Research Institute for Sport and Exercise Sciences Physical Activity & Sport Promotion in Schools...

Research Institute for Sport and Exercise Sciences

Physical Activity & Sport Promotion in Schools

Effective School-Based Interventions: What Works?

Stuart J. Fairclough, PhDProfessor of Physical Activity Education

Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK

Denizli, Turkey, 12-14 December 2012

Research Institute for Sport and Exercise SciencesResearch Institute for Sport and Exercise Sciences

Why schools as environments for physical activity promotion?

• Captive audience – school is mandatory• Infra-structure – teachers, facilities,

curriculum• Time – 30-35 h/wk for 40+wks/yr• Links to home, community, business [gyms

etc]• Most MVPA accrued at school (Fairclough et al., 2008; Ed

3-13, 36: 371-381)


School-related physical activity during the day

(Trost et al., 2002, MSSE. 32, 426-431

School40%

lunchtime and outside school ac-tivities

12%

period before bed time 9%

morning time before school 8%

Other32%


But, all schools and their students are different…confounding variables

• Age• Gender• Maturation• Motivation • Ethnicity• Culture• Religion• Socio-economic status• Stage of schooling

• School type• Curriculum structures• Geographic location• Physical environment• School policies and

ethos• Climate and weather• Class sizes

Can effective intervention approaches work in all cases?


Schools as micro-environments for applying the socio-ecological model

Schools •National curricula, standards, government policy•Relationships with community groups, sports clubs, commercial organisations•School departments, classes, streaming•Friends, peers, teachers, parents•Individual children and adolescents

INTERVENTIONS TARGETING ALL

LEVELS


School-based PA interventions...what works?

It depends on the outcomes...• Context-specific PA -

usually successful• Whole day PA -

equivocal (possibility of compensation)

• Non-school PA - seldom successful

• PA-related outcomes (e.g., fitness, motor skills, BMI, etc) - equivocal

• Some examples...


Active school travel (Cooper et al., 2012, MSSE, 44, 1890-1897)

Primary school children

Secondary school children


Travelling Green Project (McKee et al., 2007, J Epid Comm Health, 1: 818-823)

• Classes of 9-10 y olds from 2 schools in Scotland;

• Intervention: 10 week active travel cross-curricular project comprising interactive resources: – Curriculum materials– Child and family materials

• Generic and school-specific components (e.g., maps, road crossing points, etc)


Change in school travel mode (McKee et al., 2007, J Epid Comm Health, 1: 818-823)

Mean distance walked increased by 389%Mean distance travelled by car decreased by 58%


Active school travel

• Active travel is simple, free and sustainable• Active travel can potentially occur 10 times

each week• Limited number of active travel interventions

of sufficient quality • Relatively small effects reported


PA promotion through physical education (PE)

• Major goal of PE is to produce physically educated young people who have knowledge, skills, attitudes to engage in PA beyond the curriculum and throughout life– PA during class time– Influence PA out of school


• Aim to increase MVPA without compromising motivation and learning

• 11-12 y old girls’ gymnastics lessons• Control vs. intervention classes• Intervention: MVPA included as lesson objective;

modified teaching styles, organisation of pupils & equipment

• HR monitoring, systematic observation and questionnaire

Simple teaching intervention to increase PE class time MVPA

(Fairclough & Stratton, 2005, Health Ed Res, 20: 448-457)


Increased PE MVPA without compromised motivation

42.6%

27.3%

4.54.7

0

10

20

30

40

50

Control Intervention

MV

PA

(%

les

son

)

0

1

2

3

4

5

Mo

tiva

tio

n

MVPA

Mtvn

** p < 0.001

**

(Fairclough & Stratton, 2005, Health Ed Res, 20: 448-457)


KISS Clustered RCT (Kriemler et al., 2010, BMJ, 340 :c785)

• 1 year PE intervention in 16 classes within 15 elementary schools

• Multicomponent approach: daily PE, daily PA breaks, PA homework

• Intervention children accumulated significantly more MVPA in school and over whole day than Control group

• But out of school MVPA was similar• Improvements in fitness, body composition, CVD risk• Compulsory and structured PA approach• No follow-up after intervention ended


Integrated curriculum approaches to PA promotion

• Emphasis on behaviour change through improved knowledge, understanding, behavioural skills

• Cross-curricular approaches allow reinforcement throughout the curriculum

• Lesson content commonly based around physical activity, sedentary time, plus other behaviours like healthy eating

• Tasks provide opportunities for content to be applied in other social contexts (e.g., home)


Low cost integrated curriculum approach: The CHANGE! Intervention

(Mackintosh et al., 2011, Boddy et al., 2012 BMC Pub Health; Fairclough et al., in rev PLoS ONE)

• Aim: Promote healthy weight through…– 1.Increased physical activity – 2. Reductions in sedentary behaviours– 3. Healthy eating

• Intervention– CHANGE! curriculum: 306 page teacher & pupil resource – Twilight teacher training– 5 month programme, with 10 weeks follow-up

• Key results: Increased VPA, decreased waist circumference, increased breakfast consumption


Integrated curricular & extra-curricular intervention: Great Fun 2 Run

(Gorely et al., 2009, 2011, IJBNPA)

• Aim: to increase physical activity and improve dietary behaviours among 7-11 year olds

• Parental and family involvement

• ‘Highlight’ events and media campaign

• 10 month duration, 20 months follow-up period


Major findings (Gorely et al., 2009, 2011, IJBNPA)

• Post-intervention…– MVPA increased by ~ 9min/day– Rate of increase in % body fat, BMI, and waist

circumference slowed significantly in older children – No change in fruit and vegetable intake

• At 20 months follow up– Significant increases in % body fat, BMI, and waist

circumference with increasing age• Post-intervention effects were not sustained


Non-curricular PA promotion

Rationale:• Content can complement formal curriculum• No mandatory curriculum guidelines to

follow so more flexibility• Access to facilities and children


Play/breaktime (recess)

• Mandatory part of the school day• Outdoors • Potentially 600 playtimes per year [based on

3 x day, 5 days/wk]• Largely unstructured physical activity

encompassing various modes and intensities


Liverpool Sporting Playgrounds Project (Ridgers & Stratton, 2005, Ped Exerc Sci, 17: 281-290)

http://www.youthsporttrust.org/page/zp-film/index.html


Sustained increases in MVPA in the painted Zoneparc playgrounds

(Ridgers et al., 2007, Prev. Med, 44: 393-397)

Baseline 6 weeks 6 months0

5

10

15

20

25

30

35

40

45

Int boys

Int girls

Con boys

Con girls

% M

VP

A


Meta-analysis of effects of after-school programmes (Beets et al., 2009, Am J Prev Med, 36: 527-537)

Positive effects


PA during different types of after-school clubs using active video games

(Fairclough et al., 2012, unpublished report)

Children most active doing multi-skills…

Least active/fit 11-12 y old children participating in twice weekly after-school clubs

& least active playing Wii Sports


Methodological limitations of youth PA interventions

(van Sluijs et al., 2007, BMJ, 335, 703)

• Short duration of follow-up• Lack of adjustment for potential

confounders• Lack of adjustment for clustering when

randomisation at group level occurred• Lack of precision of PA outcome

measure [over-reliance on self-report]


So, what does work? Back to the future…?

Child & Adolescent Trial for Cardiovascular Health: CATCH

Why was it successful?• Size: 96 elementary

schools (5000+ children) in 4 states

• Duration: 3 years, with extensive follow-up

• Socio-ecological approaches (individual, social, organisational, community, policy)

(Luepker et al., 1996, JAMA, 275, 768-776;

McKenzie et al., 1996, Prev. Med., 25, 423-431)

http://www.catchinfo.org/

http://www.catchinfo.org/


Intervention focused on changes to:• PE curriculum, training, & support [individual, policy,

organisational]

– At least 90 minutes of PE spread across a minimum of three sessions per week

• Food services [policy, organisational]

• Family involvement [social]

• Health education curriculum [individual, policy, organisational]

• After-school community involvement [community, social, policy, organisational]


• Significant improvements in…– MVPA during PE classes– Out of school vigorous PA– Dietary behaviour

• Changes sustained after intervention had ended


5 year maintenance effects: CATCH-ON Study

(McKenzie et al., 2003, Health Ed Behav, 30: 447-462)

• 5 year follow-up of CATCH in 88 schools• PE MVPA maintained in Intervention schools• Delayed adoption of CATCH resources plus

training in Control schools

But no evidence of maintenance in out of school PA…


Based on the evidence, what works? (Kriemler et al., 2011, BJSM, 45, 923-930)

• Multi-component interventions (e.g., educational, curricular, environmental) more effective than single component interventions and can broaden the reach of the population (socio-ecological model)

• Family involvement (pre-adolescents?) – mediators of non-school PA and positive PA attitudes

• Context-specific interventions...but long-term effects questionable

• BUT…Lack of effect on out of school PA• Should intervention efforts be directed elsewhere?

– Discretionary time [after-school, weekends], targeted to least active?


Thanks for listening!

@PAEH_Group_JMU

[email protected]://www.ljmu.ac.uk/sps/RISES/100465.htm


• 4 month pilot, 12 month intervention • 3 treatment arms (plus control schools):

– High intensity PA (HIPA)– Fundamental movement skills (FMS)– PA signposting scheme (PASS)

• 8 schools in total (2 per treatment)• Assessment of CV health, PA, fitness, FMS, body

composition, self-perceptions at baseline, 6 months & post-intervention

• Summary report available: http://www.sportslinx.org/index.php?option=com_content&view=category&layout=blog&id=24&Itemid=95


A-CLASS FMS results (Foweather et al., 2008, Percep Mot Skills, 106, 745-754)


Naylor et al., 2006


Active school model: Action Schools!: BC (Naylor et al., 2008, BJSM, 42: 338-343)

• Participatory model• Customised 11 month programme based on schools’

perceived needs• Targeted zones: environment, PE, family/community,

classroom, school spirit, extra-curricular• School ‘action teams’ with AS!: BC support team• Prescriptive components: 15 min classroom PA/day & 2x40

min PE classes/week• Aim: children get 150 minutes school-based PA/week• 3 conditions: Usual practice, Liaison, Champion• 4-8 week follow-up


Action Schools! BC...effective? (Naylor et al., 2008, BJSM, 42: 338-343)

• Modest increases in whole-day pedometer counts in Intervention boys but not girls– Suggests limited non-school effects or compensation– Reflects known gender differences in PA related to

discretionary time?

• Significant increase in PA delivery time• 75% compliance• High teacher satisfaction• School-based intervention models should seek to

maintain current PA to prevent/slow age-related decline?

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