1. Ingredients in the Recipe for Success of School-Based Physical Activity Interventions
Karin Allor Pfeiffer, Ph.D.
Department of Kinesiology
Center for Physical Activity and Health
Michigan State University

2. Outline
Why are school-based physical activity interventions important?
What do the data show?
Which ingredients belong in the recipe for success?
What are other considerations?
What are practical ingredients in the recipe for success?
Example (Project FIT)

3. Why are school-based physical activity interventions important?
Approximately 40% of U.S. children and adolescents (6-11 years old) do not achieve recommended levels of physical activity (Troiano et al., MSSE, 2008)
Physical activity sharply declines during adolescence (Pate et al., J Adolesc Health, 2009; Kimm et al., Lancet, 2005)
Intervention prior to, during, and after the decline can all be useful
Children in school are a captive audience

4. What do the data show? Recent literature reviews indicate
Mostly positive results for increasing physical activity during school time
Successful trials usually last longer and use multi-component approaches
Questionable whether results apply to children only (adolescents?)
Results may differ by type of physical activity assessment
Dobbins et al., 2009; De Meester et al., 2009; Salmon et al., 2007; van Sluijs et al., 2007

5. What do the data show? (2) Latest review:
Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Kriemler et al., Br J Sports Med, 2011; 45:
Included studies from January 2007-December 2010
20 trials were relevant
16 of these reported effects with a physical activity outcome
14 included children up to 12 years old (4 adolescent, 2 included both)
Half were multi-component
60% included a family or community component

6. What do the data show? (3) Results of Kriemler et al.
Every study with a physical activity outcome reported a significant effect
Nine of these addressed total physical activity (included time outside of school) and were effective
Five used objective measures, four subjective measures of physical activity
Two randomized controlled trials with intervention duration of one year provided the highest level of rigor and showed significant increase in physical activity (assessed by accelerometer)

7. What do the data show? (4) Noteworthy points regarding Kriemler et al.
20 trials were eligible to include in the review over a four-year time period
In contrast, Dobbins review included 26 trials over 50 years
75% of those examining a physical activity outcome reported increase in overall physical activity
Results extended to overall physical activity instead of in-school only (found in previous reviews)
Similar results found for objective and subjective physical activity assessments

8. What do the data show? (5) Kriemler et al., cont’d.
Studies including highest level of rigor and public health significance included
Children
Multi-component approach over one school year
Integration into school curriculum with PE expert
Family involvement

9. Which ingredients belong in the recipe for success?
Multi-component approach over adequate time frame
Include the family (may not be as relevant for adolescents) and environment (community)
Establish sustainability
Examine components of implementation and other aspects of intervention (and conduct formative evaluation)

10. Which ingredients belong in the recipe for success? (2)
Examine mediation of the intervention effect
Consider cost-effectiveness
Consider reducing sedentary behaviors, particularly in combination with academic activities

11. What are other considerations?
Little information is available regarding certain types of populations
Cultural tailoring to racial/ethnic minority groups
Novelty
Media
Technology
Measurement tools
Intervention tools
Activity permissive environments
Age group (elementary, middle, high school)
Inter-generational efforts

12. What are practical ingredients in the recipe for success?
Know your environment
Understand that you are asking people to change behavior
Find a champion for your cause
Determine who in the setting is a stakeholder in your cause
Communicate as much as possible
Be collaborative rather than prescriptive

13. Example – Project FIT: A School- and Community-Based Intervention to Address Physical Activity and Healthy Eating in Low-Income Elementary School Children
Elementary schools in Grand Rapids, MI (>95% of students in schools eligible for free/reduced-price lunch)
Measures in children grades 3-5
Intervention lasted two years
Guided by social ecological framework
Multi-component
School, community, social marketing
Eisenmann et al., BMC Public Health, 2011, 11:607

14. Project FIT (2) School-based intervention components Staff training
30 min structured physical activity during the school day
20 hours of nutrition education for the school year
Healthy eating coaches in the school cafeteria
Physical activity and nutrition policy improvements via coordinated school health team
Staff wellness

15. Project FIT (3) Baseline results Mean age = 9.7 years
48% overweight/obese (6% severely obese)
30% met physical activity recommendations
(7 days, 60 min/day) – pedometer data not yet available
24% met screen time recommendations (<2 hrs/day)

16. Project FIT (4) Preliminary examination of follow-up data
Positive results for ST
Fruits/vegetables
Process evaluation from first year, grades 3-5
Average of ~9 min/day of PA
Average of 4.5 hours/classroom of nutrition education
Process evaluation from first year, grades K-2
Average of ~10 min/day of PA
Average of 7 hours/classroom of nutrition education

17. Summary
School-based intervention research has progressed in recent years
More work to be performed
Use provided ingredients in recipe for success in school-based interventions; the chef has to appropriately combine and prepare

18. Thank You