Implementation of a School Physical Activity Policy Improves Student Physical Activity Levels: Outcomes of a Cluster-Randomized Controlled Trial

Abstract

Aim: To assess the impact of a multistrategy intervention designed to improve teachers’ implementation of a school physical activity (PA) policy on student PA levels. Methods: A cluster-randomized controlled trial was conducted in 12 elementary schools. Policy implementation required schools to deliver 150 minutes of organized PA for students each week via physical education, sport, or class-based activities such as energizers. Schools received implementation support designed using the theoretical domains framework to help them implement the current policy. Results: A total of 1,502 children in kindergarten to grade 6 participated. At follow-up compared with control, students attending intervention schools had, measured via accelerometer, significantly greater increases in school day counts per minute (97.5; 95% confidence interval [CI], 64.5 to 130.4; P < .001) and moderate to vigorous physical activity (MVPA) (3.0; 95% CI, 2.2–3.8, P < .001) and a greater decrease in sedentary time (−2.1; 95% CI, −3.9 to −0.4, P = .02) per school day. Teachers in intervention schools delivered significantly more minutes (36.6 min) of PA to their students at follow-up (95% CI, 2.7–70.5, P = .04). Conclusions: Supporting teachers to implement a PA policy improves student PA. Additional strategies may be needed to support teachers to implement activities that result in larger gains in student MVPA.

The Effectiveness of School-Based Interventions on Obesity-Related Behaviours in Primary School Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…Seven different methods were used to measure PA and SB. Both PA and SB were objectively measured via accelerometer in 13 studies [65][66][67][68][69][70][71][72][73][74] and subjectively measured through self-report questionnaires in 12 studies [58,60,69,[75][76][77][78][79]. One study used a combination of self-report and accelerometers to measure PA and SB [80], and three studies used questionnaires to measure both PA and SB [63,64,81].…”

“…There were 35 (71%) multi-component interventions, while others adopted single component and 21 (48%) multi-component interventions targeted a change in PA, SB and nutrition behaviour [56,58,60,[63][64][65][68][69][70]76,[79][80][81][82]91,95,100,101]. Eight (17%) interventions targeted a change in PA and SB [62,67,[71][72][73][74][75]81], and five (9%) interventions targeted a change in PA and nutrition behaviour [57,77,86,87,90]. Intervention strategies included school environment adaptions, interactive drama activities, modified PE lessons, extracurricular PA sessions, gardening, cooking workshops, educational sessions, counselling sessions and provision of further opportunities to be physically active (e.g., active homework, lunch and break time, PA clubs).…”

“…One study used several intervention activities including: classroom lessons, 19 takehome activities, cooking demonstrations, school gardens, family newsletters, health fairs, salad bars, procurement of regional produce and school-site wellness committees [93]. Four interventions did not measure BMI at any time point [72,77,81,82]. One study used a self-reported measurement for height and weight [103]; the remainder of the interventions measured the participants' body weight and height objectively by a member of the research team.…”

A Systematic Review of School Health Policy Measurement Tools: Implementation Determinants and Outcomes

“…The nding that readiness for implementation as a general construct was most measured re ects prior research stressing the importance of assessing readiness and organizational capacity for implementation (22,(68)(69)(70)(71)(72)(73). Within this broader construct, non-training resources was the most common determinant assessed; provision of nancial resources and personnel support have been cited as supportive factors for policy and innovation implementation in school research (9,74,75). Following this, leadership for implementation was very prevalent in the measures, which again re ects extant knowledge that new innovations require a leader to succeed (61,76,77).…”

Implementation of Physical Activity in US Elementary Schools: The Role of Administrative Support, Financial Resources, and Champions

“…Several implementation outcomes [19] are relevant to improving the understanding of movement integration, including adoption (i.e., the use of an evidence-based practice), as well as organizational penetration to subsystems (i.e., classrooms), and dose (i.e., the extent of movement-integration opportunities available to students). While other studies have explored the extent to which teachers within a school adopt movement integration [20][21][22][23][24][25], there is a need for estimates of organizational penetration rates and dose in a national sample of schools. Furthermore, in addition to the need for national surveillance of various implementation outcomes, there is a need to explore the prevalence of factors that often support or hinder school-level and classroom-level implementation.…”