The Daily Mile: Whole-school recommendations for implementation and sustainability. A mixed-methods study

Comparing the impact of "The Daily Mile™" vs. a modified version on Irish primary school children's engagement and enjoyment in structured physical activity

Introduction

The repetitive nature of The Daily Mile may affect long-term engagement. This study compared the impact of The Daily Mile with a modified version on engagement and enjoyment of structured physical activity.

Methods

A ∼7-year-old and ∼11-year old cohort from six primary schools participated in this study, which primarily evaluated pre- to post-assessment changes within each group. Two schools were assigned to The Daily Mile (n = 102 children; M = 8.81 years, SD = 1.97), two schools to the modified version (n = 87; M = 9.16 years, SD = 2.76), and two schools served as controls (n = 79; M = 10.05 years, SD = 1.9) for 10-weeks. Health assessments conducted included cardiorespiratory fitness (550 m Run), fundamental movement skills (Test of Gross Motor Development-2), and health-related quality of life (KIDSCREEN-27). Accelerometers measured school-based physical activity, while enjoyment was assessed using a modified PACES questionnaire. Post-intervention focus groups (n = 10) included teachers and children.

Results

Both the Daily Mile (∼7-year-old: p < 0.001; ∼11-year-old: p = 0.004) and its modified version (∼7-year-old: p < 0.001; ∼11-year-old: p < 0.001) had a significant impact on cardiorespiratory fitness. Participation in the modified version led to significant improvements in fundamental movement skills (∼7-year-old: p = 0.034; ∼11-year-old: p < 0.001), unlike participation in The Daily Mile (∼7-year-old: p = 1.000; ∼11-year-old: p = 0.807). A significant positive effect on health-related quality of life was attributed to participation in the modified version (p = 0.036), but not to The Daily Mile (p = 0.205). Enjoyment scores were significantly higher for the modified version (4.61 vs. 4.43; p = 0.024).

Discussion

Participation in The Daily Mile is associated with improved health outcomes. Nevertheless, modifying the initiative to include greater variety has the potential to offer broader health benefits, longer engagement, and increased enjoyment. Future research should explore the long-term implementation of this modified version in schools.

Examining the health literacy and health behaviours of children aged 8-11 in Wales, UK

Childhood is a period of significant formative development where knowledge, skills, and capacities for adequate health literacy are acquired, particularly within school settings. The new Curriculum for Wales (CfW), phasing in from September 2022 for learners aged 3-16 years, places statutory focus on health and well-being and school-level curriculum design, providing unprecedented opportunities to empower children as agents in making health-enhancing decisions. Designing, tracking, and evaluating impacts of the CfW on children's health literacy requires scalable monitoring tools; however, research efforts have focused on adolescent populations. This national-scale scoping and pilot study, the first to explore children's health literacy in Wales, piloted the Health Literacy for School-Aged Children (HLSAC-5) within the existing nationwide Health and Attainment of Pupils in Primary EducatioN (HAPPEN-Wales) health and well-being survey to examine the health literacy of children aged 8-11 (n = 2607) and explore associations between health literacy and health behaviours. Children's health literacy was categorized as low (22.6%), moderate (50.4%), and high (27.0%). Multinomial logistic regression analyses suggest high health literacy compared to low health literacy was associated with higher sleep [relative risk ratio (RRR): 1.08, 95% CI 1.01-1.15], higher weekly physical activity (RRR: 1.13, 95% CI 1.03-1.25), fewer sedentary days per week (RRR: 0.89, 95% CI 0.81-0.99), and higher health-related well-being (RRR: 1.35, 95% CI 1.27-1.44). This study offers a sustainable measure of pre-adolescent children's health literacy and health behaviours and tracking of CfW impacts. This enables efforts to be tailored to person-centred (understanding children's health literacy needs), place-based (examining specific organizational health literacy context within schools and CfW design), and policy-focused approaches (re-energizing health literacy within current/emerging policies in Wales including the CfW).

Cohort profile: Health and Attainment of Pupils in a Primary Education National Cohort (HAPPEN) - a hybrid total population cohort in Wales, UK

PURPOSE

Health and Attainment of Pupils in a Primary Education National (HAPPEN) is a primary school national cohort which brings together education, health and well-being research in line with the Curriculum for Wales framework. Health, education and social care data are linked and held in the Secure Anonymised Information Linkage (SAIL) Databank. In addition, school-aged children complete the HAPPEN Survey to inform the design and implementation of the Health and Well-being curriculum. Over 600 schools take part in the HAPPEN Survey. Linkage of health and education records from the HAPPEN national cohort with HAPPEN Survey responses gives enriched cohort detail which can be used to extrapolate to other schools in Wales. We present the descriptive data available in HAPPEN, and the future expansion plans.

PARTICIPANTS

The HAPPEN cohort includes 37 902 primary-aged school children from 2016 to July 2023. Of this number, 28 019 can be linked in SAIL with their anonymised linkage field. In addition, to date (May 2024), HAPPEN Survey data have been captured from over 45 000 children, which can be linked to the electronic data. The survey continues to rise by 7000-8000 responses annually.

FINDINGS TO DATE

The cohort is 49% girls, 47% boys (3% prefer not to state their gender and 1% of this data is missing) and 14% are from an ethnic minority background (10% prefer not to state their ethnicity). Initial findings have explored the impact of COVID-19 on well-being and play opportunities, along with a longitudinal exploration of well-being throughout the years.

FUTURE PLANS

HAPPEN is an ongoing dynamic cohort of data collection. Access to the cohort is available through SAIL. Ongoing research includes the evaluation of interventions for primary school children such as natural experiment methods, free school meal roll-out in Wales, interventions to improve physical literacy including changes to the built environment and interventions to improve the health and well-being of primary school children.

The Daily Mile reduces depressive and anxiety symptoms in school-going Ugandan adolescents aged 16-17

Introduction

school-based physical activity (PA) programs such as The Daily Mile (TDM) might be vital in the prevention and treatment of mental health problems in adolescents in low-income countries. The aim of this single-arm non-controlled pilot intervention study was to investigate TDM on symptoms of anxiety and depression in adolescents aged 16-17 years in Uganda.

Methods

The Daily Mile (TDM) took place between February and April 2022. In total 177 adolescents (62.7% girls) completed the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Questionnaire (GAD-7) pre and post-12 weeks TDM.

Results

moderate effect sizes were found for reductions in PHQ-9 (Cohen´s d=-68, 95% CI=-0.84 to -0.52, P<0.001) and GAD-7 (Cohen´s d=-0.54, 95%CI=-0.68 to -0.38, P<0.001) following TDM. In those with at least mild symptoms, large effect sizes were observed for reductions in PHQ-9 (Cohen´s d=-0.94, 95%CI=-1.14 to -0.72, P<0.001) and GAD-7 (Cohen´s d =-0.85, 95% CI=-1.07 to -0.62, P<0.001) following TDM. The prevalence of mild depression dropped from 70.1% to 50.8% and moderate depression from 28.2% to 15.3%, while the prevalence of mild anxiety dropped from 54.8% to 38.4%, and moderate anxiety from 21.5% to 10.7% (all P<0.001). Rates of severe depression and anxiety did not drop significantly.

Conclusion

The Daily Mile (TDM) might potentially reduce mild and moderate symptoms of anxiety and depression in school-going adolescents in low-income countries such as Uganda. For more severe cases, additional support is needed.

Evaluating the Perceived Health-Related Effectiveness of 'The Daily Mile' Initiative in Irish Primary Schools

Many Irish primary school children do not meet recommended physical activity (PA) guidelines. The Daily Mile (TDM) is a primary school initiative designed to increase children's PA output. This study evaluates TDM's perceived effect on Irish primary school children's health-related metrics. A mixed-methods study, comprising two data collection phases, used the RE-AIM framework to evaluate TDM. Phase One involved teachers, principals and classroom assistants (n = 191) from TDM-registered schools completing a questionnaire. Two TDM-registered schools participated in Phase Two, where (i) interviews were conducted with each principal, (ii) a teacher sub-sample (n = 4) participated in a focus group, and (iii) a child sub-sample (n = 14) participated in separate focus groups. TDM was perceived to positively impact the markers of children's health, including their PA behaviour, physical fitness and social well-being. Inclement weather (66.5%) and a lack of time (56.5%) were reported as the top-ranked implementation barriers. Moreover, TDM's repetitive nature often left children feeling disinterested and resulted in some teachers modifying the initiative to maintain engagement levels. Maintaining the long-term implementation of TDM and its health benefits in primary schools may require bespoke amendments to the original format to preserve children's engagement.

Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review

BACKGROUND

Health inequity (HI) remains a major challenge in public health. Improving the health of children with low socioeconomic status (SES) can help to reduce overall HI in children. Childhood obesity is a global problem, entailing several adverse health effects. It is crucial to assess the influencing factors for adoption, implementation, and sustainment of interventions. This review aims to identify articles reporting about influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low SES. It aims to critically appraise the articles' quality, assess influencing factors, categorize and evaluate them, and to discuss possible implications.

METHODS

A systematic search was conducted in 7 databases with the following main inclusion criteria: (1) school-based interventions and (2) target group aged 5-14 years. The Consolidated Framework for Implementation Research, its five domains (intervention characteristics, inner setting, outer setting, characteristics of individuals, process) along with 39 categories within these domains were used as deductive category system for data analysis. We grouped the articles with regard to the characteristics of the interventions in simple and complex interventions. For each domain, and for the groups of simple and complex interventions, the most commonly reported influencing factors are identified.

RESULTS

In total, 8111 articles were screened, and 17 met all eligibility criteria. Included articles applied mixed methods (n=11), qualitative (n=5), and quantitative design (n=1). Of these, six were considered to report simple interventions and eleven were considered to report complex interventions. In total, 301 influencing factors were assessed. Aspects of the inner setting were reported in every study, aspects of the outer setting were the least reported domain. In the inner setting, most reported influencing factors were time (n=8), scheduling (n=6), and communication (n=6).

CONCLUSION

This review found a wide range of influencing factors for implementation and contributes to existing literature regarding health equity as well as implementation science. Including all stakeholders involved in the implementation process and assessing the most important influencing factors in the specific setting, could enhance implementation and intervention effectiveness. More empirical research and practical guidance are needed to promote obesity prevention behaviors among children with low SES.

REGISTRATION

CRD42021281209 (PROSPERO).

Predicting school uptake of The Daily Mile in Northern Ireland- a data linkage study with School Census Data and Multiple Deprivation Measures

BACKGROUND

Participating in physical activity benefits health, yet a majority of children remain inactive. The Daily Mile™ (TDM) originated in Scotland in 2012 with the aim of increasing primary school children's physical fitness. Despite being a practically feasible and popular initiative, it remains unclear the extent to which schools implement TDM, and whether TDM core principles are adhered to (i.e., run or jog at least 3-days per week). In Northern Ireland it is unknown how many schools regularly participate in TDM, and whether there is an association between TDM participation with school type, school location, size, total number of children attending the school, school deprivation level, and/or motivation as measured by the COM-B model (Capabilities, Opportunities, Motivation model of behaviour). Therefore, this study aimed to quantify the uptake of TDM in Northern Ireland, assess whether schools are following the core principles, and analyse if there is an association between aforesaid demographic factors and TDM participation.

METHODS

An online cross-sectional survey was sent to all primary and special education schools in Northern Ireland with the support of the Education Authority for Northern Ireland and the Public Health Agency for Northern Ireland. The survey was completed by the school principal or teacher, and was available from 31st August until 16th December 2022. Survey results were linked with the 2021/2022 Northern Ireland School Census Data and Northern Ireland Multiple Deprivation Measure 2017. Quantitative and qualitative questions were included in the survey to assess participation and implementation of TDM.

RESULTS

The survey received 609 school responses. After data cleaning, and removal of duplicates from schools a sample of 358 primary schools (45%) and 19 special education schools (47.5%) was analysed. Over half (54.7%) of primary schools and 36.8% of special education schools reported taking part in TDM. More special education needs schools reported taking part in their own version of an 'active mile' rather than TDM formally, and qualitative findings showed TDM was not perceived as appropriate for many children in special educational settings. There was wide variation in adherence to TDM core principles. A multivariate binary logistic regression model was fitted to the data, but it was not statistically significant (χ2(17) = 22.689, p = .160). However, univariate effects showed that increasing levels on COM-B (Capability) was associated with increased likelihood of TDM participation (OR = 2.506), and Catholic Maintained schools were almost twice as likely as Controlled schools to be delivering TDM (OR = 1.919). There was no association found between deprivation and TDM uptake.

CONCLUSION

Encouragingly over 50% of schools in Northern Ireland reported taking part in TDM. However, despite being a low-cost and practically feasible physical activity initiative, further intervention work with sound research methodology is needed to promote adherence to TDM core principles to maximise benefits to children's health. Furthermore, concerted efforts are required to adjust TDM so that it is inclusive for all educational settings, and children's abilities.

Real-world application of a scalable school-based physical activity intervention: A cross-sectional survey of the implementation of The Daily Mile in Greater London primary schools

School-based physical activity interventions are considered ideal given their potential to reach most children. They can help children achieve the recommended guidelines of 60 minutes of moderate-to-vigorous physical activity per day. The Daily Mile is a popular school-based active mile intervention with a global reach. It recommends ten core principles for successful implementation, three of which are key for effectiveness: that it is quick (15 minutes), the whole school participates, and that it takes place in the school day during lessons (excluding physical education lessons and scheduled breaks). Studies assessing the impacts of The Daily Mile do not often report implementation of the ten core principles which is crucial to identifying the potential impact and feasibility of scalable interventions in real-world settings. Our aim was to assess adherence to The Daily Mile's ten core principles in Greater London primary schools. We created and distributed a survey to 1717 primary schools during September 2020 and achieved a 21% (n = 369/1717) response rate by September 2021. Our sample was representative of Greater London primary schools with responses from every London borough. A total of 196/369 (53%) schools reported implementing The Daily Mile but none of them reported adherence to all ten core principles. Adherence to at least 6/10 principles in various combinations was reported by 54/196 (28%) schools. Only 19/196 (10%) schools that reported implementing The Daily Mile reported adherence to the three key principles recommended for effectiveness. Despite its popularity and global reach, our findings suggest that an implementation gap exists when The Daily Mile is adopted in real-world settings which is likely to challenge its intended purpose. Further research in school settings is needed to understand factors that can improve adherence to increase the potential public health impact of The Daily Mile and other similar interventions.

A Systematic Review of the Implementation and Effectiveness of 'The Daily Mile' on Markers of Children's Health

Currently, a high percentage of children globally fail to meet the World Health Organisation's (WHO) recommended daily physical activity (PA) guidelines. The Daily Mile (TDM) is a school-based PA initiative, designed to improve primary school children's PA behaviour. The purpose of this review was to evaluate the extant TDM implementation process and identify its impact on health-related metrics. Three databases were used to search for articles from the time TDM originated in 2012 until February 2022. The identification and screening process of articles for their ability to meet this review's eligibility criteria were facilitated by use of PRISMA and Rayyan. Sixteen articles from the initial search (n = 202) were deemed eligible for inclusion. An analysis of these articles identified five common outcome categories that permeated throughout the research articles: (1) cardiorespiratory fitness (CRF); (2) anthropometry and body composition; (3) PA; (4) cognition; and (5) process evaluation. Results presented from the included articles suggests TDM positively impacts markers of a variety of health-related metrics, namely CRF and PA. However, implementation barriers including TDM's repetitive nature, time constraints associated with competing curriculum demands and inadequate facilities regularly necessitate the adaptation and development of the original TDM format by schools and teachers.

Do socioeconomic inequities arise during school-based physical activity interventions? An exploratory case study of the GoActive trial

OBJECTIVE

To investigate socioeconomic inequities in the intervention and evaluation process of the GoActive school-based physical activity intervention and demonstrate a novel approach to evaluating intervention-related inequalities.

DESIGN

Exploratory post-hoc secondary data analysis of trial data.

SETTING

The GoActive trial was run in secondary schools across Cambridgeshire and Essex (UK), between September 2016 and July 2018.

PARTICIPANTS

13-14 years old adolescents (n=2838, 16 schools).

METHODS

Socioeconomic inequities across six stages in the intervention and evaluation process were evaluated: (1) provision of and access to resources; (2) intervention uptake; (3) intervention effectiveness (accelerometer-assessed moderate-to-vigorous physical activity (MVPA)); (4) long-term compliance; (5) response in evaluation; and (6) impact on health. Data from self-report and objective measures were analysed by individual-level and school-level socioeconomic position (SEP) using a combination of classical hypothesis tests and multilevel regression modelling.

RESULTS

Stage: (1) There was no difference in the provision of physical activity resources by school-level SEP (eg, quality of facilities (0-3), low=2.6 (0.5); high=2.5 (0.4). (2) Students of low-SEP engaged significantly less with the intervention (eg, website access: low=37.2%; middle=45.4%; high=47.0%; p=0.001). (3) There was a positive intervention effect on MVPA in adolescents of low-SEP (3.13 min/day, 95% CI -1.27 to 7.54, but not middle/high (-1.49; 95% CI -6.54 to 3.57). (4) At 10 months post-intervention, this difference increased (low SEP: 4.90; 95% CI 0.09 to 9.70; middle/high SEP: -2.76; 95% CI -6.78 to 1.26). (5) There was greater non-compliance to evaluation measures among adolescents of low-SEP (eg, % accelerometer compliance (low vs high): baseline: 88.4 vs 92.5; post-intervention: 61.6 vs 69.2; follow-up: 54.5 vs 70.2. (6) The intervention effect on body mass index (BMI) z-score was more favourable in adolescents of low-SEP (low SEP: -0.10; 95% CI -0.19 to 0.00; middle/high: 0.03; 95% CI -0.05 to 0.12).

CONCLUSIONS

These analyses suggest the GoActive intervention had a more favourable positive effect on MVPA and BMI in adolescents of low-SEP, despite lower intervention engagement. However, differential response to evaluation measures may have biassed these conclusions. We demonstrate a novel way of evaluating inequities within young people's physical activity intervention evaluations.

TRIAL REGISTRATION NUMBER

ISRCTN31583496.

The effectiveness of school-based run/walk programmes to develop physical literacy and physical activity components in primary school children: A systematic review

The objectives of this review were to systematically review the research on school-based run/walk programmes and their measurements of physical literacy (PL) and physical activity (PA)-related components and to assess the different intervention methods and their impact on encouraging PL and PA. To be included in the review, studies had to satisfy all inclusion criteria. An electronic search was conducted on six databases, the last date search was 25 April 2022. All outcome measures were grouped using the Shearer et al. (2021) PL checklist and additional PA related outcomes. Ten studies were included in the final review. Five different run/walk interventions were identified and six studies followed or referred to The Daily Mile (TDM) protocol. Outcomes relating to the physical domain were most commonly explored, and no studies explored the cognitive domain. Four studies reported significant differences in cardiovascular endurance measures. Positive findings were also reported for outcomes relating to motivation and self-perception/self-esteem in the affective domain. Overall, run/walk programmes appear to provide promising results in favour of physical and affective development in PL. However, further high-quality studies are needed to draw firm conclusions. This review highlights the popularity of TDM and its potential to contribute to PL development.

Commentary: Comment and reflection about Mental health outcomes of the Daily Mile in elementary school children: a single-arm pilot study. The implementation of the Daily Mile in the school context

In 'Mental health outcomes of the Daily Mile in elementary school children: a single-arm pilot study', Arkesteyn et al. (Child and Adolescent Mental Health, 2022) discussed and investigated the effect of a classroom activity break, named The Daily Mile, on pupils' self-esteem, self-perception competence, and mental health. Starting from the interesting and novel results of Arkesteyn et al. (Child and Adolescent Mental Health, 2022), this comment focuses on the concurrent evidence about the effect of The Daily Mile on pupils' physical and mental health. Overall, this comment would reflect and critically review considerations for future research on the topic and to adopt it in the school context.

A systematic review of the effect of The Daily Mile™ on children's physical activity, physical health, mental health, wellbeing, academic performance and cognitive function

BACKGROUND

A minority of children in the United Kingdom meet the recommended physical activity guidelines. One initiative which has been introduced to try and increase the physical activity levels of school children is The Daily Mile™ (TDM). The aim of this review was to determine the effect of TDM on children's physical activity levels, physical health, mental health, wellbeing, academic performance and cognitive function.

METHODS

Six databases were systematically searched from TDM's inception (2012) to 30th June 2022. Studies were included if they involved school-aged children (aged 4-12 years), taking part in TDM and measured at least one pre-defined outcome.

RESULTS

Thirteen studies were included from the 123 studies retrieved. Longer-term participation in TDM was found to increase moderate-to-vigorous physical activity and physical fitness. None of the studies reported a significant change in Body Mass Index or academic performance. An acute bout of TDM was not found to improve cognitive function, however one good-quality study reported that longer-term participation in TDM increased visual spatial working memory. There was evidence from one fair-quality design study that TDM can improve mental health in the short term. There were no significant effects on wellbeing, however scores on self-perceptions improved mainly for children with low baseline self-perceptions.

CONCLUSION

There is evidence to show that TDM can increase physical activity and physical fitness. However, higher-quality research, with adequate participant randomisation and longer-term, post-intervention follow-up is needed to ensure that any changes accurately reflect the components of TDM and are sustained beyond an intervention time frame. Policy recommendations of TDM increasing PA levels in the short term are supported by the evidence in this review. However, long-term improvement on mental health, wellbeing, academic performance and cognitive function requires further good-to excellent quality research. Promisingly, several protocol articles that include randomised controlled trials with long term follow-up have been published. These higher-quality design studies may provide a stronger evidence-base on the effects of TDM on children's health and should underpin future recommendations in public health policy.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022340303.

Mental health outcomes of the Daily Mile in elementary school children: a single-arm pilot study

BACKGROUND

School-based physical activity (PA) programmes such as The Daily Mile (TDM) are widely promoted to address shortfalls in meeting PA recommendations. This study is the first to examine TDM (a daily one mile outdoor run/walk performed at a self-selected pace during school hours) on mental health, self-esteem and self-perceived competence of elementary schoolchildren.

METHODS

In total, 550 children (n = 289 boys, aged 5-13 years) were recruited from seven schools across Flanders. The Self-Perception Profile for Children (SPPC) and the Strengths and Difficulties Questionnaire (SDQ) were completed before, during and post-intervention. One-way repeated measures ANOVA was used to examine changes over time. Additional subgroup analyses of children with low scores on the SPPC (-1SD) were performed.

RESULTS

Only perceived global self-worth (SPPC) was significantly higher (p = .041) following TDM. However, in children with low baseline SPPC scores, significant increases with large effect sizes were found for global self-worth (p = <.001), scholastic competence (p = .001), social competence (p = .003), athletic competence (p = .002), physical appearance (p = <.001) and behavioural conduct (p = .003) following TDM. Moreover, significant reductions over time were reported by parents for total difficulties (p < .001), hyperactivity (p = .004), peer problems (p = .008) and emotional symptoms (p = <.001) and an increase in prosocial behaviour (p = .038) on the SDQ following TDM. However, no changes for conduct problems were observed (p = .143).

CONCLUSIONS

The study is the first to indicate that TDM potentially improves mental health, self-esteem and self-perceived competence in elementary schoolchildren, especially in those with a poor mental health status. Randomised controlled trials are now required to more definitively test these findings.

Developing a core outcome set for physical activity interventions in primary schools: a modified-Delphi study

OBJECTIVES

To develop a core outcome set (COS) for physical activity interventions in primary schools.

DESIGN

Modified-Delphi study.

SETTING

The UK and international.

PARTICIPANTS

104 participants from four stakeholder groups (educators, public health professionals, health researchers, parents); 16 children (aged 8-9 years) from 1 London primary school.

INTERVENTIONS

Physical activity interventions.

METHODS

Four-stage process: (1) outcomes extracted from relevant studies identified from an umbrella review and a focus group; (2) list of outcomes produced and domains established; (3) stakeholders completed a two-round Delphi survey by rating (Round 1) and re-rating (Round 2) each outcome on a nine-point Likert Scale from 'not important' to 'critical': a>70% participant threshold identified the outcomes rated 'critical' to measure, and outcomes important to children were identified through a workshop; and (4) a stakeholder meeting to achieve consensus of the outcomes to include in the COS.

RESULTS

In total, 74 studies were extracted from 53 reviews. A list of 50 outcomes was produced and three domains were established: 'physical activity and health' (16 outcomes), 'social and emotional health' (22 outcomes) and 'educational performance' (12 outcomes). 104 participants completed survey Round 1; 65 participants completed both rounds. In total, 13 outcomes met the threshold; children identified 8 outcomes. Fourteen outcomes achieved consensus to produce the COS: five outcomes for physical activity and health (diet (varied and balanced), energy, fitness, intensity of physical activity, sleep (number of hours)); seven outcomes for social and emotional health (anxiety, depression, enjoyment, happiness, self-esteem, stress, well-being); and two outcomes for educational performance (concentration, focus).

CONCLUSIONS

We have developed the first COS for physical activity interventions in primary schools in consultation with those interested in the development and application of an agreed standardised set of outcomes. Future studies including these outcomes will reduce heterogeneity across studies.

TRIAL REGISTRATION NUMBER

Core Outcome Measures in Effectiveness Trials Initiative registration number 1322; Results.

Pre-COVID-19 pandemic health-related behaviours in children (2018-2020) and association with being tested for SARS-CoV-2 and testing positive for SARS-CoV-2 (2020-2021): a retrospective cohort study using survey data linked with routine health data in Wales, UK

OBJECTIVES

Examine if pre-COVID-19 pandemic (prior March 2020) health-related behaviours during primary school are associated with (1) being tested for SARS-CoV-2 and (2) testing positive between 1 March 2020 and 31 August 2021.

DESIGN

Retrospective cohort study using an online cohort survey (January 2018 to February 2020) linked with routine PCR SARS-CoV-2 test results.

SETTING

Children attending primary schools in Wales (2018-2020), UK, who were part of the Health and Attainment of Pupils in a Primary Education Network (HAPPEN)_school network.

PARTICIPANTS

Complete linked records of eligible participants were obtained for n=7062 individuals. 39.1% (n=2764) were tested (age 10.6±0.9; 48.9% girls) and 8.1% (n=569) tested positive for SARS-CoV-2 (age 10.6±1.0; 54.5% girls).

MAIN OUTCOME MEASURES

Logistic regression of health-related behaviours and demographics were used to determine the ORs of factors associated with (1) being tested for SARS-CoV-2 and (2) testing positive for SARS-CoV-2.

RESULTS

Consuming sugary snacks (1-2 days/week OR=1.24, 95% CI 1.04 to 1.49; 5-6 days/week OR=1.31, 95% CI 1.07 to 1.61; reference 0 days), can swim 25 m (OR=1.21, 95% CI 1.06 to 1.39) and age (OR=1.25, 95% CI 1.16 to 1.35) were associated with an increased likelihood of being tested for SARS-CoV-2. Eating breakfast (OR=1.52, 95% CI 1.01 to 2.27), weekly physical activity ≥60 min (1-2 days OR=1.69, 95% CI 1.04 to 2.74; 3-4 days OR=1.76, 95% CI 1.10 to 2.82; reference 0 days), out-of-school club participation (OR=1.06, 95% CI 1.02 to 1.10), can ride a bike (OR=1.39, 95% CI 1.00 to 1.93), age (OR=1.16, 95% CI 1.05 to 1.28) and girls (OR=1.21, 95% CI 1.00 to 1.46) were associated with an increased likelihood of testing positive for SARS-CoV-2. Living in least deprived areas (quintile 4 OR=0.64, 95% CI 0.46 to 0.90; quintile 5 OR=0.64, 95% CI 0.46 to 0.89) compared with the most deprived (quintile 1) was associated with a decreased likelihood.

CONCLUSIONS

Associations may be related to parental health literacy and monitoring behaviours. Physically active behaviours may include coparticipation with others and exposure to SARS-CoV-2. A risk-versus-benefit approach must be considered in relation to promoting these health behaviours, given the importance of health-related behaviours such as childhood physical activity for development.

Identifying local authority need for, and uptake of, school-based physical activity promotion in England-a cluster analysis

BACKGROUND

School-based physical activity interventions such as The Daily Mile (TDM) are widely promoted in children's physical activity guidance. However, targeting such interventions to areas of greatest need is challenging since determinants vary across geographical areas. Our study aimed to identify local authorities in England with the greatest need to increase children's physical activity and assess whether TDM reaches school populations in areas with the highest need.

METHODS

This was a cross-sectional study using routinely collected data from Public Health England. Datasets on health, census and the built environment were linked. We conducted a hierarchical cluster analysis to group local authorities by 'need' and estimated the association between 'need' and registration to TDM.

RESULTS

We identified three clusters of high, medium and low need for physical activity interventions in 123 local authorities. Schools in high-need areas were more likely to be registered with TDM (incidence rate ratio 1.25, 95% confidence interval: 1.12-1.39) compared with low-need areas.

CONCLUSIONS

Determinants of children's physical activity cluster geographically across local authorities in England. TDM appears to be an equitable intervention reaching schools in local authorities with the highest needs. Health policy should account for clustering of health determinants to match interventions with populations most in need.

Effect of 5-weeks participation in The Daily Mile on cognitive function, physical fitness, and body composition in children

The aim of the present study was to determine the effect of 5-weeks participation in The Daily Mile on cognitive function, physical fitness, and adiposity in primary school children. In a quasi-experimental study, one class from each school completed The Daily Mile (n = 44) or acted as a control group (n = 35). Baseline measures included cognitive function tests (Stroop test, Sternberg paradigm, Flanker task), physical fitness (multi-stage fitness test) and body composition (BMI percentile, waist:hip circumference, sum of skinfolds). The intervention group completed 5-weeks of The Daily Mile. Follow-up measurements were completed within 48-h of the last training session. Data were analysed via ANCOVA, examining between group differences at follow-up, controlling for baseline values. Response times on the complex Stroop test were faster at follow-up in the intervention group (Intervention: 1357 ms [1280–1400 ms]; Control: 1463 ms, [1410–1523 ms], d = 0.31, p = 0.048). There was no effect of The Daily Mile on the Sternberg paradigm or Flanker test. Physical fitness was greater at follow-up in the intervention group (Intervention: 880 m, [820–940 m]; Control: 740 m, [680–800 m], d = 0.39, p = 0.002). There was no effect of the intervention on adiposity. In conclusion, five-weeks of The Daily Mile enhanced inhibitory control and physical fitness in children, but did not affect working memory, attention, or adiposity.

The Daily Mile in practice: implementation and adaptation of the school running programme in a multiethnic city in the UK

OBJECTIVES

The aim of this study was to generate new evidence on how The Daily Mile (TDM), a popular school-based running programme in the UK, is implemented in a diverse and multiethnic city in the UK and also the barriers faced by non-implementer schools.

DESIGN

Mixed method cross-sectional study (including survey data collection and qualitative interviews).

SETTING

Primary schools in a multiethnic city in the East Midlands, UK.

PARTICIPANTS

Forty-two schools in Leicester city completed an online survey, and five teaching staff from five schools took part in follow-up semistructured qualitative interviews.

RESULTS

Overall, 40.5% of schools who completed the survey reported having never implemented TDM, and 96.0% of implementer schools reported delivering TDM on three or more days per week. Reported barriers included space limitations and safety issues, timetabling and curriculum pressures, and pupil and teacher attitudes. Facilitators of implementation were teacher engagement and school culture/ethos, communication of the initiative and substantial delivery adaptations.

CONCLUSIONS

The findings from this study, based on data from schools in a multiethnic city in the UK, suggest that implementation of TDM is variable, and is influenced by a range of factors related to the school context, as well as the characteristics of TDM itself.

Impact of The Daily Mile on children's physical and mental health, and educational attainment in primary schools: iMprOVE cohort study protocol

INTRODUCTION

School-based active mile initiatives such as The Daily Mile (TDM) are widely promoted to address shortfalls in meeting physical activity recommendations. The iMprOVE Study aims to examine the impact of TDM on children's physical and mental health and educational attainment throughout primary school. METHODS AND ANALYSIS: iMprOVE is a longitudinal quasi-experimental cohort study. We will send a survey to all state-funded primary schools in Greater London to identify participation in TDM. The survey responses will be used for non-random allocation to either the intervention group (Daily Mile schools) or to the control group (non-Daily Mile schools). We aim to recruit 3533 year 1 children (aged 5-6 years) from 77 primary schools and follow them up annually until the end of their primary school years. Data collection taking place at baseline (children in school year 1) and each primary school year thereafter includes device-based measures of moderate-to-vigorous physical activity (MVPA) and questionnaires to measure mental health (Strengths and Difficulties Questionnaire) and educational attainment (ratings from 'below expected' to 'above expected levels'). The primary outcome is the mean change in MVPA minutes from baseline to year 6 during the school day among the intervention group compared with controls. We will use multilevel linear regression models adjusting for sociodemographic data and participation in TDM. The study is powered to detect a 10% (5.5 min) difference between the intervention and control group which would be considered clinically significant.

ETHICS AND DISSEMINATION

Ethics has been approved from Imperial College Research Ethics Committee, reference 20IC6127. Key findings will be disseminated to the public through research networks, social, print and media broadcasts, community engagement opportunities and schools. We will work with policy-makers for direct application and impact of our findings.

Activity patterns of primary school children during participation in The Daily Mile

The Daily Mile is a popular physical activity initiative in primary schools, yet little is known regarding the activity patterns of children during The Daily Mile. Eighty children (10.4 ± 0.7 years) participated in The Daily Mile (20-min). Activity patterns were assessed using global positioning systems (total distance and age-specific speed zones), alongside heart rate. Cardiorespiratory fitness was assessed using the Multi-Stage Fitness Test. Participants covered a distance of 2511 ± 550 m during The Daily Mile, and heart rate was 163 ± 27 beats^.min^-1. Participants travelled the furthest distance, and were most intermittent, during the first 5 min (main effect of time, both p < 0.001). Boys ran further and their activity was more intermittent compared to girls (main effect of sex, both p < 0.001). Moreover, the highest fit children ran further than less fit children (main effect of fitness, p < 0.001). This study provides novel evidence of the nature of physical activity during The Daily Mile; demonstrating that children covered, on average, 1.5-miles and exercised at a moderate-to-vigorous intensity. Furthermore, boys covered a greater distance and were more intermittent than girls; whilst higher fit children ran further than lower fit children. In summary, The Daily Mile makes a valuable contribution to in-school physical activity targets in all children.

Sociodemographic profiles, educational attainment and physical activity associated with The Daily Mile™ registration in primary schools in England: a national cross-sectional linkage study

OBJECTIVE

To examine primary school and local authority characteristics associated with registration for The Daily Mile (TDM), an active mile initiative aimed at increasing physical activity in children.

DESIGN

A cross-sectional linkage study using routinely collected data.

SETTING

All state-funded primary schools in England from 2012 to 2018 (n=15,815).

RESULTS

3,502 of all 15,815 (22.1%) state-funded primary schools in England were registered to do TDM, ranging from 16% in the East Midlands region to 31% in Inner London. Primary schools registered for TDM had larger mean pupil numbers compared with schools that had not registered (300 vs 269, respectively). There was a higher proportion of TDM-registered schools in urban areas compared with non-urban areas. There was local authority variation in the likelihood of school registration (intraclass correlation coefficient: 0.094). After adjusting for school and local authority characteristics, schools located in a major urban conurbation (OR 1.46 (95% CI 1.24 to 1.71) urban vs rural) and schools with a higher proportion of disadvantaged pupils had higher odds of being registered for TDM (OR 1.16 (95% CI 1.02 to 1.33)). Area-based physical activity and schools' educational attainment were not significantly associated with registration to TDM.

CONCLUSION

One in five primary schools in England has registered for TDM since 2012. TDM appears to be a wide-reaching school-based physical activity intervention that is reaching more disadvantaged primary school populations in urban areas where obesity prevalence is highest. TDM-registered schools include those with both high and low educational attainment and are in areas with high and low physical activity.

The Daily Mile Is Able to Improve Cardiorespiratory Fitness When Practiced Three Times a Week

The Daily Mile is a promising initiative aimed at removing some of the barriers to physical activity in the school setting. This quasi-experimental study investigated the dose–effect of The Daily Mile on cardiorespiratory fitness, waist-to-height ratio, and body mass index (BMI) after a period of 3- and 6-months. A total of 279 students (mean age = 9 ± 1 years) participated in The Daily Mile while 269 students (mean age = 9 ± 1 years) did not (control group). A posteriori, the classes performing The Daily Mile on average two times per week were included in the 2_times subgroup, while those performing the activity on average three times per week in the 3_times subgroup. A significant difference was observed in favor of the experimental compared to the control group in the 6 Minute Run Test (F = 13.932, p = 0.008). Moreover, the improvement of the 6-minute run test was more pronounced for 3_times (effect size = 0.51) rather than for the 2_times subgroup (effect size = 0.29). No differences were observed in waist-to-height ratio and BMI scores. In conclusion, teachers are strongly recommended to implement The Daily Mile at least three times a week to see appreciable effects on cardiorespiratory fitness.