Janette M. Watkins

Background: Community-based physical activity interventions face challenges in adoption, implementation, and sustainability. Lion Hearts is a family-based physical activity intervention designed to promote cardiovascular health among mothers and children aged 3–6 years. This study applied Implementation Mapping during intervention development to identify implementation determinants and develop stakeholder-informed strategies for subsequent pilot testing. Methods: The five iterative tasks of Implementation Mapping were applied through a co-design process with seven CrossFit affiliate owner-coaches: (1) conducting an implementation needs and assets assessment and identifying adopters and implementers; (2) specifying implementation outcomes, performance objectives, determinants, and change objectives; (3) selecting theoretical change methods and implementation strategies; (4) producing implementation protocols and materials; and (5) developing a prospective implementation-evaluation plan. Two 60-min co-design sessions were conducted approximately eight weeks apart. The first elicited barriers and facilitators to adoption and delivery within affiliate settings. Audio recordings were transcribed verbatim, and three researchers reviewed and coded both transcripts using structured matrices, supplemented by facilitator notes. Findings were synthesized using rapid qualitative analysis and integrated with behavioral theory and implementation science frameworks to identify implementation determinants and develop implementation strategies and materials. This study applied the five tasks of Implementation Mapping to identify implementation determinants and develop stakeholder-informed strategies, delivery supports, and a prospective evaluation plan for subsequent pilot testing. Results: Stakeholders identified implementation determinants related to coach knowledge and self-efficacy, participant engagement and competing demands, class structure and flow, scheduling, staffing, equipment availability, and compatibility with affiliate workflows. These findings informed implementation strategies and delivery supports targeting affiliate owners and coaches, including coach training resources, structured session templates, class-flow guidance, and fidelity-monitoring tools. Performance objectives and an implementation logic model were developed to specify hypothesized pathways linking determinants and strategies to prospective implementation outcomes. An evaluation plan was developed to assess reach, adoption, feasibility, acceptability, fidelity, and maintenance during subsequent pilot implementation. Conclusion: Implementation Mapping and stakeholder co-design produced a theory-informed, contextually responsive implementation package for Lion Hearts. Although implementation outcomes have not yet been evaluated, the resulting strategies, materials, and prospective evaluation plan are positioned for testing and refinement in community fitness settings. Clinical trial registration: ClinicalTrials.gov , NCT07147387.

Body dissatisfaction is a key predictor of poor mental health and disordered eating, yet prior studies often examine its psychological correlates in isolation or within narrow demographic groups. This study tested whether negative urgency—the tendency to act impulsively in response to negative emotions—mediates the association between depression and body dissatisfaction in young adults. Participants were drawn from the Nathan Kline Institute Rockland Sample ( N = 232; 127 males, 105 females). A composite body dissatisfaction score was derived from Shape Concern and Weight Concern subscales. Path analyses indicated that negative urgency mediated the depression–body dissatisfaction link in the full sample, driven by significant mediation among males but not females. Specificity analyses for Shape and Weight Concern showed the same pattern. Findings highlight negative urgency as a vulnerability factor connecting mood symptoms to body dissatisfaction, underscoring sex differences and the need for targeted interventions addressing impulsivity and emotion regulation.

Children and adolescents with disabilities experience disproportionate challenges in achieving recommended levels of physical activity (PA) and adequate sleep, two core determinants of health and functional well-being. This systematic review examined associations between meeting PA guidelines and sleep duration among youth with disabilities. Following PRISMA guidelines, MEDLINE, PsycARTICLES, and SPORTDiscus were searched through Spring 2024 for studies assessing PA and sleep in children and adolescents (N = 138,016) and synthesized using qualitative methods and regression-based quantitative analyses to examine the effects of diagnosis category and PA guideline adherence on sleep duration. The diagnosis type was associated with sleep duration, with youth with autism spectrum disorder (ASD) exhibiting shorter sleep than those with physical disabilities. Meeting PA guidelines (≥60 min/day) was associated with longer sleep duration among youth with ASD, but not consistently across other diagnostic groups. Qualitative findings further indicated diagnosis-specific variability, with PA positively associated with sleep outcomes in ASD, attention deficit/hyperactivity disorder, and epilepsy, and mixed associations observed for cerebral palsy and intellectual disability. These findings suggest that PA may support sleep health in specific disability groups. Given persistently low PA participation among youth with disabilities, integrating accessible, diagnosis-specific PA opportunities within school, community, and clinical settings may represent a feasible strategy to improve sleep and overall health.

With over 14,000 CrossFit affiliates worldwide, there is untapped potential to serve many autistic athletes. However, current CrossFit coaching certifications and continuing education programs lack autism-specific training. This study assessed CrossFit affiliates’ capacity to work with autistic athletes, evaluated coach knowledge, and identified perceived barriers and facilitators to participation. Two surveys were conducted. The first, completed by 97 CrossFit affiliate owners and coaches, found that over 90% of respondents were interested in working with autistic athletes and enhancing their coaching capacity. Additionally, 59.79% indicated they had the necessary knowledge and skills to work with autistic athletes. The second survey, targeting those interested in or already working with autistic athletes ( n = 20), showed that experience working with autistic athletes was positively correlated with a better understanding core characteristics of autism and related physical health issues. Consistent barriers included a lack of training/confidence, parent/athlete interest, financial support, and transportation. Facilitators included adequate coaching/support staff, behavior supports, and family/community involvement. The findings highlight a strong interest in including autistic athletes in CrossFit but also reveal significant gaps in coaches’ knowledge, skills, and confidence. Addressing these gaps is crucial to increasing the capacity for autistic athletes to participate in CrossFit and other functional fitness programs.

Background/Objectives: Physical inactivity and sedentary lifestyles remain leading behavioral risk factors for chronic disease across generations. Mothers with young children face unique barriers to exercise, including time constraints, fatigue, and limited access to supportive environments. Lion Hearts was developed to address these barriers through a family-centered, community-based approach that integrates physical activity, strength training, and health education. This protocol describes the systematic application of the Intervention Mapping (IM) framework to develop Lion Hearts, a multigenerational CrossFit-based program for mothers and children. Methods: Following the first four steps of the IM framework—needs assessment, matrices, intervention design, and program creation—behavioral determinants were identified through literature review, national data, and community input. The resulting 12-week program integrates twice-weekly family CrossFit sessions, monthly cardiovascular health workshops, and weekly home-based challenges delivered through local affiliates using a train-the-trainer model. Results: IM produced a theoretically grounded and evidence-based intervention targeting individual (self-efficacy, outcome expectations), interpersonal (modeling, relatedness), and environmental (access, social support) determinants. The process resulted in detailed logic models, behavior change matrices, and implementation materials, including family handbooks and coach guides. Conclusions:Lion Hearts represents a scalable, multigenerational approach to CVD prevention that leverages existing community fitness infrastructure. By embedding prevention within family systems and CrossFit affiliates, the program offers a sustainable, replicable model to enhance physical activity, strengthen family health behaviors, and reduce intergenerational CVD risk.

Cardiovascular disease remains the leading cause of death in the United States, with rural communities experiencing elevated risk. Youth in rural settings are particularly vulnerable, reporting worse health outcomes than their urban peers. The growing influence of social media has added complexity to adolescent health behaviors, particularly among youth experiencing challenges with physical and mental well-being. This qualitative study presents findings from a co-design initiative conducted with rural middle school students to examine adolescents’ views on body image, social media use, and engagement in physical activity, and to inform the development of the Hoosier Sport Re-Social intervention. Fourteen middle school students (grades 7–8) from a rural community participated in a structured co-design process spanning five sessions over nine weeks. A deductive thematic analysis was employed using Basic Psychological Needs Theory (BPNT) and Social Comparison Theory (SOCO) as guiding frameworks.

Background: Body dissatisfaction is a growing concern among adolescent females, particularly those living in rural communities where access to supportive mental and physical health resources is limited. High levels of social media use and low engagement in structured physical activity are linked to negative body image, elevated anxiety, and reduced overall well-being in this population. The Hoosier Sport Re-Social intervention was developed to address these challenges by integrating sport participation, social media literacy, and mental skills training in a community-based program designed for adolescent girls. Methods: This study follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines and is structured around three aims. First, we will conduct a cross-sectional study with adolescent girls in grades 6 through 9 to examine the relationship between body satisfaction, physical activity levels, and social media use. Second, we will develop the Hoosier Sport Re-Social intervention using a co-design process that actively involves adolescents, parents, and school staff to ensure relevance and feasibility. Finally, we will conduct a mixed-methods pilot study in two rural middle and high schools to assess feasibility and acceptability. The intervention will be implemented within physical education and health classes over a 6-week period. Primary outcomes will include feasibility indicators such as recruitment, retention, fidelity, and participant engagement. Secondary outcomes will include measures of body satisfaction and social media literacy, while exploratory outcomes will examine changes in psychosocial factors and physical literacy. Discussion: This study will provide important insights into the acceptability and practicality of delivering a biopsychosocial, school-based intervention targeting body dissatisfaction among rural adolescent girls. Findings will inform future efforts to scale the program and evaluate its effectiveness in improving mental, physical, and cognitive health outcomes. Trial registration: This trial was prospectively registered with ClinicalTrials.gov (NCT06556719).

Background: Fundamental movement skills (FMS)—including muscular strength, endurance, and mobility—are linked to better health-related quality of life and higher physical activity in children. Rural children often score lower on FMS tests than urban peers due to resource limitations rather than ability. Thus, increasing access to FMS activities in under-resourced rural areas is essential. The primary objective was to test the feasibility of Hoosier Strength in a rural middle school sample, and the secondary objective was to observe the preliminary changes in FMS-related outcomes pre- to post-intervention and at follow-up. The exploratory objective was to explore how participants responded to different coaches on the Hoosier Strength coaching team (i.e., gender, coaching style during activities). Methods: This study used a Hybrid Type 3 design to evaluate feasibility and FMS outcomes, integrating qualitative and quantitative data. The four-week intervention included a test group (n = 24; 14 females, 10 males; mean age: females 12.4 ± 0.5 years, males 12.7 ± 0.4 years) and a control group (n = 12; 8 females, 4 males; mean age: females 12.9 ± 0.3 years, males 12.7 ± 0.3 years). Data analysis included descriptive statistics for feasibility indicators (Acceptability of Intervention Measures [AIM], Intervention Appropriateness Measure [IAM], and Feasibility of Intervention Measure [FIM]), linear regression for mobility and muscular endurance changes, t-tests for psychological need satisfaction and frustration, and regression analysis for squat knowledge and post-intervention confidence. Results: (1) There was high feasibility across the 4-week Hoosier Strength intervention and at follow-up; (2) there were no statistically significant changes in squat performance; (3) participants’ confidence in their ability to squat at the end of the intervention was significantly predicted by their squat knowledge at baseline; and (4) participants prioritized leadership and team management over tactical analysis, highlighting a preference for coaches who foster teamwork. Conclusions: The findings offer a transparent approach for evaluating the feasibility and preliminary outcomes of the Hoosier Strength intervention in an under-resourced rural middle school, thereby encouraging further investigation into strength training interventions in rural schools.

Purpose: This investigation aimed to explore relationships among health behaviors, psychological factors, and body image in rural adolescents. Design: A cross-sectional survey was conducted. Setting: The study took place in a rural school in the Midwest region of the United States. Subjects: Participants (n = 45) were rural adolescents (6th-9th grade). Measures: Physical activity was assessed using the CAPL-2 and IPAQ, social media usage and addiction were evaluated through daily screen time and the BSMAS, body image was measured using the BSQ and BAS-2, anxiety levels were assessed with the GAD-7, and interoceptive abilities were measured by the MAIA-Y. These measures are validated for use in adolescent populations. Analysis: Linear regression models examined relationships between physical activity, social media usage, anxiety, body image, and interoceptive abilities. Effect sizes for significant predictors were determined using Cohen’s d. Results: Novel relationships were identified among rural adolescents, including a positive association between body appreciation and physical literacy (d = 0.322, P = 0.002), a negative association between body appreciation and social media addiction (d = 0.866, P < 0.001), and a positive association between social media addiction and anxiety levels (d = 0.341, P < 0.001). Conclusion: Social media impacts the well-being of rural adolescents. Promoting physical literacy and social media literacy may mitigate negative effects and should be prioritized in future interventions.