The development and evaluation of IN2SHAPE : a physical activity promotion program for adolescent mental health
Date
2012
Authors
Brewer, Jacqueline Louise
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At any time, one in three adolescents experiences at least one depressive symptom. There is some evidence that physical activity is associated with reduced depressive symptomatology in adolescents. This study therefore investigated physical activity as a potential preventive intervention for depression in youth. The thesis presents the development, trial, and evaluation of a novel physical activity promotion program, and its effect on symptoms of depression and related health and psychosocial outcomes in adolescents (aged 11-18 years). The first phase of the project involved reviews of the current literature. These reviews, which informed the development of the Intervention to Stay Healthy and Physical Everyday (IN2SHAPE) program, established that few physical activity interventions for adolescent mental health exist. Interventions that were reviewed had substantial methodological limitations. None of the trials employed distal (non-face-to-face) delivery, although distal delivery methods have potential for widespread implementation and may be acceptable to adolescents. A systematic review then identified characteristics of physical activity interventions that have been conducted distally with adolescents, none of which have examined mental health outcomes. The IN2SHAPE program was designed in accordance with this literature, to address many of the methodological flaws of previous programs and for use either with or without face{u00AD}to-face delivery. In the second phase of the project, four empirical studies were conducted. Study 1 was a screening survey of 774 secondary school students from the Australian Capital Territory (ACT). This survey identified participants who met the eligibility criteria for participation in Studies 2 and 3. The study found that lower depression symptoms were associated with higher physical activity participation in this population. In Study 2, focus groups were used to provide adolescent input into the IN2SHAPE program and the planned intervention design. In Study 3, the IN2SHAPE program was administered as part of a three-arm pilot randomised controlled trial (RCT) in a sample of 26 adolescents identified by the screening survey to have elevated, but sub-clinical, depressive symptoms, and less than one hour per day of physical activity. Physical activity interventions with and without face-to-face researcher contact were compared to a nutrition control with researcher contact. Participants were assessed at post-intervention and 4-month follow-up. Physical activity participation significantly increased for both physical activity conditions over the 8-week intervention, as measured by pedometer step counts but not by self-report measures. No significant between-groups effects were found for depressive symptoms, although the effect size for the physical activity group with researcher contact was moderate from pre- to post-intervention (d = .56). The final study involved a participant evaluation of the intervention, using questionnaires and focus groups. It was determined that IN2SHAPE was an acceptable program to adolescent participants. Although there were difficulties recruiting a sample of adolescents with symptoms of depression and limited physical activity, this project highlights the potential utility of physical activity as an intervention to reduce depressive symptoms. Some researcher contact appears necessary to encourage adolescent engagement with the IN2SHAPE program. Further research on the optimal delivery and measurement of physical activity in depression interventions is warranted.
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