Class-based interventions to promote physical activity and reduce sedentary behaviour: exploring the impact on children’s physical activity, educational, and psychological outcomes

Abstract

Schools play a vital role in promoting healthy lifestyles, but the predominantly sedentary nature of classroom settings contributes to high levels of inactivity in children. Traditional school-based physical activity interventions usually involve additional time for physical activity outside of academic class hours, which can be difficult to implement considering children’s competing priorities. In the last decade, there has been a growing focus on interventions which integrate physical activity into the curriculum in school settings. With the development of technology, a growing number of interventions have applied wearable activity trackers in physical activity promotion among children. Previous research suggested that pedometer-based integrated curriculum interventions effectively increase physical activity in school-aged children. However, there is a lack of investigation into psychological and educational outcomes and participant experiences, indicating a need for comprehensive future studies to understand the full impact and mechanisms of interventions. This PhD project reviewed the existing literature on classroom-based physical activity and sedentary behaviour intervention studies and explored the feasibility, participants’ experiences and perceptions, and the effects of the Datafit project, a multi-component integrated-curriculum pedometer intervention. This PhD thesis consisted of three studies.

The first study was a meta-analysis and systematic review which examined the influence of classroom-based physical activity and sedentary behaviour interventions on children’s classroom behaviour, academic achievement, and cognitive abilities. The current review included randomised controlled studies conducted in the classroom during school hours among typically developing school-age children (5-18 years). The review protocol was registered on PROSPERO (CRD42018107809). Eight electronic literature databases were searched, including MEDLINE, EMBASE, ERIC, PsycINFO, SPORTDiscus, SCOPUS, ASSIA, and Web of Science. The final database search was conducted in August 2023. Meta-analyses were conducted using the Comprehensive Meta-analysis software, version 2.2.06. Random effects models were used to calculate the effect sizes. The risk of bias was assessed using the ‘Quality Assessment Tool for Quantitative Studies’ developed by the Effective Public Health Practice Project in 1998. In total, 20 studies were included in the systematic review and 15 in the meta-analysis. A significant positive effect was observed on the following outcomes: on-task behaviour, maths performance, spelling performance, reading performance, inhibition, and moderate to vigorous intensity physical activity (MVPA). There was no significant effect on cognitive flexibility, verbal memory, visual-spatial memory, and sedentary behaviour. Results of the moderator analysis indicated that shorter-term interventions (< 6 months) had a better effect on children’s on-task behaviour and verbal memory than longer-term interventions (≥ 6 months). Meanwhile, intervention type could be a potential moderator, with classroom activity breaks showing a better effect on children’s inhibition than physically active lessons. This review found that classroom-based physical activity and sedentary behaviour interventions had a positive impact on children’s classroom behaviour, academic achievement, inhibition, and physical activity levels. These findings supported policy initiatives encouraging the integration of physical activity into the classroom and a need to further explore feasible and acceptable intervention designs.

Study 2 was a feasibility study which explored the feasibility and effect of the Datafit project, a multi-component integrated-curriculum pedometer intervention. The Datafit project was a health intervention aimed at promoting physical activity and data literacy among young people through a wearable activity tracker (i.e. Moki). It engaged children in physical activity while educating them on maths and data literacy through step count feedback and reports. During the 4-week intervention, pupils (n=20, mean age 10.2 ± 0.4 years old, 10 males) were encouraged to take more steps by comparing the daily feedback on step counts, setting personal and group challenges, and reading the weekly report graphs. Meanwhile, the teacher taught pupils about data literacy using numbers and graphs from the Moki band data. This study explored the feasibility of the Datafit project, the effect of the intervention on children’s psychological determinants of physical activity and academic outcomes, and the teacher’s and pupils’ perceptions and experience of the project. This research took a mixed-methods approach. For the quantitative part, a pre- and post-design was adopted to examine the effect of the intervention. For the qualitative part, focus groups among pupils and an interview with the teacher were conducted, and thematic analysis was used to explore their experiences and perceptions of the project. Twenty pupils from a primary six (P6) class in a primary school in Edinburgh, Scotland, participated in this study. Overall, the intervention showed good feasibility in the school environment among P6 pupils. Pupils and the teacher enjoyed the project and found it helpful in promoting physical activity and enhancing maths and data literacy learning. Statistical analysis showed significant changes in introjected and intrinsic regulation, classroom behaviour, and learning content. Feedback from focus groups and the interview suggested a broader positive impact on physical activity, psychological determinants of physical activity, and educational outcomes. This study demonstrated the feasibility and potential benefits of the Datafit project. The next study was therefore designed to further explore the effects and experiences of the intervention using a more robust controlled design.

Study 3 was a cluster-randomised controlled trial. It investigated the effect of the Datafit project on pupils’ physical activity, psychological determinants of physical activity, cognitive abilities, and learning outcomes, explored pupils’ and the teacher’s experience and perceptions, explored the mechanism of the intervention, and made suggestions for future research. Similar to Study 2, this study also took a mixed-methods design. For the quantitative part, a cluster-randomised controlled design was adopted, and Generalized Linear Mixed Models (GLMMs) were used to examine the effect. For the qualitative part, two focus groups among pupils and an interview with the teacher were arranged to explore their experience and perception of the project and the mechanism of the intervention. Fifty-three pupils (mean age 10.60 ± 0.27 years old, 24 males) from two primary six classes in a primary school in Edinburgh, Scotland, participated in this study. Analysis revealed a significant positive intervention effect on children’s self-reported and objectively measured physical activity level, whereas no significant effect was found on psychological determinants of physical activity, cognitive abilities, and learning outcomes. However, evidence from the teacher interview and pupils’ focus groups indicated the intervention helped in promoting physical activity and the learning of maths and data literacy. Pupils and the teacher generally had a positive experience with the Datafit project. The qualitative analysis also revealed components that might be effective in the current intervention. This study demonstrated the potential of a creative approach to integrating physical activity into the academic curriculum. This intervention increased children’s physical activity levels without negatively influencing children’s educational outcomes and cognitive abilities, thereby alleviating educators’ concerns and facilitating the dissemination of such interventions.

The encouraging findings from the meta-analysis indicated the need for the development and investigation of interventions which integrate physical activity into the curriculum in school settings. The following two studies explored the effect and participants’ experience of a multi-component integrated-curriculum pedometer intervention. To our knowledge, this is the first study exploring the effect of such intervention on children’s physical activity levels, psychological determinants of physical activity, educational outcomes, and cognitive abilities. This series of studies has showcased the potential of a creative approach to integrating physical activity into the academic curriculum, thus providing information for educators and future research.