Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: active for life year 5 (AFLY5) school-based cluster randomised controlled trial
Open accessAbstract
OBJECTIVE: To investigate the effectiveness of a school based intervention to increase physical activity, reduce sedentary behaviour, and increase fruit and vegetable consumption in children. DESIGN: Cluster randomised controlled trial. SETTING: 60 primary schools in the south west of England. PARTICIPANTS: Primary school children who were in school year 4 (age 8-9 years) at recruitment and baseline assessment, in year 5 during the intervention, and at the end of year 5 (age 9-10) at follow-up assessment. INTERVENTION: The Active for Life Year 5 (AFLY5) intervention consisted of teacher training, provision of lesson and child-parent interactive homework plans, all materials required for lessons and homework, and written materials for school newsletters and parents. The intervention was delivered when children were in school year 5 (age 9-10 years). Schools allocated to control received standard teaching. MAIN OUTCOME MEASURES: The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day, accelerometer assessed minutes of sedentary behaviour per day, and reported daily consumption of servings of fruit and vegetables. RESULTS: 60 schools with more than 2221 children were recruited; valid data were available for fruit and vegetable consumption for 2121 children, for accelerometer assessed physical activity and sedentary behaviour for 1252 children, and for secondary outcomes for between 1825 and 2212 children for the main analyses. None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group. The difference in means comparing the intervention group with the control group was -1.35 (95% confidence interval -5.29 to 2.59) minutes per day for moderate to vigorous physical activity, -0.11 (-9.71 to 9.49) minutes per day for sedentary behaviour, and 0.08 (-0.12 to 0.28) servings per day for fruit and vegetable consumption. The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account: self reported time spent in screen viewing at the weekend (-21 (-37 to -4) minutes per day), self reported servings of snacks per day (-0.22 (-0.38 to -0.05)), and servings of high energy drinks per day (-0.26 (-0.43 to -0.10)) were all reduced. Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results. CONCLUSION: The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity, decreasing sedentary behaviour, and increasing fruit and vegetable consumption in primary school children. Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level, as well as at the school environment level. These findings have relevance for researchers, policy makers, public health practitioners, and doctors who are involved in health promotion, policy making, and commissioning services. Trial registration Current Controlled Trials ISRCTN50133740.
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Overall, multicomponent approaches led to an inconclusive evidence rating of MVPA.
“This most commonly took the form of a combination of expanding and enhancing PA opportunities, but overall these approaches led to an inconclusive evidence rating of MVPA.63, 65, 74, 77, 81, 82, 85,88, 89, 90,93, 96, 97, 101, 108”
From A mixed-studies systematic review and meta-analysis of school-based interventions to promote physical activity and/or reduce sedentary time in children (2020) · cites this paper as [63]
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- Authors
- Kipping, R. R., Howe, L. D., Jago, R., Campbell, R., Wells, S., Chittleborough, C. R., Mytton, J., Noble, S. M., Peters, T. J., & Lawlor, D. A.
- Affiliations
- University of Bristol (GB)
- The University of Adelaide (AU)
- Bristol City Council (GB)
- Corresponding author
- Lawlor, D. A.
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2014-05-27
- Volume
- 348
- Issue
- may27 4
- Pages
- g3256-g3256
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC4035503
- OpenAlex
- W1997976024
- Cited by
- 221
- References
- 58
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 13 · 2023: 11 · 2022: 18 · 2021: 24 · 2020: 30 · 2019: 35 · 2018: 21 · 2017: 17 · 2016: 23 · 2015: 15 · 2014: 3 · 2013: 1
- FWCI
- 12.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UWE Research Repository (UWE Bristol) (submittedVersion, cc-by-nc)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Wellcome Trust (MC_UU_12013/5, WT087640MA)
- United Kingdom Clinical Research Collaboration
- Cancer Research UK
- National Institute for Health and Care Research (NF-SI-0611-10196, NF-SI-0512-10026, 09/3005/04)
- British Heart Foundation
- Institut pour la Recherche en Santé Publique
- National Institutes of Health
- Medical Research Council (MR/K025643/1, MC_UU_12013_5, MC_UU_12013, WT087640MA, MR/K023233/1, G1002375)
- Economic and Social Research Council (RES-590-28-0005)
- Public Health Research Programme (09/3005/04)
- 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
- physical activity promotion, sedentary behavior, fruit and vegetable intake, school-based intervention, elementary school students, teacher professional development, screen viewing, snacking, parent-child communication, intervention effectiveness, moderate-to-vigorous physical activity, parental involvement, child health promotion, school newsletter
- MeSH terms
- Child, England, Feeding Behavior, Female, Follow-Up Studies, Fruit, Health Promotion, Humans, Male, Motor Activity, Obesity, School Health Services, Schools, Vegetables, Exercise, Cluster Analysis, Sedentary Behavior
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