Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements Adult-led Curricular Activities/Training CLASSROOM_SCHOOL

Intervention Description: In this randomized control trial, we examined Moderate-to-vigorous physical activity (MVPA) in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined.

Intervention Results: Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p < .01). Intervention girls increased weekday MVPA; whereas TAU girls decreased weekday MVPA (F(1,99) = 7.36, p < .01). Among those with obesity, there was no difference in MVPA between conditions (F(1, 56) = 0.33, p = .57), but Intervention decreased zBMI significantly more than TAU (F(1, 56) = 6.16, p < .05).

Conclusion: Structured PE classes grounded in behavioral theory may be an important strategy to prevent typical decreases in MVPA during adolescence, particularly among girls and for youth with obesity.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL PE Enhancements

Intervention Description: This school-based feasibility study of a randomised cluster trial recruited adolescents aged 12-14 years (n = 224) from five schools (three intervention; two control) in Belfast, Northern Ireland. The 22-week intervention (The StepSmart Challenge) informed by self-determination theory and incorporating gamification strategies involved a school-based pedometer competition. Outcomes, measured at baseline, and post-intervention (at 22 weeks post-baseline and 52 weeks post-baseline) included daily minutes of moderate to vigorous physical activity (MVPA) (measured using ActiGraph accelerometer), mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), social support for physical activity, time preference (for delayed and larger rewards or immediate and smaller rewards), pro-social behaviour (Strengths and Difficulties Questionnaire (SDQ)) and the influence of social networks. The intervention's acceptability was explored in focus groups.

Intervention Results: We invited 14 schools to participate; eight showed interest in participating. We recruited the first five who responded; all five completed the trial. Of the 236 pupils invited, 224 participated (94.9%): 84.8% (190/224) provided valid MVPA (minutes/day) at baseline and 57.2% (123/215) at 52 weeks. All other outcomes were well completed apart from the SDQ (65% at baseline). Qualitative data highlighted that participants and teachers found The StepSmart Challenge to be an acceptable intervention.

Conclusion: The level of interest and high recruitment and retention rates provide support for the feasibility of this trial. The intervention, incorporating gamification strategies and the recruitment methods, using parental opt-out procedures, were acceptable to participants and teachers. Teachers also suggested that the implementation of The StepSmart Challenge could be embedded in a lifelong learning approach to health within the school curriculum. As young people's lives become more intertwined with technology, the use of innovative gamified interventions could be one approach to engage and motivate health behavioural change in this population.

Study Design: Feasibility study of a randomized cluster trial

Setting: 5 post-primary schools

Population of Focus: Adolescents aged 12-14 years from 5 schools

Data Source: Accelerometers and questionnaires. Aggregate step counts from Fitbit Zip data were updated weekly for each team on the StepSmart Challenge website leader board

Sample Size: 224 students

Age Range: Ages 12-14

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL PE Enhancements

Intervention Description: We followed up 228 children who started school in 1998-2000 seven years later, when they had reached a mean age of 14.8. The 152 children (59% boys) at the intervention school did 200 minutes of physical education per week during that period, and the 76 children (50% boys) in the three control schools did the standard 60 minutes. Questionnaires assessed the durations of total and leisure-time physical activity and screen-time activity at baseline and after five and seven years.

Intervention Results: Physical activity and screen-time activity were similar between the two groups before the study started. The intervention group then achieved higher durations of total physical activity than the controls (p < 0.001) and these levels remained in the sex-specific evaluations. There were no differences between the groups in the durations of leisure-time activity (p 0.08-0.77) or screen-time activity (p 0.31-0.91).

Conclusion: A school-based exercise intervention programme increased the total duration of physical activity in both sexes without any compensatory increase in screen-time activity. The findings contradict the activity-stat theory, which stated that the duration of physical activity in children is constant.

Study Design: Comparative study (pre-post test) intervention vs. control schools

Setting: 4 primary schools

Population of Focus: Primary school students

Data Source: Questionnaires assessed the durations of total and leisuretime physical activity and screen-time activity at baseline and after 5 and 7 years

Sample Size: 228 students

Age Range: Ages 6-9 at beginning of study; Ages 13-16 at end of study

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements CLASSROOM_SCHOOL

Intervention Description: Six weekly 45-minute physical education classes conducted by school PE teachers.1 - An athletic subgroup of 20 participants received two additional 90-minute athletic classes per week.2 - School environment modifications: colorful floor markings, sports equipment during recess.3 - Active recess (30 minutes once a week) and sports days (once a month)4. - Teachers trained to incorporate physical activity into regular classes.5

Intervention Results: - Significant improvements were seen in the stand-and-reach test among girls in the intervention group. - Improvements in the shuttle-run beep test were observed only in the athletic subgroup. - No differences were found in daily physical activity, screen time, or school climate between the intervention and control groups.

Conclusion: - Physical education curricula should focus more on athletic performance and increase the number of weekly classes to daily sessions lasting at least 45 minutes.1 - Improvements in athletic endurance for boys and flexibility for girls were seen following daily PE lessons. - 2Significant improvements in beep test results were only seen in the group with additional athletic training.3 - More than six weekly PE classes are needed to improve athletic performance,4 with a focus on athletic skills rather than just achieving high standards.5 - Future studies should involve parents in cultural adjustment programs, examine longer intervention periods, and conduct follow-up assessments.6

Study Design: Controlled intervention trial, parallel design

Setting: - Location: Schools in a disadvantaged neighborhood - Time period: October 2021 to May 2022 - Population: Fifth-sixth-grade children - Environmental factors: Adapted school environment with enhanced physical activity opportunities, active recess, and sports days - Experimental context: Intervention group with six weekly PE classes vs. control group with standard twice-weekly PE classes

Population of Focus: Fifth-sixth-grade children (boys and girls) from disadvantaged schools

Sample Size: - Intervention group: 44 - Control group: 73 - Total: 117

Age Range: 10-12 years old (grades 5-6)

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL PE Enhancements Active Recess Upgrade of School Facilities

Intervention Results: - Physical activity habits, emotional regulation, and subjective well-being were positively correlated. - Emotional self-regulation partially mediates the relationship between physical activity habits and subjective well-being. - The study suggests that promoting physical activity can enhance emotional regulation and improve subjective well-being.

Conclusion: The study found positive correlations between physical activity habits, emotional regulation, and subjective well-being, with the strongest association being between subjective well-being and emotional self-regulation.1 Emotional self-regulation partially mediates the relationship between physical activity habits and subjective well-being,2 highlighting its importance in improving adolescent well-being.3 The study suggests promoting physically active lifestyles and emotional self-regulation through public programs and policies.4 Limitations include not considering maturity levels and using a vulnerability index for socioeconomic status.5 Future research should explore additional variables like self-efficacy or self-image to further understand these relationships.6

Study Design: Cross-sectional observational study

Setting: - Location: All 16 regions of Chile - Time period: 2017 academic year - Population: Adolescents aged 10 to 19 years old attending primary and secondary schools - Environmental factors: Schools, during regular school hours

Population of Focus: Adolescents aged 10 to 19 years old attending primary and secondary schools in Chile

Sample Size: 9585

Age Range: 10-19 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Teacher/Staff Training PE Enhancements CLASSROOM_SCHOOL

Intervention Description: The aim of this study was to evaluate the role of a teacher to implement the Team Pentathlon (TP) in order to improve the PAP in primary children.

Intervention Results: Several teachers noted significant increases in PAP in the IG for both boys and girls (p ≤ 0.05 or p < 0.01), whereas others found only small improvements in PAP. One teacher even observed higher PAP in the CG. Training session records revealed that the teacher himself, how the TP is implemented, and proper resources were the three elements that explained the successful implementation of the TP program.

Conclusion: The implementation of the TP significantly increased the PAP in primary children. Training sessions helped teachers to implement the TP program but personal engagement, motivation, respecting protocol, and an adequate environment are also necessary in improving the PAP of children.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL PE Enhancements

Intervention Description: Effective physical activity interventions are needed for children because health behaviors track into adulthood, and risk factors for diseases begin early in life. No study has determined whether an intervention designed using a Community-Based Participatory Research approach can improve moderate to vigorous physical activity (MVPA) and the related psychosocial constructs in underserved children. This study determined whether improvements in MVPA and related psychosocial constructs (self-efficacy, knowledge, beliefs, attitudes, and skills) occurred following a Community-Based Participatory Research intervention in underserved, rural children. It was then determined if these constructs were mediators of MVPA.

Intervention Results: There were no differences at baseline between groups. MVPA (30.0 [4.4] min), knowledge, and skill scores were significantly higher in the intervention group compared with the comparison group at follow-up (P < .05). Knowledge and skills were mediating variables of MVPA.

Conclusion: Priority should be placed on research that determines the sustained impact of similar Community-Based Participatory Research interventions.

Study Design: RCT

Setting: 2 fifth-grade classes in a public school in rural Alabama

Population of Focus: Students in grade 5 (all African American; all on free or reducedpriced lunch)

Data Source: Accelerometer; survey with questions from the Patientcentered Assessment and Counseling for Exercise (PACE) Adolescent Psychosocial Scale

Sample Size: 39 students

Age Range: Ages 10-11-year-olds

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Curricular Activities/Training PE Enhancements CLASSROOM_SCHOOL

Intervention Description: We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents.

Intervention Results: Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (- 11.6 m, 95% CI: - 22.0, - 1.1).

Conclusion: The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF.

Intervention Components (click on component to see a list of all articles that use that intervention): Active Recess PE Enhancements CLASSROOM_SCHOOL

Intervention Description: The purpose of this study was to investigate the effects of schoolyard renovations and a physical activity (PA) recess curriculum alone and in combination on children's PA.

Intervention Results: No meaningful intervention effects were found. Lack of an effect may be due to the brief dose of recess, the curriculum not being integrated within the schoolyard, the LL implementation occurring prior to the study, or the already high levels of PA.

Conclusion: Potential avenues to promote PA include making recess longer, integrating recess into the school curricula, and developing recess PA curricula integrating schoolyards.

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL PE Enhancements

Intervention Description: A seventh-grade mountain biking unit was modified to include instructional activities targeting known correlates of PA behavior following principles of Physical Education Dedicated to Physical Activity for Life (PEDAL). A three-group design (intervention, standard PE, no PE) was employed. Participants completed a survey at baseline, postintervention, and follow-up at 4 weeks.

Intervention Results: A total of 300 seventh graders (girls = 151) from two schools completed the surveys. Data suggest PE may influence certain correlates of and autonomous motivation for PA although results revealed no intervention main effects for continuous and noncontinuous dependent variables. Results also provide evidence of sport-specific skill being improved through physical education.

Conclusion: While results of this study showed no main effects from the intervention, data suggest PE may influence certain correlates of and autonomous motivation for PA. This warrants attention toward autonomy supporting PE environments and instruction sensitive to autonomous motivation. Future studies should examine PEDAL-designed PE programs over an entire year or more.

Study Design: Three-group pre-, post-, and post-experimental design (intervention, standard PE, no PE)

Setting: 7th graders in 2 schools

Population of Focus: 7th grade students

Data Source: Weekly Activity Checklist (Sallis 1993)

Sample Size: 300 students

Age Range: Ages 12-13

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL PE Enhancements

Intervention Description: SPARK is dedicated to creating, implementing, and evaluating research-based programs that promote lifelong wellness. SPARK strives to improve the health of children, adolescents, and adults by disseminating evidence-based Physical Education, After School, Early Childhood, and Coordinated School Health programs to teachers and recreation leaders serving Pre-K through 12th grade students. Each SPARK program fosters environmental and behavioral change by providing a coordinated package of highly active curriculum, on-site teacher training, extensive follow-up support, and content-matched equipment.

Intervention Results: Although there was no detectable intervention effect on increasing the number of students exercising 60 minutes per day, there was a negative intervention effect detected for muscle-strengthening exercises. A significant positive intervention effect was detected for both PE enjoyment and FitnessGram passing. Deeper analysis of these findings revealed that the positive effect on PE enjoyment occurred only among male students.

Conclusion: The SPARK curriculum had mixed effects on students' PA behavior as well as predisposing, enabling, and reinforcing factors for PA. Incorporating student perspectives into the evaluation of intervention efforts to promote PA can facilitate a better understanding of the ways in which these efforts influence PA behaviors and its determinants.

Study Design: Quasi experimental cohort

Setting: 16 middle schools in Los Angeles, CA

Population of Focus: 7th & 8th grade majority Latinx students in low-income Los Angeles, CA

Data Source: Questionnaires, observation for PE testing

Sample Size: 3,763 students

Age Range: Ages 12-14

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements CLASSROOM_SCHOOL

Intervention Description: A total of 823 students (52.8% boys) wore accelerometers at baseline (fall 2015) and outcome (spring 2016) on PE and non-PE days. The System for Observing Fitness Instruction Time+ measured changes in PA promotion practices. Teachers ( n = 9) attended a 90-minute workshop prior to outcome data collection. Mixed-model linear regressions estimated changes in teacher practices and students' MVPA. Three of the nine targeted PA promotion practices changed in the desired direction (i.e., p < .05; increased motor content and lessons taught outdoors, reduced activities with lines), with three more teacher practices trending in the desired direction (i.e., reduced management time and activities with elimination, increased small-sided games).

Intervention Results: During PE, boys and girls increased MVPA by 2.0 (95% confidence interval [1.1, 3.0]), and 1.3 (95% confidence interval [0.5-2.0]) minutes, respectively. However, there were no statistically significant changes in boys' or girls' MVPA during the school day. Greater implementation of promotion practices by the PE teachers was associated with boys', but not girls', MVPA during PE. Girls in high- and low-implementing teachers' lessons experienced increases in MVPA, suggesting that even small changes in PA promotion practices can increase girls' MVPA during PE.

Conclusion: Overall, the workshops were effective at increasing teachers' PA promotion and students' MVPA in PE. Other school-based strategies that complement and extend efforts targeting PE are recommended to increase children's total daily PA.

Study Design: Single group pre-test and multiple post-test repeated cross-sectional study/ Pilot

Setting: Students at 8 elementary schools in one low-income school district in SE state

Population of Focus: 1st grade and 4th grade students

Data Source: Accelerometer

Sample Size: 1,570 students

Age Range: Ages 6, 9

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements CLASSROOM_SCHOOL

Intervention Description: Participatory-based, experiential, competency-building professional development workshop for physical education and classroom teachers. Baseline was fall 2015, and the intervention was delivered during spring 2016 through spring 2017.

Intervention Results: A total of 1,570 first- and fourth-grade students (49.8% girls, 87.0% African American, 88% free and reduced-price lunch) were measured across the project. Primary analyses indicated that the percentage of girls and boys meeting the 30-minutes/day guideline increased by 9.3% (95% CI=4.7%, 13.9%) and 10.4% (95% CI=5.5%, 15.3%), respectively. A corresponding increase of 1.7 (95% CI=0.5, 2.8) and 2.5 (95% CI=1.1, 3.8) MVPA minutes accumulated during the school day were observed for both girls and boys, respectively. Primary analyses indicated that statistically significant increases in MVPA and total activity for boys and girls were observed across the school day, during classroom time, and during physical education.

Conclusion: Participatory-based, experiential, competency-building professional development is an effective strategy for increasing students' MVPA and total activity in low-income schools. However, data from this study indicate that targeting settings outside of the school day may be more appropriate given that schools were providing more than two thirds of the recommended 30 minutes/day of MVPA prior to intervention.

Study Design: 2-year evaluation, single-group pre/ posttest design Pilot

Setting: 8 rural elementary schools in one school district of a Southeastern state

Population of Focus: Elementary school students

Data Source: Accelerometer; fitness instruction time measured by SOFIT+ systematic observation instrument

Sample Size: 823

Age Range: Ages 6-10 (based on mean/SD ages)

Intervention Components (click on component to see a list of all articles that use that intervention): PE Enhancements CLASSROOM_SCHOOL

Intervention Description: While the control group continued academic classes as usual, the experimental group participated in cross-training involving resistance training (RT), calisthenics, and stretching twice a week for 10 weeks. Pre- and post-intervention measures included height, mass, ATPA, and PA. BMI was calculated and ATPA and PA levels were assessed via questionnaire.

Intervention Results: The groups did not differ significantly (p > .05) for either pre- or post-intervention regarding BMI, ATPA, and PA. However, BMI and PA levels significantly increased over time for both groups (p ≤ .05).

Conclusion: Overall, cross-training in a school setting may be a safe and enjoyable option for physical activity participation. BMI and PA increases were likely the result of the natural growth process and seasonal weather pattern changes, respectively. Nevertheless, the cross-training did not detract from PA levels and may have led to an overall increase in PA levels. As subdomain analyses revealed decreased attitude toward health and fitness in the experimental group, shorter programs involving RT with various protocols are recommended.

Study Design: RCT

Setting: 1 elementary school (6 classes)

Population of Focus: 4th & 5th graders

Data Source: Measures included height, mass, ATPA, and PA. BMI was calculated, and ATPA and PA levels were assessed via questionnaire

Sample Size: 60 control; 58 experimental

Age Range: Ages 9-11

Intervention Components (click on component to see a list of all articles that use that intervention): CLASSROOM_SCHOOL PE Enhancements

Intervention Description: The Chinese Childhood Health; Activity and Motor Performance Study (Chinese CHAMPS) was a cluster randomized controlled trial to modify school physical activity policies and the physical education (PE) curriculum; using teacher training and parent engagement to increase opportunities and support students' physical activity and healthy eating. Using a 2 × 2 factorial design, the study tested the incremental effects of increasing the amount and intensity of physical activity, alongside adding support for healthy eating, on health-related and cognitive function outcomes in Chinese middle school students.

Intervention Results: The intervention was implemented by PE teachers in 12 middle schools in three Chinese cities, with a targeted enrollment of 650 students from August 2015⁻June 2016. The assessment of the outcomes involved a test battery of physical fitness and cognitive functioning at both baseline and at the end of the intervention. Process information on implementation was also collected.

Conclusion: The Chinese CHAMPS is a multi-level intervention that is designed to test the influences of policy and environmental modifications on the physical activity and eating behaviors of middle school students. It also addresses some key weaknesses in school-based physical activity interventions.

Study Design: Cluster RCT using 2 x 2 factorial design

Setting: 12 middle schools in three Chinese cities

Population of Focus: 7th grade students

Data Source: Accelerometers to measure time spent each day in light, moderate, and vigorous activities and sedentary behavior

Sample Size: 650 students

Age Range: Age 12