Identifying strategies to support implementation of the Resistance Training for Teens (RT for Teens) school-based health-related fitness program for adolescents

In a recent cluster randomised controlled trial (RCT) delivered in New South Wales (NSW) government schools, we demonstrated that the ‘Resistance Training for Teens’ (RT for Teens) intervention improved adolescents’ muscular fitness, body composition and RT skill competency (e.g., squat, lunge and push-up technique). In the current project, we will partner with the NSW Department of Education (DoE) and five Local Health Districts (LHDs) to evaluate strategies to support the implementation of the RT for Teens program in NSW government and non-government secondary schools. Using findings from our previous RCT and dissemination studies, we have adapted our implementation support strategies to optimise reach, dose delivered, fidelity, sustainability, and impact. The aim of our proposed study is to assess the effect of three implementation support models (i.e., Low, Moderate and High) on the implementation (i.e., reach, effectiveness, dose delivered, fidelity, adoption, sustainability, impact and cost) of the RT for Teens program in NSW schools. To achieve this aim, we will conduct a hybrid type III implementation-effectiveness cluster RCT in 90 schools to determine the most effective and cost-effective RT for Teens implementation model. One teacher from each school will attend the RT for Teens professional learning workshop, provided by members of the RT for Teens design team from University of Newcastle, and serve as the “School Champion”. School Champions will attend 1 full day face-to-face training and be provided with curricular materials, including units of work, lesson plans, assessments task, technique and workout cards. The workshop will occur in Term 2 (2023), while the RT for Teens program can be delivered from Term 2 until Term 4 (2023). The School Champions will train the other teachers of their school who will also deliver the program to the students. This training (delivered by the School Champions to other teachers in school) include a 2-hour workshop and will be scheduled during Term 2 (2023) prior start of the program. The attendance of the School Champion workshop will be monitored by the Project Manager (i.e., by using an attendance list) and the teachers are required to complete an Action Plan to support implementation in their school, this plan will be evaluated by the Project Manager to ensure it is of high quality. In addition, app analytics will be accessed to monitor students' participation in the practical sessions. In addition to the teacher workshop, the Medium and High support groups will both include on-going support from external change agents (i.e., LHD Project Officers). Contact includes guidance via email, phone or face-to-face, depending teachers' preferences. Furthermore, Project Officers will observe one or two teachers per school who deliver an RT for Teens session and provide feedback to teachers on the structure of the RT for Teens session. The SAAFE observation checklist will be used to determine intervention fidelity and a brief checklist will be completed after each school meeting. This approach is consistent with the existing NSW health model for supporting the implementation of healthy eating and physical activity programs in schools. Project Officers from 5 LHDs will work directly with School Champions to facilitate implementation of the RT for Teens program. The 'High' support group will also receive a basic resistance training equipment pack valued at approximately $1000 AUD. The RT for Teens program includes the following: Resistance training (RT) sessions: Teachers will be trained to deliver the RT for Teens sessions. The 8-week program will utilise the following structured format: i) Warm-up (~5 mins); ii) GymFit (~20-25 mins); iii) Workout Of the Day (WOD)/GameFit/FunFit (~10-15 mins); and iv) StretchFit (i.e., a cool down including static stretching) (~5 mins). Within the 8-week implementation period, teachers will be encouraged to deliver approximately one session (theory and practice) per week. Theory lessons: Teachers are provided with 8 x 40 min theory lessons designed by the research team to align with the Australian Curriculum for health and physical education (HPE) and the Australian Physical Literacy Framework. They will be delivered during health lessons, with content covering: (i) introduction to RT, (ii) self-assessment of fitness, motivation and monitoring, (iii) fitness and eHealth technologies, (iv) principles of training and RT program design, (v) social media, physical activity and body image, (vi) Yoga, Pilates and other muscle-strengthening activity, (vii) nutrition myths and recommendations, and (viii) community-based opportunities for RT. Access to a smartphone app: Students and teachers will be able to access the RT for Teens app. Note: only students that provided their consent (i.e., opt-in) will be able to use the app. The app includes: a fitness testing feature – whereby students are able to use criterion-referenced standards to develop self-assessment skills; skill testing – a function for evaluating competence in six specific RT movements; and workouts – a library of pre-designed bodyweight resistance training workouts organised by difficulty (with a custom workout generator). Teachers will be encouraged to implement the full program including all sessions, but can still participate in the program when teaching part of the intervention. Teacher logbooks will be consulted by the research team after the implementation period to collect data on what sessions have been delivered by the teachers. Students fitness results (e.g., number of push-ups until fatigue) will be recorded through the smartphone app (students) or tablet app version (teachers). Data on level of intensity during the RT for Teens sessions will not be collected as the prior focus of the project is on implementation. Students will not be asked to engage in additional RT exercises outside of school hours or outside this program, but they will be encouraged to get familiar with RT, feel confident about it and include it in their own exercise schedule after participation.