Abstract
BackgroundIncreasing children’s physical activity (PA) at school is critical to obesity prevention and health promotion. Implementing novel, low-cost PA programs offers potential to contribute to children’s in-school PA, particularly in resource-constrained schools. This evaluation describes implementation fidelity, reach, and dose of two PA programs in the Fueling Learning through Exercise (FLEX) Study.MethodsThirteen diverse, low-income Massachusetts elementary schools were recruited and randomized to the 100 Mile Club walking/running program (n = 7) or CHALK/Just Move classroom activity break PA program (n = 6). Intervention programs were delivered across two school years. Surveys with program champions/teachers and children, in-session measurement of children’s PA by accelerometry (Actigraph GT3X) in a subset of schools, and key informant interviews were used to collect information on implementation, including fidelity, dose, reach, and sustainability, and to calculate an implementation score.ResultsSix CHALK/Just Move schools implemented the program in both years. Two schools randomized to 100 Mile Club did not implement at all, and only three schools implemented both years. Implementing schools had similar implementation scores (range = 0–3; 100 Mile Club = 2.0 vs. CHALK/Just Move = 1.9) but fidelity to core and enhanced elements differed between programs. In 100 Mile Club schools, dose of program delivered was greater than in CHALK/Just Move schools (34.9 vs. 19.7 min per week). Dose of PA received per session was also greater in 100 Mile Club schools (n = 55, 2 schools) compared with CHALK/Just Move schools (n = 160, 2 schools) (13.6 min vs. 2.7 min per session). A slightly higher proportion of eligible children participated in CHALK/Just Move compared to 100 Mile Club (54.0% vs. 31.2%). Both programs were well received by champions/teachers and students.ConclusionsProgram implementation varied across programs and schools, and erosion in delivery was seen over the two years. However, among implementing schools, additional PA was delivered and received, and the programs were generally well-received. Although school resource issues remain barriers to implemention, this evaluation demonstrates that low-cost programs may enhance PA opportunities. Future research should evaluate how multiple programs can be implemented to increase children’s PA at school.Trial registrationClinicalTrials.gov Identifier: NCT02810834. Registered May 11, 2015.
Highlights
Increasing children’s physical activity (PA) at school is critical to obesity prevention and health promotion
This paper describes the implementation of two innovative school-based PA programs in the Fueling Learning through Exercise (FLEX) study [14], a cluster-randomized-controlled trial designed to evaluate the impact of two programs, 100 Mile Club® and CHALK/Just MoveTM, on PA, cognition, and academic outcomes among elementary school children from low-income communities
The schools randomized to 100 Mile Club and CHALK/Just Move are similar: more than half of the students are non-white (62.6% non-white at 100 Mile Club schools; 58.9% non-white at CHALK/Just Move schools) and more than a third are from economically disadvantaged families [23] (39.2% at 100 Mile Club; 45.0% at CHALK/Just Move schools)
Summary
Increasing children’s physical activity (PA) at school is critical to obesity prevention and health promotion. Implementing novel, low-cost PA programs offers potential to contribute to children’s in-school PA, in resource-constrained schools. Experts have recently called for a “whole school” approach to increasing children’s PA [8], in which physical education (PE), recess, in-class PA breaks, and beforeand after-school programs collectively promote a healthy school environment. Evidence suggests that this may be even more critical for socioeconomically disadvantaged children who often accrue a greater proportion of their total daily PA at school [9]. Even small increases in school-time MVPA may lead to the accumulation of additional daily PA and contribute positively to academic outcomes [12]
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