A Systematic Review of Multi-Component Comprehensive School Physical Activity Program (CSPAP) Interventions

Determinants of Change in Physical Activity in Children during the Transition from Elementary to High School

INTRODUCTION

Effective public health interventions targeting factors that influence physical activity are urgently needed to reduce the age-related decline in physical activity in youth. The purpose of this study was to identify associations between physical activity and a set of potential influences on physical activity in children as they transition from elementary to high school.

METHODS

Participants were 951 children from South Carolina school districts who completed outcome and independent variable measures on at least two time points from the 5th to 11th grades in 2010-2017. The primary outcome variable was physical activity, measured by accelerometry. Independent variables included a comprehensive set of variables in the child, parent/home, school, and community domains. Children, parents and school administrators, and staff completed questionnaires to assess psychosocial and home, school, and neighborhood environmental influences. Growth curve analyses identified independent variables associated with physical activity over time, either as a main effect or as an interaction with age.

RESULTS

As main effects, self-efficacy, self-schema, sport participation, weekday outdoor hours, importance of child participating in sports and physical activity, safe to play outside, and Physical Activity Resource Assessment weighted score were positively associated with physical activity. The associations between physical activity and enjoyment motivation, appearance motivation, weekend outdoor time, and home equipment exhibited significant interactions with age. Enjoyment motivation influenced physical activity during the earlier years, whereas the remaining three variables influenced physical activity in the later years.

CONCLUSIONS

Interventions should target multiple domains of influences that may vary by age.

Systematic review and meta-analysis of physical activity interventions to increase elementary children's motor competence: a comprehensive school physical activity program perspective

BACKGROUND

Regular participation in physical activity (PA) benefits children's health and well-being and protects against the development of unhealthy body weight. A key factor in children's PA participation is their motor competence (MC). The comprehensive school physical activity program (CSPAP) framework offers a way to classify existing PA interventions that have included children's MC development and understand the potential avenues for supporting children's MC. However, there have been no systematic reviews or meta-analyses of PA interventions and their effects on the MC of elementary school children (aged 5-12 years) from a CSPAP perspective.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We searched seven electronic databases (PubMed/Medline, Embase, ERIC, SPORTDiscus, CINAHL, Web of Science, and PsycINFO) for articles on 29 November 2021. The CSPAP framework was used to categorize the different intervention approaches. This review was registered with PROSPERO (CRD42020179866).

RESULTS

Twenty-seven studies were included in the review, and twenty-six studies were included in the meta-analysis. A wide range of PA intervention approaches (e.g., single component or multicomponent) within the context of the CSPAP framework appear to be promising pathways in enhancing children's MC. The results of the aggregate meta-analysis presented that effect sizes for the development of MC from pre-and post- intervention ranged from moderate to large (Hedges' g = 0.41-0.79). The analysis revealed that the predicted moderators, including study length, delivery agent, and study design, did not result in statistically significant moderate variations in MC outcomes. There was, however, considerable heterogeneity in study design, instruments, and study context, and studies were implemented in over 11 countries across diverse settings.

CONCLUSIONS

This study uniquely contributes to the literature through its primary focus on the effectiveness of PA interventions on elementary children's MC. This review emphasizes the importance of customizing CSPAP to fit the specific characteristics of each school setting, including its environmental, demographic, and resource attributes. The effectiveness of CSPAP, particularly its physical education (PE) component, is significantly enhanced when these programs are adapted to address the unique needs of each school. This adaptation can be effectively achieved through targeted professional teacher training, ensuring that PE programs are not only contextually relevant but also optimized for maximum impact in diverse educational environments. Researchers and practitioners should pursue how to effectively translate the evidence into practice to better conceptualize CSPAPs designed for children's MC development.

Fishing Downstream: Does CSPAP Promotion During PETE Transfer to Teaching Practice by K-12 Physical Educators?

Physical Education Teacher Education (PETE) training has the potential to influence graduates' decisions as physical educators. Utilizing themes from Rogers' Diffusion of Innovations and Lawson's Occupational Socialization theories, we focused on graduates from a single PETE program which, beginning in 2007, began integrating content, expectations, and experiences relating to an expanded role of the physical educator such as in comprehensive school physical activity programs (CSPAPs). Purpose: The purpose of this study was to examine transfer in terms of university training leading to teaching practices in expanded physical activity programming. Method: An electronic questionnaire was sent to 335 graduates from May 2000 through May 2019. Sixty-seven graduates' questionnaires were investigated looking at perceptions of CSPAP as an innovation, current expanded physical activity (PA) offerings, and memories of PETE. Additionally, 13 participants participated in a school visit and interview which acted as a fidelity check for self-reported levels of expanded PA programming reported in the questionnaire. Results: All 67 graduates included some amount of expanded PA programming. Positive correlations were found with perception of CSPAP as an innovation, for both year of graduation and memory of PETE programming, thus students exposed to CSPAP programming during PETE were implementing components at their schools at higher levels. Conclusion: There is positive potential for professional socialization to influence graduates' practices. Perceptions of CSPAP as an innovation were positive and support the promotion of triability and starting small when PETE programs encourage expanded PA programming.

Promoting physical activity and academic achievement through physically active learning: Qualitative perspectives of co-design and implementation processes

This article discussed the issue of low PA levels among school-aged children and highlights the promising approach of school-based interventions, including physically active learning (PAL), to increase PA levels. The study aimed to co-design and to assess the implementation of a PAL program for 8 weeks in 4 elementary classrooms (82 students and 7 teachers), emphasizing the potential of integrating PA with academic learning and the importance of co-designing programs with teachers to maximize their effectiveness. Technology was found to support PAL practices in promoting PA and academic achievement. The study underscores the need for further research to explore the societal implications of PAL programs, including their potential to improve the health and well-being of children while promoting positive academic outcomes.

The Comprehensive School Physical Activity Program: An Invited Review

Physical inactivity is a global challenge that necessitates early intervention during childhood. Schools are positioned to make a significant impact on children's current and future physical activity behavior, but numerous barriers hinder the implementation and sustainability of school-based physical activity opportunities. The purpose of this invited article is to provide an overview of the comprehensive school physical activity program (CSPAP) as a concept, framework, and promising approach to institutionalizing physical activity within the school environment. Despite the availability of numerous published reviews on the topic, a broad, up-to-date panorama of the CSPAP literature that encompasses and consolidates historical, conceptual, empirical, and practical perspectives is currently lacking. Contained within this article is an explanation of the public health context that undergirds the CSPAP concept, a historical perspective of the concept's origins and evolution, examples of CSPAP research, recommendations for advancing the knowledge base, and evidence-informed frameworks and principles for professional practice.

Observed and perceived benefits of providing physical activity opportunities in elementary schools: a qualitative study

Introduction

Schools play an important role in promoting physical activity for youth. However, school-based physical activity opportunities often compete with other academic priorities, limiting their implementation. The purpose of this study was to qualitatively explore elementary school teacher and staff perspectives on providing physical activity opportunities and how they impact students and learning.

Methods

We partnered with a school district in Texas to conduct semi-structured individual interviews. We used a purposeful sampling approach to recruit elementary teachers and staff knowledgeable about the physical activity opportunities provided at their school. Interviews included questions about participant opinions of providing physical activity opportunities and the types of opportunities provided. We analyzed data using a directed content analysis and iterative categorization approach.

Results

Fifteen participants (4 teachers, 4 physical education teachers, 3 assistant principals, and 4 principals) completed interviews from 10 elementary schools. Participants discussed observed and perceived benefits when providing physical activity opportunities, which emerged into four themes and subthemes: (1) academic benefits (learning readiness, learning engagement, and academic performance); (2) social-emotional benefits (behavior, interpersonal and social skills, and classroom culture); (3) physical benefits (brain health, skill development, physical health); and (4) instructional benefits (quality teaching time, helpful teaching tools, and teacher-student relationships).

Conclusions

Teachers and staff observed numerous benefits when students had opportunities to be physically active, including the positive impact on academic and social-emotional outcomes. Our findings highlight the alignment of physical activity with other school priorities. Physical activity programming can be used in ways to support academics, learning, behavior, and other important outcomes.

Flipping the Script: An Initial Exploration of Flipped Learning as an Enhanced Alternative to Traditional Physical Education Lessons

BACKGROUND

Physical activity (PA) is related to a variety of positive outcomes for youth and physical education (PE) represents a primary school-based environment where students can engage in moderate-to-vigorous physical activity (MVPA). Limitations exist in secondary schools with low socio-economic status, where MVPA engagement is generally below the recommended 50% of lesson time. Growing evidence suggests that using a flipped learning approach (FLA) may naturally enhance PE lessons as outlined by The Theory of Expanded, Extended, and Enhanced Opportunities for Youth Physical Activity Promotion.

PURPOSE

The purpose of this study was to compare the impact of the FLA to traditional instruction on student MVPA, lesson context, and teacher involvement during middle school PE lessons.

METHODS

Participants were 56 male students from two 7th-grade classes from a low-SES, suburban school. This study employed the System for Observing Fitness Instruction Time (SOFIT). Data were examined through descriptive statistics. Linear regression models were used to predict SOFIT outcomes as a function of FLA versus traditional instruction.

RESULTS

Students in the FLA class spent significantly more class time in MVPA (p < 0.01). Regression models predicted participants in FLA classes would spend 55% more class time in MVPA (p < 0.01). After adjusting for covariates, models showed students in FLA classes would spend almost 18 more minutes in MVPA than students in traditional classes (p < 0.01).

DISCUSSION/CONCLUSION

The FLA may be a practical lesson enhancement strategy to increase student MVPA and improve PE opportunities for students in low SES schools when compared to the use of traditional instruction. The results of this study demonstrated positive potential of using FLA in PE but should be considered within the context of their limitations. Further examination of the FLA is warranted.

Comprehensive school health: teachers' perceptions and implementation of classroom physical activity breaks in US schools

Modifications to the social-ecological model, such as Whole School, Whole Community, Whole Child (WSCC) frameworks, have been utilized in comprehensive school health interventions. Classroom physical activity breaks are used when implementing whole-of-school approaches. However, the onus to implement classroom physical activity breaks is on school stakeholders. This study aimed to explore teacher and principal perceptions and implementation of physical activity breaks in elementary schools. Further, this study investigated how theoretical factors representative of the social-ecological model and their interactions affect teacher and principal perceptions and utilization of classroom physical activity breaks. Interviews were conducted to understand teacher and principal perceptions and implementation. A total of 12 classroom teachers and five principals participated in semi-structured interviews which were analyzed using constant comparison and deductive analysis to identify relationships and themes coded across the social-ecological and WSCC models. To ensure fidelity individuals that led the professional development (n = 2) were also interviewed. Three main themes emerged as part of the data analysis: (i) The Connection Between Intrapersonal Knowledge and Interpersonal Professional Development, (ii) Resources, Sharing Means Caring and (iii) The Policy Level Creates Time. Teachers and principals valued knowledge and resources and felt that policy facilitated implementation. Results suggest that classroom physical activity breaks are influenced by multiple factors across varied levels of the social-ecological model. Understanding this relationship can inform future professional development to increase the provision of classroom physical activity breaks among teachers.

Predicting the Presence of Active Schools: A National Survey of School Principals in the United States

BACKGROUND

Principals are key to the promotion of physical activity (PA) in schools. The purpose of this study was to understand how school principals' PA values, behaviors, and individual and school characteristics were associated with the presence of an active school.

METHODS

A representative sample of 1019 school principals in the United States was surveyed. Survey items addressed principals' values and behaviors associated with PA, individual and school demographic factors, such as years of experience and school level, and a single item asking whether principals perceived their school to be an active school (ie, provides students with opportunities to be physically active before, during, and after the school day). Significant variables from a cross-tabulation and chi-square analysis were added to a hierarchical logistic regression model to assess the predictive properties of principal values and behaviors as they relate to the presence of an active school.

RESULTS

Approximately half of principals (47%) reported having an active school. The model significantly predicted the presence of an active school but accounted for only 6.6% of the total variance. Although values toward PA and more frequent personal PA behaviors were associated with the presence of an active school within the cross-tabulation and chi-square analysis, neither variable emerged as a significant predictor in the regression model.

CONCLUSIONS

Principals' personal PA values and behaviors contribute to the presence of an active school, but other variables, including years of experience and school contextual factors, are more powerful predictors.

Fitness Promotion in a Jump Rope-Based Homework Intervention for Middle School Students: A Randomized Controlled Trial

Physical activity (PA) homework offers a promising approach for students to be physically active after school. The current study aims to provide holistic insights into PA homework design and the effects of implementation in practice. In total, ninety-three middle school students were randomly assigned to a homework group (HG) or control group (CG). Participants in HG (n = 47) were requested to complete jump rope homework three times per week for 12 weeks, while their counterparts in CG attended one health education class every week. A homework sheet was used to provide instructions and record information for exercise behaviors during homework completion. Physical fitness tests were conducted to investigate the effects of the jump rope homework on the physical fitness of middle school students. After the intervention, participants in HG reported moderate to vigorous PA during jump rope exercise. The average duration for each practice was approximately 48 min. The returned homework sheets accounted for 86.88% of all homework assignments, indicating a good completion rate. Compared with their counterparts in CG, participants performing jump rope exercise indicated greater improvement in speed, endurance, power, and core muscular endurance. Jump rope homework strengthened physical fitness for middle school students, which provided a valuable addition to comprehensive school PA practice.

A Day in the Life: Secondary School Students’ Experiences of School-Based Physical Activity in Ireland, Finland, and the United States

Internationally, there is an effort to have schools adopt a whole-school approach to physical activity promotion. Such a model includes physical activity opportunities throughout the whole school day, including physical education; before, during, and after school physical activity; and staff and community engagement. The purpose of this study was to describe the physical activity experiences of young people attending secondary schools in Finland, Ireland, and the United States where a whole-school approach to physical activity promotion was employed. One school in each country was identified based on its adoption of a national physical activity initiative (i.e., Finland—Finnish Schools on the Move; Ireland—Active School Flag; United States—Let’s Move Active Schools). Data were collected through observation with field notes, photos, and interviews with key stakeholders. The results are presented as analytic narrative vignettes that represent a “typical” school day. The results provide a glimpse into available physical activity opportunities for young people at each school and demonstrate an emphasis on active school culture.

Development of a School-Based Physical Activity Intervention Using an Integrated Approach: Project SMART

Physical activity (PA) is a health-protective factor with multiple benefits for school-age children, yet only 22% of children and adolescents living in the United States (United States) accrue the recommended amount of moderate to vigorous PA. Given the prevalence of insufficient PA among children, promoting and providing PA opportunities during the school day, especially when integrated into the curriculum and linked to the learning standards, is essential for children. The purpose of this paper is to describe the procedure for the development of a school-based PA program using an integrated approach through the modified intervention mapping protocol (IMP). A total of 22 physical education teachers and 167 children from five different elementary schools were involved in the process. The procedure includes the Self-Determination Theory (SDT) that provides a theoretical framework that plays a vital role in motivating students to have a physically active lifestyle. This study applied SDT and IMP to develop and pilot a PA intervention called Project SMART using an integrative community participatory approach. As a pilot PA intervention, Project SMART is an online educational game where the students navigate a virtual journey across the United States A class’s aggregate PA propels the students on their journey, where standards-based modules are unlocked to achieve STEM (science, technology, engineering, and math) and social-emotional learning outcomes while gaining an understanding of the importance of health behaviors and opportunities to habitually engage in healthy decision-making with the support of their peers. Although initially labor intensive for the researchers, the process of tailoring the intervention to the children’s contextual and cultural needs has implications for all theoretically grounded and evidence-based PA interventions.

Associations between elementary and middle school teachers' physical activity promoting practices and teacher- and school-level factors

BACKGROUND

Few studies have evaluated teacher- and school-level characteristics associated with implementation of recommended physical activity (PA) promoting practices. The purpose of this study is to examine associations between teachers' PA practices and: [1] teacher-level factors, including their own PA, and [2] school-level factors.

METHODS

This cross-sectional study examined time spent daily in light PA (LPA) and moderate-vigorous PA (MVPA) in association with 7 teacher PA practices among 288 classroom/special area teachers and teaching assistants in 20 urban, suburban and rural schools (recruited through a school wellness trial) in 4 districts. LPA and MVPA was assessed using 24-h ankle accelerometry (up to seven consecutive days). A sum score for teacher PA practices was assessed via survey (7 items; sum score range: 7-35; Cronbach's alpha = 0.73; higher scores indicate more PA promoting practices). Teacher-level factors included gender, race, self-reported height/weight, years teaching, and education. School-level factors included school type, free-and-reduced-price meal eligibility, student racial/ethnic composition, and urbanicity. Analyses included multilevel regression models, accounting for clustering within schools and adjusting for demographic covariates and school district.

RESULTS

Teachers were 91% female, 63% elementary, 60% white, mean age 43.2 years (SD = 11.3), and 41% obese). Teachers wore accelerometers an average of 5.8 days, spent 399.6 min in LPA (SD = 85.0) per day, 24.1 min in MVPA (SD = 14.4) per day, and the mean teacher PA practices sum score was 22.4 (SD = 5.0). Every 15-min increase in MVPA was related to an increase in teacher PA practices sum score (coeff =1.07; SE = 0.28; p < 0.001). Female gender (versus males; coeff = - 1.95; SE = 0.92, p = 0.034), an obese weight status (versus non-obese; coeff = - 1.38; SE = 0.54, p = 0.010), and teaching in a middle school (versus elementary; coeff = - 3.86; SE = 0.54, p < 0.001) were associated with lower teacher PA practices scores. LPA was not associated with teacher PA promoting practices.

CONCLUSIONS

Teachers with higher MVPA, but not higher LPA, and those without obesity were more likely to implement PA promoting practices that could positively impact their students' PA. Similar to prior studies, these practices were more commonly implemented in elementary schools and by male teachers. Future studies in schools should explore whether improvement of teacher health behaviors subsequently impacts student health behaviors.

TRIAL REGISTRATION

Clinical Trials, NCT03432715 ; Registered on 02/2/2018.