Intervention Summary

New Moves

New Moves is a school-based physical education (PE) intervention aimed at preventing weight-related problems in adolescent girls by increasing their physical activity, improving their body image and self-worth, and improving their diet. The primary component of New Moves is an all-girls PE class that is designed to provide participants with a noncompetitive, supportive environment in which they are encouraged to be physically active regardless of size, shape, or skill level. The intervention's theoretical model of change is based on social cognitive theory and addresses a combination of socioenvironmental, personal, and behavioral factors.

New Moves is typically implemented over a two-semester, 9-month school year (but can be used over quarters or trimesters):

During the first semester, the New Moves curriculum is delivered by a teacher through 50-minute classes that are held each weekday and target eight behavioral objectives: (1) aim to be physically active for at least 1 hour per day, (2) limit sedentary time to no more than 1 hour per day, (3) increase intake of fruits and vegetables (up to at least five servings per day), (4) limit intake of sugar-sweetened beverages, (5) eat breakfast daily, (6) pay attention to portion sizes and personal signs of hunger and fullness, (7) avoid unhealthy weight control behaviors, and (8) focus on personal positive traits. On 1 day each week, the class consists of nutrition or social support lessons, which alternate weekly for a total of eight lessons each; on the other 4 days, participants attend the girls-only PE class.
During the second semester, girls participate in maintenance activities, such as "lunch bunches," which are weekly get-togethers held over lunch, at which girls are served healthy food and engage in informal discussions on New Moves topics.

Throughout the entire school year, each girl also schedules five to seven individual counseling sessions with a New Moves coach (i.e., a teacher, a guidance counselor, or a student who completed New Moves in a prior year). During these 15- to 20-minute sessions, each girl sets personal goals for behavioral change on the basis of the eight objectives; explores how to best achieve her goals; and, if ready for change, makes an action plan. The coach uses motivational interviewing strategies to assist each girl in moving toward change. Also during the school year, the curriculum is reinforced through parent outreach activities; for example, six postcards are sent home with each participant for discussion with her parent, and a parent-daughter retreat day is held at a local community center.

In the study reviewed for this summary, New Moves coaches received training and ongoing support in motivational interviewing techniques.

Descriptive Information

Areas of Interest	Mental health promotion Substance use disorder prevention
Outcomes	1: Physical activity 2: Eating patterns 3: Unhealthy weight control behaviors 4: Body image 5: Self-worth
Outcome Categories	Mental health Quality of life
Ages	13-17 (Adolescent)
Genders	Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	School
Geographic Locations	Urban Suburban
Implementation History	New Moves was first implemented and has since been implemented in 25 schools in Minnesota, serving approximately 5,000 students.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal Selective

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Neumark-Sztainer, D. R., Friend, S. E., Flattum, C. F., Hannan, P. J., Story, M. T., Bauer, K. W., et al. New Moves--Preventing weight-related problems in adolescent girls: A group-randomized study. American Journal of Preventive Medicine, 39(5), 421-432.

Supplementary Materials

Neumark-Sztainer, D., Story, M., Hannan, P. J., & Rex, J. New Moves: A school-based obesity prevention program for adolescent girls. Preventive Medicine, 37(1), 41-51.

New Moves Intervention Session Observation Checklist

New Moves Nutrition Class Evaluation Form

New Moves Student Survey

Pate, R. R., Ross, R., Dowda, M., Trost, S. G., & Sirard, J. R. Validation of a three-day physical activity recall instrument in female youth. Pediatric Exercise Science, 15, 257-265.

Pingitore, R., Spring, B., & Garfield, D. Gender differences in body satisfaction. Obesity Research, 5(5), 402-409.

Rudasill, K. M., & Callahan, C. M. Psychometric characteristics of the Harter Self-Perception Profiles for adolescents and children for use with gifted populations. Gifted Child Quarterly, 52(1), 70-86.

Outcomes

Outcome 1: Physical activity
Description of Measures	Physical activity was assessed with the following measures: 3-Day Physical Activity Recall (3-DPAR) survey. Using numbered codes for 65 activities, participants recorded the physical and sedentary activities they took part in during the majority of each 30-minute time block between 6:00 a.m. and midnight on the 3 days prior to the day of data collection. If the participant recorded a physical activity, she also reported her perceived exertion level ("light," "moderate," "hard," or "very hard"). Total physical activity and total sedentary activity were calculated as the daily average number of blocks recorded for physical and sedentary activities, respectively. Physical activity stage of change. Using a 5-point scale ranging from "I am not physically active and do not intend to become active" to "I am physically active on most days of the week and have been for longer than 6 months," participants described their physical activity stage of change. Physical activity goal setting. Using a 5-point scale ranging from "never" to "very often," participants rated 5 items in terms of their frequency of setting goals related to physical activity (e.g., "I set goals to do physical activity," "I ask a friend to do physical activities with me"). Self-efficacy for physical activity. Using a 5-point scale ranging from "not at all sure" to "very sure," participants rated 6 items regarding how sure they were that they could implement new activities and be active in different situations (e.g., "exercise when you feel bad about your body," "be active when you are stressed," "participate in a physical activity that you don't think you are good at").
Key Findings	In a study conducted in Minnesota, 12 high schools were randomly assigned to the intervention or comparison condition. At the beginning of the school year in both intervention and comparison schools, girls with sedentary lifestyles were invited to register for an all-girls PE class as an alternative to the regular, coeducational class. Girls in the six intervention schools received the New Moves curriculum in the fall semester through PE class and nutrition and social support lessons and participated in New Moves activities throughout the rest of the school year. In the fall semester, girls in the six comparison schools participated in a PE class that used the standard curriculum but consisted of all girls. Participants were assessed at baseline (at the start of the school year), postclass (immediately after the fall semester), and at follow-up (at the end of the school year, approximately 9 months from the beginning of the intervention). From baseline to the follow-up assessment, girls in the intervention schools had a decrease in their total sedentary activity (p = .05) and an increase in their stage of change for physical activity (p = .039), physical activity goal setting (p = .021), and self-efficacy for physical activity (p = .003) compared with girls in the comparison schools. Girls in the intervention schools also had an increase in their total physical activity compared with girls in the comparison schools; however, this result was not significant. Analyses were adjusted for the baseline measure, age, ethnicity/race, and school.
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.4 (0.0-4.0 scale)

Outcome 2: Eating patterns
Description of Measures	Eating patterns were assessed using stage of change, goal setting, and portion control measures: Stage of change for fruits and vegetables. Using a 5-point scale ranging from "I do not eat 5 or more servings of fruits and vegetables per day and do not intend to start" to "I eat at least 5 or more servings of fruits and vegetables per day and have been doing so for longer than 6 months," participants described their stage of change for fruits and vegetables. Stage of change for breakfast. Using a 5-point scale ranging from "I do not eat breakfast and do not intend to start" to "I eat breakfast every day and have been doing so for longer than 6 months," participants described their stage of change for breakfast. Stage of change for portion control. Using a 5-point scale ranging from "I do not pay attention to the portion sizes of the food I eat and do not intend to start" to "I pay attention to the portion sizes of the food I eat and have been doing so for longer than 6 months," participants described their stage of change for portion control. Goal setting for healthy eating. Using a 5-point scale ranging from "never" to "very often," participants rated 4 items regarding their frequency of setting goals related to healthy eating (e.g., "I set goals for making healthy food choices," "I plan ahead of time what I'm going to eat for snacks"). Portion control. Using a 4-point scale ranging from "hardly ever" to "almost always," participants responded to 4 items describing food choice behaviors and awareness of portion size (e.g., "I am aware of the portion sizes that I eat," "I check the serving size on food and drink labels").
Key Findings	In a study conducted in Minnesota, 12 high schools were randomly assigned to the intervention or comparison condition. At the beginning of the school year in both intervention and comparison schools, girls with sedentary lifestyles were invited to register for an all-girls PE class as an alternative to the regular, coeducational class. Girls in the six intervention schools received the New Moves curriculum in the fall semester through PE class and nutrition and social support lessons and participated in New Moves activities throughout the rest of the school year. In the fall semester, girls in the six comparison schools participated in a PE class that used the standard curriculum but consisted of all girls. Participants were assessed at baseline (at the start of the school year), postclass (immediately after the fall semester), and at follow-up (at the end of the school year, approximately 9 months from the beginning of the intervention). From baseline to the follow-up assessment, girls in the intervention schools had improvements in stage of change for fruits and vegetables (p = .002), stage of change for breakfast (p = .028), stage of change for portion control (p = .006), goal setting for healthy eating (p = .002), and portion control (p = .014) compared with girls in the comparison schools. Analyses were adjusted for the baseline measure, age, ethnicity/race, and school.
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.9 (0.0-4.0 scale)

Outcome 3: Unhealthy weight control behaviors
Description of Measures	Unhealthy weight control behaviors were assessed using a 10-item measure. Using a response of "yes" or "no," each participant reported whether she engaged in any of the following behaviors in the past month: fasted, ate very little, took diet pills, made herself vomit, used laxatives, used diuretics, used food substitutes, skipped meals, smoked more cigarettes, and/or went on a diet. A participant was classified as having used unhealthy weight control behaviors if she responded "yes" to one or more items.
Key Findings	In a study conducted in Minnesota, 12 high schools were randomly assigned to the intervention or comparison condition. At the beginning of the school year in both intervention and comparison schools, girls with sedentary lifestyles were invited to register for an all-girls PE class as an alternative to the regular, coeducational class. Girls in the six intervention schools received the New Moves curriculum in the fall semester through PE class and nutrition and social support lessons and participated in New Moves activities throughout the rest of the school year. In the fall semester, girls in the six comparison schools participated in a PE class that used the standard curriculum but consisted of all girls. Participants were assessed at baseline (at the start of the school year), postclass (immediately after the fall semester), and at follow-up (at the end of the school year, approximately 9 months from the beginning of the intervention). From baseline to the follow-up assessment, the percentage of girls in the intervention schools who used unhealthy weight control behaviors decreased by 13.7% compared with girls in the comparison schools (p = .021). Analyses were adjusted for the baseline measure, age, ethnicity/race, and school.
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.9 (0.0-4.0 scale)

Outcome 4: Body image
Description of Measures	Body image was assessed using body satisfaction and perceived athletic competence measures: Body satisfaction. Using a 6-point scale ranging from "very dissatisfied" to "very satisfied," participants rated 10 items, adapted from the Body Shape Satisfaction Scale and the Body Cathexis Scale, to indicate their satisfaction with their height, weight, body shape, and specific body parts (e.g., waist, hips, stomach). Perceived athletic competence. Using the choices of "really true for me" or "sort of true for me," participants responded to 5 sets of statements assessing perceived athletic competence by selecting the statement that most applies to them and then indicating how strongly the statement applies (e.g., "some teenagers do very well at all kinds of sports/other teenagers don't feel that they are very good when it comes to sports").
Key Findings	In a study conducted in Minnesota, 12 high schools were randomly assigned to the intervention or comparison condition. At the beginning of the school year in both intervention and comparison schools, girls with sedentary lifestyles were invited to register for an all-girls PE class as an alternative to the regular, coeducational class. Girls in the six intervention schools received the New Moves curriculum in the fall semester through PE class and nutrition and social support lessons and participated in New Moves activities throughout the rest of the school year. In the fall semester, girls in the six comparison schools participated in a PE class that used the standard curriculum but consisted of all girls. Participants were assessed at baseline (at the start of the school year), postclass (immediately after the fall semester), and at follow-up (at the end of the school year, approximately 9 months from the beginning of the intervention). From baseline to the follow-up assessment, girls in the intervention schools had improvements in body satisfaction (p = .045) and perceived athletic competence (p = .044) compared with girls in the comparison schools. Analyses were adjusted for the baseline measure, age, ethnicity/race, and school.
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.2 (0.0-4.0 scale)

Outcome 5: Self-worth
Description of Measures	Self-worth was assessed with a 5-item measure. Using the choices of "really true for me" or "sort of true for me," participants responded to 5 sets of statements, adapted from the Harter Self-Worth Scale, by selecting the statement that most applies to them and then indicating how strongly the statement applies (e.g., "Some teenagers don't like the way they are leading their lives/other teenagers do like the way they are leading their lives").
Key Findings	In a study conducted in Minnesota, 12 high schools were randomly assigned to the intervention or comparison condition. At the beginning of the school year in both intervention and comparison schools, girls with sedentary lifestyles were invited to register for an all-girls PE class as an alternative to the regular, coeducational class. Girls in the six intervention schools received the New Moves curriculum in the fall semester through PE class and nutrition and social support lessons and participated in New Moves activities throughout the rest of the school year. In the fall semester, girls in the six comparison schools participated in a PE class that used the standard curriculum but consisted of all girls. Participants were assessed at baseline (at the start of the school year), postclass (immediately after the fall semester), and at follow-up (at the end of the school year, approximately 9 months from the beginning of the intervention). From baseline to the postclass assessment (p = .024) and follow-up assessment (p = .031), girls in the intervention schools had an improvement in self-worth compared with girls in the comparison schools. Analyses were adjusted for the baseline measure, age, ethnicity/race, and school.
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.3 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	13-17 (Adolescent)	100% Female	28.4% Black or African American 24.4% White 23% Asian 14.3% Hispanic or Latino 7.3% Race/ethnicity unspecified 2.5% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Physical activity	3.8	4.0	2.3	3.4	3.3	3.5	3.4
2: Eating patterns	3.3	2.0	2.3	3.4	3.3	3.5	2.9
3: Unhealthy weight control behaviors	3.0	2.0	2.3	3.4	3.3	3.5	2.9
4: Body image	4.0	2.8	2.3	3.4	3.3	3.5	3.2
5: Self-worth	4.0	3.4	2.3	3.4	3.3	3.5	3.3

Study Strengths

A variety of measures were used; all had strong reliability, and validity varied from fair to strong. Intervention fidelity efforts included the use of a manual to guide intervention implementation, training for PE teachers, ongoing coaching and support, and observations of intervention implementation. The levels of missing data and attrition were very low. There were no baseline differences between participants with complete data and those with missing data, and statistical analysis minimized the impact of missing data. In general, potential confounds were well addressed. Study groups were randomly assigned, and participants in the comparison schools also received an all-girls PE class. Analyses were appropriate and adjusted for baseline levels of the outcome variable, age, and ethnicity/race. Sample size and power were good.

Study Weaknesses

The fidelity instrument had unknown psychometric properties. Girls received somewhat different dosage levels of the intervention (i.e., 91% of girls attended at least 80% of classes, and 56% of girls attended at least half of the lunch bunches), and only 21% of the girls had a parent attend the parent-daughter event. No correction was applied to adjust for multiple comparisons.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Neumark-Sztainer, D., Flattum, C., Feldman, S., & Petrich, C. Striving to prevent obesity and other weight-related problems in adolescent girls: The New Moves approach. In J. A. O'Dea & M. Eriksen (Eds.), Childhood obesity prevention--International research, controversies, and interventions (pp. 269-277). New York, NY: Oxford University Press.

New Moves Intervention Session Observation Checklist

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.8	3.3	3.4	3.5

Dissemination Strengths

All of the intervention materials are available online. The teacher guidebook includes the background, rationale, and overview of the intervention. It also provides outlines for each class, individual sessions, and other activities, including step-by-step lesson plans and detailed ideas for the fitness components. The participant manual (i.e., Girl Pages) is written at the appropriate grade level, and supplemental materials (i.e., classroom posters, postcards for parents, trivia cards, fitness cards) are available and attractively packaged. The teacher guidebook and program Web site provide information on implementing the intervention to meet varying budgets and school schedules. Although the sufficiently detailed, well-organized materials provide sites with all information needed to implement the intervention, the developer offers implementation training and assistance. Well-developed pretests, posttests, and maintenance phase surveys for participants and satisfaction surveys for participants, teachers, and parents are provided.

Dissemination Weaknesses

The teacher guidebook suggests that motivational interviewing techniques should be used by coaches in individual sessions; however, these techniques are likely beyond the expertise of people who typically would serve as coaches, and little guidance on training in this approach is provided. There is limited written guidance on how to evaluate and use program data to improve the delivery of the intervention. Written guidance is not provided for the administration of the observation checklist.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Teacher Guidebook	Free for online electronic file, or $12 per hard copy	Yes
Girl Pages	Free for online electronic file, or $33 per hard copy	Yes
Interview Session Observation Checklist	Free	Yes
1-day, off-site implementation training at the University of Minnesota (includes teacher guidebook and student curriculum, i.e., Girl Pages, reproducible worksheets, and resources for teachers)	$1,200 per group of 8-12 participants	No
Assistance via phone or email	Free	No

Additional Information

Depending on the site, implementation may include guest instructor fees and costs for exercise equipment, t-shirts, pedometers, magazines, craft supplies, assorted prizes, water bottles, beverages, snacks, and a parent-daughter event. These costs are estimated at $2,200 annually.