Effects of a programme of vigorous physical activity during secondary school physical education on academic performance, fitness, cognition, mental health and the brain of adolescents (Fit to Study): study protocol for a cluster-randomised trial

Abstract

Background: Early adolescence is a period of dynamic neurobiological change. Converging lines of research suggest that regular physical activity (PA) and improved aerobic fitness have the potential to stimulate positive brain changes, improve cognitive function and boost academic attainment in this age group, but high-quality studies are needed to substantiate these findings. The primary aim of the Fit to Study trial is to investigate whether short infusions of vigorous PA (VPA) delivered during secondary school physical education (PE) can improve attainment in maths, as described in a protocol published by NatCen Social Research. The present protocol concerns the trial's secondary outcome measures, which are variables thought to moderate or mediate the relationship between PA and attainment, including the effect of the intervention on cardiorespiratory fitness, cognitive performance, mental health and brain structure and function.

Method: The Fit to Study project is a cluster-randomised controlled trial that includes Year 8 pupils (aged 12-13) from secondary state schools in South/Mid-England. Schools were randomised into an intervention condition in which PE teachers delivered an additional 10 min of VPA per PE lesson for one academic year, or a 'PE as usual' control condition. Intervention and control groups were stratified according to whether schools were single-sex or co-educational. Assessments take place at baseline (end of Year 7, aged 11-12) and after 12 months (Year 8). Secondary outcomes are cardiorespiratory fitness, objective PA during PE, cognitive performance and mental health. The study also includes exploratory measures of daytime sleepiness, attitudes towards daily PA and PE enjoyment. A sub-set of pupils from a sub-set of schools will also take part in a brain imaging sub-study, which is embedded in the trial.

Discussion: The Fit to Study trial could advance our understanding of the complex relationships between PA and aerobic fitness, the brain, cognitive performance, mental health and academic attainment during adolescence. Further, it will add to our understanding of whether school PE is an effective setting to increase VPA and fitness, which could inform future PA interventions and education policy.

Trial registration: ClinicalTrials.gov, NCT03286725 . Retrospectively registered on 18 September 2017. ClinicalTrials.gov, NCT03593863 . Retrospectively registered on 19 July 2018.

Keywords: Academic achievement; Adolescence; Cluster-randomised trial; Cognitive functions; Exercise; Fitness; MRI; Mental health; Physical activity.

Fig. 1

Fit to Study trial schedule of forms and procedures (adapted from SPIRIT figure). Abbreviations: HBSC Health Behaviour in School-aged Children, PDSS Paediatric Daytime Sleepiness Scale, PE physical education, P-SDQ Physical Self-Description Questionnaire, SDQ Strengths and Difficulties Questionnaire, PA physical activity, VPA vigorous physical activity

Fig. 2

Flow diagram of schools and participants. ¹A total of 104 schools were randomised into an intervention and a control group. Prior to baseline assessments, 11 schools dropped out. Schools were informed of their assigned group by the research team after completing baseline assessments

Fig. 3

Flow diagram brain imaging sub-study. ¹Note: post-intervention assessments differ between cohorts 1 and 2, but not within a cohort; see text and Additional file 2: Figure S7. Abbreviations: MRI magnetic resonance imaging, n number of schools, nS number of subjects, PE physical education, VO₂max maximal oxygen consumption, VPA vigorous physical activity