Effect of Active Lessons on Physical Activity, Academic, and Health Outcomes: A Systematic Review

Hyperactivity in ADHD: Friend or Foe?

BACKGROUND

Hyperactivity may play a functional role in upregulating prefrontal cortical hypoarousal and executive functioning in ADHD. This study investigated the neurocognitive impact of movement during executive functioning on children with ADHD.

METHODS

Twenty-four children with and without ADHD completed a Stroop task and self-efficacy ratings while remaining stationary (Stationary condition) and while desk cycling (Movement condition). Simultaneous functional near-infrared spectroscopy (fNIRS) recorded oxygenated and deoxygenated changes in hemoglobin within the left dorsolateral prefrontal cortex (DLPFC).

RESULTS

Among children with ADHD, the Movement condition produced superior Stroop reaction time compared to the Stationary condition (p = 0.046, d = 1.00). Self-efficacy improved in the Movement condition (p = 0.033, d = 0.41), whereas it did not in the Stationary condition (p = 0.323). Seventy-eight percent of participants showed greater oxygenation in the left DLPFC during the Movement condition vs. the Stationary condition. Among children without ADHD, there were no differences in Stroop or self-efficacy outcomes between Stationary and Movement conditions (ps > 0.085, ts < 1.45); 60% of participants showed greater oxygenation in the left DLPFC during the Movement vs. the Stationary condition.

CONCLUSIONS

This work provides supportive evidence that hyperactivity in ADHD may be a compensatory mechanism to upregulate PFC hypoarousal to support executive functioning and self-efficacy.

Sedentary Behavior and Physical Inactivity Among Secondary School Students in the 2017 Sierra Leone Global School-Based Student Health Survey

BACKGROUND

The 2020 World Health Organization Guidelines on Physical Activity and Sedentary Behavior are the first to provide evidence-based recommendations for reducing both dimensions of languorous behavior. The relationship between sitting time and exercise remains understudied among diverse adolescent populations worldwide.

METHODS

The 2017 Sierra Leone Global School-based Student Health Survey was a nationally representative cross-sectional study of secondary school students.

RESULTS

Of the 2798 participants, 82% did not engage in moderate or vigorous physical activity for at least an hour every day, 25% sat for 3 or more hours each day outside of school and homework, and 87% were physically inactive and/or sedentary based on those thresholds. Girls who never or rarely exercised tended to maintain light physical activity outside of school rather than sitting, while boys who exercised daily tended to be sedentary when they were not playing sports.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Students spend their waking hours doing a mix of sitting, light physical activity, and moderate or vigorous physical activity. Schools can help reduce sedentarism and increase movement among students.

CONCLUSIONS

Home, school, and community health interventions may be useful for increasing energy expenditure among adolescents in low- and middle-income countries.

In-classroom physical activity breaks program among school children in Sri Lanka: study protocol for a randomized controlled trial

Background

The problem of sedentary behavior among primary school children is alarming, with numbers gradually increasing worldwide, including Sri Lanka. Physical activity interventions within classroom settings have been acknowledged as a critical strategy to increase students' movement behaviors while enhancing their academic achievement and health. Yet, the busy curriculum and challenging educational demands encourage more sedentary classroom behavior. Hence, this study aims to develop and evaluate an in-classroom physical activity breaks (IcPAB) intervention among fifth graders in Sri Lanka.

Methods

The study will adopt a randomized controlled trial (RCT), comprising an in-classroom physical activity breaks program group and a control group to evaluate the effects of IcPAB on academic achievement, movement behaviors and health outcomes. The intervention design is based on the capability (C), opportunity (O) and motivation (M) behavior (B) (COM-B) model. A least 198 fifth graders will be recruited from two schools in Uva province, Sri Lanka. The recruitment process will start in late 2022. Class teachers of the intervention group will implement 5-min activity breaks at least three times a day after completing a training session. The primary variables include mathematics and reading achievement. The secondary variables include physical activity levels, steps count, sedentary behavior, body mass index, aerobic fitness, and perceived stress. Data collection will be implemented at pre-test and post-test, respectively. Intervention fidelity and the process will also be evaluated.

Discussion

The IcPAB is designed to prevent pure educational time loss by introducing curriculum-integrated short bouts of physical active breaks into the classroom routine. If the IcPAB is effective, it can (1) improve the mathematics and reading achievement of fifth-grade girls and boys, which is a significant factor determining the performance at the Grade Five National Scholarship Examination in Sri Lanka; (2) improve movement behaviors as well as physical and mental health outcomes among primary school students. Sequentially, the IcPAB will enrich school-based physical activity intervention approaches which can in turn bring academic and health benefits to primary school children in Sri Lanka.

Trial registration

The first version of the trial was registered with the ISRCTN registry (Ref: ISRCTN52180050) on 20/07/2022.

Identifying opportunity, capability and motivation of Sri Lankan 5th grade schoolteachers to implement in-classroom physical activity breaks: A qualitative study

BACKGROUND

Classroom-based physical activity interventions have demonstrated positive effects in reducing sedentary behaviour among school children. However, this is an understudied area, especially in low- and middle-income countries such as Sri Lanka. This study aims to explore teachers' opportunity, capability and motivation relating to the implementation of an in-classroom physical activity breaks programme.

METHODS

Twenty-seven teachers were recruited through snowball sampling and participated in semi-structured telephone interviews from early-January to the mid-June 2022. The Capability, Opportunity, and Motivation Behaviour (COM-B) model was used to guide and deductively thematic analyse the interviews.

RESULTS

21 out of the recruited teachers responded to the full study. The mean age of respondents was 39.24 years old ranging from 27 years to 53 years. Teaching experience of the respondents ranged from three to 37 years, and 57% were female. Three teachers had a degree with a teacher training diploma, while others were having General Certificate of Education in Advanced Level with a teacher training diploma as the highest education qualification. Capability factors such as age, dress code, mask wearing, knowledge, skills and workload of the teachers were identified as important factors in implementing a physical activity breaks intervention in a Sri Lankan classroom setting. Classroom space, facilities, student backgrounds and safety were identified as opportunity factors. Obtaining policy level decisions to implement the activity breaks and managing the time of the activities to reduce time lost in education time were identified as motivational factors.

CONCLUSION

During the intervention development phase, implementation facilitators and barriers must be considered carefully. Behaviour change techniques can be utilised to address the identified COM-B factors to ensure a good implementation of the intervention.

Impact of an Interdisciplinary Educational Programme on Students' Physical Activity and Fitness

Educational initiatives and actions are needed to provide students with skills to create active habits and lifestyles in order to increase the physical activity and fitness levels of young people. The main objective of this study was to analyse the effects of a classroom-based physical activity and life skills programme on students' physical activity and fitness levels. The sample consisted of 65 students in the 6th grade of Primary Education, aged between 11 and 13 years (11.86 ± 0.53), divided into a control group (CG) and an experimental group (EG) for convenience and accessibility. This was a quasi-experimental, repeated measures, longitudinal cut-off research design. For 16 weeks, an interdisciplinary educational programme based on a combination of classroom-based physical activity and life skills was implemented. The results showed that the educational programme had a positive effect on students' physical activity levels during school hours, specifically on reducing sedentary time (p < 0.001) and increasing light (p < 0.001) and moderate-to-vigorous (p < 0.001) physical activity. Positive effects were also found on the variables of explosive strength (p < 0.05) and aerobic capacity (p < 0.05) related to physical fitness. In conclusion, interdisciplinary educational programmes based on the promotion of physical activity and life skills could contribute to the development of responsible daily physical activity habits in students to facilitate their transfer to other environments (social and family) outside school.

Feasibility, acceptability and potential efficacy of a virtual physical activity program in primary and secondary schools in New South Wales, Australia: A quasi-experimental study

ISSUE ADDRESSED

Child and youth participation in physical activity (PA) is fundamental for healthy development and obesity prevention. Government policy requires schools to offer 150 minutes of PA each week, however compliance is low. Race around Australia (RAA) is a New South Wales (NSW) Department of Education, virtual PA program aimed at assisting schools in meeting the PA guidelines.

METHODS

A pre- and post-intervention, quasi-experimental study was conducted using a mixed-methods approach comprising teacher interviews, a student questionnaire and a 1.6 kilometre (km) timed run. Data were collected from April to September 2021 among students and teachers in Grades 5 to 8, from 10 schools in NSW, Australia.

RESULTS

The analytical sample included data from 918 students and 17 teachers. The RAA program was deemed feasible and acceptable in primary schools, whereas there were several systemic and intrapersonal barriers to implementation success for secondary schools. In primary schools, RAA increased PA opportunities and the 1.6 km timed runs revealed a statistically significant treatment by time effect in favour of the intervention group for cardiorespiratory fitness (-36.91 seconds, 95% CI [-63.14, -10.68], P = .006).

CONCLUSIONS

RAA has demonstrated feasibility and potential efficacy in improving cardiorespiratory fitness. We recommend that program refinement be made to deliver an intervention that addresses the unique barriers of the secondary school setting through a multi-level ecological approach. SO WHAT?: Despite evident benefits, implementation of PA initiatives in the school setting reveals many challenges. Stronger consideration of the Health Promotion with Schools Framework is evidently needed.

Pre-Service Teachers' Perceptions of and Experiences with Classroom Physical Activity

Physical inactivity is one of the most modifiable factors linked to childhood obesity. Several Canadian provinces adopted daily physical activity (DPA) policies to promote physical activity during the school day. In Ontario, only 23% of in-service teachers meet DPA mandates. Promoting DPA implementation must occur at the pre-service level to foster self-efficacy and create long-term teaching habits. This study surveyed 155 pre-service teachers from an Ontario university to determine key perceptions and practices that should be targeted during their educational training to improve DPA fidelity. Findings revealed that over 96% of pre-service teachers viewed physical activity as beneficial for their own and their students mental and physical health, and as much as 33% received no education or training related to DPA. Pre-service teachers valued DPA more if they had opportunities to learn about and observe DPA during school placements. Pre-service teachers were more confident implementing DPA if they were more physically active, viewed themselves as more athletic, and had more positive physical education experiences. This work brings to the forefront important factors that could contribute to DPA implementation among in-service teachers and highlights target areas at the pre-service level for improved fidelity.

Classroom teachers' "off-the-shelf" use of movement integration products and its impact on children's sedentary behavior and physical activity

Movement integration (MI) products are one of many MI strategies that aim to reduce students' sedentary behavior (SB) and increase physical activity (PA) during classroom time. This study examined elementary classroom teachers' off-the-shelf (i.e., no researcher support) use of MI products (GoNoodle Plus [GN], ABC for Fitness [ABC], Take10) and their impact on students' SB and PA. Teachers (N = 57) at five schools received one MI product and reported MI strategy uses/day while student (n = 1,098, 52% female, 66% Black) accelerometer-determined SB and PA was assessed. Mixed regression models estimated changes in MI uses/day and SB and PA during the school day prior to and after teachers received the MI product. GoNoodle was the only MI product where overall MI strategy uses/day increased (∆ = 0.8, 95% CI = 0.1, 1.4). Across products, students' SB increased (∆ = 2.2, 95% CI = 1.2, 3.1) while light (∆ = -1.7, 95% CI = 1.2, 3.1) and MVPA (∆ = -0.5, 95% CI = -0.8, -0.2) decreased. For GN SB (∆ = -3.3, 95% CI = -7.8, 1.3), light (∆ = 2.5, 95% CI = -0.7, 5.7), and MVPA (∆ = 0.8, 95% CI = -0.9, 2.5), did not show statistically significant change. For Take10 SB (∆ = 1.0, 95% CI = -0.2, 2.2) and MVPA (∆ = 0.1, 95% CI = -0.3, 0.6) did not change while light PA decreased (∆ = -1.1, 95% CI = -2.0, -0.3). For ABC SB increased (∆ = 11.1, 95% CI = 8.4, 13.9) while light (∆ = -7.0, 95% CI = -8.9, -5.0) and MVPA (∆ = -4.2, 95% CI = -5.2, -3.1) decreased. GN shows promise for classroom teacher use. However, given limited uptake of the other products and the lack of change in children's SB and PA, this study suggests that off-the-shelf MI products cannot be integrated into classroom routines without additional support.

The Effects of the ACTIVE VALUES Program on Psychosocial Aspects and Executive Functions

The main objective of this study was to implement an educational program named ACTIVE VALUES and to analyse the psychosocial and cognitive effects of its application. It is a quasi-experimental repeated measures research with a non-randomised experimental group (EG) and a control group (CG). The sample consisted of 102 students in the 6th grade of primary school, aged between 11 and 13 years (M = 11.59; SD = 0.60), and 4 teachers aged between 27 and 52 years (M = 38.5). The intervention program lasted 4 months, in which the EG implemented a teaching methodology based on the incorporation of classroom-based physical activity (CB-PA) in the structure of the Teaching for Personal and Social Responsibility (TPSR) model to develop personal and social values in students, as well as to reduce children's sedentary behaviour in the classroom in different educational areas (e.g., mathematics, Spanish language, social sciences and natural sciences), while the CG used a conventional methodology based on direct instruction. The main results found show significant improvements in intrinsic motivation variables (including intrinsic motivation for achievement, stimulating experiences and knowledge), self-determination index, autonomy, relatedness, psychological mediators index, personal and social responsibility, teacher climate, intention to be physically active and executive functions in the EG, while amotivation values increased in the CG. In conclusion, interdisciplinary educational programs based on the combination of pedagogical models and active methodologies are postulated as methodological alternatives to achieve an integral and multilateral development of children and adolescents, as well as to improve the different learning domains of physical education, such as cognitive, social and motor. It is recommended that future research should consider longitudinal designs with mixed methods and follow-up data to assess learning retention, as well as larger samples and the measurement of a greater number of executive functions (e.g., inhibitory control and attention).

Exploring physical activity trends and lesson context of incarcerated youth in a sport-leadership program

Incarcerated youth are one subset of the population in dire need of physical activity interventions. As inactivity within incarcerated populations has become a mounting public health concern, several sport-based physical activity and fitness programs within prisons have emerged. The purpose of this study is to explore physical activity levels and lesson context of a sport-leadership program in one juvenile detention center. Participants in this study were 27 incarcerated males (Mage = 19.3), imprisoned in one juvenile detention center. Participants participated in 20, 40-min sport-leadership lessons over the course of 3 months. Each lesson was live coded using the System for Observing Instructional Time (SOFIT) to examine physical activity levels and lesson context. Over the course of 20 lessons, participants engaged in moderate to vigorous physical activity (MVPA) for 61% of lesson time (24.5 min). Further, over 23% of lesson time was spent vigorously (9.5 min). Specific to lesson context, 18% of total lesson time (7.5 min) was spent in management whereas 7.96% (3.1 min) was consumed by knowledge acquisition. Furthermore, a vast majority of each session (70%) was spent in gameplay (28.04 min). This study is the first to adopt the SOFIT systematic observation instrument to evaluate and quantify MVPA and lesson context during a sport-leadership program within a juvenile detention center. Results from this study indicate incarcerated youth who participated in this program engaged in MVPA for more than 60% of lesson time. It was reported that overall MVPA of participants within programming slightly decreased across the 20 total lessons.

Intensity matters: impact of physical activity energy expenditure at moderate and vigorous intensity on total and abdominal obesity in children

BACKGROUND/OBJECTIVES

Physical activity (PA) guidelines advocate that children should accumulate at least 60 min of moderate-to-vigorous PA daily. Still, it is not clear how body fat may differ if the same dose of PA is accumulated at different intensities. We aimed to determine the independent associations of energy expenditure (EE) at moderate (MPA) and vigorous (VPA) PA intensity on total and abdominal fat in children and if these associations were moderated by cardiorespiratory fitness (CRF).

SUBJECTS/METHODS

A total of 326 children (girls = 171, boys = 151) aged 10-12 years had PA assessed with accelerometers. Total fat mass index (FMI) and abdominal FMI were assessed with DXA. CRF was assessed by a cycle ergometer test. Linear regression models were used to model the outcomes with the inclusion of an interaction term to test for moderation effects.

RESULTS

An inverse association was found between VPA EE and FMI (β = -0.013, p < 0.001) and abdominal FMI (β = -0.0014, p < 0.001) independent of MPA EE. In contrast, MPA EE was not related to adiposity independent of VPA EE (p > 0.05). The relationships between the PA intensities and FMI and abdominal FMI were moderated by CRF. MPA EE was positively associated with adiposity in children with high levels of CRF, whereas VPA EE remained inversely associated with adiposity regardless of CRF level, although the strength of the association was lower in those with higher CRF levels.

CONCLUSION

PA programs should provide opportunities for children to perform VPA in order to achieve healthier body fat profiles and avoid excess adiposity.

Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

BACKGROUND

Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions.

OBJECTIVES

1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review.

SELECTION CRITERIA

We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines.

MAIN RESULTS

We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review.

AUTHORS' CONCLUSIONS

The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Effects of In-Classroom Physical Activity Breaks on Children's Academic Performance, Cognition, Health Behaviours and Health Outcomes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

In-Classroom physical activity breaks (IcPAB) are a promising way to promote children’s health behaviors, while contributing to the development of their academic and cognitive ability and health outcomes. Yet the effect of the activity breaks, which are exclusive to classroom settings, are still mixed and unclear. Hence, this review was conducted to identify the characteristics and the effects of IcPAB among primary school children. The review protocol was registered on PROSPERO (CRD42021234192). Following the Cochrane guidelines, PubMed, PsycINFO (ProQuest), MEDLINE (EBSCOhost), Embase/Ovid, SportDISCUS (EBSCOhost), Web of Science, Scopus and Academic Search Premier (EBSCOhost) databases were searched to collect data on randomised control trials without a time restriction. The final database search was conducted on the 8 November 2021. Random effects models were used to calculate the effect sizes. The systematic review identified ten eligible studies, nine of which were also included in the meta-analysis. Few studies used the theoretical frameworks and process evaluations. IcPAB showed mixed effectiveness on academic outcomes: i.e., IcPAB had effects on spelling performance (p < 0.05) and foreign language learning (p < 0.01) but not on mathematics and reading performance. Health behaviors such as moderate-to-vigorous physical activity levels were improved (p < 0.01), but IcPAB did not have an impact on cognition outcomes and health outcomes. Given these mixed results, further research is needed underpinned by strong methodological quality, theoretical underpinnings and reliable process evaluation methods.

Online physically active academic lessons in COVID-19 times: A pilot study

Schools play an important role in promoting physical activity among students. This paper studies the perception of educators, students, and parents about the use of online physically active academic lessons during COVID-19 in the north of Chile. Starting the first week of November 2020, and for a period of five weeks, 323 students, alongside 11 educators, practiced a geometry-based dance routine online. The qualitative analysis results reveal a positive perception of the experience and an increase in physical activity without reducing the amount of time spent on academic activities. There were also improvements in learning, social relationships, and enjoyment.

The effectiveness of school physical education on students' cognitive competence: a systematic review and meta-analysis

INTRODUCTION

School physical education plays an important role in improving the cognitive competencies of students. The theoretical background related to how school physical education positively influences students' cognitive domains has been consistently structured; however, there are few previous studies that have systematically analyzed how physical education interventions produce positive outcomes related to learners' cognitive competencies. The aim of the present study was to analyze the effectiveness of physical education interventions on students' cognitive competencies.

EVIDENCE ACQUISITION

The study involved searching for related quantitative research studies through electronic research databases including SPORTDiscus, ScienceDirect, and MEDLINE Patent Applications and conducting a screening process considering the purpose of the meta-analysis. The present study assessed for a risk of bias, extracted data, and conducted a meta-analysis to determine the effectiveness of physical education interventions.

EVIDENCE SYNTHESIS

According to the results of the meta-analysis, school physical education has a significant impact on students' cognitive competencies such as intelligence and academic achievement. In terms of the characteristics of the interventions, the effectiveness of aerobic exercise rooted in physical education was more significant than that of model-based physical education or traditional physical education.

CONCLUSIONS

Based on the results of the meta-analysis, the present study concluded that school physical education has a statistically significant impact on changing students' cognitive conditions; however, there is need for a follow-up study on how the contents of school physical education and the methods of teaching have distinct effects on students' cognitive competencies.

“When You Move You Have Fun”: Perceived Barriers, and Facilitators of Physical Activity From a Child's Perspective

In Northern Ireland (NI), many children do not meet the recommended levels of physical activity (PA). To reduce the prevalence of physical inactivity and associated health conditions, it is important to understand the influences on children's PA, which in turn has the potential to inform future intervention design. The purpose of this formative study was to examine the current views, barriers, facilitators, experiences, and perceptions of children in relation to PA in the classroom, school, and home environments, and to assess the acceptability of components for a school-based intervention. Write and draw tasks and semi-structured focus groups (n = 10) were conducted with 50 children aged 7–9 years (22 boys, 28 girls) from six primary schools. Focus groups were recorded, transcribed, and analyzed thematically. Pen profiles were constructed from the transcripts in a deductive manner and represent key emergent themes. Results indicated that children's perception and knowledge of PA was mainly structured and sport-based, while some referred to fun, play and health. Fun, social support and outdoor activity were identified as key facilitators. Barriers included parental restrictions, lack of time and space in the different environments. The acceptability of intervention components was examined, children recognized the potential benefits of additional movement in the classroom, but opinions differed on the sit-to-stand desks. Findings contribute to a more detailed understanding of children's perceptions of context specific PA, the barriers they face, in addition to factors that support them to lead a physically active lifestyle, which may inform future PA promotion strategies.

Positive Impacts of a Sport Intervention on Male Students of Color and School Climate

A positive school climate is strongly associated with enhanced student outcomes. With the disengagement of Black and Latinx youth living in poverty being at an all-time high, participation in sport-based youth development (SBYD) programs may enhance school climate, while capitalizing on existing interests. Purpose: The purpose of this study was to examine the impact of a SBYD intervention on male students of color and school climate. Method: Using a mixed-methods quasi-experimental design, 32 male students of color (11 Black, 13 Latinx, 8 two or more races) participated in an SBYD intervention, twice a week for a total of 20 weeks (Ages 10-14, M = 11.46). School climate data were gathered at the beginning and the end of the school year. Student, teacher, and administrator focus groups and interviews were also conducted at the end of the year. Results: A statistically significant interaction was found between students who participated in the intervention and those who did not participate in the intervention, on school climate measures F(1,74) = 15.00, p < .01, partial η² = .17. Overall school climate scores were statistically significantly greater in the intervention group (F(1,74) = 19.22, p < .01, partial η² = .20) at the end of the year. Focus group data also revealed themes of improved school connectedness, peer support, the acquisition of social/civic skills, and school engagement. Conclusions: A SBYD intervention may be a viable strategy to engage disconnected students and increase school climate perceptions, particularly among male students of color living in poverty.

Physical Exercise of Primary and Middle School Students From the Perspective of Educational Psychology and Parents' Entrepreneurship Education

The study aims to help primary and secondary school students develop a good habit of physical exercise by exploring the current situation of physical exercise of primary and secondary school students and analyzing the factors affecting their physical exercise. Then, intervention strategies are figured out for different groups of students and help them develop a good habit of physical exercise. From the perspective of educational psychology and parents' entrepreneurship education, the research on the physical exercise of primary and secondary school students is conducted by a questionnaire survey, mathematical statistics and literature review. A total of 280 students from five schools in Tianjin are selected as the research subjects, and the current situation of students' physical exercise in these five schools is investigated. The results show that 40.5% of boys and 39.4% of girls can take physical exercise more than three times a week; 48.9% of the students do physical exercise for more than 30 mins each time; the students who usually take regular exercise at school account for 82.1%. The physical exercise that students always do is running, badminton and table tennis, which rank the top three among the sports they do. The students usually play basketball, volleyball, and football, and they rarely do the sports like swimming, Wushu, and aerobics. This result is closely related to the characteristics and places of primary and middle school students. The survey shows that the physical exercise awareness of most primary and secondary school students is correct; most students can participate in physical exercise, but few students can do it regularly; parents' support, parents' habits of doing exercise, and family's spending on physical exercise have a significant impact on developing students' habits of doing physical exercise. Based on the above, it is concluded that the primary and secondary stage is very important for students. Physical education teachers should follow the principle of teaching different students with different methods, enrich teaching materials, and improve teaching quality. The study provides a reference for the reform of PE to guide primary and middle school students to participate in sports activities, improving students' physical quality.

Exploring Teacher Educators’ Perspectives of Play-Based Learning: A Mixed Method Approach

Background: This study examined teacher educators’ perceptions of play-based learning in the context of university-based teacher education programmes in Palestine. Methods: Using a cross-sectional, multi-method design, we explored factors relating to teacher educators’ capability, opportunity and motivation to incorporate play-based learning into their practice. Thirty-six staff from four Palestinian universities completed an online survey and 17 were interviewed. Results: Teacher educators recognise the value of play-based learning and are motivated to apply this pedagogical approach. However, attempts to incorporate play-based learning into their practices is affected by insufficient knowledge and skills to apply play-based learning in practical contexts. Furthermore, social cues, cultural norms and physical challenges currently limit their opportunity to adopt play-based approaches. Conclusion: Our findings highlight that Palestinian teacher educators are motivated to embrace play-based learning as a pedagogical approach and recognise the importance of using play-based learning in educational practices. The findings can inform future professional development programs for teacher educators.

Behaviours that prompt primary school teachers to adopt and implement physically active learning: a meta synthesis of qualitative evidence

BACKGROUND

Physically active learning (PAL) - integration of movement within delivery of academic content - is a core component of many whole-of-school physical activity approaches. Yet, PAL intervention methods and strategies vary and frequently are not sustained beyond formal programmes. To improve PAL training, a more comprehensive understanding of the behavioural and psychological processes that influence teachers' adoption and implementation of PAL is required. To address this, we conducted a meta-synthesis to synthesise key stakeholders' knowledge of facilitators and barriers to teachers' implementing PAL in schools to improve teacher-focussed PAL interventions in primary (elementary) schools.

METHODOLOGY

We conducted a meta-synthesis using a five-stage thematic synthesis approach to; develop a research purpose and aim, identify relevant articles, appraise studies for quality, develop descriptive themes and interpret and synthesise the literature. In the final stage, 14 domains from the Theoretical Domain Framework (TDF) were then aligned to the final analytical themes and subthemes.

RESULTS

We identified seven themes and 31 sub-themes from 25 eligible papers. Four themes summarised teacher-level factors: PAL benefits, teachers' beliefs about own capabilities, PAL teacher training, PAL delivery. One theme encompassed teacher and school-level factors: resources. Two themes reflected school and external factors that influence teachers' PAL behaviour: whole-school approach, external factors. Ten (of 14) TDF domains aligned with main themes and sub-themes: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, Beliefs about Consequences, Reinforcement, Goals, Environmental Context and Resources, Social influences and Emotion.

CONCLUSIONS

Our synthesis illustrates the inherent complexity required to change and sustain teachers' PAL behaviours. Initially, teachers must receive the training, resources and support to develop the capability to implement and adapt PAL. The PAL training programme should progress as teachers' build their experience and capability; content should be 'refreshed' and become more challenging over time. Subsequently, it is imperative to engage all levels of the school community for PAL to be fully integrated into a broader school system. Adequate resources, strong leadership and governance, an engaged activated community and political will are necessary to achieve this, and may not currently exist in most schools.

Effects of Physically Active Lessons on Movement Behaviors, Cognitive, and Academic Performance in Elementary Schoolchildren: ERGUER/Aracaju Project

BACKGROUND

To evaluate the effects of the introduction of physically active lessons on movement behaviors, cognitive, and academic performance in schoolchildren.

METHODS

This was a cluster-controlled trial. A total of 61 students from the second year of elementary school in a public school in Brazil made up 2 intervention classes (n = 34) with the introduction of physically active lessons and 2 control classes (n = 27). Sedentary behavior, physical activity, cognitive, and academic performance were evaluated in 3 moments, which were compared using models of generalized estimating equations.

RESULTS

The intervention was effective for reducing the standing time between the baseline and 3 months while increasing the walking time between baseline and 3 months and baseline and 9 months. There was a reduction in time in stationary activities and increased time in light physical activities between all moments. The intervention group increased their performance in the go/no go test, showing a smaller number of errors between the baseline and 3 months and baseline and 9 months, and a reduction in the test time between baseline and 3 months. No impact on students' academic performance was observed.

CONCLUSION

Physically active lessons improve movement behaviors and cognitive functions among elementary schoolchildren.

Directly Observed Physical Activity of Year 1 Children during School Class Time: A Cross-Sectional Study

Providing physical activity opportunities to children throughout the school day may be beneficial for children’s health and learning. Existing practices regarding the frequency, type and context of physical activity opportunities being provided to children in the early years of primary school remains largely unknown. The aim of this study was to observe Year 1 children’s physical activity and its contexts during school class time and identify opportunities to incorporate additional activity. A cross-sectional study was conducted with 34 Year 1 children (20 boys, 14 girls; mean age = 6.36 ± 0.34 years) from one primary school in Queensland, Australia. A modified version of the Observational System for Recording Physical Activity in Children—Elementary School was used to assess children’s physical activity and its contexts during class time. Observational data were collected over a four-week period. The frequencies (and percentages) of intervals of children’s activity observed in sedentary, light and moderate-to-vigorous intensities during different instructional and social contexts and physical settings were recorded and calculated. Pearson’s chi-square test of association was conducted to evaluate whether social context (group composition) was related to incidental physical activity. A total of 5305 observation intervals (i.e., 5 s observation interval followed by a 25 s recording interval) were available for analysis (~44 h of observation). Year 1 children were sedentary for the majority (86%) of observed intervals during school class time. Children spent limited time performing light (12% of intervals) and moderate-to-vigorous physical activity (2% of intervals). Organised physical activity observed during class time included physical education/school sport (5.9% of intervals) and classroom-based physical activity (2.8% of intervals). When children completed activities in small groups, they were significantly more likely to engage in incidental physical activity than when they completed activities as a whole class (χ² = 94.73 p < 0.001). Incorporating movement into academic lessons or during transitions between lessons and classrooms may encourage children to be more active. Incidental physical activity may also be promoted through small group activities. Schools should ideally be encouraged and supported to employ a whole-of-school approach to physical activity promotion, which includes identifying and implementing opportunities for children to be active during class time.

Predicting school students' physical activity intentions in leisure-time and school recess contexts: Testing an integrated model based on self-determination theory and theory of planned behavior

Background

Identifying psychological correlates of children’s physical activity intentions may signpost potentially modifiable targets for interventions aimed at promoting physical activity participation. School recess and leisure-time outside of school are appropriate contexts in which such interventions may be delivered. However, few studies have identified correlates of physical activity intentions in these environments. Examining correlates in these contexts may provide formative evidence on which to base interventions to promote physical activity.

Purpose

The current study adopted an integrated theoretical model to test relations between motivational constructs from self-determination theory, social cognition constructs from the theory of planned behavior, and physical activity intentions in leisure-time and school recess contexts.

Methods

Finnish school children (N = 845, M age = 13.93, SD = 0.99) from three lower-secondary schools completed self-report measures of perceived autonomy support by peers, autonomous and controlled motivation, attitudes, subjective norms, perceived behavioral control, and physical activity intentions for both contexts.

Results

Well-fitting structural equation models controlling for past behavior indicated that autonomous motivation in the school recess context and attitude in both contexts were the most pervasive predictors of physical activity intentions, and mediated the relationship between perceived autonomy support and intentions. Multi-group analyses supported invariance of the models in both contexts across gender, grades, and school, with few variations.

Conclusions

The current study supports relations between motivational and social cognition correlates of children’s physical activity intentions in school recess and leisure-time contexts. Future research should extend these findings to the prediction of follow-up participation in physical activity.

Moderate-to-Vigorous Physical Activity in Primary School Children: Inactive Lessons Are Dominated by Maths and English

BACKGROUND

A large majority of primary school pupils fail to achieve 30-min of daily, in-school moderate-to-vigorous physical activity (MVPA). The aim of this study was to investigate MVPA accumulation and subject frequency during academic lesson segments and the broader segmented school day.

METHODS

122 children (42.6% boys; 9.9 ± 0.3 years) from six primary schools in North East England, wore uniaxial accelerometers for eight consecutive days. Subject frequency was assessed by teacher diaries. Multilevel models (children nested within schools) examined significant predictors of MVPA across each school-day segment (lesson one, break, lesson two, lunch, lesson three).

RESULTS

Pupils averaged 18.33 ± 8.34 min of in-school MVPA, and 90.2% failed to achieve the in-school 30-min MVPA threshold. Across all school-day segments, MVPA accumulation was typically influenced at the individual level. Lessons one and two-dominated by maths and English-were less active than lesson three. Break and lunch were the most active segments.

CONCLUSION

This study breaks new ground, revealing that MVPA accumulation and subject frequency varies greatly during different academic lessons. Morning lessons were dominated by the inactive delivery of maths and English, whereas afternoon lessons involved a greater array of subject delivery that resulted in marginally higher levels of MVPA.

Adolescents' Physical Activity in Education Systems Varying in the Number of Weekly Physical Education Lessons

Purpose: School physical activity (SPA) is a significant component of daily PA. We investigated differences in PA between boys and girls in two differing education systems-Poland and the Czech Republic-which have four and two physical education lessons (PELs) per week, respectively. Method: This project was conducted from 2012-2016 at 17 Polish and 23 Czech secondary schools (N = 921; mean age = 16.2 ± 0.7 years). ActiTrainer accelerometers were used to monitor participants' PA and heart rate during school days. Weekly PA was measured using pedometers. Subjective levels of weekly PA were self-reported on the International Physical Activity Questionnaire-long form. Results: The Polish education system enabled adolescents to meet the recommendations for moderate-to-vigorous PA more likely than did the Czech system. SPA also represented a higher portion of daily PA in the Polish (vs. Czech system); however, the differences in total daily step count between Polish and Czech adolescents were non-significant. SPA accounted for 30-37% of the daily PA (as measured by step count) of Polish girls (23-30% of Czech girls) and 28-39% of Polish boys (25-37% of Czech boys). Conclusions: Participation in PELs was associated with a higher rate of meeting SPA recommendations in both countries. Compared with the Czech Republic, more PELs in the Polish education system was associated with increased daily vigorous PA and a greater portion of SPA in daily PA. Differences in overall daily and weekly moderate-to-vigorous PA between Polish and Czech adolescents were non-significant.

2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence

BACKGROUND

The World Health Organization (WHO) released in 2020 updated global guidelines on physical activity and sedentary behaviour for children, adolescents, adults, older adults and sub-populations such as pregnant and postpartum women and those living with chronic conditions or disabilities.

OBJECTIVE

To summarize the evidence on the associations between physical activity, sedentary behaviour, and health-related outcomes used to inform the 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years.

METHODS

The update of the WHO guideline recommendations for children and adolescents utilized and systematically updated the evidence syntheses on physical activity and sedentary behaviour conducted for the 2016 Canadian 24-Hour Movement Guidelines for Children and Youth, the 2019 Australian 24-Hour Movement Guidelines for Children and Young People (5-17 years), and the 2018 Physical Activity Guidelines for Americans, Second Edition. Systematic reviews published from 2017 up to July 2019 that addressed the key questions were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rate the certainty of the evidence for the entire body of evidence.

RESULTS

The updated literature search yielded 21 relevant systematic reviews. The evidence base reviewed (i.e., existing and new systematic reviews) provided evidence that greater amounts and higher intensities of physical activity as well as different types of physical activity (i.e., aerobic and muscle and bone strengthening activities) are associated with improved health outcomes (primarily intermediate outcomes). There was sufficient evidence to support recommendations on limiting sedentary behaviours, which was not addressed in the 2010 WHO guidelines. However, there is still insufficient evidence available to fully describe the dose-response relationships between physical activity or sedentary behaviour and health outcomes, and whether the associations vary by type or domain of physical activity or sedentary behaviour.

CONCLUSIONS

Addressing the identified research gaps will better inform guideline recommendations in children and adolescents, and future work should aim to prioritize these areas of research. In the meantime, investment and leadership is needed to scale up known effective policies and programs aimed at increasing activity in children and adolescents.

Elementary Classroom Teachers' Self-Reported Use of Movement Integration Products and Perceived Facilitators and Barriers Related to Product Use

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers' self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators and barriers. MI product use lasted for 11.2 (Standard Deviation (SD) = 7.5) min/occasion and MI products were used 4.1 (SD = 3.5) times/week on average. Activity Bursts in the Classroom for Fitness, GoNoodle, and Physical Activity Across the Curriculum were most frequently used. Facilitators of and barriers to MI product use were identified within three central areas-logistics, alignment with teaching goals, and student needs and interests. Teachers were receptive to MI products and used them frequently throughout the week. When considering the adoption of MI products, teachers, administrators, and policy makers should consider products that are readily usable, align with teaching goals, and are consistent with student needs and interests.

Physical Activity and Academic Achievement: An Umbrella Review

Background: This umbrella review aimed to summarise the evidence presented in systematic reviews and meta-analyses regarding the effect of physical activity on academic achievement of school-age children and adolescents. Methods: A comprehensive electronic search for relevant systematic reviews and meta-analyses were performed in Pubmed, Cochrane Library, Web of Science, Scopus, and Latin American and Caribbean of Health Sciences Information System, and reference lists of the included studies, from inception to May 2020. Studies were included if they were systematic reviews or meta-analyses, included school-age children or adolescents, the intervention included physical activity, and the outcome was the academic achievement. Two independent authors screened the text of potentially eligible studies and assessed the methodological quality of the studies using the AMSTAR 2 tool. Results: Forty-one systematic reviews and meta-analyses that examined the effects of physical activity on children and adolescents’ academic achievement were identified. Overall, the systematic reviews reported small positive or mixed associations between physical activity and academic achievement. From meta-analyses, it was observed that physical activity had null or small-to-medium positive effects on academic achievement. Chronic physical activity showed a medium positive effect on academic achievement, and acute physical activity did not demonstrate benefits. Conclusions: Physical activity seems not to be detrimental to school-age children and adolescents’ academic achievement, and may, in fact, be beneficial.

The Influence of Role Models on the Sedentary Behaviour Patterns of Primary School-Aged Children and Associations with Psychosocial Aspects of Health

BACKGROUND

High levels of sedentary behaviour (SB) are associated with poor health outcomes in children, but the effects on mental health are less clear. This study explored the relationship between SB and psychosocial aspects of health in children, and what influence key role models, including parents and schoolteachers, have on the SB levels of children.

METHODS

Physical activity (PA) and SB were measured using accelerometery in 101 children, 113 parents and 9 teachers. Children were aged 9 or 10 years old and in fourth grade. Child psychosocial outcomes were assessed using the Rosenberg Self-Esteem Scale and the Strengths and Difficulties Questionnaire.

RESULTS

Children engaged in a high volume of SB (9.6 h/day) but interrupted SB often. They accumulated less than 11,000 steps per day, and thus, many may not meet the recommended daily levels of PA. No associations were found between child SB and teacher SB during the school day or child SB and parent SB during the after-school period. No association was found between SB and self-esteem, although children with a higher body mass index had a higher number of emotional and behavioural difficulties.

CONCLUSIONS

Although there was no indication that children's SB was linked to that of parents and teachers, or that SB was associated with self-esteem or behavioural problems, school children were highly sedentary and insufficiently physically active. Therefore, there is a need to explore school practices and curriculum delivery methods, as well as school and home environments, to reduce the volume of SB children engage in.

A critical evaluation of systematic reviews assessing the effect of chronic physical activity on academic achievement, cognition and the brain in children and adolescents: a systematic review

BACKGROUND

International and national committees have started to evaluate the evidence for the effects of physical activity on neurocognitive health in childhood and adolescence to inform policy. Despite an increasing body of evidence, such reports have shown mixed conclusions. We aimed to critically evaluate and synthesise the evidence for the effects of chronic physical activity on academic achievement, cognitive performance and the brain in children and adolescents in order to guide future research and inform policy.

METHODS

MedLine, Embase, PsycINFO, Cochrane Library, Web of Science, and ERIC electronic databases were searched from inception to February 6th, 2019. Articles were considered eligible for inclusion if they were systematic reviews with or without meta-analysis, published in peer-reviewed (English) journals. Reviews had to be on school-aged children and/or adolescents that reported on the effects of chronic physical activity or exercise interventions, with cognitive markers, academic achievement or brain markers as outcomes. Reviews were selected independently by two authors and data were extracted using a pre-designed data extraction template. The quality of reviews was assessed using AMSTAR-2 criteria.

RESULTS

Of 908 retrieved, non-duplicated articles, 19 systematic reviews met inclusion criteria. One high-quality review reported inconsistent evidence for physical activity-related effects on cognitive- and academic performance in obese or overweight children and adolescents. Eighteen (critically) low-quality reviews presented mixed favourable and null effects, with meta-analyses showing small effect sizes (0.1-0.3) and high heterogeneity. Low-quality reviews suggested physical activity-related brain changes, but lacked an interpretation of these findings. Systematic reviews varied widely in their evidence synthesis, rarely took intervention characteristics (e.g. dose), intervention fidelity or study quality into account and suspected publication bias. Reviews consistently reported that there is a lack of high-quality studies, of studies that include brain imaging outcomes, and of studies that include adolescents or are conducted in South American and African countries.

CONCLUSIONS

Inconsistent evidence exists for chronic physical activity-related effects on cognitive-, academic-, and brain outcomes. The field needs to refocus its efforts towards improving study quality, transparency of reporting and dissemination, and is urged to differentiate between intervention characteristics for its findings to have a meaningful impact on policy.

Understanding Elementary Classroom Teachers' Use of Movement Integration Resources

Movement integration (MI)-infusing physical activity (PA) into normal classroom time during school-is an evidence-based strategy to support public health goals and enhance educational outcomes for elementary children. However, few elementary classroom teachers in the United States appear to be using MI resources. In order to understand teachers' MI resource use, this study's purpose was 3-fold: (a) to examine teachers' perceptions about MI and MI resources, (b) to identify teachers' latent class membership based on their perceptions, and (c) to determine the extent to which teachers' MI preferences, demographics, background, and school context predict class membership. We recruited a national sample of participants (N = 420) who completed an electronic survey including six sections: perceived benefits of MI, perceived barriers to using MI resources, satisfaction with MI resources, perceived importance of different MI resource characteristics, MI resource preferences, and participant demographics, background, and school context. Data analysis consisted of descriptive analyses, exploratory factor analysis, confirmatory factor analysis, latent profile analysis, and multinomial regression analysis. Participants mostly agreed about the benefits of MI and were satisfied with the MI resources they were using but had varying perceptions about the presence of barriers to using MI resources. Participants rated the integration of an MI resource with the academic curriculum, the amount of time required for teacher training, the type of training materials provided, and the timing of the training as the most important characteristics they would consider before adopting a resource. Factor analyses supported single factor solutions for perceived benefits, perceived barriers, and satisfaction, and a three-factor solution for perceived importance of different MI resource characteristics (Curriculum Integration, Training Logistics, and Feasibility). Based on these factors, we identified five latent classes of teachers. Regression results showed that desirable latent class membership depended on certain MI preferences and demographic, background, and school context characteristics. Teacher educators and interventionists should consider teachers' MI perceptions, the nature of MI trainings, teacher characteristics, and school context in efforts to increase teachers' use of MI resources. Further research is needed to explore the intrinsic value of MI for teachers, given MI's education- and public health-related benefits.

Are There Effective Interventions to Increase Physical Activity in Children and Young People? An Umbrella Review

BACKGROUND

Obesity and physical inactivity among children and young people are public health concerns. While numerous interventions to promote physical activity are available, little is known about the most effective ones. This study aimed to summarize the existing evidence on interventions that aim to increase physical activity.

METHODS

A systematic review of reviews was conducted. Systematic reviews and meta-analyses published from January 2010 until November 2017 were identified through PubMed, Scopus and the Cochrane Library. Two reviewers independently assessed titles and abstracts, performed data extraction and quality assessment. Outcomes as level of physical activity and body mass index were collected in order to assess the efficacy of interventions.

RESULTS

A total 30 studies examining physical activity interventions met the inclusion criteria, 15 systematic reviews and 15 meta-analyses. Most studies (N = 20) were implemented in the school setting, three were developed in preschool and childcare settings, two in the family context, five in the community setting and one miscellaneous context. Results showed that eight meta-analyses obtained a small increase in physical activity level, out of which five were conducted in the school, two in the family and one in the community setting. Most promising programs had the following characteristics: included physical activity in the school curriculum, were long-term interventions, involved teachers and had the support of families.

CONCLUSION

The majority of interventions to promote physical activity in children and young people were implemented in the school setting and were multicomponent. Further research is needed to investigate nonschool programs.

Implementing physically active learning: Future directions for research, policy, and practice

PURPOSE

To identify co-produced multi-stakeholder perspectives important for successful widespread physically active learning (PAL) adoption and implementation.

METHODS

A total of 35 stakeholders (policymakers n = 9; commercial education sector, n = 8; teachers, n = 3; researchers, n = 15) attended a design thinking PAL workshop. Participants formed 5 multi-disciplinary groups with at least 1 representative from each stakeholder group. Each group, facilitated by a researcher, undertook 2 tasks: (1) using Post-it Notes, the following question was answered: within the school day, what are the opportunities for learning combined with movement? and (2) structured as a washing-line task, the following question was answered: how can we establish PAL as the norm? All discussions were audio-recorded and transcribed. Inductive analyses were conducted by 4 authors. After the analyses were complete, the main themes and subthemes were assigned to 4 predetermined categories: (1) PAL design and implementation, (2) priorities for practice, (3) priorities for policy, and (4) priorities for research.

RESULTS

The following were the main themes for PAL implementation: opportunities for PAL within the school day, delivery environments, learning approaches, and the intensity of PAL. The main themes for the priorities for practice included teacher confidence and competence, resources to support delivery, and community of practice. The main themes for the policy for priorities included self-governance, the Office for Standards in Education, Children's Services, and Skill, policy investment in initial teacher training, and curriculum reform. The main themes for the research priorities included establishing a strong evidence base, school-based PAL implementation, and a whole-systems approach.

CONCLUSION

The present study is the first to identify PAL implementation factors using a combined multi-stakeholder perspective. To achieve wider PAL adoption and implementation, future interventions should be evidence based and address implementation factors at the classroom level (e.g., approaches and delivery environments), school level (e.g., communities of practice), and policy level (e.g., initial teacher training).

Class Time Physical Activity Programs for Primary School Aged Children at Specialist Schools: A Systematic Mapping Review

Children with disabilities tend to be less active than typically developing peers and may therefore miss important developmental benefits. Class time physical activity (PA) programs can provide additional PA to children and have shown to contribute to numerous benefits in mainstream classrooms. However, it is unclear whether class time PA opportunities are provided in specialist education settings. This review aimed to identify and map class time PA programs that have been implemented in specialist schools and classes. Nine electronic databases were searched. Grey literature searches were also conducted. Programs were included if they were implemented in a primary/elementary specialist school or class, involved a PA component, were conducted during class time and involved more than one child from the class participating. Included programs were mapped and narratively synthesised according to activity type. Of the 2068 records screened, 34 programs were included. Programs involving dance/drama activities (k = 11) were most common and programs involving stretching activities (k = 2) were least frequently implemented. Twenty-three programs had been evaluated, of which only two were randomised controlled trials. More class time PA opportunities are warranted in specialist education settings. Further research is required to build the evidence base for these programs.

'It's not because we don't believe in it...': Headteachers' perceptions of implementing physically active lessons in school

INTRODUCTION

Implementation of school-based physical activity (PA) programmes has proven to be difficult, particularly due to schools' focus on academic performance and lack of organisational support for PA interventions. However, physically active lessons (PA integrated into academic lessons) holds promise as a teaching method that increases children's PA levels without reducing academic time. Headteachers play a significant role in facilitating change in school, but little is known about headteachers' attitudes towards physically active lessons and their benefits. The purpose of this study was to explore headteachers' perceptions of physically active lessons, and identify factors affecting headteachers' acceptance or rejection of physically active lessons implementation.

METHOD

A total of 29 semi-structured telephone interviews were conducted with headteachers in primary and secondary schools in the city of Stavanger, Norway. Adopting a phenomenological approach, qualitative data were analysed using inductive content analysis.

RESULTS

Although most of the headteachers believed that physically active lessons could contribute positively to pupils' health and learning, only four of 29 schools decided to proceed with implementation. Physically active lessons were more likely to be adopted when the intervention addressed a clearly defined priority area at the school. Change overload and lack of in-depth knowledge of physically active lessons' function and intent appeared to be the most important factors for choosing not to implement physically active lessons.

CONCLUSION

One of the major challenges for headteachers was deciding which of the many proposed changes the school should prioritise. If physically active lessons was to be prioritised by headteachers it is very important to communicate thoroughly to the headteachers what the schools can achieve by implementing physically active lessons and how the innovation aligns with school policies and goals. Given the flexibility inherent in physically active lessons and the schools' differing needs and priorities, it was important to emphasise to headteachers that physically active lessons could be adapted to different local school contexts.

Effects of school-based physical activity on mathematics performance in children: a systematic review

BACKGROUND

The benefits of physical activity (PA) on children's health and wellbeing are well established. However, the benefits of PA on academic performance and particularly on mathematics performance warrant systematic analysis. Mathematics is one of the core subjects in school education globally.

METHODS

We systematically searched, analysed and synthesized the literature on the effects of school-based PA interventions on mathematics performance in children aged 4-16. A total of 29 studies consisting of randomised trials and other interventions with control groups were identified through a systematic search, and 11 of them provided sufficient data and appropriate design for a meta-analysis.

RESULTS

Of the 29 studies involving 11,264 participants, positive overall effects of a PA intervention on mathematics performance were found in 13 studies (45%) and neutral overall effects in 15 studies (52%). Only one study reported a significant negative result for a subgroup of children in the first half of the intervention. In a risk-of-bias assessment, 12 studies had low, 17 moderate, and none had a high risk of bias. The meta-analysis of 11 studies suggested an overall small positive effect (ES = 0.23) of the interventions. Only one study in the meta-analysis indicated a negative effect in one of the intervention groups.

CONCLUSIONS

Adding PA to the school day may enhance children's mathematics performance or has no negative effects on performance. Several types of PA interventions can be recommended to be added to the school day.

Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis

OBJECTIVE

This review provides the first meta-analysis of the impact of physically active lessons on lesson-time and overall physical activity (PA), as well as health, cognition and educational outcomes.

DESIGN

Systematic review and meta-analysis of controlled studies. Six meta-analyses pooled effects on lesson-time PA, overall PA, in-class educational and overall educational outcomes, cognition and health outcomes. Meta-analyses were conducted using the metafor package in R. Risk of bias was assessed using the Cochrane tool for risk of bias.

DATA SOURCES

PubMed, Embase, PsycINFO, ERIC and Web of Science, grey literature and reference lists were searched in December 2017 and April 2019.

STUDIES ELIGIBILITY CRITERIA

Physically active lessons compared with a control group in a randomised or non-randomised design, within single component interventions in general school populations.

RESULTS

42 studies (39 in preschool or elementary school settings, 27 randomised controlled trials) were eligible to be included in the systematic review and 37 of them were included across the six meta-analyses (n=12 663). Physically active lessons were found to produce large, significant increases in lesson-time PA (d=2.33; 95% CI 1.42 to 3.25: k=16) and small, increases on overall PA (d=0.32; 95% CI 0.18 to 0.46: k=8), large, improvement in lesson-time educational outcomes (d=0.81; 95% CI 0.47 to 1.14: k=7) and a small improvement in overall educational outcomes (d=0.36; 95% CI 0.09 to 0.63: k=25). No effects were seen on cognitive (k=3) or health outcomes (k=3). 25/42 studies had high risk of bias in at least two domains.

CONCLUSION

In elementary and preschool settings, when physically active lessons were added into the curriculum they had positive impact on both physical activity and educational outcomes. These findings support policy initiatives encouraging the incorporation of physically active lessons into teaching in elementary and preschool setting.

TRIAL REGISTRATION NUMBER

CRD42017076933.

Healthy or Unhealthy? The Cocktail of Health-Related Behavior Profiles in Spanish Adolescents

The aim of this study was to identify the prevalence and clustering of health-related behaviors in Spanish adolescents and to examine their association with sex, body mass index (BMI), different types of sedentary screen time, and adherence to 24-hour movement guidelines. A final sample of 173 students (M = 12.99 ± 0.51) participated in this study. Cluster analysis was conducted based on five health-related behaviors: PA and sedentary time derived from accelerometers, as well as healthy diet, sedentary screen time, and sleep duration derived from self-reported scales. Recommendations for 24-hour movement guidelines (i.e., physical activity (PA), screen time, and sleep duration) were analyzed both independently and combined. A total of 8.9% of the sample did not meet any of the guidelines, whereas 72.3%, 17.3%, and 1.7% of the sample met 1, 2, or all 3 guidelines, respectively. Six distinct profiles were identified, most of them showing the co-occurrence of healthy- and unhealthy-related behaviors. Given that most of the adolescents failed to meet the combination of PA, screen time, and sleep duration guidelines, these findings suggest the necessity to implement school-based interventions that target multiple health behaviors, especially because (un)healthy behaviors do not always cluster in the same direction.

Integrating Juggling with Math Lessons: A Randomized Controlled Trial Assessing Effects of Physically Active Learning on Maths Performance and Enjoyment in Primary School Children

There are tentative indications that physical activity (PA) during school time can be beneficial for children's academic performance. So far, most studies have focused on the effects of moderate-to-vigorous PA, for example, in the form of energizers or extra physical education lessons. Little is known about the effects of physically active learning, in which PA is integrated with the academic content of the lessons, especially in preadolescent children. Moreover, there is a lack of knowledge regarding the enjoyment of physically active learning in this age group. Therefore, the aim of the current study was to assess the effects of integrating juggling with math practice in primary school children, on (1) multiplication memorization performance and (2) enjoyment during the math lessons. We conducted a cluster randomized controlled trial, in which 312 children (mean age 10.4 years) from nine Dutch primary schools participated. Fourteen classes were randomly assigned to either a group that learned juggling whilst practicing multiplication tables (intervention group), or to a group that practiced the same multiplication tables while sedentary (control group). Both interventions had a duration of 5 weeks and consisted of 20 short lessons (4 lessons per week, 5 to 8 min). We used mixed-model analyses to examine the effect of the intervention on multiplication memorization performance. Group (control or intervention) was used as the fixed factor, and class and school as random intercepts. Analyses were adjusted for pretest multiplication performance, age, gender, general motor skill level, physical activity behavior (PAQ-C), and academic math performance. No significant intervention effect on multiplication performance were observed. However, the math-juggling program significantly increased enjoyment of children during the math lessons. We can conclude that the intervention did not improve, but neither deteriorated children's math performance. The increased enjoyment in the math-juggling group can serve as an important starting point for structurally incorporating physical activities in the classroom setting.

Introducing physically active lessons in UK secondary schools: feasibility study and pilot cluster-randomised controlled trial

OBJECTIVES

Assess feasibility, acceptability and costs of delivering a physically active lessons (PAL) training programme to secondary school teachers and explore preliminary effectiveness for reducing pupils' sedentary time.

DESIGN AND SETTING

Secondary schools in East England; one school participated in a pre-post feasibility study, two in a pilot cluster-randomised controlled trial. In the pilot trial, blinding to group assignment was not possible.

PARTICIPANTS

Across studies, 321 randomly selected students (51% male; mean age: 12.9 years), 78 teachers (35% male) and 2 assistant head teachers enrolled; 296 (92%) students, 69 (88%) teachers and 2 assistant head teachers completed the studies.

INTERVENTION

PAL training was delivered to teachers over two after-school sessions. Teachers were made aware of how to integrate movement into lessons; strategies included students collecting data from the environment for class activities and completing activities posted on classroom walls, instead of sitting at desks.

PRIMARY AND SECONDARY OUTCOMES

Quantitative and qualitative data were collected to assess feasibility and acceptability of PAL training and delivery. Outcomes were assessed at baseline and ~8 weeks post-training; measures included accelerometer-assessed activity, self-reported well-being and observations of time-on-task. Process evaluation was conducted at follow-up.

RESULTS

In the feasibility study, teachers reported good acceptability of PAL training and mixed experiences of delivering PAL. In the pilot study, teachers' acceptability of training was lower and teachers identified aspects of the training in need of review, including the outdoor PAL training and learning challenge of PAL strategies. In both studies, students and assistant head teachers reported good acceptability of the intervention. Preliminary effectiveness for reducing students' sedentary time was not demonstrated in either study.

CONCLUSIONS

No evidence of preliminary effectiveness on the primary outcome and mixed reports of teachers' acceptability of PAL training suggest the need to review the training. The results do not support continuation of research with the current intervention.

TRIAL REGISTRATION NUMBER

ISRCTN38409550.

Exploring the effectiveness of a school-based physical activity policy in British Columbia, Canada: a mixed-methods observational study

The Daily Physical Activity (DPA) policy in British Columbia requires elementary schools to help students achieve 30 min of physical activity during instructional and noninstructional time on school days. The purpose of this study was to determine how elementary teachers implement the DPA policy, and examine differences in children's light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) at school, based on how the teacher implemented the DPA policy during the school day (provision of DPA during instructional time or only noninstructional time). In this observational mixed-methods study, 12 teachers were interviewed on their implementation approaches. Teachers provided DPA opportunities during instructional time (i.e., prescriptive implementers, n = 9) or relied on students to be active during noninstructional times (i.e., nonprescriptive, n = 3). Next, 10 students from each interviewed teacher's classroom were randomly selected to wear accelerometers for one school week. Hierarchical linear modeling was used to examine the contribution of teacher's implementation strategy on student's activity levels. t-Tests examined differences in students' activity levels between implementation groups. Teacher's DPA implementation strategy accounted for a significant proportion of variance in student's activity throughout the school day (p's < .05). The prescriptive group (n = 88) was more active (LPA and MVPA) and spent a greater proportion of their school days in MVPA during instructional time than the nonprescriptive group (n = 23). Heterogeneity in policy implementation creates variations in policy effectiveness. Students provided with opportunities to be active during instructional time may accumulate more MVPA compared with those who are not given these opportunities. Registration: Not applicable.

Pathways leading to success and non-success: a process evaluation of a cluster randomized physical activity health promotion program applying fuzzy-set qualitative comparative analysis

BACKGROUND

Health promotion programs can only lead to improvements in health outcomes if they are effectively implemented. However, most studies assessing implementation success focus on only one condition, although more conditions influence this process. Therefore, evidence is scarce on what conditions play a role in successful implementation and how they interact. Hence, we aimed to identify which combinations of teacher and implementation process characteristics affected the emotional and social school experience (SCE) of pupils participating in a school-based health promotion program.

METHODS

This study was part of an effectiveness and process evaluation including 24 intervention and 27 control classes. We used fuzzy-set qualitative comparative analysis (fsQCA) to identify combinations of conditions that were associated with either an increase or no increase in the outcome SCE in comparison to the control group at 20 months post intervention. We deductively selected five conditions based on the Consolidated Framework for Implementation Research: teachers' perceived self-efficacy, teachers' expectations of the benefits of the intervention, teachers' previous knowledge about the intervention, dosage of physical activity breaks, and quality of the implementation.

RESULTS

We identified five different pathways that led to no increase in the pupils' outcome (parameters of fit: consistency 94%, coverage 66%). The combination of an unsatisfying quality of implementing the intervention and a low previous knowledge about the intervention showed the highest empirical relevance. Similarly, fewer physical activity breaks in combination with other conditions impeded the program's success. Furthermore, we identified two different pathways characterizing ways to success (consistency: 81%, coverage: 52%). The most relevant combination was good quality implementation of physical activity breaks, implemented by teachers with a high self-efficacy, and a good previous knowledge about the intervention.

CONCLUSIONS

QCA has potential for an in-depth analysis of complex interventions as it can rely on small to medium sample sizes and analyze pathways to success and non-success separately. The investigated program can be improved by considering the following suggestions: The quality of the implementation process should be monitored during the implementation phase, and regular feedback loops and learning opportunities for teachers should accompany a program. Clear recommendations regarding the dosage should be established.

TRIAL REGISTRATION

German register of clinical studies: DRKS00000622 . Retrospectively registered: December 3, 2010, ( http://www.drks.de/drks_web/setLocale_EN.do ). Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107-2010).

Adiposity, fitness, health-related quality of life and the reallocation of time between children's school day activity behaviours: A compositional data analysis

Sedentary time (ST), light (LPA), and moderate-to-vigorous physical activity (MVPA) constitute the range of school day activity behaviours. This study investigated whether the composition of school activity behaviours was associated with health indicators, and the predicted changes in health when time was reallocated between activity behaviours. Accelerometers were worn for 7-days between October and December 2010 by 318 UK children aged 10-11, to provide estimates of school day ST, LPA, and MVPA. BMI z-scores and percent waist-to-height ratio were calculated as indicators of adiposity. Cardiorespiratory fitness (CRF) was assessed using the 20-m shuttle run test. The PedsQL™ questionnaire was completed to assess psychosocial and physical health-related quality of life (HRQL). Log-ratio multiple linear regression models predicted health indicators for the mean school day activity composition, and for new compositions where fixed durations of time were reallocated from one activity behaviour to another, while the remaining behaviours were unchanged. The school day activity composition significantly predicted adiposity and CRF (p = 0.04-0.002), but not HRQL. Replacing MVPA with ST or LPA around the mean activity composition predicted higher adiposity and lower CRF. When ST or LPA were substituted with MVPA, the relationships with adiposity and CRF were asymmetrical with favourable, but smaller predicted changes in adiposity and CRF than when MVPA was replaced. Predicted changes in HRQL were negligible. The school day activity composition significantly predicted adiposity and CRF but not HRQL. Reallocating time from ST and LPA to MVPA is advocated through comprehensive school physical activity promotion approaches.

TRIAL REGISTRATION

ISRCTN03863885.

Relationships Between Motor Proficiency and Academic Performance in Mathematics and Reading in School-Aged Children and Adolescents: A Systematic Review

Positive associations exist between physical activity, cognition, and academic performance in children and adolescents. Further research is required to examine which factors underpin the relationships between physical activity and academic performance. This systematic review aimed to identify, critically appraise, and synthesize findings of studies examining relationships between motor proficiency and academic performance in mathematics and reading in typically developing school-aged children and adolescents. A systematic search of electronic databases was performed to identify relevant studies. Fifty-five eligible articles were critically appraised and key data was extracted and synthesized. Findings support associations between several components of motor proficiency and academic performance in mathematics and reading. There was evidence that fine motor proficiency was significantly and positively associated with academic performance in mathematics and reading, particularly during the early years of school. Significant positive associations were also evident between academic performance and components of gross motor proficiency, specifically speed and agility, upper-limb coordination, and total gross motor scores. Preliminary evidence from a small number of experimental studies suggests motor skill interventions in primary school settings may have a positive impact on academic performance in mathematics and/or reading. Future research should include more robust study designs to explore more extensively the impact of motor skill interventions on academic performance.

Systematic review of acute physically active learning and classroom movement breaks on children's physical activity, cognition, academic performance and classroom behaviour: understanding critical design features

Objective

To examine the impact of acute classroom movement break (CMB) and physically active learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour.

Design

Systematic review.

Data sources

PubMed, EBSCO, Academic Search Complete, Education Resources Information Center, PsycINFO, SPORTDiscus, SCOPUS and Web of Science.

Eligibility criteria for selecting studies

Studies investigating school-based acute bouts of CMB or PAL on (PA), cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias.

Results

Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or moderate-to-vigorous PA dependent on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 min), or shorter more intense (5 min), CMB/PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies.

Conclusion

Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time on task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies.

PROSPERO registration number

CRD42017070981.