Effects of a school-based physical activity intervention on academic performance in 14-year old adolescents: a cluster randomized controlled trial - the School in Motion study

School-based physical activity interventions: which intervention characteristics are associated with participation and retention? A meta-analysis

OBJECTIVE

Many school-based intervention studies are conducted to increase students' physical activity (PA). Recruitment and retention problems potentially impact the robustness of RCT findings. We conducted a meta-analysis to summarize recruitment and retention rates in long-term secondary school-based PA intervention studies and examined associated participant and intervention characteristics.

METHODS

Web of Science, Pubmed, Medline, and PsychInfo were searched until March 20th 2023. We included studies on secondary school-based PA interventions ≥12 weeks, aimed at typically developing adolescents. We abstracted number of schools and students invited, randomized, and participating at follow-up to calculate pooled recruitment and retention rates; participant and intervention characteristics were abstracted to execute subgroup or meta-regression analyses.

RESULTS

Recruitment rates were 51% for invited schools and 80% for invited students, the retention for schools was almost 100% and for students 91%. Interventions with fixed and flexible components, executed in Asia and South America, and from later publication years had higher student recruitment rates. Students' retention rates were lower for interventions which had flexible components, were theory/model-based, used an accelerometer, had a longer intervention duration, and included more females.

CONCLUSION

Recruitment and retention rates in school-based PA interventions are high. Some participant and intervention characteristics influence these rates: flexibility of the intervention, theory/model-based intervention, accelerometer use, intervention duration, continent, and number of females. Researchers should consider these characteristics in intervention development to achieve optimal balance between intervention effectiveness, recruitment, and retention.

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.

Effectiveness of Intervention Strategies to Increase Adolescents' Physical Activity and Reduce Sedentary Time in Secondary School Settings, Including Factors Related to Implementation: A Systematic Review and Meta-Analysis

BACKGROUND

Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness.

OBJECTIVE

The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation.

METHODS

Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained.

RESULTS

Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles.

CONCLUSION

While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained.

REGISTRATION

PROSPERO (CRD42020169988).

Study protocol for the ACTIVE SCHOOL study investigating two different strategies of physical activity to improve academic performance in Schoolchildren

BACKGROUND

Previous research has suggested that school-based physical activity (PA) interventions may have a positive impact on academic performance. However, existing literature on school-based interventions encompasses various forms of PA, spanning from vigorous intensity PA outside the academic classes to light intensity PA and movement integrated into academic learning tasks, and results on academic performance are inconclusive. ACTIVE SCHOOL will implement two different PA interventions for one school year and assess the effects on the pupils' academic performance, with math performance as the primary outcome.

METHODS/DESIGN

The ACTIVE SCHOOL project consists of two phases: 1) Development phase and 2) Randomized Controlled Trial (RCT). In phase one, two interventions were developed in collaboration with school staff. The two interventions were tested in an 8-weeks feasibility study. In phase two, a RCT-study with three arms will be conducted in 9-10-year-old children for one school year. The RCT-study will be carried out in two intervention rounds during the school years 2023/2024 and 2024/2025. Schools will be randomized to one of two interventions or control;1) Run, Jump & Fun intervention (4 × 30 min/week of moderate-to-vigorous physical activity; 2) Move & Learn intervention (4 × 30 min/week focusing on embodied learning in math and Danish lessons); or 3) a control condition, consisting of normal teaching practices. Outcome measures include academic performance, PA level, cognitive functions, cardiorespiratory fitness, anthropometry, well-being and school motivation (collected before, during and after the intervention period). A process evaluation will be conducted to assess implementation.

DISCUSSION

The ACTIVE SCHOOL study will expand knowledge regarding the impact of PA on academic performance. The study will have the potential to significantly contribute to future research, as well as the scientific and educational debate on the best way to implement PA to support education and learning.

TRIAL REGISTRATION

The study was registered on the 25th of October 2022 in ClinicalTrials.gov, NCT05602948.

School-based physical activity in relation to active travel - a cluster randomized controlled trial among adolescents enrolled in the school in motion study in Norway

BACKGROUND

Active travel and school settings are considered ideal for promoting physical activity. However, previous research suggests limited effect of school-based interventions on overall physical activity levels among adolescents. The relationship between physical activity in different domains remains inconclusive. In this study, we examined the effects of adding two weekly hours of school-based physical activity on active travel rates.

METHOD

We analyzed data from 1370 pupils in the 9th-grade participating in the cluster RCT; the School In Motion (ScIM) project. Intervention schools (n = 19) implemented 120 min of class-scheduled physical activity and physical education, in addition to the normal 2 hours of weekly physical education in the control schools (n = 9), for 9 months. Active travel was defined as pupils who reported walking or cycling to school, while motorized travel was defined as pupils who commuted by bus or car, during the spring/summer half of the year (April-September), or autumn/winter (October-February). The participants were categorized based on their travel mode from pretest to posttest as; maintained active or motorized travel ("No change"), changing to active travel (motorized-active), or changing to motorized travel (active-motorized). Multilevel logistic regression was used to analyze the intervention effect on travel mode.

RESULTS

During the intervention period, most participants maintained their travel habits. In total, 91% of pupils maintained their travel mode to school. Only 6% of pupils switched to motorized travel and 3% switched to active travel, with small variations according to season and trip direction. The intervention did not seem to influence the likelihood of changing travel mode. The odds ratios for changing travel habits in spring/summer season were from active to motorized travel 1.19 [95%CI: 0.53-2.15] and changing from motorized to active travel 1.18 [0.30-2.62], compared to the "No change" group. These findings were consistent to and from school, and for the autumn/winter season.

CONCLUSION

The extra school-based physical activity does not seem to affect rates of active travel among adolescents in the ScIM project.

TRIAL REGISTRATION

Clinicaltrials.gov ID nr: NCT03817047. Registered 01/25/2019' retrospectively registered'.

Adolescents' experiences of a school-based health promotion intervention in socioeconomically advantaged and disadvantaged areas in Sweden: a qualitative process evaluation study

BACKGROUND

Adolescence is a transition period in which positive experiences of physical activity have the potential to last into later adulthood. These experiences are influenced by socioeconomic determinants, leading to health inequalities. This study aims to explore adolescents' experiences and participation in a multi-component school-based intervention in schools located in socioeconomically advantaged and disadvantaged areas in Sweden.

METHODS

A qualitative design was used to evaluate how participants experienced the intervention. The intervention was a multi-component school-based intervention. It was conducted in six schools (four control and two intervention schools) with a total of 193 students and lasted one school year. It was teacher-led and consisted of three 60-minute group sessions per week: varied physical activities, homework support with activity breaks, and walks while listening to audiobooks. In total, 23 participant observations were conducted over eight months and 27 students participated in focus groups. A content analysis was conducted.

RESULTS

The results describe a main category 'Engaging in activities depending on socioeconomic status' and three generic categories: 1. Variations in participation in PA together with classmates and teachers; 2. Variations in engagement in PA after school; and 3. Differences in time and place allocated to do homework and listen to audiobooks. These categories illustrate how participants looked forward to the physical activities but used the time spent during the walks and homework support differently depending on how busy they were after school. Frequently, those who were busiest after school were also those from the advantaged area, and those who had little to do after school were from the disadvantaged area.

CONCLUSION

Socioeconomic factors influence participants' possibilities to engage in the intervention activities as well as how they use their time in the activities. This study showed that it is crucial to support adolescents' participation in physical activities by providing structure and engaging well-known teachers in the activities, especially in schools located in disadvantaged areas.

Physical activity: associations with health and summary of guidelines

The understanding of how physical activity and insufficient physical activity are associated with health outcomes has increased considerably over the past decades. Along with physical activity, the evidence on the associations between sedentary behavior and health has increased, which has resulted in the introduction of recommendations of sedentary behavior. In this article, we 1) present terminology for physical activity and sedentary behavior epidemiology, 2) show the relevant scientific evidence on associations of physical activity and sedentary behavior with selected health-related outcomes and 3) introduce the global guidelines for physical activity and sedentary behavior by the World Health Organization (WHO). Health-related outcomes include cardiovascular morbidity and mortality, total mortality, glucose regulation and type 2 diabetes, adiposity, overweight, obesity, cancer, musculoskeletal and bone health, brain health, and quality of life. These health-related outcomes are reflected across age groups and some population groups, such as pregnant and postpartum women. Furthermore, we discuss physical activity levels across Nordic countries and over time. For the Nordic Nutrition Recommendations, shared common physical activity guidelines were not developed. Instead, each country has created their own guidelines that are being referenced in the article, along with the global WHO guidelines.

School-based physical activity interventions and language skills: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

School-based physical activity (PA) interventions have proven beneficial for improving cognitive performance and overall academic achievement, but their benefits on language skills remain unclear. We aimed to assess the effects of school-based PA interventions on language skills in children and adolescents.

DESIGN

Systematic review with meta-analysis.

METHODS

A systematic search was performed in PubMed, PsycINFO and Scopus until September 10th, 2022. We included randomized controlled trials (RCTs) that performed a school-based PA intervention in children/adolescents and that assessed language-related outcomes (i.e., reading, spelling, vocabulary, verbal fluency, comprehension and grammar) or language school grades. Random effect meta-analyses were conducted to pool study results.

RESULTS

Thirty-one studies (18,651 participants) were finally included. Significant benefits were observed for reading (standardized mean difference [SMD]: 0.15; 95% confidence interval [CI]: 0.08, 0.22), vocabulary (SMD: 0.71; 95%CI: 0.44, 0.97), and comprehension (SMD: 0.24; 95%CI: 0.09, 0.40), with a non-significant trend (p = 0.083) also observed for language school grades (SMD: 0.40; 95%CI: -0.05, 0.86). No significant benefits were observed for spelling or verbal fluency (both p > 0.05), and no meta-analysis could be performed for grammar skills. No consistent differences were observed between integrated (i.e., performing PA along with the academic content) and non-integrated PA interventions (e.g., extra physical education lessons).

CONCLUSIONS

School-based PA interventions appear as an effective strategy for improving different language-related skills, although further research is needed to determine how interventions' and participants' characteristics moderate these effects.

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.

Establishing the Convergent Validity of the Travel Habit Questions in the Health Behavior in School-Aged Children Questionnaire by Quantifying Active Travel in Norwegian Adolescents

Background

Active travel (cycling or walking to school) can be a substantial part of adolescents' daily physical activity. Research on transport activities primarily relies on self-reported indices of travel mode and travel time. However, many researchers do not report the psychometric properties of their instruments. The Health Behavior in School-aged Children (HBSC) questionnaire is a commonly used instrument, but the items in this questionnaire on travel habits have not yet been validated. The present study was conducted to investigate the convergent validity and agreement between the HBSC items and a travel diary on (1) transport mode to and from school and (2) travel time to school.

Methods

The study sample consisted of 50 participants in the 9th grade (15 ± 0.3 years, 62% girls) from seven Norwegian schools. Outcome variables included transport mode and travel time derived from the HBSC items and a five-day travel diary. Convergent validity was assessed by evaluating Cohen's kappa for travel mode and the correlation coefficient (Spearman Rho) for travel time. Simple agreement calculations between the two measurement methods were also conducted.

Results

The association between the HBSC questionnaire and the diary for travel mode to and from school was κ = 0.63 (P < 0.001) and κ = 0.77 (P < 0.001), respectively. The total agreement between the HBSC questionnaire and the diary for was 78%. However, the agreement was higher for walking (88%) and cycling (91%) than for motorized transport (67%). For travel time, the Spearman correlation coefficient was ρ = 0.60 (P < 0.001) between the HBSC questionnaire and the diary. The total agreement on travel time was 67%; however, active commuters (86%) seemed to more accurately estimated travel time than motorized commuters (55%).

Conclusion

Although the overall agreement between the HBSC questionnaire and the diary for mode of transport was 78%, the HBSC questionnaire may underestimate the prevalence of motorized transport compared to walking and cycling.

Trial Registration

ClinicalTrials.gov, identifier: NCT03817047.

A Sustainable Swedish School Intervention with Extra Aerobic Exercise—Its Organization and Effects on Physical Fitness and Academic Achievement

A large majority of Swedish children do not reach the recommended daily activity level. Some, but not all, studies show that extra physical activity may have positive effects on children’s school performance, physical fitness and health. The present purpose was to offer pupils from the 7th to the 8th grade extra aerobic exercise led by physical education teachers and to evaluate the effects on aerobic fitness, muscle strength, school grades and health. The hypothesis was that extra aerobic exercise would improve physical fitness, school grades and health. In the two-year project, 122 pupils aged 13–14 years from three schools constituted an aerobic group with 30 min extra exercise sessions (≥70% maximal heart rate) twice weekly. A control group of 26 pupils was included. All 148 pupils also had regular 60 min physical education lessons (2/week). A moderate to large significant effect size (via partial eta-squared) of the interaction effect for the aerobic group compared to the control group over time was generally seen for aerobic fitness, the muscle strength test with push-ups, school grades in Swedish, English and physical education, and in average school grade for four school subjects combined, thus also including mathematics. Within the aerobic group, significant improvements were also shown for aerobic fitness, endurance and strength of abdominal and leg muscles, and the total physical test index during the two-year project. The control group showed no corresponding improvement in these parameters. Improvements in school grades were generally seen among both sexes in the aerobic group, whereas improvements in physical capacity were distinctly more pronounced among boys and seldom among girls. A similar pattern with significant improvement in several school grades was noted in all three intervention schools, although one of the schools had a distinctly larger proportion of children who immigrated to Sweden. The aerobic group showed significantly higher ratings (with a small to moderate effect size) on several questions about physical self-perception than the control group at the end of the 8th grade. This teacher-led school intervention generated a sustainable project with improvements in physical fitness and school grades. The project might act as an inspiration for other schools to increase physical activity to improve physical fitness and possibly school grades.

Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study - A cluster randomized controlled trial

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Physical activity is associated with increased aerobic fitness and academic performance.

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Little is known on mechanism of physical activity effects on academic performance.

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We performed a cluster randomized controlled trial.

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Aerobic fitness mediated the intervention effect on academic performance.

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Activity increasing aerobic fitness is a strategy to improve academic performance.

Little information exists on the mechanism of how physical activity interventions effects academic performance. We examined whether the effects of a school-based physical activity intervention on academic performance were mediated by aerobic fitness. The School in Motion study was a nine-month cluster randomized controlled trial between September 2017 and June 2018. Students from 30 Norwegian lower secondary schools (N = 2,084, mean age [SD] = 14 [0.3] years) were randomly assigned into three groups: the Physically Active Learning (PAL) intervention (n = 10), the Don’t Worry—Be Happy (DWBH) intervention (n = 10), or control (n = 10). Aerobic fitness was assessed by the Andersen test and academic performance by national tests in reading and numeracy. Mediation was assessed according to the causal steps approach using linear mixed models. In the PAL intervention, aerobic fitness partially mediated the intervention effect on numeracy by 28% from a total effect of 1.73 points (95% CI: 1.13 to 2.33) to a natural direct effect of 1.24 points (95% CI: 0.58 to 1.91), and fully mediated the intervention effect on reading, with the total effect of 0.89 points (95% CI: 0.15 to 1.62) reduced to the natural direct effect of 0.40 points (95% CI: −0.48 to 1.28). Aerobic fitness did not mediate the effects on academic performance in the DWBH intervention. As aerobic fitness mediated the intervention effect on academic performance in one intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents.