Manitoba Increasing Physical Activity among
Secondary Students: MIPASS
An natural experiment evaluating the
Manitoba Grade 11 and 12 PE Policy
Jonathan McGavock, PhD
Department of Pediatrics, Faculty of Medicine
University of Manitoba
Manitoba Institute of Child Health
Centre for Physical Activity and Cardiometabolic Health in Youth
On Behalf of…
•
•
•
•
•
•
Steve Manske, PhD Propel – U of Waterloo
Erin Hobin, PhD
Propel – U of Waterloo
Donna Murnaghan, PhD - UPEI
Catherine Casey, PhD
- U of Manitoba
Jane Griffith, PhD
- CancerCare MB
Paul Veugelers, PhD
- U of Alberta
Presentation Overview
1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
Presentation Overview
1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
Physical Activity Status: Manitoba
• Only 22% of Manitoba
youth aged 5-19
achieve the equivalent
of 120 – 150 min/day of
MVPA (CLFRI, 2009)
• >30% of Manitoba
youth are overweight or
obese (CHMS 2007)
Physical Activity Status:
Manitoba
Average steps, by child age, Manitoba
13000
12000
11000
10000
9000
8000
5-10
11-14
2005-07
(CLFRI, 2009)
2007-09
15-19
Physical Activity Levels
Manitoba Context
Healthy Kids, Healthy Futures
Task Force Report:
The task force recommends that the
government mandate PE/HE from
kindergarten to Grade 12 in Sept. ‘08.
http://www.gov.mb.ca/healthykids/
Manitoba PE policy
0%
25% Minimum
75% Maximum
IN-Class Time
OUT-of-Class Time
Impacts ~65,000 students in
270 schools in MB
25%
25%
Core Component
50%
25%
Flexibility Component
75%
50%
PA Practicum
100%
Manitoba PE Policy
Requirements
• Minimum of 110 credit hours of PE/HE
• Minimum 55 hours of MVPA (30 mins MVPA
Daily)
Support:
• $3.8 Million to support policy implementation
• Secondment of PE/Health Consultant for 2
years to oversee implementation
Manitoba PE Policy
Options for Policy Implementation:
1) 100% IN – All PE and Health Ed In School
2) 50/50% - Some in, some out (Health On-line)
3) 25%/75% - eg. All PE in health ed on-line
4) 100% out of school on-line
NOTE: Out of class time is logged on an excel
sheet and reviewed by PE teacher frequently
Manitoba PE policy
• Student fitness portfolio
• Student-teacher conferences
• Pre- and post-sign off sheets
for teachers and parents
• Graded as Complete or
Incomplete
www.edu.gov.mb.ca/k12/docs/policy/imp_pe
he/document.pdf
Presentation Overview
1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy
Evaluation
3) Research Design and Methods
4) Results and Future Directions
Asking a Research Question
Target
Population
Exposure
to risk
factors
Outcomes
Asking a Research Question
Men >
50yrs
Reducing
Cholesterol
Risk of a
Heart
Attack
Epidemiology 101
How do you know
that this
Men > 50
Lowering
Cholesterol
Causes This
Reduces
Heart
Attacks
Gold Standard Design
Target Population
Study Sample
Random Assignment
Intervention
Control
Outcome Change
Outcome Change
Are they Different?
Example Problem
Finland
Proposed Solution
Gold Standard for Policy Eval?
Entire
Population
How do you know
that this
North
Karelia
Project
Causes This
Reduces
Heart
Attacks
Policy Evaluation
How did it Happen?
Change in Obesity rates over the same time frame
% Change from 1977-1999
350
300
250
200
OW
OB
150
100
50
0
Boys
Girls
Policy Evaluation
Manitoba PE Evaluation
All Grade
11 and 12
Students
in MB
How do you know
that this
Grade 11/12
PE Policy
Causes This
Increasing
PA /
Reducing
Obesity
Gold Standard Design
All Grade 11 and
12 Students
Small Sample
Random Assignment
Policy Yes
Policy No
Increased MVPA
Reduced MVPA
The Challenge
- PE levels decline over
time in adolescence
-Parallel intervention at
provincial/national level
-Child tax credit,
Participaction Olympic
Games, gas prices
-School-based initiatives
Nader, P. R. et al. JAMA 2008;300:295-305
Centre for Physical Activity and Cardiometabolic Health in Youth
Presentation Overview
1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
RESEARCH QUESTIONS
1. Will the policy reduce the number of inactive
youth in Manitoba?
2. Will the policy prevent the major decline in
PA levels between grade 9 and 12?
3. Does the school environment determine the
effectiveness of the policy?
4. What factors identified by stakeholders
facilitate effective policy implementation?
Centre for Physical Activity and Cardiometabolic Health in Youth
Question 1 Design
YOUTH HEALTH SURVEY
4 pages, 51 questions
• Multiple choice,
machine scannable
• 20‐30 minutes to
complete (short)
• Includes questions on
tobacco, nutrition,
physical activity,
self‐esteem and school
connectedness
CENSUS of PA in MB
• 46,919 students
participated in the survey
• ~33,000 in grades 9-12
• 265 of these schools
included grade 9‐12
• All 11 Manitoba Regional
Health Authorities
participated
Research Design 1
How do you
know it’s the
policy?
Rates of inactivity 2008
n = 33,000
Rates of inactivity 2012
n = 33,000
Research Design 1
Policy
No Policy
2012
Research Design #2
1) Cohort study of ~700
adolescents between
grades 9 and 12 in
Manitoba
2) 32 schools - 20-30/
school beginning in
2008. Followed to
2012
3) Randomly Selected
with 40% rural
4) Parallel cohort of 800
youth in Alberta
Assessment of Physical Activity
• Actical (minimeter)
• 7 day data collection
• Data collected every 15
seconds
• Youth asked to wear it for a
minimum of 10 hrs daily
• Provided with a minimal
incentive to wear the unit
• Same research assistant for
all 4 years
Eslinger Tremblay APNM 2008
Research Design #2
100
90
MVPA (mins/day)
80
70
60
AB
MB
50
40
30
20
10
0
2008
2009
2010
2011
2012
SHAPES Environment Survey
Research Design #3
Original Cohort in
Grade 9
Test for Differences in PA levels or
change in PA according to School
environment and/or polciy type
Follow the cohort until
grade 12
Research Question #4
Method
• 12 schools
– 60% urban
– 6 schools 50/50
– 3 schools 75/25
– 2 schools 25/75
• 12 PE teachers
Participants
• Concerns-based
model
• 1 interview
(~60min) with
each of the 12 PE
teachers
• 1 yr post-policy
(May/Jun 2009)
• Interviews
transcribed
verbatim
• Thematic analysis
to identify key
concepts
• Identify themes
that fall into each
SWOT category
Analysis
Presentation Overview
1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
Policy Implementation
Fall 2008
40
% Of Total
35
30
25
20
15
10
5
0
25/75
50/50
75/25
100
Results Question #1
65
60
% of total
55
50
<30 mins
>30 mins
45
40
35
30
Grade 9
Grade 10
Grade 11
Grade 12
Results Research Question #1
• Data were very similar for PEI in 2008
(n=~8000)
• 2012 being collected this year in MB
• Plan to collect data in PEI
• Data will be available mid 2013 for
comparison between the two provinces
Manitoba
Alberta
N = 966 Youth
(44 Schools)
N = 377
N = 588
N=175 (invalid 4 days/8hours) in 2008
N=175 (invalid 4 days/8hours) in 2008
N = 309
N = 413
N=35 (No weekend) in 2008
N=61(No weekend) in 2008
N = 352
N = 274
N=22 (invalid 4 days/8hours)in 2009
N=110 (invalid 4 days/8hours)in 2009
N = 253
N = 242
(including 1 weekend day)
(including 1 weekend day)
N = 24 (No Weekend Day) in 2009
N = 29 (No Weekend Day) in 2009
N = 229
N = 213
(including 1 weekend day)
(including 1 weekend day)
N = 442 Youth
(2008+2009 3 days/8 hours
including 1 weekend day)
Results Question #2
Percentage of Time
2008
2009
Sedentary
Light
MVPA
100
80
22
28
100
80
60
60
40
40
70
66
20
20
0
0
Weekday
Weekend
Sedentary
Light
MVPA
21
23
72
72
Weekday
Weekend
Figure 3
Results Question #2
B
80
80
Weekday
Weekend
60
*
*
40
MVPA TIME (mins)
MVPA TIME (mins/day)
A
Weekday
Weekend
†
60
*
*†
40
0
0
BOYS
GIRLS
mean ± SE
*=p<0.05 vs. weekday; † vs urban
URBAN
RURAL
Results Question #2
Weekday MVPA
Weekend MVPA
Results Question #2
Figure 5
Light PA Time (mins)
220
Week day
Weekend
210
200
*
190
Boys
180
170
*
160
Girls
150
0
2008
* = p < 0.01, change in Light PA over time
2009
Results Question #2
Mins/Day
Average MVPA Daily
58
56
54
52
50
48
46
44
42
40
AB-MVPA
MB-MVPA
2008
2009
2010
Results Question #2
Weekday MVPA
Mins/Day
65
AB Weekday
MB Weekday
60
55
50
45
40
2008
2009
2010
Results Question #2
Weekend MVPA
41
AB Weekend
MB Weekend
Mins/Day
40
39
38
37
36
35
34
33
2008
2009
2010
Research Question #2
65
Mins/Day
60
55
2008
2009
2010
50
45
40
35
30
Weekday
Weekend
Manitoba
Weekday
Weekend
Alberta
Research Question #2
100
% > 30 mins Daily
90
80
% of Youth
70
60
2008
2009
2010
50
40
30
20
10
0
Weekday
Weekend
Research Question #3
• Still analyzing data.
• No insight into what policy model works best
to date.
Research Question #4
Commitment and support of PE teachers
‘As far as what it has done to our school environment, as a physical
educator I was thrilled.’
‘…improvement will come from the school level, just talking to each
other and seeing how we can deliver the policy more effectively.‘
‘Most PE teachers felt it was long overdue.’
Research Question #4
Offering students choice in activities
‘…one of our teachers had a student trying to get his PE hours because
he’s a drummer. So we gave him a heart rate monitor…and he spent
quite a bit of time in the target heart rate zone drumming.’
‘A lot of students pick skateboarding and they’re very talented and it is a
lot of work…so you have students pick different things like that….’
Weaknesses
Tracking and Reporting
‘The bookkeeping part of it is kind of overwhelming…the amount of
paperwork we took in was tremendous.’
‘Finding time to track those kids and keep them up to date is very
difficult, a huge challenge.’
Weaknesses
Scheduling courses
‘…my administrative
colleagues weren’t thrilled
when they had to timetable
and make some hard
decisions…we had to make
decisions on actually cutting
some other courses.’
Weaknesses
Communication with parents
‘… I’d like to have more with the parents…I had them sign the declaration
and their logs and then a sign-off on policy but then I don’t really know
how much they’re actually sort of keeping up with if their child is actually
doing it.’
‘We do have a lot of ESL kids in our schools so we can’t communicate
because their parents don’t understand…having the declaration in different
languages.’
Opportunities
Access to resources and professional development
‘…we went through some orientation of the new curriculum. I went to
some sessions, professional development sessions…’
‘…there’s also good things on the [government’s] website and all the
PowerPoint presentations.’
‘The materials that we are provided are fabulous.’
Opportunities
Flexible delivery model
‘…we are able to look at what is
available and what our kids want and try
and meet their needs within the
curriculum.’
‘You try something, you throw it out, or
you modify it. As long as you are willing
to try then it will get better.’
Threats
Increased Workload
‘…we were told it shouldn’t be putting more work on the teachers…it produced
more work, bigger classes and less time…’
‘…it is difficult to have enough time for conferences with each student so it
would be helpful to have a supply teacher help fill the time away from
class.’
Threats
Access to facilities
‘Facilities are a bit of a challenge…no question it’s a juggling act to get 4
classes going at the same time. It works, but it is a juggling act.’
‘The #1 problem is our location. We can’t just walk to community recreation
facilities. We have to get on a bus or we need rides. When you look at other
urban schools, they can just walk across their parking lot to great facilities.’
Teacher Survey 2012
100
% Responding Yes
90
80
70
60
50
40
30
20
10
0
% Honesty
Effective?
Recommend?
Mandate?
Does the Policy Impact PA
outside of class
• They are … feeling good, developing better
lifestyles, buying gym memberships. Students in the
past have come back and said they are continuing
to be active, and understand it is important for their
health.
• Students are now more aware of what is out there,
that you can do for free. For example some rec
centers have discounts, and a lot of games, you do
not need equipment for
• they do not want to be physically active. The
students that want to be active are going to do it
even without the policy
Is the Alberta DPA Working?
Post-Policy
Pre-Policy
60
50.8
51.1
50.4
52.3
52.6
51.1
Prevalence
50
%unfit
40
30
24.3
23.2
22.1
23.4
2004
2005
2006
24.6
26.7
%OW/OB
20
10
0
2008
Year
2009
2010
Frequency of DPA in Year 1
Simcoe Muskoka SB 2007, n=258 teachers
4 to 5 times per week
45%
2 to 3 time per week
43%
About once per week
Less than once per week
10%
2%
Modeski and O’Connor, 2007
Centre for Physical Activity and Cardiometabolic Health in Youth
Challenges with DPA in Year 1
Simcoe Muskoka SB 2007, n=260 teachers
Lack of time
75%
Inadequate facilities
32%
Poor weather
27%
Lack of resources
21%
Safety concerns
15%
Personal discomfort
15%
Lack of training
No challenges with DPA
12%
10%
Modeski and O’Connor, 2007
Centre for Physical Activity and Cardiometabolic Health in Youth
Specific barriers to DPE or DPA
Calgary School Board, n=55 schools
Barriers to increasing time for DPE
Barriers to increasing time for DPA
50.0%
38.7%
Lack of space
68.4%
Lack of time in the curriculum
Lack of funding for a PE teacher
Lack of student or parent interest
Other
54.8%
47.4%
12.9%
2.6%
6.5%
15.8%
Kennedy et al., 2010
Centre for Physical Activity and Cardiometabolic Health in Youth
65.5%
Arkansas' BMI Report Cards
Underweight
Healthy weight
Overweight
21%
20%
21%
17%
17%
17%
60%
60%
60%
2%
2%
2%
Year 5 '07-'08
Year 6 '08-'09
Year 7 '09-'10
Arkansas Center for Health Improvement, 2010
Centre for Physical Activity and Cardiometabolic Health in Youth
Obese
Acknowledgements
•
•
•
•
•
•
•
Melisa Comte
Pinar Esciogolu
Andrea MacIntosh
Paul MacArthur
Dr. Rob Santos
Heather Willoughby
Jackie Nylen
• Dr. Steve Manske
• Dr. Jane Griffith
• Dr. Donna
Murnaghan
• Dr. Catherine Casey
Centre for Physical Activity and Cardiometabolic Health in Youth
Questions?
ephobin@uwaterloo.ca
www.mich.ca/dr_mcgavock
E-mail: jmcgavock@mich.ca
Centre for Physical Activity and Cardiometabolic Health in Youth