CoChat
Sign Up
Cited by 280Physical Activity and HealthObesity, Physical Activity, DietSchool Health and Nursing Education

The effectiveness of school-based physical activity interventions for adolescent girls: a systematic review and meta-analysis

Open access
Owen, Michael B., Curry, Whitney B., Kerner, Charlotte, Newson, Lisa, Fairclough, Stuart J.·2017·Preventive Medicine
DOI 10.1016/j.ypmed.2017.09.018
Open this paper in CoChat — free accountOpen PDF

Abstract

Physical activity (PA) decreases during the transition from childhood to adolescence, with larger declines observed in girls. School-based interventions are considered the most promising approach for increasing adolescents' PA levels although, it is unclear which types of school-based interventions have the greatest impact. The objective of this systematic review is to assess the impact and design of school-based PA interventions targeting adolescent girls. A systematic search was conducted using four electronic databases (PubMed, Web of Science, SPORTDiscus and PsychInfo). This systematic review was registered with PROSPERO (Registration number: CRD42016037428) and PRISMA guidelines (2009) were followed throughout. Twenty studies were identified as meeting the inclusion criteria and were included in a narrative synthesis. Seventeen studies were eligible for inclusion in a meta-analysis. There was a significant small positive treatment effect for school-based PA interventions for adolescent girls (k=17, g=0.37, p<0.05). After an outlier was removed (residual z=7.61) the average treatment effect was significantly reduced, indicating a very small positive effect (k=16, g=0.07, p=0.05). Subgroup analysis revealed very small significant effects for multi-component interventions (k=7, g=0.09, p<0.05), interventions underpinned by theory (k=12, g=0.07, p<0.05), and studies with a higher risk of bias (k=13, g=0.09, p<0.05). Intervention effects were very small which indicates that changing PA behaviors in adolescent girls through school-based interventions is challenging. Multi-component interventions and interventions underpinned by theory may be the most effective approaches to positively change adolescent girls' PA.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found that school-based physical activity interventions for adolescent girls had only a very small positive effect after removing an outlier. Multi-component interventions and interventions underpinned by theory showed small significant effects, but changing adolescent girls’ physical activity through school-based programmes remains challenging.

Key findings

  • Across 17 studies, school-based physical activity interventions showed a significant small positive treatment effect for adolescent girls (k=17, g=0.37, p<.05). After removing one outlier (Taymoori et al., 2008; residual z=7.61), the effect fell to a very small positive effect (k=16, g=0.07, p=.05).
  • Subgroup analyses found very small significant effects for multi-component interventions (k=7, g=0.09, p<.05), interventions underpinned by theory (k=12, g=0.07, p<.05), and studies with higher risk of bias (k=13, g=0.09, p<.05).
  • Heterogeneity was high in the main analysis (Q=80.12, p<0.001; I²=94.91%) and substantially reduced after outlier removal (Q=23.98, p=0.05; I²=0.01%). Publication bias was indicated: trim-and-fill added 3 studies and reduced the overall effect by 0.01; Orwin’s fail-safe N was 16; Egger’s regression test was significant (z=2.07, p<.05).
  • The review included 20 studies in narrative synthesis, evaluating 10,755 girls (mean age=12.88 years); 17 studies were eligible for meta-analysis.

Methods

  • Systematic review and meta-analysis registered with PROSPERO (CRD42016037428) and reported using PRISMA. Four databases were searched: PubMed, Web of Science, SPORTDiscus, and PsychInfo; journal articles published in English after 31/12/2004 up to 01/12/2016 were considered.
  • Inclusion criteria covered school-based physical activity interventions among adolescent girls (mean age 11–18 years), with objectively measured or self-reported physical activity outcomes; mixed-sex studies were included if girls’ data were reported separately or provided on request. Twenty studies met criteria for narrative synthesis, and 17 had sufficient data for meta-analysis.
  • Meta-analysis used R with the metafor package, random-effects models, and Hedges’ g. Heterogeneity was assessed with Cochrane’s Q and I²; subgroup analyses examined measurement method, intervention duration, risk of bias, intervention design, underpinning theory, and target sex. Outliers and publication bias were assessed using residual values, funnel plots, trim-and-fill, Orwin’s fail-safe N, and Egger’s regression test.

Limitations

  • The paper states that 21 studies were excluded because authors did not respond to requests for physical activity data by gender within a 7-day timescale; this limited response time could have doubled the number of included studies, and interaction by sex tests were not explored for those studies.
  • The paper states that including all study types, including feasibility and pilot studies, may have affected overall findings because these tended to be smaller-scale projects with small sample sizes. It also notes that where multiple primary physical activity outcomes were reported, MVPA or MPA was used where possible, but alternative outcomes such as steps and accelerometer counts were sometimes included.
  • The paper reports that all studies scored weakly for allocation concealment and/or blinding, only two studies attempted to blind intervention staff, and most studies did not explicitly explain randomisation. Evident from the text: the main pooled estimate had very high heterogeneity before outlier removal, publication bias was judged highly probable, and only 3 mixed-sex studies were available for the target-sex subgroup analysis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.ypmed.2017.09.018

Cites

68 of 68 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 28 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Heterogeneity in the pooled analysis was significant (Q=80.12, p<0.001; I2=94.91%).

    “Heterogeneity analysis indicated significant between-study variance (Q= 80.12, p<0.001;I 2 = 94.91%).”
    Quote in the paperSubstantial claim
  • Findingown data

    For studies rated at higher risk of bias (* or **), the subgroup analysis showed a small significant effect (k=13, g=0.09, p<.05).

    “Significant effects were observed for studies with * or ** bias ratings (k= 13, g = 0.09, p<.05), for multi-component interventions (k= 7, g = 0.09, p<.05), and for interventions underpinned by theory (k= 12, g = 0.07, p<.05) but the magnitudes of these were small (Table 4).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Individual study effects were extremely inconsistent, ranging from g=-0.29 to 1.04.

    “Although heterogeneity from the pooled analysis was low, the individual effects from the included studies were extremely inconsistent, ranging from g= -0.29 to 1.04.”
    Quote in the paperSubstantial claim
  • Findingown data

    After removing one outlier, the average treatment effect was significantly reduced to a very small positive effect approaching significance (k=16, g=0.07, p=.05).

    “After an outlier was removed (residual z = 7.61) the average treatment effect was significantly reduced, indicating a very small positive effect (k = 16, g= 0.07, p=.05).”
    • Also stated in: § 3.10 Meta-analysis · hedged
      “Once this study was removed the average treatment effect was significantly reduced by 0.30, indicating a very small positive effect which approached significance (k = 16, g= 0.07, p=.05) (Figure 2).”
    • Also stated in: § 4. Discussion · hedged
      “The meta-analysis results indicate that school-based PA interventions have only a very small effect on adolescent girls' PA levels.”
    Quote in the paperSubstantial claim
  • Findingown data

    Twenty studies met the inclusion criteria and were included in a narrative synthesis.

    “Twenty studies were identified as meeting the inclusion criteria and were included in a narrative synthesis.”
    • Also stated in: § 3.1 Literature Search · plain
      “After screening and eligibility assessments, 20 records met the inclusion criteria for the narrative synthesis (Figure 1).”
    Quote in the paperSubstantial claim
  • May combine two claims. 14
  • Classified as probably not a substantial claim. 11
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data

    Although eleven studies stated a randomisation procedure, most (n=10) did not explain the randomisation process.

    “Although eleven studies stated a randomisation procedure, the majority (n=10) did not provide an explicit explanation of the randomisation process”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Thirteen included studies used objective measures of PA for the complete sample or a sub-sample.

    “Thirteen studies employed objective measures of PA, either for the complete sample size or for a sub-sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Subgroup analysis found no effect for whether interventions targeted girls only or mixed-sex, though only 3 mixed-sex studies were included.

    “Subgroup analyses also revealed no effect for whether the interventions were targeted at girls only or mixed-sex, although only 3 mixed sex studies were included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All included studies scored weakly for allocation concealment and/or blinding, with only two attempting to blind intervention staff.

    “All studies scored weakly for allocation of concealment and/or blinding, with just two studies attempting to blind intervention staff (Jago et al., 2012;Webber et al., 2008).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The trim and fill procedure added 3 studies to the left side and reduced the overall treatment effect by 0.01.

    “The trim and fill procedure added 3 studies to the left side of the plot which reduced the overall treatment effect by 0.01.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The pooled analysis showed a small positive effect of school-based PA interventions on adolescent girls' PA that was statistically significant (k=17, g=0.37, p<.05).

    “There was a significant small positive treatment effect for schoolbased PA interventions for adolescent girls (k=17, g= 0.37, p<.05).”
    • Also stated in: § 3.10 Meta-analysis · plain
      “The meta-analysis revealed a significant small positive treatment effect (k=17, g= 0.37, p<.05,)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The review found that theoretical fidelity was rarely reported, preventing direct conclusions about links between theory and intervention effectiveness.

    “Few studies reported theoretical fidelity, which precludes direct inferences being made between intervention effectiveness and underpinning theory.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Allocation concealment and blinding were usually absent in the included studies, and this negatively affected the risk of bias scores for the majority of included studies.

    “As found in previous reviews, both for PA interventions for adolescents (Camacho-Minano et al., 2011) and schoolbased behavioural interventions (Khambalia, Dickinson, Hardy, Gill, & Baur, 2012), allocation concealment and blinding were usually absent, and this negatively affected the risk of bias scores for the majority of included studies.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Camacho-Minano et al., 2011 source

      Not checked in the free run.

    • cites Khambalia, Dickinson, Hardy, Gill, & Baur, 2012

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Risk of bias scores were low across the included interventions mainly due to the need for a greater explanation of the randomisation process.

    “Risk of bias scores were low across the included interventions mainly due to the need for a greater explanation of the randomisation process which is consistent with a previous systematic review of adolescent girls (Camacho-Minano et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Camacho-Minano et al., 2011 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Findingown data

    The risk-of-bias distribution was one study very strong, three strong, ten moderate, and six weak.

    “Only one study received a 'very strong' risk of bias score (Jago et al., 2012); three studies received a 'strong' risk of bias score (Fairclough & Stratton, 2005;Jago et al., 2015;Webber et al., 2008); ten studies received a 'moderate' risk of bias score”
    • Also stated in: § 3.7 Behaviour Change Theories · plain
      “six studies received a 'weak' risk of bias score (Bronikowski & Bronikowska, 2011;Haerens et al., 2006;Pate et al., 2005;Schofield et al., 2005;Spruijt-Metz et al., 2008;Young et al., 2006).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Approaches that are multi-component or grounded in theory may be the most effective for improving adolescent girls' PA.

    “Multicomponent interventions and interventions underpinned by theory may be the most effective approaches to positively change adolescent girls' PA.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    A recent review found no convincing evidence that theory-based programs outperformed those without a stated theory.

    “It was reported that a lack of convincing evidence exists that interventions underpinned by theory were more effective than those with no specified theory (Mears & Jago, 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mears & Jago, 2016

      Not checked in the free run.

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

    Study design and conductnone given

    The review was registered with PROSPERO under registration number CRD42016037428.

    “This systematic review was registered with PROSPERO (Registration number: CRD42016037428)”
    • Also stated in: § 1. Methods · plain
      “This systematic review was registered with PROSPERO (Registration number: CRD42016037428).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Interpretationcitation

    The subgroup finding of a very small significant effect for theory-based interventions is consistent with a recent review of after-school PA interventions.

    “This is consistent with findings from a recent review investigating the effectiveness of after-school PA interventions to increase MVPA (Mears & Jago, 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mears & Jago, 2016

      Not checked in the free run.

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

    Study design and conductcitation

    The review followed PRISMA 2009 reporting guidelines.

    “PRISMA guidelines (2009) were followed throughout.”
    • Also stated in: § 1. Methods · plain
      “This review adhered to the PRISMA reporting guidelines for systematic reviews (Moher, Liberati, Tetzlaff, & Altman, 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher, Liberati, Tetzlaff, & Altman, 2009 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The small effects may be partly explained by social or cultural norms, limited PA opportunities, short intervention periods, measurement methods, and small samples.

    “These difficulties may in part be due to a number of factors such as, social or cultural norms, ability to provide a wide range of PA opportunities, short-term intervention periods, PA measurement methods, and small sample sizes which precluded the detection of significance.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Titles and abstracts were initially screened by the first author, with a random 20% sample checked by a second author.

    “Initially, the first author (MO) screened all titles and abstracts for obvious irrelevance, and a random sample (20%) were also checked by another author (WC).”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    The inclusion of all study types, including feasibility and pilot studies, may have impacted the overall findings of the review as these tended to be smaller scale projects with small sample sizes.

    “The inclusion of all study types, including feasibility and pilot studies, may have impacted the overall findings of the review as these tended to be smaller scale projects with small sample sizes.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Multi-component intervention designs are consistent with Comprehensive School Physical Activity Programmes, which are recommended as effective strategies to increase young people's physical activity.

    “Multicomponent intervention designs are consistent with the concept of Comprehensive School PA Programmes (CSPAPs), which are recommended as effective strategies to increase young people's PA (Centers for Disease Control and Prevention, 2013;World Health Organisation, 2010).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Centers for Disease Control and Prevention, 2013

      Not checked in the free run.

    • cites World Health Organisation, 2010

      Not checked in the free run.

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

    Study design and conductown data

    Full texts of eligible studies were reviewed by two authors.

    “The full-text of eligible studies were then retrieved and reviewed by two authors (MO and WC).”
    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 conductown data

    The first author extracted data from the selected studies, and the second author checked it.

    “Relevant data from the selected studies were extracted by the first author (MO) and checked by the second author (WC) (see Table 1).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    School-based programs are regarded as the most promising setting for improving adolescent girls' PA.

    “Camacho-Minano et al. (2011) and Pearson et al. (2015) suggested that school-based PA interventions are the most promising setting to impact adolescent girls' PA levels.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Camacho-Minano et al., 2011 source

      Not checked in the free run.

    • cites Pearson et al., 2015 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    School-based interventions are more effective when enjoyment of physical education is prioritised and girls are given freedom of choice of activities.

    “Similarly, Camacho-Minano et al. (2011) suggested that school-based interventions are more effective when enjoyment of PE is prioritised and girls are given freedom of choice of activities.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Camacho-Minano et al., 2011 source

      Not checked in the free run.

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

    Interpretationcitation

    The low dropout rates could be due to the structure a school environment provides and the influence schools have on girls of this age.

    “This could be due to the structure a school environment provides and the influence schools have on girls of this age (Kohl & Cook, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kohl & Cook, 2013

      Not checked in the free run.

24 of 24

  • The paper relies on this without support.

    Mixed-sex interventions may be as effective for girls as girls-only interventions.

    “when mixed-sex interventions could be equally as effective for girls.”

  • The paper relies on this without support.

    Physical education occurs infrequently within schools, usually 1-2 hours per week, and accounts for only a very small percentage of weekly waking hours.

    “However, PE occurs infrequently within schools (usually 1-2 hours per week) and accounts for only a very small percentage of weekly waking hours, therefore its impact on total daily MVPA is limited.”
2 of 2

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?

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 = 2.07reported p < .05 · recomputed p = .038

    “(z = 2.07, p < .05”

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.

  • After-school dance count does not match its list

    Minor

    The sentence says three interventions were after-school dance interventions but names only two studies.

  • Risk-of-bias ratings for the two Jago studies are reversed

    Minor

    The text identifies Jago et al. (2012) as the only very-strong-rated study and Jago et al. (2015) as strong. Table 3 assigns them *** and ****, respectively-the reverse.

2 of 2

Cites

Flagged first, then by citations

4 of the 72 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Higgins, 2011, Vol. 4
  2. Martin, 2008, Dance as a health enhancing physical activity: an extra-curricular teaching intervention to increase physical activity in girls dance, Physical Education Matters, 3, 37

Cited by

Sorted by citations

Related

Authors
Owen, M. B., Curry, W. B., Kerner, C., Newson, L., & Fairclough, S. J.
Affiliations
  • Edge Hill University (GB)
  • Brunel University of London (GB)
  • Liverpool John Moores University (GB)
Corresponding author
Owen, Michael B.
ORCID
Venue
Preventive Medicine
Publisher
Elsevier BV
Published
2017-12
Volume
105
Pages
237-249
ISSN
0091-7435 (ISSN-L)
DOI
10.1016/j.ypmed.2017.09.018
OpenAlex
W2759514624
Semantic Scholar
f5cac54bc86ac5fadc6ebf0610b7770bd78ce25a
Cited by
280
References
72
Citations by year
2026: 9 · 2025: 10 · 2024: 23 · 2023: 21 · 2022: 32 · 2021: 26 · 2020: 131 · 2019: 20 · 2018: 8
FWCI
5.33
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Liverpool John Moores University (acceptedVersion)
  • Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
  • Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion)
  • Figshare (submittedVersion, cc-by-nc-sa)
  • Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion, cc-by-nc-nd)
  • Edge Hill University (submittedVersion)
  • University of Limerick Institutional Repository (University of Limerick) (submittedVersion, cc-by-nc-sa)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Keywords
school-based intervention, physical activity, adolescent girls, physical activity promotion, multicomponent intervention, theory-based intervention, intervention effectiveness, risk of bias, transition to adolescence
MeSH terms
Adolescent, Adolescent Behavior, Health Promotion, Humans, Schools, Health Behavior, Exercise

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 ›

Are you an author, or do you see a problem with this page? Request a review