School-based Physical Activity Promotion Research Articles

Comprehensive School Physical Activity Programming in Dubai International Schools: A Mixed Methods Study

The purpose of this study was to examine comprehensive school physical activity program (CSPAP) policies and practices in interna-tional schools in Dubai, the United Arab Emirates. Following an ex-planatory-sequential mixed-methods research design, the researchers employed the Comprehensive School Physical Activity Program Policies and Practices Questionnaire (CSPAP-Q) and follow-up interviews to describe CSPAP implementation and explore implementation enablers and challenges. A convenience sample of physical education teachers (N=18) participated in the questionnaire, and seven of these teachers participated in individual interviews. Teachers’ responses to the ques-tionnaire indicated considerable heterogeneity and numerous gaps in existing school-based physical activity opportunities and promotion O'Reilly and Websterefforts. Interviews revealed three themes related to CSPAP implemen-tation: (a) time constraints in secondary schools, (b) facilities, and (c) location. This study provides an initial glimpse into whole-of-school physical activity programming in Dubai international schools.

Increasing adolescents’ physical activity levels through a comprehensive school-based physical activity program: study protocol of the cluster randomized controlled trial Active School

BackgroundThe positive effects of regular physical activity on children and adolescents’ physical and mental health are well-established. Despite these health benefits, most Swiss adolescents do not meet WHO’s recommended level of physical activity, which includes a daily minimum of 60 min of moderate-to-vigorous physical activity. Due to their inclusivity, schools are identified as a key setting to promote physical activity. Recently, the comprehensive school physical activity program (CSPAP), in which teachers as physical activity leaders (PALs) play a crucial role to advance comprehensive school-based physical activity promotion, has been discussed. However, such comprehensive approaches are still lacking in Switzerland, and specific PAL trainings do not exist. Therefore, the aim of this study is to implement and evaluate Active School, a comprehensive school-based physical activity program for Swiss secondary schools with integrated PAL training.Methods/designA cluster randomized controlled trial (RCT) involving 12 secondary schools (6 experimental, 6 waiting control schools) will assess baseline data and effectiveness of Active School at 12 and 24 months. Active School includes five components based on the CSPAP. Each school is encouraged to set individual physical activity goals in this regard. This process is guided by the PALs, who will participate in professional development training before and during Active School implementation. As a primary outcome, students’ moderate-to-vigorous physical activity will be assessed via accelerometers. As secondary outcomes, inactivity, light physical activity, step counts, aerobic fitness and coordination will be measured, and students’ general wellbeing, learning behavior, and multiple psychosocial measures related to physical activity will be assessed by questionnaires. The effectiveness evaluation is accompanied by a process evaluation that focuses on the implementation outcomes of dose of delivery, reach, feasibility, and sustainability. A mixed methods approach, including ripple effect mapping, will be employed to reconstruct and understand the implementation process.DiscussionThis study will be the first to implement and evaluate a CSPAP in the Swiss school system. The specific PAL training and the simultaneous application of effectiveness and process evaluation are considered strengths of the study.Trial registrationGerman Clinical Trials Register (DRKS00033362). Date of registration: January 25, 2024. Retrospectively registered.

Attributes Contributing to the Use of Technology in School-Based Physical Activity Promotion: A Diffusion of Innovations Approach

Purpose: This study examined the attributes contributing to the use of technology among school staff to facilitate and promote physical activity. Method: A mixed-methods sequential explanatory research design was employed with the diffusion of innovations theory as a guide. The Comprehensive School Physical Activity Program Technology Practice Questionnaire, a diffusion of innovations questionnaire, and semistructured interviews were used to collect data. Multiple regression analysis and open and axial coding techniques were conducted to analyze quantitative and qualitative data, respectively. Results: Complexity and trialability attributes contributed to the use of technology in schools. Despite acknowledging the benefits of technology use in promoting physical activity, school staff also expressed concerns about barriers and risks related to its use. Discussion/Conclusion: The study provides insights into factors affecting the use of technology among school staff and recommends that schools, districts, and professional organizations offer more opportunities for staff to explore and learn about various technologies.

Adapting a Preschool Physical Activity Intervention to Be Inclusive of Children on the Autism Spectrum

ABSTRACT Interventions for promoting physical activity designed specifically for preschoolers with autism spectrum disorders (ASD) are lacking, which is problematic given the low rates of physical activity among this population. This study used a stakeholder-engaged approach to adapt the Wellness Enhancing Physical Activity for Young Children (WE PLAY) teacher training for preschoolers with ASD. Specifically, we solicited and integrated feedback from experts in ASD, adapted physical education, and school-based physical activity promotion, and we incorporated behavioural teaching strategies while preserving the intervention’s core components and theoretical basis. Following the adaptation process, teachers and a public preschool director implemented WE PLAY-Autism. This case study reports on the adaptation process and process evaluation from the WE PLAY-Autism pilot study. Results indicated high feasibility and acceptability. WE PLAY-Autism warrants further research and dissemination to preschools that aim to appropriately include students with ASD in physical activity.

Efficacy and mechanisms of an education outside the classroom intervention on pupils’ health and education: the MOVEOUT study protocol

BackgroundEducation can create better opportunities for health, and vice versa. Using a so-called ‘add-in’ approach, school-based physical activity (PA) promotion and prevention of sedentary behaviours can increase pupils’ wellbeing and learning and, on the longer term, reduce the risk of non-communicable diseases. A PA ‘add-in’ approach involves integrating PA into teachers’ curricular obligations without being an extra burden as opposed to an ‘add-on’ approach which requires additional operational resources and include activities that do not explicitly contribute towards curricular targets making them less long-term acceptable in a school-based context.Previous studies investigating education outside the classroom (EOtC) show mutual benefits for both health and education outcomes among children and adolescents. However, the evidence is of mixed quality and questionable certainty, which calls for further investigation. The aim of this study protocol is to describe and discuss the study design and methods to investigate the efficacy and mechanisms of EOtC as a vehicle for health and education. The study investigates the intervention developed and conducted in the TEACHOUT study with updated and strengthened design and measures.MethodsThe efficacy of EOtC will be investigated in a cluster randomised waitlist design. Participants will be pupils in ~54 classes, grades 4-10 (ages 10-15 years) in ~30 Danish elementary schools. Fifteen schools will be randomised to the intervention: a two-day EOtC training course targeting teachers followed by the teachers implementing EOtC >5 hours weekly over the course of one school year. Pre- and post-measures of health (PA and wellbeing) and learning (school motivation and academic achievement) will be collected. Investigation of pedagogical and motivational mechanisms will be based on observations of EOtC.DiscussionThe updated randomised controlled design will provide firmer evidence for the efficacy and mechanisms of EOtC and provide knowledge about how mutual benefits of health and education can be obtained.Trial registrationRegistered with ClinicalTrials.gov (ID NCT05237674) [University of Copenhagen. MOVEOUT: a Cluster RCT of the Efficacy, Mechanisms, and Mediation of an Education Outside the Classroom Intervention on Adolescents’ Physical Activity, 2023], February 14, 2022. Most recently updated on November 23, 2022 (Version 2).

S12-1 School-based interventions to promote physical activity amongst children and adolescents

Abstract Background Regular physical activity (PA) is associated with many benefits for physiological and mental wellbeing in children and adolescents. Despite this, many children and adolescents are failing to meet current PA guidelines. Given the age-related declines in PA as children move into adolescence, and then adulthood, the development of interventions to promote PA in this population is important. Schools have been identified as a key setting for the promotion of health-related behaviours, and young people spend a significant proportion of their waking day within the school setting. Aim This symposium will engage researchers, practitioners, health care professionals and policy makers to discuss novel school-based interventions. The objectives of this symposium are to: (1) Disseminate the findings of school-based interventions across a number of countries (France, Ireland, United Kingdom, Spain); (2) Highlight cross-cultural challenges in the development and evaluation of school-based interventions, and (3) Outline how co-design and Patient and Public Involvement (PPI) have been utilised in the development of school-based interventions. Symposia presentations 1. The effectiveness of a peer-led school-based walking intervention on adolescent girls’ physical activity: the Walking In ScHools (WISH) study. This presentation will highlight findings from the first fully powered trial to investigate the effectiveness of a peer-led brisk walking intervention in adolescent girls, including primary and secondary outcome data, and process evaluation measures. 2. School-based physical activity promotion in a cross-cultural context: interventions from France and Spain. This presentation will highlight key learnings on how best to connect cross-cultural educational contexts for the promotion of physical activity and discuss the development of a cross-cultural intervention guide. 3. Co-production of the Move Well, Feel Good movement behaviours intervention. This presentation will describe the feasibility evaluation of the Move Well, Feel Good intervention. The Move Well, Feel Good intervention was developed using a co-design approach, and aims to enhance children’s mental health through motor competence and psychosocial development. 4. Physical activity trends among Second-level Active School Flag programme 2019-2021. This presentation will evaluate the impact of the Active School Flag programme and outline changes in physical activity levels over a three-year period.

S12-3 School-based physical activity promotion in a cross-cultural context: interventions from France and Spain

Abstract Purpose School-based interventions seems to be effective to promote active lifestyles among youth but recent literature shows that these interventions have a lack of effectiveness and very few report data on its sustainability. In the same way, few of these interventions are being replicated in different contexts than their beginning. Therefore, the balance between the adaptability and fidelity of a programme in a new context is nowadays an implementation gap. Project For this reason, the 2PASS-4Health (Promoting PA in Secondary Schools for Health) project has created a collaborative network between different European universities with the purpose of promoting Health-Enhancing Physical Activity (HEPA) in adolescents in a school-based environment. This project was made to identify the good practices and the main problems linked to the design, implementation, evaluation, and sustainability of interventions aimed at HEPA promotion. In this line, two school-based (effective) interventions in a cross-cultural context have been disseminated and developed, at the same time, both in France and Spain respectively to examine the key parts in the process of fidelity, adaptability and sustainability of them. The intervention developed in France, took place in Tarbes, a little city in the south of the country. In the other side of the Pyrenees, the other intervention took place in Jaca (Spain), in the north of Aragon’s region. Both interventions adopted a multi-level approach involving all parts of the educational community: students, families, teachers and policymakers. The research team (all together) with the school’s staff developed the interventions by a co-creational process helped by local policymakers. As a result of these interventions, an intervention guide was developed. This tool can be used by stakeholders to disseminate and adapt these school-based interventions to make their effects sustainable over time (sustainability). Conclusion The collaborative line of this project renders visible the possibility of connecting cross-cultural educational contexts, through common elements in similar school-based interventions, with the aim of creating environments that promote HEPA.

O.4.6-11 MOVEOUT: a cluster randomised wait list design to investigate the effect of education outside the classroom on pupil’s physical activity

Abstract Purpose Education outside the classroom (EOtC) is a physical activity (PA)-integrating pedagogical approach that aligns PA with the primary goals of schools and is therefore thought to present an acceptable, feasible, and efficacious model for school-based PA. The aim of this study was to investigate the efficacy of an EOtC intervention that aims to increase adolescents’ (ages 10-16 years) school-based and overall PA by providing a course on the pedagogical and didactic methods of EOtC to teachers across 30 Danish schools, and subsequently the teachers implementing EOTC in their classes > 5 hours weekly over the course of one school year. We expect that pupils in the intervention group will retain higher PA intensities compared to the control group, specifically 1a) more MVPA, 1b) more LPA, 1c) less SED time. Further, we hypothesise that pupils in the intervention group will retain 2a) more running, 2b) more walking, 2c) more standing, 2d) less sitting time compared to the control group. Methods The intervention was evaluated using a cluster randomised wait list study comparing PA behaviours amongst pupils in the intervention group with pupils in the waitlist control group. Results In this presentation, we will present novel results from data that is currently underway. Data collection is expected to be finalised in June 2023. Conclusions Almost 20% of Danish schools practice some form of EOtC, and the findings of this study will inform whether such practice should be further encouraged in Denmark and elsewhere, or whether alterations are required to support more pupils in meeting PA recommendations. The findings have important implications for school-based PA promotion. Novo Nordisk Foundation (grant no. 0062703), ClinicalTrials.gov (NCT number: NCT05237674). Peter Elsborg and Lærke Mygind share first-authorship.

Feasibility and acceptability of at-home play kits for middle school physical activity promotion during the COVID-19 pandemic

BackgroundSchools are central to providing opportunities for youth physical activity (PA), however such opportunities were limited during the COVID-19 pandemic. Identifying feasible, acceptable, and effective approaches for school-based PA promotion amid pandemic-related barriers can inform resource allocation efforts in future circumstances necessitating remote instruction. The aims of this study were to: (1) describe the pragmatic, stakeholder-engaged and theory-informed approach employed to adapt one school’s PA promotion efforts to pandemic restrictions, leading to the creation of at-home “play kits” for students, and (2) assess the feasibility, acceptability, and preliminary effectiveness of this intervention.MethodsIntervention activities occurred in one middle school (enrollment: 847) located in a Federal Opportunity Zone in the Seattle, WA area, with control data from a nearby middle school (enrollment: 640). Students at the intervention school were eligible to receive a play kit during the quarter they were enrolled in physical education (PE) class. Student surveys were completed across the school year (n = 1076), with a primary outcome of days/week that the student engaged in ≥ 60 min of PA. Qualitative interviews (n = 25) were conducted with students, staff, parents, and community partners, and focused on play kit acceptability and feasibility.ResultsDuring remote learning play kits were received by 58% of eligible students. Among students at the intervention school only, students actively enrolled in PE (versus not enrolled) reported significantly more days with ≥ 60 min of PA in the previous week, however the comparison between schools was not statistically significant. In qualitative interviews, most students reported the play kit motivated them to participate in PA, gave them activity ideas, and made virtual PE more enjoyable. Student-reported barriers to using play kits included space (indoors and outdoors), requirements to be quiet at home, necessary but unavailable adult supervision, lack of companions to play outdoors, and inclement weather.ConclusionsA pre-existing community organization-school partnership lent itself to a rapid response to meet student needs at a time when school staff and resources were highly constrained. The intervention developed through this collaborative response—play kits—has potential to support middle school PA during future pandemics or other conditions that necessitate remote schooling, however modifications to the intervention concept and implementation strategy may be needed to improve reach and effectiveness.

Active Schools in Europe—A Review of Empirical Findings

Physical activity is an important part of children’s and young people’s healthy functioning, but evidence suggests many students are inactive to the extent that they are compromising their well-being. Traditionally, schools have played a minor role in contributing to physical activity, but it has held relatively low prestige. Some commentators have called for Whole-School or Active School approaches. Physical activity, in these models, is integrated into all aspects of school life. This article reports on a review of the most-cited elements of school-based physical activity promotion, assesses evidence of actual and potential contributions, and provides a tentative weight of evidence judgement for each component. A rapid reviewing methodology was followed, and the searches used a range of specialist academic databases (PsycARTICLES, PsycINFO, SPORTdiscus, CINAHL Complete), Google Scholar, ResearchGate, and Academia.edu, restricted to 2010–2021. Six settings were found to have the potential to add physical activity time, although none suffices alone: Active Breaks; Active Homework; Active Learning; Active Recess; Active Transport; and School Sports. Active Schools offer a plausible solution to the problem of physical inactivity by adding moments of movement and integrating physical activity in all aspects of school life, underlining the need for school-level change, the consideration of stakeholder groups, and the social and physical environments of school.

Barriers and facilitators to comprehensive, school-based physical activity promotion for adolescents prior to and during the COVID-19 pandemic: a qualitative study.

This study aimed to identify barriers and facilitators to comprehensive, school-based physical activity (PA) promotion among adolescents prior to and during the coronavirus disease of 2019 (COVID-19) pandemic, considering the perspectives of students, parents, and school staff. Data were collected from 2020 to 2021 using semi-structured individual interviews with students (n = 15), parents (n = 20), and school staff (n = 8) at a Title I middle school (i.e.high percentage of students from low-income families). Two theoretical frameworks guided analysis: the Comprehensive School Physical Activity Program framework and Bronfenbrenner's ecological systems theory. Using an iteratively developed codebook, data were coded, thematically analyzed, and synthesized. PA barriers and facilitators were present throughout the school day, at home, and in the community. Key determinants included pandemic-induced challenges (e.g. COVID-19 exposure); neighborhood characteristics/weather (e.g. neighborhood safety); school-family communication/collaboration; implementation climate (i.e.school staff's support for programming); time, spatial, and monetary resources (e.g. funding); staffing capacity/continuity and school champions; staffing creativity and adaptability; PA opportunities before, during, and after school; and child's motivation/engagement. Efforts to improve school-based PA programs, irrespective of pandemic conditions, should include strategies that address factors at the community, school, family and individual levels. School-family communication/collaboration, school staff programming support, and PA opportunities throughout the day can help promote comprehensive, school-based PA.

P02-01 Promoting Physical Activity in Secondary School for Health, a collaborative European project

IssueThe 2PASS-4Health project (Promoting Physical Activity in Secondary School for Health) was founded by the Erasmus+ Sport programme of the European Union to improve the participation in sport and physical activity (PA). This project aims at examining examples of PA promotion interventions in secondary school, identifying good practices as well as the main barriers and difficulties linked to the design, implementation and evaluation of such interventions in order to improve their quality and sustainability. This project targets both the scientific community and various stakeholders involved in school-based PA promotion for adolescents to provide them with clear knowledge and usable tools. The overall design of this project will be presented as well as the first results and deliverables created to implement the interventions.DescriptionIn order to fill the existing gap between theory and practice by identifying evidence-based practices that work we are translating recent scientific knowledge into accessible information and tools that meet the needs of the stakeholders in the field. Furthermore, using a co-design approach involving several internationally recognised experts, stakeholders, and end-users, we developed some adapted and ready-to-use contents and we designed an optimised multicomponent school-based intervention that has been implemented in France and Spain. We evaluated these interventions not only in terms of outcomes related to PA and sedentary time, but also in relation to other important domains like implementation or maintenance based on the RE-AIM framework.ResultsWe are producing: (1) a white paper geared towards professionals and policy makers, and a consensus statement intended for the scientific community; (2) two handbooks on the implementation of the intervention and its evaluation, accompanied by two scientific publications; (3) an educational toolkit to support PA promotion in schools; and (4) articles on the evaluation of the interventions held in France and Spain.LessonsSystem approach seems needed to implement a sustainable multilevel whole-of-school intervention co-constructed with the different stakeholders and end-users involved.

Physical activity opportunities for secondary school students: International best practices for whole-of-school physical activity programs

The World Health Organization ([WHO], 2018 ) encourages schools to engage with a multi-component, whole-of-school approach to physical activity promotion. However, little evidence exists describing the practices of schools that successfully promote a physically active school culture. The purpose of this study was to explore and describe the best practices of “active” secondary schools. Three schools, each in a different country (i.e. the United States, Finland, and Ireland), were identified as sites for investigation based on the presence of nationally established whole-of-school physical activity initiatives. Data were collected in one secondary school in each country and were generated from several sources including semi-structured interviews with stakeholders, field notes, three days of on-site observation, and artifact collection. Inductive analysis using open and axial coding was conducted ( Corbin and Strauss, 2008 ). Three common themes related to best practices were evident at each site: an established school-based leader, support from the school community, and many available physical activity opportunities. Successful school-based physical activity promotion is possible if there is a motivated physical activity champion and if their promotion efforts are supported. These schools created multiple physical activity opportunities for students and have developed a strong physical activity culture.

Impact of a school-based health intervention program on body composition among South African primary schoolchildren: results from the KaziAfya cluster-randomized controlled trial

BackgroundThe prevalence of overweight and obesity is increasing among African children potentially predisposing them to greater obesity and non-communicable diseases (NCDs) in adulthood. This risk may be higher among growth-impaired children who may have greater fat mass. Therefore, we examined the effects of school-based physical activity (PA) promotion and multi-micronutrient supplementation (MMNS) on body composition among South African children enrolled in a longitudinal school-based randomized controlled trial.MethodsChildren were cluster-randomized by class to one of four groups: (a) a physical activity group (PA), (b) a multi-micronutrient supplementation group (MMNS), (c) a physical activity + multi-micronutrient supplementation group (PA + MMNS), and (d) control group, and were being followed for 3 years. Linear random effects regression models with random intercepts for school classes tested the associations of each intervention arm with overall fat mass (FM), fat-free mass (FFM), truncal fat mass (TrFM), and truncal fat-free mass (TrFFM) at 9 months (T2) for boys and girls. These differences were then explored among children who differed in height velocity (HV).ResultsA total of 1304 children (614 girls, 667 boys) in twelve clusters were assessed at baseline and after 9 months follow-up (T2). At baseline, approximately 15% of children were classified as overweight or obese while approximately 38% of children were classified as mildly stunted or moderately/severely stunted. Among girls, promotion of PA was associated with reduced FM and TrFM at T2 while MMNS was associated with increased FFM. Children with reduced HV in the PA arm had reduced FM while children in the MMNS arm with lower HV had increased FFM compared to children in the control arm. Similarly, children with lower HV in the MM and PA groups had reduced TrFM compared to children in the control arm.ConclusionsOur study suggests that the promotion of school-based physical activity programs and micronutrient supplementation can reduce childhood adiposity and so reduce the risk of obesity and chronic diseases later in adulthood.Trial registrationISRCTN, ISRCTN29534081. Registered on August 9, 2018. The trial was designed, analyzed, and interpreted based on the CONSORT protocol (Additional file 1: CONSORT checklist for randomized trial)

How to Make Physical Activity Promotion Work in Thai Schools: Perspectives of Multiple Stakeholders.

This study aimed to determine current practice in physical activity (PA) promotion in Thai schools, explore barriers and facilitators to PA promotion within the school setting, and identify strategies to support schools' future practice. A qualitative study design was applied comprising document analysis, focus groups, in-depth interviews, and onsite observations. The focus groups and in-depth interviews were conducted with 144 informants, purposively recruited through 24 schools in 4 regions across Thailand. Inductive content analysis was used. Most schools were promoting PA in the absence of written policies, and without an accurate understanding of PA. Nonalignment of school performance indicators and policies, concerns about children's academic performance, and lack of budget were raised as barriers to PA promotion, whereas strong partnerships with multiple local stakeholders facilitated school-based PA promotion. Mandated government PA policies and more information support were suggested as strategies to enhance schools' future practices. For PA promotion to be successful in the school setting, significant challenges will need to be addressed. Results from this study help the government and concerned stakeholders to better understand the situation at the school level, and further strive for achieving the target PA levels specified in the National PA Plan.

Parents' Perceptions and Engagement Regarding School-Based Physical Activity Promotion.

This study examined parents' perceived importance of, and engagement in, school-based physical activity (PA) promotion. A cross-sectional, quantitative survey design was employed. The survey was conducted in the United States. Using a probability-based panel (AmeriSpeak®), a national sample of 3599 parents was randomly recruited to participate in the survey and 1015 participants (28.2%) completed it. Parents or legal guardians of children enrolled in K-12 during the 2017-2018 school year were eligible to participate. The survey was developed and distributed by a national collaborative for active schools with the support of a national research center. Data were analyzed using structural equation modeling and path analysis. The data supported a 6-factor solution encompassing perceived importance of PA before, during, and after school, communication with administrators, and volunteering and participating in school-based PA (CFI = .974, RMSEA = .034, SRMR = .056). Path coefficients from perceived importance of PA before/after school to current (β = .43; 95%CI[.25, .61]) and future communication with administrators (β = .40; 95%CI[.23, .55]) were statistically significant, as were coefficients from perceived importance of PA before/after school to past (β = .60; 95%CI[.35, .83]) and current volunteering/participating in school-based PA (β = .63; 95%CI[.42, .85]). Parents' perceived importance of school-based PA opportunities before and after school warrants emphasis in future research and advocacy.

Identifying local authority need for, and uptake of, school-based physical activity promotion in England-a cluster analysis.

BackgroundSchool-based physical activity interventions such as The Daily Mile (TDM) are widely promoted in children’s physical activity guidance. However, targeting such interventions to areas of greatest need is challenging since determinants vary across geographical areas. Our study aimed to identify local authorities in England with the greatest need to increase children’s physical activity and assess whether TDM reaches school populations in areas with the highest need.MethodsThis was a cross-sectional study using routinely collected data from Public Health England. Datasets on health, census and the built environment were linked. We conducted a hierarchical cluster analysis to group local authorities by ‘need’ and estimated the association between ‘need’ and registration to TDM.ResultsWe identified three clusters of high, medium and low need for physical activity interventions in 123 local authorities. Schools in high-need areas were more likely to be registered with TDM (incidence rate ratio 1.25, 95% confidence interval: 1.12–1.39) compared with low-need areas.ConclusionsDeterminants of children’s physical activity cluster geographically across local authorities in England. TDM appears to be an equitable intervention reaching schools in local authorities with the highest needs. Health policy should account for clustering of health determinants to match interventions with populations most in need.

A school-based, peer-led programme to increase physical activity among 13- to 14-year-old adolescents: the GoActive cluster RCT

Background Adolescent physical activity levels are low and are associated with rising disease risk and social disadvantage. The Get Others Active (GoActive) intervention was co-designed with adolescents and teachers to increase physical activity in adolescents. Objective To assess the effectiveness and cost-effectiveness of the school-based GoActive programme in increasing adolescents’ moderate-to-vigorous physical activity. Design A cluster randomised controlled trial with an embedded mixed-methods process evaluation. Setting Non-fee-paying schools in Cambridgeshire and Essex, UK (n = 16). Schools were computer randomised and stratified by socioeconomic position and county. Participants A total of 2862 Year 9 students (aged 13–14 years; 84% of eligible students). Intervention The iteratively developed feasibility-tested refined 12-week intervention trained older adolescents (mentors) and in-class peer leaders to encourage classes to undertake two new weekly activities. Mentors met with classes weekly. Students and classes gained points and rewards for activity in and out of school. Main outcome measures The primary outcome was average daily minutes of accelerometer-assessed moderate-to-vigorous physical activity at 10 months post intervention. Secondary outcomes included accelerometer-assessed activity during school, after school and at weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness; well-being and a mixed-methods process evaluation. Measurement staff were blinded to allocation. Results Of 2862 recruited participants, 2167 (76%) attended 10-month follow-up measurements and we analysed the primary outcome for 1874 (65.5%) participants. At 10 months, there was a mean decrease in moderate-to-vigorous physical activity of 8.3 (standard deviation 19.3) minutes in control participants and 10.4 (standard deviation 22.7) minutes in intervention participants (baseline-adjusted difference –1.91 minutes, 95% confidence interval –5.53 to 1.70 minutes; p = 0.316). The programme cost £13 per student compared with control. Therefore, it was not cost-effective. Non-significant indications of differential impacts suggested detrimental effects among boys (boys –3.44, 95% confidence interval –7.42 to 0.54; girls –0.20, 95% confidence interval –3.56 to 3.16), but favoured adolescents from lower socioeconomic backgrounds (medium/low 4.25, 95% confidence interval –0.66 to 9.16; high –2.72, 95% confidence interval –6.33 to 0.89). Mediation analysis did not support the use of any included intervention components to increase physical activity. Some may have potential for improving well-being. Students, teachers and mentors mostly reported enjoying the GoActive intervention (56%, 87% and 50%, respectively), but struggled to conceptualise their roles. Facilitators of implementation included school support, embedding a routine, and mentor and tutor support. Challenges to implementation included having limited school space for activities, time, and uncertainty of teacher and mentor roles. Limitations Retention on the primary outcome at 10-month follow-up was low (65.5%), but we achieved our intended sample size, with retention comparable to similar trials. Conclusions A rigorously developed school-based intervention (i.e. GoActive) was not effective in countering the age-related decline in adolescent physical activity. Overall, this mixed-methods evaluation provides transferable insights for future intervention development, implementation and evaluation. Future work Interdisciplinary research is required to understand educational setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale. Trial registration Current Controlled Trials ISRCTN31583496. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information. This work was additionally supported by the Medical Research Council (London, UK) (Unit Programme number MC_UU_12015/7) and undertaken under the auspices of the Centre for Diet and Activity Research (Cambridge, UK), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation (London, UK), Cancer Research UK (London, UK), Economic and Social Research Council (Swindon, UK), Medical Research Council, the National Institute for Health Research (Southampton, UK) and the Wellcome Trust (London, UK), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (087636/Z/08/Z; ES/G007462/1; MR/K023187/1). GoActive facilitator costs were borne by Essex and Cambridgeshire County Councils.

Reach, Recruitment, Dose, and Intervention Fidelity of the GoActive School-Based Physical Activity Intervention in the UK: A Mixed-Methods Process Evaluation.

School-based multi-component physical activity (PA) promotion is advocated; however, research has indicated that a multi-component approach may not always be effective at increasing adolescent PA. Evaluation of the GoActive 12-week multi-component school-based intervention showed no effect on adolescent PA. A mixed-methods process evaluation was embedded to facilitate greater understanding of the results, to elicit subgroup perceptions, and to provide insight into contextual factors influencing intervention implementation. This paper presents the reach, recruitment, dose, and fidelity of GoActive, and identifies challenges to implementation. The process evaluation employed questionnaires (1543 Year 9s), individual interviews (16 Year 9s; 7 facilitators; 9 contact teachers), focus groups (48 Year 9s; 58 mentors), alongside GoActive website analytics and researcher observations. GoActive sessions reached 39.4% of Year 9s. Intervention satisfaction was relatively high for mentors (87.3%) and facilitators (85.7%), but lower for Year 9s (59.5%) and teachers (50%). Intervention fidelity was mixed within and between schools. Mentorship was the most implemented component. Factors potentially contributing to low implementation included ambiguity of the roles subgroups played within intervention delivery, Year 9 engagement, institutional support, and further school-level constraints. Multiple challenges and varying contextual considerations hindered the implementation of GoActive in multiple school sites. Methods to overcome contextual challenges to implementation warrant in-depth consideration and innovative approaches.

Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: Acluster randomised controlled trial.

Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school's social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents. Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] -1.91 minutes [-5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample. In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational-setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale. ISRCTN Registry ISRCTN31583496.