The school environment and adolescent physical activity and sedentary behaviour: a mixed-studies systematic review

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

The majority of qualitative studies included between 30 and 100 participants.

“The majority of qualitative studies included between 30 and 100 participants.”

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

Physical activity was assessed using subjective methods in 43 (63%) studies, whilst objective assessment was featured in 25 studies (37%).

“Physical activity was assessed using subjective methods in 43 (63%) studies, whilst objective assessment was featured in 25 studies (37%).”

May combine two claims.

Studies deemed of low quality tended to be small pilot designs, which did not adopt randomisation or where complete outcome data was not reported.

“Studies deemed of low quality tended to be small pilot designs, which did not adopt randomisation (e.g. 27) or where complete outcome data was not reported (e.g. 28).”

• cites [27] Knox GJ, Baker JS, Davies B et al. Effects of a novel school‐based cross‐curricular physical activity intervention on cardiovascular disease risk factors in 11‐ to 14‐year‐olds: the activity knowledge circuit. Am J Health Promot 2012; 27: 75– 83. 23113776 sourceNot checked yet

  Not checked in the free run.

• cites [28] Cecchini JA, Fernandez‐Rio J, Mendez‐Gimenez A. Effects of Epstein's TARGET on adolescents' intentions to be physically active and leisure‐time physical activity. Health Educ Res 2014; 29: 485– 490. 24650945 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

In the physical environment group, those rated as high quality all adopted objective measures of physical activity and utilized objective exposure measures where possible.

“However, in this group, those rated as high quality all adopted objective measures of physical activity 32, 33, 34, 35, 36 and utilized objective exposure measures where possible 33, 34 (e.g. geographic information system (GIS) techniques to map campus characteristics).”

• cites [32] Bocarro JN, Kanters MA, Cerin E et al. School sport policy and school‐based physical activity environments and their association with observed physical activity in middle school children. Health Place 2012; 18: 31– 38. 21900034 sourceNot checked yet

  Not checked in the free run.

• cites [33] Cohen D, Scott M, Wang FZ, McKenzie TL, Porter D. School design and physical activity among middle school girls. J Phys Act Health 2008; 5: 719– 731. 18820346 PMC3689591 sourceNot checked yet

  Not checked in the free run.

• cites [34] Cradock AL, Melly SJ, Allen JG, Morris JS, Gortmaker SL. Characteristics of school campuses and physical activity among youth. Am J Prev Med 2007; 33: 106– 113. 17673097 PMC2735893 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Most studies assessed either total physical activity or moderate to vigorous physical activity (>90%), with very few addressing light physical activity (n=3) or sedentary behaviour (n=3).

“Most assessed either total physical activity or moderate to vigorous physical activity (>90%) with very few studies addressing light physical activity (n = 3) or sedentary behaviour (n = 3).”

May combine two claims.

The group of studies focused on the social environment included relatively more prospective and experimental studies (mostly relating to PE teaching behaviours), but the majority used self-report outcome measures.

“In contrast, the group of studies focussed on the social environment included relatively more prospective and experimental studies (mostly relating to PE teaching behaviours), but the majority used self‐report outcome measures.”

May combine two claims.

Most of the 11 experimental studies were of moderate quality; only one PE-based study was deemed of high quality.

“Most of the 11 experimental studies were of moderate quality; only one PE‐based study was deemed of high quality 25.”

• cites [25] Lonsdale C, Rosenkranz RR, Sanders T et al. A cluster randomized controlled trial of strategies to increase adolescents' physical activity and motivation in physical education: results of the Motivating Active Learning in Physical Education (MALP) trial. Prev Med 2013; 57: 696– 702. 24035889 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Almost two-thirds of included studies (62%) targeted the whole school environment, with approximately 38% exclusively targeting the PE environment.

“Almost two‐thirds of the included studies (62%) targeted the whole school environment, with approximately 38% exclusively targeting the PE environment.”

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

Most included studies were published within the last 5 years (68%) and conducted in North America (primarily the USA).

“Overall, most studies were published within the last 5 years (68%) and conducted in North America (primarily the USA).”

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

The majority of quantitative studies had sample sizes of >1000 participants, with several studies including >10,000 participants.

“The majority of quantitative studies had sample sizes of >1000 participants, with several studies including >10,000 participants.”

May combine two claims.

Most quantitative studies were cross-sectional (68%), 11 used prospective designs (16%), and 11 were experimental (16%) including five RCTs.

“Regarding the quantitative studies, most were cross‐sectional (68%), 11 used a prospective designs (16%) and 11 were experimental (16%) including five randomized controlled trials (RCTs).”

May combine two claims.

Studies focusing on the school's policy environment tended to adopt larger sample sizes across multiple sites; however, the majority also adopted self-report outcome measures.

“Lastly, studies focusing on the school's policy environment tended to adopt larger sample sizes across multiple sites; however, the majority of these also adopted self‐report outcome measures.”

May combine two claims.

Higher quality cross-sectional studies tended to adopt objective activity measures, objective/valid exposure measures, and adequately control for confounding.

“Higher quality cross‐sectional studies tended to adopt objective activity measures, objective/valid exposure measures and adequately control for confounding (and adjust for nested data if relevant).”

May combine two claims.

Few observational studies adopted prospective designs (n=11), of which only two utilized objective measures of physical activity.

“Few adopted prospective designs (n = 11), of which only two utilized objective measures of physical activity 30, 31.”

• cites [30] Gao Z, Lochbaum M, Podlog L. Self‐efficacy as a mediator of children's achievement motivation and in‐class physical activity. Percept Mot Skills 2011; 113: 969– 981. 22403939 sourceNot checked yet

  Not checked in the free run.

• cites [31] Cleland V, Dwyer T, Blizzard L, Venn A. The provision of compulsory school physical activity: associations with physical activity, fitness and overweight in childhood and twenty years later. Int J Behav Nutr Phys Act 2008; 5: 14. 18312621 PMC2292742 sourceNot checked yet

  Not checked in the free run.

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

Sixty-eight of the included papers were quantitative studies and 25 were qualitative.

“Sixty‐eight of these were quantitative studies and 25 were qualitative.”

May combine two claims.

Qualitative evidence highlighted the influence of the wider school climate and shed light on complexities of the associations observed in the quantitative literature.

“Qualitative evidence highlighted the influence of the wider school climate and shed light on complexities of the associations observed in the quantitative literature.”

May combine two claims.

Extracurricular activities may be more important for boys than girls, with three out of four stratified studies showing a positive association in boys only.

“there was a suggestion that the latter may be more important for boys than girls, with three out of the four studies conducting stratified analyses showing a positive association in boys only.”

May combine two claims.

Important physical education-related factors were a mastery-oriented motivational climate and autonomy supportive teaching behaviours.

“Important physical education‐related factors were a mastery‐oriented motivational climate and autonomy supportive teaching behaviours.”

May combine two claims.

High-quality qualitative studies tended to describe participants in greater detail and include a justification for sampling and recruitment.

“Furthermore, these tended to describe the participants in greater detail and include a justification for the sampling and recruitment method used (e.g. purposive sampling).”

May combine two claims.

A total of eight unique physical environmental exposure variables were investigated, half of which were only investigated in one or two studies.

“A total of eight unique physical environmental exposure variables were investigated, half of which were only investigated in one or two studies.”

May combine two claims.

'Physical activity facilities' and 'physical activity area/field size' showed indeterminate associations.

“‘Physical activity facilities’ and ‘physical activity area/field size’ showed indeterminate associations.”

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

High-quality qualitative studies provided a richer description of study context, data collection and analyses, which establishes credibility of the findings.

“In addition, they provided a richer description of study context, data collection and analyses, which establishes credibility of the findings 42.”

• cites [42] Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf 2004; 22: 63– 75. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Most included qualitative studies were of moderate quality, with four of high quality.

“Most included qualitative studies were of moderate quality, with four of high quality 38, 39, 40, 41.”

• cites [38] Goh YY, Bogart LM, Sipple‐Asher BK et al. Using community‐based participatory research to identify potential interventions to overcome barriers to adolescents' healthy eating and physical activity. J Behav Med 2009; 32: 491– 502. 19544091 PMC2863037 sourceNot checked yet

  Not checked in the free run.

• cites [39] MacQuarrie C, Murnaghan D, MacLellan D. Physical activity in intermediate schools: the interplay of school culture, adolescent challenges, and athletic elitism. Qual Rep 2008; 13: 262– 277.Not checked yet

  Not checked in the free run.

• cites [40] Azzarito L, Solmon MA, Harrison L. “… If I had a choice, I would …” A feminist poststructuralist perspective on girls in physical education. Res Q Exerc Sport 2006; 77: 222– 239. 16898278 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

A range of school-based policy, physical and social-environmental factors were associated with adolescent physical activity, with limited research on sedentary behaviour.

“A range of school‐based policy (e.g. break time length), physical (e.g. facilities) and social‐environmental (e.g. teacher behaviours) factors were associated with adolescent physical activity, with limited research on sedentary behaviour.”

May combine two claims.

'Access to physical activity or sports equipment' was consistently not associated with physical activity, although in two studies, positive associations were shown for boys only.

“‘Access to physical activity or sports equipment’ was consistently not associated with physical activity, although in two studies, positive associations were shown for boys only.”

May combine two claims.

Only two observational studies investigated physical environmental factors related to the PE-specific environment, investigating three unique exposure variables.

“Only two observational studies investigated physical environmental factors related to the PE‐specific environment (Table 3), investigating three unique exposure variables.”

May combine two claims.

Two experimental studies including social environmental intervention components as part of wider environmental strategies both showed positive effects on physical activity, albeit only in boys in the first instance.

“Both showed positive effects on physical activity, albeit only in boys in the first instance.”

May combine two claims.

In one study, middle school teachers reported that open gym policies had positive effects on participation, although this appeared to benefit boys the most.

“In one study, middle school teachers reported that open gym policies had positive effects on participation, although this appeared to benefit boys the most 54.”

• cites [54] Bauer KW, Yang YW, Austin SB. “How can we stay healthy when you're throwing all of this in front of us?” – Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity. Health Educ Behav 2004; 31: 34– 46. 14768656 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Important PE teacher behaviours included role modelling physical activity, encouragement and enthusiasm, caring and supportive behaviours, and positive feedback.

“These included role modelling PA (i.e. actively taking part in lessons), encouragement and enthusiasm, caring and supportive behaviours and positive feedback 65, 66”

• cites [65] Morton KL, Keith SE, Beauchamp MR. Transformational teaching and physical activity: a new paradigm for adolescent health promotion? J Health Psychol 2010; 15: 248– 257. 20207668 sourceNot checked yet

  Not checked in the free run.

• cites [66] Smith MA, St. Pierre PE. Secondary students' perceptions of enjoyment in physical education: an American and English perspective. Phys Educ 2009; 66: 209– 221.Not checked yet

  Not checked in the free run.

May combine two claims.

Break-time policies included policies on which grades get to participate in outdoor recess, rules about accessing equipment during break times, and regulations regarding access to physical activity facilities during breaks and out-of-hours/after-school.

“These included policies on which grades get to participate in outdoor recess 78, rules about accessing equipment during break times 38, 53, 56 and regulations regarding access to physical activity facilities during breaks and out‐of‐hours/after‐school (usually because of no supervision) 49, 53, 55.”

• cites [78] Moore JB, Jilcott SB, Shores KA, Evenson KR, Brownson RC, Novick LF. A qualitative examination of perceived barriers and facilitators of physical activity for urban and rural youth. Health Educ Res 2010; 25: 355– 367. 20167607 PMC10170971 sourceNot checked yet

  Not checked in the free run.

• cites [38] Goh YY, Bogart LM, Sipple‐Asher BK et al. Using community‐based participatory research to identify potential interventions to overcome barriers to adolescents' healthy eating and physical activity. J Behav Med 2009; 32: 491– 502. 19544091 PMC2863037 sourceNot checked yet

  Not checked in the free run.

• cites [49] Kirby J, Levin KA, Inchley J. Socio‐environmental influences on physical activity among young people: a qualitative study. Health Educ Res 2013; 28: 954– 969. 23969630 sourceNot checked yet

  Not checked in the free run.

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

In another study, participants emphasized the need for cycle proficiency training and reward/incentive policies for students to promote active travel.

“In another study, participants emphasized the need for cycle proficiency training and reward/incentive policies for students to promote active travel 48.”

• cites [48] Kirby J, Inchley J. Active travel to school: views of 10–13 year old schoolchildren in Scotland. Health Educ 2009; 109: 169– 183. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Other wider school policies that created barriers to physical activity included physical activity uniforms, amounts of homework and school scheduling that leaves students too tired or busy for physical activity.

“Other wider school policies that created barriers to physical activity included physical activity uniforms (particularly for girls and related to body image concerns) 64, amounts of homework 78 and school scheduling that leaves students too tired or busy for physical activity 55, 56.”

• cites [64] Slater A, Tiggemann M. “Uncool to do sport”: a focus group study of adolescent girls' reasons for withdrawing from physical activity. Psychol Sport Exerc 2010; 11: 619– 626. sourceNot checked yet

  Not checked in the free run.

• cites [78] Moore JB, Jilcott SB, Shores KA, Evenson KR, Brownson RC, Novick LF. A qualitative examination of perceived barriers and facilitators of physical activity for urban and rural youth. Health Educ Res 2010; 25: 355– 367. 20167607 PMC10170971 sourceNot checked yet

  Not checked in the free run.

• cites [55] Kubik MY, Lytle L, Fulkerson JA. Fruits, vegetables, and football: findings from focus groups with alternative high school students regarding eating and physical activity. J Adolesc Health 2005; 36: 494– 500. 15901514 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Studies highlighted lack of opportunities for physical activity, poor range of sporting options for girls, or lack of extracurricular sport for all as barriers to physical activity.

“Studies highlighted the lack of opportunities for physical activity 59, poor range of sporting options for girls 64 or a lack of extracurricular sport for all 54, 58 as barriers to physical activity.”

• cites [59] Robbins LB, Talley HC, Wu TY, Wilbur J. Sixth‐grade boys' perceived benefits of and barriers to physical activity and suggestions for increasing physical activity. J Sch Nurs 2010; 26: 65– 77. 19850952 sourceNot checked yet

  Not checked in the free run.

• cites [64] Slater A, Tiggemann M. “Uncool to do sport”: a focus group study of adolescent girls' reasons for withdrawing from physical activity. Psychol Sport Exerc 2010; 11: 619– 626. sourceNot checked yet

  Not checked in the free run.

• cites [54] Bauer KW, Yang YW, Austin SB. “How can we stay healthy when you're throwing all of this in front of us?” – Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity. Health Educ Behav 2004; 31: 34– 46. 14768656 sourceNot checked yet

  Not checked in the free run.

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

Female students reported that PE grading systems that focus on effort rather than skill increase effort and participation in PE.

“female students reported that PE grading systems that focus on effort rather than skill increases effort and participation in PE 67.”

• cites [67] Constantinou P, Manson M, Silverman S. Female students' perceptions about gender‐role stereotypes and their influence on attitude toward physical education. Phys Educ 2009; 66: 85– 96.Not checked yet

  Not checked in the free run.

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

Adolescents in a separate study highlighted that too much supervision negatively impacted physical activity.

“Interestingly, adolescents in a separate study highlighted that too much supervision negatively impacted physical activity 53.”

• cites [53] Hyndman B, Telford A, Finch CF, Benson AC. Moving physical activity beyond the school classroom: a social‐ecological insight for teachers of the facilitators and barriers to students' non‐curricular physical activity. Aust J Teach Educ 2012; 37: 1– 24.Not checked yet

  Not checked in the free run.

May combine two claims.

Students reported the need for more non-competitive activities and emphasized participation rather than competition and exclusion.

“Students also reported the need for more non‐competitive activities 38, 47, 54, 56 and emphasized participation rather than competition and exclusion 56.”

• cites [38] Goh YY, Bogart LM, Sipple‐Asher BK et al. Using community‐based participatory research to identify potential interventions to overcome barriers to adolescents' healthy eating and physical activity. J Behav Med 2009; 32: 491– 502. 19544091 PMC2863037 sourceNot checked yet

  Not checked in the free run.

• cites [47] Hannay J, Dudley R, Milan S, Leibovitz PK. Combining Photovoice and focus groups: engaging Latina teens in community assessment. Am J Prev Med 2013; 44: S215– S224. 23415186 sourceNot checked yet

  Not checked in the free run.

• cites [54] Bauer KW, Yang YW, Austin SB. “How can we stay healthy when you're throwing all of this in front of us?” – Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity. Health Educ Behav 2004; 31: 34– 46. 14768656 sourceNot checked yet

  Not checked in the free run.

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

One study highlighted that unsupervised active transport was generally discouraged because of a perception of 'stranger danger' and by the school's not providing crossing-guards.

“One study highlighted that unsupervised active transport was generally discouraged because of a perception of ‘stranger danger’ and by the school's not providing crossing‐guards (‘lollipop man/lady’) 54.”

• cites [54] Bauer KW, Yang YW, Austin SB. “How can we stay healthy when you're throwing all of this in front of us?” – Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity. Health Educ Behav 2004; 31: 34– 46. 14768656 sourceNot checked yet

  Not checked in the free run.

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

Students and PE teachers perceived that they simply do not acquire enough PE.

“Students (and PE teachers) additionally perceived that they simply do not acquire enough PE 45, 47, 49, 52, 57, 78.”

• cites [45] Boyle SE, Jones GL, Walters SJ. Physical activity among adolescents and barriers to delivering physical education in Cornwall and Lancashire, UK: a qualitative study of heads of PE and heads of schools. BMC Public Health 2008; 8: 273. 18673562 PMC2518562 sourceNot checked yet

  Not checked in the free run.

• cites [47] Hannay J, Dudley R, Milan S, Leibovitz PK. Combining Photovoice and focus groups: engaging Latina teens in community assessment. Am J Prev Med 2013; 44: S215– S224. 23415186 sourceNot checked yet

  Not checked in the free run.

• cites [49] Kirby J, Levin KA, Inchley J. Socio‐environmental influences on physical activity among young people: a qualitative study. Health Educ Res 2013; 28: 954– 969. 23969630 sourceNot checked yet

  Not checked in the free run.

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

Some studies discussed policies that limit physical activity during breaks.

“Some of the studies discussed the policies that limit physical activity during breaks.”

May combine two claims.

Students reported that they would like teachers to make them feel more involved and give students more choice.

“Students reported that they would like teachers to make them feel more involved and give students more choice 40, 52”

• cites [40] Azzarito L, Solmon MA, Harrison L. “… If I had a choice, I would …” A feminist poststructuralist perspective on girls in physical education. Res Q Exerc Sport 2006; 77: 222– 239. 16898278 sourceNot checked yet

  Not checked in the free run.

• cites [52] Ntoumanis N, Pensgaard AM, Martin C, Pipe K. An idiographic analysis of amotivation in compulsory school physical education. J Sport Exerc Psychol 2004; 26: 197– 214. sourceNot checked yet

  Not checked in the free run.

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

One study highlighted that timetabling PE class at the end of the day would facilitate participation in girls.

“Scheduling was also discussed in relation to PE, with one study highlighting that timetabling (avoid repetition of scheduling) PE class at the end of the day would facilitate participation in girls 47”

• cites [47] Hannay J, Dudley R, Milan S, Leibovitz PK. Combining Photovoice and focus groups: engaging Latina teens in community assessment. Am J Prev Med 2013; 44: S215– S224. 23415186 sourceNot checked yet

  Not checked in the free run.

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

In a different study, school scheduling was described by a school principal as being key to 'crafting a culture of physical fitness'.

“However, in a different study, school scheduling was described (by a school principal) as being key to ‘crafting a culture of physical fitness’ 39 (p. 267)”

• cites [39] MacQuarrie C, Murnaghan D, MacLellan D. Physical activity in intermediate schools: the interplay of school culture, adolescent challenges, and athletic elitism. Qual Rep 2008; 13: 262– 277.Not checked yet

  Not checked in the free run.

May combine two claims.

The qualitative evidence emphasized the importance of overall school connectedness/cohesion and how the overall ethos and culture of the school influences student physical activity.

“The qualitative evidence also emphasized the importance of overall school connectedness/cohesion (i.e. how connected student's feel to the school and their sense of belonging) and how the overall ethos and culture of the school influences student physical activity”

Classified as probably not a substantial claim.

With the exception of a very small number of experimental designs predominantly focused on PE, there have been few attempts to modify adolescents' school environment.

“With the exception of a very small number of experimental designs predominantly focussed on PE, there have been few attempts to modify adolescent's school environment.”

Classified as probably not a substantial claim.

Activity breaks in class, active lessons, and changes to the classroom environment are under-represented in the present review.

“This may require the development of novel intervention strategies (for adolescent populations) such as implementing activity breaks in class, the delivery of active lessons and changes to the classroom environment – all of which are under‐represented in the present review.”

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

In a study of students identified as 'motivated' for PE, a desire for groups of similar ability was expressed.

“In a study of students identified as ‘motivated’ for PE, a desire for groups of similar ability was expressed 52.”

• cites [52] Ntoumanis N, Pensgaard AM, Martin C, Pipe K. An idiographic analysis of amotivation in compulsory school physical education. J Sport Exerc Psychol 2004; 26: 197– 214. sourceNot checked yet

  Not checked in the free run.

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

One paper argued that intramural activities helped to create an atmosphere of playfulness, encouraged those who do not want to take part in organized sports and signified the value of physical activity in the school.

“One argued that intramural activities helped to create an atmosphere of playfulness, encouraged those who do not want to take part in organized sports and signified the value of physical activity in the school 39.”

• cites [39] MacQuarrie C, Murnaghan D, MacLellan D. Physical activity in intermediate schools: the interplay of school culture, adolescent challenges, and athletic elitism. Qual Rep 2008; 13: 262– 277.Not checked yet

  Not checked in the free run.

May combine two claims.

Whereas the limited amount of PE was highlighted as a barrier to activity in qualitative studies, the observational evidence consistently showed no association.

“Interestingly, whereas the (limited) amount of PE was highlighted as a barrier to activity in qualitative studies, the observational evidence consistently showed no association.”

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

Parents and PE teachers noted that separating class by gender would facilitate participation for girls.

“Parents 47 and PE teachers 39 noted that separating class by gender would facilitate participation for girls.”

• cites [47] Hannay J, Dudley R, Milan S, Leibovitz PK. Combining Photovoice and focus groups: engaging Latina teens in community assessment. Am J Prev Med 2013; 44: S215– S224. 23415186 sourceNot checked yet

  Not checked in the free run.

• cites [39] MacQuarrie C, Murnaghan D, MacLellan D. Physical activity in intermediate schools: the interplay of school culture, adolescent challenges, and athletic elitism. Qual Rep 2008; 13: 262– 277.Not checked yet

  Not checked in the free run.

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

Whether these types of strategies are feasible, acceptable or effective for adolescent populations is unknown.

“Whether these types of strategies are feasible, acceptable or effective for adolescent populations is unknown and worth exploring in future studies.”

May combine two claims.

Adolescent girls were positive about co-educational PE and felt that the interaction with boys fostered participation (effort) and skill development.

“In contrast, adolescent girls were positive about co‐educational PE and felt that the interaction with boys fostered participation (effort) and skill development 40, 67.”

• cites [40] Azzarito L, Solmon MA, Harrison L. “… If I had a choice, I would …” A feminist poststructuralist perspective on girls in physical education. Res Q Exerc Sport 2006; 77: 222– 239. 16898278 sourceNot checked yet

  Not checked in the free run.

• cites [67] Constantinou P, Manson M, Silverman S. Female students' perceptions about gender‐role stereotypes and their influence on attitude toward physical education. Phys Educ 2009; 66: 85– 96.Not checked yet

  Not checked in the free run.

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

The review of the school environment facet of HPS included intervention studies only, with just two studies targeting physical activity in adolescent populations.

“This review included intervention studies only, with just two studies targeting physical activity in adolescent populations.”

• cites [11] Bonell C, Jamal F, Harden A et al. Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis. Public Health Res 2013; 1: 1. 25642578 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Ecological approaches to behaviour change posit that environments restrict the range of behaviour by promoting and sometimes demanding certain actions and by discouraging or prohibiting others.

“This is consistent with ecological approaches to behaviour change, which posits that environments restrict the range of behaviour by promoting and sometimes demanding certain actions and by discouraging or prohibiting others 10.”

• cites [10] Green LW, Richard L, Potvin L. Ecological foundations of health promotion. Am J Health Promot 1996; 10: 270– 281. 10159708 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Human behaviour is not only driven by deliberation but can also be automatic, cued by environmental stimuli.

“A growing body of research suggests that human behaviour is not only driven by deliberation (e.g. knowledge, attitudes and beliefs) but can also be automatic, cued by environmental stimuli 9.”

• cites [9] Marteau TM, Hollands GJ, Fletcher PC. Changing human behavior to prevent disease: the importance of targeting automatic processes. Science 2012; 337: 1492– 1495. 22997327 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Environmental interventions show potential for increasing physical activity.

“Another review focussing exclusively on the school environment facet of HPS 11 found that environmental interventions show potential for increasing physical activity.”

• cites [11] Bonell C, Jamal F, Harden A et al. Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis. Public Health Res 2013; 1: 1. 25642578 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

An HPS approach demonstrated effectiveness for physical activity promotion.

“On the whole, an HPS approach demonstrated effectiveness for physical activity promotion.”

• cites [12] Langford R, Bonell C, Jones H et al. The World Health Organization's Health Promoting Schools framework: a Cochrane systematic review and meta‐analysis. BMC Public Health 2015; 15: 130. 25886385 PMC4339015 sourceNot checked yet

  Not checked in the free run.

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

The quality assessment tool assessed qualitative studies on appropriateness of qualitative approach, description of context, justification of sampling, and descriptions of data collection and analyses.

“Finally, qualitative studies are assessed according to the appropriateness of the qualitative approach, description of the context, the justification of the sampling and the descriptions of the data collection and analyses.”

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

Full-text articles were screened by at least two authors, with disagreements resolved in a meeting involving all three authors.

“At this stage, all articles were screened by at least two authors (K. M., A. A. and E. v. S.). Any disagreements were resolved in a meeting involving all three authors.”

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

Items were added to distinguish quality of observational design, quality of exposure variables, and nature of physical activity outcome assessment.

“Specifically, we added items to be able to distinguish between the quality of the observational design (e.g. cross‐sectional or prospective), the quality of the exposure variables (for the observational studies) and the nature of the physical activity outcome assessment (e.g. subjective or objective) used in the quantitative studies.”

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

Titles and abstracts were screened by the first author, with 15% double checked by another author.

“Initially, titles and abstracts were screened by the first author (K. M.) for obvious irrelevance; 15% were double checked by another author (E. v. S).”

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

With limited experimental evidence, inclusion of multiple forms of evidence is crucial to identify potentially effective approaches that have yet to be tested.

“With such limited experimental evidence available, the inclusion of multiple forms of evidence is crucial to identify potentially effective approaches that have yet to be tested.”

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

The quality assessment tool assessed quantitative observational studies on sampling appropriateness, justification of measures, and control of confounding variables.

“This tool assesses quantitative observational studies using items that reflect the appropriateness of the sampling, the justification of the measures and the control of confounding variables.”

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

The quality assessment tool assessed quantitative experimental studies on appropriateness of randomisation, blinding and complete outcome data.

“Quantitative experimental studies are assessed according to the appropriateness of randomisation, blinding and complete outcome data.”

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

Relevant data were extracted by the first author and double-checked by a second author, with discrepancies resolved through consensus.

“Relevant data were extracted by the first author (K. M.) and double‐checked by a second author (A. A. or K. C.). Discrepancies were resolved through a consensus discussion.”

Classified as probably not a substantial claim.

Consistency across studies was summarized using a previously applied algorithm.

“Consistency across studies was then summarized using a previously applied algorithm 22 labelled as: ‘+’ or ‘−’ or ‘0’ if 60–100% of the studies reported the same direction, or ‘?’ (indeterminate/possible) if fewer than 60% of the studies (for each correlate) reported a consistent direction.”

• cites [22] Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc 2000; 32: 963– 975. 10795788 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

It is unknown whether environmental interventions that appear effective in primary schools may also be beneficial for adolescent populations.

“It is therefore unknown whether these types of environmental interventions that appear to be effective in primary schools may also be beneficial for adolescent populations.”

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

Taken together, the findings highlight the importance of wider school support and involvement in establishing a school culture that promotes physical activity for all, not just the competent and active students.

“Taken together, the findings highlight the importance of wider school support and involvement in establishing a school culture that promotes physical activity for all, not just the competent and active students.”

May combine two claims.

Although adequate facilities and equipment are considered important for physical activity promotion, if the wider school policies do not encourage and support the use of these by all students, the overall impact on physical activity is likely to be negligible.

“For example, although adequate facilities and equipment are considered important for physical activity promotion, if the wider school policies do not encourage and support the use of these by all students, the overall impact on physical activity is likely to be negligible.”

May combine two claims.

Generally speaking, school policies have the potential to create a school environment signalling that physical activity is important and a priority, or that physical activity is not important and undervalued.

“Generally speaking, school policies have the potential to create a school environment signalling that physical activity is important and a priority, or (as in most cases) that physical activity is not important and undervalued.”

Classified as probably not a substantial claim.

Sedentary behaviour may have independent health effects in young people.

“In view of emerging evidence that sedentary behaviour may have independent health effects in young people 79”

• cites [79] Tremblay MS, LeBlanc AG, Kho ME et al. Systematic review of sedentary behaviour and health indicators in school‐aged children and youth. Int J Behav Nutr Phys Act 2011; 8: 98. 21936895 PMC3186735 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Taken together, the findings indicate a lack of independence and empowerment of the students, which is both encouraged by the school and ultimately perceived by the students, thus negatively impacting upon their physical activity within school.

“Taken together, the findings indicate a lack of independence and empowerment of the students, which is both encouraged by the school (e.g. through restrictive rules and regulations) and ultimately perceived by the students, thus negatively impacting upon their physical activity within school.”