Interventions to Change School Recess Activity Levels in Children and Adolescents: A Systematic Review and Meta-Analysis.

Abstract

The school environment is globally recognised as a key setting to promote child and adolescent physical activity. School recess contributes up to 40% of the school day and recommended physical activity levels, providing a critical physical activity promotion opportunity for children and adolescents. To examine the effectiveness of school recess interventions on children's and adolescents' physical activity (PA) and sedentary behaviour (SED) during this time. Systematic review and meta-analysis. EBSCOhost (Academic Search Complete, Education Source, ERIC, Global Health, MEDLINE complete, SPORTDiscus), Scopus, and ProQuest electronic databases with full text. Forty-three studies were included in the systematic review, trialling eight different intervention strategies including loose equipment, structured recess, and multicomponent studies. The meta-analysis included 16 studies. Overall, between group mean difference for: (i) time spent in moderate to vigorous-intensity physical activity (MVPA) for randomised controlled trials (RCTs) (n = 6) was 0.18 (95% CI - 0.00 to 0.36) with a marginal significant effect of Z = 1.93 (p = 0.05), (ii) time spent in MVPA for non-RCTs (n = 7) was 0.52 (95% CI - 0.01 to 1.03) with an overall effect of Z = 1.99 (p = 0.05), (iii) time spent in sedentary behaviour for RCTs (n = 3) was - 0.48 (95% CI - 1.38 to 0.43) with an overall effect of Z = 1.03 (p = 0.30). All outcomes had high heterogeneity. School recess interventions show promise for increasing MVPA. It was difficult to draw strong conclusions due to low study numbers in the meta-analysis and varied intervention designs. Interventions may need to focus on single component strategies (e.g., loose equipment) to improve understanding of outcome effects for future studies.