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Randomized Controlled Trial
. 2022 Apr;56(7):385-393.
doi: 10.1136/bjsports-2020-103764. Epub 2021 May 26.

Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial

Nicole Nathan  1   2   3 , Alix Hall  4   3 , Nicole McCarthy  4   2   3 , Rachel Sutherland  4   2   3 , John Wiggers  4   2   3 , Adrian E Bauman  4   5 , Chris Rissel  6 , Patt-Jean Naylor  7 , Angie Cradock  8 , Cassandra Lane  4   2   3 , Kirsty Hope  4   2 , Benjamin Elton  2   3 , Adam Shoesmith  4   2   3 , Christopher Oldmeadow  3 , Penny Reeves  3 , Karen Gillham  2 , Bernadette Duggan  9 , James Boyer  10 , Christophe Lecathelinais  2   3 , Luke Wolfenden  4   2   3
Affiliations
Randomized Controlled Trial

Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial

Nicole Nathan et al. Br J Sports Med. 2022 Apr.

Abstract

Objectives: To assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months.

Methods: A cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal's mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October-December 2017), 12-month (October-December 2018) and 18-month (April-June 2019). Data were analysed using linear mixed effects regression models.

Results: Overall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001).

Conclusion: A multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods.

Trial registration number: Australian New Zealand Clinical Trials Registry (ACTRN12617001265369).

Keywords: children; implementation; intervention effectiveness; physical activity; school.

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Conflict of interest statement

Competing interests: Authors NN, RS, KG, NM, MP, RJ, VA, JW and LW receive salary support from Hunter New England Local Health District, which contributes funding to the project outlined in this study. Similarly, author CR and receive salary support from the New South Wales Health Office of Preventive Health which also contributed funding to this project. All other authors declare that they have no competing interests. The project is funded by the National Health and Medical Research Council (NHMRC) Partnership Project grant (APP1133013). The NHMRC has not had any role in the design of the study as outlined in this protocol and will not have a role in data collection, analysis of data, interpretation of data and dissemination of findings. As part of the NHMRC Partnership Grant funding arrangement, the following partner organisations also contribute fund: Hunter New England Local Health District and the NSW Health Office of Preventive Health. Individuals in positions that are fully or partly funded by these partner organisations (as described in the Competing interests section) had a role in the study design, data collection, analysis of data, interpretation of data and dissemination of findings. At the time of this study NN was supported by an NHMRC TRIP Fellowship (APP1132450) and a Hunter New England Clinical Research Fellowship; LW was supported by an NHMRC Career Development Fellowship (APP1128348), Heart Foundation Future Leader Fellowship (101175) and a Hunter New England Clinical Research Fellowship; RS was supported by an NHMRC TRIP Fellowship (APP1150661).

Figures

Figure 1
Figure 1
Time schedule of participant enrolment, data collection and intervention delivery. PA, physical activity.
See this image and copyright information in PMC

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