Effectiveness and cost-effectiveness of the PLAN-A intervention, a peer led physical activity program for adolescent girls: results of a cluster randomised controlled trial

Russell Jago,Simon J Sebire,Ruth R Kipping,Emily Sanderson,Tom Reid,Byron Tibbitts,William Hollingworth,Kathryn Willis,Stephanie J Macneill,Rebecca Kandiyali,Rona Campbell

doi:10.1186/s12966-021-01133-8

Abstract

BackgroundPhysical activity is associated with improved health. Girls are less active than boys. Pilot work showed that a peer-led physical activity intervention called PLAN-A was a promising method of increasing physical activity in secondary school age girls. This study examined the effectiveness and cost-effectiveness of the PLAN-A intervention.MethodsWe conducted a cluster randomised controlled trial with Year 9 (13–14 year old) girls recruited from 20 secondary schools. Schools were randomly assigned to the PLAN-A intervention or a non-intervention control group after baseline data collection. Girls nominated students to be peer leaders. The top 18 % of girls nominated by their peers in intervention schools received three days of training designed to prepare them to support physical activity. Data were collected at two time points, baseline (T0) and 5–6 months post-intervention (T1). Participants wore an accelerometer for seven days to assess the primary outcome of mean weekday minutes of moderate-to-vigorous physical activity (MVPA). Multivariable mixed effects linear regression was used to estimate differences in the primary outcome between the two arms on an Intention-to-Treat (ITT) basis. Resource use and quality of life were measured and a within trial economic evaluation from a public sector perspective was conducted.ResultsA total of 1558 girls were recruited to the study. At T0, girls in both arms engaged in an average of 51 min of MVPA per weekday. The adjusted mean difference in weekday MVPA at T1 was − 2.84 min per day (95 % CI = -5.94 to 0.25) indicating a slightly larger decline in weekday MVPA in the intervention group. Results were broadly consistent when repeated using a multiple imputation approach and for pre-specified secondary outcomes and sub-groups. The mean cost of the PLAN-A intervention was £2817 per school, equivalent to £31 per girl. Economic analyses indicated that PLAN-A did not lead to demonstrable cost-effectiveness in terms of cost per unit change in QALY.ConclusionsThis study has shown that the PLAN-A intervention did not result in higher levels of weekday MVPA or associated secondary outcomes among Year 9 girls. The PLAN-A intervention should not be disseminated as a public health strategy.Trial registrationISRCTN14539759–31 May, 2018.

Highlights

Physical activity is associated with improved health
This study has shown that the Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A) intervention did not result in higher levels of weekday moderate-to-vigorous intensity physical activity (MVPA) or associated secondary outcomes among Year 9 girls
A largely under-explored approach to increasing physical activity among girls is via peer supporters, which is a method that has been shown to be effective to reduce smoking in the ASSIST (A Stop Smoking In Schools Trial) programme [9]

Summary

Introduction

Physical activity is associated with improved health. Girls are less active than boys. The amount of physical activity in which young people engage decreases with age and a number of studies have shown that large proportions of adolescents do not meet the current public health guidance of an hour of moderate-to-vigorous intensity physical activity (MVPA) per day [4,5,6]. This issue is acute among girls, with girls less active than boys from the start of primary school and the slope of decline being steeper than boys throughout adolescence [4,5,6]. The limited effectiveness of these programmes has led to calls for more novel school-based approaches to increase physical activity for girls [8]

Methods

Results

Discussion

Conclusion