Background

Regular physical activity provides multiple health benefits (including reduced risk of cardiovascular disease, hypertension, hyperlipidemia, and Type 2 diabetes. Physical activity increases lean body mass and contributes to the control of body weight. Thus it aids in the prevention of obesity, a major public health problem in Americans of all ages including adolescents. In addition, physical activity promotes bone mass, reduces sleep disorders and improves psychological well-being. Although most of these benefits have been documented in adult populations, recent research suggests that habitual physical activity may also benefit children, including reducing the risk of cardiovascular disease, obesity, hypertension and hyperlipidemia.

Despite these benefits, participation in physical activity has declined dramatically among U.S. youth. The transition from childhood to adolescence is associated with a 34% decline in physical activity in girls. Data from the 1999 Youth Behavioral Risk Factor Survey indicated that female students (57%) were less likely than male students (72%) to report vigorous physical activity. Female students (69.6%) were also less likely than male students (82%) to exercise more than 20 minutes during PE classes. The prevalence of overweight among U.S. adolescents has also increased. In addition, most physical activity interventions have targeted children and have been based in schools. There is a need to improve interventions for middle school girls and to extend interventions beyond the school into the community.

The Trial of Activity for Adolescent Girls (TAAG) presented an opportunity to test the benefits and effectiveness of school- and community-based physical activity programs in middle school girls.

Purpose

TAAG was a randomized, multi-center field trial of 36 middle schools with the goal of reducing the decline in physical activity in adolescent girls. Its primary aim was to determine if an intervention that links schools to community organizations reduces the age-related decline in moderate to vigorous physical activity (MVPA) in middle school girls. The intervention hypothesized to reduce by one-half the decline in physical activity between 6th and 8th grade, resulting in a 10 percentage-point difference in minutes of intensity weighted moderate to vigorous physical activity in girls in intervention schools compared to those in control schools. Secondary aims included those at the individual, environmental (school and community), and maintenance (one year after the intervention) levels.

Design and Study Population

 The study design is a two-arm group randomized trial. Evaluations for the primary outcome and most other response variables involve two cross-sectional samples, one drawn from 6th grade girls in spring 2003 and a second drawn from 8th grade girls in the spring of 2005. This sampling design is based on the aim of intervening on the entire population of girls. Another cross-sectional sample of 8th-grade girls was measured in the spring of 2006. Variables hypothesized to be mediators of the effects of the intervention on physical activity were assessed using a closed-cohort design in which final measurements were made in the 8th grade during 2005 on the same girls measured in the cross-sectional sample of 6th grade. Environmental variables were assessed using cross-sectional samples in the spring of 2003, 2005 and 2006.

Intervention

The TAAG intervention was grounded in the social-ecological model, which targeted intrapersonal variables but emphasized interpersonal, organizational, policy, and other environmental factors that influence human behavior. It emphasized structured and unstructured (or unsupervised) physical activities in and out of school. The intervention consisted of four major components: physical education; health education with activity challenges; partnerships among TAAG investigators, schools, and community agencies for physical activity, called Partnerships for Physical Activity; and promotional activities.

Measurement 

School levels of moderate-to-vigorous physical activity are the primary outcome variable measured in MET-weighted minutes of MVPA in cross-sectional samples of 6th and 8th grade girls taken from each school approximately 18 months apart. The Computer Science Applications (CSA) accelerometer monitors, worn by each girl in the sample for one week, supply a minute-by-minute record of the magnitude of her movements throughout the week and are supplemented by a retrospective questionnaire she completed concerning her daily activities for that week. The level of cardiorespiratory fitness (a secondary outcome variable) in cross-sectional samples of girls in each school was measured by means of a cycle ergometer in the 8th grade. Height, weight and skinfold measurement provided values for calculating body-mass index and percent body fat in cross-sectional samples of girls in each of the two grades. Self-reported data were collected on secondary measures, mediators, descriptive variables, and environmental outcome variables.

Other measures include classroom observations of physical activity. Process evaluation assessed various aspects of the intervention, particularly whether the intervention was delivered and received as intended. Fidelity of intervention delivery, the intervention dose, reach, context, and potential effects of contamination and secular trends were evaluated. Environmental outcomes are defined as change in physical activity-related organizational, policy, physical or social environments that are targeted by the intervention. Physical education class structure, school physical activity programs and school-community physical activity partnerships were also evaluated.

Project Details

Timeline: 2005 - 2008
Funding Source: NIH/NHLBI
Principal Investigator: Russell R. Pate
Co-Investigator(s): Cheryl Addy, Gwen Felton, Ruth Saunders, Rod Dishman, Deborah Parra-Medina, Andrea Dunn, Dwayne Porter

Publications

Pate RR, Sallis JF, Ward DS, Stevens J, Dowda M, Welk GJ, Young DR, Jobe JB, Strikmiller PK. Age-related changes in types and contexts of physical activity in middle school girls. Am J Prev Med, 2010 Nov; 39(5):433-9.[pdf]

Pate RR, Stevens J, Webber LS, Dowda M, Murray DM, Young DR, Going S. Age- related change in physical activity in adolescent girls. J Adolesc Health, 2009; 44:275-82.[pdf]

Cohen D, Scott M, Wang FZ, McKenzie TL, Porter D. School design and physical activity among middle school girls. J Phys Act Health, 2008; Sep; (5):719-31[pdf]

Webber LS, Catellier DJ, Lytle LA, Murray DM, Pratt CA, Young DR, Elder JP, Lohman TG, Stevens J, Jobe JB, Pate RR. Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls. American Journal of Preventive Medicine, 2008; 34(3): 173-84.[pdf]

Griser M, Neumark-Sztainer D, Saksvig Bl, Lee JS, Felton GM, Kibik MY. Black, Hispanic, and white girls’ perceptions of environmental and social support and enjoyment of physical activity. J Sch Health, 2008; Jun; 78(6): 314-20[pdf]

Elder JP, Shuler L, Moe SG, Grieser M, Pratt C, Cameron S, Hingle M, Pickrel JL, Saksvig Bl, Schachter K, Greer S, Guth Bothwell EK. Recruiting a diverse group of middle school girls into the trial of activity for adolescent girls. J Sch Health. 2008; Oct; 78(10): 523-31[pdf].

Lohman TG, Ring K, Pfeiffer K, Camhi S, Arredondo E, Pratt C, Pate RR, Webber LS. Relationships among fitness, body composition, and physical activity. Med Sci Sports Exerc. 2008; Jun; 40(6): 1163-70.[pdf]

Johnson CC, Murray DM, Elder JP, Jobe JB, Dunn AL, Kubik M, Voorhees C, Schachter K. Depressive symptoms and physical activity in adolescent girls. Med Sci Sports Exerc; 2008; May; 40(5): 818-26.[pdf]

Young DR, Steckler A, Cohen S, Pratt C, Felton G, Moe SG, Pickrel J, Johnson CC, Grieser M, Lytle LA, Lee JS, Raburn B. Process evaluation results from a school- and community- linked intervention: the Trial of Activity for Adolescent Girls (TAAG). Health Educ Res. 2008 Jun; 23 (6): 976-986. Epub 2008 Jun 16.[pdf]

Young DR, Felton GM, Grieser M, Elder JP, Johnson C, Lee JS, Kubik MY. Policies and opportunities for physical activity in middle school environments. J Sch Health. 2007 Jan;77(1):41-7.[pdf]

Elder JP, Lytle L, Sallis JF, Young DR, Steckler A, Simons-Morton D, Stone E, Jobe JB, Stevens J, Lohman T, Webber L, Pate R, Saksvig BI, Ribisl K. A description of the social-ecological framework used in the trial of activity for adolescent girls (TAAG).Health Educ Res. 2007 Apr;22(2):155-65. Epub 2006 Jul 19.[pdf]

Treuth MS, Catellier DJ, Schmitz K, Pate RR, Elder JP, McMurray RG, Blew RM, Yang S, Webber L. Weekend and weekday patterns of physical activity in overweight and normal-weight adolescent girls. Obesity, 2007; 15:1782-1788.[pdf]

Dowda M, McKenzie TL, Cohen DA, Scott MM, Evenson KR, Bedimo-Rung AL, Voorhees CC, Almeida MJ. Commercial venues as supports for physical activity in adolescent girls.Prev Med. 2007 Aug-Sep;45(2-3):163-8. Epub 2007 Jun 7.[pdf]

Stevens J, Murray DM, Baggett CD, Elder JP, Lohman TG, Lytle LA, Pate RR, Pratt CA, Treuth MS, Webber LS, Young DR. Objectively assessed associations between physical activity and body composition in middle-school girls: the Trial of Activity for Adolescent Girls. Am J Epidemiol. 2007 Dec 1;166(11):1298-305. Epub 2007 Sep 12.[pdf]

Saksvig BI, Catellier DJ, Pfeiffer K, Schmitz KH, Conway T, Going S, Ward D, Strikmiller P, Treuth MS. Travel by walking before and after school and physical activity among adolescent girls. Arch Pediatr Adolesc Med. 2007 Feb;161(2):153-8.[pdf]

Cohen DA, Ashwood JS, Scott MM, Overton A, Evenson KR, Staten LK, Porter D, McKenzie TL, Catellier D. Public parks and physical activity among adolescent girls. Pediatrics. 2006 Nov;118(5):e1381-9.[pdf]

Moe SG, Pickrel J, McKenzie TL, Strikmiller PK, Coombs D, Murrie D. Using school-level interviews to develop a Multisite PE intervention program. Health Educ Behav. 2006 Feb;33(1):52-65.[pdf]

Pate RR, Stevens J, Pratt C, Sallis JF, Schmitz KH, Webber LS, Welk G, Young DR.Objectively measured physical activity in sixth-grade girls. Arch Pediatr Adoles Med, 2006; 160(12):1262-8.[pdf]

Pfeiffer KA, Schmitz KH, McMurray RG, Treuth MS, Murray DA, Pate RR. Physical activities in adolescent girls: variability in energy expenditure. American Journal of Preventive Medicine, 2006; 31(4).[pdf]

Young DR, Johnson CC, Steckler A, Gittelsohn J, Saunders RP, Saksvig B, Ribisl KM, Lytle LA, McKenzier TL. Data to action: using formative research to develop intervention programs to increase physical activity in adolescent girls. Health Educ Behav. 2006 Feb;33(1):97-111.[pdf]

Saunders RP, Moody J. Community agency survey formative research results from the TAAG study. Health Educ Behav. 2006; 33(1):12-24.[pdf]

Murray DM, Stevens J, Hannan PJ, Catellier DJ, Schmitz KH, Dowda M, Conway TL, Rice JC, Yang W. School-level intraclass correlation for physical activity in sixth grade girls. Med Sci Sports Exerc. 2006 May;38(5):926-36.[pdf]

Vu MB, Murrie D, Gonzalez V, Jobe JB. Listening to girls and boys talk about girls' physical activity behaviors. Health Educ Behav. 2006 Feb;33(1):81-96.[pdf]

Rushovich BR, Voorhees CC, Davis CE, Neumark-Sztainer D, Pfeiffer KA, Elder JP, Going S, Marino VG. The relationship between unsupervised time after school and physical activity in adolescent girls. Int J Behav Nutr Phys Act. 2006 Jul 31;3:20.[pdf]