Dr. Whitt-Glover's Presentation

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Dr. Whitt-Glover's Presentation

INSTANT RECESS®

BUILDING A FIT NATION 10 MINUTES AT

A TIME

Melicia C. Whitt-Glover, Ph.D.

Gramercy Research Group

Winston-Salem, NC

Email: mwhittglover@gramercyresearch.com

Phone: (336) 293-8540, EXT 110

Website: www.gramercyresearch.com


Initial Questions

• How do we get children more excited about

recess?

• How is this program being implemented

across the state of NC?

• How is the program received by school

administration and teachers?

• What is the best way to incorporate Instant

Recess® into a worksite wellness program?


Poll:

How many people are

already familiar with

Instant Recess®?


Physical Activity Prevalence in

Children

Whitt-Glover MC, Taylor WC, Floyd MF, Yore MM, Yancey AK, and Matthews CE.

Disparities in Physical Activity among US Children and Adolescents: Prevalence,

Correlates, and Intervention Implications. Journal of Public Health Policy 2009, 30

(Supplement 1): S309 – S334.


Obesity in Adults Children: Health

Risks


• 2/3rds of adults are

overweight or obese

• 1/3 of children are

overweight or obese

• Average life

expectancy today= 78

years

• Life expectancy of our

children= 74 years


What has changed?

then

now

then

now

1980 2004

Overweight children (ages 6-11) 7.0% 18.8%

Overweight adolescents (ages 12-19) 5.0% 17.1%

then

now

then

now


Prevention vs. Treatment

• Most experts agree that diet is most critical for weight

loss (treating obesity), but physical activity (PA) is most

critical for preventing weight gain (PAGAC, 2008)

• Without increases in PA at a population level,

impossible to decrease caloric intake sufficiently to

achieve energy balance and get essential

micronutrients (Hill et al., 2005)

• White hunger drives eating, there is no inherent

biological drive to be active in adulthood—therefore

push strategies necessary to achieve population-wide

PA increases (Yancey, 2009; 2010)


What is Instant Recess ® ?

• Instant Recess ® is a 10-minute physical activity break

designed for everyday use by everybody, anywhere,

anytime, in any attire

unique fusion of popular culture and science to

promote physical and mental fitness

movement of major muscle groups to increase

blood flow throughout the body & burn calories

re-invigorates faculty, staff and students to feel

more alert and increase their energy levels


What’s great about Instant Recess ® ?

• Use it anywhere!

School, home, offices, etc.

• No need to change clothes!


We recommend wearing clothes that let you move, but

that can be what you wear to school.

• All fitness levels welcome!



All moves can be modified to your own ability

You can adjust the moves if you have an joint problem or

mobility issues, or increase the difficulty once you’ve

practiced a few times


Instant Recess

Integrating 10-min. Instant Recess breaks

into organizational routine:

• Short bouts easier for sedentary individuals,

minimizes sweating & hairstyle disturbance

• Variable intensity, low-impact activity to

accommodates overweight, unfit or disabled


Instant Recess

Integrating 10-min. Instant Recess breaks into

organizational routine (cont.):

• Social support + desire to conform drive

participation

• Associated with fun, play and stress release, vs.

exercise=work, obligation

• Framing as entitlement to employees & students,

competitive or market advantage to administrators


INSTANT RECESS® IN FORSYTH

COUNTY SCHOOLS


Forsyth County, NC

Community-Based Dissemination of Instant Recess

Breaks

• Goal: Evaluate planned policy change for PA in

elementary schools and afterschool sites

TA through teacher training & provision of IR materials

7 elementary schools & 8 after schools enrolled

Randomized (delayed intervention control)

PA measured using modified SOFIT to capture

• Activity level

• On-task vs. off-task behavior

• Context of lesson being taught

• Teacher behavior


Why Schools?

• Schools are prime targets for interventions to increase PA

among children since 95% of children are enrolled in school.

• Attendance enforcement ensures high levels of exposure.

• The organizational infrastructure permits institutionalization.


Why Forsyth County, NC

• 16 th most obese state

among adults

• 5 th most obese state

among children

• ~40% of children in

WSFCS school system

OW/OB

70

60

50

40

30

20

10

Underweight

Healthy

OW/OB

0

1st 4th 7th 9th


Documented Policy

• NC State Board of Education Healthy Active

Children Policy (HSP-S-000)

Establish and maintain a local School Health Advisory

Council

Provide > of 150 minutes/week of [moderate-tovigorous]

physical activity to all K – 8 students.

Move toward having 225 minutes per week of

physical activity (every other day throughout 180-day

school year)

Full policy available at

http://www.learnnc.org/lp/media/articles/physed0510/F

inal_HAC_Policy.pdf


Concerned Parent


How to get In

Winston Salem/Forsyth County Schools (WSFCS)

Dr. Donald L. Martin

WSFCS Superintendent of Schools

Local School Health Advisory Council

Nancy Hoover

WSFCS Health and Physical Education Program Specialist

WSFCS Elementary School Principals and Staff


INSTANT RECESS ®

TEACHER TRAINING


Overview of the Training

• Why am I here?

• Why is this important?

• What do you want me to do?

• How do you want me to do it?

• When do you want me to do it?

• What is supposed to change?


Let’s Get Fit!

• YOU can help Winston-

Salem/Forsyth County lead

the way in creating

healthier, more active

school and afterschool

environments and lifestyles!

“You must be the change you wish to see in the world.”

-- Mahatma Gandhi

“Never doubt that a small group of thoughtful, committed citizens

can change the world. Indeed it’s the only thing that ever has!”

--Margaret Mead


%

Demographics for Schools

100

90

80

70

60

50

40

30

20

10

0

N=344

N=707

N=621

N=749

N=763

N=576

N=527

N=644

1 2 3 4 5 6 7 8

White

Black

Hispanic


% Time

Percent of Time Spent in Fitness

Skills

100

90

80

70

60

50

40

30

20

10

0

% time in fitness skills (Instant Recess) increased in

intervention (8.7%) and control (0.5%) schools, p > 0.05

School Baseline

Intervention

Control

School Post


% Time

Percent Time in On Task Behavior

100

90

80

70

60

50

40

30

20

10

0

% time in on-task behavior increased in intervention schools (+6.4%)

and decreased in control schools (-5.2%), p = 0.03

School Baseline

School Post

Intervention

Control


Mean Minutes

Mean Minutes of PA in School

Classrooms by Intervention Type

14.0

12.0

Bar = SE

10.0

8.0

6.0

4.0

2.0

0.0

Spring baseline Spring followup Fall baseline Fall followup

Intervention Schools Crossover Schools

Control Schools

Instant Recess Classrooms


Intervention

Crossover

Intervention

Crossover

Intervention

Crossover

Intervention

Crossover

Mean Minutes

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Mean Minutes of Fitness Skills and Game and

Free Play in School Classrooms by Intervention

Type

Game and Free

Play

Fitness Skills

Spring baseline Spring followup Fall baseline Fall followup


Minutes of MVPA

Minutes of Fitness Skills and MVPA in

Classrooms by Level of Enthusiasm for

Instant Recess

16

14

12

10

8

6

4

2

0

-2

0 5 10 15 20

Minutes of Fitness Skills

No Instant Recess

Mixed Enthusiasm

Min FS Min MVPA

No Instant Recess 0.64 0.61

Mixed enthusiasm 4.79 a 0.54

Enjoyed Instant Recess 6.47 b 2.57 b

a p = 0.0008 vs No Instant Recess

b p < 0.0001 vs No Instant Recess


Lessons Learned

• Having support is critical

Dr. Martin, Superintendent of Schools

Nancy Hoover, WSFCS Program Specialist for Physical Education/Health

School Health Advisory Council

School principals and staff

• Instant Recess was used

Involve students in creating additional breaks

• Need additional, more frequent evaluation

• Consider ways to expand for middle/high school


Poll:

Have you ever participated in

an activity break at school,

work, or in a meeting?


Recently tested in middle

school kids


Implementation

• Mandate by enthusiastic Superintendent

• Principal and Assistant Principal at each

school trained

No individual teacher training at school

• School bell schedule issues

• Created content targeted toward older

students


Results

• Increased PA slightly

• Teacher enthusiasm major factor

Teacher resentment

• “Cool” factor not there

Home room

Picture day

• Autonomy is key


Next Steps

• Currently working with students in NOLA to

increase “cool” factor

• Currently working with pop culture stars to

serve as spokespersons

• Looking for teen sparkplugs


How about adults?


Whitt-Glover MC, Taylor WC, Heath GW, Macera CA. Self-reported

physical activity among blacks: Estimates from national surveys.

American Journal of Preventive Medicine 2007, 33(5): 412 – 417.


INSTANT RECESS® IN ADULTS


Study Design

• Transitional supplement funding from RWJF

• Focus on disseminating materials to schools

and churches in South

They asked for it, we studied it

• Two phases, 1 year study

Phase 1—call for proposals

Phase 2—program implementation and

evaluation


Phase 1

Months 1 – 3

Call for proposals for $500 mini-grants

Schools or churches

Interested in increasing PA within their organization

Willing to incorporate the Lift Off concept

Attend information session

Willing to conduct exercise program for at least 3 months

Recruit and retain 20 program participants

Agree to allow data collection

Provided grant writing assistance when requested

• The goal was to fund 25 organizations to execute the

program


Results

• Phase 1

25 participants representing 19 organizations attended grant session

12 applicant packets

Funded 3 schools and 9 faith-based institutions *


Phase 2

Months 4 – 12

Technical assistance to train on implementation of Lift Off

Provided copies of materials

Pre-program data collection

PAR-Q for screening

Self-report PA using IPAQ

Anthropometrics

7-day accelerometer with Actical

Health status and process measures


Results

• Planned Programs





Group walking/exercise sessions with Lift Off as warm up (some incorporated

prayer and scripture before sessions)

Group-facilitated health discussion with Lift Off as exercise break followed

by healthy meal and bible study

Individual PA program with log sheets and monthly check-in (Lift Off was

done at check-in)

Daily activity break incorporated into work day

• Funding used for




Incentives (e.g., individual Lift Off copies, pedometers, videos)

Exercise leaders

Guest speakers


Baseline Participant

Characteristics

**N=199 participants recruited initially

% of total*

Women 89.1

African-American 68.1

White 29.7

Hispanic 1.5

Education beyond high school 67.9

Married/Living with partner 53.6

Raising Children 44.9

Self report health status as “Good” 49.0

Self report health status as “Very Good or Excellent” 35.0

*N=138 (includes only those who completed pre and post data forms)

Significant difference between schools in churches for raising children


Baseline Participant

Characteristics

Variable Mean SD

Age 47.9 12.4

Body Mass Index 31.2 0.6

# Chronic Conditions 1.8 1.5

Systolic Blood Pressure 123.1 1.7

Diastolic Blood Pressure 77.6 0.9

Church participants significantly older than school participants

There was a significant difference among sites for BMI (p=0.0016)

Average BMI between churches and schools significantly different (p=0.0008)


MET-minutes/week

Self-Reported Physical Activity

1200

1000

*

800

600

400

*

Pre

Post

200

*

0

Walking Moderate Vigorous Total


1-minute bouts

Accelerometer-Assessed Physical Activity

700

32.1, p = 0.047

600

-53.5, p = 0.045

500

400

300

200

100

0

21.3, p > 0.05

Sedentary Light Mod/Vig

Pre

Pos

**Changes likely driven by large improvements among participants in schools


10-minute bouts

Accelerometer-Assessed Physical Activity

500

450

400

350

300

250

200

150

100

50

0

-50.8, p = 0.04

15.4, p > 0.05

8.8, p > 0.05

Sedentary Light Mod/Vig

**Changes likely driven by large improvements among participants in schools

Pre

Pos


Anthropometric Changes

140

120

-1.2, p >0.05

100

80

60

-1.8, p=0.007

Pre

Post

40

-0.19, p >0.05

20

0

BMI SBP DBP


Process Measures

Reasons for joining

77% to improve physical health

26% to improve mental/psychological health

Thoughts about program

91% said breaks made them feel good about themselves

80% planned to continue the 10-mintue PA breaks after program

96% stated PA was worthwhile

67% experienced increased motivation

68% intended to increase PA levels after program end

Several sites have continued programs

Extra available funding was used to support maintenance ($500)

Follow-up planned this summer to see if sites are continuing


A Success Story!


Conclusions

• These data suggest the feasibility and acceptability of Lift

Off in schools/churches in the south

• Participating organizations were able to incorporate the

activity breaks into routine activities

• Participants showed progress toward increasing PA levels

• Additional support/technical assistance may be needed to:




Improve programs offered

Increase focus on 10-minute bouts of PA

Increase focus on overall PA


KEEN


Other Uses for Instant Recess®

• Stretch break/Energizer at meetings

• Team building

• Entertainment at sporting events

• Blood sugar control

• Calibration tool for self-report PA


To access Instant Recess®

www.toniyancey.com

www.gramercyresearch.com

www.youtube.com/gramercync

To access Keen materials

http://recess.keenfootwear.com/recess-at-work/

QUESTIONS?

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