Purpose:

Whole-school physical activity programmes is recognised as part of Ireland’s National Physical Activity Plan. Attempts to transfer the successful primary Active School Flag programme to second-level schools (SLASF) have led to the need for conducting a feasibly trial before a definitive randomised control trial. The SLASF is a theory driven two-year and two-tiered (Year 1 – certificate, Year 2 – flag) intervention using co-design between students, policy and researchers. The purpose of this study is to report the limited efficacy during the first year of the programme.

 Methods:

In the first year, three feasibility and process evaluation case-study schools (mixed, all-girls and mixed lower socio-economic status) were recruited. Multiple methods throughout the school year included monthly observations, full school needs assessment questionnaires, stakeholder interviews and a subsample completed an outcomes survey and physical health measures including accelerometers at baseline (T0) and the end of year 1 (T1).  Matched, by school type, control schools (without SLASF) were recruited to provide limited efficacy data on the SLASF outcomes survey and were analysed through t-tests between conditions and reported through Cohen’s d.

 Results:

The response rate in the outcomes survey dropped by 86% (n=299) and 74% (n=216) between T0 and T1 in intervention and control schools respectively. Accelerometer data dropped by 79% (T0; n=163, T1; n=128), and physical health measures dropped by 89% (T0; n=206, T1; n=184) between the two time points from the intervention schools. Control schools were involved with these measures. At baseline, screening of physical activity levels and screen time did not differ among females, between the intervention and the control schools. However, females in intervention schools had lower levels of physical activity self-efficacy (p=.001, d=0.33), and higher student autonomy (p<.001, d=0.35), whereas for males there were higher levels of peer support (p=.04, d=0.32) than control schools.

 Conclusions:

The SLASF is a complex behaviour intervention. More effort on student engagement and staff involvement is needed to increase adherence of the intervention across the two-year two-tier intervention. Subtle statistical differences in T0 outcome data between the conditions must be taken into consideration when analysing the limited efficacy data from the feasibility study. 

Purpose: Behan et. al (2019) highlights that primary school children display low levels of Fundamental Movement Skills (FMS) proficiency. FMS are reported to have a significant impact on physical activity participation (Barnett et. al, 2009). The Moving Well-Being Well (MWBW) intervention was designed to develop FMS in 7 – 9-year-old primary school children. Design and implementation of the intervention is innovative as the system sees coaches from the Gaelic Athletic Association deliver intervention components, while upskilling classroom teachers onsite. The aim of this study was to process-evaluate and examine the impact of this intervention.

Methods: Intervention design was informed by findings from Behan et. al (2019). Participants (n=926, 47% Female, mean age 7.55) were recruited from 18 primary schools. Participants partook in an 8-week intervention incorporating three elements: 2 x 30-minute PE classes/week, classroom components and home activity. Data were collected on eight FMS and two balance skills pre and post intervention using the TGMD-3 and the BOT-2. Data were gathered from students via focus groups in 4 schools (n=32, 62% Male) which incorporated a Write, Draw, Show & Tell component. This aimed to evaluate children’s enjoyment and motivation towards the intervention and game components. Data informing the process-evaluation were gathered from teachers (n=31) and Principals (n=5) via online questionnaire and coaches via focus groups (n=16, 62% male) and weekly reflections. A mixed methods analysis approach was employed.

Results/findings: Results show significant increases in all FMS and balance skills from pre to post intervention. Qualitative data sources generated 7 themes: PE in schools, Intervention programme, Implementation, Games, Challenges, Improvements and Outcomes. These themes were broken down into sub-themes which highlighted the necessity for culture change, suggested MWBW is an enjoyable, effective and inclusive alternative, however fidelity of implementation was mixed.

Conclusions: This study suggests that the MWBW intervention is effective in improving FMS among 7 – 9 year old primary school children. The process-evaluation confirmed that, from the children and teachers perspective, the MWBW intervention is suitable, efficient and enjoyable for all. Results from child focus groups could also aid the design of future intervention components/games, enabling maximum enjoyment and benefit.

References:

Behan S, Belton S, Peers C, O’Connor NE, Issartel J. Moving Well-Being Well: Investigating the maturation of fundamental movement skill proficiency across sex in Irish children aged five to twelve. J Sports Sci. 2019 Aug 5;1–9.

Barnett LM, van Beurden E, Morgan PJ, Brooks LO, Beard JR. Childhood Motor Skill Proficiency as a Predictor of Adolescent Physical Activity. J Adolesc Heal. 2009 Mar;44(3):252–9.

Issartel., J, McGann, J, Behan, S, Peers, C, O’Connor, N, Belton, S. (under review). Development of a ‘refraction’ framework to underpin design of the Moving Well-Being Well physical literacy intervention 

Purpose: Governments internationally have released guidelines or policies mandating the minimum time each week primary schools are to schedule structured physical activity (PA) for children. Despite this, the majority of schools in many jurisdictions fail to implement these policies. The aim of this study was to assess the impact of a multi-strategy implementation intervention in increasing and sustaining primary school teachers scheduling of weekly PA.

Methods: A cluster randomised controlled pilot trial was undertaken in 12 primary schools with over 100 teachers in New South Wales, Australia. Schools were randomly allocated to receive a multi-strategy implementation intervention to increase their scheduling of weekly PA including time in sport, physical education, energisers and integrated lessons. Designed using the Theoretical Domains Framework (TDF) the implementation strategy consisted of; provision of centralised technical assistance, identification and training of school champions, obtaining executive support and provision of ongoing support, tools and resources. Data were collected at 12 months i.e. directly following implementation support and 30 months i.e. 18 months with no implementation support. The mean minutes of PA scheduled by primary school teachers was measured via teacher log-book at both time points.

Results: At 12 months, teachers in intervention schools were scheduling a mean of 135.95 minutes of PA each week (SD=59.46) compared to teachers in control schools 99.04 (SD=51.83) [adjusted mean difference of 36.6 minutes [95% CI 2.7 - 70.5, p=0.04]]. However at 30 month follow-up teachers in intervention schools had significantly decreased the minutes they scheduled for PA with a mean of 94.39 minutes (SD: 38.85)

Conclusion: A multi-strategy intervention was effective in achieving initial implementation, however not for sustaining teachers’ scheduling of PA. Without sustained program implementation the potential public health benefits of evidence based interventions cannot be achieved.

Purpose: Time-efficient interventions are needed for older adolescents (≥16 years) in secondary schools where there is a heavy focus on academic performance and physical activity (i.e., physical education and school sport) is not mandatory. The aim of our study was to evaluate the impact of a school-based intervention designed to improve older adolescents’ cardiorespiratory fitness by integrating vigorous intensity activity breaks into curriculum time.

Methods:  The Burn 2 Learn (B2L) intervention was evaluated using a cluster randomized controlled trial with adolescents (N=670) from 20 secondary schools in New South Wales, Australia. We utilized a range of implementation strategies to support teachers to facilitate at least two high intensity interval training (HIIT) breaks/week during lessons: (i) training (professional development), (ii) resource provision (activity cards, heart rate monitors, bespoke smartphone/tablet application) and (iii) on-going support (observations, monitoring, feedback). The innovative HIIT sessions involved a combination of aerobic and muscle-strengthening exercises, designed to be fun and engaging as well as vigorous in nature. Teachers and students in the control group continued with their usual practice. Outcomes were assessed at baseline and 6-months. The primary outcome was cardiorespiratory fitness (multi-stage fitness test). Secondary outcomes were muscular fitness (push-up and standing long jump tests), body composition (body mass index), and mental health (questionnaires) assessed at baseline and 6-months. Data were analyzed using linear mixed models, accounting for clustering of effects at the class level. A detailed process evaluation was also conducted.

Results: Significant group-by-time effects were found for the primary outcome cardiorespiratory fitness (4.0 laps [95% CI, 1.7 to 6.4], p = 0.001) and for upper body muscular endurance (1.2 repetitions [95% CI, 0.3 to 2.2], p = 0.008]. Effects for lower body muscular power, body composition, and mental health outcomes were not statistically significant.

Conclusions: Implementing high intensity breaks during curricular time improved older adolescents’ cardiorespiratory and muscular endurance, but not their mental health. Our findings highlight the health benefits of re-allocating curriculum time to physical activity during the final years of secondary school.

Trial registration: ACTRN12618000293268 

Purpose: Physical activity declines with age, and fewer than 6% of Australian older adolescents (≥16 years) are sufficiently active. Competing time pressures contribute to the low physical activity levels among this group, and time-efficient interventions are needed. The aim of this study is to evaluate the impact of embedding high-intensity interval training (HIIT) into the school day on older adolescents’ physical activity. A secondary aim was to identify potential moderators of intervention effects.

Methods: We conducted a cluster randomized controlled trial in 20 secondary schools in New South Wales, Australia (N=670, 16.0 ± 0.4 years, 45% female). Participants randomized to the Burn 2 Learn (B2L) intervention participated in 2-3 teacher-facilitated HIIT sessions/week during curriculum time for 16 weeks. The control group continued their usual practice. Physical activity was assessed using ActiGraph GT9X accelerometers worn on the non-dominant wrist for seven consecutive days at baseline (February-April, 2018/19) and post-test (August-September, 2018/19). Steps per day and counts per minute (CPM) on weekdays and during school hours were analyzed separately using linear mixed models, adjusted for clustering. Five potential moderators (socio-economic status [SES], sex, weight status, psychological distress, and cardiorespiratory fitness [CRF]) were examined and sub-group analyses were conducted if interaction tests were significant at p < 0.10.

Results: A significant group-by-time effect was observed for steps during school hours in favor of the intervention group (853 steps/day [95% CI, 513 to 1194], p < 0.001). Intervention effects for CPM during school hours, steps and CPM during weekdays were not statistically significant. Sex (p = 0.004), psychological distress (p = 0.033), and SES (p < 0.001) moderated intervention effects for steps during school hours, with stronger effects observed for girls, students with higher levels of psychological distress, and students from low SES backgrounds.

Conclusions: The B2L intervention significantly increased older adolescents’ steps during school hours. However, the volume of activity provided by the school-based HIIT sessions did not contribute to a significant effect on older adolescents’ physical activity across the whole day.

Purpose:

Physical activity levels drop dramatically during adolescence and less than 10% of older adolescents are sufficiently active. Considering that previous school-based physical activity interventions targeting adolescents have been largely ineffective, we need to explore novel intervention strategies to provide older adolescents with a dose of health-enhancing physical activity. The purpose of this study was to evaluate the impact of the “Burn 2 Learn” (B2L) intervention program that involved high intensity activity breaks on older adolescents’ on-task behaviour and subjective vitality.

Methods:

This was a sub-study of the Burn 2 Learn (B2L) cluster randomised controlled trial, which included two cohorts. Participants for this sub-study (N = 221) were from 10 secondary schools (23 classes) in NSW (cohort 2). Teachers allocated to the B2L intervention group were provided with training, resources and support to implement 2-3 high intensity activity breaks per week for the study period. The control condition followed their normal curriculum. On-task behaviour was assessed at baseline and post-test, using a momentary time sampling procedure and expressed as a percentage of lesson time. Students were observed on a rotational basis in 15 sec intervals for 30 min in the allotted curricular time. At post-test, subjective vitality was assessed at the start and end of the lesson using a validated questionnaire. Linear mixed models were used to assess the impact of the intervention.

Results:

Linear mixed models revealed significant group-by-time effects for on-task behaviour in the B2L group [adjusted mean difference = 18.9% (95% CI, 3.2 to 34.6), p = .020, d = 0.4]. Also, significant group-by-time effects on subjective vitality favouring the B2L group were observed [adjusted mean difference = 0.71 (95% CI, 0.28 to 1.14), p = .003, d = .02].

Conclusions:

The B2L intervention was successful in improving senior school students’ on-task behaviour and their subjective vitality. These findings highlight the potential academic benefits of re-allocating curriculum time to physical activity during the senior school years.  

Australian and New Zealand Clinical Trials Registry (ACTRN12617000544370)