Abstract
Action Schools! BC (AS! BC) was scaled-up from an efficacy trial to province-wide delivery across 11 years (2004–2015). In this study we: (1) describe strategies that supported implementation and scale-up; (2) evaluate implementation (teachers’ physical activity (PA) delivery) and student’s PA and cardiorespiratory fitness (CRF) within a cluster randomized controlled trial during years 2 and 3 of scale-up; and (3) assess relationships between teacher-level implementation and student-level outcomes. We classified implementation strategies as process, capacity-building or scale-up strategies. Elementary schools (n = 30) were randomized to intervention (INT; 16 schools; 747 students) or usual practice (UP; 14 schools; 782 students). We measured teachers’ PA delivery (n = 179) using weekly logs; students’ PA by questionnaire (n = 30 schools) and accelerometry (n = 9 schools); and students’ CRF by 20-m shuttle run (n = 25 schools). INT teachers delivered more PA than UP teachers in year 1 (+33.8 min/week, 95% CI 12.7, 54.9) but not year 2 (+18.8 min/week, 95% CI −0.8, 38.3). Unadjusted change in CRF was 36% and 27% higher in INT girls and boys, respectively, compared with their UP peers (year 1; effect size 0.28–0.48). Total PA delivered was associated with change in children’s self-reported MVPA (year 1; r = 0.17, p = 0.02). Despite the ‘voltage drop’, scaling-up school-based PA models is feasible and may enhance children’s health. Stakeholders must conceive of new ways to effectively sustain scaled-up health promoting interventions if we are to improve the health of students at a population level. Clinical Trials registration: NCT01412203.
Highlights
Physical activity (PA) [1] and cardiorespiratory fitness (CRF) [2] are powerful, independent [3] indicators of child and youth health
Implementation Process Strategies: The Support Team worked with schools to support implementation of Action Schools! British Columbia (BC) (AS! BC)
AS! BC is one of only two other whole-school PA models (CATCH [73] and Take10! [74]) to be implemented at scale with continuous stakeholder support over more than a decade; (ii) we evaluated the impact of AS! BC across two years of scale-up in a large and diverse cohort of children (~1500 children across the province); and (iii) we investigated the link between program implementation and student-level health outcomes
Summary
Physical activity (PA) [1] and cardiorespiratory fitness (CRF) [2] are powerful, independent [3] indicators of child and youth health. Relatively few children and youth engage in recommended amounts of PA [4]; national and international data show secular declines in both PA [5,6] and CRF [6,7,8]. PA and CRF track across childhood [9], into adolescence [10] and early adulthood [11,12]. High CRF in adolescence is associated with reduced risk of cardiovascular events, cancer and premature mortality in adulthood [13,14,15]. Effective strategies that reach large numbers of young children are urgently needed to promote PA and CRF, and to maintain behaviors across the life course. Most interventions do not extend beyond short-term (e.g., one month to one school year in length) well-controlled efficacy
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