Belton et al.

BMC Public Health 2014, 14:122

http://www.biomedcentral.com/1471-2458/14/122

RESEARCH ARTICLE Open Access

Youth-Physical Activity Towards Health:

evidence and background to the development
of the Y-PATH physical activity intervention
for adolescents
Sarahjane Belton1*, Wesley O’ Brien2, Sarah Meegan1, Catherine Woods1 and Johann Issartel1

Abstract
Background: Despite known benefits of regular physical activity for health and well-being, many studies suggest
that levels of physical activity in young people are low, and decline dramatically during adolescence. The purpose
of the current research was to gather data on adolescent youth in order to inform the development of a targeted
physical activity intervention.
Methods: Cross-sectional data on physical activity levels (using self report and accelerometry), psychological
correlates of physical activity, anthropometic characteristics, and the fundamental movement skill proficiency of
256 youth (53% male, 12.40 ± 0.51 years) were collected. A subsample (n = 59) participated in focus group interviews to
explore their perceptions of health and identify barriers and motivators to participation in physical activity.
Results: Findings indicate that the majority of youth (67%) were not accumulating the minimum 60 minutes of
physical activity recommended daily for health, and that 99.5% did not achieve the fundamental movement skill
proficiency expected for their age. Body mass index data showed that 25% of youth were classified as overweight or
obese. Self-efficacy and physical activity attitude scores were significantly different (p < 0.05) between low, moderate
and high active participants. Active and inactive youth reported differences in their perceived understanding of health
and their barriers to physical activity participation, with active youth relating nutrition, exercise, energy and sports with
the definition of ‘being healthy’, and inactive youth attributing primarily nutritional concepts to ‘being healthy’.
Conclusions: Data show a need for targeting low levels of physical activity in youth through addressing poor health
related activity knowledge and low fundamental movement skill proficiency. The Y-PATH intervention was developed
in accordance with the present study findings; details of the intervention format are presented.
Keywords: Physical activity, Adolescents, Intervention, Fundamental movement skills

Background with a rise in incidence of overweight and obesity [1,2].

Physical activity (PA) as a preventive measure is widely Consequently, children and adolescents are a target popu-
recognised as central to effective management of over- lation for the promotion of PA to enhance health. A
weight and obesity problems [1], and for children it is critical consideration for children, adolescents, parents,
seen as an important factor in reducing the risk of chronic professionals, and scientists is the implementation and ad-
disease in adulthood [2,3]. Evidence suggests that habitual herence to PA guidelines for health [4]. The most widely
physical activity (PA) amongst young people is declining endorsed PA guideline stipulates that in order to enhance
health, youth should accumulate at least 60 minutes of
moderate-to-vigorous PA (≥ 60 min. MVPA) daily [5-7].
* Correspondence: [email protected]
Despite the known importance and associated benefits
1
School of Health and Human Performance, Dublin City University, Dublin 9, of regular PA in promoting lifelong health and well be-
Ireland ing, studies suggest that levels of PA decline dramatically
Full list of author information is available at the end of the article

© 2014 Belton et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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during adolescence [8,9], with males significantly more family or community component can increase PA in ado-
active than females [10-13]. Evidence now emphasises lescents (defined as ≥ 10 years).
the need for research to generate sound knowledge on The strategic advice outlined in the Children’s Sports
models of successful intervention in PA [4]. In their Participation and Physical Activity study [12] in order to
policy guidelines aligned to the Health Behviour in achieve the overall recommendation of increasing PA
School-aged Children 2012 results, the World Health levels of Irish youth include the development and pro-
Organisation (WHO) [13] supported the need for policy motion of fundamental movement skills (FMS). Cross-
interventions to increase PA. The WHO [13] state that sectional evidence has grown regarding the importance
policy-makers and practitioners should seek to identify of fundamental movement skill proficiency, showing that
what prevents and what motivates participation. Some of it is positively associated with total PA [25], moderate-
the factors listed as ensuring equitable access in this re- to-vigorous PA [26], skill-specific PA [27] and organised
port include “providing a range of activities that appeal PA [28] in youth. Mastery of motor skills in childhood is
specifically to girls, ensuring activities are free or afford- likely to be a key determinant of later adolescent PA
able, with provision of free or low-cost transportation to [29]. Findings of a recent study [30] provide support for
the venue, and involving young people in programme de- the simultaneous targeting of increasing PA and funda-
sign to identify barriers to participation.” (pp 137) [13]. mental movement skills in PA interventions; such is the
The Centres for Disease Control and Prevention’s evidence of a school-based programme [31] which found
(CDC) Task Force on Community Preventive Services positive effects in FMS and PA levels following a 5
[14] in a systematic review of community interventions month respective PE intervention. The CSPPA study
designed to increase PA, recommended six different [12] found that ‘lack of competence’ was the most com-
types of intervention as having good evidence for achiev- mon reason cited for non-participation in sport and PA
ing sustainable behaviour change in PA. Consistent with by children and youth. The link between poor FMS
recent findings [15,16], the organisation level or school- levels and low levels of PA have been described above,
based physical education (PE) was highly recommended however what is less apparent in an Irish context is the
as one of these intervention types [14]. PE has the op- current levels of FMS of youth, particularly at the critical
portunity to reach nearly all school-aged children [17], period of transition from primary to post primary educa-
and has been associated with improved mental health, tion. Children have the developmental potential to mas-
dietary choices and academic achievement [18]. For an ter most of the FMS by 6 years of age [32], yet recent
increasing number of children PE may be the only op- evidence outside of Ireland suggests adolescent youth
portunity they have during the week to engage in MVPA are not performing FMS to their expected developmen-
[19], and as subject area PE is now widely accepted as a tal capability [33-35]. This emerging evidence indicates
public health resource [15]. Increasingly, studies are that children are likely making the transition to adoles-
reporting the positive effect school-based PE interven- cence without acquiring basic movement skill profi-
tions have on PA participation [16,20,21]. ciency, though this has yet to be confirmed in an Irish
A systematic review [22] of 76 interventions world- context.
wide aimed at promoting PA participation in children In order to counteract the attraction of sedentary pur-
and adolescents found that for children (defined as 4 – suits, and to promote lifelong engagement in PA, inter-
12 years), school-based interventions with a focus on PE vention programs need to be developed focusing on the
and involving school break times were the most effective. unique needs of young people [4]. To design personally
For youth (defined as 13 – 17 years old), tailored advice meaningful and socially relevant PA interventions for
sessions were found to be more effective. A previous sys- youth, their views and opinions and insight into motiva-
tematic evaluation of evidence [23] found that at approxi- tions and barriers they experience in relation to partici-
mately 10 years of age PA priorities start to change from pation both within and beyond school must be sought.
general PA with an emphasis on motor skill development This improved understanding of the factors that influ-
to prescriptive PA with an emphasis on health, fitness and ence young people’s physical activity behaviors will allow
behavioural outcomes. To this end another review on the for the planning of more appropriate interventions to
effectiveness of PA interventions [24] shows that a large promote PA within this cohort [36]. To simplify this
number of PA intervention programmes have reported process the Youth Physical Activity Promotion (YPAP)
some element of health education (related to PA) as part Model [37] guided the development of the Y-PATH
of the intervention structure, however, it not clear how intervention. The YPAP model adopts a social-ecological
young people’s knowledge of (or beliefs and attitudes to- framework acknowledging the input of various personal,
wards) the role of PA in ensuring optimal health, affects social and environmental influences on physical activity.
their PA participation. This review [24] reported strong The social-ecological framework acknowledges that self-
evidence showing that school-based interventions with a regulation is difficult to establish without broader social
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and institutional support [38]. The YPAP model was de- data to get a more objective picture of the amount of PA
veloped based on aspects of the Precede-Proceed health youth participate in. The purpose of the current study
promotion model [39], which advocates a ‘bottom-up’ (Y-PATH: Youth Physical Activity Towards Health) was to
approach to program planning, considering the specific collect such data in an Irish context so that a meaningful
characteristics and needs of a population prior to estab- and relevant intervention could be developed. In line with
lishing any programme. the factors outlined in the YPAP model data on current
The YPAP model has four major components; enab- levels of PA and FMS of 12 – 14 year old adolescent youth
ling factors, predisposing factors, reinforcing factors, were collected, along with data on psychological correlates
and personal demographics. Predisposing factors are of PA (including attitude and self-efficacy). Focus group
identified as those which impact on the decision making interviews were then used to explore barriers and motiva-
processes of youth as they decide whether to engage in, tors to PA of the cohort. Based on the information
or avoid PA opportunities. These factors include youth’s gathered an intervention program ‘Y-PATH’ specifically
attitudes towards PA, and their perceptions of the bene- tailored for the needs of this age group was developed.
fits, the level of enjoyment and their competence levels
for the particular type of PA offered. The reinforcing fac- Methods
tors are those influences that encourage participation Participants and recruitment
through the social environment. Specifically, for youth As part of a cross-sectional research design all second
significant others include parents, teachers/coaches and level schools in a rural Irish town (two mixed schools,
peers. This network of significant others can provide one all male school, and one all female school) were tar-
positive support (e.g. providing transport) and encour- geted and provided consent. All first year students (aged
agement (e.g. asking about sport engagement) for regu- 12 – 14 years) within these four schools were invited to
lar engagement in PA, and in doing so enhance the be involved in the study; 256 participants (from a pos-
likelihood of youth engagement in PA opportunites [37]. sible total of 288) agreed to participate. Informed con-
Enabling factors or personal attributes (such as fitness, sent for participation was granted by each of the 256
FMS, body composition) are recognized in the model as participants and their parent/guardian; all participants
necessary but not sufficient determinants of physical ac- were free to withdraw from the research at any stage. Full
tivity. Demographic factors (such as age, gender) are approval for this study was given by the Dublin City Uni-
identified as those directly influencing how an individual versity Research Ethics Committee (DCUREC/2010/081).
will assimilate various influences. The YPAP model as
applied in the Y-PATH intervention development is pre- Procedures and data management
sented in Figure 1. Body mass (kg) and height (m) were directly measured
Martínez-Andrés et al. [40] advocate for the use of using a SECA Leicester Portable Height Measure and
mixed methods in studies aiming to develop effective in- SECA heavy duty scales. Level of PA participation, and
terventions for youth, using qualitative methods to bet- psychological correlates of PA were assessed via self-
ter understand young peoples points of view in relation report (detail given below). A sub sample of participants
to barriers and motivators for PA, and using quantitative (one class group from each school, total n = 117) also

Physical Activity

Enabling Predisposing Reinforcing

• Fitness • Family Influence
• Skills • Peer Influence
• Access Am I able? Is it worth it? • Teacher/Coach
• BMI • Perceived • Enjoyment Influence
Competence • Beliefs
• Self-efficacy • Attitudes

Personal Demographics
• Age
• Gender
Figure 1 Interrelationships within the Youth Physical Activity Promotion model.
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wore an Actigraph GT1M or GT3X accelerometer for a inter-observer agreement for all 9 skills on pre-coded
period of 9 days in order to provide an objective mea- data. The following 9 FMS were assessed (along with
sure of habitual PA participation; due to a firmware mal- height and weight) during a timetabled 80 minute PE
function data from almost all of the sub sample failed to lesson: run, skip, horizontal jump and vertical jump
download and as such accelerometer data has been (locomotor; maximum score = 34); kick, catch, overhand
omitted analysis. Each FMS was assessed in conjunction throw, strike and stationary dribble (object control; max-
with the behavioral components from three established imum score = 40). Prior to FMS data analysis, re-
instruments: Test of Gross Motor Development [41], searchers were required to reach a minimum of 95%
Test of Gross Motor Development 2 [42] and the Victor- inter-observer agreement for all 9 skills on pre-coded
ian Fundamental Motor Skills manual [43]. Focus group data. FMS analysis focused exclusively on the raw scores
(FG) interviews were used to explore students’ percep- across the selected 9 FMS. The number of FMS per-
tions of what it means to be healthy and to identify their formance criteria varied from 3 to 6 across the range of
motivators and barriers to PA participation (further in- selected FMS; all participants were given a ‘1’ for correct
formation given below). execution of criteria, and a ‘0’ for a failed attempt. Par-
The questionnaire developed for the Y-PATH study ticipants performed the skill on 3 occasions including 1
was a combination of well-known, valid, and reliable familiarization practice and 2 performance trials. For
self-report measures. The measures used were develop- each FMS, the two performance trials were added to-
mentally suitable for adolescents of this age group and gether to get the total for each skill score. There were a
addressed the key areas of research interest. Habitual PA total of 74 performance criteria for all 9 gross motor
was assessed using two questions [44] - the number of skills. A Total score for all 9 skills was calculated for
days during the past week, and for a typical week, that each participant, along with an object control score, and
participants accumulated 60 minutes or more of MVPA. a locomotor score.
A composite average of the 2 items provided a score of FG interviews that explored student perceptions of what
days per week that the adolescents had accumulated 60 it means to be healthy and their views on the important
minutes of MVPA, this method has recently shown factors that influenced their involvement in, or avoidance
moderate to large correlations with objective accelerom- of, PA were also conducted. A semi-structured interview
eter data (0.20-0.51) amongst adolescents [45]. Ques- guide, using questions designed by the research team
tions on psychological correlates of PA (self-efficacy, whom had specific expertise in qualitative design and PA
perceived benefits and barriers to participation, PA atti- intervention development were developed. Questions
tudes, and social support) were all taken, with scales in- were piloted on a sample of 16 students from the target
tact, from the FifeActive survey [46]. group. Following the pilot work, 8 FG interviews were
Data was collected on participants in their class groups conducted in the 4 schools post self-report and FMS data
(maximum n = 30) during a 2-hour school visit, with a collection. Each school had 2 focus group interviews, 1
ratio of 1 researcher to 10 students for questionnaire with a ‘high active’ group and 1 with an ‘inactive’ group. A
completion, and 1 researcher to 5 students for all other subsample of students (n = 59) randomly selected from
measures. The study was briefly explained and instruc- the 4 schools were selected into either ‘high active’ or
tions provided on how to complete the questionnaire. ‘inactive’ categories based on the previously collected self-
Participants were encouraged to take their time, reflect report data at baseline (0–3 days 60 minutes MVPA =
on their answers, and to be as honest as possible. All inactive; 6–7 days 60 minutes MVPA = high active). The
questionnaires were completed online through ‘Survey rationale for this was, in line with a previous study [47],
Monkey’ in class, with an ID number assigned. In cases that students were more likely to contribute to discussions
where computer networks failed, participants completed about PA if homogeneously grouped in terms of PA par-
hardcopies of the questionnaire. A 48 hour time sam- ticipation levels. Prior to FG commencement, all partici-
pling test-rest reliability measurement among a sample pants received and signed a consent form and a plain
of 35 participants (11–12 years of age) was carried out language statement providing details of the research.
to ensure comparability of the two administration proto- Focus groups occurred in a school classroom and lasted
cols (computer versus hardcopy); reliability coefficients an average of 45 minutes. Participants were reminded that
ranged from 0.81 to 0.94, showing the scores across both they could withdraw from the interview at any stage and
formats of the questionnaires to be very stable over that all recordings would remain confidential. The FG in-
time, terviews were recorded by Dictaphone and were tran-
FMS data were collected during physical education scribed verbatim. Each of the eight FG interviews were
(PE) classes; again, participants were assigned ID num- conducted by two researchers; a facilitator and a note
bers for anonymity purposes. Prior to FMS data analysis, taker. The facilitator’s role was to guide the FG, stimulate
researchers were required to reach a minimum of 95% interaction among students toward the theme, oversee
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group discussion and encourage all students to respond. Results

The note taker kept a record of the discussion as it Table 1 gives the gender breakdown of mean (SD), along
evolved to add details for instances where the recording with the sample size, for all variables, both overall and
was not audible [47]. across PA grouping.

Data analysis Descriptive and anthropometric characteristics

All data were analysed using SPSS version 20.0 with Of the 256 participants involved in this study, 53% were
alpha set at p < 0.05. Where participants had incomplete male and 47% were female, with a mean (± sd) age of
data for a given variable, participants were excluded 12.40 ± 0.51 years. Just over half (52%) of participants
from analysis of this variable specifically. The number of were attending a mixed school, with 25% attending an
days self-reported meeting the 60 minutes PA guideline all male school, and 23% attending an all female school.
were analysed descriptively using means, standard devia- Participants had an average BMI of 20.03 ± 3.30 kg/m2,
tions and proportions. Students were categorised as low with 75% categorised as normal weight, 21% overweight,
active (meeting guidelines on 0, 1, 2 or 3 days a week), and 4% obese using the Cole at al. [50] classification.
moderate active (meeting on 4 or 5 days), or high active
(meeting on 6 or 7 days). A summative score was calcu- PA (self-report)
lated for each psychological determinant (scoring system Self-report PA data showed that 20% of participants met
detailed in FifeActive [46]). Descriptive statistics and fre- the 60-minute guideline on 0 – 3 days a week (low ac-
quencies for all FMS were calculated. “Mastery” was de- tive), with 31% meeting the guideline on 4 or 5 days
fined as correct performance of all skill components on (moderate active); the remaining 49% of participants met
both trials, “Near Mastery” was defined as correct per- the guideline on 6 or 7 days (high active). The percent-
formance of all components but one on both trials [48]. age of participants meeting the guideline on all 7 days
As the assumptions for ANOVA were met, two-way be- was 33%. Results of the two-way ANOVA’s exploring the
tween groups ANOVA’s were used to explore the impact impact of gender and PA grouping on the different vari-
of gender and PA grouping (low, moderate or high ac- ables are given in Table 1. The interaction effect for gen-
tive) on total FMS score, locomotor score, object control der and PA grouping was not significant for any of the
score, BMI, and on all psychological correlates. In in- variables. Statistically significant main effects for gender
stances where significant main effects were found, post- and/or PA grouping is shown in the main effect column
hoc comparisons were be carried out using the Tukey in Table 1, along with the effect size (strength of associ-
HSD to determine where the differences occurred. ation - Partial Eta Squared) in each case.
The FG data was analyzed using the constant com-
parative method [49]. This process involved manually Psychological correlates (self-report)
highlighting and comparing the emergent themes from Of the psychological variables only social support
the associated data collected in the FG interviews. Simi- showed no significant main effect for either gender or
lar themes from the high active and inactive focus group PA category. All other psychological variables demon-
participants were grouped together under several head- strated a significant main effect for PA but not for gen-
ings. Areas of significance and importance in relation to der, with a small effect size in each case (see Table 1).
students’ perception of health and their views on the Post-hoc comparisons using the Tukey HSD showed that
factors, deemed important in motivating or preventing in each case the mean score for the low active group
their participation in PA, were identified. In order to en- was significantly lower than the high active group; only
sure data trustworthiness and credibility, various steps in the Barriers to Self-Efficacy and the Attitudes to PA
were taken including member checking, peer examin- variables were the low active group mean scores also sig-
ation and independent data coding. Member checking nificantly lower than the moderate active groups.
involved the researchers discussing the main findings
with the FG participants to verify accurate reflections of FMS
the discussion [49]. Participants were given the oppor- Only one participant (0.5%) possessed complete mastery
tunity to make amendments or add suggestions. No par- level across all 9 object related and locomotor move-
ticipants made any changes to the research findings. ment skills, with 11% scoring mastery or near mastery
Peer examination of the data occurred between the re- across the 9 skills (see Table 2). The poorest perfor-
searchers to ensure individual researchers found similar mances were for the vertical and horizontal jumps (loco-
trends from the data and a second reader independently motor) where 13% and 29% respectively achieved
coded the data. Differences in the coding were discussed mastery and 10% and 28% achieved near mastery. Re-
between the researchers and independent coder until sults of a two-Way ANOVA showed that while there
consensus was reached. was no main effect for PA grouping, male participants
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Table 1 Mean (SD) across PA grouping with significant main effects and effect size of two-way ANOVA’s
Physical activity grouping
Variable Gender N Overall Low Moderate High Main effect Partial eta squared
BMI Male 131 19.89 (3.45) 20.60 (4.32) 19.61 (3.04) 19.93 (3.25) No sig.
Female 113 20.17 (3.13) 20.26 (2.77) 20.16 (3.28) 19.79 (3.49)
Total FMS Male 120 61.93 (5.56) 60.81 (6.03) 62.51 (6.76) 62.18 (4.14) No sig.
Female 103 60.13 (5.33) 60.73 (5.14) 60.60 (4.90) 59.96 (5.30)
Object control Male 110 36.62 (2.62) 36.13 (2.81) 36.49 (3.17) 36.75 (1.97) Gender, F(1,199) = 9.147, p = 0.003 0.044
Female 95 35.27 (2.82) 35.30 (2.93) 35.57 (2.71) 35.04 (2.47)
Loco-motor Male 120 25.31 (4.19) 24.68 (4.61) 26.03 (4.63) 25.43 (3.39) No sig.
Female 103 24.85 (3.94) 25.43 (3.45) 25.03 (3.67) 24.93 (4.16)
Self efficacy Male 133 25.36 (4.04) 23.74 (41.8) 26.30 (4.17) 25.73 (3.47) PA, F(2,245) = 4.087, p = 0.018 0.032
Female 118 24.80 (4.27) 24.28 (4.58) 24.74 (4.20) 25.56 (3.90)
Benefits Male 133 31.71 (4.04) 31.23 (4.80) 32.11 (3.88) 31.71 (3.55) PA, F(2,245) = 3.513, p = 0.031 0.028
Female 118 31.31 (4.24) 30.19 (4.23) 32.68 (3.40) 31.27 (4.23)
Barriers Male 133 33.86 (8.12) 32.63 (7.85) 35.07 (7.05) 33.67 (9.21) PA, F(2,245) = 3.650, p = 0.027 0.029
Female 118 33.91 (6.57) 31.76 (6.61) 34.29 (5.51) 36.38 (6.81)
Attitudes Male 129 13.78 (2.30) 12.87 (2.43) 14.09 (2.16) 14.18 (2.17) PA, F(2,240) = 11.332, p = 0.000 0.086
Female 118 33.91 (6.57) 31.76 (6.61) 34.29 (5.51) 36.38 (6.81)
Social support Male 129 16.14 (3.94) 15.89 (4.03) 15.88 (3.44) 16.55 (4.32) No Sig.
Female 117 15.90 (3.12) 15.52 (2.99) 16.57 (3.32) 15.68 (3.04)

obtained a significantly higher object control score com- Being healthy: diet, exercise and body image
pared to female participants (p = 0.003). There was, how- High active participants perceived being healthy to be
ever, no significant gender (or PA grouping) difference related to eating and exercising. One student commen-
in the overall locomotor mean score performance. ted that being healthy means: ‘eating healthy and you
see people jogging on the road and you know they are fit
Focus groups and healthy.’ Similarly, another student linked being
Three key themes emerged from the FG data that were healthy with: ‘well say if you are not doing exercise and
pertinent to students perception of health and what stu- you eat too much fattening foods, it will clog up your
dents deemed important in influencing their participa- heart and you will get a heart attack.’
tion in, and barriers to, PA, PE, sport and exercise These Inactive participants’ perception of health differed as
themes were:(1) Being healthy: diet, exercise and body they largely associated being healthy with nutrition and
image, (2) Motivators: PA is fun, and (3) Barriers: lack of body image, with exercise rarely mentioned. To illustrate
time, distance, PE related factors. this, one participant associated being healthy as ‘not
Table 2 Percentage and raw score, and 95% confidence intervals (95% CI) of mastery of FMS
Mastery Raw score (SD)
Locomotor Male Female Male Female
Run 95.1% (89.2, 98) 76% (66.2, 83.7) 7.92 (0.40) 7.45 (1.09)
Skip 10.6% (6, 17.7) 11% (6, 19.2) 3.67 (1.36) 4.18 (0.95)
Horizontal jump 35.8% (27.5, 45) 20% (12.9, 29.4) 6.30 (1.64) 5.22 (1.93)
Vertical jump 13.8% (8.5, 21.5) 12% (6.6, 20.4) 7.46 (2.68) 7.94 (2.00)
Object control
Catch 70.7% (61.7, 78.4) 64% (53.7, 73.2) 5.57 (0.82) 5.55 (0.66)
Overhand throw 60.2% (50.9, 68.8) 27% (18.9, 36.7) 7.08 (1.33) 6.00 (1.58)
Stationary dribble 65.9% (56.7, 74) 55% (44.8, 64.9) 7.05 (1.62) 6.87 (1.55)
Strike 43.1% (34.3, 52.3) 55% (44.8, 64.9) 9.05 (0.94) 9.25 (0.99)
Kick 86.2% (78.5, 91.5) 78% (68.4, 85.4) 7.80 (0.52) 7.64 (0.76)
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getting fat…eating the right food to help your body’. When HSBC study [13]. Given the consistently reported de-
this response was probed, the same participant went on to cline in activity with age [8,9], the need for intervention
explain that eating the right food consists of ‘replacing to address these low levels reported for young people
junk foods with fruit and vegetables’. Other responses from aged 12 – 14 years old is evident.
the inactive participants who associated being healthy with The majority of youth in this study (99.5%) failed to
body image included: ‘you don’t have to worry about being reach a level of mastery across key FMS, indicating that
fat’ and being healthy ‘kind of keeps you skinny’. basic movement skill proficiency is low. Other research
outside of Ireland examining the FMS proficiency of ad-
Motivators: PA is fun olescents support this low level of FMS mastery [34,51].
The key emergent theme in relation to motivators for Guided by previous findings [22], it is important to recog-
PA among high active participants was enjoyment and nise that an intervention designed around movement skill
fun. Examples of this include a student stating: ‘I think acquisition alone would probably be insufficient to change
it’s [physical activity] fun and like if you’re at home all PA behaviour in youth long term. This points to the tar-
day, its great to get out for a couple of hours.’ Similarly, geting of an improvement in FMS proficiency as a stra-
another student stated: ‘well I enjoy it and I know it’s tegic supplement in the promotion of PA in adolescents.
very good and like healthy for you’. Perceiving physical Consistent with other studies [36,52-56], analysis of
activity as ‘being fun’ was similarly attributed by inactive psychological variables reveals an association with PA
participants as a participation motivator, with one stu- level. This was evident for self-efficacy, perceived bar-
dent stating: ‘I just find them fun, they’re good to do’. riers and benefits, and attitude towards PA, all of which
exhibited moderate effects. At the individual level, the
Barriers: lack of time, distance, PE related factors CDC [3] recognises that for young people perceived
In relation to barriers to PA participation, insufficient competence, and perceptions of their ability to perform
time to participate was identified as the main barrier a PA (self-efficacy), will affect their participation in an
amongst the high active group. One student indicated: activity. This is also consistent with recent reviews
‘we don’t really have any time to do extra sport apart [3,52,53,57], where self-efficacy was found to be a con-
from like football training cos you get back from school at sistent positive determinant of PA in children and ado-
like quarter to 5, you get the bus from here to [place lescents. Like self-efficacy, a significant difference was
name] so you just kind of get time to eat your dinner, get found in the attitude to PA variable between low and
changed for training, go training, and go home and do moderately active, and low and high active participants;
your homework’. Findings illustrated that barriers to PA with low active participants scoring significantly lower
participation amongst the inactive participants out- than their moderate and high active counterparts in each
weighed the motivating factors of their high active coun- case. These variables (attitude, self-efficacy) are cate-
terparts. Several inactive participants cited distance to gorised as predisposing factors for PA in the YPAP
activity as a barrier to PA participation with one partici- model [37], indicating they have a strong influence on
pant stating ‘you travel for sometimes an hour, all the the likelihood that a young person will become physic-
way just to play a match, and then you lose, and it’s a ally active. It is worth noting that social support (ad-
waste of time pretty much.’ Other identified barriers to dressing the reinforcing factors presented in the YPAP
participation were PE related factors and included the model [37]) was not found to be significantly associated
apparent competitive nature, and perceived lack of with PA level in this study. However its previously iden-
choice, in PE class. One such participant stated: ‘the guys tified importance in intervention design [58,59] and as a
played and they just got really competitive and it was correlate of PA behaviour [52-57] cannot be discounted.
not fair.’ Another student voiced concerns about the The evaluation of social support in the pilot study was
choice in PE: ‘It’s very like, only the team can play, you conducted using the social support items from the
can’t really choose how you want to do it, and you don’t FifeActive survey [46], it is very possible that had a stand-
get to choose what you do.’ alone social support instrument (such as that presented in
Sallis et al. [60]) been used in this research a significant as-
Discussion sociation with PA level may have been found.
Results of this study highlight that a large number of From the FG findings, it was evident that the high ac-
Irish youth are insufficiently active to benefit their tive and inactive participants had different perceptions
current and future health (only 33% meeting PA guide- of health, and the relative contribution of physical activ-
line for health). Though higher than the 19% reported ity to that concept. High active participants cited the im-
for a slightly older age group in the CSPPA study [12], portance of ‘exercise’, which supports previous research
this finding is relatively consistent with the range of [61] that found that students’ responses similarly linked
findings reported for other European countries in the practices like eating and exercise with being healthy.
Belton et al. BMC Public Health 2014, 14:122 Page 8 of 12
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Findings from the FGs suggest however that inactive insufficiently skilled to benefit their current and future
participants associate the term health with body images health. Inactive students did not demonstrate the same
such as being skinny and avoiding becoming fat. Similar depth of knowledge of the health benefits of PA as did the
research [62] also found that children perceived being fit high active students, and they demonstrated significantly
and healthy as being skinny and losing weight. lower scores for Self-Efficacy and Attitude than their mod-
As was found in a previous study [63], both high active erate and high active counterparts. As such the Y-PATH
and inactive participants identified PA being fun as a intervention was developed with a strong focus on phys-
primary motivator for participation. Participation bar- ical education based Health Related Activity (HRA), with
riers identified by inactive participants included lack of key school, teacher and parent components. The CDC
time [64], distance [65], the competitive nature of PE, [59] recommend the promotion of PA through coordi-
and lack of choice in PE. Research examining the environ- nated school health programmes such as this, with links
mental influences on PA among adolescents [66] similarly established between the school and the family. This is in
found that competition was one of the predominant bar- line with the YPAP model (see Figure 1), and is strongly
riers to students fully participating in PE. Other research supported by a recent systematic review of PA interven-
suggests offering alternate, non-competitive forms of PE tions for adolescents, which suggests the importance of
as realistic ways for change and improving the long-term targeting ecological domains beyond the individual level
participation in PE for children and youth [47,67]. [70]. It also encompasses lessons learned from the current
Findings of this study clearly highlight the need for study, which recommended enhancement of our interven-
intervention to improve PA levels of young people, and tion’s social support element and the use of more detailed
provide good insight into how we can best structure the questionnaires to evaluate the impact of social support in
intervention so that it is most meaningful and relevant. any future research evaluating the effect of the Y-PATH
Specifically findings point to the need to: intervention.
The Y-PATH intervention was designed in line with
1) Target both low locomotor and object control FMS the YPAP model with a view to enabling youth to posi-
levels. tively re-evaluate their predisposing factors ‘Am I able’
2) Build PA opportunities that help children to develop (e.g. self-efficacy) and reinforcing factors ‘Is it worth it’
positive predisposing factors for PA engagement, (e.g. enjoyment, attitudes), while also addressing the en-
specifically exercise self-efficacy and attitude. abling factors (e.g. skill level) that influence participation.
3) Ensure PE class consists of choice and is primarily An overview of the structure of the Y-PATH programme
cooperative rather than competitive is given in Figure 2. Detail on the student, teacher and
4) Educate on the health benefits of PA parents components of the intervention are given below.
The guiding principles of the Y-PATH intervention are
It has been acknowledged widely in the literature that then detailed, in each case the relevant component of
there is strong rationale for school-based programmes the YPAP model that is being addressed is identified.
aimed at increasing PA levels [4,23,68], FMS levels [31]
and reducing inactivity [3]. Schools have direct contact Student component
with children and youth for on average 6 hours per day, A printed Y-PATH resource comprising of two main
and for up to 13 years of their critical social, psychological, parts was developed for PE teachers in the intervention
physical and intellectual development [3]. In the 2012 fol- school. The first part is a six-lesson scheme of resources.
low up paper to their 1991 publication describing the im- Within each lesson there is both a direct HRA and PA
portance of PE in addressing public health problems [15], focus, and also a targeted psychosocial focus aimed at
authors reiterate their recommendation of the following improving self-efficacy and attitude towards PA of the
two goals for health related PE to (i) prepare youth for a students. The second component is a resource to guide
lifetime of PA, and (ii) provide them with opportunities PE teachers in the integration of HRA, psychosocial, and
for PA participation during PE classes. Welk [37] states FMS components across the remaining seven strands of
that PE is recognised as an optimal vehicle for influencing the Irish Junior Cycle Physical Education curriculum.
PA habits of young people, specifically paying a primary The importance of teaching strategies within PE classes
role in influencing the enabling and predisposing factors cannot be overlooked as an important component of the
identified in the YPAP model. Through education in PE intervention, with Rosenkranz et al. [17] and Ntoumanis
class youth have the potential to be influenced to adopt a [71] indicating that teachers should use motivational
physically active lifestyle, with much research showing that strategies within PE classes to support students’ needs,
activity levels in youth track into adulthood [58,69]. and thus generate a climate where students feel more
Based on the findings of this study it is apparent that a self-determined to participate in PE. The authors high-
large number of students were insufficiently active and light four such motivational strategies: (1) “choice”
Belton et al. BMC Public Health 2014, 14:122 Page 9 of 12
http://www.biomedcentral.com/1471-2458/14/122

• Engage in PE curriculum

Access to resources on Y-PATH website and Facebook page

• Student HRA journal
Student • Physical activity advocacy posters
Component • Pathways to activity directory providing
information regarding local sports clubs
and activities

• PE teachers receive handbook and one

day in-service workshop
Teacher

Media
• Information leaflets for ALL teaching staff
Component • Information session for ALL teaching staff
• A one week staff ‘pedometer challenge’

Parent/Guardian • Information leaflets

Component • Information session

Figure 2 Overview of the structure of the Y-PATH programme.

providing students with the opportunity to make deci- become facilitators of PA and active role models for
sions about the activities they participate in during les- young people. Two one-hour workshops are held with all
sons; (2) “relevance” providing a rationale and explaining teachers in the school at the beginning and midpoint of
to students the relevance of an activity; (3) “acknow- the academic school year. During the first workshop, Y-
ledgement” acknowledging students’ difficulties when PATH information leaflets are distributed to reinforce the
learning skills; and (4) “feedback” providing feedback importance of PA and PA promotion and to offer sugges-
using praise for students’ effort and improvement. tions for how adults can influence youth PA by becoming
PE teachers receive a one-day in-service workshop to active role models and encouraging PA. Teachers are then
train them in delivery of the Y-PATH programme with lead by the Y-PATH researcher to develop a charter for
their first year class groups, with specific pedagogical the promotion of PA with their students, which is subse-
emphasis on the use of motivational strategies within quently, given to the school following the workshop. The
their teaching such as those detailed above. The TAR- second teacher workshop explores the ‘voice’ of the
GET model of creating a mastery motivational climate teacher in terms of PA promotion.
as proposed by Ntoumanis & Biddle [72] was used as a
basis for this. The focus of the workshop is to identify Parents component
with teachers the need to move PE classes from a The parent/guardian aspect of the intervention involves
performance-involving climate (characterised by norma- a face-to-face meeting between a member of the Y-
tive competition, students’ worried about mistakes, and PATH research team and the parents of first year stu-
an orientation to succeed with little effort [73]), to a mo- dents in the school. This is held at the beginning of the
tivational climate (characterized by cooperative learning academic school year. In this session parents (and stu-
and a focus on individual improvement, with students dents in some instances, depending on school policy)
oriented towards developing new skills, and improving are introduced to the Whole-School Y-PATH inter-
levels of competence and sense of mastery [74]). vention as an integral aspect of the school first year
A printed handbook is provided to the students sup- programme. Similar to the first teacher workshop par-
porting all of the PE teachers’ resources, including a PA ents are directly informed about the importance of PA,
log book, which is used within PE class by students to information on strategies they can use to promote youth
periodically monitor their PA levels. In addition to this PA, and are given the Y-PATH information leaflets.
teachers receive four posters to display in or around the
school sports hall, the focus of these were increasing PA Y-PATH guiding principles
and decreasing sedentary behavior.
1. The first experience of Physical Education (PE) for
Teacher component the students at second level school will be Health
The teacher aspect of the intervention targets all non- Related Activity, with a focus on PA participation
specialist PE teachers of the school, challenging all to [move from PE being associated with a specific
Belton et al. BMC Public Health 2014, 14:122 Page 10 of 12
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activity or sport, to being associated with learning to References

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doi:10.1186/1471-2458-14-122
Cite this article as: Belton et al.: Youth-Physical Activity Towards Health:
evidence and background to the development of the Y-PATH physical
activity intervention for adolescents. BMC Public Health 2014 14:122.

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