten to Grade 12 in Sept. ‘08.kindergarten to Grade 12 in Sept. ‘08.http://www.gov.mb.ca/healthykids/http://www.gov.mb.ca/healthykids/

Manitoba PE policy

25%Core Component

25% Minimum

IN-Class Time

25% Flexibility Component

0% 25% 50% 75% 100%

75% Maximum

OUT-of-Class Time

50% PA Practicum

Impacts ~65,000 students in 270 schools in MB

Manitoba PE Policy

Requirements• Minimum of 110 credit hours of PE/HE• Minimum 55 hours of MVPA (30 mins MVPA

Daily)

Support:• $3.8 Million to support policy implementation• Secondment of PE/Health Consultant for 2

years to oversee implementation

Manitoba PE PolicyOptions for Policy Implementation:

1) 100% IN – All PE and Health Ed In School

2) 50/50% - Some in, some out (Health On-line)

3) 25%/75% - eg. All PE in health ed on-line

4) 100% out of school on-line

NOTE: Out of class time is logged on an excel

sheet and reviewed by PE teacher frequently

Manitoba PE policy

• Student fitness portfolio• Student-teacher conferences• Pre- and post-sign off sheets

for teachers and parents• Graded as Complete or

Incompletewww.edu.gov.mb.ca/k12/docs/policy/

imp_pehe/document.pdf





Asking a Research Question

Target Population

Target Population

Exposure to risk factors

Exposure to risk factors

OutcomesOutcomes

Asking a Research Question

Men > 50yrsMen > 50yrs

ReducingCholesterolReducing

Cholesterol

Risk of a Heart Attack

Risk of a Heart Attack

Men > 50Men > 50

Lowering CholesterolLowering

Cholesterol

Reduces Heart

Attacks

Reduces Heart

Attacks

How do you know that this

Causes This

Epidemiology 101

Gold Standard Design

Target PopulationStudy Sample

Random Assignment

Intervention Control

Outcome Change Outcome ChangeAre they Different?

Example Problem

Finland

Proposed Solution

Entire Population

Entire Population

North Karelia Project

North Karelia Project

Reduces Heart

Attacks

Reduces Heart

Attacks


Causes This

Gold Standard for Policy Eval?

Policy Evaluation

How did it Happen?

0

50

100

150

200

250

300

350

Boys Girls

% C

ha

ng

e f

rom

19

77

-19

99

OWOB

Change in Obesity rates over the same time frame

Policy Evaluation

All Grade 11 and 12 Students

in MB

All Grade 11 and 12 Students

in MB

Grade 11/12 PE Policy

Grade 11/12 PE Policy

Increasing PA /

Reducing Obesity

Increasing PA /

Reducing Obesity


Causes This

Manitoba PE Evaluation

Gold Standard DesignAll Grade 11 and

12 Students

Small Sample

Random Assignment

Policy Yes Policy No

Increased MVPA Reduced MVPA


The Challenge

Nader, P. R. et al. JAMA 2008;300:295-305

- PE levels decline over time in adolescence

-Parallel intervention at provincial/national level

-Child tax credit, Participaction Olympic Games, gas prices

-School-based initiatives





RESEARCH QUESTIONS1. Will the policy reduce the number of inactive

youth in Manitoba?2. Will the policy prevent the major decline in

PA levels between grade 9 and 12?3. Does the school environment determine the

effectiveness of the policy? 4. What factors identified by stakeholders

facilitate effective policy implementation?


Question 1 DesignYOUTH HEALTH SURVEY4 pages, 51 questions• Multiple choice, machine

scannable• 20 30 minutes to ‐

complete (short)• Includes questions on

tobacco, nutrition, physical activity, self‐esteem and school connectedness

CENSUS of PA in MB• 46,919 students

participated in the survey • ~33,000 in grades 9-12• 265 of these schools

included grade 9 12‐• All 11 Manitoba Regional

Health Authorities participated

Research Design 1

Rates of inactivity 2008 n = 33,000

Rates of inactivity 2012 n = 33,000

How do you know it’s the

policy?

Research Design 1

Policy

No Policy

20122008

Research Design #21) Cohort study of ~700

adolescents between grades 9 and 12 in Manitoba

2) 32 schools - 20-30/ school beginning in 2008. Followed to 2012

3) Randomly Selected with 40% rural

4) Parallel cohort of 800 youth in Alberta

Assessment of Physical Activity

• Actical (minimeter)• 7 day data collection• Data collected every 15

seconds• Youth asked to wear it for a

minimum of 10 hrs daily• Provided with a minimal

incentive to wear the unit• Same research assistant for

all 4 years

Eslinger Tremblay APNM 2008

Research Design #2

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010 2011 2012

MV

PA

(m

ins/

day

)

ABMB

SHAPES Environment Survey

Research Design #3

Follow the cohort until grade 12

Test for Differences in PA levels or change in PA according to School environment and/or polciy type

Original Cohort in Grade 9

Research Question #4

MethodMethod

• 12 schools 12 schools

– 60% urban60% urban

– 6 schools 50/506 schools 50/50



• 12 PE teachers12 PE teachers

• Concerns-based Concerns-based modelmodel

• 1 interview 1 interview (~60min) with (~60min) with each of the 12 PE each of the 12 PE teachersteachers

• 1 yr post-policy 1 yr post-policy (May/Jun 2009)(May/Jun 2009)

• Interviews Interviews transcribed transcribed verbatimverbatim

• Thematic analysis Thematic analysis to identify key to identify key conceptsconcepts

• Identify themes that fall into each SWOT category





Policy Implementation

0

5

10

15

20

25

30

35

40

25/75 50/50 75/25 100

Fall 2008

% O

f Tot

al

Results Question #1

30

35

40

45

50

55

60

65

Grade 9 Grade 10 Grade 11 Grade 12

% o

f to

tal

<30 mins>30 mins

Results Research Question #1

• Data were very similar for PEI in 2008 (n=~8000)

• 2012 being collected this year in MB• Plan to collect data in PEI• Data will be available mid 2013 for

comparison between the two provinces

N = 966 Youth(44 Schools)

N = 377

N = 309

N = 274

N = 442 Youth(2008+2009 3 days/8 hours

including 1 weekend day)

N = 253(including 1 weekend day)

Manitoba

N = 588

N = 413

N = 352


Alberta



N=175 (invalid 4 days/8hours) in 2008

N=35 (No weekend) in 2008

N=22 (invalid 4 days/8hours)in 2009

N = 24 (No Weekend Day) in 2009

N=175 (invalid 4 days/8hours) in 2008

N=61(No weekend) in 2008

N=110 (invalid 4 days/8hours)in 2009

N = 29 (No Weekend Day) in 2009

Weekday Weekend

Per

cen

tag

e o

f T

ime

0

20

40

60

80

100

70 66

22 28

SedentaryLight MVPA

2008

Weekday Weekend

0

20

40

60

80

100

72 72

21 23

SedentaryLight MVPA

2009

Results Question #2

Figure 3

mean ± SE*=p<0.05 vs. weekday; † vs urban

BOYS GIRLS

MV

PA

TIM

E (

min

s/d

ay)

0

40

60

80WeekdayWeekend

A

*

*

MV

PA

TIM

E (

min

s)

B

URBAN RURAL

040

60

80WeekdayWeekend

* *

†

†

Results Question #2

Results Question #2Weekday MVPA Weekend MVPA

Figure 5

2008 2009

Lig

ht

PA

Tim

e (

min

s)

* = p < 0.01, change in Light PA over time

0150

160

170

180

190

200

210

220

Week day Weekend

*

*

Boys

Girls

Results Question #2

Results Question #2

4042

444648

505254

5658

2008 2009 2010

Min

s/D

ay

AB-MVPA

MB-MVPA

Average MVPA Daily

Results Question #2

40

45

50

55

60

65

2008 2009 2010

AB Weekday

MB Weekday

Min

s/D

ay

Weekday MVPA

Results Question #2M

ins

/Da

y

Weekend MVPA

33

34

35

36

37

38

39

40

41

2008 2009 2010

AB Weekend

MB Weekend


30

35

40

45

50

55

60

65

Weekday Weekend Weekday Weekend

2008

2009

2010

Min

s/D

ay

Manitoba Alberta


0

10

20

30

40

50

60

70

80

90

100

Weekday Weekend

% o

f Y

ou

th

200820092010

% > 30 mins Daily

Research Question #3• Still analyzing data.• No insight into what policy model works best

to date.


‘As far as what it has done to our school environment, as a physical educator I was thrilled.’

Commitment and support of PE teachers

‘…improvement will come from the school level, just talking to each other and seeing how we can deliver the policy more effectively.‘

‘Most PE teachers felt it was long overdue.’

‘…one of our teachers had a student trying to get his PE hours because he’s a drummer. So we gave him a heart rate monitor…and he spent quite a bit of time in the target heart rate zone drumming.’

‘A lot of students pick skateboarding and they’re very talented and it is a lot of work…so you have students pick different things like that….’

Offering students choice in activities


Weaknesses

‘The bookkeeping part of it is kind of overwhelming…the amount of paperwork we took in was tremendous.’

Tracking and Reporting

‘Finding time to track those kids and keep them up to date is very difficult, a huge challenge.’

Weaknesses

‘…my administrative colleagues weren’t thrilled when they had to timetable and make some hard decisions…we had to make decisions on actually cutting some other courses.’

Scheduling courses

Weaknesses

‘… I’d like to have more with the parents…I had them sign the declaration and their logs and then a sign-off on policy but then I don’t really know how much they’re actually sort of keeping up with if their child is actually doing it.’

Communication with parents

‘We do have a lot of ESL kids in our schools so we can’t communicate because their parents don’t understand…having the declaration in different languages.’

Opportunities

‘…we went through some orientation of the new curriculum. I went to some sessions, professional development sessions…’

‘…there’s also good things on the [government’s] website and all the PowerPoint presentations.’

Access to resources and professional development

‘The materials that we are provided are fabulous.’

Opportunities

‘…we are able to look at what is available and what our kids want and try and meet their needs within the curriculum.’

‘You try something, you throw it out, or you modify it. As long as you are willing to try then it will get better.’

Flexible delivery model

Threats

Increased Workload

‘…we were told it shouldn’t be putting more work on the teachers…it produced more work, bigger classes and less time…’

‘…it is difficult to have enough time for conferences with each student so it would be helpful to have a supply teacher help fill the time away from class.’

Threats

Access to facilities

‘Facilities are a bit of a challenge…no question it’s a juggling act to get 4 classes going at the same time. It works, but it is a juggling act.’

‘The #1 problem is our location. We can’t just walk to community recreation facilities. We have to get on a bus or we need rides. When you look at other urban schools, they can just walk across their parking lot to great facilities.’

Teacher Survey 2012

0

10

20

30

40

50

60

70

80

90

100

% Honesty Effective? Recommend? Mandate?

% R

esp

on

din

g Y

es

Does the Policy Impact PA outside of class

• They are … feeling good, developing better lifestyles, buying gym memberships. Students in the past have come back and said they are continuing to be active, and understand it is important for their health.

• Students are now more aware of what is out there, that you can do for free. For example some rec centers have discounts, and a lot of games, you do not need equipment for

• they do not want to be physically active. The students that want to be active are going to do it even without the policy

0

10

20

30

40

50

60

2004 2005 2006 2008 2009 2010

Year

Pre

vale

nce

%unfit

%OW/OB

Pre-Policy Post-Policy

23.2 22.1 23.424.3 24.6

26.7

50.8 51.1 50.4 52.352.6

51.1

Is the Alberta DPA Working?

Frequency of DPA in Year 1 Simcoe Muskoka SB 2007, n=258 teachers


Modeski and O’Connor, 2007

Challenges with DPA in Year 1Simcoe Muskoka SB 2007, n=260 teachers


Modeski and O’Connor, 2007

Specific barriers to DPE or DPACalgary School Board, n=55 schools


Kennedy et al., 2010

Arkansas' BMI Report Cards


Arkansas Center for Health Improvement, 2010


Acknowledgements• Melisa Comte• Pinar Esciogolu• Andrea MacIntosh• Paul MacArthur• Dr. Rob Santos• Heather Willoughby• Jackie Nylen

• Dr. Steve Manske• Dr. Jane Griffith• Dr. Donna

Murnaghan• Dr. Catherine Casey


Questions?

[email protected]

www.mich.ca/dr_mcgavockE-mail: [email protected]

mailto:[email protected]

http://www.mich.ca/dr_mcgavock

Documents

Centre for Physical Activity and Cardiometabolic Health in Youth Manitoba Increasing Physical Activity among Secondary Students: MIPASS An natural experiment