Annesi JJ, Vaughn LL. (2015). Evidence-Based Referral: Effects of the Revised Youth Fit 4 Life Protocol on Physical Activity Outputs: A Randomized Controlled Trial. The Permanente Journal, 19 (3), 48-53.
Designed to increase physical activity among students aged 5-12 years, this after-school intervention provides children with four weekly counselor-led sessions, each with physical activity, nutrition education about making healthy food choices, and behavioral skills training (e.g., how to manage stress), and provides parents with a letter summarizing the lessons and ways to reinforce physical activity and healthy eating at home. The study showed an increase in physical activity.
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The U.S. Department of Health and Human Services recommends that elementary school students participate in daily physical activity for 60 minutes, with most of that time being spent in moderate to vigorous physical activity (MVPA). (MVPA is aerobic activity including the moderate activities of brisk walking, skateboarding, and playing table tennis and the vigorous activities of running, jumping rope, and playing soccer.) However, less than half of U.S. children participate in 60 minutes of MVPA daily, and the percentage of youth doing so declines from elementary to middle and high school. Schools can influence the amount and quality of physical activity during the school day as well as in after-school programs. For example, partnerships between schools and community organizations to share facilities for physical activity programs outside of school time might encourage children meeting physical activity recommendations in a safe and supervised environment.
Among children, regular daily physical activity promotes improvement in cardiovascular health, muscular fitness, and bone health. It is also associated with improved wellness and quality of life by decreasing levels of body fat and symptoms of depression and reducing long-term consequences including the development of chronic diseases such as diabetes, high blood pressure, high cholesterol, asthma, and arthritis. More school-based physical activity curricula that are guided by up-to-date research are needed to help students meet the recommended standards for physical activity and to promote their healthy development.
Youth Fit 4 Life (YF4L) is a 24-week school-based nutrition and physical activity education curriculum for children aged 5-8 and 9-12 (the version for youth aged 5-8 was not included in the evaluation reviewed for this summary). Operated by the YMCA of Metro Atlanta, the program is conducted after school hours in the same school participants attend. The curriculum is based on the Youth Fit For Life program, and like that original version, is grounded in social cognitive theory and self-efficacy theory to build self-regulatory skills, feelings of ability and mastery, and use of social supports.
The original Youth Fit For Life is a 12-week after-school physical activity program for children aged 5-12 years. Participants in groups of up to 15 per counselor meet 3 times per week for 45-minute sessions. The intervention has four components: cardiovascular exercise, strength exercise (with resistance bands), behavioral life-skills education, and nutrition education.
Building on the original Youth Fit For Life, the revised YF4L aims to further increase time in MVPA, improve nutrition behaviors, and enhance self-regulatory skills training. Four days per week for 24 weeks, participants meet with trained YF4L counselors for 45-minute sessions in groups of up to 18 participants per counselor. The curriculum consists of three components:
-- Physical activity, including 30 minutes of daily MVPA. The intervention was modified to increase time in cardiovascular activity by minimizing non-active time. The separate strength training component of the original program was eliminated, with participants now using their own body weight instead of resistance bands to minimize time being nearly stationary. In addition, new moderate- and high-intensity tasks were incorporated to minimize repetition and avoid participants' elimination from physical activity due to a low or high score. Counselors now have a list of "go-to" games from which to select activities to keep participants engaged in physical activity.
-- Nutrition education that teaches children to make healthy food choices. The revised intervention reinforces nutrition content in each session through the use of targeted cardiovascular activities.
-- Behavioral skills training that teaches children how to successfully engage in physical activity, eat well, and manage stress. These behavioral skills include setting short- and long-term goals, tracking progress, using positive self-talk and thought restructuring, recruiting social supports, and using deep breathing and progressive muscle relaxation. Behavioral topics are reinforced in each session through the use of activities and age-appropriate materials (e.g., posters, stickers, emoticons).
Each structured YF4L session includes a 5-minute warm-up and isolated movements to help improve flexibility, cardiovascular fitness, and strength; a 10-minute fun, high-intensity activity (e.g., a game of sharks and minnows or hungry cat and dog) that may include the use of equipment such as hula hoops or beach balls; a 10-minute didactic lesson on health (e.g., circulatory system, balanced diet) and behavioral topics (e.g., action planning for short-term physical activity and nutrition goals) that uses worksheets, illustrations, and other materials; a 10-minute moderate to vigorous activity (e.g., strength circuit, goal-grasping game) to reinforce the health/behavior topics that were taught; and a 10-minute "go-to" game.
In addition, parents receive an introduction letter describing the structure of the curriculum and 12 letters thereafter summarizing the content of lessons and ways to reinforce regular physical activity and healthy eating in the home. After participating in the program, children receive certificates of completion.
Community Preventive Services Task Force Finding
-- 5-hour training for counselors providing after-school care
-- Four 45-minute sessions weekly for 24 weeks for program participants
The curriculum is for children aged 9-12 years. A curriculum for children aged 5-8 years is also available.
The intervention has been primarily delivered in schools, but is also appropriate for settings such as community wellness centers and camps.
Required resources to implement the program include the following:
-- Youth Fit 4 Life Training Manual
-- Introduction Parent Letter
-- Parent Letters for Weeks 1-12
-- Activity Sheet
-- Food Card Game Set
-- Color Card Game Set
-- Posters (8)
-- Activity Word Game Set
-- Illustration Card Game Set
-- Certificate of Achievement
-- Youth Fit 4 Life Training PowerPoint Slides Presentation
For costs associated with this program, please contact the developer, James Annesi. (See products page on the RTIPs website for developer contact information.)
About the Study
A three-group post-test-only randomized study compared the revised YF4L with the original Youth Fit For Life and usual after-school care in randomly selected elementary schools in the Atlanta, Georgia, area offering YMCA-based after-school care. The study's 138 children aged 9-12 participated in one of the three 12-week study arms: the original Youth Fit For Life (n=49), the revised YF4L (n=43), or usual care (n=46). (Although YF4L is delivered over 24 weeks, the study was conducted over a 12-week period.) All three groups participated in 45-minute sessions in the school gymnasium.
Approximately 51% of the children were female, 43.5% were African American, 31.9% were White, 14.5% were Hispanic, 6.5% were Asian, and 3.6% represented other ethnic groups. The children's mean age was 9.7 years, and almost all children were middle class based on the postal zip codes of their residence. The sample characteristics did not differ significantly among the three study groups. The number of children per after-school care group ranged from 10 to 18.
For both the Youth Fit For Life and the YF4L groups, 30-35 of the 45 minutes were dedicated to physical activities, with the goal of spending 25-30 minutes on average in MVPA. Participants in the Youth Fit For Life group met with after-school counselors 3 days per week. Counselors were trained in the program's four components and followed an instructor manual, and youth received a participant workbook that guided program processes along with required tools (e.g., balls, bean bags, resistance bands). Participants in the revised YF4L group met with counselors for 4 days each week. The counselors received a training of approximately 5 hours, a supporting manual, and equipment similar to that used by the Youth Fit For Life group. Counselors in the usual care group did not follow a structured curriculum. Instead, they supervised participants engaged in physical activity, such as skill games in small groups, running, and playing with physical activity equipment available in the school gymnasium. The usual care group participated 5 days per week.
The mean number of minutes per session in MVPA was measured using the Actigraph GT3X accelerometer attached to the left side of the waist with a belt over participants' clothing. The accelerometer recorded 45 minutes of physical activity during three measurements conducted in week 4-5, week 7-8, and week 11-12. Study inclusion required attendance in at least two of the three monthly measurement sessions. Measurement times were counterbalanced so that study groups were not always measured at the same time within the measurement window. MVPA was calculated by summing the times in moderate and vigorous physical activity across the three measurements.
- Participants in the revised YF4L group spent significantly more minutes in MVPA compared with participants in either the original Youth Fit For Life or usual care group (p<.001).
- Participants in the revised YF4L group spent significantly more minutes in vigorous physical activity compared with participants in the original Youth Fit For Life and usual care groups (p<.001).
- YF4L participants spent significantly fewer minutes being sedentary compared with participants in the usual care group (p=.005) but not compared with those in the original Youth Fit For Life group (n.s.).
- Across the three study groups, boys spent more minutes in MVPA (p<.001), moderate physical activity (p=.001), and vigorous physical activity (p=.002) compared with girls, whereas girls spent more minutes in light physical activity (p=.030) compared with boys.
Annesi, JJ, Smith, AE, Walsh, SM, Mareno, N, Smith, KR. (2015). Effects of an after-school care-administered physical activity and nutrition protocol on body mass index, fitness levels, and targeted psychological factors in 5- to 8-year-olds. Translational Behavioral Medicine, 1-11.
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