The effect of a school-based intervention on physical activity, cardiorespiratory fitness and muscle strength: the School in Motion cluster randomized trial

Abstract

Background: Physical activity (PA) declines throughout adolescence, therefore PA promotion during this period is important. We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents.

Methods: For the nine-month School in Motion intervention study (ScIM), we cluster-randomized 30 Norwegian secondary schools (N = 2084, mean age [SD] = 14 [0.3] years) to one of three study arms. The physically active learning (PAL) intervention included 30 min physically active learning, 30 min PA and a 60 min physical education (PE) lesson per week. The Don't worry-Be happy (DWBH) intervention included a 60 min PA lesson and a 60 min PE lesson per week, both tailored to promote friendships and wellbeing. Both intervention arms were designed to engage the adolescents in 120 min of PA per week in addition to recess and mandatory PE lessons. The control group continued as per usual, including the standard amount of mandatory PE. PA (main outcome) was assessed by accelerometers, CRF and muscle strength (secondary outcomes) were assessed by an intermittent running test and selected tests from the Eurofit test battery.

Results: Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (- 11.6 m, 95% CI: - 22.0, - 1.1).

Conclusion: The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF.

Trial registration: ClinicalTrials.gov ID nr: NCT03817047 . Registered 01/25/2019 'retrospectively registered'.

Keywords: Adolescents; Fitness; Physical activity; Randomized controlled trial.

Fig. 1

Flow of schools and participants through the study. All numbers are schools [participants]. T1 = baseline; T2 = follow-up

Fig. 2

The intervention effect on physical activity variables during the full day and during school hours stratified by study group. MVPA = moderate- to vigorous-intensity physical activity, min = minutes, cpm = counts per minute, CI = confidence interval; ICC = intraclass correlation coefficient (for school). Each model contained fixed effects for intervention, time (baseline – follow-up) and intervention x time interaction, in addition to random effects for school, class and subject ID

Fig. 3

The intervention effect on cardiorespiratory fitness and muscle strength stratified by study group. Each model contained fixed effects for intervention, time (baseline – follow-up) and intervention x time interaction, in addition to random effects for school, class and subject ID