A ‘strengths’-based approach to improving youth physical activity behaviour

Physical activity is an important preventative health measure – benefiting our physical (García-Hermoso et al. 2019; Ortega et al. 2008; Smith et al. 2014; Westcott 2012) and psychological (Smith et al. 2014) health. Evidence highlights the link between meeting physical activity guidelines and a reduced risk of cardiovascular disease, diabetes, anxiety, and depression (García-Hermoso et al. 2019; Ortega et al. 2008; Smith et al. 2014; Westcott 2012). Beyond these immediate benefits, there is also evidence that health behaviours (including physical activity) (Herman et al. 2009) and markers of health risk (Craigie et al. 2011) present during childhood and adolescence track into adulthood (Baranowski et al. 2000). National (Department of Health 2014b; Piercy et al. 2018; Tremblay et al. 2011) and international (World Health Organization 2010) guidelines recommend that children and adolescents aged 5-17 participate in 60 minutes of primarily aerobic moderate-to-vigorous physical activity daily. In 2020, the World Health Organisation updated this guideline to recommend that the 60 minutes be averaged each day across the week (World Health Organization 2020). It is also recommended young people participate in muscle-strengthening activities, such as jumping, gymnastics, weight-bearing sports (such as basketball and tennis), and resistance training (Chalkley 2021), at least three days per week (Department of Health 2014b; Piercy et al. 2018; Tremblay et al. 2011; World Health Organization 2010). For adults aged 18+, 150 minutes of aerobic moderate-to-vigorous physical activity across the week and two days of muscle-strengthening activities are recommended (Department of Health 2014a; World Health Organisation 2022). Despite the benefits of physical activity, only around a quarter of Australian adults do enough activity (Australian Bureau of Statistics 2022). Amongst young people, approximately 20% of 5-14 year olds (Australian Institue of Health and Welfare 2022) and less than 10% of 15-17 year olds meet guidelines (Australian Bureau of Statistics 2022).

In contemporary Australia, the ongoing marginalisation and inequality of Indigenous peoples contribute to disadvantage across many outcomes (Walter et al. 2017). Lasting, negative consequences resulting from colonisation and ensuing socio-economic disadvantage have created a ‘gap’ between Indigenous and non-Indigenous peoples. This gap includes disparities in health, education, and economic outcomes. Regarding health, Indigenous peoples have higher rates of chronic disease, lower levels of physical activity, and rates of overweight/obesity (Australian Bureau of Statistics 2019). Given the impact physical activity has on improving health, it is no surprise that physical inactivity is a major modifiable risk factor contributing to many chronic diseases, including cardiovascular disease, type two diabetes, some cancers, and dementia (Australian Institue of Health and Welfare 2017). These chronic conditions are many of the major chronic conditions negatively impacting Indigenous peoples’ health and well-being (Australian Institue of Health and Welfare 2021), including heart disease and type 2 diabetes. These and other chronic diseases are responsible for approximately 70% of the health gap that exists between Indigenous and non-Indigenous people (Australian Institue of Health and Welfare 2016). This gap is evident in the disparity between Indigenous and non-Indigenous peoples’ physical activity behaviours, with around 12% of adults and 5% of those aged 15-17 years doing enough physical activity (Australian Bureau of Statistics 2019). This is around half of the proportion reported for the overall Australian population.

Most people are familiar with aerobic activities, including walking, swimming, or bicycling. The type of activity people are not as familiar with is muscle-strengthening activity – such as resistance training. This is where we use our body weight or an external force (such as free weights) to improve muscular fitness. In addition to the benefits above, resistance training has the added advantage of improving bone health in youth (Smith et al. 2014) and into adulthood/old age (D’Onofrio et al. 2023), improving sports performance (Zwolski et al. 2017), and contributing to the prevention of falls (D’Onofrio et al. 2023). Barriers to participation in physical activity exist across both the aerobic and muscle-strengthening categories. These include perceived lack of time, knowledge, skills and confidence (Rhodes et al. 2017), and perceptions related to equipment requirements (Steele et al. 2017). For muscle-strengthening activity, there are also myths related to safety and risk of injury – and the appropriateness of resistance training as an activity for youth (Faigenbaum et al. 2022). It is important that we look to provide individuals with the knowledge, skills, and confidence to develop positive physical activity behaviours in youth, as these behaviours are often carried on into adulthood.  

Schools present themselves as a great place to deliver public health programs to young people (Centers for Disease Control and Prevention 2013) and help develop these physical activity behaviours. Many school-based programs have been delivered over the years and found to be effective (Cohen et al. 2015; Corder et al. 2016; Luepker et al. 1996; Naylor et al. 2008; R. Sutherland et al. 2016; R. L. Sutherland et al. 2016). However, the majority have been small in their scale (Glasgow et al. 2004; Reis et al. 2016), limiting the number of youths impacted. This is of particular concern to mob kids, as programs are often delivered in metropolitan areas – away from many of the communities and people most in need. Scale-up of effective interventions is necessary, meaning that programs are delivered to more young people in more schools – enhancing the public health impact and ensuring many young people can access programs to benefit their health. This will assist them in developing the health habits needed to take into adulthood. Not only have limited interventions been scaled up, but few have focused on resistance training.

Resistance Training for Teens (RT for Teens) was the first program focused on resistance training (Kennedy et al. 2019; Kennedy et al. 2018; Lubans et al. 2016; Smith et al. 2018) to be delivered at scale (Kennedy et al. 2021; Kennedy et al. 2018). Developed in partnership with the NSW Department of Education, RT for Teens was a 10-week program that aimed to improve the knowledge, skills and confidence of young people to participate in resistance training. To maximise the reach into the student population, teachers delivered the program to students within their schools. They were trained to do so during a professional learning workshop through practical and theory-based learning opportunities designed to improve their knowledge, skills and confidence to deliver resistance training in their schools. They were also provided with resources to aid in program delivery.

This workshop was an important aspect of the program, as teachers play an important role as health promotion champions within schools. As such, engaging with them and providing them with the tools to positively influence youth health through quality program delivery is vital. Since 2016, 468 teachers from 249 schools across NSW have been trained to deliver RT for Teens. That’s almost half of all secondary schools in NSW with a trained teacher and accompanying resources. Teachers who delivered the program reported improvements in their confidence and enhanced perceptions of their own fitness. RT for Teens has reached approximately 10,000 students across NSW. Importantly, of all the students/schools within the RT for Teens cohort – 10% of students were Aboriginal or Torres Strait Islander. NSW school data indicates that 6% of students are Indigenous, so we were able to reach a higher proportion of mob kids than expected (Kennedy et al. 2018).

Students involved in the program improved their muscular fitness – and given the compelling physical and psychological health benefits associated with adequate levels of muscular fitness – including reduced cardiovascular disease risk, stronger bones, improved self-esteem, and well-being – the health impact of RT for Teens is undeniable. Not only that –  students’ technique got better, and they had more belief in their own resistance training ability – which are important factors in lasting behaviour change. RT for Teens gave these young people the strength, knowledge, skills, and confidence to overcome barriers related to physical activity participation and the associated health consequences of inactivity.

This research shows the good that can be done in the community, influencing the health of young people – when effective school-based programs are delivered at scale. For Aboriginal and Torres Strait Islander young people, this is especially important, as community-level barriers (such as transport and facilities) were reported as the most prevalent to participation in physical activity and sport (May et al. 2020). Overcoming these through providing evidence-based programs, delivered on a large scale, in the school setting may present effective ways to promote physical activity in mob kids. However, there is a long way to go. We must continue to work together as a community to fight the good fight and give all young people the knowledge, the skills, and the confidence to live a healthy life. As we move forward, we are now updating RT for Teens for its next phase of implementation in schools. Partnering with the NSW Department of Education and NSW Health to continue to encourage and educate an even wider proportion of the population on the importance of resistance training (and overall physical activity) for all.