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

Abstract

The intentional integration of physical activity in elementary school classrooms—including brief instructional breaks for activity, or integration into lessons—can benefit children’s physical activity and education outcomes. Teachers are key implementation agents, but despite physical activity in the classroom being an evidence-informed practice, many teachers do not regularly implement it. The aim of this study was to obtain updated nationally representative prevalence estimates in United States public elementary schools, regarding four key outcomes: (1) school adoption of physically active lessons (PA lessons); (2) school adoption of physical-activity breaks (PA breaks); (3) penetration in the classroom, defined as ≥50% of teachers using PA breaks; and (4) dose, defined as an average of at least 50 min per week of PA breaks. We examined variations in outcomes by school demographic characteristics, and by three factors hypothesized to be implementation facilitators (administrative support, financial resources, and presence of a wellness champion at the school). In the 2019–20 school year, surveys were distributed to a nationally representative sample of 1010 public elementary schools in the US; responses were obtained from 559 (55.3%). The weighted prevalence of schools reporting adoption of PA lessons was 77.9% (95% CI = 73.9% to 81.9%), and adoption of PA breaks was nearly universal at 91.2% (95% CI = 88.4% to 94.1%). Few demographic differences emerged, although adoption of PA lessons was less prevalent at higher-poverty schools (73.9%) and medium-poverty schools (77.0%) as compared to schools with lower poverty levels (87.1%; p < 0.01). Across all four outcomes, associations emerged with facilitators in multivariable logistic regression models. The prevalence of adoption of PA lessons, adoption of PA breaks, and dose of PA breaks were all significantly higher at schools where administrative encouragement occurred more frequently. Financial support was associated with implementation outcomes, including adoption of PA lessons, and penetration and dose of PA breaks. Presence of a champion was associated with higher prevalence of reporting adoption of PA lessons. School leaders can play a crucial role in supporting teachers’ implementation of PA breaks and lessons in the classroom, through providing financial resources, encouragement, and supporting champions. Effective school-leadership practices have the potential to positively impact students at a large-scale population level by supporting implementation of PA lessons and breaks.

Is level of implementation linked with intervention outcomes? Process evaluation of the TransformUs intervention to increase children’s physical activity and reduce sedentary behaviour

“…Since adaptability is one element of sustainability, the goal for intervention evaluation may be to ascertain what degree of fidelity is needed to achieve outcomes [61], and how much variation is necessary to align with the delivery context [69]. Consistent with previous interventions targeting school settings [70], and a systematic review of factors required for sustainable implementation in schools [71]; the need for school Principals and senior school leaders to champion and embed initiatives within routine school practices, was integral to TransformUs uptake, delivery and sustainability. Innovative ways of building schools' capacity to support teachers to align and integrate curriculum modifications into their existing teaching practices, may improve the feasibility and delivery of programs such as TransformUs.…”

Children Are Back to School, but Is Play Still in Lockdown? Play Experiences, Social Interactions, and Children’s Quality of Life in Primary Education in the COVID-19 Pandemic in 2020

“…Research on children’s physical activity in the pandemic showed that the lack of physical activity worsened after the pandemic, with children showing a decrease, as a result of confinement and social isolation [ 39 , 40 ]. Teachers and other school professionals should be supported to allow active play opportunities to happen for children, and to ensure administrative and financial support from the school’s management [ 41 ].…”

Closing the Gap Between Classroom-Based Physical Activity Intervention Adoption and Fidelity in Low-Resource Schools

“…Previous research also suggests that classroom activity breaks provide positive PA experiences for boys, girls, and children with asthma, helping to reduce gender and asthma disparities in PA participation (Beemer et al, 2018(Beemer et al, , 2022. Consistent with these findings, adoption rates (the intention, initial decision, or action to try or employ an innovation or evidence-based practice; Proctor et al, 2011) of classroom-based PA interventions across the United States are nearly universal in elementary schools (92%; Densley et al, 2021). This represents a 16% increase since 2013 (Turner & Chaloupka, 2017) and a 112% increase since 2007 (Services, 2014).…”

“…Teachers can incorporate PA into their planned academic lessons or provide short breaks from seated instruction. This approach enables schools to universally increase child PA throughout the school day (Daly- Densley et al, 2021;Masini et al, 2020). Other PA opportunities can be more resource dependent (e.g., sports programming), making them less accessible to low-resource schools (Hoff & Mitchell, 2007;Zdroik & Veliz, 2016).…”

“…A growing body of literature now confirms that evidencebased classroom PA interventions implemented in elementary school settings significantly increase PA levels (Bassett et al, 2013;Masini et al, 2020) and improve weight status (Donnelly et al, 2009), on-task behavior (Daly- , and academic achievement (Norris et al, 2020)-all of which are key motivators for schools to adopt these programs (Densley et al, 2021). Previous research also suggests that classroom activity breaks provide positive PA experiences for boys, girls, and children with asthma, helping to reduce gender and asthma disparities in PA participation (Beemer et al, 2018(Beemer et al, , 2022.…”