Implementation of a school physical activity policy improves student physical activity levels: Outcomes of a cluster-randomized controlled trial

Nathan, Nicole K.; Sutherland, Rachel L.; Hope, Kirsty; McCarthy, Nicole J.; Pettett, Matthew; Elton, Ben; Jackson, Rebecca; Trost, Stewart G.; Lecathelinais, Christophe; Reilly, Kathryn; Wiggers, John H.; Hall, Alix; Gillham, Karen; Herrmann, Vanessa; Wolfenden, Luke

doi:10.1123/jpah.2019-0595

Cited by 76Physical Activity and HealthSchool Health and Nursing EducationPhysical Education and Pedagogy

Implementation of a school physical activity policy improves student physical activity levels: Outcomes of a cluster-randomized controlled trial

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Nathan, Nicole K., Sutherland, Rachel L., Hope, Kirsty, McCarthy, Nicole J., Pettett, Matthew, Elton, Ben, Jackson, Rebecca, Trost, Stewart G. +7 more·2020·Journal of Physical Activity and Health

DOI 10.1123/jpah.2019-0595

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Abstract

AIM: To assess the impact of a multistrategy intervention designed to improve teachers' implementation of a school physical activity (PA) policy on student PA levels. METHODS: A cluster-randomized controlled trial was conducted in 12 elementary schools. Policy implementation required schools to deliver 150 minutes of organized PA for students each week via physical education, sport, or class-based activities such as energizers. Schools received implementation support designed using the theoretical domains framework to help them implement the current policy. RESULTS: A total of 1,502 children in kindergarten to grade 6 participated. At follow-up compared with control, students attending intervention schools had, measured via accelerometer, significantly greater increases in school day counts per minute (97.5; 95% confidence interval [CI], 64.5 to 130.4; P < .001) and moderate to vigorous physical activity (MVPA) (3.0; 95% CI, 2.2-3.8, P < .001) and a greater decrease in sedentary time (-2.1; 95% CI, -3.9 to -0.4, P = .02) per school day. Teachers in intervention schools delivered significantly more minutes (36.6 min) of PA to their students at follow-up (95% CI, 2.7-70.5, P = .04). CONCLUSIONS: Supporting teachers to implement a PA policy improves student PA. Additional strategies may be needed to support teachers to implement activities that result in larger gains in student MVPA.

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Seventeen of the included studies were assessed as high risk of detection bias.
“Seventeen of the included studies were assessed as high risk [26, 28, 37, 41, 43, 44, 46–49, 52, 54–56, 58, 66, 67] and seven studies were assessed as low risk of detection bias [27, 42, 51, 53, 60, 62, 63].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [37]
The risk of attrition was assessed as unclear in six studies, as insufficient information regarding the loss of schools and treatment of missing data were provided.
“The risk of attrition was assessed as unclear in six studies, as insufficient information regarding the loss of schools and treatment of missing data were provided [26, 37, 41, 42, 54, 57].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [37]
Seven studies were assessed as unclear for potential risk of recruitment to cluster.
“Seven studies were assessed as unclear [26, 37, 38, 41, 42, 46, 67], whilst the remaining study [27] was assessed as high risk of bias due to randomization occurring prior to recruitment and a lack of blinding of recruiters.”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [37]
Two studies were classified as high risk for selective reporting as the implementation outcome was not previously registered in the available protocol or trial registration.
“Two studies were classified as high risk for selective reporting as the implementation outcome was not previously registered in the available protocol or trial registration [37, 41].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [37]
For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups.
“For risk of bias due to baseline imbalances, the majority of studies (n = 11) were assessed as low risk as studies accounted for imbalances by making adjustments for baseline differences during analyses, stratifying by school characteristics or through random allocation of schools to experimental groups [37, 38, 41, 46, 47, 55, 56, 58, 60, 64, 67].”
From Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review (2021) · cites this paper as [37]

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Additional file 2 of School-level factors associated with the sustainment of weekly physical activity scheduled in Australian elementary schools: an observational study
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Yoong, S., Crane, M. A., Lane, C., McCarthy, N., Lecathelinais, C., & Nathan, N. (2022) · Figshare · doi:10.6084/m9.figshare.20364996
Additional file 1 of School-level factors associated with the sustainment of weekly physical activity scheduled in Australian elementary schools: an observational study
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Yoong, S., Crane, M. A., Lane, C., McCarthy, N., Lecathelinais, C., & Nathan, N. (2022) · Figshare · doi:10.6084/m9.figshare.20364993
Additional file 2 of An initial typology of approaches used by policy and practice agencies to achieve sustained implementation of interventions to improve health
Wolfenden, L., Shoesmith, A., Hall, A., Bauman, A. E., & Nathan, N. (2024) · Figshare · doi:10.6084/m9.figshare.26689166
Additional file 1 of Identifying essential implementation strategies: a mixed methods process evaluation of a multi-strategy policy implementation intervention for schools
Lane, C., Naylor, P.-J., Shoesmith, A., Wolfenden, L., Hall, A., Sutherland, R., & Nathan, N. (2022) · Figshare · doi:10.6084/m9.figshare.19589381
Additional file 2 of Identifying essential implementation strategies: a mixed methods process evaluation of a multi-strategy policy implementation intervention for schools
Lane, C., Naylor, P.-J., Shoesmith, A., Wolfenden, L., Hall, A., Sutherland, R., & Nathan, N. (2022) · Figshare · doi:10.6084/m9.figshare.19589384
Additional file 5 of Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis
Bourke, M., Haddara, A., Loh, A., Saravanamuttoo, K., Bruijns, B. A., & Tucker, P. (2024) · Figshare · doi:10.6084/m9.figshare.26725952
Additional file 4 of Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis
Bourke, M., Haddara, A., Loh, A., Saravanamuttoo, K., Bruijns, B. A., & Tucker, P. (2024) · Figshare · doi:10.6084/m9.figshare.26725949
Additional file 1 of Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis
Bourke, M., Haddara, A., Loh, A., Saravanamuttoo, K., Bruijns, B. A., & Tucker, P. (2024) · Figshare · doi:10.6084/m9.figshare.26725940
Additional file 1 of A cluster randomised controlled trial to assess the effectiveness of a multi-strategy sustainability intervention on teachers’ sustained implementation of classroom physical activity breaks (energisers): study protocol
Nathan, N., Hall, A., Shoesmith, A., Bauman, A. E., Peden, B., Duggan, B., Gardner, C., Lane, C., Lecathelinais, C., Oldmeadow, C., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26624200
Additional file 2 of Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis
Bourke, M., Haddara, A., Loh, A., Saravanamuttoo, K., Bruijns, B. A., & Tucker, P. (2024) · Figshare · doi:10.6084/m9.figshare.26725943
Additional file 1 of Evaluating the scaling up of an effective implementation intervention (PACE) to increase the delivery of a mandatory physical activity policy in primary schools
Hall, A., Lane, C., Wolfenden, L., Wiggers, J. H., Sutherland, R., McCarthy, N., Jackson, R., Shoesmith, A., Lecathelinais, C., Reeves, P., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24098253
Additional file 1 of An initial typology of approaches used by policy and practice agencies to achieve sustained implementation of interventions to improve health
Wolfenden, L., Shoesmith, A., Hall, A., Bauman, A. E., & Nathan, N. (2024) · Figshare · doi:10.6084/m9.figshare.26689163
Additional file 3 of School-level factors associated with the sustainment of weekly physical activity scheduled in Australian elementary schools: an observational study
Shoesmith, A., Hall, A., Wolfenden, L., Shelton, R. C., Yoong, S., Crane, M. A., Lane, C., McCarthy, N., Lecathelinais, C., & Nathan, N. (2022) · Figshare · doi:10.6084/m9.figshare.20364999
Additional file 3 of Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis
Bourke, M., Haddara, A., Loh, A., Saravanamuttoo, K., Bruijns, B. A., & Tucker, P. (2024) · Figshare · doi:10.6084/m9.figshare.26725946
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Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial
Nathan, N., Hall, A. E., McCarthy, N., Sutherland, R., Wiggers, J. H., Bauman, A. E., Rissel, C. E., Naylor, P. J., Cradock, A. L. I., Lane, C., et al. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-103764 · Cited by 61 · see citing works
A cluster randomised controlled trial of an intervention to increase the implementation of school physical activity policies and guidelines: study protocol for the physically active children in education (PACE) study
Nathan, N., Wiggers, J. H., Bauman, A. E., Rissel, C. E., Searles, A., Reeves, P., Oldmeadow, C. J., Naylor, P., Cradock, A. L. I., Sutherland, R., et al. (2019) · BMC Public Health · doi:10.1186/s12889-019-6492-z · Cited by 42 · see citing works
Evaluation of a policy to integrate physical activity into the school day
Holt, E., Bartee, T., & Heelan, K. (2013) · Journal of Physical Activity and Health · doi:10.1123/jpah.10.4.480 · Cited by 55 · see citing works
Exploring the effect of a school-based cluster-randomised controlled trial to increase the scheduling of physical activity for primary school students on teachers' physical activity.
Murawski, B., Reilly, K., Hope, K., Hall, A. E., Sutherland, R., Trost, S., Yoong, S., McCarthy, N., Lecathelinais, C., Wolfenden, L., et al. (2021) · Health Promotion Journal of Australia · doi:10.1002/hpja.499
Integrating A School Mandated Physical Activity Policy into Classrooms in Rural Midwestern Community
Holt, E. E., Heelan, K. A., & Bartee, R. T. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000402770.83063.f6 · Cited by 2 · see citing works

Authors: Nathan, N. K., Sutherland, R. L., Hope, K., McCarthy, N. J., Pettett, M., Elton, B., Jackson, R., Trost, S. G., Lecathelinais, C., Reilly, K., Wiggers, J. H., Hall, A., Gillham, K., Herrmann, V., & Wolfenden, L.
Affiliations: Hunter New England Local Health District (AU)
Corresponding author: Nathan, Nicole K.
ORCID: Nathan, Nicole K.
Sutherland, Rachel L.
Trost, Stewart G.
Lecathelinais, Christophe
Reilly, Kathryn
Wiggers, John H.
Hall, Alix
Gillham, Karen
Herrmann, Vanessa
Wolfenden, Luke
Venue: Journal of Physical Activity and Health
Publisher: Human Kinetics
Published: 2020-10-01
Volume: 17
Issue: 10
Pages: 1009-1018
ISSN: 1543-3080 (ISSN-L)
1543-5474
DOI: 10.1123/jpah.2019-0595
OpenAlex: W3084877583
Cited by: 76
References: 30
Citations by year: 2026: 5 · 2025: 9 · 2024: 19 · 2023: 14 · 2022: 15 · 2021: 14
FWCI: 6.46
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Physical Activity and Health (publishedVersion)
PubMed (publishedVersion)
NOVA (University of Newcastle Australia) (submittedVersion)
Funders: Hunter Medical Research Institute
National Health and Medical Research Council (1128348, 1132450, 1150661, 101175)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Physical Education and Pedagogy
Keywords: school physical activity policy, policy implementation, student physical activity, moderate-to-vigorous physical activity, sedentary time, Theoretical Domains Framework, elementary school students, physical education, energizers, school-based intervention
MeSH terms: Child, Health Promotion, Humans, Physical Education and Training, School Health Services, Schools, Students, Exercise, Policy

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Implementation of a school physical activity policy improves student physical activity levels: Outcomes of a cluster-randomized controlled trial

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