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Louise Mansfield, Tess Kay, Catherine Meads, Lily Grigsby-Duffy, Jack Lane, Alistair John, Norma Daykin, Paul Dolan, Stefano Testoni, Guy Julier, Annette Payne, Alan Tomlinson and Christina Victor
Sport and dance interventions for healthy young people (15–24 years) to promote subjective well-being: a systematic review Article (Published version) (Refereed)
Original citation: Mansfield, Louise and Kay, Tess and Meads, Catherine and Grigsby-Duffy, Lily and Lane, Jack and John, Alistair and Daykin, Norma and Dolan, Paul and Testoni, Stefano and Julier, Guy and Payne, Annette and Tomlinson, Alan and Victor, Christina (2018) Sport and dance interventions for healthy young people (15–24 years) to promote subjective well-being: a systematic review. BMJ Open, 8 (7). e020959. ISSN 2044-6055 DOI: 10.1136/bmjopen-2017-020959 © 2018 the Author(s) CC BY 4.0 This version available at: http://eprints.lse.ac.uk/89711/ Available in LSE Research Online: August 2018 LSE has developed LSE Research Online so that users may access research output of the School. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LSE Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain. You may freely distribute the URL (http://eprints.lse.ac.uk) of the LSE Research Online website.
http://www.lse.ac.uk/researchAndExpertise/Experts/profile.aspx?KeyValue=p.h.dolan@lse.ac.ukhttps://bmjopen.bmj.com/http://doi.org/10.1136/bmjopen-2017-020959http://eprints.lse.ac.uk/89711/
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1Mansfield L, et al. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
Open access
Sport and dance interventions for healthy young people (15–24 years) to promote subjective well-being: a systematic review
Louise Mansfield,1 Tess Kay,2 Catherine Meads,3 Lily Grigsby-Duffy,2 Jack Lane,4 Alistair John,2 Norma Daykin,5 Paul Dolan,6 Stefano Testoni,6 Guy Julier,4 Annette Payne,2 Alan Tomlinson,4 Christina Victor7
To cite: Mansfield L, Kay T, Meads C, et al. Sport and dance interventions for healthy young people (15–24 years) to promote subjective well-being: a systematic review. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
► Prepublication history and additional material for this paper are available online. To view these files, please visit the journal online (http:// dx. doi. org/ 10. 1136/ bmjopen- 2017- 020959).
Received 6 December 2017Revised 26 March 2018Accepted 11 May 2018
1Department of Life Sciences, Division of Sport Health and Exercise Sciences, Brunel University London, Uxbridge, UK2Life Sciences, Brunel University London, Uxbridge, UK3Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK4Arts and Humanities, University of Brighton, Brighton, UK5Health and Wellbeing, University of Winchester, Winchester, UK6Social Policy, The London School of Economics and Political Science, London, UK7Clinical Sciences, Brunel University London, Uxbridge, UK
Correspondence toProfessor Louise Mansfield; louise. mansfield@ brunel. ac. uk
Research
AbstrACtObjective To review and assess effectiveness of sport and dance participation on subjective well-being outcomes among healthy young people aged 15–24 years.Design Systematic review.Methods We searched for studies published in any language between January 2006 and September 2016 on PsychINFO, Ovid MEDLINE, Eric, Web of Science (Arts and Humanities Citation Index, Social Science and Science Citation Index), Scopus, PILOTS, CINAHL, SPORTDiscus and International Index to Performing Arts. Additionally, we searched for unpublished (grey) literature via an online call for evidence, expert contribution, searches of key organisation websites and the British Library EThOS database, and a keyword Google search. Published studies of sport or dance interventions for healthy young people aged 15–24 years where subjective well-being was measured were included. Studies were excluded if participants were paid professionals or elite athletes, or if the intervention was clinical sport/dance therapy. Two researchers extracted data and assessed strength and quality of evidence using criteria in the What Works Centre for Wellbeing methods guide and GRADE, and using standardised reporting forms. Due to clinical heterogeneity between studies, meta-analysis was not appropriate. Grey literature in the form of final evaluation reports on empirical data relating to sport or dance interventions were included.results Eleven out of 6587 articles were included (7 randomised controlled trials and 1 cohort study, and 3 unpublished grey evaluation reports). Published literature suggests meditative physical activity (yoga and Baduanjin Qigong) and group-based or peer-supported sport and dance has some potential to improve subjective well-being. Grey literature suggests sport and dance improve subjective well-being but identify negative feelings of competency and capability. The amount and quality of published evidence on sport and dance interventions to enhance subjective well-being is low.Conclusions Meditative activities, group and peer-supported sport and dance may promote subjective well-being enhancement in youth. Evidence is limited. Better designed studies are needed.trial registration number CRD42016048745; Results.
IntrODuCtIOnGovernments and international organisa-tions acknowledge subjective well-being (SWB) as a policy goal.1–3 The international focus on measuring SWB is gaining recogni-tion in some aspects of UK sport,4 5 dance6 and physical activity policy.7 SWB describes well-being in terms of the good and bad feel-ings arising from what people do and how they think.8 Good feelings include happi-ness, joy, contentment and excitement while sadness, worry, stress and anxiety are exam-ples of more negative feelings. People’s experiences also involve a sense of purpose (eg, worthwhileness, meaningfulness) and pointlessness (eg, futility, boredom). Since 2011, SWB measured as satisfaction with life, worthwhileness, happiness and anxiety has been included in UK population surveys conducted by the Office of National Statistics.9 Links between sports and cultural activities
strengths and limitations of this study
► Prepublication of our protocol on the International Prospective Register of Systematic Reviews ensures methodological transparency and mitigates against potential post hoc decision making.
► A comprehensive research, policy and practice-rele-vant search strategy was used including searches of published and unpublished data, and study selection was carried out by two reviewers independently.
► Data extraction and quality assessments were con-ducted using standardised forms, independently by two reviewers.
► The focus on a specific target age group may have excluded evidence from studies that have aggregat-ed data across younger and older age groups in their analysis.
► Meta-analysis was not possible due to the heteroge-neity of study interventions and outcomes.
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and SWB have been reported and sport engagement is included in national-level data collection and analysis.10 Significant associations have been found between engage-ment in sport, the arts and enhanced SWB as measured by life satisfaction.11 Yet, it is acknowledged that SWB is a complex concept, with no single agreed definition or measure.12 The term SWB is used synonymously with a wide range of concepts including self-esteem, self-effi-cacy, self-determination, resilience, quality of life, mood enhancement, positive mental health, life satisfaction, worthwhileness and happiness.13 Measures of SWB use various scales that demonstrate well-being as multidimen-sional, for example, The Warwick and Edinburgh Mental Wellbeing Scale,14 Rosenberg’s Self-Esteem Scale and15 The Profile of Mood States.16
The What Works Centre for Well-being initiative,17 funded by the Economic and Social Research Council has commissioned evidence reviews in key areas including Culture, Sport and Well-being. Following consultation with stakeholders,18 four topics were identified for system-atic review between 2015 and 2018 (music and singing, sport and dance, visual arts, and outdoor nature-based physical activity). This paper reports the findings of the second systematic review topic; sport and dance interven-tions for healthy young people (15–24 years) to promote subjective well-being.
The established definition of sport, used throughout the sector, remains that cited from the European Charter (1992) and refers to forms of physical activity either casually or formally organised in which people take part for fitness, health and well-being, social relationships or competition.19 Sport includes a wide range of indi-vidual and group activities including jogging, running, cycling, martial arts, yoga, team games and athletics. Dance is commonly defined differently from sport as a performing art form which refers to the rhythmic move-ments and sequences of steps usually set to music.20 Sport and dance programmes in the UK operate in different delivery, programming and funding environments, yet both sport and dance organisations identify young people as a key target group for engagement in physical activity to enhance well-being. The evidence, however, is theoret-ically and methodologically diverse and less attention has been given to children and adolescents. Existing evidence reviews on sport have tended to focus on physical rather than mental health or well-being outcomes21–23 or they have examined the effect of exercise in populations with specific mental health conditions such as depression24 and anxiety.25 26 Dance-related reviews of evidence have examined the effectiveness of dance therapy on psycho-logical and physical health and well-being outcomes in patients with cancer,27 for schizophrenia28 and on depression.29 A review of reviews on physical activity and mental health in children and adolescents identified an association between physical activity and positive well-being outcomes connected to reduced depression and anxiety, and enhanced self-esteem and cognitive func-tion.30 No systematic review to date has focused on sport
and dance interventions in healthy young people (15–24 years) to promote subjective well-being. Interventions that positively influence the well-being of young people have the potential to promote good physical and mental health.31–33 This review provides evidence that may improve understanding of the effects of sport and dance on a range of SWB measures and contribute to informing policy development, programme delivery and measure-ment and evaluation of sport and dance interventions to enhance well-being.
MethODsThe protocol for this systematic review was registered with the International Prospective Register of System-atic Reviews on 3 October 2016 (registration number CRD42016048745). The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Anal-ysis guidelines.34
Patient and public involvementParticipant observation by one investigator (LM) of public groups taking part in community arts and sports activities contributed to the development of the review question for this study. Patients were not involved in the conduct of the systematic review. The findings of this study will be written in accessible English and disseminated through the What Works Centre for Wellbeing website accessible by the public.
Inclusion criteriaInclusion criteria were any comparative studies investi-gating any form of sport or dance compared with no sport or dance, usual routine or comparing pretest and post-test scores in healthy young people aged 15–24 years and measuring any form of subjective well-being (table 1). We included studies worldwide from countries economically similar to the UK (using OECD–DAC list of country devel-opment; http://www. oecd. org/ dac/ stats/ daclist. htm) or with study populations similar in terms of socioeconomic status. Studies could be fully published with search dates of 2006–2016 to reflect current and long-term work on sport, dance and well-being,or grey literature (with search dates of 2013–2016). Shorter timescales for grey literature search ensured a focus on finding recent rele-vant studies that had not yet been published. Grey liter-ature was included if it was a final evaluation or report on empirical data, had the evaluation of sport-related or dance interventions as the central objective and included details of authors (individuals, groups or organisations).
exclusion criteriaPublished studies were excluded if participants were paid professionals or elite athletes, or if the intervention was sport or dance therapy delivered in a clinical setting for rehabilitation purposes. We did not include studies of walking as there is existing review level evidence on the health and well-being benefits of this activity.35 36 Grey
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literature was excluded if it did not meet the criteria for inclusion on date, format of reporting, type of data and details of authorship. Eligibility criteria are summarised in table 1.
Data sources and search strategyWe searched for empirical studies published between January 2006 and September 2016 on the following data-bases: PsychINFO, Ovid MEDLINE, Eric, Web of Science (Arts and Humanities Citation Index, Social Science and Science Citation Index), Scopus, PILOTS, CINAHL, SPORTDiscus and International Index to Performing Arts. There were no language restrictions.
Electronic databases were searched using a combina-tion of Medical Subject Headings (MeSH) and free text terms. An example of the Ovid MEDLINE search strategy used can be found in online supplementary appendix 1. All database searches were based on this strategy but were appropriately revised to suit each database.
Additionally, reference lists of all relevant reviews37–42 from the last 5 years were hand-searched to identify addi-tional relevant empirical evidence. We also carried out a search for up-to-date UK unpublished (grey) literature completed between 2013 and 2016 via: (i) an online call for evidence on the What Works Centre for Wellbeing
website between October and November 2016; (ii) contacting known experts in the field for recommenda-tions of sport or dance sector reviews or repositories to search; (iii) a review of key sector websites; (iv) a search of the British Library EThOS website for unpublished PhD dissertations and (v) reviewing the titles of the first 100 results in a Google search with the use of key terms (‘sport’ AND ‘physical activity’ AND ‘dance’ AND ‘wellbeing’ AND ‘young people’). ‘Physical activity’ was included as a search term because it is used by the sector when reporting on sport and dance activities.
study selectionTwo reviewers independently screened the titles and abstracts of all studies identified by the search strategy for their eligibility. Where it was not clear from the title and abstract whether a study was relevant, the selection criteria were independently applied to the full article to confirm its eligibility. Where two independent reviewers did not agree in their primary judgements they discussed the conflict and attempted to reach a consensus. If they could not agree then a third member of the review team considered the full paper and a majority decision was made. Online supplementary appendix 2 lists excluded studies and reasons for exclusions.
Table 1 Eligibility criteria for selecting studies
PICOS criteria Inclusion Exclusion
Participants ► Participants were to be 15–24 years of age. ► Studies from countries economically similar to the UK (ie, other high-income countries with similar economic systems) or with study populations that have similar socioeconomic status to the UK.
► Participants with a health condition diagnosed by a health professional.
► Participants who were paid professionals or elite athletes.
► Participants in clinically based sport and dance interventions.
Intervention ► Participatory sport and dance interventions including watching and performing.
► Including sport-related and dance therapy offered to enhance well-being in healthy young people.
► Clinical sport-based or dance therapy.
► Sport and dance for clinical procedures such as surgery, medical tests and diagnostics.
► Walking.
Comparison ► No sport or dance, usual routine, ie, inactive comparator or historical/time-based comparator, ie, pre-post study design.
Outcomes ► Subjective well-being using any recognised method or measure.
Study design ► Empirical research: either quantitative, qualitative or mixed methods, outcomes or process evaluations.
► Grey literature: if it was a final evaluation or report on empirical data, had the evaluation of sport-related or dance interventions as the central objective and included details of authors (individuals, groups or organisations).
► Published studies published between 2006 and 2016.
► Grey literature and practice surveys published between 2013 and 2016.
► Discussion articles, commentaries or opinion pieces not presenting empirical or theoretical research.
► Grey literature if it did not have details of authorship.
PCOS, Population Intervention Comparator Outcome Study Design.
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Data extractionTwo review authors independently extracted data using a standardised form (online supplementary appendix 3). Discrepancies were resolved by discussion and consensus. Where agreement could not be reached, a third review author considered the paper and a majority decision was reached. The following data were extracted: (1) evaluation design and objectives (the interventions studied and control conditions used, including detail where available on the intervention content, dose and adherence, ethics); (2) sample (size, representativeness, reporting on dropout, attrition and details of participants including demographics and protected characteristics where reported); (3) the outcome measures (the scales used and the collection time-points, independence, validity, reliability, appropriateness to well-being impact questions); (4) analysis (assessment of methodological quality/limitations); (5) results and conclusions; (6) the presence of possible conflicts of interest for authors. In order to capture project details in the grey literature, we used an adapted version of the Public Health England Arts and Health Evaluation Framework43 and extracted project aims; costs; commissioners, partners and funding sources; intervention details; population and reported outcomes. Where available, evaluation details (aims, objectives, budget, procedures, timeline, data analysis and findings) were also extracted.
Our protocol included for us to contact the authors of articles if the required information could not be extracted and was essential for the interpretation of their results but we did not need to do this.
Quality assessmentTo assess the methodological quality of the included published studies, two review authors independently applied the quality checklist for quantitative studies based on the Early Intervention Foundation checklist and detailed in the What Works Centre for Wellbeing methods guide44 (online supplementary appendix 4). The checklist was used to indicate if a specific study had been well designed, appropriately carried out and prop-erly analysed. A summary of quality scores is presented in table 2.
We then employed the Grading of Recommendations Assessment, Development and Evaluation working group methodology (GRADE) schema for judging strength and quality of evidence on well-being overall from sport and dance interventions. Four categories of evidence are used in GRADE; high, moderate, low or very low. Applying GRADE, randomised controlled trial (RCT) studies were initially judged as high quality and sound observational studies as low quality. Evidence was downgraded for methodological limitations, inconsistent findings, sparse data, indirect evidence and reporting bias. Evidence was graded upwards if there was a large magnitude of effect or a dose-response gradient. The PHE Arts for Health and Wellbeing Evaluation Framework43 was used to judge the quality of the grey literature in terms of the
appropriateness of the evaluation design, the rigour of the data collection and analysis and precision of reporting.
Data synthesisDue to heterogeneity of interventions and well-being outcomes between studies, a meta-analysis was not appro-priate. We report the findings narratively. Summaries of the characteristics of the included studies were organ-ised in a tabular form (table 3) and present informa-tion on the participants (number and characteristics), intervention and comparison conditions, outcomes and measure used, study design, conclusions and study limita-tions. Summaries of the results (number of participants, mean scores and SD) for each outcome measure at each measurement point, are presented in table 4 and synthe-sised in the text according to sport/dance intervention type and well-being outcomes. No studies reported CIs and so these have not been included.
resultssearch resultsAfter the removal of duplicates, the electronic searches returned 5597 records for title and abstract screening. Of these, 143 relevant articles remained for full-text assess-ment as well as 60 additional texts identified through other sources (6 through hand searching the reference lists of included reviews and 54 grey literature submissions were found: 12 received through the call for evidence, 33 via the extended search for grey literature and 9 PhDs found on Ethos). After screening the 203 full texts, 11 studies were included in the systematic review. The search screening process is illustrated in figure 1.
study characteristicsThe systematic review includes seven RCTs45–51 (with a total of 884 participants) and one cohort study52 (93 participants) from the published literature. Three eval-uation reports were included from the grey literature. A summary of the characteristics of the included papers is presented in table 3. Table 4 provides a summary of the numerical results for each published study.
The included studies investigated the effects of a range of sport and dance interventions; the most common form of intervention reported were based on meditative prac-tices including yoga46 50 and Baduanjin Qigong.48 Other interventions reported included body conditioning, aerobic exercise,47 dance forms delivered through dance training,45 hip-hop dance,47 an empowerment-based exercise intervention programme49 and specifically identified sports including, body conditioning, and ice skating47 and Nintendo Wii Active Games.51 Descriptions of interventions tended to be brief. All studies identi-fied the frequency and type of intervention activity, the duration and content of activity sessions, the delivery site and the number of times per week participants took part. All differed in these characteristics as detailed in table 3. Interventions in six of the RCT studies45–51 and
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Tab
le 2
Q
ualit
y ch
eckl
ist
scor
es o
f inc
lud
ed p
ublis
hed
stu
die
s: W
hat
Wor
ks C
entr
e fo
r W
ellb
eing
che
cklis
t
Aut
hors
Eva
luat
ion
des
ign
Sam
ple
Par
tici
pan
ts
com
ple
ted
th
e sa
me
set
of
mea
sure
s b
efo
re a
nd a
fter
in
terv
enti
on
Ap
pro
pri
ate
rand
om
as
sig
nmen
t to
tre
atm
ent
and
co
ntro
l co
ndit
ions
Gro
up a
ssig
nmen
t w
as a
t th
e ap
pro
pri
ate
leve
l (e
g, i
ndiv
idua
l, co
mm
unit
y)
An
inte
nt-t
o-
trea
t d
esig
n w
as u
sed
The
tre
atm
ent
and
co
mp
aris
on
cond
itio
ns a
re
tho
roug
hly
des
crib
ed
The
ext
ent
to w
hich
th
e in
terv
enti
on
was
del
iver
ed w
ith
fid
elit
y is
cle
ar
Ap
pro
pri
ate
com
par
iso
n co
ndit
ion
The
sam
ple
is
rep
rese
ntat
ive
of
the
targ
et p
op
ulat
ion
and
cha
ract
eris
tics
st
ated
The
sam
ple
is
suffi
cien
tly
larg
e to
te
st f
or
the
des
ired
im
pac
t (m
in 2
0 p
er
gro
up)
The
re is
a c
lear
p
roce
ss f
or
det
erm
inin
g a
nd
rep
ort
ing
dro
p-o
ut
and
do
se
Ove
rall
stud
y at
trit
ion
no h
ighe
r th
an 6
5%
Aka
nder
e an
d
Dem
ir45
xx
xx
xx
xx
Am
oros
e et
al5
2x
xx
Kan
ojia
et
al46
xx
xx
xx
x
Kim
and
Kim
47x
xx
xx
xx
Li e
t al
48x
xx
xx
xx
xx
xx
Lind
gren
et
al49
xx
xx
xx
xx
Nog
gle
et a
l50
xx
xx
xx
xx
Sta
iano
et
al51
xx
xx
xx
xx
x
Aut
hors
Sam
ple
Ana
lysi
s
Tota
l sc
ore
: st
udy
Bas
elin
e eq
uiva
lenc
e b
etw
een
trea
tmen
t an
d
com
par
iso
n g
roup
s
Co
nfo
und
ing
fa
cto
rs
cont
rolle
d f
or
Par
tici
pan
ts
blin
ded
to
gro
up
assi
gnm
ent
Co
nsis
tent
an
d e
qui
vale
nt
mea
sure
men
t
Cle
ar
pro
cess
es f
or
det
erm
inin
g
and
rep
ort
ing
d
rop
-out
and
d
ose
Ass
esse
d a
nd
rep
ort
ed o
n o
vera
ll an
d
diff
eren
tial
at
trit
ion
Ap
pro
pri
ate
mea
sure
s w
ere
used
Mea
sure
s us
ed w
ere
valid
and
re
liab
le
Mea
sure
men
t in
dep
end
ent
of
trea
tmen
t m
easu
res
Mea
sure
men
t w
as b
lind
to
gro
up
assi
gnm
ent
Incl
uded
ass
essm
ent
info
rmat
ion
ind
epen
den
t o
f th
e p
arti
cip
ants
fo
r ex
amp
le, i
ndep
end
ent
ob
serv
er
Ap
pro
pri
ate
met
hod
s us
ed t
o
anal
yse
resu
lts
Ap
pro
pri
ate
met
hod
s us
ed f
or
the
trea
tmen
t o
f m
issi
ng d
ata
Aka
nder
e an
d
Dem
ir45
xx
xx
xx
xx
x17
Am
oros
e et
al5
2x
xx
xx
x9
Kan
ojia
et
al46
xx
xx
xx
13
Kim
and
Kim
47x
xx
xx
x13
Li e
t al
48x
xx
xx
xx
xx
x21
Lind
gren
et
al49
xx
xx
xx
xx
xx
x19
Nog
gle
et a
l50
xx
xx
xx
x15
Sta
iano
et
al51
xx
xx
xx
x16
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Tab
le 3
C
hara
cter
istic
s of
incl
uded
stu
die
s
Pub
lishe
d li
tera
ture
Aut
hors
Cou
ntr
yN
umb
ers
of
par
tici
pan
tsP
arti
cip
ant
des
crip
tio
nIn
terv
enti
on/
com
par
iso
nW
ell-
bei
ng o
utco
mes
and
mea
sure
s us
edM
easu
rem
ent
tim
esS
tud
y d
esig
nLi
mit
atio
ns (r
isk
of
bia
s)
Aka
nder
e an
d
Dem
ir45
Turk
ey
n=12
0G
end
er: 5
0% fe
mal
eA
ge: 2
0–24
yea
rsE
thni
city
: NR
Dan
ce t
rain
ing
inte
rven
tion
90+
20 m
in w
arm
-up
and
coo
l dow
n 3x
w
eek
for
12 w
eeks
Com
par
ison
: no
inte
rven
tion
1.
Dep
ress
ion
(Bec
k D
epre
ssio
n S
cale
)B
efor
e an
d a
fter
12
wee
k d
ance
inte
rven
tion
RC
T
►O
nly
one
mea
sure
use
d
►S
mal
l pop
ulat
ion
►
Sam
ple
alre
ady
had
dan
ce k
now
led
ge
►P
artic
ipan
t d
etai
ls n
ot c
lear
ly r
epor
ted
►
Bas
elin
e le
vels
of d
epre
ssio
n d
iffer
in
grou
ps
Am
oros
e et
al5
2
US
An=
93G
end
er: f
emal
eA
ge: 1
3–18
yea
rs
(M=
15.7
8 ye
ars)
Eth
nici
ty: m
ostly
Cau
casi
an
(90.
6%)
AI:
mem
ber
s of
a c
omp
etiti
ve
club
vol
leyb
all p
rogr
amm
e in
M
idw
este
rn U
nite
d S
tate
s
Follo
wed
a c
ohor
t of
fem
ale
adol
esce
nt
volle
ybal
l pla
yers
thr
ough
a s
easo
n of
com
pet
itive
vol
leyb
all g
ames
. A
pp
roxi
mat
ely
4 m
onth
sC
omp
aris
on: t
ime
(bef
ore
vs a
fter
)
1.
Nee
d s
atis
fact
ion
–S
por
t co
mp
eten
ce (5
-ite
m s
ubsc
ale
of
the
Intr
insi
c M
otiv
atio
n In
vent
ory)
–N
eed
for
auto
nom
y (6
-ite
m s
cale
: H
olle
mb
eak
and
Am
oros
e 20
05)
–N
eed
for
rela
ted
enes
s (1
0-ite
m
Ric
her
and
Val
lera
nd’s
Fee
lings
of
Rel
ated
enes
s S
cale
)2.
W
ell-
bei
ng –
Sel
f-es
teem
(10-
item
Ros
enb
erg’
s S
elf-
Est
eem
Sca
le)
–B
urno
ut (1
5-ite
m A
thle
te B
urno
ut
Que
stio
nnai
re)
1–2
wee
ks b
efor
e co
mp
etiti
ve s
easo
n st
arts
an
d p
osts
easo
n (1
–2 w
eeks
bef
ore
the
last
of
ficia
l gam
e/~
4 m
aft
er s
tart
of s
easo
n)
Coh
ort
►
Sam
ple
bia
s: o
ne c
lub
in W
este
rn U
SA
, one
sp
ort.
All
fem
ales
. Mos
tly C
auca
sian
–S
elec
tion
bia
s: o
nly
thos
e th
at a
gree
d t
o vo
lunt
eer.
Dro
pou
t no
t re
por
ted
►
Stu
dy
des
ign:
no
cont
rol g
roup
. Onl
y 2
time
poi
nts
look
ed a
tDid
not
ass
ess
soci
al
cont
extu
al fa
ctor
s, e
g, c
oach
ing
beh
avio
ur
Kan
ojia
et
al46
Ind
ian=
50G
end
er: f
emal
eA
ge: 1
8–20
yea
rsE
thni
city
: NR
AI:
stud
y co
nduc
ted
in t
he
Dep
artm
ent
of P
hysi
olog
y,
Lad
y H
ard
inge
Med
ical
C
olle
ge a
nd S
mt.
Suc
heta
K
ripla
ni H
osp
ital,
New
Del
hi,
Ind
ia
Yoga
35–4
0 m
in 6
x w
eek
for
the
dur
atio
n of
th
ree
men
stru
al c
ycle
sC
omp
aris
on: n
o in
terv
entio
n
1.
Ang
er (1
6-ite
m q
uest
ionn
aire
)Tra
it an
xiet
y (4
0-ite
m q
uest
ionn
aire
)2.
D
epre
ssio
n (1
0-ite
m q
uest
ionn
aire
)3.
S
ubje
ctiv
e w
ell-
bei
ng (5
0-ite
m
que
stio
nnai
r e)
Que
stio
nnai
res
wer
e d
evel
oped
by
the
Def
ense
In
stitu
te o
f Phy
siol
ogy
and
Alli
ed S
cien
ces
At
the
beg
inni
ng a
nd a
fter
com
ple
tion
of t
hree
m
enst
rual
cyc
les
RC
T
►D
rop
out
not
rep
orte
d
►R
ecru
itmen
t m
etho
ds
not
rep
orte
d
►N
ot p
ossi
ble
to
dou
ble
blin
d
►C
onsi
sten
t fin
din
gs
Kim
and
Kim
47
Kor
ean=
277
Gen
der
: 48%
fem
ale
Age
: 17–
22 y
ears
(M=
20.6
ye
ars)
Eth
nici
ty: N
RA
I: K
orea
n hi
gh s
choo
l (n=
45)
and
und
ergr
adua
te s
tud
ents
(n
=23
2) v
olun
teer
s
One
of f
our
exer
cise
ses
sion
s: a
erob
ic
exer
cise
, bod
y co
nditi
onin
g, h
ip-h
op
dan
cing
and
ice
skat
ing
One
-off
40
min
ses
sion
+10
min
war
m-u
p
and
coo
l dow
n
1.
Moo
d (S
ubje
ctiv
e E
xer c
ise
Exp
erie
nces
S
cale
: mea
surin
g th
ree
dim
ensi
ons;
p
ositi
ve w
ell-
bei
ng, p
sych
olog
ical
dis
tres
s an
d fa
tigue
)B
efor
e an
d a
fter
the
exe
rcis
e se
ssio
n
RC
T
►D
ata
bas
ed o
n on
e se
ssio
n on
ly
Li e
t al
48
Chi
nan=
222
Gen
der
: 82.
5% fe
mal
eA
ge: 1
8–25
yea
rs (M
=20
.78
year
s)E
thni
city
: NR
AI:
colle
ge s
tud
ents
rec
ruite
d
from
col
lege
in C
hina
Bad
uanj
in e
xerc
ise
1 ho
ur 5
x w
eek
for
12 w
eeks
Com
par
ison
: usu
al e
xerc
ise
1.
Sel
f-es
teem
(Sel
f-es
teem
Sca
le (S
ES
))2.
M
ood
/min
dfu
lnes
s (P
rofil
e of
Moo
d S
tate
s (P
OM
S) s
cale
)3.
Q
oL (W
HO
QO
L-B
RE
F)4.
S
tres
s (C
hine
se P
erce
ived
Str
ess
Sca
le)
5.
Sel
f-sy
mp
tom
inte
nsity
(SC
L-90
sca
le)
Bas
elin
e (b
efor
e st
art),
at
the
end
of t
he
inte
rven
tion
(wee
k 13
), 12
-wee
k fo
llow
-up
(w
eek
25)
RC
T
►N
ot b
lind
ed
►P
artic
ipan
ts r
ecru
ited
from
one
med
ical
un
iver
sity
►
Gre
ater
pro
por
tion
of fe
mal
e p
artic
ipan
ts
►S
mal
l effe
ct s
ize
►
Exc
elle
nt p
roto
col a
dhe
renc
e
►N
o si
gnifi
cant
loss
to
follo
w-u
p
Con
tinue
d
on 6 August 2018 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2017-020959 on 15 July 2018. D
ownloaded from
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-
7Mansfield L, et al. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
Open access
Pub
lishe
d li
tera
ture
Aut
hors
Cou
ntr
yN
umb
ers
of
par
tici
pan
tsP
arti
cip
ant
des
crip
tio
nIn
terv
enti
on/
com
par
iso
nW
ell-
bei
ng o
utco
mes
and
mea
sure
s us
edM
easu
rem
ent
tim
esS
tud
y d
esig
nLi
mit
atio
ns (r
isk
of
bia
s)
Lind
gren
et
al49
Sw
eden
n=11
0G
end
er: f
emal
eA
ge: 1
3–19
yea
rs
(ave
rage
=15
.3)
Eth
nici
ty: N
RA
I: p
hysi
cally
inac
tive
stud
ents
from
sec
ond
ary
scho
ols
in lo
w s
ocio
econ
omic
st
atus
are
as
Em
pow
erm
ent-
bas
ed e
xerc
ise
inte
rven
tion
pro
gram
me
45 m
in m
oder
ate
exer
cise
+15
min
d
iscu
ssio
n (to
pic
s su
ch a
s he
alth
y lif
esty
les
wer
e ad
dre
ssed
) 2x
wee
k fo
r 6
mon
ths
Com
par
ison
: wai
ting
list
1.
Sel
f-ef
ficac
y (S
wed
ish
vers
ion
of a
10-
item
G
ener
al S
elf-
effic
acy
Sca
le)
2.
Beh
avio
ur c
hang
es (S
ocia
l Bar
riers
to
Exe
rcis
e S
elf-
effic
acy
Que
stio
nnai
re)
Onc
e at
the
sta
rt o
f the
pro
gram
me
and
onc
e at
end
(6 m
onth
s)
RC
T
►S
mal
l sam
ple
siz
e
►H
igh
dro
pou
t ra
te
Nog
gle
et a
l50
US
An=
51G
end
er: 6
1% fe
mal
e in
Yog
a gr
oup
, 47%
fem
ale
in c
ontr
olA
ge: a
vera
ge a
ge 1
7 ye
ars
(gra
des
11
and
12)
Eth
nici
ty: 9
2.2%
whi
te, 3
.5%
H
isp
anic
, 2.1
% A
fric
an-
Am
eric
an, 1
.4%
mul
tirac
e an
d 0
.8%
Asi
anA
I: st
uden
ts a
t a
pub
lic
high
sch
ool i
n ru
ral w
este
rn
Mas
sach
uset
ts.
A K
ripal
u-b
ased
yog
a p
rogr
amm
e of
p
hysi
cal p
ostu
res,
bre
athi
ng e
xerc
ises
, re
laxa
tion
and
med
itatio
n30
min
2–3
x w
eek
for
10 w
eeks
(28
yoga
se
ssio
ns t
otal
)C
omp
aris
on: p
hysi
cal e
duc
atio
n as
us
ual
30–4
0 m
in 2
–3x
wee
k fo
r 10
wee
ks
1.
Moo
d (P
OM
S-S
hort
For
m)
2.
Affe
ct (P
ositi
ve a
nd N
egat
ive
Affe
ct
Sch
edul
e fo
r C
hild
ren)
3.
Str
ess
(Per
ceiv
ed S
tres
s S
cale
)4.
P
ositi
ve p
sych
olog
y (In
vent
ory
of P
ositi
ve
Psy
chol
ogic
al A
ttitu
des
)5.
R
esili
ence
(Res
ilien
ce S
cale
)6.
A
nger
(Sta
te T
rait
Ang
er E
xpre
ssio
n In
vent
ory-
2TM
)7.
M
ind
fuln
ess
(Chi
ld A
ccep
tanc
e M
ind
fuln
ess
Mea
sure
)O
ne w
eek
bef
ore
and
aft
er
RC
T
►S
mal
l sam
ple
siz
e.
►W
ould
hav
e b
een
idea
l to
rand
omis
e in
div
idua
lly b
ut b
eing
in a
sch
ool s
ettin
g re
qui
red
allo
catio
n at
the
cla
ssro
om le
vel
►
Mod
erat
e at
tend
ance
at
the
yoga
cla
sses
Sta
iano
et
al51
US
An=
54G
end
er: 5
5.6%
fem
ale
Age
: 15–
19 y
ears
Eth
nici
ty: A
fric
an-A
mer
ican
AI:
over
wei
ght
and
ob
ese
stud
ents
from
an
urb
an p
ublic
hi
gh s
choo
l
Exe
rgam
e (E
G) i
nter
vent
ion—
stud
ents
en
cour
aged
to
pla
y th
e N
inte
ndo
Wii
Act
ive
gam
e. T
wo
EG
gro
ups:
co
oper
ativ
e E
G w
orke
d w
ith a
pee
r to
exp
end
cal
orie
s an
d e
arn
poi
nts
toge
ther
; com
pet
itive
EG
par
ticip
ants
co
mp
eted
aga
inst
a p
eer
30–6
0 m
in p
er s
choo
l day
in a
lunc
h-tim
e or
aft
er-s
choo
l pro
gram
me
for
20 w
eeks
Com
par
ison
: reg
ular
dai
ly a
ctiv
ities
1.
Sel
f-ef
ficac
y (E
xerc
ise
Con
fiden
ce S
urve
y)2.
S
elf-
este
em (R
osen
ber
g S
elf-
Est
eem
S
cale
)3.
P
eer
sup
por
t (F
riend
ship
Qua
lity
Que
stio
nnai
r e)
Bas
elin
e, T
2 (1
0 w
eeks
), T3
(20
wee
ks)
RC
T
►S
amp
le b
ias:
sm
all s
amp
le fr
om o
ne s
choo
l an
d s
ome
attr
ition
Gre
y lit
erat
ure
Aut
hors
Cou
ntr
yP
arti
cip
ant
des
crip
tio
nP
roje
ct/o
rgan
isat
ion
Typ
e o
f in
terv
enti
on
Eva
luat
ion
aim
s an
d o
bje
ctiv
esS
tud
y d
esig
nLi
mit
atio
ns
Pot
ter
and
Stu
bb
s55
UK
n=14
98 p
artic
ipat
ed in
in-s
choo
l w
orks
hop
sn=
2096
in t
he fi
nal s
harin
g ev
ents
Age
: 11–
13 y
ears
Par
ticip
ants
are
from
urb
an a
nd
rura
l are
as o
f dep
rivat
ion
Dan
ceQ
uest
—d
ance
in s
choo
l se
ttin
gs (i
nclu
din
g p
erfo
rmin
g an
d
wat
chin
g d
ance
suc
h as
bal
let,
co
ntem
por
ary,
hip
-hop
, jaz
z,
stre
et);
freq
uenc
y N
R
1.
Exa
min
e th
e p
roce
sses
, out
com
es a
nd
imp
acts
for
bot
h in
div
idua
ls a
nd o
rgan
isat
ions
p
artic
ipat
ing
in D
ance
Que
st 2
014/
2015
–M
easu
re t
he s
ucce
sses
of D
ance
Que
st
2014
/201
5 ag
ains
t th
e p
resc
ribed
aim
s an
d
obje
ctiv
es e
stab
lishe
d a
t th
e ou
tset
–In
vest
igat
e th
e lo
ng-t
erm
imp
acts
of
Dan
ceQ
uest
201
2/20
15 d
escr
ibed
and
p
rese
nted
thr
ough
rep
rese
ntat
ive
case
st
udie
s –
Dra
w o
ut a
ny g
ener
al le
sson
s fo
r ef
fect
ive
pra
ctic
es fo
r fu
ture
, sim
ilar
pro
ject
s d
eliv
ered
by
Chi
ldre
n &
the
Art
s
Qua
litat
ive—
inte
rvie
ws,
ob
serv
atio
ns a
nd p
hoto
grap
hs
thro
ugho
ut
►
Focu
s on
the
pos
itive
wel
l-b
eing
ou
tcom
es
►Fa
ce v
alue
rep
ortin
g us
ed
Tab
le 3
C
ontin
ued
Con
tinue
d
on 6 August 2018 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2017-020959 on 15 July 2018. D
ownloaded from
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-
8 Mansfield L, et al. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
Open access
in the cohort study52 involved delivery by qualified sport or dance instructors in formal group sessions. One RCT used the Nintendo Wii Active Games Programme incorpo-rating a cooperative or competitive peer-to-peer method of participation.51 A wide range of well-being measures were used and are summarised in online supplementary appendix 5.
Projects reported in the grey literature included the following interventions: martial arts, dance, gym-based exercise, exercise classes, swimming, netball, cycling and football,53 circus-based skills (eg, juggling, balancing, diabolo)54 and a range of dance forms.55 Interventions were led by instructors in group settings. Well-being was evaluated using descriptive statistics and/or thematic analysis from surveys, focus groups, interviews and struc-tured observations.
All of the included studies were carried out in countries categorised in the same group as the UK in the OECD Development Assistance Committee (DAC) categories apart from two (one took place in India,46 and the other was based in Korea47). The sample participants in these two studies were university students, whose educational status indicates their relatively high socioeconomic status, making them broadly comparable with the categorisation of the DAC group in which the UK is located.
study qualityThe scores for the included studies from the What Works Centre for Wellbeing quality checklist for quantitative data are presented in table 2. The most frequent meth-odological weaknesses within the studies (with four or fewer studies meeting the criteria) were the absence of an intent-to-treat design, not having a clear process for determining and reporting dropout and dose, not having an appropriate method for the treatment of missing data, not controlling for confounding factors, not being able to blind participants or measurements and not including assessment information independent of the participants. Common (all studies meeting the criteria) strengths included using appropriate measures, independent of treatment measures, giving measures before and after the intervention/control and using appropriate methods to analyse the data. The results of the quality checklist varied across studies, with Amorose et al52 52 scoring the worst (9 criteria met) and Li et al48 48 scoring the highest (21 criteria met).
The use of the GRADE schema for judging quality of evidence means that despite the predominance of RCT designs, overall the quality of the published evidence on sport and dance interventions to enhance well-being is low in respect of there being very little evidence in total, methodological limitations noted above, small sample sizes in studies and some sample bias.
Using the PHE Arts for Health and Wellbeing Evalu-ation Framework, the evidence from the grey literature were judged to have a high degree of credibility. The strongest reports included descriptive and theoretical detail about evaluation methods and acknowledged the G
rey
liter
atur
e
Aut
hors
Cou
ntr
yP
arti
cip
ant
des
crip
tio
nP
roje
ct/o
rgan
isat
ion
Typ
e o
f in
terv
enti
on
Eva
luat
ion
aim
s an
d o
bje
ctiv
esS
tud
y d
esig
nLi
mit
atio
ns
BO
P C
onsu
lting
54
UK
n=23
Age
: 8–2
1 ye
ars
Lond
on (U
K) B
orou
ghs
of
Tott
enha
m a
nd H
arin
gey
Jack
son
Lane
—m
ultia
rts
venu
e in
the
com
mun
ity (i
nclu
din
g co
ntem
por
ary
circ
us, c
omed
y,
dan
ce a
nd p
erfo
rman
ce);
wee
kly,
tim
e an
d le
ngth
NR
Ass
ess
the
imp
act
of t
he p
rogr
amm
e:1.
W
ho is
rea
ched
by
Jack
sons
Lan
e’s
pro
gram
mes
?2.
W
hat
was
par
ticip
ants
’ exp
erie
nce
of t
hem
?3.
W
hat
diff
eren
ce d
id p
artic
ipat
ing
mak
e?
Qua
litat
ive—
sem
i-st
ruct
ured
in
terv
iew
s w
ith p
artic
ipan
ts a
nd
volu
ntee
rs
►
Focu
s on
the
pos
itive
wel
l-b
eing
ou
tcom
es
►Fa
ce v
alue
rep
ortin
g us
ed
Man
sfiel
d e
t al
53
UK
Pop
ulat
ion
targ
et: i
nact
ive
peo
ple
in t
he L
ond
on B
orou
gh o
f H
ouns
low
Hea
lth a
nd S
por
t E
ngag
emen
t (H
AS
E) P
roje
ct—
spor
t in
co
mm
unity
set
tings
(inc
lud
ing
yoga
, pila
tes,
sw
imm
ing,
net
bal
l, fo
otb
all,
adap
ted
and
dis
abili
ty
spor
t); w
eekl
y 1
hour
ses
sion
s,
12-m
onth
del
iver
y p
hase
Con
duc
t a
long
itud
inal
pro
cess
eva
luat
ion
exam
inin
g th
e ke
y in
gred
ient
s of
suc
cess
ful H
AS
E
com
mun
ity p
rogr
amm
es a
nd id
entif
y ch
alle
nges
in
des
igni
ng, d
eliv
erin
g an
d e
valu
atin
g th
e H
AS
E
pro
ject
s
Qua
litat
ive—
focu
s gr
oup
s,
stru
ctur
ed o
bse
rvat
ions
, in-
dep
th in
terv
iew
met
hod
s
►
Att
emp
ted
to
sear
ch fo
r d
isco
nfirm
ing
case
s an
d c
onsi
der
th
e ne
gativ
e w
ell-
bei
ng im
pac
t of
sp
ort
par
ticip
atio
n
AI,
add
ition
al in
form
atio
n; n
, num
ber
of p
artic
ipan
ts; N
R, n
ot r
epor
ted
; M, m
ean;
RC
T, r
and
omis
ed c
ontr
olle
d t
rial.
Tab
le 3
C
ontin
ued
on 6 August 2018 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2017-020959 on 15 July 2018. D
ownloaded from
https://dx.doi.org/10.1136/bmjopen-2017-020959https://dx.doi.org/10.1136/bmjopen-2017-020959http://bmjopen.bmj.com/
-
9Mansfield L, et al. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
Open access
Tab
le 4
S
umm
ary
of n
umer
ical
res
ults
of i
nclu
ded
stu
die
s
Aut
hors
Out
com
e (m
easu
re)
Bas
elin
eFo
llow
-up
1Fo
llow
-up
2
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
l num
ber
sM
ean
(SD
)
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
lN
umb
ers
Mea
n (S
D)
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
lN
umb
ers
Mea
n (S
D)
Aka
nder
e an
d D
emir4
5D
epre
ssio
n(B
eck
Dep
ress
ion
Sca
le)
n=60
15.7
2 (7
.004
)n=
6016
.53
(5.9
22)
n=60
13.9
0 (5
.568
)*†
n=60
17.4
8 (7
.740
)N
/AN
/A
Am
oros
e et
al5
2N
eed
sat
isfa
ctio
n; s
por
t co
mp
eten
ce, n
eed
for
auto
nom
y, n
eed
for
rela
ted
enes
s
n=93
Sp
ort
com
pet
ence
: 5.7
1 (0
.84)
Nee
d fo
r au
tono
my:
3.7
9 (0
.79)
Nee
d fo
r re
late
dne
ss: 5
.47
(1.1
5)
n=93
Sp
ort
com
pet
ence
: 5.5
0 (1
.07)
Nee
d fo
r au
tono
my:
3.7
6 (0
.59)
Nee
d fo
r re
late
dne
ss: 5
.50
(1.2
1)
N/A
N/A
Sel
f-es
teem
(10-
item
R
osen
ber
g’s
Sel
f-es
teem
S
cale
)
n=93
3.21
(0.4
5)n=
933.
21 (0
.47)
Bur
nout
(15-
item
Ath
lete
B
urno
ut Q
uest
ionn
aire
)n=
932.
05 (0
.71)
n=93
2.15
(0.6
4)
Kan
ojia
et
al46
Ang
er (1
6-ite
m
que
stio
nnai
re)
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 8
.84
(4.0
1)P
rem
enst
rual
pha
se:
initi
al c
ycle
15.
0 (5
.92)
‡
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 9
.12
(4.4
1)P
rem
enst
rual
pha
se:
initi
al c
ycle
14.
32 (5
.24)
‡
n=N
RP
ostm
enst
rual
seco
nd c
ycle
7.7
6 (3
.53)
§P
rem
enst
rual
sec
ond
cy
cle
9.52
(4.7
0)§‡
n=N
RP
ostm
enst
rual
seco
nd c
ycle
9.0
4 (4
.33)
Pre
men
stru
al s
econ
d
cycl
e 14
.28
(4.8
9)‡
n=N
RP
ostm
enst
rual
third
cyc
le 7
.92
(4.2
9)P
rem
enst
rual
thi
rd c
ycle
8.
52 (4
.15)
§¶
n=N
RP
ostm
enst
rual
third
cyc
le 8
.96
(4.6
5)P
rem
enst
rual
thi
rd c
ycle
13
.12
(4.8
3)‡
Trai
t an
xiet
y (4
0-ite
m
que
stio
nnai
re)
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 4
0.64
(6.2
2)P
rem
enst
rual
pha
se:
initi
al c
ycle
46.
96 (5
.87)
‡
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 4
1.6
(5.4
9)P
rem
enst
rual
pha
se:
initi
al c
ycle
46.
76 (5
.33)
‡
n=N
RP
ostm
enst
rual
seco
nd c
ycle
39.
40 (6
.69)
Pre
men
stru
alse
cond
cyc
le 4
1.48
(5
.77)
§‡
n=N
RP
ostm
enst
rual
seco
nd c
ycle
40.
24 (6
.97)
Pre
men
stru
al s
econ
d
cycl
e 45
.80
(6.4
1)‡
n=N
RP
ostm
enst
rual
third
cyc
le 3
7.24
(9.1
4)§¶
Pre
men
stru
alth
ird c
ycle
40.
80 (5
.75)
§¶
n=N
RP
ostm
enst
rual
third
cyc
le 3
8.64
(12.
76)
Pre
men
stru
al t
hird
cyc
le
43.8
8 (7
.06)
Dep
ress
ion
(10-
item
que
stio
nnai
re)
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 6
.84
(3.1
0)P
rem
enst
rual
pha
se:
initi
al c
ycle
10.
72 (4
.19)
‡
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 6
.36
(4.1
3),
Pre
men
stru
al p
hase
: in
itial
cyc
le 9
.72
(3.8
9)‡
n=N
RP
ostm
enst
rual
seco
nd c
ycle
3.9
6 (2
.59)
§P
rem
enst
rual
seco
nd c
ycle
5.9
2 (3
.76)
§‡
n=N
RP
ostm
enst
rual
seco
nd c
ycle
6.2
4 (4
.98)
Pre
men
stru
al s
econ
d
cycl
e 9.
56 (3
.22)
‡
n=N
RP
ostm
enst
rual
third
cyc
le 3
.12
(2.7
1)§¶
Pre
men
stru
alth
ird c
ycle
4.7
6 (2
.82)
§¶‡
n=N
RP
ostm
enst
rual
third
cyc
le 6
.07
(2.8
1)P
rem
enst
rual
third
cyc
le 9
.36
(2.9
6)‡
Sub
ject
ive
wel
l-b
eing
(50-
item
que
stio
nnai
re)
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 4
1.72
(16.
05)
Pre
men
stru
al p
hase
: in
itial
cyc
le 5
3.92
(20.
35)‡
n=25
Pos
tmen
stru
al p
hase
: in
itial
cyc
le 4
5.6
(14.
05)
Pre
men
stru
al p
hase
: in
itial
cyc
le 5
1.04
(14.
89)
n=N
RP
ostm
enst
rual
seco
nd c
ycle
39.
64
(16.
07)§
Pre
men
stru
al s
econ
d
cycl
e 44
.48
(17.
87)§
‡
n=N
RP
ostm
enst
rual
seco
nd c
ycle
44.
68 (1
6.5)
Pre
men
stru
al s
econ
d
cycl
e 50
.40
(18.
67)
n=N
RP
ostm
enst
rual
third
cyc
le 3
7.20
(1
5.17
)§¶
Pre
men
stru
al t
hird
cyc
le
40.2
4 (1
6.22
)§¶
n=N
RP
ostm
enst
rual
third
cyc
le 4
3.96
(14.
01)
Pre
men
stru
al t
hird
cyc
le
49.7
6 (1
7.02
)‡ Con
tinue
d
on 6 August 2018 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2017-020959 on 15 July 2018. D
ownloaded from
http://bmjopen.bmj.com/
-
10 Mansfield L, et al. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
Open access
Aut
hors
Out
com
e (m
easu
re)
Bas
elin
eFo
llow
-up
1Fo
llow
-up
2
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
l num
ber
sM
ean
(SD
)
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
lN
umb
ers
Mea
n (S
D)
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
lN
umb
ers
Mea
n (S
D)
Kim
and
Kim
47P
ositi
ve w
ell-
bei
ng(S
ubje
ctiv
e E
xerc
ise
Exp
erie
nces
Sca
le)
Ice
skat
ing
(n=
84):
19 (3
.9)
Hip
-hop
dan
ce (n
=45
): 16
.3 (4
.2)
Bod
y co
nditi
onin
g (n
=64
): 15
.3 (2
.9)
Aer
obic
dan
ce (n
=84
): 16
.8 (4
.0)
Ice
skat
ing
(n=
84):
20.4
(3.4
)H
ip-h
op d
ance
(n=
45):
19.7
(3.4
)*B
ody
cond
ition
ing
(n=
64):
18 (2
.8)
Aer
obic
dan
ce (n
=84
): 19
.9 (3
.9)*
N/A
N
/A
Psy
chol
ogic
al d
istr
ess
(Sub
ject
ive
Exe
rcis
eE
xper
ienc
esS
cale
)
Ice
skat
ing:
8.3
(3.9
)H
ip-h
op d
ance
: 9.8
(4.6
)B
ody
cond
ition
ing:
10.
7 (4
.1)
Aer
obic
dan
ce: 9
.4 (4
.2)
Ice
skat
ing:
8.1
(3.9
)H
ip-h
op d
ance
: 7.3
(4.2
)*B
ody
cond
ition
ing:
9.6
(3.2
)A
erob
ic d
ance
: 6.7
(2.9
)*
N/A
N
/A
Fatig
ue(S
ubje
ctiv
eE
xerc
ise
Exp
erie
nces
Sca
le)
Ice
skat
ing:
10.
9 (5
.4)
Hip
-hop
dan
ce: 1
6.2
(4.4
)B
ody
cond
ition
ing:
15.
9 (4
.4)
Aer
obic
dan
ce: 1
4.4
(5.0
)
Ice
skat
ing:
13.
9 (5
.3)
Hip
-hop
dan
ce: 1
2.9
(4.7
)*B
ody
cond
ition
ing:
13.
9 (4
.1)
Aer
obic
dan
ce: 1
1.2
(4.3
)*
N/A
N
/A
Li e
t al
48S
elf-
este
em(S
elf-
este
em S
cale
)n=
101
31.1
7 (3
.69)
n=10
531
.41
(3.2
9)n=
96 (1
01 in
clud
ed in
ITT
anal
ysis
)31
.56
(3.3
0)
n=10
5 (1
05 in
clud
ed in
IT
T an
alys
is) 3
1.31
(3.2
7)n=
93 (I
TT a
naly
sis)
30.8
1 (3
.45)
n=10
1 (IT
T an
alys
is)
31.0
(3.7
1)
Moo
d/m
ind
fuln
ess
(Pro
file
of M
ood
Sta
tes
(PO
MS
) sca
le)
n=10
110
2.3
(16.
14)
n=10
510
3.5
(17.
34)
n=96
(101
incl
uded
in IT
T an
alys
is)
106
(15.
68)
n=10
5 (1
05 in
clud
ed in
IT
T an
alys
is) 1
07.4
(17.
95)
n=93
(ITT
ana
lysi
s)10
3.8
(16.
78)
n=10
1 (IT
T an
alys
is)
104.
6 (1
6.89
)
QoL
(WH
OQ
OL-
BR
EF)
n=10
155
.84
(6.6
5)n=
105
54.9
4 (6
.45)
n=96
(101
incl
uded
in IT
T an
alys
is)
55.0
9 (6
.93)
n=10
5 (1
05 in
clud
ed in
IT
T an
alys
is) 5
4.26
(7.0
2)n=
93 (I
TT a
naly
sis)
56.2
9 (7
.45)
n=10
1 (IT
T an
alys
is)
55.6
1 (7
.45)
Att
entio
n (S
chul
te G
rid)
n=10
121
3.9
(58.
84)
n=10
522
4.6
(47.
52)
n=96
(101
incl
uded
in IT
T an
alys
is)
192.
4 (4
7.14
)
n=10
5 (1
05 in
clud
ed in
IT
T an
alys
is)
210.
4 (5
4.15
)†
n=93
(ITT
ana
lysi
s)19
3.9
(54.
31)
n=10
1 (IT
T an
alys
is)
202.
8 (5
8.34
)
Str
ess
(Chi
nese
Per
ceiv
ed
Str
ess
Sca
le)
n=10
124
.22
(5.1
8)n=
105
23.9
1 (5
.50)
n=96
(101
incl
uded
in IT
T an
alys
is)
23.5
3 (5
.40)
n=10
5 (1
05 in
clud
ed in
IT
T an
alys
is)
22.6
0 (5
.43)
n=93
(ITT
ana
lysi
s)22
.72
(5.7
2)n=
101
(ITT
anal
ysis
)23
.22
(5.7
2)
Sel
f-sy
mp
tom
inte
nsity
(S
CL-
90 s
cale
)n=
101
142.
9 (3
3.58
)n=
105
142.
1 (3
2.77
)n=
96 (1
01 in
clud
ed in
ITT
anal
ysis
)13
5.6
(31.
3)
n=10
5 (1
05 in
clud
ed in
IT
T an
alys
is)
136.
2 (3
2.4)
n=93
(ITT
ana
lysi
s)13
0.6
(34.
83)
n=10
1 (IT
T an
alys
is)
130.
4 (3
1.94
)
Lind
gren
et
al49
Gen
eral
sel
f-ef
ficac
y (G
ener
al S
elf-
effic
acy
Sca
le)
n=55
Med
ian
(IQR
)32
.0 (1
1.0–
54.0
)
n=53
Med
ian
(IQR
)32
.0 (1
4.0–
47.0
)
n=27
Med
ian
(IQR
)28
.0 (1
5.0–
48.0
)*†
n=36
Med
ian
(IQR
)35
.0 (1
6.0–
48.0
0)
N/A
N
/A
Sp
ecifi
c se
lf-ef
ficac
y (S
ocia
l Bar
riers
to
Exe
rcis
e S
elf-
effic
acy
Que
stio
nnai
re)
n=56
Med
ian
(IQR
)S
upp
ort:
9.0
(3.0
–18.
0)S
ocia
l: 22
.0 (7
.0–3
5.0)
n=54
Med
ian
(IQR
)S
upp
ort:
8.0
(3.0
–16.
0)S
ocia
l: 18
.5 (7
.0–3
7.0)
n=27
Med
ian
(IQR
)S
upp
ort:
8.0
(3.0
–17.
0)S
ocia
l: 19
.0 (7
.0–3
6.0)
n=36
Med
ian
(IQR
)S
upp
ort:
7.0
(3.0
–18.
0)S
ocia
l: 19
.0 (8
.0–3
1.0)
Tab
le 4
C
ontin
ued
Con
tinue
d
on 6 August 2018 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2017-020959 on 15 July 2018. D
ownloaded from
http://bmjopen.bmj.com/
-
11Mansfield L, et al. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
Open access
Aut
hors
Out
com
e (m
easu
re)
Bas
elin
eFo
llow
-up
1Fo
llow
-up
2
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
l num
ber
sM
ean
(SD
)
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
lN
umb
ers
Mea
n (S
D)
Inte
rven
tio
nN
umb
ers
Mea
n (S
D)
Co
ntro
lN
umb
ers
Mea
n (S
D)
Nog
gle
et a
l50
Moo
d (P
OM
S-S
hort
Fo
rm)
n=36
Moo
d d
istu
rban
ce (−
): 42
.8 (1
9.3)
Tens
ion
anxi
ety
(−):
6.4
(4.7
)D
epre
ssio
n-d
ejec
tion
(−):
5.1
(5.0
)A
nger
hos
tility
(−):
6.5
(4.7
)V
igou
r ac
tivity
(+):
9.8
(4.4
)Fa
tigue
iner
tia (−
): 8.
3 (5
.7)
Con
fusi
on b
ewild
erm
ent
(−):
6.8
(3.5
)
n=15
Moo
d d
istu
rban
ce (−
): 44
.5 (1
0.2)
Tens
ion
anxi
ety
(−):
6.7
(2.8
)D
epre
ssio
n-d
ejec
tion
(−):
4.9
(3.0
)A
nger
hos
tility
(−):
6.3
(2.7
)V
igou
r ac
tivity
(+):
10.2
(3
.8)
Fatig
ue in
ertia
(−):9
.8 (4
.5)
Con
fusi
on b
ewild
erm
ent
(−):
6.6
(2.7
)
n=35
Moo
d d
istu
rban
ce (−
): 38
.4 (1
6.9)
# m
ediu
m-
larg
e ef
fect
siz
e=0.
689
(Coh
en’s
d)
Tens
ion
anxi
ety
(−):
5.1
(3.6
)#
Larg
e ef
fect
siz
e=0.
870
(Coh
en’s
d)
Dep
ress
ion-
dej
ectio
n (−
): 4.
7 (4
.9)
Ang
er h
ostil
ity (−
): 5.
7 (5
.0)
Vig
our
activ
ity (+
): 9.
3 (4
.0)
Fatig
ue in
ertia
(−):
7.2
(5.2
)C
onfu
sion
bew
ilder
men
t (−
): 6.
3 (3
.5)
n=15
Moo
d d
istu
rban
ce (−
): 51
.2 (2
0.1)
Tens
ion
anxi
ety
(−):
9.3
(5.8
)D
epre
ssio
n-d
ejec
tion
(−):
6.3
(4.2
)A
nger
hos
tility
(−):
7.1
(4.5
)V
igou
r ac
tivity
(+):
10.9
(3
.5)
Fatig
ue in
ertia
(−):
9.3
(4.6
)C
onfu
sion
bew
ilder
men
t (−
): 8.
3 (4
.1)
N/A
N
/A
Str
ess
(Per
ceiv
edS
tres
s S
cale
)n=
3619
.2 (7
.4)
n=15
19.1
(3.8
)n=
3518
.6 (6
.2)
n=15
20.3
(5.4
)N
/A
N/A
Pos
itive
psy
chol
ogy
(Inve
ntor
y of
Pos
itive
P
sych
olog
ical
Att
itud
es)
n=36
Pos
itive
psy
ch a
ttrib
utes
(+
): 4.
5 (1
.0)
Life
pur
pos
e/sa
tisfa
ctio
n (+
): 4.
7 (1
.0)
Sel
f-co
nfid
ence
dur
ing
stre
ss (+
): 4.
2 (1
.0)
n=15
Pos
itive
psy
ch a
ttrib
utes
(+
): 4.
5 (0
.78)
Life
pur
pos
e/sa
tisfa
ctio
n (+
): 4.
8 (0
.94)
Sel
f-co
nfid
ence
dur
ing
stre
ss (+
): 4.
2 (0
.67)
n=35
Pos
itive
psy
ch a
ttrib
utes
(+
): 4.
5 (1
.2)
Life
pur
pos
e/sa
tisfa
ctio
n (+
): 4.
8 (1
.1)
Sel
f-co
nfid
ence
dur
ing
stre
ss (+
): 4.
3 (0
.98)
n=15
Pos
itive
psy
ch a
ttrib
utes
(+
): 4.
2 (0
.88)
Life
pur
pos
e/sa
tisfa
ctio
n (+
): 4.
6 (0
.88)
Sel
f-co
nfid
ence
dur
ing
stre
ss (+
): 4.
0 (0
.90)
N/A
N
/A
Res
ilien
ce (R
esili
ence
Sca
le)
n=36
132.
9 (1
8.4)
n=15
132.
1 (1
2.4)
n=35
131.
9 (2
4.5)
n=15
127.
9 (2
3.4)
N/A
N
/A
Affe
ct (P
ositi
ve a
ndN
egat
ive
Affe
ctS
ched
ule
for
Chi
ldre
n)
n=36
Pos
itive
affe
ct (+
): 50
.1
(11.
5)N
egat
ive
affe
ct (−
):32
.1 (1
2.5)
n=15
Pos
itive
affe
ct (+
): 47
.7
(9.4
)N
egat
ive
affe
ct (−
):28
.8 (7
.7)
n=35
Pos
itive
affe
ct (+
): 48
.6
(11.
7)N
egat
ive
affe
ct (−
):29
.4 (1
1.5)
#
Med
ium
-lar
ge e
ffect
si
ze=
0.65
9 (C
ohen
’s d
)
n=15
Pos
itive
affe
ct (+
): 49
.2
(11.
3)N
egat
ive
affe
ct (−
):38
.4 (1
5.5)
N/A
N
/A
Min
dfu
lnes
s (C
hild
A
ccep
tanc
eM
ind
fuln
ess
Mea
sure
)
n=36
53.9
(8.6
)n=
1552
.3 (6
.7)
n=35
53.4
(7.8
)n=
1549
.4 (7
.2)
N/A
N
/A
Ang
er (S
tate
Tra
it A
nger
E
xpre
ssio
n In
vent
ory-
2TM
)
n=36
Inw
ard
(−):
16.4
(4.2
)O
utw
ard
(−):
17.2
(5.7
)C
ontr
ol (+
): 22
.8 (5
.5)
n=15
Inw
ard
(−):
15.9
(3.3
)O
utw
ard
(−):
16.5
(4.0
)C
ontr
ol (+
): 22
.7 (5
.3)
n=35
Inw
ard
(−):
16.8
(4.9
)O
utw
ard
(−):
16.9
(5.5
)C
ontr
ol (+
): 22
.4 (6
.1)
n=15
Inw
ard
(−):
17.9
(4.6
)O
utw
ard
(−):
17.1
(3.7
)C
ontr
ol (+
): 20
.9 (3
.7)
N/A
N
/A
Tab
le 4
C
ontin
ued
Con
tinue
d
on 6 August 2018 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2017-020959 on 15 July 2018. D
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12 Mansfield L, et al. BMJ Open 2018;8:e020959. doi:10.1136/bmjopen-2017-020959
Open access
limitations of evaluation design. Two studies reported both preproject and postproject data. It was not always clear how themes were identified and developed and it was not always apparent that conclusions emerged from comprehensive data treatment. One report made a clear attempt to search for disconfirming cases and consider the negative well-being impact of sport participation,53 but evaluation reports tended to focus only on the posi-tive impacts of sport and dance. Furthermore, there was a tendency in evaluations on dance and performance to rely on face value reporting of participants’ accounts rather than developing latent forms of thematic analysis informed by identified theory where appropriate.
the effect of meditative sport activity on well-beingThree published RCT studies assessed the effectiveness of meditative practices including yoga46 50 and Baduanjin Qigong48 on well-being in young people. All three studies used several different measures of well-being including mood scales for rating anger, anxiety, positive and negative affect, confusion/bewilderment and stress, anxiety and depression.46 48 50 One stu
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