An RCT to facilitate implementation of school practices known to increase physical activity
Open accessAbstract
INTRODUCTION: Although comprehensive school-based physical activity interventions are efficacious when tested under research conditions, they often require adaptation in order for implementation at scale. This paper reports the effectiveness of an adapted efficacious school-based intervention in improving children's moderate to vigorous physical activity. The impact of strategies to support program implementation was also assessed. DESIGN: A cluster RCT of low socioeconomic elementary schools in New South Wales, Australia. SETTING/PARTICIPANTS: Consenting schools were randomized (25 intervention, 21 control) using a computerized random number function. Follow-up measures were taken at 6 months post-randomization (May-August 2015) by blinded research assistants. The multicomponent school-based intervention, based on an efficacious school-based physical activity program (Supporting Children's Outcomes using Rewards, Exercise and Skills), consisted of four physical activity strategies and seven implementation support strategies. The intervention was adapted for scalability and delivery by a local health service over 6 months. The primary outcome was accelerometer assessed, student mean daily minutes spent in moderate to vigorous physical activity. Physical education lesson quality and other school physical activity practices were also assessed. RESULTS: Participants (n=1,139, 49% male) were third- through sixth-grade students at follow-up (May-August 2015). Valid wear time and analysis of data were provided for 989 (86%) participants (571 intervention, 568 control). At 6-month follow-up, there were no significant effects in overall daily minutes of moderate to vigorous physical activity between groups (1.96 minutes, 95% CI= -3.49, 7.41, p=0.48). However, adjusted difference in mean minutes of overall vigorous physical activity (2.19, 95% CI=0.06, 4.32, p=0.04); mean minutes of school day moderate to vigorous physical activity (2.90, 95% CI=0.06, 5.85, p=0.05); and mean minutes of school day vigorous physical activity (1.81, 95% CI=0.78, 2.83, p≤0.01) were significantly different in favor of the intervention group. Physical education lesson quality and school physical activity practices were significantly different favoring the intervention group (analyzed October 2015-January 2016). CONCLUSIONS: The modified intervention was not effective in increasing children's overall daily minutes of moderate to vigorous physical activity, when adapted for implementation at scale. However, the intervention did improve daily minutes of vigorous physical activity and school day moderate to vigorous physical activity, lesson quality, and school physical activity practices. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12615000437561.
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Among 10 studies reporting the proportion of schools implementing a targeted policy, practice, or program versus a minimal or usual practice control, the median unadjusted effect size was 16.2%, ranging from -0.2% to 66.6%.
“For example, among 10 studies reporting the proportion of schools implementing a targeted policy, practice, or program versus a minimal or usual practice control, the median unadjusted effect size was 16.2%, ranging from –0.2% to 66.6%.”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
Seven studies were assessed as low risk of detection bias.
“Seventeen of the included studies were assessed as high risk [26, 28, 37, 41, 43, 44, 46–49, 52, 54–56, 58, 66, 67] and seven studies were assessed as low risk of detection bias [27, 42, 51, 53, 60, 62, 63].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups.
“For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups [37, 38, 41, 46, 47, 55, 56, 58, 60, 64, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
For studies using a cluster-RCT design (n = 15), potential risk of recruitment to cluster was assessed as low for seven studies as randomization occurred either postrecruitment or postbaseline data collection.
“Potential risk of recruitment (to cluster) was assessed as low for seven studies as randomization occurred either postrecruitment or postbaseline data collection [47, 54–56, 58, 60, 64].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
Ten studies were assessed as low risk of selective reporting as a trial registration or a published protocol paper was identified and all a priori determined outcomes were reported.
“Ten studies were assessed as low risk of selective reporting as a trial registration or a published protocol paper was identified and all a priori determined outcomes were reported [26, 44, 51, 53, 54, 60, 62–64, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
Three studies compared implementation strategies to a usual care or minimal support control on measures of lesson quality.
“Three studies compared implementation strategies to a usual care or minimal support control on measures of lesson quality [26, 56, 60].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
Among studies that assessed changes in the implementation of a physical activity policy, practice, or program, effects were modest with median effect sizes ranging from no change (-0.2%) in Farmer et al. to a change of almost 20% in Sutherland et al.
“Among studies that assessed changes in the implementation of a physical activity policy, practice, or program [27, 41, 60, 64], effects were modest with median effect sizes ranging from no change (–0.2%) in the study by Farmer et al. [41] to a change of almost 20% in the Australian randomized trial by Sutherland et al. [60].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
Significant improvements were reported in physical activity program quality score in an Australian randomized trial by Sutherland et al.
“Significant improvements were also reported in physical activity program quality score in an Australian randomized trial by Sutherland et al. [60]”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [60]
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Self-citationHow effective are physical activity interventions when they are scaled-up: a systematic review
Lane, C., McCrabb, S., Nathan, N., Naylor, P., Bauman, A. E., Milat, A., Lum, M., Sutherland, R., Byaruhanga, J., & Wolfenden, L. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01080-4 · Cited by 135 · see citing works
Self-citationWolfenden, L., Goldman, S., Stacey, F. G., Grady, A., Kingsland, M., Williams, C. M., Wiggers, J. H., Milat, A., Rissel, C. E., Bauman, A. E., et al. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012439.pub2 · Cited by 128 · see citing works
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Barnes, C., McCrabb, S., Stacey, F., Nathan, N., Yoong, S. L., Grady, A., Sutherland, R., Hodder, R., Innes-Hughes, C., Davies, M., et al. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab037 · Cited by 84 · see citing works
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Kennedy, S. G., Smith, J. J., Estabrooks, P. A., Nathan, N., Noetel, M., Morgan, P. J., Salmon, J., dos Santos, G. C., & Lubans, D. R. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01195-8 · Cited by 29 · see citing works
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Tensions and Paradoxes of Scaling Up: A Critical Reflection on Physical Activity Promotion
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Self-citationImproving physical activity and screen time in Australian Outside School Hours Care: Study protocol
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Prevalence of Physical Activity Initiatives in Australian Primary Schools: A Cross‐Sectional Survey
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- Authors
- Sutherland, R. L., Nathan, N. K., Lubans, D. R., Cohen, K., Davies, L. J., Desmet, C., Cohen, J., McCarthy, N. J., Butler, P., Wiggers, J., & Wolfenden, L.
- Affiliations
- Hunter Medical Research Institute (AU)
- Hunter New England Local Health District (AU)
- University of Newcastle Australia (AU)
- Corresponding author
- Sutherland, Rachel L.
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 53
- Issue
- 6
- Pages
- 818-828
- ISSN
- 0749-3797 (ISSN-L)
- OpenAlex
- W2766165623
- Cited by
- 58
- References
- 71
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 21 · 2020: 9 · 2019: 3 · 2018: 4 · 2017: 1
- FWCI
- 3.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Preventive Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Figshare (submittedVersion)
- RUNE (Research UNE) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- Hunter Medical Research Institute
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- school-based physical activity intervention, intervention adaptation, moderate-to-vigorous physical activity, children, low socioeconomic status schools, elementary school students, accelerometer-measured activity, scalability, physical activity promotion, exercise strategies
- MeSH terms
- Child, Female, Follow-Up Studies, Humans, Male, New South Wales, Physical Education and Training, Schools, Socioeconomic Factors, Students, Program Evaluation, Exercise, Accelerometry
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