Bristol Girls Dance Project: a cluster randomised controlled trial of an after-school dance programme to increase physical activity among 11- to 12-year-old girls

Abstract

BackgroundMany children do not meet UK physical activity (PA) guidelines. Girls are less active than boys, and the age-related decline in activity is steeper for girls. Dance is the favourite form of PA among adolescent girls in the UK. Participation in after-school dance classes could significantly contribute to girls’ PA. Therefore, after-school dance may be effective for increasing PA levels.ObjectivesTo determine the effectiveness and cost-effectiveness of a dance-based intervention to increase the objectively assessed mean weekday minutes of moderate- to vigorous-intensity physical activity (MVPA) of Year 7 girls (11- and 12-year olds) 1 year after baseline measurement.DesignTwo-arm cluster randomised controlled trial and economic evaluation. Year 7 girls in participant schools received a ‘taster’ session and were invited to participate. Up to 33 girls per school were able to participate. Schools were randomly assigned (equal numbers) to intervention or control arms.SettingA total of 18 mainstream secondary schools across greater Bristol.ParticipantsYear 7 girls in participating schools who could participate in physical education.InterventionNine intervention schools received an after-school dance intervention (40 × 75-minute sessions) underpinned by self-determination theory, which attempts to improve intrinsic motivation for being active, and delivered by external dance instructors. Control schools continued as normal.Main outcome measuresThe main outcome was accelerometer-assessed mean minutes of MVPA at T2. Measures were assessed at baseline (T0), the end of the intervention (T1) and at T0 + 52 weeks (T2).ResultsBaseline MVPA levels were high. A total of 508 girls were included in the primary analysis, which found no difference in weekday MVPA between trial arms. There was no effect on secondary accelerometer outcomes. Data were subjected to a per-protocol analysis and no effect was found. However, at T1, girls who attended dance classes had 4.61 minutes more of MVPA and 14.27 minutes more of light-intensity activity between 15.00 and 17.00 on the days on which they attended intervention sessions. The intervention was inexpensive at £73 per participant (£63 when excluding dance instructor travel) but was not cost-effective owing to the ineffectiveness of the intervention. The European Quality of Life-5 Dimensions Youth survey data were unresponsive to changes in the sample. The process evaluation reported that girls in attendance enjoyed the sessions, that exertion levels were low during sessions and that attendance was low and declined. Fidelity to the session-plan manual was low but theoretical fidelity (to self-determination theory) was good. Qualitative information provides information for improving future interventions.ConclusionsThe intervention was enjoyed by participants. However, there was no difference in the MVPA levels (which were high at baseline) of girls allocated to receive dance compared with girls receiving the control. High baseline MVPA levels indicate that the study appealed to an already active cohort and, therefore, may not have targeted those most in need of an intervention. Dance is an enjoyable activity for adolescent girls and could be further trialled as a means by which to increase PA. Research might consider the impact of dividing the intervention period into smaller blocks.Trial RegistrationCurrent Controlled Trials ISRCTN52882523.FundingThe National Institute for Health Research Public Health Research programme. The work was also undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) PHR Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. This study was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration, a UKCRC Registered Clinical Trials Unit in receipt of NIHR Clinical Trials Unit support funding. All intervention costs were funded by the respective councils to which the participant schools were affiliated, namely North Somerset Council, Bristol City Council, and Bath and North East Somerset Council.

Trends in health behavior and weight outcomes following enhanced afterschool programming participation

“…The community-recommended response actions include the need for activities that increase access to healthier food, exercise, and weight loss programs [ 32 ]. Like other after-school programs that promote nutritional eating guidelines, we have demonstrated that attendance at structured nutrition education and physical activity hours is associated with reducing BMI Z-scores [ 21 – 24 ]. Unlike other studies that focus on after-school programming among the more general population, in low-income youth, or in ethnic minority populations, we have demonstrated a positive behavior change trend in a predominantly overweight and obese cohort of impoverished minority youth most at risk for future health disparities.…”

“…Unlike other studies that focus on after-school programming among the more general population, in low-income youth, or in ethnic minority populations, we have demonstrated a positive behavior change trend in a predominantly overweight and obese cohort of impoverished minority youth most at risk for future health disparities. A majority of the reviewed studies focused on youth in less disadvantaged communities, and although youth with minorities were studied, they had lower rates of overweight and obesity [ 21 – 24 ].…”

“…Afterschool settings have focused on increasing physical activity and nutrition education have predominantly concentrated on the general population of middle school children, without highlighting a specific ethnicity, baseline obesity, or socioeconomic background, and have not reported significant improvement in BMI or measured lifestyle changes [ 21 – 24 ]. Findings from other interventions provide guidance for improving physical activity, related to the amount and quality of after-school programming required, and document the degree to which after-school programs increase physical activity or access to fruits and vegetables [ 25 , 26 ].…”

Go Girls!—Dance-Based Fitness to Increase Enjoyment of Exercise in Girls at Risk for PCOS

“…Regarding subject recruitment, the Loozit ® study reported difficulty recruiting subjects, with only a 32% success rate per inquiry [37]. Despite improving girls’ physical activity levels, the Bristol Girls Dance Project found retention difficult as attendance steadily declined [38,39]. Still, encouraging dance as exercise is likely motivating and beneficial for girls.…”

A study protocol for a clustered randomised controlled trial to evaluate the effectiveness of a peer-led school-based walking intervention on adolescent girls’ physical activity: the Walking In ScHools (WISH) study

“…During the refresher training, walk leaders will have the opportunity to practice leading a walk and they will be provided with feedback on pace, route and social engagement. The walk leader training is theoretically underpinned by SDT and similar to the Bristol Girls Dance Project [70], the training facilitator will adopt an autonomy-supportive teaching style that strengthens walk leaders' personal resources. Walk leaders will be encouraged to decide the format of the walks for example, the use of music or games and routes taken.…”