Before-school physical activity programs and youth physical activity, health and learning-related outcomes: a systematic review

Abstract

Introduction: School-based approaches have been recommended to address inadequate physical activity (PA) levels among children and adolescents. This includes opportunities before and after school, distinct from curricular time and associated barriers. Available research in the before school space, including reviews, has predominantly focused on active transport. Accordingly, this review aimed to synthesise available evidence and evaluate the impact of school-based, before-school PA programs on PA levels, health indicators and learning-related outcomes. Methods: Five databases were searched up to January 2021. Eligibility criteria were: (a) original research, published in English, (b) examined school-based PA programs delivered before school start time, (c) sample included typically developing school-age children and/or adolescents, (d) reported associations with PA, physical health, learning-related, and/or psychosocial outcome domains, (e) included a comparator. Studies examining before-school active transport or sport were excluded. Risk of bias was assessed for each outcome domain using the Cochrane Collaboration tools. Associations with each outcome domain and subdomain (categories of characteristic-sharing variables) were synthesised as null, indeterminate, positive or negative, according to the consistency and direction of individual study findings. Results: Thirteen articles representing 10 studies were included, published between 2012 and 2020. Seven studies were conducted in primary schools. Programs ranged between 3 weeks and 6 months, primarily operating daily and for 25-40 minutes. One study explicitly aligned the examined program to theory, while six incorporated fidelity measures. Risk of bias was high among randomised studies (n=4) for each outcome domain, and serious or insufficiently detailed for non-randomised studies (n=6) in all domains except PA, which included moderate-risk studies. Associations were indeterminate for the physical health, learning-related and psychosocial outcome domains. Among subdomains, associations were positive with before-school and daily PA, cardiorespiratory and muscular fitness, and readiness to learn. An inverse association was found with adiposity. Discussion: Existing evidence on before-school PA programs is limited, having arisen from few studies with concerning levels of bias. In particular, evidence on PA outcomes and secondary school populations is lacking. Further research examining PA levels associated with before-school programs can improve understanding of their potential role in addressing downward trends in PA. The feasibility of sustained implementation in schools without support from external providers or researchers should also receive attention through follow-up research and qualitative perspectives. Conflict of interest statement: The authors have no relevant conflict of interest to declare.