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Cited by 189Physical Activity and HealthSchool Health and Nursing EducationObesity, Physical Activity, Diet

A mixed-studies systematic review and meta-analysis of school-based interventions to promote physical activity and/or reduce sedentary time in children

Open access
Jones, Michelle, Defever, Emmanuel, Letsinger, Ayland, Steele, James, Mackintosh, Kelly A·2020·Journal of Sport and Health Science
DOI 10.1016/j.jshs.2019.06.009PMC PMC6943767
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Abstract

Purpose: The aim of this mixed-studies systematic review was to ascertain the effectiveness of school-based interventions in increasing physical activity (PA) and/or reducing sedentary time (ST) in children aged 5-11 years, as well as to explore their effectiveness in relation to categories of the theory of expanded, extended, and enhanced opportunity (TEO). Methods: = 419) resulted in 112 records that were full-text screened. Two independent reviewers subsequently used the mixed-methods appraisal tool to assess the methodological quality of 57 full-text studies that met the inclusion criteria after full-text screening. The interventions were summarised using the TIDierR checklist and TEO. The strength of evidence was determined using a 5-level rating system utilising a published decision tree. Results: Overall evidence ratings for interventions implemented within school settings were: no evidence of effects on moderate-to-vigorous physical activity (MVPA) and inconclusive evidence of effects on sedentary time. In relation to the TEO, expansion of PA appeared to be the most promising intervention type for MVPA, with moderate evidence of effect, whereas extension and enhancement of PA opportunity demonstrated no evidence of effect. A critical issue of possible compensatory behavior was identified by analysis of intervention effect in relation to PA measurement duration; when studies measured changes in PA during the actual intervention, there was moderate evidence of effect, whereas those that measured changes in PA during the school day presented inconclusive evidence of effect, and those that measured changes in PA over a whole day yielded no evidence of effect. Two meta-analyses of those studies using a whole-day accelerometer measure for MVPA or ST showed a significant but moderate effect for MVPA (effect size = 0.51; 95% confidence interval (CI): 0.02-0.99) and a large but nonsignificant effect for ST (effect size = 1.15; 95%CI: -1.03 to 3.33); both meta-analyses demonstrated low precision, considerable inconsistency, and high heterogeneity. Conclusion: The findings have important implications for future intervention research in terms of intervention design, implementation, and evaluation.

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Written from the paper’s full text.

TL;DR

This mixed-studies systematic review and meta-analysis of school-based interventions in children aged 5–11 found no overall evidence of effect on MVPA and inconclusive evidence on sedentary time, despite many individual studies reporting positive effects. Expanded PA opportunities (e.g., after-school clubs, class PA breaks, active learning, active travel) were the most promising, but whole-day effects were limited and meta-analytic estimates were imprecise and highly heterogeneous.

Key findings

  • Across 57 original studies (29 RCTs, 17 non-randomised, 10 descriptive, 1 mixed-methods), 68% reported a positive PA effect; 62% of 37 MVPA studies were positive; 6 of 11 ST studies reported positive effects. Overall evidence ratings were no evidence for MVPA and inconclusive for ST.
  • By TEO category, expanded opportunities had moderate evidence for MVPA (82% positive), extended opportunities had inconclusive evidence, and enhanced opportunities had no evidence. After-school clubs (moderate), class PA breaks, physically active learning, and active travel (limited) were the most promising intervention types.
  • Measurement time influenced findings: during intervention delivery, 100% of 9 studies reported positive effects (moderate evidence); during the school day, 76% of 16 studies were positive (inconclusive evidence); over the whole day, 58% (19/33) were positive (no evidence). Whole-day accelerometer meta-analysis gave pooled ES 0.51 (95%CI 0.02–0.99) for MVPA and 1.15 (95%CI –1.03 to 3.33) for ST, with I² = 98.43% and 98.6%, respectively.
  • Publication bias was suggested for MVPA (Egger z = 4.3749, p < 0.0001), and sensitivity analyses made the pooled MVPA effect non-significant after removing several individual studies.

Methods

  • Mixed-studies systematic review and meta-analysis registered with PROSPERO (CRD42017082184) and reported per PRISMA; searched ERIC, MEDLINE, PsychINFO, SPORTDiscus, and Web of Science through 30 June 2017. Inclusion criteria were children aged 5–11, school-based PA/SB interventions lasting at least 4 weeks, and objectively assessed PA, ST, or both; 57 original studies plus 3 follow-up reports were included.
  • Quality was appraised with the Mixed Methods Appraisal Tool (MMAT); strength of evidence used a 5-level rating system (strong, moderate, limited, inconclusive, no evidence); data extraction used the TIDieR checklist and categorised interventions by the Theory of Expanded, Extended, and Enhanced Opportunities (TEO).
  • A post hoc random-effects meta-analysis was conducted on whole-day accelerometer studies reporting MVPA or ST, using Hedges’ g; mixed-effect meta-regression examined study type and quality; heterogeneity used Q and I²; publication bias used funnel plots and Egger regression (not for ST due to only 4 studies).

Limitations

  • Stated: the initial literature search did not include specific intervention-type or sex terms, though secondary searches likely mitigated this; the TEO was applied retrospectively rather than underpinning included studies; methodological quality was variable, with common lack of randomisation and unclear dropout; many studies did not report tailoring/modifications or adherence; some used objective PA only in a subsample, risking selection bias; device, time frame, and cut-point variation weakened conclusions; ST meta-analysis had only 4 studies, precluding meta-regression and funnel plots.
  • Evident: meta-analytic estimates had low precision and considerable heterogeneity; MVPA publication bias was detected and sensitivity analyses made the pooled MVPA effect non-significant after removing several studies; the abstract and Results report different pooled ES values (0.57/1.57 vs 0.51/1.15), an inconsistency in reporting.

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Integrity signals

Registry

Crossref · 10.1016/j.jshs.2019.06.009

Cites

119 of 119 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 139 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    The evidence regarding the use of differing intervention types to expand physical activity opportunity was inconsistent.

    “The evidence regarding the use of differing intervention types to expand PA opportunity was inconsistent.”
    Quote in the paperSubstantial claim
  • Findingown data

    A positive effect on physical activity was reported in 68% of the 57 studies.

    “A positive effect on PA was reported in 68% of the 57 studies.”
    Quote in the paperSubstantial claim
  • Findingown data

    Focusing specifically on those studies that measured moderate-to-vigorous physical activity (37 studies), 62% indicated a positive effect.

    “Focusing specifically on those studies that measured MVPA (37 studies), 62% indicated a positive effect.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The sample size of children with objectively assessed physical activity and/or sedentary time was < 250 in 30 studies.

    “The sample size of children with objectively assessed PA and/or ST was < 250 in 30 studies,47, 49, 51, 52, 55, 56,58, 59, 60,65, 66,70, 71, 72, 73, 74,78, 79, 83, 84, 87, 89, 90, 94, 95,98, 99, 100,102, 103”
    Quote in the paperNot a substantial claim
  • Findingown data

    Overall, the evidence rating for sedentary time was inconclusive.

    “Overall, the evidence rating for ST was inconclusive.”
    • Also stated in: § Abstract · plain
      “Overall evidence ratings for interventions implemented within school settings showed no evidence of effects of moderate-to-vigorous physical activity and inconclusive evidence of effects of sedentary time.”
    Quote in the paperSubstantial claim
  • May combine two claims. 68
  • Classified as probably not a substantial claim. 54

  • May combine two claims.

    Findingreasoning

    The systematic review included 57 original studies and 3 additional studies that reported follow-up data from 3 of the 57 original studies.

    “The systematic review, therefore, included 57 original studies and 3 additional studies that reported follow-up data from 3 of the 57 original studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Intervention studies that extended opportunity by increasing time for pre-existing physical activity comprised 2 studies that extended physical education, with no evidence to support their effectiveness, and 2 studies that extended recess time, with inconclusive evidence of their effectiveness.

    “Intervention studies that extended opportunity by increasing time for pre-existing PA comprised 2 studies that extended PE, with no evidence to support their effectiveness, and 2 studies that extended recess time, with inconclusive evidence of their effectiveness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no overall evidence of effect for moderate-to-vigorous physical activity due to the quality of evidence, with 2 of the 3 large, high-quality randomised controlled trials reporting no effect on moderate-to-vigorous physical activity.

    “There was no overall evidence of effect for MVPA due to the quality of evidence, with 2 of the 3 large, high-quality RCTs48, 63, 67 reporting no effect on MVPA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Enhancing opportunity for physical activity was identified in 18 studies, and approaches to modifying current physical activity opportunities in order to increase the amount of physical activity included physical education, recess, and overall school physical activity.

    “Enhancing opportunity for PA was identified in 18 studies, and approaches to modifying current PA opportunities in order to increase the amount of PA included PE, recess, and overall school PA.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Typically, total step count was the dependent variable for pedometer measures.

    “Typically, total step count was the dependent variable for pedometer measures.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was evidence of a moderate effect on physical activity measured during actual interventions, but this was not replicated across the whole day.

    “There was evidence of a moderate effect on physical activity measured during actual interventions, but this was not replicated across the whole day, suggesting compensatory behaviors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Overall, 82% of studies that expanded physical activity opportunities reported a positive effect on physical activity or moderate-to-vigorous physical activity, and there was moderate evidence of effect on moderate-to-vigorous physical activity.

    “Overall, 82% of studies that expanded PA opportunities reported a positive effect on PA or MVPA, and there was moderate evidence of effect on MVPA.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The descriptions of the device-based measurements of physical activity typically included device-model details, time frame for device measures, cut-points, and data-inclusion criteria, although the descriptions were not consistent across all studies.

    “The descriptions of the device-based measurements of PA typically included device-model details, time frame for device measures, cut-points, and data-inclusion criteria, although the descriptions were not consistent across all studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Taken together, the evidence rating for multicomponent programmes was inconclusive evidence on moderate-to-vigorous physical activity, with 66% reporting a positive impact on either physical activity or moderate-to-vigorous physical activity.

    “Taken together, the evidence rating for multicomponent programmes was inconclusive evidence on MVPA, with 66% reporting a positive impact on either PA or MVPA.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One study used both accelerometer and pedometer measures.

    “One study93 used both accelerometer and pedometer measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of studies (n = 49, 86%) were published within the past decade.

    “The majority of studies (n = 49, 86%) were published within the past decade.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The sample size of children with objectively assessed physical activity and/or sedentary time was > 1000 in 8 studies.

    “and > 1000 in 8 studies.50, 63, 67, 68, 92, 93, 97, 101”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The remaining 6 studies were conducted in Canada, Hong Kong, Iceland, Norway, and Switzerland.

    “the remaining 6 studies were conducted in Canada;75, 92 Hong Kong, China;103 Iceland;65 Norway;68 and Switzerland.64”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 6 studies, only a subsample had objectively assessed physical activity and/or sedentary time.

    “In 6 studies, only a subsample had objectively assessed PA and/or ST.62, 70, 76, 78, 83, 95”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Studies were conducted in 2 Australasian countries (n = 7, 12%).

    “and in 2 Australasian countries52, 56, 57, 73, 74, 86, 102 (n = 7, 12%)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The sample size of children with objectively assessed physical activity and/or sedentary time was between 250 and 999 in 19 studies.

    “between 250 and 999 in 19 studies,48, 53, 54, 57, 61, 62, 64, 69,75, 76, 77,80, 81, 82,85, 86, 88, 91, 96”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Studies were conducted in 7 European Union countries (n = 18, 32%).

    “7 European Union countries50, 51, 55, 67, 70, 79, 80, 85, 87, 89 (n = 18, 32%)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The analysis of the accelerometer data collected varied; 9 different cut-points were utilized for time spent in moderate-to-vigorous physical activity.

    “The analysis of the accelerometer data collected varied; 9 different cut-points were utilized for time spent in MVPA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A number of studies (n = 18) were multicomponent, combining theory of expanded, extended, and enhanced opportunities categories, most commonly expanding and enhancing physical activity opportunities.

    “A number of studies (n = 18) were multicomponent, combining TEO categories, most commonly expanding and enhancing PA opportunities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only 11 studies included a measure of sedentary time, 6 of which reported a positive effect during the school day or whole day.

    “Only 11 studies47, 52, 58, 59, 63, 68, 77, 78, 81, 84, 85 included a measure of ST, 6 of which47, 58, 59, 77, 78, 84 reported a positive effect during the school day or whole day.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of the studies enhancing physical activity opportunities, 61% reported a positive effect on either physical activity or moderate-to-vigorous physical activity, but the evidence ratings showed no evidence on moderate-to-vigorous physical activity.

    “Of the studies enhancing PA opportunities, 61% reported a positive effect on either PA or MVPA, but the evidence ratings showed no evidence on MVPA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 57 studies, 67% utilised accelerometer measurement, and 35% used pedometers.

    “Of the 57 studies, 67% utilised accelerometer measurement, and 35% used pedometers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Studies were conducted within the UK (n = 8, 14%).

    “within the UK (n = 8, 14%),60, 61, 63, 76, 78, 82, 90, 100”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The 57 studies included 29 randomised controlled trials (mean quality 45%), 17 non-randomised controlled studies (mean quality 50%), 10 descriptive studies (mean quality 83%), and 1 mixed-methods study (quality 50%).

    “The 57 studies included 29 RCT studies47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 (mean quality 45%), 17 NR studies76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92 (mean quality 50%), 10 descriptive studies93, 94, 95, 96, 97, 98, 99, 100, 101, 102 (mean quality 83%), and 1 mixed-methods study103 (quality 50%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Meta-analysis of the studies with whole-day accelerometer measures suggested a pooled effect size of 0.57 for moderate-to-vigorous physical activity and 1.57 for sedentary time, but with low precision, significant heterogeneity, and considerable inconsistency.

    “Meta-analysis of the studies with whole-day accelerometer measures suggested a pooled effect size of 0.57 and 1.57 for moderate-to-vigorous physical activity and sedentary time, respectively, but with low precision, significant heterogeneity, and considerable inconsistency.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Studies were conducted in the USA (n = 26, 46%).

    “The studies were conducted in the USA,47, 48, 49,53, 54, 58, 59, 62, 66, 69, 71, 72, 77, 81, 83, 84, 88, 91,93, 94, 95, 96, 97, 98, 99,101 (n = 26, 46%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Expanded opportunities, where time allocated for physical activity replaced time previously allocated for low-active or sedentary activities, were present in 17 studies (30%) and included class physical activity breaks, physically active learning, before- and after-school clubs, physically active homework, active travel, and a whole-school physical activity expansion.

    “Expanded opportunities, where time allocated for PA replaced time previously allocated for low-active or sedentary activities, were present in 17 studies (30%) and included class PA breaks, physically active learning, before- and after-school clubs, physically active homework, active travel, and a whole-school PA expansion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The pooled effect size estimate for the effects of interventions on MVPA was 0.51 (95%CI: 0.02-0.99), indicating a statistically significant moderate effect, albeit with relatively low precision.

    “The pooled ES estimates for the effects of interventions on MVPA was 0.51 (95%CI: 0.02–0.99), indicating a statistically significant moderate effect, albeit with relatively low precision, as indicated by the CIs ranging from trivial to large.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Sensitivity analysis revealed that effect estimates for MVPA were no longer significant after removal of several individual studies, though the magnitude of the estimates and their precision were similar.

    “Sensitivity analysis revealed that effect estimates for MVPA were no longer significant after removal of several individual studies, though the magnitude of the estimates and their precision were similar”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The pooled effect size estimate for the effects of interventions on sedentary time was 1.15 (95%CI: -1.03 to 3.33), indicating a nonsignificant large effect, with very low precision.

    “The pooled ES estimates for the effects of interventions on ST were 1.15 (95%CI: –1.03 to 3.33), indicating a nonsignificant large effect, with very low precision, as indicated by the CIs from a negative large effect to a positive large effect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The time period for physical activity data collection varied, with measurements taken during the actual intervention (16%, 9 studies), during the school day (28%, 16 studies), or during the whole day (58%, 33 studies).

    “As shown in Table 3, the time period for PA data collection varied, with measurements being taken during the actual intervention (16%, 9 studies), during the school day (28%, 16 studies), or during the whole day (58%, 33 studies).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One study analyzed multiple time frames (during the intervention and during the whole day).

    “Notably, 1 study47 analyzed multiple time frames (during the intervention and during the whole day).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Adkins, 2013, Can dance exergaming contribute to improving physical activity levels in elementary school children?, Fr J Phys Health Educ Recreat Dance

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    68% of the studies in this review reported a positive impact on physical activity, and 62% reported a positive impact on MVPA.

    “In accord with previous studies,28, 29 68% of the studies in our review reported a positive impact on PA, and 62% reported a positive impact on MVPA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    A total of 3 studies identified differential responses based on baseline characteristics, including 2 studies that reported a larger effect for the least active participants.

    “A total of 3 studies identified differential responses based on baseline characteristics, including 2 studies that reported a larger effect for the least active participants.71, 102”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [71] Kang, 2009, Effects of group and individual-based step goals on children's physical activity levels in school, Pediatr Exerc Sci source

      Not checked in the free run.

    • cites [102] Oliver, 2006, An integrated curriculum approach to increasing habitual physical activity in children: a feasibility study, J Sch Health source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The Cochrane Q showed significant heterogeneity for MVPA (Q = 168.7, df = 10, p < 0.0001) and a considerable inconsistency measure, with I2 = 98.43%.

    “The Cochrane Q showed a significant heterogeneity (Q = 168.7, df = 10, p < 0.0001) for MVPA and a considerable inconsistency measure, with I2 = 98.43%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    There was no evidence of effect for either step count or MVPA when intervention effectiveness was measured across a whole day.

    “There was, therefore, no evidence of effect for either step count or MVPA when intervention effectiveness was measured across a whole day.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    There was no overall pattern in differential response by sex, with some studies reporting a greater effect for girls than boys and vice versa.

    “There was no overall pattern, with some studies reporting a greater effect for girls than boys79, 91 and vice versa.75”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [79] Weaver, 2018, Partnerships for active children in elementary schools: outcomes of a 2-year pilot study to increase physical activity during the school day, Am J Health Promot source

      Not checked in the free run.

    • cites [91] Pangrazi, 2003, Impact of promoting lifestyle activity for youth (PLAY) on children's physical activity, J Sch Health source

      Not checked in the free run.

    • cites [75] Naylor, 2008, An active school model to promote physical activity in elementary schools: action schools! BC, Br J Sports Med source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    For sedentary time, the Cochrane Q showed significant heterogeneity (Q = 38.7, df = 3, p < 0.0001) and a considerable inconsistency measure, with I2 = 98.6%.

    “For ST, the Cochrane Q showed a significant heterogeneity (Q = 38.7, df = 3, p < 0.0001) and a considerable inconsistency measure, with I2 = 98.6%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Extending PE time did not lead to any reported increase in MVPA in 2 studies; 1 high-quality, large RCT increased PE time from 2 to 6 lessons (4.5 h/week) and found no significant difference in MVPA between children in intervention and control schools when measured over a whole day.

    “Extending PE time did not lead to any reported increase in MVPA in 2 studies; in fact, 1 high-quality, large RCT increased PE time from 2 to 6 lessons (4.5 h/week) and found that, when measured over a whole day, there was no significant difference in MVPA between children in intervention and control schools.67”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Moller, 2014, Do extra compulsory physical education lessons mean more physically active children: findings from the childhood health, activity, and motor performance school study Denmark (The CHAMPS-study DK), Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The intervention duration of these studies was variable, with 4 studies lasting 4-10 weeks, others implemented over a longer duration (e.g., 10 months, 1 year, or 2 years).

    “Whilst the intervention duration of these studies was variable, with 4 studies lasting 4–10 weeks,55, 58, 66 others were implemented over a longer duration, for example, 10 months,73 1 year,81 or 2 years.70”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [55] Martin, 2017, Active classrooms: a cluster randomized controlled trial evaluating the effects of a movement integration intervention on the physical activity levels of primary school children, J Phys Act Health source

      Not checked in the free run.

    • cites [58] Crouter, 2015, Effect on physical activity of a randomized afterschool intervention for inner city children in 3rd to 5th grade, PLoS One source

      Not checked in the free run.

    • cites [66] Mendoza, 2011, The walking school bus and children's physical activity: a pilot cluster randomized controlled trial, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Of the 3 studies reporting expansion of after-school physical activity, only one had >250 participants, and although 1 study reported more than 80% attendance, the other 2 studies did not report attendance rates.

    “Indeed, of the 3 studies reporting expansion of after-school PA, only one had >250 participants,48 and although 1 study reported more than 80% attendance,58 the other 2 studies did not report attendance rates.58, 103”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [48] Dzewaltowski, 2010, HOP'N after-school project: an obesity prevention randomized controlled trial, Int J Behav Nutr Phys Act source

      Not checked in the free run.

    • cites [58] Crouter, 2015, Effect on physical activity of a randomized afterschool intervention for inner city children in 3rd to 5th grade, PLoS One source

      Not checked in the free run.

    • cites [103] Cheung, 2015, Parental attitude on children's after-school physical activity participation: lesson from a pilot study, Asian J Phys Edu Recr

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    After-school clubs (moderate evidence rating), class PA breaks (limited evidence rating), physically active learning (limited evidence rating), and active travel (limited evidence rating) appear to be the most promising expanded opportunity interventions in school settings for children.

    “After-school clubs (moderate evidence rating), class PA breaks (limited evidence rating), physically active learning (limited evidence rating), and active travel (limited evidence rating) appear to be the most promising expanded opportunity interventions in school settings for children.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    All 4 studies reporting class PA breaks found positive outcomes for MVPA or PA, but the risk of bias (quality and/or sample size) led to a limited-evidence rating.

    “In our review, all 4 studies reporting class PA breaks found positive outcomes for MVPA or PA, but the risk of bias (quality and/or sample size) led to a limited-evidence rating.59, 60, 72, 98”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [59] Donnelly, 2009, Physical activity across the curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children, Prev Med source

      Not checked in the free run.

    • cites [60] Drummy, 2016, The effect of a classroom activity break on physical activity levels and adiposity in primary school children, J Paediatr Child Health source

      Not checked in the free run.

    • cites [72] Mahar, 2006, Effects of a classroom-based program on physical activity and on-task behaviour, Med Sci Sports Exerc source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Enhancing existing physical activity opportunities included enhancing PA in PE, recess, and overall school PA, but these enhancements resulted in an overall rating of no evidence of effect on MVPA.

    “Enhancing existing PA opportunities included enhancing PA in PE,62, 69, 79 recess,49, 50,52, 53, 54,61, 76, 84, 86, 87, 94 and overall school PA,70, 71, 92, 100 but these enhancements resulted in an overall rating of no evidence of effect on MVPA.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [62] Going, 2003, The effects of the pathways obesity prevention program on physical activity in American Indian children, Prev Med source

      Not checked in the free run.

    • cites [69] Sallis, 1997, The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students, Am J Public Health source

      Not checked in the free run.

    • cites [79] Weaver, 2018, Partnerships for active children in elementary schools: outcomes of a 2-year pilot study to increase physical activity during the school day, Am J Health Promot source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The meta-analysis of the studies with whole-day accelerometer measures suggested a pooled effect size of 0.57 and 1.57 for MVPA and sedentary time, respectively, both with low precision, significant heterogeneity, and considerable inconsistency.

    “Whilst the meta-analysis of the studies with whole-day accelerometer measures suggested a pooled ES of 0.57 and 1.57 for MVPA and ST, respectively, both of these had low precision, significant heterogeneity, and considerable inconsistency.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The high risk of bias due to research quality led to an inconclusive evidence rating on MVPA for enhancing recess, which differs from previous systematic reviews that have suggested interventions could lead to improvements in PA during school recess.

    “Overall, the high risk of bias due to research quality led to an inconclusive evidence rating on MVPA, which differs from previous systematic reviews, which have suggested that interventions could lead to improvements in PA during school recess.21, 22, 23”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [21] Erwin, 2014, Impact of recess interventions on children's physical activity-a meta-analysis, Am J Health Promot source

      Not checked in the free run.

    • cites [22] Escalante, 2014, Playground designs to increase physical activity levels during school recess: a systematic review, Health Educ Behav source

      Not checked in the free run.

    • cites [23] Ridgers, 2012, Physical activity during school recess, Am J Prev Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Of these 17 studies, 11 were focused on older children, 3 were included in the current study, and the remaining 3 were screened out because the intervention focus of those 3 studies was weight loss/obesity prevention.

    “Of these 17 studies, 11 were focused on older children, 3 were included in the current study, and the remaining 3 were screened out because the intervention focus of those 3 studies was weight loss/obesity prevention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Intervention reporting in the included studies was in line with the TIDieR checklist, which highlighted some common shortcomings.

    “the intervention reporting was in line with the TIDieR checklist,45 which highlighted some common shortcomings”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Cohen, 1988

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    2 studies included in this review explored PA over differing time periods, and both identified increased PA during the target intervention of recess or PE but not during the school day or the whole day.

    “More specifically, 2 studies included in our review explored PA over differing time periods, and both identified increased PA during the target intervention of recess52 or PE69 but not during the school day or the whole day.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [52] Engelen, 2013, Increasing physical activity in young primary school children: it's child's play: a cluster randomised controlled trial, Prev Med source

      Not checked in the free run.

    • cites [69] Sallis, 1997, The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students, Am J Public Health source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The most common methodological quality limitations among included studies were lack of randomization and lack of clarity regarding drop-out rates.

    “the most common limitations included the lack of randomization and lack of clarity regarding drop-out rates”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    An additional 26 RCTs were identified in the current systematic review, including 12 that measured whole-day PA via accelerometer, thereby providing confidence that the current review included a comprehensive set of studies.

    “Furthermore, an additional 26 RCTs were identified in the current systematic review, including 12 that measured whole-day PA via accelerometer, thereby providing confidence that the current review included a comprehensive set of studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    It was typically possible to identify the rationale, materials, and procedures used in the included studies, including who administered the intervention and how it was implemented.

    “it was typically possible to identify the rationale, materials, and procedures used in the studies, including who administered the intervention and how it was implemented”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Global physical activity guidelines recommend that children aged 5-18 years engage in at least 60 min of moderate-to-vigorous physical activity every day.

    “global PA guidelines recommend that children aged 5–18 years engage in at least 60 min of moderate-to-vigorous physical activity (MVPA) every day.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] World Health Organization. Global recommendations on physical activity for health 5–17 years old. Available at: https://www.who.int/dietphysicalactivity/factsheet_young_people/en/; 2017. [accessed 06.10.2018].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent 24-h movement guidelines promote whole-day movement patterns that target both enhanced moderate-to-vigorous physical activity and restriction of sedentary time.

    “Recent 24-h movement guidelines have promoted whole-day movement patterns that target both enhanced MVPA and restriction of sedentary time (ST).6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Tremblay, 2016, Canadian 24-hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep, Appl Physiol Nutr Metab source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity behaviors develop in early childhood and track through to adolescence and adulthood.

    “PA behaviors develop in early childhood and track through to adolescence and adulthood.7”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Telama, 2014, Tracking of physical activity from early childhood through youth into adulthood, Med Sci Sports Exerc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    An analysis of report cards of active healthy kids across 15 countries found that 20%-39% of kids in 10 of those countries earned a grade of D in meeting physical activity guidelines and <20% earned an F.

    “an analysis of report cards of active healthy kids across 15 countries found that 20%–39% of kids in 10 of those countries earned a grade of D in meeting PA guidelines and <20% earned an F.4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Tremblay, 2016, Global matrix 2.0: report card grades on the physical activity of children and youth comparing 38 countries, J Phys Act Health source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Physical activity is associated with numerous physiological and psychosocial health benefits in school-aged children.

    “Physical activity (PA) has been associated with numerous physiological and psychosocial health benefits in school-aged children.1”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Janssen, 2010, Systematic review of the health benefits of physical activity and fitness in school-aged children and youth, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Existing reviews of physical activity interventions in school settings have examined evidence across childhood and adolescence or focused exclusively on adolescents.

    “existing reviews of PA interventions in school settings have examined evidence across childhood and adolescence16, 28, 29, 32, 34 or focused exclusively on adolescents.17, 18, 19, 20,30, 31”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] Dobbins, 2013, School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [28] Salmon, 2007, Promoting physical activity participation among children and adolescents, Epidemiol Rev source

      Not checked in the free run.

    • cites [29] Timperio, 2004, Evidence-based strategies to promote physical activity among children, adolescents and young adults: review and update, J Sci Med Sport source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent multilevel, worldwide review highlighted local school contexts as important correlates to physical activity in children.

    “a recent multilevel, worldwide review highlighted local school contexts as important correlates to PA in children.3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Gomes, 2017, Correlates of compliance with recommended levels of physical activity in children, Sci Rep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The search strategies combined multiple keyword search terms agreed to a priori.

    “The search strategies combined multiple keyword search terms agreed to a priori and were developed by breaking down the research question (Table 1).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The quality of the included studies was assessed by 2 independent reviewers using the mixed-methods appraisal tool.

    “The quality of the included studies was assessed by 2 independent reviewers (ED, AL) using the mixed-methods appraisal tool (MMAT).39”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Pluye, 2009, A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews, Int J Nurs Stud source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A 2-step screening process was used to determine whether each study met the inclusion criteria.

    “A 2-step screening process was used to determine whether each study met the inclusion criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Booth and Okely highlighted the compulsory nature of attendance, teachers as credible change agents, and access to facilities as the primary strengths of a school as an intervention setting.

    “Booth and Okely15 highlighted the compulsory nature of attendance, teachers as credible change agents, and access to facilities as the primary strengths of a school as an intervention setting.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Booth, 2005, Promoting physical activity among children and adolescents: the strengths and limitations of school-based approaches, Health Promot J Austr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent review found that 10 countries had an annual decrease of 4.2% in physical activity and an increase in sedentary time after the age of 5 years.

    “a recent review finding that 10 countries had an annual decrease of 4.2% in PA and an increase in ST after the age of 5 years.11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Cooper, 2015, Objectively measured physical activity and sedentary time in youth: the International Children's Accelerometry Database (ICAD), Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    van Sluijs et al. suggested that additional structural environmental and policy changes might be required to change children's physical activity behavior, thereby advocating for the need to examine children and adolescents as separate groups.

    “van Sluijs et al.34 have suggested that additional structural environmental and policy changes might be required to change children's PA behavior, thereby advocating for the need to examine children and adolescents as separate groups.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] van Sluijs, 2007, Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In cases where the 2 independent reviewers disagreed on either the study design or the scoring of criteria within a study design criteria, a third reviewer considered the study and mediated agreement.

    “In cases where the 2 independent reviewers disagreed on either the study design or the scoring of criteria within a study design criteria, a third reviewer (MJ or KM) considered the study and mediated agreement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    Hynynen et al. suggested that future research should acknowledge that moderate-to-vigorous physical activity and sedentary time require different intervention strategies.

    “One exception is a review by Hynynen et al.,17 who suggested that future research should acknowledge that MVPA and ST require different intervention strategies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Hynynen, 2016, A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents, Int Rev Sport Exerc Psychol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The theory of expanded, extended, and enhanced opportunities proposes a common taxonomy to identify appropriate targets for interventions across different settings and contexts.

    “the theory of expanded, extended, and enhanced opportunities (TEO), which proposes a common taxonomy to identify appropriate targets for interventions across different settings and contexts, could afford a more practical approach to school-based PA interventions.19, 37”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [19] Owen, 2017, The effectiveness of school-based physical activity interventions for adolescent girls: a systematic review and meta-analysis, Prev Med source

      Not checked in the free run.

    • cites [37] Beets, 2016, The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    The theory of expanded, extended, and enhanced opportunities could afford a more practical approach to school-based physical activity interventions.

    “the theory of expanded, extended, and enhanced opportunities (TEO), which proposes a common taxonomy to identify appropriate targets for interventions across different settings and contexts, could afford a more practical approach to school-based PA interventions.19, 37”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Owen, 2017, The effectiveness of school-based physical activity interventions for adolescent girls: a systematic review and meta-analysis, Prev Med source

      Not checked in the free run.

    • cites [37] Beets, 2016, The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent longitudinal study involving more than 1000 children reported a decline in moderate-to-vigorous physical activity (3 min for girls; 7 min for boys) and an increase in sedentary time (83 min for girls; 74 min for boys) between UK School Year 1 (5-6 years) and 4 (8-9 years).

    “a recent longitudinal study involving more than 1000 children reported a decline in MVPA (3 min for girls; 7 min for boys) and an increase in ST (83 min for girls; 74 min for boys) between UK School Year 1 (5–6 years) and 4 (8–9 years).10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Jago, 2017, Change in children's physical activity and sedentary time between year 1 and year 4 of primary school in the B-PROACT1V cohort, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two independent reviewers assessed the full-text of the remaining 112 studies against the inclusion criteria.

    “Two independent reviewers (ED, AL) assessed the full-text of the remaining 112 studies against the inclusion criteria, resulting in a further 52 studies’ being excluded.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The present review was registered with PROSPERO and is reported in accordance with PRISMA criteria.

    “The present review was registered with the prospective register of systematic reviews (PROSPERO) (CRD42017082184) and is reported in accordance with the preferred items for systematic reviews and meta-analysis (PRISMA) criteria.38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Moher, 2015, Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement, Syst Rev source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A review of reviews found strong evidence for the positive effect of school-based interventions on physical activity in youth and confirmed the public health potential of high-quality, school-based physical activity interventions.

    “A review of these reviews found strong evidence for the positive effect of school-based interventions on PA in youth and confirmed the public health potential of high-quality, school-based PA interventions.33”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Kriemler, 2011, Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update, Br J Sports Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The mixed-methods appraisal tool has been content-validated for each domain, and items were developed from the literature as well as from consultations and workshops with experts.

    “The MMAT has been content-validated for each domain, and items were developed from the literature as well as from consultations and workshops with experts.36, 39, 40”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [36] Pluye, 2014, Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews, Annu Rev Public Health source

      Not checked in the free run.

    • cites [39] Pluye, 2009, A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews, Int J Nurs Stud source

      Not checked in the free run.

    • cites [40] Pace, 2012, Testing the reliability and efficiency of the pilot mixed methods appraisal tool (MMAT) for systematic mixed studies review, Int J Nurs Stud source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Strength of evidence was assessed utilizing a 5-level rating system (strong, moderate, limited, inconclusive, and no evidence) adopted from a previous high-quality systematic review.

    “Initially, strength of evidence was assessed utilizing a 5-level rating system (strong, moderate, limited, inconclusive, and no evidence) adopted from a previous high-quality systematic review34 based on study design, methodological quality, and sample size.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] van Sluijs, 2007, Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is evidence of both the reliability and efficiency of the mixed-methods appraisal tool as a tool for appraising the methodological quality of research.

    “There is evidence of both the reliability and efficiency of the MMAT as a tool for appraising the methodological quality of research.40, 41”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Pace, 2012, Testing the reliability and efficiency of the pilot mixed methods appraisal tool (MMAT) for systematic mixed studies review, Int J Nurs Stud source

      Not checked in the free run.

    • cites [41] Souto, 2015, Systematic mixed studies reviews: updating results on the reliability and efficiency of the mixed methods appraisal tool, Int J Nurs Stud source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Neither meta regression nor funnel plots were conducted for sedentary time as an outcome due to the low number of studies (n = 4).

    “Notably, neither meta regression nor funnels plots were conducted for ST as an outcome due to the low number of studies (n = 4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Data extraction was accumulated by 2 independent reviewers into a shared file and then checked and expanded by a 3rd reviewer.

    “Whilst the assessment of quality was undertaken independently, data extraction was accumulated by the 2 independent reviewers (ED, AL) into a shared file and then was checked and expanded by a 3rd reviewer (MJ or KM).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Random effects meta-analyses were chosen because heterogeneity was expected, given differences in interventions.

    “Random effects meta-analyses were chosen because heterogeneity was expected, given differences in interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sensitivity analyses were performed for random effects meta-analyses by removing studies one by one to assess the robustness of the summary estimates.

    “Sensitivity analyses were performed for random effects meta-analyses by removing studies one by one to assess the robustness of the summary estimates.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Publication bias was analysed using funnel plots and the Egger regression asymmetry test.

    “Publication bias was analysed using funnel plots and the Egger regression asymmetry test.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    To the best of the authors' knowledge, there has been no previous systematic review that considered interventions to reduce sedentary time specifically in school children.

    “To the best of our knowledge, there has been no previous systematic review that considered interventions to reduce ST specifically in school children”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    The finding of no evidence of effect for physical activity reinforces the point that systematic reviews, including meta-analyses, that combine children and adolescents as one homogeneous group need careful interpretation.

    “The finding of no evidence of effect for PA reinforces the point that systematic reviews, including meta-analyses, that combine children and adolescents as 1 homogeneous group need careful interpretation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Two previous reviews also identified no overall evidence for physical activity during school-based interventions when focusing on children: van Sluijs et al. found less evidence for children than for adolescents, and Metcalf et al. identified a small effect on MVPA and a lower mean standardised difference among children younger than 10 years of age compared to older children.

    “Two previous reviews also identified no overall evidence for PA during school-based interventions when focusing on children: van Sluijs et al.34 found less evidence for children than for adolescents, and Metcalf et al.104 identified a small effect on MVPA and a lower mean standardised difference among children younger than 10 years of age compared to older children.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites van Sluijs et al.34 van Sluijs, 2007, Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials, BMJ source

      Not checked in the free run.

    • cites Metcalf et al.104 Metcalf, 2012, Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54), BMJ source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    After-school clubs and active travel appear to lead to promising outcomes for MVPA, but scaling-up implementation is likely to be challenging due to the resources required and given that participation by children is typically optional, thereby potentially reducing intervention reach.

    “Whilst after-school clubs and active travel appear to lead to promising outcomes for MVPA, scaling-up implementation is likely to be challenging due to the resources required and given that participation by children is typically optional, thereby potentially reducing intervention reach.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Beets et al. emphasized the importance of compulsory physical activity opportunities during the school day and in terms of expanded physical activity opportunities.

    “Beets et al.37 emphasized the importance of compulsory PA opportunities during the school day and in terms of expanded PA opportunities.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Beets et al.37 Beets, 2016, The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    It is plausible that such interventions could reduce the negative effects of seasonal change or, in the case of noncontrolled trials, changes in physical activity may be a consequence of time rather than the intervention itself.

    “It is plausible that such interventions could reduce the negative effects of seasonal change or, indeed, in the case of noncontrolled trials, changes in PA, irrespective of whether they are positive or negative, may be a consequence of time rather than the intervention itself.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    No previous systematic reviews have considered different types of interventions in relation to the TEO, so this is a novel finding.

    “No previous systematic reviews have considered different types of interventions in relation to the TEO, so this is a novel finding that may help inform future research and/or policy implementation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Class PA breaks appear to have potential for sustainability, with 2 of the 4 studies reviewed reporting good teacher compliance and with all 4 studies having been conducted over at least 8 weeks.

    “This type of intervention appears to have potential for sustainability, with 2 of the 4 studies we reviewed reporting good teacher compliance59, 72 and with all 4 studies having been conducted over at least 8 weeks.59, 60, 72, 98”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [59] Donnelly, 2009, Physical activity across the curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children, Prev Med source

      Not checked in the free run.

    • cites [72] Mahar, 2006, Effects of a classroom-based program on physical activity and on-task behaviour, Med Sci Sports Exerc source

      Not checked in the free run.

    • cites [60] Drummy, 2016, The effect of a classroom activity break on physical activity levels and adiposity in primary school children, J Paediatr Child Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This finding highlights the importance of whole-day measurement of physical activity in order to fully elucidate the effect of an intervention in a particular setting and the likely health impacts.

    “This finding highlights the importance of whole-day measurement of PA in order to fully elucidate the effect of an intervention in a particular setting and the likely health impacts.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A very recent meta-analysis of school-based PA interventions, which included only studies using whole-day accelerometer measurements, found a pooled effect size of 0.02 and concluded that current school-based interventions do not increase young people's daily PA.

    “A very recent meta-analysis of school-based PA interventions, which included only studies using whole-day accelerometer measurements, found a pooled ES of 0.02 and concluded that current school-based interventions do not increase young people's (children's and adolescents’) daily PA.109”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [109] Love, 2019, Are school-based physical activity interventions effective and equitable? A meta-analysis of cluster randomized controlled trials with accelerometer-assessed activity, Obes Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    A number of intervention studies might not have aimed specifically to increase whole-day physical activity, but rather focused on behavior change over one small portion of the day.

    “It should be noted that a number of intervention studies might not have aimed specifically to increase whole-day PA, but rather focused on behavior change over 1 small portion of the day.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Analysing studies based on measurement duration is a key strength of the present review.

    “Indeed, analysing studies based on measurement duration is a key strength of the present review.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Love et al. indicated a nonsignificant trend towards a decrease in standardised mean difference with increasing mean age of participants, which may explain the study's lower effect in comparison to our findings.

    “Interestingly, Love et al.109 indicated a nonsignificant trend towards a decrease in standardised mean difference with increasing mean age of participants, which may explain the study's lower effect in comparison to our findings.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Love et al.109 Love, 2019, Are school-based physical activity interventions effective and equitable? A meta-analysis of cluster randomized controlled trials with accelerometer-assessed activity, Obes Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Possible reasons for the difference in findings on enhancing recess could be a reported effect that the difference in PA is moderated by age, or it could relate to the use of different time periods for the measurement of outcomes.

    “Possible reasons for this difference could be a reported effect that the difference in PA is moderated by age,21 or it could relate to the use of different time periods for the measurement of outcomes (e.g., measuring effects during recess vs. during the whole day).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Erwin, 2014, Impact of recess interventions on children's physical activity-a meta-analysis, Am J Health Promot source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The inconclusive evidence for extending physical activity opportunities during the school day, alongside the significant time pressure reported by schools, suggests that there is little evidence to support extending PE or recess time as an evidence-based approach to increasing MVPA.

    “The inconclusive evidence for extending PA opportunities during the school day, alongside the significant time pressure reported by schools, suggest that there is little evidence to support extending PE or recess time as an evidence-based approach to increasing MVPA.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Previous systematic reviews have analysed intervention effects collectively, regardless of the duration of objective physical activity measurement.

    “Previous systematic reviews have analysed intervention effects collectively, regardless of the duration of objective PA measurement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Although whole-day increases in PA may be minimal due to compensatory behaviors, PA interventions may be successful in improving other outcomes.

    “Thus, although whole-day increases in PA may be minimal due to compensatory behaviors, PA interventions may be successful in improving other outcomes.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    The TEO was generally easily applied in this context, and analysis by intervention category identified differential effectiveness, suggesting that the theory provided a useful taxonomy and framework for considering intervention effectiveness.

    “The TEO was, generally, easily applied in this context, and analysis by intervention category identified differential effectiveness, suggesting that the theory provided a useful taxonomy and framework for considering intervention effectiveness.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Despite the lack of evidence for the effect of PA interventions in increasing PA levels across the whole day, the increases in PA exhibited during intervention periods (which were moderately evidenced) might provide some benefit.

    “Despite the lack of evidence for the effect of PA interventions in increasing PA levels across the whole day, it should be noted that the increases in PA exhibited during intervention periods (which were moderately evidenced) might provide some benefit.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The inconclusive evidence rating for sedentary time over a whole day provides some promise in that even though attempts to increase MVPA do not seem to persist through a whole day, they may bring about some other behavior changes, for instance, reduced sedentary time.

    “The inconclusive evidence rating for ST over a whole day provides some promise in that even though attempts to increase MVPA do not seem to persist through a whole day, they may bring about some other behavior changes, for instance, reduced ST.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The TEO was not used specifically to underpin any studies included in the current review but was retrospectively applied as a taxonomy to describe interventions.

    “The TEO was not used specifically to underpin any studies included in the current review but was retrospectively applied as a taxonomy to describe interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The current systematic review was prospectively registered with PROSPERO and, therefore, the risk of bias by adjustment of protocol was minimized.

    “The current systematic review was prospectively registered with the Prospective Register of Systematic Reviews (PROSPERO) and, therefore, the risk of bias by adjustment of protocol was minimized.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    On the basis of these findings, it appears that practitioners and researchers are effectively identifying and implementing approaches to increasing PA during specific domains of the school day but are unable to ensure that the increases are sustained over the whole day.

    “On the basis of these findings, it appears that practitioners and researchers are effectively identifying and implementing approaches to increasing PA during specific domains of the school day but are unable to ensure that the increases are sustained over the whole day.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Ridgers et al. has advocated for strategies that negate compensatory responses and for the use of these strategies in intervention design and evaluation.

    “Ridgers et al.110 has advocated for strategies that negate compensatory responses and for the use of these strategies in intervention design and evaluation”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [110] Ridgers, 2014, Compensation of physical activity and sedentary time in primary school children, Med Sci Sports Exerc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rowlands recently used raw accelerometer data to generate an activity gradient, which removed the issue of multiple cut-points.

    “Rowlands113 recently used raw accelerometer data to generate an activity gradient, which removed the issue of multiple cut-points”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [113] Rowlands, 2018, Moving forward with accelerometer-assessed physical activity: two strategies to ensure meaningful, interpretable, and comparable measures, Pediatr Exerc Sci source

      Not checked in the free run.

106 of 106

  • The authors state this as an assumption.

    The correlation between baseline and postintervention values is r = 0.5.

    “assuming a correlation of r = 0.5 between baseline and postintervention.44”

  • The paper relies on this without support.

    Increasing MVPA and reducing ST among children produce health benefits.

    “given the health benefits that can result”

  • The paper relies on this without support.

    The school setting is an important location for health-promoting interventions.

    “the importance of the school setting as a location for health-promoting interventions”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There is some evidence that intervention strategies based at the school, home/family or community/neighbourhood level can increase physical activity in children and adolescents.

    “There is some evidence that intervention strategies based at the school, home/family or community/neighbourhood level can increase physical activity in children and adolescents.115–120”

    From Physical activity and health in Chinese children and adolescents: expert consensus statement (2020) (2020) · cites this paper as [120]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = 4.3749reported p < .0001 · recomputed p < .001

    “(z = 4.3749, p < .0001”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting pooled effect sizes for MVPA

    Major

    The abstract and discussion report a pooled MVPA effect size of 0.57, but the meta-analysis results report 0.51.

  • Conflicting pooled effect sizes for sedentary time

    Major

    The abstract and discussion report a pooled sedentary-time effect size of 1.57, whereas the meta-analysis results report 1.15.

  • Study 58 both reports and does not report attendance

    Minor

    Study 58 is cited as reporting more than 80% attendance, but is also listed among the studies that did not report attendance rates.

  • PE studies described as both extending and enhancing opportunities

    Minor

    The discussion cites studies 62, 69, and 79 as examples of extending PE time, then cites the same studies as examples of enhancing activity during existing PE lessons.

4 of 4

Cites

Flagged first, then by citations

3 of the 122 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Cooper, 2015, Objectively measured physical activity and sedentary time in youth: the International Children's Accelerometry Database (ICAD), Int J Behav Nutr Phys Act, 12, 113, 10.1186/s12966-015-0274-5 · DOI · Paper page
  2. Tuvey S, Steele J, Horton E, Mayo X, Liguori G, Mann S, et al. Do changes in cardiorespiratory fitness resulting from physical activity interventions impact academic performance and executive function in children and adolescents? A systematic review, meta-analysis, and meta-regression. preprint. Available at: https://osf.io/preprints/sportrxiv/4j2sa/. [accessed 04.03.2019].

Cited by

Sorted by citations

Related

Authors
Jones, M., Defever, E., Letsinger, A., Steele, J., & Mackintosh, K. A.
Affiliations
  • Plymouth Marjon University (GB)
  • Southampton Solent University (GB)
  • Texas A&M University (US)
  • Swansea University (GB)
Corresponding author
Jones, Michelle
ORCID
Venue
Journal of Sport and Health Science
Publisher
Elsevier BV
Published
2020-01
Volume
9
Issue
1
Pages
3-17
ISSN
  • 2213-2961 (ISSN-L)
  • 2095-2546
DOI
10.1016/j.jshs.2019.06.009
PMC
PMC6943767
OpenAlex
W2954737868
Semantic Scholar
67ea0e7a2ab23e0f07258ac7c77f5074e681e033
Cited by
189
References
122
Citations by year
2026: 21 · 2025: 30 · 2024: 33 · 2023: 27 · 2022: 22 · 2021: 43 · 2020: 11 · 2019: 2
FWCI
2.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of sport and health science/Journal of Sport and Health Science (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Plymouth Marjon University Repository (Plymouth Marjon University) (acceptedVersion)
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 intervention, children, physical activity, sedentary time, moderate-to-vigorous physical activity, compensatory behavior, accelerometer-measured activity, intervention effectiveness
MeSH terms
Child, Child, Preschool, Health Promotion, Humans, Schools, Exercise, Sedentary Behavior

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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