The pulse of recent research on school-based physical activity and wellness

School is an ideal setting in which to reach and impact children and adolescents in order to improve their health and wellness. A large number of scholarly articles have been published on the subject of school-based physical activity (PA) and wellness promotion. However, given the diversity of schools worldwide, intervention programs, curricula, and strategies are not “one size fits all” and may not be universally applicable. The inconsistent application of theoretical frameworks and various measurement methods further muddles the evidence. One problem with many school-based PA and wellness interventions is their prospect for generalization and sustainability. In recent years, many researchers have turned attention to devising interventions, including school-based interventions targeting children and adolescents, to reduce health-compromising sedentary behavior, as well as to promote health-enhancing PA. Additional evidence—and stronger evidence than currently available—is needed to shed light on how these interventions can and should be scaled up, implemented, disseminated, and adopted more broadly in schools and populations.

In this special topic of the Journal of Sport and Health Science (JSHS), we present 5 invited papers contributed by 4 world-renowned research groups to capture the pulse of the latest research on school-based PA and wellness. The 5 papers are all empirical studies, including 4 original first-hand studies and 1 systematic review with meta-analysis. The types of research conducted in these studies range from natural experiment and mixed-methods process evaluation to qualitative research, survey, and review. All 5 papers are based on recent competitively funded research projects carried out in schools. These research investigations were guided by implementation science and robust theoretical frameworks such as the socioecologic model and the theory of enhanced, extended, and expanded opportunity (TEO).¹ Last, these 5 studies represent mainly the Western perspective (i.e., USA, UK, and Norway) on school-based PA promotion and sedentary behavior mitigation, although Jones et al.’s systematic review and meta-analysis also summarizes findings from studies that took place in Canada; European Union countries; Hong Kong, China; Iceland; and Switzerland. Below, we present a synopsis of these 5 articles and encourage readers to refer to the full-text articles for more details.

Jones and colleagues feature a multi-institutional collaboration for a systematic review with meta-analysis of school-based interventions to promote PA and/or reduce sedentary behavior in children aged 5–11 years of age. Guided by the TEO as the theoretical framework,¹ the study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, conducted a thorough search of 5 databases, and screened 1044 records for analysis. The study's inclusion criteria determined 57 full-text studies (29 having a randomized controlled trial design) to be relevant, and they were subsequently coded by 2 independent raters. The study demonstrated that interventions implemented within school settings showed limited overall effect on moderate-to-vigorous PA or sedentary time. The study also observed potential compensatory behaviors (occurring at various times during the whole day when measurements were taken) that may have offset intervention effects. Meta-analysis of the studies that used accelerometers as a measure of PA showed moderate-to-large intervention effects, in spite of great heterogeneity and variation across these studies. The authors further indicated that, of the 3 Es (enhancement, extension, and expansion) of the TEO,¹ expansion appears to be the most promising intervention strategy. Such expansion of PA opportunities may include after-school clubs, active transportation, or classroom PA breaks. The findings add important insights to the existing research literature and shed light on the design, implementation, and evaluation of future school-based PA/sedentary behavior interventions.

Weaver and colleagues conducted a natural experiment in South Carolina, USA, that compared the effects of a year-round school calendar and a traditional school calendar on children's weight status and cardiorespiratory fitness. The study was guided by the “structured days hypothesis”,² which posits that schools are a preplanned, segmented, and adult-supervised compulsory environment that plays a protective role for children against obesogenic behaviors. Weaver and colleagues posit that altering the school calendar may have the potential to interrupt long stretches of less-structured time and, therefore, result in more favorable health results. The sample involved 1 elementary school that followed the year-round calendar (n = 375 students) and 2 elementary schools that followed the traditional calendar (n = 616 students). The 3 schools showed similar socioeconomic status with 81%–87% of the students eligible for free or reduced-price lunches. The study showed that the students enrolled at the year-round calendar school gained less in body mass index and fitness than the students attending the traditional-calendar schools during the entire study period (summer 2017–summer 2018). Secondary analyses further showed that weight and fitness results were more favorable in the year-round calendar school during the 2 summer periods (summer 2017 and summer 2018), although the opposite trend was observed when looking at the school year (August 2017–May 2018). The authors concluded that the observed changes in weight status and fitness between the 2 school calendars support the structured days hypothesis.²

Jong and colleagues conducted a mixed-method process evaluation study in the UK that examined adolescents’ perspectives of a school-based PA intervention called GoActive. This study involved a large sample of adolescents (n = 1542; 13.2 ± 0.4 years old (mean  ±  SD)) who completed a questionnaire at 2 time points to assess shyness and PA level (at baseline) and intervention acceptability and satisfaction (postintervention). Subsamples also participated in interviews (n = 16) and focus-group interviews (n = 48). The quantitative and qualitative data collected from the study were analyzed for group differences by gender, shyness, and activity level to determine the intervention’s acceptability and satisfaction with it. Although boys preferred class-based sessions oriented toward competition, girls and students who were shy or inactive did not enjoy competition. The results highlight that future school-based PA and wellness interventions should take into account factors such as students’ gender, preference of competition, and mentorship training.

Daly-Smith and colleagues conducted a multinational collaborative study (UK, USA, and Norway) that convened 35 stakeholders (including policy makers, commercial education sector staff, teachers, and researchers) to acquire their perspectives on the successful adoption and implementation of physically active learning programs. According to the study, the classroom can be considered an environmental setting where students learn academic achievement and also participate in PA for health. The authors advocated physically active learning programs in schools and also noted that such programs were most successful when full attention was given to multiple levels of the socioecological framework, including classroom, school, and national policy. Themes based on the qualitative data were generated and discussed to determine the implications of the implementation of physically active learning, practice, policy, and research priorities. The article is one of the earliest studies to have gathered the perspectives of multiple stakeholders in order to identify factors underlying the implementation of physically active learning in schools. The findings provide important insights into future directions for research, policy, and practice in this area.

Sacheck and Wright provide a highlight article that looks at teachers’ perspectives of 2 school-time PA programs from the Fueling Learning through Exercise (FLEX) Study in Massachusetts, USA. The 2 programs are called 100 Mile Club, a walking/running program whose goal is for children to accumulate 100 miles of walking or running during the course of a school year, and Choosing Healthy and Active Lifestyles for Kids (CHALK)/Just Move, a program that integrates PA breaks into the classroom. Classroom teachers (n = 6 from the 100 Mile Club schools; n = 8 from the CHALK/Just Move schools) self-reported students’ behaviors. The 100 Mile Club schools showed better student behaviors than the CHALK/Just Move schools. The more favorable student behaviors were believed to correspond with how and by whom these 2 programs were implemented in each classroom. The article concludes that classroom teachers’ “buy-in”, motivation, and eventual implementation of nontraditional PA programs outside of recess and physical education are essential factors for school-based PA interventions. Competing interests within schools and administrators’ support are also influencing factors to the success and sustainability of such intervention programs.

In summary, the collection of these 5 papers captures the pulse of the latest research in school PA and wellness. Promoting PA and wellness will not be an easy process, and it demands purposeful, carefully planned, multilevel interventions that create conducive environments within the school and the settings beyond. School is an important venue for addressing not only education but also public health goals. It is also a complex system comprising elements that often must function in conjunction with one another to allow and safeguard smoother implementation of intervention efforts. Successful interventions that have enacted changes to policies (e.g., school calendar) and the school environment may lead to important changes in the school system that facilitate healthier behaviors and, therefore, create a healthier generation of children than the current generation. The reality is that schools usually are faced with multiple competing interests and limited personnel and funding. Without tailored cooperation and deliberate local adaptation, researchers often find school administrators and teachers reluctant to fully accept, implement, and embrace their external, nontraditional programs. Interventions should also consider and cater to the students’ individual characteristics. We appreciate these authors’ fine contributions to this special topic of JSHS. It is our sincere hope that these studies will spark more interest in and empirical research into the topic of school-based PA and wellness.