Denizli, Turkey, 12-14 December 2012
Physical Activity & Sport
Promotion in Schools
Effective School-Based Interventions: What Works?
Stuart J. Fairclough, PhD
Professor of Physical Activity Education
Research Institute for Sport and Exercise Sciences,
Liverpool John Moores University, UK
Research Institute for Sport and Exercise Sciences
Why schools as environments
for physical activity promotion?
• Captive audience – school is mandatory
• Infra-structure – teachers, facilities,
curriculum
• Time – 30-35 h/wk for 40+wks/yr
• Links to home, community, business [gyms
etc]
• Most MVPA accrued at school (Fairclough et al., 2008; Ed
3-13, 36: 371-381)
Research Institute for Sport and Exercise Sciences
School-related physical activity during
the day
(Trost et al., 2002, MSSE. 32, 426-431
Other
32%
morning time
before school
8%
period before
bed time
9%
Research Institute for Sport and Exercise Sciences
School
39%
lunchtime and
outside school
activities
12%
But, all schools and their students are
different…confounding variables
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School type
Curriculum structures
Geographic location
Physical environment
School policies and
ethos
• Climate and weather
• Class sizes
Can effective intervention
approaches work in all cases?
Research Institute for Sport and Exercise Sciences
•
•
•
•
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Age
Gender
Maturation
Motivation
Ethnicity
Culture
Religion
Socio-economic status
Stage of schooling
Schools as micro-environments for
applying the socio-ecological model
Schools
•National curricula, standards,
government policy
•Relationships with community
groups, sports clubs,
commercial organisations
•School departments, classes,
streaming
•Friends, peers, teachers,
parents
•Individual children and
adolescents
INTERVENTIONS
TARGETING ALL
LEVELS
Research Institute for Sport and Exercise Sciences
School-based PA
interventions...what works?
It depends on the
• PA-related outcomes
outcomes...
(e.g., fitness, motor
skills, BMI, etc) • Context-specific PA equivocal
usually successful
• Some examples...
• Whole day PA equivocal (possibility
of compensation)
• Non-school PA seldom successful
Research Institute for Sport and Exercise Sciences
Active school travel
(Cooper et al., 2012, MSSE, 44, 1890-1897)
Secondary school children
Primary school children
Research Institute for Sport and Exercise Sciences
Travelling Green Project
(McKee et al., 2007, J Epid Comm Health, 1: 818-823)
• Classes of 9-10 y olds from 2 schools in
Scotland;
• Intervention: 10 week active travel crosscurricular project comprising interactive
resources:
– Curriculum materials
– Child and family materials
• Generic and school-specific components
(e.g., maps, road crossing points, etc)
Research Institute for Sport and Exercise Sciences
Change in school travel mode
(McKee et al., 2007, J Epid Comm Health, 1: 818-823)
Mean distance walked increased by 389%
Mean distance travelled by car decreased by 58%
Research Institute for Sport and Exercise Sciences
Active school travel
• Active travel is simple, free and sustainable
• Active travel can potentially occur 10 times
each week
• Limited number of active travel interventions
of sufficient quality
• Relatively small effects reported
Research Institute for Sport and Exercise Sciences
PA promotion through physical
education (PE)
• Major goal of PE is to produce
physically educated young people who
have knowledge, skills, attitudes to
engage in PA beyond the curriculum
and throughout life
– PA during class time
– Influence PA out of school
Research Institute for Sport and Exercise Sciences
Simple teaching intervention to increase
PE class time MVPA
(Fairclough & Stratton, 2005, Health Ed Res, 20: 448-457)
•Aim
to increase MVPA without compromising motivation and
learning
•11-12
y old girls’ gymnastics lessons
•Control vs. intervention classes
•Intervention: MVPA included as lesson objective; modified
teaching styles, organisation of pupils & equipment
•HR monitoring, systematic observation and questionnaire
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Increased PE MVPA without
compromised motivation
(Fairclough & Stratton, 2005, Health Ed Res, 20: 448-457)
50
5
MVPA (% lesson)
40
42.6%
**
30
3
20
2
10
1
0
0
Intervention
** p < 0.001
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Mtvn
4
27.3%
Control
MVPA
Motivation
4.5
4.7
KISS Clustered RCT
(Kriemler et al., 2010, BMJ, 340 :c785)
• 1 year PE intervention in 16 classes within 15
elementary schools
• Multicomponent approach: daily PE, daily PA breaks, PA
homework
•Intervention children accumulated significantly more MVPA
in school and over whole day than Control group
•But out of school MVPA was similar
•Improvements in fitness, body composition, CVD risk
•Compulsory and structured PA approach
•No follow-up after intervention ended
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Integrated curriculum approaches to
PA promotion
• Emphasis on behaviour change through improved
knowledge, understanding, behavioural skills
• Cross-curricular approaches allow reinforcement
throughout the curriculum
• Lesson content commonly based around physical
activity, sedentary time, plus other behaviours like
healthy eating
• Tasks provide opportunities for content to be
applied in other social contexts (e.g., home)
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Low cost integrated curriculum approach:
The CHANGE! Intervention
(Mackintosh et al., 2011, Boddy et al., 2012 BMC Pub Health; Fairclough et al., in rev PLoS ONE)
• Aim: Promote healthy weight through…
– 1.Increased physical activity
– 2. Reductions in sedentary behaviours
– 3. Healthy eating
• Intervention
– CHANGE! curriculum: 306 page teacher & pupil resource
– Twilight teacher training
– 5 month programme, with 10 weeks follow-up
• Key results: Increased VPA, decreased waist
circumference, increased breakfast consumption
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Integrated curricular & extra-curricular
intervention: Great Fun 2 Run
(Gorely et al., 2009, 2011, IJBNPA)
• Aim: to increase physical
activity and improve dietary
behaviours among 7-11 year
olds
• Parental and family
involvement
• ‘Highlight’ events and media
campaign
• 10 month duration, 20
months follow-up period
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Major findings
(Gorely et al., 2009, 2011, IJBNPA)
• Post-intervention…
– MVPA increased by ~ 9min/day
– Rate of increase in % body fat, BMI, and waist
circumference slowed significantly in older children
– No change in fruit and vegetable intake
• At 20 months follow up
– Significant increases in % body fat, BMI, and waist
circumference with increasing age
• Post-intervention effects were not sustained
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Non-curricular PA promotion
Rationale:
• Content can complement formal curriculum
• No mandatory curriculum guidelines to
follow so more flexibility
• Access to facilities and children
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Play/breaktime (recess)
• Mandatory part of the school day
• Outdoors
• Potentially 600 playtimes per year [based on
3 x day, 5 days/wk]
• Largely unstructured physical activity
encompassing various modes and intensities
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Liverpool Sporting Playgrounds Project
(Ridgers & Stratton, 2005, Ped Exerc Sci, 17: 281-290)
Research Institute for Sport and Exercise Sciences
Sustained increases in MVPA in the
painted Zoneparc playgrounds
(Ridgers et al., 2007, Prev. Med, 44: 393-397)
45
40
% MVPA
35
30
25
20
Int boys
15
Int girls
10
Con boys
5
Con girls
0
Baseline
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6 weeks
6 months
Meta-analysis of effects of after-school
programmes
(Beets et al., 2009, Am J Prev Med, 36: 527-537)
Positive effects
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Research Institute for Sport and Exercise Sciences
PA during different types of after-school
clubs using active video games
(Fairclough et al., 2012, unpublished report)
Least active/fit 11-12 y old children participating in twice
weekly after-school clubs
Children most active doing multi-skills…
& least active playing Wii Sports
Research Institute for Sport and Exercise Sciences
Research Institute for Sport and Exercise Sciences
Methodological limitations of
youth PA interventions
(van Sluijs et al., 2007, BMJ, 335, 703)
• Short duration of follow-up
• Lack of adjustment for potential
confounders
• Lack of adjustment for clustering when
randomisation at group level occurred
• Lack of precision of PA outcome
measure [over-reliance on self-report]
Research Institute for Sport and Exercise Sciences
So, what does work?
Back to the future…?
Child & Adolescent Trial for Cardiovascular Health: CATCH
http://www.catchinfo.org/
Why was it successful?
• Size: 96 elementary
schools (5000+ children) in
4 states
• Duration: 3 years, with
extensive follow-up
• Socio-ecological
approaches (individual,
social, organisational,
community, policy)
(Luepker et al., 1996, JAMA, 275, 768-776;
McKenzie et al., 1996, Prev. Med., 25, 423-431)
Research Institute for Sport and Exercise Sciences
Intervention focused on changes to:
• PE curriculum, training, & support [individual, policy,
organisational]
– At least 90 minutes of PE spread across a minimum of
three sessions per week
• Food services [policy, organisational]
• Family involvement [social]
• Health education curriculum [individual, policy,
organisational]
• After-school community involvement [community,
social, policy, organisational]
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• Significant improvements in…
– MVPA during PE classes
– Out of school vigorous PA
– Dietary behaviour
• Changes sustained after intervention had
ended
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5 year maintenance effects:
CATCH-ON Study
(McKenzie et al., 2003, Health Ed Behav, 30: 447-462)
• 5 year follow-up of CATCH in 88 schools
• PE MVPA maintained in Intervention schools
• Delayed adoption of CATCH resources plus
training in Control schools
But no evidence of maintenance
in out of school PA…
Research Institute for Sport and Exercise Sciences
Based on the evidence,
what works?
(Kriemler et al., 2011, BJSM, 45, 923-930)
• Multi-component interventions (e.g., educational, curricular,
environmental) more effective than single component
interventions and can broaden the reach of the population
(socio-ecological model)
• Family involvement (pre-adolescents?) – mediators of nonschool PA and positive PA attitudes
• Context-specific interventions...but long-term effects
questionable
• BUT…Lack of effect on out of school PA
• Should intervention efforts be directed elsewhere?
– Discretionary time [after-school, weekends], targeted to least
active?
Research Institute for Sport and Exercise Sciences
Thanks for listening!
@PAEH_Group_JMU
s.j.fairclough@ljmu.ac.uk
http://www.ljmu.ac.uk/sps/RISES/100465.htm
Research Institute for Sport and Exercise Sciences
• 4 month pilot, 12 month intervention
• 3 treatment arms (plus control schools):
– High intensity PA (HIPA)
– Fundamental movement skills (FMS)
– PA signposting scheme (PASS)
• 8 schools in total (2 per treatment)
• Assessment of CV health, PA, fitness, FMS, body
composition, self-perceptions at baseline, 6 months &
post-intervention
• Summary report available:
http://www.sportslinx.org/index.php?option=com_content&view=category&layout=blog&id=24&Itemid=95
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A-CLASS FMS results
(Foweather et al., 2008, Percep Mot Skills, 106, 745-754)
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Naylor et al., 2006
Research Institute for Sport and Exercise Sciences
Active school model: Action
Schools!: BC
(Naylor et al., 2008, BJSM, 42: 338-343)
• Participatory model
• Customised 11 month programme based on schools’
perceived needs
• Targeted zones: environment, PE, family/community,
classroom, school spirit, extra-curricular
• School ‘action teams’ with AS!: BC support team
• Prescriptive components: 15 min classroom PA/day & 2x40
min PE classes/week
• Aim: children get 150 minutes school-based PA/week
• 3 conditions: Usual practice, Liaison, Champion
• 4-8 week follow-up
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Action Schools! BC...effective?
(Naylor et al., 2008, BJSM, 42: 338-343)
• Modest increases in whole-day pedometer counts in
Intervention boys but not girls
– Suggests limited non-school effects or compensation
– Reflects known gender differences in PA related to
discretionary time?
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Significant increase in PA delivery time
75% compliance
High teacher satisfaction
School-based intervention models should seek to
maintain current PA to prevent/slow age-related
decline?
Research Institute for Sport and Exercise Sciences