Supporting adolescents' participation in muscle-strengthening physical activity: protocol for the 'Resistance Training for Teens' (RT4T) hybrid type III implementation-effectiveness trial.

James Boyer, David Revalds Lubans, Avigdor Zask, Alexander Voukelatos, Jennifer Norman, Sarah Longmore, Myna Hua, Kirrilly Pursey, Penny Reeves, Christopher Oldmeadow, Rhodri S Lloyd, Hayden Thomas Kelly, Dawn Penney, Jo Salmon, Philip James Morgan, Rachel Sutherland, Nicole Nathan, Heather McKay, Joseph J Scott, Sarah Grace Kennedy, Angeliek Verdonschot, Jordan James Smith

Journal: BMJ open 2023;13(11):e075488

PMID: 37914300

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Abstract

INTRODUCTION

In Australia, only 22% of male and 8% of female adolescents meet the muscle-strengthening physical activity guidelines, and few school-based interventions support participation in resistance training (RT). After promising findings from our effectiveness trial, we conducted a state-wide dissemination of the '' (RT4T) intervention from 2015 to 2020. Despite high estimated reach, we found considerable variability in programme delivery and teachers reported numerous barriers to implementation. Supporting schools when they first adopt evidence-based programmes may strengthen programme fidelity, sustainability, and by extension, programme impact. However, the most effective implementation support model for RT4T is unclear.

OBJECTIVE

To compare the effects of three implementation support models on the reach (primary outcome), dose delivered, fidelity, sustainability, impact and cost of RT4T.

METHODS AND ANALYSIS

We will conduct a hybrid type III implementation-effectiveness trial involving grade 9 and 10 (aged 14-16 years) students from 90 secondary schools in New South Wales (NSW), Australia. Schools will be recruited across one cohort in 2023, stratified by school type, socioeconomic status and location, and randomised in a 1:1:1 ratio to receive one of the following levels of implementation support: (1) 'low' (training and resources), (2) 'moderate' (training and resources+external support) or 'high' (training and resources+external support+equipment). Training includes a teacher workshop related to RT4T programme content (theory and practical sessions) and the related resources. Additional support will be provided by trained project officers from five local health districts. Equipment will consist of a pack of semiportable RT equipment (ie, weighted bars, dumbbells, resistance bands and inverted pull up bar stands) valued at ~$A1000 per school. Study outcomes will be assessed at baseline (T0), 6 months (T1) and 18 months (T2). A range of quantitative (teacher logs, observations and teacher surveys) and qualitative (semistructured interviews with teachers) methods will be used to assess primary (reach) and secondary outcomes (dose delivered, fidelity, sustainability, impact and cost of RT4T). Quantitative analyses will use logistic mixed models for dichotomous outcomes, and ordinal or linear mixed effects regression models for continuous outcomes, with alpha levels set at p<0.025 for the outcomes and cost comparisons of the moderate and high support arms against the low support arm.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the University of Newcastle (H-2021-0418), the NSW Department of Education (SERAP:2022215), Hunter New England Human Research Ethics Committee (2023/ETH00052) and the Catholic Schools Office. The design, conduct and reporting will adhere to the Consolidated Standards of Reporting Trials statement, the Standards for Reporting Implementation Studies statement and the Template for Intervention Description and Replication checklist. Findings will be published in open access peer-reviewed journals, key stakeholders will be provided with a detailed report. We will support ongoing dissemination of RT4T in Australian schools via professional learning for teachers.

TRIAL REGISTRATION NUMBER

ACTRN12622000861752.

Address: School of Education, University of Newcastle, Callaghan, New South Wales, Australia.; Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, New South Wales, Australia.; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.; School of Health Sciences, Translational Health Research Institute, Western Sydney University, Kingswood, New South Wales, Australia.; School of Education and Tertiary Access, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.; School of Education, Edith Cowan University, Joondalup, Western Australia, Australia.; Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.; Active Aging Research Team, University of British Columbia, Vancouver, British Columbia, Canada.; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.; National Centre of Implementation Science, University of Newcastle, Newcastle, New South Wales, Australia.; Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia.; School Sport Unit, NSW Department of Education, Sydney, New South Wales, Australia.; Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, UK.; School of Health Sciences, Faculty of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.; Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.; Health Promotion Service, Population Health, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.; Health Promotion Service, Western NSW Local Health District, Bathurst, New South Wales, Australia.; School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.; Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.; Population Health Research and Evaluation Hub, Sydney Local Health District, Forest Lodge, New South Wales, Australia.; Health Promotion, Northern NSW Local Health District, Lismore, New South Wales, Australia.; North Coast University Centre for Rural Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.; School of Education, University of Newcastle, Callaghan, New South Wales, Australia [email protected].; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.

DOI: 10.1136/bmjopen-2023-075488

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MeSH Terms: Adolescent, Female, Humans, Male, Australia, Muscles, New South Wales, Resistance Training, Schools, Randomized Controlled Trials as Topic