A discussion on their implementation in Italy

Abstract

School Active Breaks are short bouts of physical activity (5-15 minutes) conducted by appropriately trained teachers and delivered during or between curricular lessons. They are a good strategy to counteract sedentary behaviors, and a growing body of evidence shows that they can represent also a tool to promote and improve health, school wellbeing and academic achievements. On 19 February 2022, the Working Group on Movement Sciences for Health of the Italian Society of Hygiene, Preventive Medicine and Public Health organized an Awareness Day on the effectiveness, usefulness and feasibility of School Active Breaks, opened to teachers, educators, school leaders, pediatricians, personnel from Departments of Prevention and Public Health and Health Policy-makers. During the event, the testimonies about the experiences already carried out in Italy showed that School Active Breaks are an effective intervention that each school can easily include in its educational offer and apply in any context.

Evaluation of feasibility, effectiveness, and sustainability of school-based physical activity "active break" interventions in pre-adolescent and adolescent students: a systematic review

Objective

The present systematic review aimed to investigate the impact of school-based physical activity (PA) interventions of “active breaks” on PA levels, classroom behaviour, cognitive functions, and well-being in pre-adolescents and adolescents attending secondary and high school.

Methods

In March 2021, we performed a systematic research in CINAHL, Cochrane Library, Embase, MedLine, and PsycINFO databases and through grey literature. Quality assessment was performed in accordance with the Cochrane Tool for Quality Assessment for RCTs and the STROBE tool for observational studies. We included studies that investigated classroom PA interventions led by teachers such as active breaks or physically active lessons on PA levels, classroom behaviour, cognitive function, and quality of life in pre-adolescent and adolescent population attending secondary and high school.

Synthesis

Three studies met the inclusion criteria. Two studies showed a positive effect of active breaks on students’ classroom behaviour and quality of life. One study registered a positive effect in the increase in school PA levels; unfortunately, this effect was not found in the overall levels of PA or in the reduction of sedentary behaviour. All three studies showed the feasibility and acceptability of active breaks intervention in secondary and high school settings.

Conclusion

This systematic review suggests the potential benefit of this type of intervention integrated in the secondary and high school curriculum on classroom behaviour, school PA levels, and well-being.

Supplementary Information

The online version contains supplementary material available at 10.17269/s41997-022-00652-6.

Different frequencies of active interruptions to sitting have distinct effects on 22 h glycemic control in type 2 diabetes

BACKGROUND & AIMS

Whether the frequency of interruptions to sitting time involving simple resistance activities (SRAs), compared to uninterrupted sitting, differentially affected 22 h glycemic control in adults with medication-controlled type 2 diabetes (T2D).

METHODS & RESULTS

Twenty-four participants (13 men; mean ± SD age 62 ± 8 years) completed three 8 h laboratory conditions: SIT: uninterrupted sitting; SRA3: sitting interrupted with 3 min of SRAs every 30 min; and, SRA6: sitting interrupted with 6 min of SRAs every 60 min. Flash glucose monitors assessed glycemic control over a 22 h period. No differences were observed between conditions for overall 22 h glycemic control as measured by AUC_total, mean glucose and time in hyperglycemia. During the 3.5 h post-lunch period, mean glucose was significantly lower during SRA6 (10.1 mmol·L^-1, 95%CI 9.2, 11.0) compared to SIT (11.1 mmol·L^-1, 95%CI 10.2, 12.0; P = 0.006). Post-lunch iAUC_net was significantly lower during SRA6 (6.2 mmol·h·L^-1, 95%CI 3.3, 9.1) compared to SIT (9.9 mmol·h·L^-1, 95%CI 7.0, 12.9; P = 0.003). During the post-lunch period, compared to SIT (2.2 h, 95%CI 1.7, 2.6), time in hyperglycemia was significantly lower during SRA6 (1.5 h, 95%CI 1.0, 1.9, P = 0.001). Nocturnal mean glucose was significantly lower following the SRA3 condition (7.6 mmol·L^-1, 95%CI 7.1, 8.1) compared to SIT (8.1 mmol·L^-1, 95%CI 7.6, 8.7, P = 0.024).

CONCLUSIONS

With standardized total activity time, less-frequent active interruptions to sitting may acutely improve glycemic control; while more-frequent interruptions may be beneficial for nocturnal glucose in those with medication-controlled T2D.

Rationale and methods of the MOVI-da10! Study -a cluster-randomized controlled trial of the impact of classroom-based physical activity programs on children's adiposity, cognition and motor competence

BACKGROUND

Although physical activity (PA) integrated in schools' classrooms have shown a positive effect on children's behaviors, its effectiveness on cognitive functions, PA levels and other health variables remains unclear. This article outlines the rationale and methods of two classroom-based PA interventions (MOVI-da10!) on improving adiposity, executive function and motor competence in preschool children.

METHODS

A three-arm cluster-randomized controlled trial (RCT) was carried out including eight schools (rural and urban areas) from Cuenca province, Spain. The schools were allocated to one of three groups: MOVI-da10-Enriched! intervention (n = 3), MOVI-da10-Standard! intervention, (n = 2), and the control group (n = 3). Around 900 children aged 4 to 6 years old were assesed at baseline (September 2017) and at the end (June 2018) of the intervention. The primary outcomes were changes in body fat by bioimpedance, executive function and motor competence. During a school year (from October 2017 to May 2018), children belonging to the MOVI-da10-Enriched! group performed enriched PA integrated into the academic curriculum including two active breaks lasting 10 min, 5 days/week. The children belonging to the MOVI-da10-Standard! group performed PA breaks (with low cognitive demand, where curricular contents were not reinforced) including two active breaks lasting 10 min, 5 days/week. In the control group, regular PA continued.

DISCUSSION

To our knowledge, MOVI-da10! is the first RCT to examine the effectiveness of two programs (enriched PA integrated into the academic curriculum and PA breaks only) versus a control group on improving adiposity, executive function and motor competence in preschool children.

TRIAL REGISTRATION

NCT03236363 (clinicaltrials.gov), 31st July 2017.

Feasibility of breaking up sitting time in mainstream and special schools with a cognitively challenging motor task

BACKGROUND

Children spend ≤70% of the school day sitting in class. Classroom-based active breaks can benefit children's physical health, but if the breaks are cognitively demanding (i.e., combine physical exertion and mental engagement), they may also improve focus and cognitive functions. Teachers and students play a crucial role in the successful implementation of active breaks, and their perspectives are critical to the feasibility of these strategies. The aim of this study was to assess the feasibility of implementing a cognitively challenging motor task as an active break in mainstream and special primary schools.

METHODS

A total of 5 teachers in 2 mainstream schools and 7 teachers in 1 special school (attended by children with neurodevelopmental disorders) attended a 20-min training on how to implement a 4-min cognitively challenging active break, before conducting a feasibility trial (twice a day for 1 week). To understand individual perceptions, one-on-one semistructured interviews were conducted before and after the trial with teachers, and focus group interviews were conducted with typically developing children after the trial. Questions were based on a predefined framework for feasibility studies. All interviews were audio recorded, transcribed and analyzed in NVivo 11 using a framework approach. A total of 12 teachers (11 females; 7 between 20 and 34years old) and 34 children (16 girls; 9.3 ± 1.7years, mean ± SD) participated in the interviews.

RESULTS

In mainstream schools, teachers viewed the cognitively challenging motor task as appropriate and potentially beneficial for children's health and focus. Children reported enjoying the active breaks. Teachers in special schools viewed the task as complex and potentially frustrating for children. In both school types, children's disruptive behavior and lack of time were seen as the main potential barriers to implementation. The use of music, videos, visual cards, and support staff were noted as potential facilitators.

CONCLUSION

The cognitively challenging motor task was a feasible way to interrupt children's sitting time and promote physical activity in mainstream schools, but required changes in special schools. Further research could investigate the effectiveness of these types of task interruptions on children's physical and cognitive health.

Are school factors and urbanization supportive for being physically active and engaging in less screen-based activities?

OBJECTIVES

The aim was to assess the association between physical activity and screen-based activities in adolescents and selected school factors and urbanization and whether these associations were modified by degree of urbanization.

METHODS

We obtained data regarding the fifth-ninth grade students from 130 schools in 2014 via the Health Behaviour in School-aged Children cross-sectional study in Slovakia (n = 9743, mean age = 13.5, 50.3% boys). We explored the associations using multilevel logistic regression.

RESULTS

We found significant associations between physical activity and the accessibility of an area for skating/tennis court [odds ratio (OR) = 1.20 and 95% confidence interval (CI) 1.01-1.42], and between physical activity and active breaks (OR = 0.83 and 95% CI 0.69-0.99). The rates of screen-based activities were higher in small towns (OR = 1.63, 95% CI 1.29-2.06), towns (OR = 1.30, 95% CI 1.08-1.57), and cities (OR = 1.40, 95% CI 1.04-1.87) than in villages.

CONCLUSIONS

School environment and degree of urbanization are associated with adolescents' physical activity and screen-based activities. This holds positively for access to an area for skating/tennis court and negatively for active breaks regarding physical activity and for living in villages regarding less use of screens.

Breaking up sedentary time, physical activity and lipoprotein metabolism

OBJECTIVES

Some authors report delayed responses of lipid metabolism after prolonged and interrupted sitting. To date no experimental studies have shown acute physical activity (PA) related changes of lipoprotein metabolism during sedentary behavior (SB). The purpose of this study was to examine immediate effects of a single PA-bout vs. regular PA-breaks on lipoprotein metabolism during postprandial SB.

DESIGN

Eighteen female subjects (25.6years±2.6; 21.5kg/m2±2.0) participated in a balanced crossover experiment with three trials: (1) 30min PA prior to 4h sitting (PRE), (2) 5×6min PA within 4h sitting (BREAK) (3) 4h sitting (CTRL). PA was ergometer cycling at 70%VO₂max. Participants consumed one standardized breakfast in each trial.

METHODS

Total cholesterol (tChol), high density lipoprotein (HDL), low density lipoprotein (LDL) and triacylglycerol (TAG) readings were taken in fasted state at the beginning (before), and immediately after each trial. Multiple 2×3-ANOVAs (trial-arm*time) and post hoc t-tests were used.

RESULTS

ANOVAs revealed trial*time-effects for tChol (p=0.043) and HDL (p=0.007) and a tendency for LDL (p=0.078). Before-to-after differences (Δ) of tChol during BREAK-trial (-0.89±5.49mg/dl) significantly differed to Δ during PRE-trial (+3.56±5.32mg/dl) (p=0.005) but not to ΔCTRL (+2.16±8.72). ΔHDL during BREAK-trial (-2.11±3.31mg/dl) significantly differed to ΔPRE (+0.83±4.26mg/dl) (p=0.007) and ΔCTRL (+0.06±4.15mg/dl) (p=0.028). Analysis of TAG revealed a time effect (p=0.007) and significant differences between TAG before and after trial within BREAK (79.22±38.69mg/dl to 94.78±44.86mg/dl) and CTRL (80.94±32.94mg/dl to 97.72±41.19mg/dl) but not in PRE (78.83±33.13mg/dl to 89.06±33.83mg/dl).

CONCLUSIONS

Breaking sedentary behavior with vigorous intensity PA seem to decelerate postprandial lipoprotein metabolism during sitting. In contrast, prior PA, might be a stimulus for lipid metabolization.