Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol

Tanya O'Brien; Catherine D Darker; David Mockler; Emer M Barrett

doi:10.12688/hrbopenres.13834.2

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Study Protocol

Revised

Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol

[version 2; peer review: 3 approved]

Tanya O'Brien ¹, Catherine D Darker², David Mockler³, Emer M Barrett¹

PUBLISHED 24 Dec 2024

Author details Author details

¹ Physiotherapy, The University of Dublin Trinity College, Dublin, Leinster, Ireland
² Public Health & Primary Care, The University of Dublin Trinity College, Dublin, Leinster, Ireland
³ School of Medicine, The University of Dublin Trinity College, Dublin, Leinster, Ireland

Tanya O'Brien
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Catherine D Darker
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing

David Mockler
Roles: Data Curation

Emer M Barrett
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Physical activity is essential for youth physical and mental health, yet just 15% of adolescent girls versus 22% of adolescent boys worldwide meet the World Health Organization guideline of at least an average of 60 minutes of moderate-to-vigorous physical activity per day. As activity patterns established in adolescence often persist into adulthood, there is a looming risk of adverse health outcomes due to insufficient physical activity. A persistent challenge faced by physical activity providers, however, is recruiting adolescent girls into their programmes. This systematic review will quantitatively synthesise existing knowledge surrounding the recruitment of adolescent girls into physical activity interventions and aims to provide evidence-based recommendations for optimal recruitment practices.

Methods

Five electronic databases will be searched to identify randomised controlled trials of physical activity interventions for adolescent girls worldwide. Hand-searches of reference lists of included randomised controlled trials, relevant systematic reviews, and author publications will also be conducted. Data will be extracted regarding study, participant, and intervention characteristics, pre-determined recruitment goals, recruitment strategies employed, and the number of participants screened, eligible, approached, randomised, and retained. Outcomes will include whether pre-determined recruitment goals were met, recruitment rate, and any adapted or extended recruitment measures required mid-study. Descriptive statistics, including the median recruitment rate for all included studies, will be calculated and stratified by subgroups such as the type or setting of physical activity. Recruitment strategies will be categorised, and the percentage of studies using each category, along with their associated recruitment rates, will be documented. If sufficient studies are found, multi-variable regression will be employed to determine if the use of a specific recruitment strategy increases enrolment.

Discussion

Application of the findings of this review by physical activity programme providers may enhance their recruitment processes, potentially increasing teenage girls’ physical activity enrolment worldwide.

Systematic review registration

PROSPERO CRD#42023475858

Keywords

physical activity, adolescents, adolescent girls, exercise, recruitment, enrolment

Corresponding author: Tanya O'Brien

Competing interests: No competing interests were disclosed.

Grant information: The research conducted in this publication was funded by the Irish Research Council Enterprise Partnership Scheme and the Dublin City Sport & Wellbeing Partnership.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 O'Brien T et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: O'Brien T, Darker CD, Mockler D and Barrett EM. Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol [version 2; peer review: 3 approved]. HRB Open Res 2024, 7:6 (https://doi.org/10.12688/hrbopenres.13834.2) First published: 16 Feb 2024, 7:6 (https://doi.org/10.12688/hrbopenres.13834.1) Latest published: 09 May 2025, 7:6 (https://doi.org/10.12688/hrbopenres.13834.3)

Revised Amendments from Version 1

This protocol has been revised following peer review. The setting of the included recruitment strategies and facilitators to the recruitment process will now be documented. Additionally, the World Health Organization physical activity guidelines have been updated to specify that adolescents are recommended to engage in at least an average of 60 minutes of moderate-to-vigorous physical activity per day.

See the authors' detailed response to the review by Joey Murphy
See the authors' detailed response to the review by Emma Pollock
See the authors' detailed response to the review by Yumi Kim

Introduction

Physical activity (PA) is essential for youth physical and mental health, and yet just 15% of adolescent girls versus 22% of adolescent boys worldwide meet the World Health Organization (WHO) guideline of at least an average of 60 minutes of moderate-to-vigorous physical activity per day¹. There is a recognised gender gap when it comes to adolescent PA participation^2,3, with a recent analysis from 146 countries showing that PA participation in girls was 7% lower than boys³. Regular exercise improves self-esteem, academic performance, cardiovascular health, and muscular fitness while reducing anxiety, depression, diabetes, cardiovascular disease, and obesity risk⁴. Furthermore, PA habits established in adolescence often endure into adulthood, putting this cohort of inactive adolescent girls at risk of adverse health outcomes due to insufficient physical activity⁵.

In 2013, global physical inactivity cost healthcare systems internationally $53.8 billion due to the management of lifestyle diseases such as coronary heart disease, stroke, and type 2 diabetes⁶. In addition to direct healthcare costs, there are indirect annual costs related to decreased productivity ($13.7 billion), not to mention the health-related impact of 13.4 million disability-adjusted life years related to physical inactivity⁶. These estimates are likely to be even higher in 2023, as childhood and adult obesity levels are on the rise, and worldwide obesity levels have tripled since 1975⁷. In 2016, 340 million children and adolescents aged 5–19, or just over 18%, were overweight or obese⁷. Fortunately, increasing awareness of the growing crisis of inactivity, and in adolescent girls specifically, has resulted in the development of new, generally well-received PA programmes based on state-of-the-art behaviour change theories and frequently involving adolescent girls in the design or evaluation of these programmes^8–11.

A persistent challenge for PA programme providers, however, is recruiting adolescent girls to join their programmes^8,12–14, with reduced interest from potential participants being cited as one of the main barriers to offering after-school extracurricular activities⁹. Girls PA programme providers, for example, report recruiting only 10–29% of eligible adolescent girls even with multiple recruitment rounds^8,10, note that adjustments to their methodology were required to improve recruitment^11,15, or end up enrolling fewer participants than intended when compared with their pre-determined recruitment goals^12,16.

Currently, there is a dearth of quantitative research internationally regarding effective recruitment practices for adolescent girls into PA programmes. Recent qualitative research has examined adolescent girls’ perceptions of PA, the types of PA programmes they are looking for, and facilitators and barriers to their participation^17–20. Individual study authors list the recruitment strategies employed in their programmes, such as presentations from researchers or teachers^8,21,22, taster sessions in advance of signing up for the entire programme²³, informational emails sent by schools⁸, posters⁸, flyers¹⁰, invitational letters to parents²², incentives for participation²², social media^10,24, and more.

Quantitative evaluations of the effectiveness of these recruitment strategies in this demographic, however, are lacking. There is very little evidence to guide programme providers on which strategies can increase enrolment and whether there are differences in recommended strategies based on subgroups such as older or younger adolescent age, urban versus rural populations, or the setting of the physical activity programme such as during physical education class, after-school on school grounds, or in the community. Therefore, this systematic review will present median recruitment rates for enrolling adolescent girls into PA programmes, synthesise existing knowledge surrounding strategies employed to recruit adolescent girls into PA programmes, and attempt to quantitatively determine which recruitment strategies are most successful with this population.

Protocol

Methods/design

This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis – Protocol (PRISMA-P) guidelines and is reported utilising the PRISMA-P checklist²⁵. The completed PRISMA-P checklist is available on the Open Science Framework repository listed below under ‘Data Availability’. This review topic has been registered with the PROSPERO database (registration number CRD#42023475858). Should any amendments to this protocol be required, an update to this protocol publication will be submitted.

Aim

The aims of this systematic review are (i) to establish recruitment rates for adolescent girls into Randomised Controlled Trials (RCTs) of PA programmes, (ii) to synthesise existing knowledge surrounding strategies employed by PA programme providers to enrol adolescent girls into RCTs of PA programmes, and (iii), to quantitatively determine which recruitment strategies are most effective with this cohort, resulting in evidence-based recommendations to inform the recruitment practices of PA providers enrolling adolescent girls into PA intervention RCTs.

Eligibility criteria

The eligibility criteria for inclusion in this review will be based on the PICOTS Framework (Population, Intervention, Comparison, Outcome, Time frame, Study Type)²⁶.

Population

Studies that include healthy adolescents who identify as female, aged 10–19, as per the WHO’s definition of adolescents²⁷ will be included. Any recorded socioeconomic status indicators, such as, programme locations in areas of deprivation, will be noted for subgroup analyses. All locations worldwide will be included.

Studies that include adolescents who do not identify as female, who are outside the included age range, or who have been identified as a special population due to a health condition will be excluded. Studies that include only overweight or obese cohorts, or only athletic cohorts from specific sports teams will be excluded.

Interventions

Any PA programmes, defined for the purposes of this review as organised, repeated PA activities, which may be online, community, or school-based programmes that provide adolescent girl-only physical activity opportunities, will be included. Examples of eligible PA programmes might include activities such as running, dance, Zumba, callisthenics, football, weight training, and more. All settings will be included; for example, programmes carried out during school Physical Education classes, programmes offered as extracurricular after-school activities on school grounds, online programmes, or community-based after-school or weekend activities at local facilities. Multi-component programmes, such as those also including nutrition advice, mental health education, or leadership skills, will be included, provided that the primary intervention is physical activity. These will be noted as a potential subgroup for comparison with PA-only opportunities.

The number of adolescent girls Screened (S), Eligible (E), Approached (A), and Randomized (R), as per the SEAR framework²⁸, will be recorded, alongside the number of girls who completed the programme, retention rates, and any pre-determined recruitment goals, which may be sourced from published RCT protocols. Characteristics of the recruitment strategies employed, such as the recruitment modality (e.g. flyers, posters, emails, presentations, or social media), setting, and who carried out the recruitment strategies (e.g. teachers, researchers, community leaders, or coaches) will be noted. A description of any changes to the recruitment process throughout the study will be recorded.

To be included, studies must report either (i) the number of eligible girls they approached, and the number subsequently Screened, Eligible, or Randomised or (ii) a pre-determined recruitment goal and the final number of Screened, Eligible, or Randomised participants.

Comparison

As only RCTs will be included, all studies will include an individual or cluster-randomised control group. This control group must receive either no physical activity programme or a usual practice physical activity programme such as their typical Physical Education class rather than an enhanced or modified class. Physical activity advice without the provision of an actual physical activity programme will also be accepted as a control group.

Outcomes

Primary outcome(s)

- Characteristics of the recruitment strategies employed.
- Binary description of whether the study met or did not meet pre-determined recruitment goals.
- Percentage of eligible participants recruited versus approached (recruitment rate).

Secondary outcome(s)

- Challenges or facilitators to recruitment identified by the research teams regarding recruitment.
- Any extra measures or changes to the recruitment process employed mid-study.
- Characteristics of the physical activity programme such as setting, physical activity modality, and whether it is a PA-only or multi-faceted programme.
- Number and percentage of girls retained until the end of the programme (retention rate).

Timeframe

There will be no retrospective start date for the date of publication, and included studies may be published until the search date of 3^rd February 2023. This search will be updated prior to submission of the completed Systematic Review manuscript for publication to ensure any new, relevant articles are included.

Study type

This review will include primary research studies that implement physical activity programmes or interventions for adolescent girls aged 10–19. Individual and cluster randomised controlled trials (RCTs) will be included, provided that the required quantitative recruitment-related data is provided. The study type was limited to RCTs as RCTs have been designated the ‘gold standard’ in effectiveness research, with higher standards regarding study conduct and reporting²⁹.

Unpublished, pre-print, non-peer-reviewed studies, conference abstracts, systematic reviews, narrative reviews, oral presentations not available in full text, and grey literature will be excluded.

Information sources and search strategy

The following electronic databases will be included in our search: Embase, Medline, CINAHL, Web of Science, and the Cochrane Library – Central Trial Registry. The search strategy will include database-specific terms, truncations, and synonyms combining ‘adolescent females’, ‘recruitment’, and ‘physical activity’ The full search strategy is (available in the Open Science Framework repository listed below under ‘Data Availability’.

Where multiple papers exist for a single RCT, the most relevant paper for each unique RCT will be designated the included ‘parent study’. If required, a hand-search of related papers such as study protocols, process evaluations, and trial registers will be retrieved from the publication lists of the first and last authors of the parent study to identify pre-determined recruitment goals, recruitment rate, and recruitment strategies employed. In instances where the recruitment-related data is partially available in existing publications, the research team will contact the study authors by email on two occasions to attempt to retrieve the remaining recruitment data. All relevant related papers will be collated with the parent RCT in Covidence and imported into EndNote for appropriate tracking and referencing.

Study records

Data management

Studies will first be imported into EndNote 20.2 Desktop software for reference management, then into Covidence’s online systematic review management software. Duplicates will be removed automatically. Screening, selection, and data extraction will be performed in Covidence. Following this process, quantitative data will be exported for analysis into software such as Microsoft Excel, SPSS, and RevMan 5.4.

Screening and selection process

Title, abstract, and full-text screening of studies for inclusion/exclusion will be performed independently by two authors in Covidence; discussion will follow to reach consensus should there be any discrepancies between authors. If the required recruitment data for a parent RCT cannot be found in published sources and the study authors do not respond to email or cannot provide the data, the study will be excluded. Any disagreements will be resolved through discussion with the third reviewer.

Data extraction process

A custom data extraction template, based on the Cochrane Review data extraction template³⁰ and modified to include additional, relevant recruitment-related details will be designed and piloted by TOB. Recruitment methods will be coded into categories; for example, social media advertising, paper flyers, electronic communication with parents, or in-person advertising by researchers or schoolteachers.

Data extracted will include recruitment details such as recruitment strategies, setting, any pre-determined recruitment goals, the number of participants from each category of the SEAR framework²⁸, the recruitment rate, the retention rate, the method of parental consent (i.e. opt-in versus opt-out), and whether the trial met or did not meet their pre-determined recruitment goals. Whether the study authors noted any difficulties or facilitators with recruitment, whether they employed any adapted or extended recruitment measures mid-study, and a description of these extra recruitment measures will be recorded. Study details such as author(s), year of publication, date(s) and location(s) where the intervention was delivered, the aim of the study, primary outcomes, and study design will be recorded. Population details such as age range, socioeconomic status indicators, and community type (urban versus rural) will also be noted. Recorded details for each intervention will include the setting (e.g. after-school or community-based), the components of the programme (e.g. PA-only or multimodal with leadership skills or other components), the physical activity modality delivered (e.g. dance, running, weight-training), the duration of the programme, the number of sessions per week, the duration of each session, the number of instructors and participants at the first and last sessions, retention rates, and methods of data collection for the studies’ primary outcome(s) (e.g. self-report, accelerometer, objective measurement of weight and body fat percentage).

As this review is not a typical systematic review wherein the effect of the intervention on the outcome could be biased by interpretation (see Quality Assessment section for further details), data will be extracted by one author (TOB) for each included study, followed by a second author performing a duplicate extraction of a randomly selected 10% of studies. If the agreement level between authors is satisfactory, data extraction will continue with one author. Any disagreements will be resolved through discussion with an independent third reviewer. A PRISMA flow diagram will be completed to illustrate the screening process³¹.

Quality assessment

Traditional quality assessment is designed to assess each study’s ability to limit the risk of bias regarding the primary outcome(s) of the RCT. In this instance, outcomes such as the impact of the studies’ interventions on physical activity levels or bone mineral density, for example, are the main outcomes, rather than the recruitment data being extracted for this systematic review. Therefore, quality assessment and related assessment of meta-biases was deemed unnecessary for this review given that included studies would not have been randomised or blinded for recruitment-related outcomes. This methodological decision is aligned with similarly styled systematic reviews examining recruitment rates and strategies in health-related RCTs^32–35. Selective reporting within studies of recruitment strategies and related data will be reported.

Data synthesis

Descriptive statistics, such as median recruitment rate, will be computed for the combined data of all studies to determine the average recruitment rate for all physical activity RCTs within this cohort. Subgroup analysis will then be performed to determine the mean and median recruitment rates categorised by physical activity or trial setting (e.g. school-based, community-based, online). Additional subgroup analyses will explore recruitment rates based on socioeconomic status indicators, urban versus rural locations, physical activity programme type, and older versus younger adolescent age.

Similarly to the categorisation practices used by Reynolds, O’Connor³², recruitment strategies will be categorised by the authors according to common themes (e.g., active vs. passive, school-based, parent-targeted). We will calculate the percentage of studies using each category of recruitment strategies, along with the mean and median recruitment rates when each category of strategies is present. We will document whether studies achieved their predefined recruitment goals, noting strategies employed by successful and unsuccessful cases. Additionally, the use of supplementary recruitment measures, like extended timelines, will be recorded and compared to strategies utilised when such measures were unnecessary using statistical methods.

As per current best-practice recommendations³⁰, if ≥ 10 studies are included, multi-variable regression will be performed to investigate the effect of categorical explanatory variables such as recruitment strategy category, PA programme type, and programme setting on recruitment rate. This would allow us to present evidence-based recommendations based on statistical significance and effect size.

Analysis of subgroups or subsets

Subgroup analysis will be performed based on the setting of the PA programme, PA programme type, younger adolescent age (10–14), older adolescent age (15–19), and socioeconomic status indicators.

Discussion

Recruitment of adolescent girls remains a persistent challenge for PA programme providers^8,12–14, and yet there is a dearth of research examining the recruitment of this demographic into PA programmes or interventions. This quantitative systematic review will complement the recent qualitative reviews examining barriers, facilitators, and perceptions of PA amongst adolescent girls^17,19,36,37 and directly address the challenge of recruiting adolescent girls into PA programmes and interventions.

One challenge we expect to encounter is that RCTs may not fully report all details of their recruitment strategies, challenges associated with recruitment, or any extended or extra steps taken to achieve recruitment goals. We hope to mitigate this challenge by contacting study authors for further details as needed and employing inclusion criteria that accept the reporting of either recruitment rate or pre-determined recruitment goals. Furthermore, there are difficulties surrounding the definition of recruitment ‘success’. To these authors’ knowledge, there are no established metrics in this cohort defining what is considered a successful, or even expected, recruitment rate into physical activity programmes outside of meeting or not meeting pre-determined recruitment goals. Metrics of recruitment ‘success’ in other cohorts vary greatly throughout the literature. In cancer survivors, the median recruitment rate into exercise trials has been shown to be 38%³², however this is a specific patient population and may not be representative of adolescent girls. In patients with advanced cancer, the mean recruitment rate into exercise trials was 49%³⁸, but again may not be representative of teenage girls. A systematic review of recruitment into workplace physical activity interventions categorised successful recruitment as a recruitment rate ≥70%³⁹, however, this metric of success was defined for a specific group of mixed gender adults rather than adolescent girls.

Meeting or not meeting pre-determined recruitment goals may be a problematic definition of recruitment success, as these authors surmise that RCTs may change their recruitment strategies, extend their recruitment timeframe, or increase personnel and financial resources mid-study until these goals are met so that power calculations are satisfied. Therefore, this metric might judge most PA RCTs' successful', whereas a different picture may emerge when the recruitment rate is also considered.

Post-analysis, we aim to provide descriptive statistics on projected recruitment rates for adolescent girls' PA RCTs and, where possible, offer evidence-based recommendations for optimal recruitment strategies. These findings will assist programme providers and researchers in evaluating recruitment efficacy and determining the required outreach and recommended strategies to achieve desired sample sizes. Moreover, the dissemination and implementation of evidence-based recruitment recommendations for adolescent girls in PA interventions could substantially increase teenage girls’ PA enrolment worldwide.

List of abbreviations

CI: Confidence Interval

PA: Physical Activity

PICOTS: Population, Intervention, Comparison, Outcome, Timeframe, Study Type

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PRISMA-P: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols

RCT: Randomized Controlled Trial

RoB2: Risk of Bias 2

SEAR: Screened, Eligible, Approached, Randomized

WHO: World Health Organization

Data availability

Underlying data

No data are associated with this article.

Reporting guidelines

Open Science Framework: The PRISMA-P Checklist and Search Strategy are registered with the Open Science Framework as “Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol PRISMA-P Checklist and Search Strategy”⁴⁰.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

The authors would like to thank Dr Lina Zgaga, Associate Professor in Public Health and Primary Care, Trinity College Dublin, for her invaluable insights when consulted regarding data analysis.

Faculty Opinions recommended

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Version 3

VERSION 3 PUBLISHED 16 Feb 2024

Author details Author details

Catherine D Darker
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing

David Mockler
Roles: Data Curation

Emer M Barrett
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The research conducted in this publication was funded by the Irish Research Council Enterprise Partnership Scheme and the Dublin City Sport & Wellbeing Partnership.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (3)

version 3

Revised

Published: 09 May 2025, 7:6

https://doi.org/10.12688/hrbopenres.13834.3

version 2

Revised

Published: 24 Dec 2024, 7:6

https://doi.org/10.12688/hrbopenres.13834.2

version 1

Published: 16 Feb 2024, 7:6

https://doi.org/10.12688/hrbopenres.13834.1

© 2024 O'Brien T et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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O'Brien T, Darker CD, Mockler D and Barrett EM. Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol [version 2; peer review: 3 approved]. HRB Open Res 2024, 7:6 (https://doi.org/10.12688/hrbopenres.13834.2)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

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Key to Reviewer Statuses VIEW HIDE

ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

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Version 2

VERSION 2

PUBLISHED 24 Dec 2024

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Reviewer Report 31 Jan 2025

Yumi Kim, University of Alabama at Birmingham, Birmingham, AL, USA

Approved

https://doi.org/10.21956/hrbopenres.15430.r44752

Thank you for the opportunity to review your submission to HRB Open Research. Engagement in physical activity, along with other health-enhancing behaviors, is a critical topic in medicine. Adolescent females represent a key subgroup who need to develop health these behaviors for lifelong health management. Effectively recruiting and engaging them in physical activity interventions is essential for fostering sustainable participation. While the protocol appears to be well-developed with detailed consideration and methodological rigor, I offer minor suggestions to improve clarity and information presentation. I look forward to reading the findings of this review.
Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of the review to include additional response rates, such as adherence to the intervention and retention to follow-up. This expansion could be reflected in the aims section. Currently, Aim 1 appears to be solely focused on recruitment rates, but in the "Intervention" subsection, the authors indicate an intent to report adherence and retention rates. To clarify this point, Aim 1 could be reframed to encompass overall response rates, including recruitment, adherence, and retention. If you are willing to take this suggestion above, to enhance distinction, Aim 2 could specifically address the synthesis of the recruitment strategies and identification of successful recruitment strategies, while Aim 3 could concentrate on strategies that enhance adherence and retention. This revision would enrich the review’s narrative and provide a more comprehensive understanding of program effectiveness beyond recruitment alone.
Protocol
I recommend adding a PRISMA-P flowchart (or diagram) in addition to the checklist, as a visual supplement can offer a clear snapshot of the study selection process.
Population
The last two sentences of this section could be revised for clarity. For instance, you may provide the listed conditions as examples, such as: "... identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions." Then, I would separate the exclusion of athletic cohorts into a new sentence and explicitly state the justification for this exclusion. Additionally, if clinical trials including mixed-gender programs (boys and girls together) are to be excluded from the final synthesis, this should be explicitly stated.
PICOTS - Timeframe
I appreciate that the study is structured using the PICOTS framework. To enhance clarity, I suggest specifying the duration of interventions under this subheading. It would be helpful to define the minimum criteria for an intervention. For example, if a program is delivered only once or over a brief period (e.g., one week), followed by post-intervention measures, would it still be included in the review?

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Physical activity intervention design and implementation; Health promotion for people with disabilities; Systematic review methods.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

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Author Response 15 May 2025

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

15 May 2025

Author Response

Thank you for your very helpful suggestions. We have addressed each comment below.

Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of ... Continue reading Thank you for your very helpful suggestions. We have addressed each comment below.

Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of the review to include additional response rates, such as adherence to the intervention and retention to follow-up. This expansion could be reflected in the aims section. Currently, Aim 1 appears to be solely focused on recruitment rates, but in the "Intervention" subsection, the authors indicate an intent to report adherence and retention rates. To clarify this point, Aim 1 could be reframed to encompass overall response rates, including recruitment, adherence, and retention. If you are willing to take this suggestion above, to enhance distinction, Aim 2 could specifically address the synthesis of the recruitment strategies and identification of successful recruitment strategies, while Aim 3 could concentrate on strategies that enhance adherence and retention. This revision would enrich the review’s narrative and provide a more comprehensive understanding of program effectiveness beyond recruitment alone.

Response:
Thank you for this constructive suggestion. While we agree that including adherence to the intervention would enrich the review, unfortunately, adherence was beyond the scope of our analysis. This manuscript is part of an overall larger PhD project focusing on recruitment of adolescent girls into PA programmes. Furthermore, due to the timeline of the review process, we have since finalised the manuscript and are preparing it for publication. As noted, we did include retention as a secondary outcome. We appreciate your insightful feedback and will consider it for future work.

Protocol
I recommend adding a PRISMA-P flowchart (or diagram) to the checklist, as a visual supplement can offer a clear snapshot of the study selection process.

Response:
Thank you we will include a PRISMA-P flowchart in the completed systematic review.

Population
The last two sentences of this section could be revised for clarity. For instance, you may provide the listed conditions as examples, such as: "... identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions." Then, I would separate the exclusion of athletic cohorts into a new sentence and explicitly state the justification for this exclusion. Additionally, if clinical trials including mixed-gender programs (boys and girls together) are to be excluded from the final synthesis, this should be explicitly stated.

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended.

“Studies that include adolescents who do not identify as female, who are outside the included age range, or who have been identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions. Studies that include only athletic cohorts from specific sports teams, for example, will be excluded, as athlete-only groups are also not representative of the typical population of adolescent girls.”

PICOTS - Timeframe
I appreciate that the study is structured using the PICOTS framework. To enhance clarity, I suggest specifying the duration of interventions under this subheading. It would be helpful to define the minimum criteria for an intervention. For example, if a program is delivered only once or over a brief period (e.g., one week), followed by post-intervention measures, would it still be included in the review?

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended in the ‘Intervention’ section.

“Any PA programmes, defined for the purposes of this review as organised, repeated PA activities, which may be online, community, or school-based programmes that provide adolescent girl-only physical activity opportunities, will be included. As physical adaptations to PA programmes have been shown to require a minimum of 2-4 weeks [1], interventions must have had a minimum of 4 weeks’ length to be included.”
Thank you for your very helpful suggestions. We have addressed each comment below.

Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of the review to include additional response rates, such as adherence to the intervention and retention to follow-up. This expansion could be reflected in the aims section. Currently, Aim 1 appears to be solely focused on recruitment rates, but in the "Intervention" subsection, the authors indicate an intent to report adherence and retention rates. To clarify this point, Aim 1 could be reframed to encompass overall response rates, including recruitment, adherence, and retention. If you are willing to take this suggestion above, to enhance distinction, Aim 2 could specifically address the synthesis of the recruitment strategies and identification of successful recruitment strategies, while Aim 3 could concentrate on strategies that enhance adherence and retention. This revision would enrich the review’s narrative and provide a more comprehensive understanding of program effectiveness beyond recruitment alone.

Response:
Thank you for this constructive suggestion. While we agree that including adherence to the intervention would enrich the review, unfortunately, adherence was beyond the scope of our analysis. This manuscript is part of an overall larger PhD project focusing on recruitment of adolescent girls into PA programmes. Furthermore, due to the timeline of the review process, we have since finalised the manuscript and are preparing it for publication. As noted, we did include retention as a secondary outcome. We appreciate your insightful feedback and will consider it for future work.

Protocol
I recommend adding a PRISMA-P flowchart (or diagram) to the checklist, as a visual supplement can offer a clear snapshot of the study selection process.

Response:
Thank you we will include a PRISMA-P flowchart in the completed systematic review.

Population
The last two sentences of this section could be revised for clarity. For instance, you may provide the listed conditions as examples, such as: "... identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions." Then, I would separate the exclusion of athletic cohorts into a new sentence and explicitly state the justification for this exclusion. Additionally, if clinical trials including mixed-gender programs (boys and girls together) are to be excluded from the final synthesis, this should be explicitly stated.

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended.

“Studies that include adolescents who do not identify as female, who are outside the included age range, or who have been identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions. Studies that include only athletic cohorts from specific sports teams, for example, will be excluded, as athlete-only groups are also not representative of the typical population of adolescent girls.”

PICOTS - Timeframe
I appreciate that the study is structured using the PICOTS framework. To enhance clarity, I suggest specifying the duration of interventions under this subheading. It would be helpful to define the minimum criteria for an intervention. For example, if a program is delivered only once or over a brief period (e.g., one week), followed by post-intervention measures, would it still be included in the review?

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended in the ‘Intervention’ section.

“Any PA programmes, defined for the purposes of this review as organised, repeated PA activities, which may be online, community, or school-based programmes that provide adolescent girl-only physical activity opportunities, will be included. As physical adaptations to PA programmes have been shown to require a minimum of 2-4 weeks [1], interventions must have had a minimum of 4 weeks’ length to be included.”
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 15 May 2025

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

15 May 2025

Author Response

Thank you for your very helpful suggestions. We have addressed each comment below.

Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of ... Continue reading Thank you for your very helpful suggestions. We have addressed each comment below.

Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of the review to include additional response rates, such as adherence to the intervention and retention to follow-up. This expansion could be reflected in the aims section. Currently, Aim 1 appears to be solely focused on recruitment rates, but in the "Intervention" subsection, the authors indicate an intent to report adherence and retention rates. To clarify this point, Aim 1 could be reframed to encompass overall response rates, including recruitment, adherence, and retention. If you are willing to take this suggestion above, to enhance distinction, Aim 2 could specifically address the synthesis of the recruitment strategies and identification of successful recruitment strategies, while Aim 3 could concentrate on strategies that enhance adherence and retention. This revision would enrich the review’s narrative and provide a more comprehensive understanding of program effectiveness beyond recruitment alone.

Response:
Thank you for this constructive suggestion. While we agree that including adherence to the intervention would enrich the review, unfortunately, adherence was beyond the scope of our analysis. This manuscript is part of an overall larger PhD project focusing on recruitment of adolescent girls into PA programmes. Furthermore, due to the timeline of the review process, we have since finalised the manuscript and are preparing it for publication. As noted, we did include retention as a secondary outcome. We appreciate your insightful feedback and will consider it for future work.

Protocol
I recommend adding a PRISMA-P flowchart (or diagram) to the checklist, as a visual supplement can offer a clear snapshot of the study selection process.

Response:
Thank you we will include a PRISMA-P flowchart in the completed systematic review.

Population
The last two sentences of this section could be revised for clarity. For instance, you may provide the listed conditions as examples, such as: "... identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions." Then, I would separate the exclusion of athletic cohorts into a new sentence and explicitly state the justification for this exclusion. Additionally, if clinical trials including mixed-gender programs (boys and girls together) are to be excluded from the final synthesis, this should be explicitly stated.

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended.

“Studies that include adolescents who do not identify as female, who are outside the included age range, or who have been identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions. Studies that include only athletic cohorts from specific sports teams, for example, will be excluded, as athlete-only groups are also not representative of the typical population of adolescent girls.”

PICOTS - Timeframe
I appreciate that the study is structured using the PICOTS framework. To enhance clarity, I suggest specifying the duration of interventions under this subheading. It would be helpful to define the minimum criteria for an intervention. For example, if a program is delivered only once or over a brief period (e.g., one week), followed by post-intervention measures, would it still be included in the review?

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended in the ‘Intervention’ section.

“Any PA programmes, defined for the purposes of this review as organised, repeated PA activities, which may be online, community, or school-based programmes that provide adolescent girl-only physical activity opportunities, will be included. As physical adaptations to PA programmes have been shown to require a minimum of 2-4 weeks [1], interventions must have had a minimum of 4 weeks’ length to be included.”
Thank you for your very helpful suggestions. We have addressed each comment below.

Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of the review to include additional response rates, such as adherence to the intervention and retention to follow-up. This expansion could be reflected in the aims section. Currently, Aim 1 appears to be solely focused on recruitment rates, but in the "Intervention" subsection, the authors indicate an intent to report adherence and retention rates. To clarify this point, Aim 1 could be reframed to encompass overall response rates, including recruitment, adherence, and retention. If you are willing to take this suggestion above, to enhance distinction, Aim 2 could specifically address the synthesis of the recruitment strategies and identification of successful recruitment strategies, while Aim 3 could concentrate on strategies that enhance adherence and retention. This revision would enrich the review’s narrative and provide a more comprehensive understanding of program effectiveness beyond recruitment alone.

Response:
Thank you for this constructive suggestion. While we agree that including adherence to the intervention would enrich the review, unfortunately, adherence was beyond the scope of our analysis. This manuscript is part of an overall larger PhD project focusing on recruitment of adolescent girls into PA programmes. Furthermore, due to the timeline of the review process, we have since finalised the manuscript and are preparing it for publication. As noted, we did include retention as a secondary outcome. We appreciate your insightful feedback and will consider it for future work.

Protocol
I recommend adding a PRISMA-P flowchart (or diagram) to the checklist, as a visual supplement can offer a clear snapshot of the study selection process.

Response:
Thank you we will include a PRISMA-P flowchart in the completed systematic review.

Population
The last two sentences of this section could be revised for clarity. For instance, you may provide the listed conditions as examples, such as: "... identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions." Then, I would separate the exclusion of athletic cohorts into a new sentence and explicitly state the justification for this exclusion. Additionally, if clinical trials including mixed-gender programs (boys and girls together) are to be excluded from the final synthesis, this should be explicitly stated.

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended.

“Studies that include adolescents who do not identify as female, who are outside the included age range, or who have been identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions. Studies that include only athletic cohorts from specific sports teams, for example, will be excluded, as athlete-only groups are also not representative of the typical population of adolescent girls.”

PICOTS - Timeframe
I appreciate that the study is structured using the PICOTS framework. To enhance clarity, I suggest specifying the duration of interventions under this subheading. It would be helpful to define the minimum criteria for an intervention. For example, if a program is delivered only once or over a brief period (e.g., one week), followed by post-intervention measures, would it still be included in the review?

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended in the ‘Intervention’ section.

“Any PA programmes, defined for the purposes of this review as organised, repeated PA activities, which may be online, community, or school-based programmes that provide adolescent girl-only physical activity opportunities, will be included. As physical adaptations to PA programmes have been shown to require a minimum of 2-4 weeks [1], interventions must have had a minimum of 4 weeks’ length to be included.”
Competing Interests: No competing interests were disclosed. Close
Report a concern

Version 1

VERSION 1

PUBLISHED 16 Feb 2024

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Reviewer Report 31 Oct 2024

Emma Pollock, The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia

Approved

https://doi.org/10.21956/hrbopenres.15158.r42534

Title: Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol

Summary: Thank you for the opportunity to review this well-written manuscript. This systematic review protocol will examine recruitment strategies for engaging adolescent girls in physical activity interventions, addressing a critical need as only 15% meet the WHO's physical activity guideline. By synthesising data from randomised controlled trials, it will assess recruitment rates, strategies, and participant retention. Descriptive statistics will explore the effectiveness of various recruitment methods. The findings aim to guide program providers on optimising recruitment, ultimately supporting more girls in meeting physical activity recommendations that can lead to improved lifelong health.

To improve the quality of the manuscript, the authors could consider the following:

Although this information may not be available in many studies, including the distribution setting of recruitment strategies (e.g., There may be differences in effectiveness depending on whether a flyer is handed directly to a student by a teacher during class time versus distributed at a P&C meeting) and the intended target audience of the recruitment material (e.g., adolescent girls directly or their parents/caregivers) as key characteristics could provide valuable insights. This approach would help identify which environments (e.g., schools, community, online platforms) and target audiences are most effective in engaging adolescent girls in physical activity programs.
While it may be beyond the scope of this study, it could be valuable to identify whether any specific retention strategies were implemented. Although the secondary aim includes examining any additional measures or adjustments to recruitment, understanding whether retention strategies were planned—particularly for longer-duration projects—could provide further insights into sustaining participant engagement.

Is the rationale for, and objectives of, the study clearly described? Yes
Is the study design appropriate for the research question? Yes
Are sufficient details of the methods provided to allow replication by others? Yes
Are the datasets clearly presented in a useable and accessible format? Yes

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Physical activity in children and adolescents; girls' physical activity levels and sport participation; School- and community-based physical activity interventions; Physical Education (PE); implementation and sustainment of physical activity programs.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

Report a concern

Author Response 24 Dec 2024

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

24 Dec 2024

Author Response
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 2:

Comment 1:
... Continue reading
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 2:

Comment 1:

To improve the quality of the manuscript, the authors could consider the following: Although this information may not be available in many studies, including the distribution setting of recruitment strategies (e.g., There may be differences in effectiveness depending on whether a flyer is handed directly to a student by a teacher during class time versus distributed at a P&C meeting) and the intended target audience of the recruitment material (e.g., adolescent girls directly or their parents/caregivers) as key characteristics could provide valuable insights. This approach would help identify which environments (e.g., schools, community, online platforms) and target audiences are most effective in engaging adolescent girls in physical activity programs.

Response: Thank you for this very helpful comment. As you have suggested, we will make note of the recruitment strategy setting in hopes of identifying which environments are most effective. The manuscript has been updated accordingly.

Comment 2:

While it may be beyond the scope of this study, it could be valuable to identify whether any specific retention strategies were implemented. Although the secondary aim includes examining any additional measures or adjustments to recruitment, understanding whether retention strategies were planned—particularly for longer-duration projects—could provide further insights into sustaining participant engagement.

Response: Thank you for this very helpful comment. While we will be reporting on retention as a secondary outcome, strategies to maintain retention are outside the scope of this current review. Depending on our findings, however, we will likely be including recommendations for future research around retention, as you have suggested.
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 2:

Comment 1:

To improve the quality of the manuscript, the authors could consider the following: Although this information may not be available in many studies, including the distribution setting of recruitment strategies (e.g., There may be differences in effectiveness depending on whether a flyer is handed directly to a student by a teacher during class time versus distributed at a P&C meeting) and the intended target audience of the recruitment material (e.g., adolescent girls directly or their parents/caregivers) as key characteristics could provide valuable insights. This approach would help identify which environments (e.g., schools, community, online platforms) and target audiences are most effective in engaging adolescent girls in physical activity programs.

Response: Thank you for this very helpful comment. As you have suggested, we will make note of the recruitment strategy setting in hopes of identifying which environments are most effective. The manuscript has been updated accordingly.

Comment 2:

While it may be beyond the scope of this study, it could be valuable to identify whether any specific retention strategies were implemented. Although the secondary aim includes examining any additional measures or adjustments to recruitment, understanding whether retention strategies were planned—particularly for longer-duration projects—could provide further insights into sustaining participant engagement.

Response: Thank you for this very helpful comment. While we will be reporting on retention as a secondary outcome, strategies to maintain retention are outside the scope of this current review. Depending on our findings, however, we will likely be including recommendations for future research around retention, as you have suggested.
Competing Interests: None. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 24 Dec 2024

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

24 Dec 2024

Author Response
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 2:

Comment 1:
... Continue reading
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 2:

Comment 1:

To improve the quality of the manuscript, the authors could consider the following: Although this information may not be available in many studies, including the distribution setting of recruitment strategies (e.g., There may be differences in effectiveness depending on whether a flyer is handed directly to a student by a teacher during class time versus distributed at a P&C meeting) and the intended target audience of the recruitment material (e.g., adolescent girls directly or their parents/caregivers) as key characteristics could provide valuable insights. This approach would help identify which environments (e.g., schools, community, online platforms) and target audiences are most effective in engaging adolescent girls in physical activity programs.

Response: Thank you for this very helpful comment. As you have suggested, we will make note of the recruitment strategy setting in hopes of identifying which environments are most effective. The manuscript has been updated accordingly.

Comment 2:

While it may be beyond the scope of this study, it could be valuable to identify whether any specific retention strategies were implemented. Although the secondary aim includes examining any additional measures or adjustments to recruitment, understanding whether retention strategies were planned—particularly for longer-duration projects—could provide further insights into sustaining participant engagement.

Response: Thank you for this very helpful comment. While we will be reporting on retention as a secondary outcome, strategies to maintain retention are outside the scope of this current review. Depending on our findings, however, we will likely be including recommendations for future research around retention, as you have suggested.
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 2:

Comment 1:

To improve the quality of the manuscript, the authors could consider the following: Although this information may not be available in many studies, including the distribution setting of recruitment strategies (e.g., There may be differences in effectiveness depending on whether a flyer is handed directly to a student by a teacher during class time versus distributed at a P&C meeting) and the intended target audience of the recruitment material (e.g., adolescent girls directly or their parents/caregivers) as key characteristics could provide valuable insights. This approach would help identify which environments (e.g., schools, community, online platforms) and target audiences are most effective in engaging adolescent girls in physical activity programs.

Response: Thank you for this very helpful comment. As you have suggested, we will make note of the recruitment strategy setting in hopes of identifying which environments are most effective. The manuscript has been updated accordingly.

Comment 2:

While it may be beyond the scope of this study, it could be valuable to identify whether any specific retention strategies were implemented. Although the secondary aim includes examining any additional measures or adjustments to recruitment, understanding whether retention strategies were planned—particularly for longer-duration projects—could provide further insights into sustaining participant engagement.

Response: Thank you for this very helpful comment. While we will be reporting on retention as a secondary outcome, strategies to maintain retention are outside the scope of this current review. Depending on our findings, however, we will likely be including recommendations for future research around retention, as you have suggested.
Competing Interests: None. Close
Report a concern

Views

Reviewer Report 11 May 2024

Joey Murphy, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK

Approved

https://doi.org/10.21956/hrbopenres.15158.r38574

Thank you for inviting me to review your work. This is well written and there is clear value in completing this systematic review. Some minor comments/suggestions below. Best of luck with this work.

Abstract and Introduction ... Continue reading

The authors state the WHO guideline as “60 minutes of MVPA per day”. I realise this is how it is quoted in the WHO news release, however, would recommend using an “average of 60 minutes of MVPA per day” so that it aligns with the current WHO guidelines.

Protocol

Can the authors explain why they are excluding studies that include only overweight or obese cohorts? These would be seen as “hard to reach” and could gain the greatest benefit in physical activity engagement – so it seems like a missed opportunity.
The secondary outcomes are interested in highlighting challenges identified regarding recruitment, which is great. However, it would also be useful to highlight recruitment facilitators noted in studies as this can help share good practice.
Will Boolean operators be used to develop the final search strategy? If so, I would encourage adding to the protocol so it is clear how the search strategy will be developed. This may be available in Additional File 2, but I can’t access.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Physical activity and public health, implementation research, systematic literature review methods.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

Report a concern

Author Response 24 Dec 2024

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

24 Dec 2024

Author Response
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 1:

Comment 1:
... Continue reading
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 1:

Comment 1:

The authors state the WHO guideline as “60 minutes of MVPA per day”. I realise this is how it is quoted in the WHO news release, however, would recommend using an “average of 60 minutes of MVPA per day” so that it aligns with the current WHO guidelines.

Response: Thank you for this very helpful comment. We have updated the manuscript as you have suggested.

Protocol
Comment 2:

Can the authors explain why they are excluding studies that include only overweight or obese cohorts? These would be seen as “hard to reach” and could gain the greatest benefit in physical activity engagement – so it seems like a missed opportunity.

Response: Thank you for your insightful comment. We agree that this cohort can be challenging to engage and would benefit from physical activity initiatives. For this review, we have focused on the 'typical' adolescent girl, which may include those with overweight or obesity, but have excluded cohorts that exclusively comprise 'special populations' to limit the project's scope.

Comment 3:

The secondary outcomes are interested in highlighting challenges identified regarding recruitment, which is great. However, it would also be useful to highlight recruitment facilitators noted in studies as this can help share good practice.

Response: This is an excellent suggestion and we have updated the protocol accordingly.

Comment 4:

Will Boolean operators be used to develop the final search strategy? If so, I would encourage adding to the protocol so it is clear how the search strategy will be developed. This may be available in Additional File 2, but I can’t access.

Response: Thank you for highlighting this oversight regarding access to the search strategy. Boolean operators were used in its development, and it was previously included in Additional File 2. However, as HRB Open no longer publishes supplementary material, we have updated the Open Science Framework repository with the search strategy with this now included. The link to this repository has been included here for your convenience: https://doi.org/10.17605/OSF.IO/YAEW8.
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 1:

Comment 1:

The authors state the WHO guideline as “60 minutes of MVPA per day”. I realise this is how it is quoted in the WHO news release, however, would recommend using an “average of 60 minutes of MVPA per day” so that it aligns with the current WHO guidelines.

Response: Thank you for this very helpful comment. We have updated the manuscript as you have suggested.

Protocol
Comment 2:

Can the authors explain why they are excluding studies that include only overweight or obese cohorts? These would be seen as “hard to reach” and could gain the greatest benefit in physical activity engagement – so it seems like a missed opportunity.

Response: Thank you for your insightful comment. We agree that this cohort can be challenging to engage and would benefit from physical activity initiatives. For this review, we have focused on the 'typical' adolescent girl, which may include those with overweight or obesity, but have excluded cohorts that exclusively comprise 'special populations' to limit the project's scope.

Comment 3:

The secondary outcomes are interested in highlighting challenges identified regarding recruitment, which is great. However, it would also be useful to highlight recruitment facilitators noted in studies as this can help share good practice.

Response: This is an excellent suggestion and we have updated the protocol accordingly.

Comment 4:

Will Boolean operators be used to develop the final search strategy? If so, I would encourage adding to the protocol so it is clear how the search strategy will be developed. This may be available in Additional File 2, but I can’t access.

Response: Thank you for highlighting this oversight regarding access to the search strategy. Boolean operators were used in its development, and it was previously included in Additional File 2. However, as HRB Open no longer publishes supplementary material, we have updated the Open Science Framework repository with the search strategy with this now included. The link to this repository has been included here for your convenience: https://doi.org/10.17605/OSF.IO/YAEW8.
Competing Interests: None. Close
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Author Response 24 Dec 2024

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

24 Dec 2024

Author Response
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 1:

Comment 1:
... Continue reading
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 1:

Comment 1:

The authors state the WHO guideline as “60 minutes of MVPA per day”. I realise this is how it is quoted in the WHO news release, however, would recommend using an “average of 60 minutes of MVPA per day” so that it aligns with the current WHO guidelines.

Response: Thank you for this very helpful comment. We have updated the manuscript as you have suggested.

Protocol
Comment 2:

Can the authors explain why they are excluding studies that include only overweight or obese cohorts? These would be seen as “hard to reach” and could gain the greatest benefit in physical activity engagement – so it seems like a missed opportunity.

Response: Thank you for your insightful comment. We agree that this cohort can be challenging to engage and would benefit from physical activity initiatives. For this review, we have focused on the 'typical' adolescent girl, which may include those with overweight or obesity, but have excluded cohorts that exclusively comprise 'special populations' to limit the project's scope.

Comment 3:

The secondary outcomes are interested in highlighting challenges identified regarding recruitment, which is great. However, it would also be useful to highlight recruitment facilitators noted in studies as this can help share good practice.

Response: This is an excellent suggestion and we have updated the protocol accordingly.

Comment 4:

Will Boolean operators be used to develop the final search strategy? If so, I would encourage adding to the protocol so it is clear how the search strategy will be developed. This may be available in Additional File 2, but I can’t access.

Response: Thank you for highlighting this oversight regarding access to the search strategy. Boolean operators were used in its development, and it was previously included in Additional File 2. However, as HRB Open no longer publishes supplementary material, we have updated the Open Science Framework repository with the search strategy with this now included. The link to this repository has been included here for your convenience: https://doi.org/10.17605/OSF.IO/YAEW8.
Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 1:

Comment 1:

The authors state the WHO guideline as “60 minutes of MVPA per day”. I realise this is how it is quoted in the WHO news release, however, would recommend using an “average of 60 minutes of MVPA per day” so that it aligns with the current WHO guidelines.

Response: Thank you for this very helpful comment. We have updated the manuscript as you have suggested.

Protocol
Comment 2:

Can the authors explain why they are excluding studies that include only overweight or obese cohorts? These would be seen as “hard to reach” and could gain the greatest benefit in physical activity engagement – so it seems like a missed opportunity.

Response: Thank you for your insightful comment. We agree that this cohort can be challenging to engage and would benefit from physical activity initiatives. For this review, we have focused on the 'typical' adolescent girl, which may include those with overweight or obesity, but have excluded cohorts that exclusively comprise 'special populations' to limit the project's scope.

Comment 3:

The secondary outcomes are interested in highlighting challenges identified regarding recruitment, which is great. However, it would also be useful to highlight recruitment facilitators noted in studies as this can help share good practice.

Response: This is an excellent suggestion and we have updated the protocol accordingly.

Comment 4:

Will Boolean operators be used to develop the final search strategy? If so, I would encourage adding to the protocol so it is clear how the search strategy will be developed. This may be available in Additional File 2, but I can’t access.

Response: Thank you for highlighting this oversight regarding access to the search strategy. Boolean operators were used in its development, and it was previously included in Additional File 2. However, as HRB Open no longer publishes supplementary material, we have updated the Open Science Framework repository with the search strategy with this now included. The link to this repository has been included here for your convenience: https://doi.org/10.17605/OSF.IO/YAEW8.
Competing Interests: None. Close
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Version 3

VERSION 3 PUBLISHED 16 Feb 2024

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	1	2	3
Version 3 (revision) 09 May 25			read
Version 2 (revision) 24 Dec 24			read
Version 1 16 Feb 24	read	read

Joey Murphy, University of Bristol, Bristol, UK
Emma Pollock, The University of Newcastle School of Medicine and Public Health, Callaghan, Australia
Yumi Kim, University of Alabama at Birmingham, Birmingham, USA

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6 Views

27 May 2025 | for Version 3

Yumi Kim, University of Alabama at Birmingham, Birmingham, AL, USA

6 Views Cite this report Responses(0)

Approved

The authors addressed all comments in this revision appropriately. I do not have any further comments to make.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Physical activity intervention design and implementation; Health promotion for people with disabilities; Systematic review methods.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

26 Views

31 Jan 2025 | for Version 2

Yumi Kim, University of Alabama at Birmingham, Birmingham, AL, USA

26 Views Cite this report Responses(1)

Approved

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Physical activity intervention design and implementation; Health promotion for people with disabilities; Systematic review methods.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Responses (1)

Author Response

15 May 2025

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

Thank you for your very helpful suggestions. We have addressed each comment below.

Aims
While the focus on recruitment rates is well articulated, I suggest broadening the scope of the review to include additional response rates, such as adherence to the intervention and retention to follow-up. This expansion could be reflected in the aims section. Currently, Aim 1 appears to be solely focused on recruitment rates, but in the "Intervention" subsection, the authors indicate an intent to report adherence and retention rates. To clarify this point, Aim 1 could be reframed to encompass overall response rates, including recruitment, adherence, and retention. If you are willing to take this suggestion above, to enhance distinction, Aim 2 could specifically address the synthesis of the recruitment strategies and identification of successful recruitment strategies, while Aim 3 could concentrate on strategies that enhance adherence and retention. This revision would enrich the review’s narrative and provide a more comprehensive understanding of program effectiveness beyond recruitment alone.

Response:
Thank you for this constructive suggestion. While we agree that including adherence to the intervention would enrich the review, unfortunately, adherence was beyond the scope of our analysis. This manuscript is part of an overall larger PhD project focusing on recruitment of adolescent girls into PA programmes. Furthermore, due to the timeline of the review process, we have since finalised the manuscript and are preparing it for publication. As noted, we did include retention as a secondary outcome. We appreciate your insightful feedback and will consider it for future work.

Protocol
I recommend adding a PRISMA-P flowchart (or diagram) to the checklist, as a visual supplement can offer a clear snapshot of the study selection process.

Response:
Thank you we will include a PRISMA-P flowchart in the completed systematic review.

Population
The last two sentences of this section could be revised for clarity. For instance, you may provide the listed conditions as examples, such as: "... identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions." Then, I would separate the exclusion of athletic cohorts into a new sentence and explicitly state the justification for this exclusion. Additionally, if clinical trials including mixed-gender programs (boys and girls together) are to be excluded from the final synthesis, this should be explicitly stated.

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended.

“Studies that include adolescents who do not identify as female, who are outside the included age range, or who have been identified as a special population due to a health condition will be excluded, such as overweight, obesity, or other relevant health conditions. Studies that include only athletic cohorts from specific sports teams, for example, will be excluded, as athlete-only groups are also not representative of the typical population of adolescent girls.”

PICOTS - Timeframe
I appreciate that the study is structured using the PICOTS framework. To enhance clarity, I suggest specifying the duration of interventions under this subheading. It would be helpful to define the minimum criteria for an intervention. For example, if a program is delivered only once or over a brief period (e.g., one week), followed by post-intervention measures, would it still be included in the review?

Response:
Thank you for this thoughtful suggestion. We have updated the manuscript as you have recommended in the ‘Intervention’ section.

“Any PA programmes, defined for the purposes of this review as organised, repeated PA activities, which may be online, community, or school-based programmes that provide adolescent girl-only physical activity opportunities, will be included. As physical adaptations to PA programmes have been shown to require a minimum of 2-4 weeks [1], interventions must have had a minimum of 4 weeks’ length to be included.”

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

32 Views

31 Oct 2024 | for Version 1

Emma Pollock, The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia

32 Views Cite this report Responses(1)

Approved

Although this information may not be available in many studies, including the distribution setting of recruitment strategies (e.g., There may be differences in effectiveness depending on whether a flyer is handed directly to a student by a teacher during class time versus distributed at a P&C meeting) and the intended target audience of the recruitment material (e.g., adolescent girls directly or their parents/caregivers) as key characteristics could provide valuable insights. This approach would help identify which environments (e.g., schools, community, online platforms) and target audiences are most effective in engaging adolescent girls in physical activity programs.
While it may be beyond the scope of this study, it could be valuable to identify whether any specific retention strategies were implemented. Although the secondary aim includes examining any additional measures or adjustments to recruitment, understanding whether retention strategies were planned—particularly for longer-duration projects—could provide further insights into sustaining participant engagement.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Physical activity in children and adolescents; girls' physical activity levels and sport participation; School- and community-based physical activity interventions; Physical Education (PE); implementation and sustainment of physical activity programs.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Responses (1)

Author Response

24 Dec 2024

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 2:

Comment 1:

To improve the quality of the manuscript, the authors could consider the following: Although this information may not be available in many studies, including the distribution setting of recruitment strategies (e.g., There may be differences in effectiveness depending on whether a flyer is handed directly to a student by a teacher during class time versus distributed at a P&C meeting) and the intended target audience of the recruitment material (e.g., adolescent girls directly or their parents/caregivers) as key characteristics could provide valuable insights. This approach would help identify which environments (e.g., schools, community, online platforms) and target audiences are most effective in engaging adolescent girls in physical activity programs.

Response: Thank you for this very helpful comment. As you have suggested, we will make note of the recruitment strategy setting in hopes of identifying which environments are most effective. The manuscript has been updated accordingly.

Comment 2:

While it may be beyond the scope of this study, it could be valuable to identify whether any specific retention strategies were implemented. Although the secondary aim includes examining any additional measures or adjustments to recruitment, understanding whether retention strategies were planned—particularly for longer-duration projects—could provide further insights into sustaining participant engagement.

Response: Thank you for this very helpful comment. While we will be reporting on retention as a secondary outcome, strategies to maintain retention are outside the scope of this current review. Depending on our findings, however, we will likely be including recommendations for future research around retention, as you have suggested.

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Competing Interests

None.

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Reviewer Report

35 Views

11 May 2024 | for Version 1

Joey Murphy, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK

35 Views Cite this report Responses(1)

Approved

The authors state the WHO guideline as “60 minutes of MVPA per day”. I realise this is how it is quoted in the WHO news release, however, would recommend using an “average of 60 minutes of MVPA per day” so that it aligns with the current WHO guidelines.

Protocol

Can the authors explain why they are excluding studies that include only overweight or obese cohorts? These would be seen as “hard to reach” and could gain the greatest benefit in physical activity engagement – so it seems like a missed opportunity.
The secondary outcomes are interested in highlighting challenges identified regarding recruitment, which is great. However, it would also be useful to highlight recruitment facilitators noted in studies as this can help share good practice.
Will Boolean operators be used to develop the final search strategy? If so, I would encourage adding to the protocol so it is clear how the search strategy will be developed. This may be available in Additional File 2, but I can’t access.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Physical activity and public health, implementation research, systematic literature review methods.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Author Response

24 Dec 2024

Tanya O'Brien, Physiotherapy, The University of Dublin Trinity College, Dublin, Ireland

Dear Reviewer, thank you for your very helpful and insightful comments. We have updated our manuscript accordingly, with the following revisions.

Reviewer 1:

Comment 1:

The authors state the WHO guideline as “60 minutes of MVPA per day”. I realise this is how it is quoted in the WHO news release, however, would recommend using an “average of 60 minutes of MVPA per day” so that it aligns with the current WHO guidelines.

Response: Thank you for this very helpful comment. We have updated the manuscript as you have suggested.

Protocol
Comment 2:

Can the authors explain why they are excluding studies that include only overweight or obese cohorts? These would be seen as “hard to reach” and could gain the greatest benefit in physical activity engagement – so it seems like a missed opportunity.

Response: Thank you for your insightful comment. We agree that this cohort can be challenging to engage and would benefit from physical activity initiatives. For this review, we have focused on the 'typical' adolescent girl, which may include those with overweight or obesity, but have excluded cohorts that exclusively comprise 'special populations' to limit the project's scope.

Comment 3:

The secondary outcomes are interested in highlighting challenges identified regarding recruitment, which is great. However, it would also be useful to highlight recruitment facilitators noted in studies as this can help share good practice.

Response: This is an excellent suggestion and we have updated the protocol accordingly.

Comment 4:

Will Boolean operators be used to develop the final search strategy? If so, I would encourage adding to the protocol so it is clear how the search strategy will be developed. This may be available in Additional File 2, but I can’t access.

Response: Thank you for highlighting this oversight regarding access to the search strategy. Boolean operators were used in its development, and it was previously included in Additional File 2. However, as HRB Open no longer publishes supplementary material, we have updated the Open Science Framework repository with the search strategy with this now included. The link to this repository has been included here for your convenience: https://doi.org/10.17605/OSF.IO/YAEW8.

View more View less

Competing Interests

None.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol

Abstract

Background

Methods

Discussion

Systematic review registration

Keywords

Revised Amendments from Version 1

Introduction

Protocol

Methods/design

Aim

Eligibility criteria

Population

Interventions

Comparison

Outcomes

Timeframe

Study type

Information sources and search strategy

Study records

Data management

Screening and selection process

Data extraction process

Quality assessment

Data synthesis

Analysis of subgroups or subsets

Discussion

List of abbreviations

Data availability

Underlying data

Reporting guidelines

Acknowledgements

References

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