Active classrooms: Development and evaluation of a movement integration intervention to increase physical activity levels of primary school children

Abstract

Physical inactivity is recognised as an international public health issue with less than 20% of children globally achieving the recommended 60 minutes of moderate-to-vigorous physical activity (MVPA) per day for health benefits (WHO 2010). School-based physical activity (PA) interventions have been acknowledged as a key strategy for reaching the majority of children (WHO 2010). The five articles presented in this thesis explore the design, implementation and evaluation of a movement integration (MI) intervention (incorporation of PA into academic lessons) on the MVPA levels of primary school children. The acceptability of this teaching method by teachers and students is also assessed. A systematic literature review was conducted to assess the effectiveness of MI interventions on PA, learning, facilitators of learning and health outcomes. Fifteen studies met the inclusion criteria. Six studies that reported PA levels were found to have mediumto- large effect sizes. All four studies reporting learning outcomes reported positive effects. Teachers and students were pleased with the programmes and enhanced on-taskbehaviour was identified (n=3). Positive effects were also reported on students’ BMI levels (n=3). These findings informed the development of a behaviour change intervention for teachers guided by the Behaviour Change Wheel (BCW) framework (Michie et al. 2011). A pilot study was conducted with one classroom teacher and her students (n=28) to evaluate the effectiveness of MI lessons on students’ MVPA levels. The teacher taught one active Maths lesson and one active English lesson each day for a week. Usual classroom lessons served as a control. Teacher and student satisfaction were also evaluated. Results demonstrated that MI lessons were effective in eliciting time in MVPA (p<.01) (mean 8 minutes daily) as well as being well received by the students and the teacher. These findings from the pilot study then informed the refinement of the ‘Active Classrooms’ protocol and conduct of a cluster randomised controlled trial to assess the effectiveness of the programme on the MVPA levels of students during class-time and throughout the school day. Ten teachers in randomly selected schools and their students (n=248) agreed to participate. The intervention group participated in two MI lessons daily (one Maths and one English) taught by the classroom teacher for 8 weeks. PA was measured using accelerometers at baseline, during the final week of the intervention and at follow-up after 4 months. A repeated measures ANCOVA identified a significant difference for change in daily class time MVPA between the intervention group and control group from pre- to post- intervention (p<.001) and this difference was maintained at follow-up (p<.001). No significant difference emerged for change in school day MVPA between the groups from pre- to post- intervention (p=.52) or follow-up (p=.09). Teachers’ (n=5) perceptions of the effectiveness and use of the intervention were assessed using questionnaire data, and students’ enjoyment of the programme was evaluated using a draw-and-write technique (n=129) and focus group discussions (n=20) postintervention. Teachers and students were highly satisfied with the programme emphasising enjoyment, health benefits and enhanced teaching and learning as contributing to its success. Since teachers are central change agents their acceptability of the programme is key to its effectiveness. The focus on teacher behaviour through the BCW framework (Michie et al 2011) in the design of a MI intervention contributes to the uniqueness of the study. While the limitations of this study must be taken into consideration, these findings provide evidence for MI as an effective and implementable strategy to increase MVPA which has important implications for the health of primary school children.