In a recently released article in Pediatrics (10.1542/peds.2017-1543), Dr. Frederick Ho and colleagues present results of a “Sports-based Youth Development Program,” a randomized controlled trial implemented in their home city of Hong Kong. The program objective was to utilize sports mentorship as a vehicle to improve the physical and mental health of healthy teenagers. This unique intervention recruited students from secondary schools in Hong Kong, China and assigned them to weekly sessions over the 18 week period of the regular school year: those receiving the intervention were in an after school “Positive Youth Development” program in facilitated groups of 12-19 students, while students in the control arm had exclusive access to a health education website. “Positive Youth Development” is an approach that focuses on modeling and supporting healthy and positive behaviors, rather than correcting or disciplining negative behaviors, and is described in reference materials that accompany this article.1 One of the most intriguing aspects of the program is that rather than a competitive or skill-based approach to sports, the intervention focused on creating a sense of belonging within the group, and asked students to choose which sports they wanted to learn: the facilitators supported the students in goal setting, and then taught skills through active play.
Overall 664 students completed pre-post assessments, and the authors were able to demonstrate improvements in mental health and some aspects of physical health even though they found no significant changes in BMI z-score. The details of the assessments and follow up are well presented and easy to read and understand. One can debate whether changes in BMI and body fat could reasonably be expected over the time period studied given the specifics of the intervention. Regardless, the authors are appropriately cautious about generalization of their intervention, and suggest that it could potentially be applicable to other high-income industrialized Chinese cities in which students are under meaningful academic stress. While their caution is reasonable, I think that their intervention and approach could be fruitfully and readily applied in the US, both as a potential “antidote” to the increasing professionalization and specialization of youth sports, and additionally as a mental health treatment approach that lacks stigma, and thus might be more acceptable to a broader group of youth and parents. The program of Dr. Ho and colleagues enrolled healthy students and did not aim to provide mental health care per se, but the impact of the program on the students’ mental health is noteworthy. As a related note, the American Medical Society for Sports Medicine’s Position Statement on the topic of overuse injuries and burn out is a compelling complementary read: both physical and mental health harm is well documented as resulting from the early intense competitive sports specialization that is becoming more common in the US.2
The beauty of Dr. Ho and colleagues’ “Sports-based Youth Development Program” lies in its focus on the youth. The program facilitators function as mentors, using sports and physical activity as ways to support the development and well-being of the students. In our competitive sports-oriented society, this approach is a welcome breath of fresh air.
1. National Research Council and Institute of Medicine. Community Programs to promote youth development. Washington DC: National Academic Press; 2002
2. DiFiori JP, Benjamin HJ, Brenner JS, et al Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine Br J Sports Med 2014;48:287-288.