Sutherland 2017.

Study characteristics
Methods	Trial name: no trial name Study design: cluster‐RCT Intervention duration: 2 school terms Length of follow‐up from baseline: 6 months Differences in baseline characteristics: assumed to be none Unit of allocation: schools Unit of analysis: schools and school classes
Participants	School type: primary schools Region: HNE region of NSW Demographic/socioeconomic characteristics: socio‐economically disadvantaged communities Inclusion/exclusion criteria Inclusion ‐ Government or Catholic schools. ‐ Located within HNE Local Health District. ‐ Having a SES score of ≤ 5 (lower 50% of NSW) based on school postcode. ‐ Not participating in other PA studies. Number of services allocated: 46 Numbers by trial group n (controls baseline) = 21 n (controls follow‐up) = 21 n (interventions baseline) = 25 n (interventions follow‐up) = 25 Recruitment Schools: 46 Students: 1139 Recruitment rate Schools: 72% Students: 58%
Interventions	Number of experimental conditions: 2 (1 intervention, 1 control) Policies, practices or programmes targeted by the intervention The evidence‐based school PA programme known as SCORES (Supporting Children's Outcomes using Rewards, Exercise and Skills) was rolled out in primary schools and the implementation intervention strategies facilitated its roll‐out. Implementation strategies EPOC: audit and feedback ‐ Schools were provided feedback on the implementation of the intervention on 3 occasions via email. Classroom teachers were given detailed feedback reports on PE lesson quality on 2 occasions. Feedback was based on the Supportive, Active, Autonomous, Fair and Enjoyable (SAAFE) teaching principles. EPOC: education materials ‐ Teachers were provided with resources (lesson booklets, posters, whistles, lanyards and fundamental motor skills cards) to support delivery of high‐quality PE lessons, teach fundamental motor skills and increase MVPA within PE lessons. EPOC: education meeting ‐ All classroom teachers were offered a 90‐minute professional learning workshop including theory and practical sessions. The workshop focused on delivery of fundamental motor skills to students, strategies to improve lesson quality through student engagement and increase students' MVPA. The quality PE teaching principles were from the original SCORES programme and known as the SAAFE teaching principles. In additional, teachers were required to team teach a PE lesson with experienced Health Promotion staff on 1 occasion. EPOC: education outreach visits ‐ Peer teaching with experienced Health Promotion staff with a PE background was offered to classroom teachers in intervention schools. PE lessons were also observed, followed by written feedback and verbal encouragement. EPOC: local opinion leader ‐ A meeting with school executive was held at the commencement of intervention and a school champion nominated for each school. School champions were responsible for embedding the PA practices within the school and leading policy development. Ongoing support was provided throughout the intervention from experienced Health Promotion staff. EPOC: other ‐ Ongoing support: was provided to school champions to embed the practices within their schools. Additional support was provided to classroom teachers via 5 × 5‐minute video clips viewed in staff meetings, reinforcing the quality PE teaching principles (based on the SAAFE principles). Classroom teachers were provided with stickers to be used as prompts for quality PE and issued to students throughout practical PE. School champions provided prompts to classroom teachers to implement the strategies via email, electronic calendar reminders and in meetings. School champion also received a polo shirt. Intervention schools also received equipment (USD180) to support delivery of recess and lunchtime activities. Theoretical underpinning: social‐ecological theory Description of control: control schools participated in the measurement components of the trial only and delivered school PA practices according to the curriculum. Support was offered postdata collection.
Outcomes	Outcome relating to the implementation of school policies, practices or programmes ‐ School PA policy or plan (% of schools) ‐ Overall lesson quality score ‐ Recess PA (mean % of days offered) ‐ Lunch PA (mean % of days offered) ‐ Provision of sports equipment at recess (mean % of days offered) ‐ Provision of sports equipment at lunch (mean % of days offered) ‐ Provision of parent newsletters regarding PA Data collection method: survey and observation Validity of measures used: not reported/contained both objective and self‐report measures. Outcome relating to cost: not reported Outcome relating to adverse consequences: not reported Outcome relating to child diet, PA or weight status: PA Data collection method: accelerometer Validity of measures used: objective
Notes	Research funding: no financial disclosures were reported by the authors of this paper. Conflicts of interest: all authors declared no conflict of interest.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Cluster‐RCT. Random sequence produced using computerised random number function in Microsoft Excel.
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 Both the schools and the Health Promotion staff delivering the intervention were aware of the schools' group allocation. Outcome: objectively measured (child PA) Low: objectively measured
Blinding of outcome assessment (detection bias) Implementation outcome	Low risk	Outcome group: PE teaching quality Low: lessons observed by trained research staff with experience in PE, blinded to group allocation. Outcome group: school PA practices High: teacher‐reported practices and due to the nature of the intervention teachers could not be blinded and, therefore, were at high risk of detection bias. Outcome: child PA Low: objectively measured
Incomplete outcome data (attrition bias) Implementation outcome	Low risk	Outcome group: school PA practice 2 Low: quote: "69 lessons were observed (88% of eligible lessons)". Outcome group: school PA practice 1, 3 and 4 High: quote: "141 (87 intervention, 54 control) of the 382 eligible school teachers (37%) completed an online survey across the 46 participating intervention and control schools". High attrition and unequal across study arms. Outcome: child PA Low: 87% provided accelerometer data.
Selective reporting (reporting bias)	Low risk	Quote: "The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000437561)". All predetermined outcomes were reported.
Other bias	Low risk	Did not appear to be at risk of contamination or other bias.
Recruitment to cluster	Low risk	Recruitment bias: individuals within each randomised cluster participated/random allocation of schools to group occurred postrecruitment.
Baseline imbalance	Low risk	Baseline imbalance: schools were randomly allocated to condition and so risk of baseline imbalance was low.
Loss of cluster	High risk	Loss of clusters: high risk of loss of clusters based on teacher reported data.
Incorrect analysis	Unclear risk	Incorrect analysis: unclear if clustering was taken into account for the teacher‐reported school PA practices.
Compatibility with individually randomised RCTs	Unclear risk	Compatibility with individually randomised RCTs (cluster‐RCTs): unable to determine if a herd effect existed.
Overall risk of bias assessment	Low risk	Most domains were at low risk of bias.