Naylor 2006.

Study characteristics
Methods	Trial name: Action Schools! British Columbia (BC) Study design: cluster‐RCT Intervention duration: 11 months Length of follow‐up from baseline: 16 months Differences in baseline characteristics: not reported Unit of allocation: schools Unit of analysis: teachers/classes
Participants	Region: British Columbia, Canada Demographic/socioeconomic characteristics: a broad socioeconomic and cultural spectrum. Inclusion criteria ‐ Elementary schools from 2 British Colombia school districts that were ranked 'low' in terms of current implementation of PA initiatives. Number of schools allocated: 10 randomised, stratified by size (< 300 or > 300 students) and geographic location to: 3 intervention (Champion schools), 4 intervention (Liaison schools), 3 controls (usual practice schools). Numbers by trial group n (controls baseline) = 3 services n (controls follow‐up) = 3 services n (interventions baseline) = 7 services (4 Liaison schools, 3 Champion schools) n (interventions follow‐up) = 7 services (4 Liaison schools, 3 Champion schools) Teachers:42 grade 3 and 4 teachers. 50 grade 5 and 6 teachers Students: not reported Recruitment School districts: elementary schools from 2 BC school districts. Schools: gave presentations at district principals' meetings and from a pool of 103 schools, 20 schools (19%) volunteered to participate. To discriminate between schools who were already undertaking PA initiatives from those who were not, they used results from the 2002 BC Ministry of Education Satisfaction Survey which assessed parent and student satisfaction with current school PA on a 5‐point Likert scale (5 = very satisfied). From the pool of 20 volunteer schools, schools (n = 11) with satisfaction score that ranked ≤ 3 were invited to participate. 1 principal withdrew his school (before randomisation) after determining there was a chance their school could be randomly selected as a control school. Students/teacher: grades 4–6 were included. 42 (100%) grade 4 and 5 teachers consented to participate in phase I and 49 (98%) grade 5 and 6 teachers consented to participate in phase II (23 taught grade 5 in both phases). They also recruited children in these grades to participate in an evaluation of multiple health outcomes. Recruitment rate School districts: – Schools: 19% of schools approached consented, 11/20 (55%) were eligible, 10/11 consented. Classrooms: 42 (100%) grade 4 and 5 teachers consented to participate in phase I and 49 (98%) grade 5 and 6 teachers consented to participate in phase II. Students:not reported
Interventions	Number of experimental conditions: 3 (2 intervention: Liaison schools and Champion schools, 1 control: usual practice schools) Policies, practices or programmes targeted by the intervention The AS! BC model provided tools for schools and teachers to create individualised Action Plans that increased PA opportunities across Six Action Zones: School Environment, Scheduled PE, Classroom Action, Family and Community, Extracurricular and School Spirit Implementation strategies EPOC: tailored interventions ‐ The AS! BC model provided tools for schools and teachers to create individualised Action Plans that increased PA opportunities across 6 action zones: School Environment, Scheduled PE, Classroom Action, Family and Community, Extracurricular and School Spirit. EPOC: educational meetings ‐ Teachers received teacher‐on‐call support to attend a Classroom Action training session (half‐day) from the AS! BC Support Team and School Facilitators and had access to further training on professional development days and by telephone consultation (on request). ‐ The AS! BC model provided generalist teachers with training and resources to operationalise their Action Plan with the ultimate goal of providing students with 150 minutes of moderate‐intensity PA per week. ‐ In the Champion school condition the School Facilitator for Champion schools provided the initial training to the designated 'champion' teacher (a teacher willing to activate and support their colleagues). EPOC: educational materials ‐ Each teacher received a Planning Guide and a copy of the Action Pages – The AS! BC model provided generalist teachers with training and resources to operationalise their Action Plan with the ultimate goal of providing students with 150 minutes of moderate‐intensity PA per week. EPOC: other ‐ Teachers received an Action Bin which remained in each teacher's classroom and contained equipment and resources to facilitate Classroom Action activities. Resources were gender inclusive and designed for children at all skill levels. ‐ Classroom Action Bins were enhanced with specific resources as requested. ‐ In the Champion school condition, Classroom Action Bins contained a basic set of resources. EPOC: local consensus process ‐ A school action team – a committee of school stakeholders (e.g. interested intermediate‐grade teachers, administrators, parents, health, sport/recreation practitioners) that created and supported implementation of the Action Plan EPOC: educational outreach meetings ‐ In the Liaison school condition, teachers had weekly contact with the School Facilitator who went to the classroom to provide mentorship and demonstrate activities. ‐ In the Champion schools condition, the School Facilitator for Champion schools provided support to the designated 'champion' teacher (a teacher willing to activate and support their colleagues). Support was not provided to each classroom in the Champion schools group Theoretical underpinning: socio‐ecological Description of control: usual practice schools were control. Teachers were asked to carry‐on with their typical delivery of PA and PE.
Outcomes	Outcome relating to the implementation of school policies, practices or programmes ‐ Minutes per week of PA Data collection method: teachers at intervention schools were asked to complete weekly activity logs during phases I and II. Teachers recorded daily, the type, frequency and duration (minutes) of PA implemented in the classroom, in PE or in the other Action Zones. Activity Logs were collected monthly by the School Facilitators. Teachers at usual practice schools completed a modified version of the Activity Log. Validity of measures used: not reported/self‐report methods Outcome relating to cost: not reported Outcome relating to adverse consequences: not reported Outcome relating to child diet, PA or weight status: PA of step count, fitness and PA score as well as anthropometry (BMI). Data collection method PA: all children wore a New Lifestyles Digiwalker SW‐200 pedometer and completed the PAQ‐C Fitness: 20‐m shuttle run. Anthropometry: standing height (without shoes) was measured to the nearest 1 mm (Seca stadiometer Model 242, Hanover, Maryland). Weight in light clothing was measured using an electronic scale (Seca Model 840, Hanover, Maryland) to the nearest 0.1 kg. BMI was determined as kg divided by height in metres squared. Validity of method PA: paper reports pedometers are a valid objective measure of PA. Validity of PAQ‐C is not reported. Fitness: objective Anthropometry: valid
Notes	Research funding: British Columbia Ministry of Health, 2010 Legacies Now, BC Ministry of Tourism, Sport and the Arts and the Provincial Health Services Authority. Conflicts of interest: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Schools were stratified by size and geographic location and randomly assigned to a usual practice or intervention or Champion condition. Random sequence generation procedure not described.
Allocation concealment (selection bias)	Unclear risk	No information provided about allocation concealment and, therefore, it was unclear if allocation was concealed.
Blinding of participants and personnel (performance bias) Implementation outcome	High risk	Outcome group: implementation outcome Given the nature of the intervention, participants and study personnel were likely to have been aware of study allocation and, therefore, high risk of performance bias. Outcome: child BMI and PA Low: objectively assessed outcome Outcome: adverse effects Unclear: little information provided
Blinding of outcome assessment (detection bias) Implementation outcome	High risk	Outcome group: implementation outcome All self‐reported outcomes and no blinding of outcome assessment and the outcome measurement is likely to be influenced by lack of blinding. Outcome: BMI, child PA (objective measure) Low: blinding would not impact objective measure. Outcome: adverse effects Unclear: little information provided
Incomplete outcome data (attrition bias) Implementation outcome	Unclear risk	Outcome: PA delivered Insufficient information to determine missing data for teacher response rates and intervention fidelity. Outcome: BMI Low: loss to follow‐up < 10%, ITT not mentioned in analysis.
Selective reporting (reporting bias)	Low risk	Prespecified outcomes appear to be covered.
Other bias	Low risk	Did not appear to be at risk of contamination.
Recruitment to cluster	Low risk	Randomisation postrecruitment.
Baseline imbalance	Unclear risk	Baseline characteristics by group not reported.
Loss of cluster	Low risk	No loss of clusters.
Incorrect analysis	Low risk	Clustering has been taken into account.
Compatibility with individually randomised RCTs	Unclear risk	Unable to determine if a herd effect existed.
Overall risk of bias assessment	Low risk	Most domains were at low risk of bias.