ICAPS: A multilevel program to improve physical activity in adolescents.

C. Simon, A. Wagner, C. Platat, D. Arveiler, B. Schweitzer, E. Triby . Diabetes Metabolism, 32 , 41-49 (2006).

Target Group: 11-12 year old students, both boys and girls.

Program Name: ICAPS (Intervention Centred on Adolescents' Physical Activity and Sedentary Behaviour) Program.

Location: France

Study Objective:

• A multilevel program, directed at modifying the personal, social and some environmental determinants of PA, was used to promote PA inside and outside school, including everyday life, with three principal targets: 1) to change knowledge, attitudes and motivation towards PA by means of information and debates but also through the PA sessions offered, 2) to encourage social support by parents, peers, teachers and PA instructors, 3) to provide environmental, structural and institutional conditions for PA that encourage the adolescents to use the knowledge and skills they have learned.

Study Design:

• Ongoing cluster randomized control trial. First six months of a proposed four year study.

Intervention or Program:

• ICAPS is based on a socioecological perspective that emphasizes the dynamic interplay among personal factors, behaviours and social or physical environmental influences and predicts that efforts to change behaviour should be most effective when targeting each of these levels
• The intervention components are not restricted to school settings but involve numerous partnerships intervening at different levels (school boards, teachers and medical staff, PA and club educators, families, territorial and community agencies in charge of recreational areas and transportation infrastructures, etc.).

• The overall program is free of charge for participants
• The program includes an educational component focusing on PA and sedentary behaviours.
• New opportunities for PA during school hours (lunch pause, breaks) and after-school hours are offered, taking into account the obstacles to being active (lack of time, poor accessibility or unsafe recreational areas, inappropriate open time, nobody to drive the adolescents to and from the activities, cost, lack of physical capacity, etc.). Various physical activities attractive to youth are organized by sport-qualified instructors: either informal (organized games during breaks), innovative (hip-hop, dance, capoeira, etc.) or more academic, but in all cases, without any restrictive competitive aspect or intensity guidelines. Participation is open and free.
• Sporting events as well as bicycle and on-foot school transfers supervised by the intervention staff are organized. An annual gathering gives the opportunity to all intervention students to meet together and to discover the activities offered throughout the year. This event is also an opportunity for the partners to exchange experiences about the program.
• Meetings are regularly organized with the parents, teachers and educators. These actors are encouraged to provide support to enhance the PA level of the adolescents by themselves adopting a physically active lifestyle, by limiting the time devoted by their child to sedentary pursuits and by letting him/her walk or cycle to school, for example. To renew interest, regular information on the ongoing actions and results are given with the help of parents' organizations and the academic staff.
• Policy makers of local communities are requested to provide a supportive environment that promotes enjoyable PA. Low-cost or free of charge entry to safe accessible facilities, such as swimming pools and sport areas, have been proposed to implement ICAPS activities. To overcome the distance and transportation barrier and to reassure the parents, transfers to the PA areas have been organized and supplementary busses made available when necessary. Reflections on the development of bikeways around the schools have been initiated. Media diffusion was used to reinforce the participants' engagement.

• In the first six months, all the students were exposed to at least two educational classes or debates devoted to PA, organized in groups of 15 pupils on school time with teacher collaboration.
• Concerning PA, a mean of 10 different weekly activities was provided on each site. About 50% of the students participated in at least one weekly activity, with a similar number of students engaged in sports clubs at baseline as those who were not
• Different sporting events, some with parental participation, were organized in each of the schools. Mobilization and implication of the teachers and partners in and outside schools increased progressively throughout the school year, thanks to regular individual contacts and more formal meetings (one every two months).

Impact on Physical Activity:

• After six months of intervention, the proportion of adolescents that did not practice supervised PA out of school PE (either in sports clubs or through ICAPS activities) was reduced by nearly half, from 36% to 17% (compared to changes in control adolescents) more markedly among girls than among boys.
• Daily time spent watching television and playing video games was reduced. The proportion of adolescents devoting more than 3 h/day to these sedentary behaviours decreased from 34% to 28% (compared to changes in control adolescents).

Implications for Practitioners:

Encouraging adolescents to simply reduce time spent on sedentary behaviours may not be sufficient to increase physical activity, but if performed in conjunction with efforts to increase physical activity then change may occur. Causing changes in physical activity of adolescents requires an integrated approach that considers personal, social, and environmental factors.

Author's Email: Chantal Simon chantal.simon@medecine-u-strasbg.fr