Are school‐based physical activity interventions effective and equitable? A meta‐analysis of cluster randomized controlled trials with accelerometer‐assessed activity

Love, Rebecca; Adams, Jean; Sluijs, Esther M. F. van

doi:10.1111/obr.12823

Cited by 283 publications

(323 citation statements)

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“…Adolescents are most active during the school day compared to evenings and weekends [31]. Additionally, the school environment provides access to PA independent of background or socioeconomic status [32]. This may expose adolescents to varying forms of PA that they may not have been exposed to outside of school.…”

Section: Protocol and Registrationmentioning

confidence: 99%

Efficacy of School-Based Interventions for Improving Muscular Fitness Outcomes in Adolescent Boys: A Systematic Review and Meta-analysis

et al. 2019

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Background It has been reported that boys' and girls' physical activity (PA) levels decline throughout adolescence. Boys are at risk of physical inactivity during adolescence; however, in intervention research, they are an under-represented group relative to girls. It is suggested that the school environment may be central to developing interventions that support adolescents in meeting the current PA guidelines. The aim of this systematic review and meta-analysis was to investigate the efficacy of school-based physical activity interventions for improving muscular fitness (MF) in adolescent males. Methods This systematic review and meta-analysis followed the preferred reporting systems for meta-analyses guidelines and was registered on PROSPERO (Registration number: CRD42018091023). Eligible studies were published in English within peer-reviewed articles. Searches were conducted in three databases, with an additional grey literature search in Google Scholar. Studies investigating MF outcomes were included. Results There were 43 data sets identified across 11 studies, from seven countries. Overall methodological quality of the studies was moderate-to-strong. Interventions targeting MF evidenced a small-to-medium effect (g = 0.32, CI 0.17, 0.48, p < 0.00). Subgroup analyses of MF delivery method resulted in small-to-medium effects: upper limb MF measures (g = 0.28, 95% CI − 0.02, 0.58, p = 0.07), lower limb MF measures (g = 0.28, 95% CI 0.09, 0.68, p = 0.03), combined MF activities (g = 0.24, 95% CI − 0.04 to 0.49, p = 0.05), plyometric activities (g = 0.39, 95% CI 0.09, 0.68, p = 0.01), body weight (g = 0.27, 95% CI − 0.10, 0.65, p = 0.15), and traditional MF methods (g = 0.43, 95% CI 0.09, 0.78, p = 0.01). Conclusions School-based interventions which aimed to increase MF outcomes in adolescent boys demonstrated smallto-moderate effects. Traditional and plyometric methods of resistance training appear to be the most effective form of PA delivery in adolescent males. More quality research is required to assess the impact of MF delivered in the school environment to inform future intervention design.It is recommended that adolescents engage in a minimum of 60 min of moderate-to-vigorous physical activity (MVPA) per day with muscle and bone strengthening exercise Key PointsMF interventions delivered in a school-based environment demonstrated small-to-moderate effects in adolescent boys.MF delivered in a traditional manner, such as weight machines and free weights, may have a greater effect on enhancing MF than other forms of MF delivery.Plyometric forms of MF delivery demonstrated significant homogeneous effects and require further quality research to assess their application in the school environment.

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Section: Protocol and Registrationmentioning

confidence: 99%

Efficacy of School-Based Interventions for Improving Muscular Fitness Outcomes in Adolescent Boys: A Systematic Review and Meta-analysis

et al. 2019

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“…Despite these calls, it remains unclear what are the most effective whole-school approaches to sustain change and how they can be successfully implemented. Concurrently, recent meta-analyses' establish that school-based interventions have little, if any, effect on school-time MVPA [11] or daily MVPA [12]. This may result from the challenge of designing and delivering feasible and sustainable approaches in schools, as evidenced by the many randomised controlled trials of school-based physical activity programmes displaying poor implementation e.g.…”

Section: Introductionmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2020

Int J Behav Nutr Phys Act

139

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Background: UK and global policies recommend whole-school approaches to improve childrens' inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure 'systems' change, a framework is required that identifies all components of a whole-school PA approach. The study's aim was to codevelop a whole-school PA framework using the double diamond design approach (DDDA).Methodology: Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one 'initial' framework. Next, stakeholders reviewed the 'initial' framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.Results: Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers' capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder wholeschool PA.Summary: To the authors' knowledge, this is the first time practitioners, policymakers and researchers have codesigned a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives 'with' schools, while abandoning outdated traditional approaches of implementing interventions 'on' schools.

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“…Despite these calls, it remains unclear what are the most effective whole-school approaches to sustain change and how they can be successfully implemented. Concurrently, recent meta-analyses' established that school-based interventions have little, if any, effect on school-time MVPA [11] or daily MVPA [12]. This may result from the challenge of designing and delivering feasible and sustainable approaches in schools, as evidenced by the many randomised controlled trials of school-based physical activity programmes displaying poor implementation e.g.…”

Section: Introductionmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2019

Preprint

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Background UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective and sustainable interventions which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies the many components of a whole-school PA approach. The aim of this paper was to co-develop a whole-school PA framework using the double diamond design approach (DDDA); a four-stage reflective process to discover, define, develop, and deliver an innovative solution to a problem. Framework development process Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n=9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n=6) stakeholder groupings. Six draft frameworks were created before stakeholders selected one ‘initial’ framework through an individual voting process. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, the original stakeholders voted on eight proposed modifications using an online questionnaire. Following voting, the final Creating Active Schools (CAS) Framework was designed. Summary To the authors knowledge, this is the first time practitioners, policy makers and researchers who understand the powerful driving agents of school systems and teacher and pupil PA behaviour, have co-designed a whole-school PA framework from initial conception. The novelty of the CAS framework resides in formally identifying the multitude of interconnecting elements of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The CAS framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, the CAS framework presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

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Are school‐based physical activity interventions effective and equitable? A meta‐analysis of cluster randomized controlled trials with accelerometer‐assessed activity

Cited by 283 publications

References 56 publications

Efficacy of School-Based Interventions for Improving Muscular Fitness Outcomes in Adolescent Boys: A Systematic Review and Meta-analysis

Efficacy of School-Based Interventions for Improving Muscular Fitness Outcomes in Adolescent Boys: A Systematic Review and Meta-analysis

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

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