Physical activity (PA), defined by the World Health Organization (WHO) as any bodily movement produced by skeletal muscles that requires energy expenditure, has been closely related to health.1 In fact, it has been estimated that 3.2 million deaths per year are attributable to insufficient levels of PA.1 But, when knowing that a child with a decrement in health-related quality of life is less likely to be able to develop normally and mature into a healthy adult, and that 81% of children are physically inactive globally,2 the concern becomes extremely alarming. In addition, greater percentages (<85%) in low-income and middle-income countries and a prediction of a 15% relative reduction of insufficient PA for 20302 increases the seriousness of the situation.
Fortunately, PA is one of the leading modifiable causes of death and disease3 and scientific evidence suggests that even moderate levels of PA are quite beneficial for health in children.1 In the short term, participation in PA may reduce the risk of suffering noncommunicable diseases such as high levels of obesity-related chronic conditions, including diabetes, metabolic syndrome, or cardiovascular disease.4–6 In the long term, a low peak of bone mass in their growing years has been highlighted as a major contributing factor to osteoporosis in advancing age, while PA could moderate this issue.7,8 In addition, a meta-analytical comparison demonstrated the relationship between PA and children’s current and future mental health,9 intensifying to a major extent the importance of practicing PA at school age.
In this scenario, syllabus have promoted physical education (PE), which brings school children the opportunity to improve physical fitness and mental health.9–12 In fact, PE must aim to make every child physically, mentally, and emotionally fit, in addition to developing intrapersonal and interpersonal qualities that will help them to live happily with others.9 Therefore, the consideration of structured PE is crucial to contribute to school-aged children’s physical and mentally healthy lifestyle; this necessity is even more pressing since computers, mobiles, and TVs are continuously in children’s lives, tempting them to be engaged in sedentary activities.4,13,14 In fact, for many children PE classes represent their only moment of exercise in a week, becoming the children’s lifestyle in the short term, and encouraging adherence to PA in the long term, one of the most important challenges for PE teachers.15,16 Unfortunately, this situation has been aggravated since the COVID-19 pandemic.17
Faced with this challenge, several authors have tried to design school-based protocols hypothesizing positive effects in some of the aforementioned parameters, providing ideas about how PE teachers may induce improvements during classes in 3 main ways: (1) for improving fundamental motor skills (FMS) or physical fitness (eg, Fit-4-Fun and iPLAY),18,19 (2) for reducing the risk of illness, such as obesity (eg, HEPAFIT and CLICK-Obesity),5,20 and (3) for improving psychological performance or core executive functions (eg, MALP).3 In addition, some theoretical frameworks supported the idea of the necessity of the social cognitive and social ecological theories to enhance positive effects.21,22 According to social cognitive theory, personal factors (health knowledge and beliefs), social systems (family, peers, and teachers), and behaviors (dietary saturated fat intake, dietary fiber intake, and PA) must be impacted to affect health outcomes. According to social ecological theory, changing the physical context (classroom, playground, school cafeteria, and home) is important.o.21 However, accepting that school-based interventions are a key opportunity to improve children’s PA, it is a lack of evidence about how pedagogical approaches to motor learning in PE might affect children’s lives in these aforementioned ways.
Until now, to the best of the author’s knowledge and supported by the research conducted in this review, a systematic review has not been published that has summarized randomized controlled trials (RCT) aimed at assessing the effectiveness of programs in elementary school children. Therefore, the present article aimed to systematically summarize primary school-based intervention programs and their effects evaluated through RCT design. This study may be helpful for PE teachers to involve children in a healthy lifestyle based on scientific evidence.
Method
Experimental Approach to the Problem
A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines23 and guidelines for performing systematic reviews in sport sciences.24
Information Sources
A systematic search of 4 databases (Web of Science, ERIC, Education Database, and PubMed) was performed to identify articles published prior to February 24, 2022.
Search Strategy
The PICO (Population, Intervention, Control, and Outcomes) design was used to provide an explicit statement of the question. The author was not blinded to journal names or manuscript authors. The following search terms were used (see Table 1): (Primary OR elementary) AND (“physical education”) AND (“randomized controlled trial*”).
Inclusion/Exclusion Criteria of Included Studies
| Item | Inclusion | Exclusion | Search coherence |
|---|---|---|---|
| Population | School children from primary/elementary education | Students from nonprimary school (eg, secondary, baccalaureate, undergraduate) | Primary OR elementary |
| Intervention or exposure | Children participating in school-based physical education sessions | Children nonparticipating in school-based physical education sessions | Physical education |
| Outcome[s] | Any outcome extracted from school-aged children involved in an intervention (eg, physical fitness, injury or illness related, cognitive) | Study protocols | a |
| Study design | Randomized controlled trials and/or parallel trials | Nonrandomized controlled trials and noncontrolled studies | Randomized controlled trial* |
| Other criteria | Peer reviewed, original, full-text studies written in English or Spanish | Written in another language or nonpeer reviewed original full-text studies | — |
aIn the search coherence, no word was applied to “outcomes” because no specific result was expected. All results were relevant for this study.
Eligibility Criteria
To identify information from the articles, the author downloaded the information (title, authors, date, and database) and transferred it into an Excel spreadsheet (Microsoft Corporation), where duplicates were removed. The remaining articles were screened for meeting inclusion and exclusion criteria (Table 1). Moreover, relevant articles not previously identified were also screened in an identical manner and further studies that complied with the inclusion–exclusion criteria were included and labeled as “included from external sources.”
Data Extraction
Data extraction was prepared using an Excel spreadsheet in accordance with the Cochrane Consumers and Communication Review Group’s data extraction template. The spreadsheet was used to assess inclusion and exclusion requirements for all selected studies. Full-text articles that were excluded from the analysis were recorded with reasons for exclusion. All records were stored in the spreadsheet.
Data Items
After identifying a list of the articles included in the data sheet and in the qualitative synthesis, the outcome domains considered the most important for interpreting the review’s conclusions and providing rationale for the labeling were all variables that provide any information about intervention (between-group differences, intervention’s main ideas, and program duration), results (test instruments, main variables, and outcomes), and the highlights that authors provided. Additionally, other variables for which data were sought were: the objective of the study, sample (number of children included, number of schools involved, school country, mean age, age range, level [primary or secondary], and grade). The articles were distributed into 3 tables depending on their aim and findings.
Quality of Studies
The Physiotherapy Evidence Database scale was used to assess the methodological quality of the RCTs included in this systematic review. The scale scores the internal study’s validity in a range from 0 (low methodological quality) to 10 (high methodological quality). Eleven items are measured in the scale. The criterion 1 is not included in the final score. Points for items 2 to 11 were only attributed when a criterion was clearly satisfied. The score that each section receives can be from 0 (“no”) to 1 (“yes”), depending on the quality obtained by each point.
Results
Identification and Selection of Studies
A total of 193 (Web of Science: 62; PubMed: 72; ProQuest: 44; SPORTDiscus: 15) original articles were found, of which 109 were duplicates. Thus, a total of 84 unique articles were identified. After checking titles and abstracts, 9 articles were excluded because they did not meet inclusion criteria number 5. The full text of the remaining 75 articles was then analyzed; 23, 3, 14, and 5 articles were excluded because they did not meet exclusion criteria number 1, 2, 3, and 4, respectively. Thus, a total of 30 articles met all the inclusion criteria and were included in the final qualitative synthesis (Figure 1).
—Flow diagram of the study.
Citation: Journal of Physical Activity and Health 20, 4; 10.1123/jpah.2022-0452
—Flow diagram of the study.
Citation: Journal of Physical Activity and Health 20, 4; 10.1123/jpah.2022-0452
—Flow diagram of the study.
Citation: Journal of Physical Activity and Health 20, 4; 10.1123/jpah.2022-0452
Quality Assessment
Using the Physiotherapy Evidence Database checklist, the quality assessment was done in Table 2.
Methodological Assessment of the Included Studies
| Reference | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Score |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Reznik et al25 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Sit et al12 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Miller et al37 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 |
| Olive et al11 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 8/10 |
| Schmidt et al33 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 |
| Meyer et al7 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 7/10 |
| Crotti et al30 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 9/10 |
| Collard et al40 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Fisher et al26 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 8/10 |
| Pinto-Escalona et al32 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Daly et al8 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Mayorga-Vega et al41 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| De Brujin et al42 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Van de Fels et al36 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Takehara et al2 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 8/10 |
| Eather et al49 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 |
| Harris et al27 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 |
| Chua et al43 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Wright et al4 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 7/10 |
| Treviño et al21 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Nathan et al13 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 8/10 |
| Fuchs et al39 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Meyer et al28 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 8/10 |
| Escriva-Boulley et al29 | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Telford et al14 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 8/10 |
| Telford et al38 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 8/10 |
| Sahota et al6 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 9/10 |
| Coolkens et al31 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 9/10 |
| Meijer et al44 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 |
| Miller et al34 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 10/10 |
Note: Item 1, subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received); Item 2, allocation was concealed; Item 3, the groups were similar at baseline regarding the most important prognostic indicators; Item 4, there was blinding of all subjects; Item 5, there was blinding of all therapists who administered the therapy; Item 6, there was blinding of all assessors who measured at least one key outcome; Item 7, measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups; Item 8, all subjects for whom outcome measures were available received the treatment or control condition as allocated, or where this was not the case, data for at least one key outcome was analyzed by “intention to treat”; Item 9, the results of between-group statistical comparisons are reported for at least one key outcome; Item 10, the study provides both point measures and measures of variability for at least one key outcome.
Study Characteristics
The characteristics of studies were extracted and clustered into Table 3 (interventions to enhance PA levels and FMS), Table 4 (interventions to reduce the risk of illness or injury prevention), and Table 5 (interventions to develop psychological aspects). Some articles were included in different sections because they found more than one effect.
Interventions to Improve Physical Fitness, PA Levels, and FMS
| References | Aim | Sample | Intervention | Results | Highlights | ||||
|---|---|---|---|---|---|---|---|---|---|
| Group differences | Intervention main ideas | Duration | Test instrument | Variables | Results | ||||
| Programs to improve physical fitness and PA levels | |||||||||
| Intensive interval training | |||||||||
| Reznik et al25 | To determine the feasibility and impact of an intervention on students from minority communities (low-income neighborhoods) with high obesity on PA | No of children: 988 Schools: 4 Country: United States Mean age: NS Level: primary Grade: 1 | EXP (n = 500) CHAM JAM | CHAM JAM, based on TAKE 10! Program, consists of a 10-min audio CD focused on aerobic activities led by teacher It is based on an interval training approach (more-intense exercise alternating with less-intense), more characteristic of spontaneous PA It does not necessitate teacher previous preparation More information: http://chc.montefiore.org/physical-activity/show-kids-that-exerciseis-fun | 8 wk 3 times a day | Pedometer | Step count | EXP significantly greater mean number of steps than CON (2839 [SD, 1262] vs 2545 [SD, 1153]; P = .0048) CHAM JAM was equally effective in gender, grade level, and BMI subgroups | CHAM JAM holds promise as a cost-effective means to integrate the physical and cognitive benefits of PA into high-risk schools |
| CON (n = 488) Usual PE classes | |||||||||
| Fisher et al26 | To identify appropriate cognitive outcomes piloting a PE intervention | No of children: 64 Schools: 6 Country: Scotland Mean age: 6.2 (0.3) y Range: 5–6 y Level: primary Grade: 1 | EXP (n = 34) Aerobic intense PE | Teachers were encouraged to make sessions as physically active as possible, minimizing instruction time, and avoiding children waiting to use equipment, or standing around. Minimize object control task Make exercise based on object control task for CON | 10 wk 1 h/wk | CANTAB ANT CAS CPRS:S | PA MVPA (>3200 counts per min) | PA significantly greater in EXP than CON (P < .0001) | The present study has identified practical and age-appropriate cognitive and behavioral outcome measures for future randomize controlled trials, and identified that schools are willing to increase PE time |
| CON (n = 996) Standard PE | |||||||||
| Harris et al27 | To determine the feasibility of delivering curriculum connected HIIT in PE time | No of children: 84 Schools: 2 Country: New Zealand Mean age: 11.9 (0.5) y Range: 10–13 y Level: primary Grade: 5 and 6 | EXP (n = 53) HIIT | HIIT intensity was 89.6% of the predicted maximum Work: rest ratio 30 s:30 s Session lasted 15 min at the beginning of the class | 8 wk 2 class/week accounting for a statutory holiday | HR monitor Muscular fitness assessment Resistance training battery Body composition Observations using psychological checklist as a guide | Peak HRmax Muscular fitness (90° push up to failure, pull-up, and squat) Resistance skills Dual-energy X-ray scanning No of practical sessions delivered | The adjusted between-group difference for cardiorespiratory fitness was trivial (ES 0.02) | Teacher delivered HIIT program was feasible and acceptable to both teachers and students. It is therefore potentially scalable |
| CON (n = 31) The usual practice | |||||||||
| Jumping and strength | |||||||||
| Meyer et al28 | To assess the 3-y follow-up of a 9 mo program on aerobic fitness, and PA | No of children: 502 Schools: 15 Country: Switzerland Mean age: 8.7 (2.1); 11.1 (0.6) y Range: 6–7 and 11–12 y Level: primary Grade: 1 and 5 | EXP (n = 278) Jump and strength training | EXP had 2 PE lessons more than CON To the curriculum content quantity of at least moderately intense PA was provided Three to five short activity breaks (2–5 min each), eg, jumps with one leg More information in study protocol50 | Nine-month intervention (immediate) + 3-y follow-up (long term) | Shuttle run test Accelerometer Questionnaires | Aerobic fitness PA | EXP showed higher average level of fitness at follow-up (P = .001) Immediate effects were not sustained | Beneficial effects seen after 1 y were not maintained when intervention was stopped. A continuous intervention seems necessary to maintain overall beneficial health as reached at the end of the intervention |
| CON (n = 205) School curriculum | |||||||||
| Escriva-Boulley et al29 | To investigate the efficacy of a teacher developmental program, grounded on self-determination theory, to increase teachers’ need supportive motivating style and students’ PA | No of children: 293 (and 15 teachers) Schools: 13 Country: France Mean age: 8.31 (1.13) y Range: 5–11 y Level: primary Grade: 1, 2, 3, 4, 5, and 6 | EXP (n = 278) Jump and strength training | Teachers received a workshop aimed at training teachers to adopt a more need-supportive (ie, autonomy support, structure, involvement) and 3 need-thwarting (ie, control, chaos, hostility) motivating styles during PE Both groups taught the same sports: orienteering, ultimate Frisbee, dance, and rugby | 8 mo | Accelerometers Observation | PA level Teachers’ motivating style | Teachers that received development program increased support of their students’ psychological needs for the majority of the school year (slight decrease in the fourth measurement) In addition, these teachers lead their students to increase MVPA, while CON decreases | The program has a potential to increase teachers’ motivating style and students MVPA in PE |
| CON (n = 205) School curriculum | |||||||||
| Teaching styles | |||||||||
| Crotti et al30 | How different pedagogical approaches in PE might affect children’s PA (physical literacy) | No of children: 360 Schools: 12 Country: England Mean age: NS Range: 5–6 y Level: primary Grade: 1 | EXP (n = 105) Linear pedagogy | Three block lessons: dance, gymnastic, and object control skills Linear pedagogy Teacher provides a clear instruction and demonstration, then children do and augment corrective feedback. A movement standard and avoidance of errors. Traditional structure (warm-up, practicing passive movements skills within drills, game activity to apply movement skill learned during the lesson, and cooldown) Nonlinear pedagogy Explore PE Hall and the different objects. Coaches did not provide demonstration or any feedback during activities. They invited children to reflect to foster an external focus of attention in the child to infuse variability in the task and channel childrens’ learning See more in study protocol51 | 15 wk Two class per week each group | Accelerometers | MVPA Mean raw accelerations Lowest acceleration (Over the most active hour and half hour) | Linear pedagogy and nonlinear pedagogy interventions did not significantly affect children’s PA levels compared to the CON | PE interventions based on linear and nonlinear pedagogies alone might not be affective in improving habitual PA in children |
| EXP (n = 112) Nonlinear pedagogy | |||||||||
| CON (n = 143) The usual PE program | |||||||||
| Telford et al14 | To investigate the effect of a specialist-taught PE program in PA | No of children: 853 Schools: 29 Country: Australia Mean age: NS Range: 8–12 y Level: primary Grade: 3, 4, 5, and 6 | EXP (n = 457) Lessons from specialist-trained PE teacher | Specialist-trained PE teacher specialized in the Bluearth approach Teaching style = guided discovery Lesson plans: (1) Mostly of game play (2) Fitness activities (3) Skill practice (4) Core movements | 4 y 2 × 45 min lessons per week Total 272 lessons (68 per year) | SOFIT Pedometers Accelerometers | MVPA Sedentary activity | With intervention 6.5 min more at MVPA (16.7 vs 10.2, P < .001), and more steps in their whole intervention days. However, EXP vs CON, the intervention does not increase habitual steps At age 11 y, the EXP boys were 20 min less sedentary than CON | Well-designed specialist-taught PE can improve student’s PA during classes, but not improve habitual PA. It suggests the need of daily classes, maybe with a wider multicomponent strategy A reduction in sedentary time showed justified more investigations about PE to enhance health |
| CON (n = 396) Usual practice PE from generalist classroom teacher | |||||||||
| Coolkens et al31 | To examine the effect of supervised vs organized recess on participation, PA and play | No of children: 281 Schools: 14 Country: Belgium Mean age: NS Range: 8–10 y Level: primary Grade: 2 | EXP (n = 136) Supervised recess | Main activity = parkour Supervised recess Free to play, PE teachers ensure safety Organized recess PE teachers provide challenging tasks | 6-d unit tin PE +3 parkour recess | SOCARP | PA Play | Boys spent more time in MVPA during organized recess Boys and girls spent more time in activity games during organized recess than in supervised (59% vs 46%, P = .01; 59% vs 47%, P = .001) | Organized recess attracted more children and made the largest contribution to daily MVPA |
| EXP (n = 136) Organized recess | |||||||||
| Other intervention programs | |||||||||
| Pinto-Escalona et al32 | To investigate the effects of a karate intervention on physical fitness | No of children: 721 Schools: 20 Country: 5 European countries Mean age: 7.4 (0.5) y Range: 7–8 y Level: primary Grade: 2 | EXP (n = 30) Karate Mind and movement program | The intervention provided sensory-motor stimuli for the development of basic motor skills and cognitive performance (facilitating collaboration) All sessions included barefoot movements aimed at developing body awareness, balance, and coordination, starting with initial bows. The main part of the session consisted of nonspecific motor tasks aimed at improving cardiorespiratory fitness, strength, coordination, balance and flexibility (eg, gymnastic exercises such as somersaults, balance tasks, and jumps), and also included some karate-specific motor skills The final part of the session included stretching exercises, discussion about the class (eg, feelings, difficulties), and final bows | 1 y | Physical fitness test | Academic physical fitness (cardiorespiratory fitness, balance, and flexibility) | EXP small significant benefits for cardiorespiratory fitness (d = 0.36; P = .001), and balance (d = 0.24; P = .015) than CON A trend of significant benefits for flexibility (d = 0.24; P = .056) | A 1-y school-based karate intervention was effective in improving physical fitness in primary school children The results support the inclusion of karate during PE lessons |
| CON (n = 333) Habitual PE classes | |||||||||
| Eather et al49 | To evaluate the feasibility and efficacy of Fit4Fun program on the physical fitness and PA levels | No of children: 48 Schools: 2 Country: Australia Mean age: 10.9 (0.7) y Range: 5–6 y Level: primary Grade: 1 | EXP (n = 32) Fit4Fun | Session focus: (wk 1) Health-related fitness theory (wk 2) Cardiorespiratory (theory) (wk 3) Cardiorespiratory (practical) (wk 4) Muscular fitness (theory) (wk 5) Muscular fitness (practical) (wk 6) Flexibility (theory) (wk 7) Flexibility (practical) (wk 8) Improve health related fitness (All weeks) Home activities Health PE lessons, a break time activity program (recess and lunch), and a home fitness program | 8 wk One session per week for 60 min each | PedometerBattery of test (7-stage sit-up test, push-up test, basketball throw, wall squat, sit and reach, shoulder stretch, 20-m shuttle test, and height and weight) Questionnaires | Mean step/day Health-related fitness Attitudes toward fitness testing | EXP improved in most health-related fitness with significant group × time effects (P < .05) No significant group × time effect in the beep test, basketball throw, PA, or psychological variables CON did not display significant within-group effects for any measure | Fit4Fun was feasible and efficacious in improving muscular fitness and flexibility levels |
| CON (n = 17) The usual PE class | |||||||||
| Programs to Improve PA levels and FMS simultaneously | |||||||||
| Team sports | |||||||||
| Schmidt et al33 | To investigate the effects of 2 qualitatively different chronic PA interventions on executive functions | No of children: 181 Schools: NS Country: Switzerland Mean age: 11.35 (0.60) y Range: 10–12 y Level: primary | EXP (n = 69) High physical exertion and high cognitive engagement | High physical exertion and high cognitive engagement Team sports (floorball and basketball) High physical exertion and low cognitive engagement Aerobic exercise (marathon and circuits). Tried to maintain motivation with music Low physical exertion and low cognitive engagement Curricular requirements (fitness, athletics, gymnastics, dance, and team sports) | 12 lessons (45 min each) | (1) Cognitive assessment (executive functions, inhibition, and shifting) (2) Multistage 20-m shuttle run test | Cognitive function VO2max | Team games and aerobic-based interventions have positive impact on aerobic fitness (4%–5% ↑VO2max) An improvement in shifting performance in team sports, but not in the other 2 groups | The inclusion of cognitive engagement (team sports) in PA seems to be the most promising type of chronic intervention to enhance executive functions, providing further evidence for the importance of the qualitative aspects of PA |
| EXP (n = 57) High physical exertion and low cognitive engagement | |||||||||
| CON (n = 55) Low physical exertion and low cognitive engagement | |||||||||
| Miller et al37 | Evaluate the efficacy of PLUNGE in MVPA and FMS | No of children: 107 Schools: 1 Country: Australia Mean age: 10.7 (0.87) y Range: 9–12 y Level: primary Grade: 4, 5, and 6 | EXP (n = 52) PLUNGE | (1) Game play (small groups) (2) Moving targets (tactics) (3) Finding space (attack no ball) (4) Defense (personal tracking) (5) Attacking play (movement and decision making) (6) Attacking play (adaptation) For more information see Tables 1 and 237 | 6 wk | TGMD (second ed.) SOFIT | Throw/catch Decision making Support and skill performance In-class PA | Significant intervention effects (P < .05) for throw (ES: d = 0.9), catch (d = 1.6), decision making (d = 0.7), support (d = 0.9), and in-class PA (d = 1.6) | PLUNGE was efficacious in simultaneously improving students’ FMS, in-class PA, decision making, and support skills in game play |
| CON (n = 55) The Games and Sports strand of the syllabus | |||||||||
| Miller et al34 | Evaluate the efficacy of PLUNGE in FMS and PA | No of children: 168 Schools: 7 Country: Australia Mean age: 11.2 (1.0) y Range: 9–12 y Level: primary Grade: 4, 5, 6 | EXP (n = 97) PLUNGE | (1) Game play (small groups) (2) Moving targets (tactics) (3) Finding space (attack no ball) (4) Defense (personal tracking) (5) Attacking play (movement and decision making) (6) Attacking play (adaptation) For more information see Tables 1 and 237 | 6 wk | TGMD (second ed.) Pedometer | Throw/catch/kick Step count In-class PA | Significant intervention effects (all P < .05) object control competency (ES: d = 0.9) in-class step/min (d = 1.0) | PLUNGE was efficacious in simultaneously improving students’ object control FMS proficiency and in-class PA |
| CON (n = 71) The Games and Sports strand of the syllabus | |||||||||
| Community engagement | |||||||||
| Wright et al4 | To evaluate the impact of a program on low-income neighborhoods children’s PA | No of children: 251 Schools: 5 Country: United States Mean age: NS Range: 8–12 y Level: primary Grade: 3, 4, 5, and 6 | EXP (n = 165) Kids N Fitness© | Kids N Fitness© Two components: a family-centered education lifestyle program (PA and nutrition education) and school-level environmental activities in school (dietary changes, staff development, and health and mental health services) Intervention team: nutritionist, nurses, physiologist, and psychologist Weekly 45 min of structured PE class and 45 min nutrition education class for parents and children | 4 mo Kids N Fitness© (6 wk) 12-mo post intervention | The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Questionnaire | Daily PA | Significant results for students in the intervention, included for girls’ increases in daily PA | Utilize nurses to implement a culturally sensitive, coordinated, intervention to decrease disparities in activity and TV viewing among underserved girls and boys |
| CON (n = 140) General education (no PA or nutrition education) | |||||||||
| Nathan et al13 | To assess the impact of a multistrategy intervention designed to improve teachers’ implementation of a school PA policy on children PA levels | No of children: 1502 Schools: 12 Country: Australia Mean age: 8.01 (2.04) y Range: 6–10 y Level: primary Grade: 1, 2, 3, 4, 5, and 6 | EXP (n = 769) PA support only | Two initiatives: PA support to increase MVPA and lunchbox support (designed to support parents to improve nutritional quality) Policy implementation require schools to deliver 150 min of organized PA for students each week via PE, sport, or class-based activities such as energizers or active lessons Implementation strategies: mandate change, identify and prepare champions, develop and distribute education materials, conduct educational outreach visits, provide ongoing consultation, and centralized technical support | 9 mo | Accelerometers | MVPA Sedentary time Day counts Daily PA | EXP significantly increases in school day counts/min (97.5; 95% CI, 64.5 to 130.4; P < .001) and MVPA (3.0; 95% CI, 2.2 to 3.8; P < .001) and a greater decrease in sedentary time (−2.1; 95% CI, −3.9 to −0.4; P = .02) per school day Teachers in EXP schools delivered significantly more minutes (36.6 min) of PA to their students at follow-up (95% CI, 2.7 to 70.5; P = .04) | Supporting teachers to implement a PA policy improves student PA Additional strategies may be needed to support teachers to implement activities that result in larger gains in student MVPA |
| CON (n = 388) Lunchbox support only | |||||||||
| EXP (n = 554) PA and lunchbox support | |||||||||
| CON (n = 437) Usual PE | |||||||||
| Other intervention programs | |||||||||
| Sit et al12 | To examine the effects of FMS training program on motor functions and PA in children with developmental coordination disorder | No of children: 131 Schools: 3 Country: China Mean age: NS Range: 6–10 y Level: primary Grade: NS | EXP (n = 35 with coordination disorder; 29 with typical development) FMS training program | Training 5 FMS: running, jumping, catching, kicking, and throwing The program underlined an approach to motor learning that reduces the occurrence of errors during practice The difficulty progressively increases over time using: distance (horizontal distance in jumps, distance between target … ) objects size, and weight | 8 wk 1 session per wk (40 min) | Accelerometers Movement Assessment Battery for Children TGMD | PA Motor functions | Intervention improved FMS and increased PA and enjoyment Children with developmental coordination disorder showed greater enjoyment over time (in short and long term) | FMS training program has the potential to promote physical and psychological health in children with developmental coordination disorder in the long run |
| CON (n = 34 with coordination disorder; 33 with typical development) Usual PE classes | |||||||||
| Van de Fels et al36 | To compare the effects of aerobic vs cognitive-engaging interventions on cardiorespiratory fitness, motor skills, and MVPA | No of children: 891 Schools: 22 Country: the Netherlands Mean age: 9.2 (0.7) y Range 8–9 y Level: primary Grade: 3 and 4 | EXP 1 (n = 221) Aerobic intervention | Aerobic intervention The focus on MVPA, aiming to elicit high heart rate levels to promote aerobic fitness via playful forms of aerobic exercise that were highly repetitive and automated (eg, relays, running, individual exercises such as squats) Cognitively-engaging intervention Focused on challenging cognition and motor skills via games (eg, dodgeball and soccer) and exercises (eg, balancing, throwing, catching) that required complex coordination of movements, and that included complex and fast changing rules to engage children’s cognitive skills | 14 wk Four lessons per week | Accelerometer 20-m shuttle run test Gross motor skills (jump and moving sideways, backward balancing) | Cardiorespiratory fitness Motor skills MVPA | No main effect on cardiorespiratory fitness and motor skills, although MVPA was higher in aerobic than in cognitively engaging and CON Children with higher dose of MVPA within both EXP had better cardiorespiratory fitness after both intervention and better motor skills after the cognitively engaging intervention | The interventions were not effective to enhance cardiorespiratory fitness and motor skills at a group level, possibly due to large individual differences and total dose of MVPA too low to find effects. However, the amount of MVPA is an important factor that influence the effectiveness of interventions |
| EXP 2 (n = 240) Cognitively-engaging intervention | |||||||||
| CON (n = 430) | |||||||||
Abbreviations: ANT, The Attention Network Test; BMI, body mass index; CAS, The Cognitive Assessment System; CANTAB, The Cambridge Neuropsychological test battery; CON, control group; CHAM JAM, the Children’s Hospital at Montefiore Joining Academics and Movement; CI, confidence interval; CPRS:S, The Connor’s Parent Rating Scale; ES, effect size; EXP, experimental group; FMS, fundamental motor skills (eg, throw, catch); HIIT, high-intensity interval training; HR, heart rate; MVPA, moderate-to-vigorous physical activity; NS, not specified; PA, physical activity; PE, physical education; PLUNGE, the professional Learning for Understanding Games Education; SOCARP, The System for Observing Children’s Activity and Relationship during Play; SOFIT, the System for Observation of Fitness Instruction Time; TGMD, the Test of the Gross Motor Development.
Interventions to Prevent Illness and Injuries
| References | Aim | Sample | Intervention | Results | Highlights | ||||
|---|---|---|---|---|---|---|---|---|---|
| Group differences | Intervention main ideas | Duration | Test instrument | Variables | Results | ||||
| Weight gain and obesity | |||||||||
| Telford et al38 | To determine the effects of a program on the blood lipid concentrations | No of children: 708 Schools: 29 Country: Australia Mean age: 8.1 (0.3) y Range: 8–12 y Level: primary Grade: 3, 4, 5, and 6 | EXP (n = 457) Lessons from specialist-trained PE teacher | See Telford et al14 in Table 3 within this systematic review | 4 y | Venus’s blood | Fasting blood lipids | EXP > CON in MVPA ↓ LDL-C in EXP group at finish (14% vs 23%, P = .02) EXP effects on mean LDL-C in boys (P = .02), not in girls (P = .2) | The program reduces the incidence of elevated LDL-C in boys and girls |
| CON (n = 396) Usual practice PE from generalist classroom teacher | |||||||||
| Sahota et al6 | To assess the effect of an intervention in factors related to obesity | No of children: 637 Schools: 10 Country: England Mean age: NS Range: 7–11 y Level: primary Grade: NS | EXP (n = 314) APPLES | Teacher training, modification of school meals, and the development of school action plans targeting curriculum (PE, tuck shops, and playground activities) | 1 academic year (Sep–July) | Technology for growth measures (magnimeter stadiometer, etc) | BMI PA Diet Psychological state (well-being) | EXP had ↑ vegetable consumption (difference equivalent with baseline ↑ 50%) ↓ fruit consumption and ↑ sedentary behavior in overweight children from EXP No difference in BMI or dieting behavior | The program had little effect on children’s behavior other than a modest increase in consumption of vegetables It is premature to conclude that in was unsuccessful in reducing risk of obesity |
| CON (n = 322) Usual health curriculum | |||||||||
| Wright et al4 | To evaluate the impact of a program on low-income neighborhoods children’s BMI | No of children: 251 Schools: 5 Country: United States Mean age: NS Range: 8–12 y Level: primary Grade: 3, 4, 5, and 6 | EXP (n = 165) Kids N Fitness© | See Wright et al4 in Table 3 within this systematic review | 4 mo Kids N Fitness© (6 wk) 12-mo post intervention | The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Questionnaire | Anthropometric measures (height, weight, BMI, resting blood pressure, and waist circumference) | Significant results for students in the intervention, included for girls decreases in BMI z scores from baseline to the 12-mo follow-up | Utilize nurses to implement a culturally sensitive, coordinated, intervention to decrease disparities in activity |
| CON (n = 140) General education (no PA or nutrition education) | |||||||||
| Meyer et al28 | To assess the 3-y follow-up of a 9 mo program on body fat | No of children: 502 Schools: 15 Country: Switzerland Mean age: 8.7 (2.1); 11.1 (0.6) y Range: 6–7 and 11–12 y Level: primary Grade: 1 and 5 | EXP (n = 278) Jump and strength training | EXP had 2 PE lessons more than CON To the curriculum content quantity of at least moderately intense PA was provided Three to five short activity breaks (2 −5 min each) (eg, jumps with one leg) More information in the study protocol50 | Nine months intervention (immediate) + 3 y follow-up (long term) | Sum of 4 skinfolds | Body fat | EXP showed higher average level of fitness at follow up (P = .001) corresponding to shift from the 50th to the 60th percentile between baseline and follow-up Immediate effects were not sustained | Beneficial effects seen after 1 y were not maintained when intervention was stopped. A continuous intervention seems necessary to maintain overall beneficial health as reached at the end of the intervention |
| CON (n = 205) School curriculum | |||||||||
| Treviño et al21 | To evaluate the impact of a diabetes mellitus prevention program on low-income children | No of children: 1221 Schools: 27 Country: Mexico Mean age: 9.78 (0.51) y Range: 9–10 y Level: primary Grade: 4 | EXP (n = 619) Bienestar Health Program | Following some theories, 4 parameters impact health: personal factors (health knowledge and beliefs), social system (family, peers, and teachers), behaviors (dietary intakes and PA), and changing the physical context (classroom, playground, cafeteria, and home) Main idea is to provide 3 messages: (1) decrease dietary saturated fat intake, increase fiber intake, and increase PA. These behaviors were taught and reinforced in classroom, home, cafeteria, and after-school care education activities. The 4 components of the program cohesively addressed the individual, relevant social groups, culture, and a health promotion environment that supports behaviors consistent with diabetes mellitus prevention | 50 sessions Through 7 mo | Glucometer 24-h dietary recall protocol | Fasting capillary glucose concentration Body fat Physical fitness level Dietary fiber and saturated fat intake | EXP decreases fasting capillary glucose levels and increases in CON (−2.24 mg/dL [0.12 mmol/L]; 95% CI, −6.53 to 2.05 [−0.36 to 0.11 mmol/L]; P = .03) Fitness scores (P = .04) and fiber intake (P = .009) significantly increased in EXP and decreased in CON % fat (P = .56) and saturated fat intake (P = .52) did not differ significantly between EXP and CON | The Bienestar Health Program showed some positive effect. However, it was encouraged additional research to examine long-term benefits, translation, and cost-effectiveness |
| CON (n = 602) Usual practices | |||||||||
| Bone-health | |||||||||
| Meyer et al7 | To determine whether a PA program influences bone mineral content and density | No of children: 502 Schools: 28 Country: Switzerland Mean age: 8.7 (2.1); 11.1 (0.6) y Range: 6–7 and 11–12 y Level: primary Grade: 1 and 5 | EXP (n = 243) Jump and strength training | Intervention consisted in at least 10 min of jumping or strength training exercises of various intensities More information in the study protocol50 | 9 mo | Dual-energy X-ray absorptiometry | Body mineral content Body mineral density in femoral neck, total hip, and lumbar spine | EXP showed significant increases in body mineral content in all total body (5.5%), femoral neck (5.4%), and lumbar spine (4.7%) (all P < .05), and increases in body mineral density of total body (8.4%) and lumbar spine (7.3%) (both P < .01) | The intervention can increase bone health in both genders, particularly before puberty |
| CON (n = 134) School curriculum | |||||||||
| Daly et al8 | To investigate the effects of a specialist-taught PE program on bone strength and body composition | No of children: 727 Schools: 29 Country: Australia Mean age: 8.1 (0.3) y Range: 7–8 y Level: primary Grade: 2 at (start), 4, 6 (at finish) | EXP (n = 398) Specialized-led PE | Specialized-led PE consisted in a more MVPA combined with static and dynamic postural activities involving muscle strength Five key elements: core movements, coordination and agility, skill activities, movement challenges, and games and dynamic movement control | 100 min/wk 4 y (35 wk each) | SOFIT DEXA Peripheral quantitative computed tomography Stadiometer | Total body bone mineral content Lean mass Fat mass Radius and tibia bone structure Volumetric density and strength Muscle cross-sectional area | Gains in total body bone mineral content, fat mass, and muscle cross-sectional area were similar between the groups in both sexes, but girls in the EXP experienced a greater gain in total body lean mass (mean 1.0 kg; 95% CI, 0.2 to 1.9 kg) Compared to CON, girls in the EXP had greater gains in cortical area (5.0% [95% CI, 0.2% to 1.9%]) and cortical thickness (7.5% [95% CI, 2.4% to 12.6%]) and at the mid-tibia (cortical area, 9.3% [95% CI, 3.5% to 15.1%] and mid-radius (cortical thickness, 14.4% [95% CI, 6.1% to 22.7%]) EXP boys had a 5.2% (95% CI, 0.4% to 10.0%) greater gain in mid-tibia Cortical thickness EXP had no significant benefits of on total bone area, cortical density or bone strength at the mid-shaft sites or at the distal skeletal sites | Intervention improves cortical bone structure due to reduced endocortical expansion. This finding challenges the notion that periosteal apposition is the predominant response of bone to loading during the prepubertal and early-pubertal period |
| CON (n = 329) Habitual PE | |||||||||
| Fuchs et al39 | To investigate the effects of high-intensity jumping on hip and lumbar spine bone mass | No of children: 89 Schools: 2 Country: United States Mean age: NS Range: 5.9–9.8 y Level: primary Grade: 3 | EXP (n = 45) Jump training | Jump-based exercises One-hundred 2-footed drop landings off of a 61-cm boxes each session | 7 mo 3 times per wk | Dual-energy X-ray absorptiometry Ground reaction force was measured | Body mineral content Bone area Bone mineral density (All from the left proximal femoral neck and lumbar spine L1–L4) | EXP had significantly greater changes at the femoral neck (4.5%) and lumbar spine (3.1%) EXP had greater bone mineral density (2.0%) at the lumbar spine than CON and approached statistical significance at the femoral neck (1.4%; P = .085) EXP had significantly greater increases in bone area at the femoral neck area (2.9%) than CON, although not significant at the spine | Jumping at ground reaction forces of 8 times body weight is a safe, effective, and simple methods of improving bone mass at the hip and spine |
| CON (n = 44) Nonimpact stretching exercises | |||||||||
| Injuries | |||||||||
| Collard et al40 | To investigate the effects of a school-based PA-related injury prevention program on risk behavior and neuromotor fitness | No of children: 2210 Schools: 40 Country: Dutch Mean age: 10.7 (0.8) y Range: 10–12 y Level: primary Grade: 5 and 6 | EXP (n = 1015) iPlay | Monthly newsletter to improve knowledge about and attitude and self-efficacy toward the prevention of PA-related injuries Parents received monthly newsletter with knowledge and strategies to avoid injuries to their child Attractive posters were displayed in the classroom about injury prevention Provide access to an informative website about injury prevention for children and parents Five-minute exercises were given at the beginning and end of each PE class to improve muscle strength, speed, flexibility and coordination More information in the study protocol52 | One academic year | MOPER fitness test Questionnaire about injuries Stadiometer | Self-reported injury prevention behavior Self-reported behavioral determinants (knowledge, attitude, social-influence, self-efficacy, and intention) Neuromotor fitness Anthropometrics | iPlay not able to significantly improve injury preventing behavior Improved scores on attitude, social norm, self-efficacy, and intention were significantly related to changes in injury preventing behavior iPlay resulted in small nonsignificant improvements in neuromotor fitness in favor of EXP | iPlay did significantly improved behavioral determinants. However, this effect on knowledge and attitude was not strong enough to improve injury preventing behavior The results confirm that injury preventing behavior is determined by intention, attitude, social norm, and self-efficacy |
| CON (n = 996) Regular PE classes | |||||||||
| Mayorga-Vega et al41 | To examine effects of a stretching development and maintenance program on hamstring extensibility | No of children: 140 Schools: 1 Country: Spain Mean age: NS Range: 7–10 y Level: primary Grade: 3 and 4 | EXP 1 (n = 51) Stretching | EXP 1 First semester = 4-min stretching Second semester = 4-min stretching EXP 2 First semester = 4-min stretching Second semester = 1-min flexibility maintenance | 9 wk 2/wk 4 min each class (first semester) + 11 wk 2/wk (second semester) | Sit and reach test | Hamstring extensibility | EXP 1 and EXP 2 significantly (P < .001) improved hamstring extensibility. No significant differences between EXP 1 and EXP 2 | After a short-term stretching development program, a stretching maintenance program of only 1-min sessions twice a week is effective in maintaining hamstring extensibility. This knowledge could help and guide teachers to design programs that allow a feasible and effective development and maintenance of students’ flexibility in the PE setting |
| EXP 2 (n = 51) Stretching and maintenance | |||||||||
| CON (n = 49) Only test | |||||||||
| Pinto-Escalona et al32 | To investigate the effects of a karate intervention on physical fitness (balance and flexibility) | No of children: 721 Schools: 20 Country: 5 European countries Mean age: 7.4 (0.5) y Range: 7–8 y Level: primary Grade: 2 | EXP (n = 388) Karate Mind and movement program | The intervention provided sensory-motor stimuli for the development of basic motor skills and cognitive performance (facilitating collaboration) All sessions included barefoot movements aimed at developing body awareness, balance, and coordination, starting with initial bows. The main part of the session consisted of nonspecific motor tasks aimed at improving cardiorespiratory fitness, strength, coordination, balance and flexibility (eg, gymnastic exercises such as somersaults, balance tasks, and jumps), and also included some karate-specific motor skills The final part of the session included stretching exercises, discussion about the class (eg, feelings, difficulties) and final bows | 1 y | Physical fitness test | Physical fitness (balance, and flexibility, between others) | EXP small significant benefits for balance (d = 0.24; P = .015) than CON A trend significant benefits for flexibility (d = 0.24; P = .056) | A 1-y school-based karate intervention was effective in improving physical fitness (balance and flexibility) in primary school children The results support the inclusion of karate during PE lessons |
| CON (n = 333) Habitual PE classes | |||||||||
Abbreviations: APPLES, Active programme promoting lifestyle in schools; BMI, body mass index; CI, confidence interval; CON, control group; EXP, experimental group; LDL-C, low-density lipoprotein-cholesterol; MVPA, moderate-to-vigorous physical activity; NS, not specified; PA, physical activity; PE, physical education; SOFIT, the System for Observation of Fitness Instruction Time.
Interventions to Develop Psychological Factors
| Reference | Aim | Sample | Intervention | Results | Highlights | ||||
|---|---|---|---|---|---|---|---|---|---|
| Group differences | Intervention main ideas | Duration | Test instrument | Variables | Results | ||||
| Core executive function and academic achievement | |||||||||
| Pinto-Escalona et al32 | To investigate the effects of a karate intervention on academic achievement | No of children: 721 Schools: 20 Country: 5 European countries Mean age: 7.4 (0.5) y Range: 7–8 y Level: primary Grade: 2 | EXP (n = 388) Karate mind and movement program | The intervention provided sensory-motor stimuli for the development of basic motor skills and cognitive performance (facilitating collaboration) All sessions included barefoot movements aimed at developing body awareness, balance, and coordination, starting with initial bows. The main part of the session consisted of nonspecific motor tasks aimed at improving cardiorespiratory fitness; strength; coordination; balance; and flexibility (eg, gymnastic exercises such as somersaults, balance tasks, and jumps); and also included some karate-specific motor skills The final part of the session included stretching exercises, discussion about the class (eg, feelings, difficulties) and final bows | 1 y | Average grade | Academic performance | EXP small significant benefits for academic achievement (d = 0.16; P = .003) than CON | A 1-y school-based karate intervention was effective in improving academic achievement in primary school children The results support the inclusion of karate during PE lessons |
| CON (n = 333) Habitual PE classes | |||||||||
| De Bruijn et al42 | To compare the effects of aerobic vs cognitive-engaging interventions on academic skills | No of children: 891 Schools: 22 Country: the Netherlands Mean age: 9.17 (0.66) y Range: 8–9 y Level: primary Grade: 3 and 4 | EXP 1 (n = 221) Aerobic intervention | See Van de Fels et al36 in Table 3 within this systematic review | 14 wk Four lessons per week | Accelerometer Standardized test battery (spelling test was a dictation) | Reading Mathematics Spelling MVPA | Academic achievements of EXP 1, EXP 2, and CON did not significantly differ Higher volume of MVPA resulted in better mathematic achievement in EXP 1 and EXP 2, and better spelling in cognitive engaging group Compared to the CON, lower achievers in reading performed better in reading after the cognitively-engaging intervention | A combination of MVPA and cognitively-engaging exercises seem to have the most beneficial effects Future intervention studies should take into account quantitative and qualitative aspects of PA, and children’s baseline academic achievement |
| EXP 2 (n = 240) Cognitively-engaging intervention | |||||||||
| CON (n = 430) | |||||||||
| Takehara et al2 | To examine the effects of a high-intensity exercise intervention on academic achievement, cognitive function, physical fitness, and other health-related outcomes | No of children: 2301 Schools: 10 Country: Mongolia Mean age: 9.7 y) Range: NS Level: primary Grade: 4 | EXP (n = 1069) HIIT | Two phases: 6 wk with 20 min program with music; 4 wk with 10 min exercise program consisting of a 3 min main session and stretching. For the rest of the class, normal PE HIIT (jumps, squats, and various steps) CON (usual class: 10-min warm-up, 30 min activities such as small-sided team sport games, 5 min cooldown) | Twice over 10 wk Ten to twenty-five minutes class | Scores in national examination | Academic achievement | EXP members in an urban area showed an 8.36-point improvement (95% CI, 6.06 to 10.66) in academic scores when compared with CON, whereas those in a mixed residential area showed 9.55-point improvement (95% CI, 6.58 to 12.51) No injuries associated with intervention | The HIIT program significantly improves children’s academic achievement |
| CON (n = 1032) The usual PE class | |||||||||
| Fisher et al26 | To identify appropriate cognitive outcomes piloting a PE intervention | No of children: 64 Schools: 6 Country: Scotland Mean age: 6.2 (0.3) y Range: 5–6 y Level: primary Grade: 1 | EXP (n = 34) Aerobic intense PE | Teachers were encouraged to make sessions as physically active as possible, minimizing instruction time, and avoiding children were waiting to use equipment, or standing around. Minimize object control task CON make exercise based on object control task | 10 wk 1 h/wk | CANTAB ANT CAS CPRS:S | Psychological variables | No significant differences between groups in CAS scores Differences between EXP and CON in CANTAB (spatial span and spatial working memory errors) and ANT accuracy | The present study has identified practical and age-appropriate cognitive and behavioral outcome measures for future randomize controlled trials, and identified that schools are willing to increase PE time |
| CON (n = 30) Standard PE | |||||||||
| Meijer et al44 | To investigate the effects of an aerobic and a cognitive demanding exercise intervention on executive functions | No of children: 856 Schools: 22 Country: NS Mean age: 9.04 (0.59) – 9.30 (0.65) y Range: 8–9 y Level: primary Grade: 3 and 4 | EXP (n = 221) Aerobic exercise intervention | In some schools one EXP vs CON and in other schools the other EXP vs CON Aerobic program Activities specially designed to target MVPA while avoiding high-cognitive demands (highly repetitive and automated exercises such as circuits, relay games, playing tag, and individual exercises like running or squats) Cognitively demanding program Team games or exercises require complex coordination movements, strategical play, cooperation between children, anticipating the behavior of teammates or opponents, and dealing with changing task demands | 14 wk Four times per week | Wechsler Intelligence Scale for Children Attention network test Digit Span Grid Task Stop signal task Accelerometers | Neurocognitive function measures MVPA | No differences between EXP and CON Independently of groups, dose of MVPA positively correlate to verbal working memory and attention abilities | This intervention did not enhance executive functioning in children Exposure to MVPA is a crucial aspect of the relationship between PA and executive functioning |
| EXP (n = 240) Cognitively demanding exercise intervention | |||||||||
| CON (n = 430) Regular PE curriculum | |||||||||
| Chua et al43 | To investigate whether a 4-min sprint interval training protocol had an acute (15 min after) effect on improving alertness, mood, and memory recall in females | No of children: 63 children and 131 adolescents Schools: 2 Country: Singapore Mean age: NS Range: 9 −10 and 12–13 y Level: primary Grade: 5 | EXP (n = 52) Sprint interval training | Sprint interval training 3 × 20-s “all-out” effort sprints interspersed with 60-s intervals of walking (work: rest ratio 1:3) CON = group sat down and rested | 3 wk Two class per week | Alertness and mood single-item hedonic scale An adapted memory recall test | RAVRT Alertness scale | Four-minute sprint interval training did not have an acute main effect on improving alertness and memory recall in female children ( | Students’ exercise adherence and feedback from PE teachers are indicatives of the potential scalability of incorporating SIT into PE programs. Different work-to-rest ratios could be used in future studies |
| EXP (n = 55) Sit down and rested | |||||||||
| CON (n = 55) The usual program | |||||||||
| Psychosocial function, well-being, mental health, and enjoyment | |||||||||
| Pinto-Escalona et al32 | To investigate the effects of a karate intervention on psychosocial functioning | No of children: 721 Schools: 20 Country: 5 European countries Mean age: 7.4 (0.5) y Range: 7–8 y Level: primary Grade: 2 | EXP (n = 388) Karate Mind and movement program | The intervention provided sensory-motor stimuli for the development of basic motor skills and cognitive performance (facilitating collaboration) All sessions included barefoot movements aimed at developing body awareness, balance, and coordination, starting with initial bows. The main part of the session consisted of nonspecific motor tasks aimed at improving cardiorespiratory fitness, strength, coordination, balance and flexibility (eg, gymnastic exercises such as somersaults, balance tasks, and jumps), and also included some karate-specific motor skills The final part of the session included stretching exercises, discussion about the class (eg, feelings, difficulties), and final bows | 1 y | Strengths and difficulties Questionnaire for parents | Psychosocial functioning | EXP small significant benefits for conduct problems (d = −0.28; P = .003) than CON No significant benefits for other variables (psychosocial difficulties, emotional symptoms, hyperactivity/inattention, peer problems, and prosocial behavior; all P > .05) | A 1-y school-based karate intervention was effective in improving conduct problems in primary school children The results support the inclusion of karate during PE lessons |
| CON (n = 333) Habitual PE classes | |||||||||
| Olive et al11 | To determine the effect of a specialist-taught PE program on indicators of childhood mental health | No of children: 821 Schools: 29 Country: Mean age: NS Range: 8 y Level: primary Grade: 3 (at beginning), 4, 5, and 6 (when finished) | EXP (n = Not found) Program for improving mental health | This study was not found. Therefore, the details about intervention cannot be extracted | 4 y | DEXA Pedometer Tanner stages Questionnaires | Mental health indicators (depression, body image, and stress) %Body fat PA Puberty Socioeconomic status | EXP decreased depressive symptoms (−0.71), while CON increased (3.01) and a mean decrease in depressive symptoms (ineffectiveness), which was −0.27 units more than the control group (P = .005) Long-term effects revealed that the early positive effect of the intervention on body dissatisfaction and depression was not sustained over time. In fact, there was evidence of an intervention effect of an overall increase in depressive symptoms over the 4 y of the study for girls only | While our specialist-taught PE intervention had a positive influence on girls’ body dissatisfaction and boys’ depressive symptoms in the first year, this was not sustained over the 4-y duration of the study |
| CON (n = Not found) Habitual PE classes | |||||||||
| Chua et al43 | To investigate whether a 4-min sprint interval training protocol had an acute (15 min after) effect on improving alertness, mood, and memory recall in females | No of children: 63 children and 131 adolescents Schools: 2 Country: Singapore Mean age: NS Range: 9–10 and 12–13 y Level: primary Grade: 5 | EXP (n = 52) Sprint interval training | Sprint interval training 3 × 20-s “all-out” effort sprints interspersed with 60-s intervals of walking (work: rest ratio 1:3) CON = group sat down and rested | 3 wk Two class per week | Alertness and mood single-item hedonic scale An adapted memory recall test | Mood scale | Four-minute sprint interval training did not have an acute main effect on mood in female children ( | Students’ exercise adherence and feedback from PE teachers are indicatives of the potential scalability of incorporating SIT into PE programs. Different work-to-rest ratios could be used in future studies |
| EXP (n = 55) Sat down and rested | |||||||||
| CON (n = 55) The usual program | |||||||||
| Sahota et al6 | To assess the effect of an intervention in factors related to psychological factors | No of children: 637 Schools: 10 Country: England Mean age: NS Range: 7–11 y Level: primary Grade: | EXP (n = 314) APPLES | Teacher training, modification of school meals, and the development of school action plans targeting curriculum (PE, tuck shops, and playground activities) | 1 academic year (Sep–July) | Questionnaires (PA, psychology) | Psychological state (well-being) | No difference in psychological measures | The program had not well-being-related benefits in comparison with baseline |
| CON (n = 322) Usual health curriculum | |||||||||
| Wright et al4 | To evaluate the impact of a program on low-income neighborhoods children’s activity behaviors | No of children: 251 Schools: 5 Country: United States Mean age: NS Range: 8–12 y Level: primary Grade: 3, 4, 5, and 6 | EXP (n = 165) Kids N Fitness© | Kids N Fitness© Two components: a family-centered education lifestyle program (PA and nutrition education) and school-level environmental activities in school (dietary changes, staff development, health and mental health services) Intervention team: nutritionist, nurses, physiologist, and psychologist Weekly 45 min of structured PE class and 45 min nutrition education class for parents and children | 4 mo Kids N Fitness© (6 wk) 12-mo post intervention | The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Questionnaire | PA behavior (daily PA, participation in team sports, attending PE class, and TV viewing/computer game playing) | Significant results for students in the intervention, included for boys decreases in TV viewing; and girls increases in daily PA, PE class attendance from baseline to the 12-mo follow-up | Utilize nurses to implement a culturally sensitive, coordinated, intervention to decrease disparities in activity and TV viewing among underserved girls and boys |
| CON (n = 140) General education (no PA or nutrition education) | |||||||||
| Sit et al12 | To examine the effects of FMS training program on psychological outcomes in children with developmental coordination disorder | No of children: 131 Schools: 3 Country: China Mean age: NS Range: 6–10 y Level: primary Grade: NS | EXP (n = 35 with coordination Disorder; 29 with typical development) FMS training program | Training 5 FMS: running, jumping, catching, kicking, and throwing The program underlined an approach to motor learning that reduces the occurrence of errors during practice The difficulty progressively increases over time using: distance (horizontal distance in jumps, distance between target … ) objects size, and weight | 8 wk 1 session per wk (40 min) | Physical Self-descriptive Questionnaire Children’s Assessment of participation and Enjoyment | Self-perceived competence Enjoyment | Intervention improved enjoyment Children with developmental coordination disorder showed greater enjoyment over time (in short and long term) | FMS training program has the potential to promote psychological health in children with developmental coordination disorder in long run |
| CON (n = 34 with coordination Disorder; 33 with typical development) Usual PE classes | |||||||||
| Miller et al37 | Evaluate the efficacy of PLUNGE in enjoyment at PE | No of children: 107Schools: 1 Country: Australia Mean age: 10.7 (0.87) y Range: 9–12 y Level: Primary Grade: 4, 5, and 6 | EXP (n = 52) PLUNGE | See Miller et al37 in Table 3 within this systematic review | 6 wk | The enjoyment and PE questionnaire SOFIT | Enjoyment | Significant intervention effects (P < .05) for support (d = 0.9) No significant intervention effects for enjoyment (d = 0.1) | PLUNGE was efficacious in simultaneously improving students’ FMS, in-class PA, decision making, and support skills in game play |
| CON (n = 55) The Games and Sports strand of the syllabus | |||||||||
| Harris et al27 | To determine the feasibility of delivering curriculum connected HIIT in PE time | No of children: 84 Schools: 2 Country: New Zealand Mean age: 11.9 (0.5) y Range: 10–13 y Level: primary Grade: 5 and 6 | EXP (n = 53) HIIT | HIIT intensity was 89.6% of the predicted maximum Work: rest ratio 30 s:30 s Session lasted 15 min at the beginning of the class | 8 wk Two class per week accounting for a statutory holiday | Observations using psychological checklist as a guide | Psychological variables (supportive, active, autonomous, fair, and enjoyable) | Positive satisfaction for teachers and all students | Teacher delivered HIIT program was feasible and acceptable to both teachers and students. It is therefore potentially scalable |
| CON (n = 31) The usual practice | |||||||||
| Miller et al34 | Evaluate the efficacy of PLUNGE in perceiving sporting competence | No of children: 168 Schools: 7 Country: Australia Mean age: 11.2 (1.0) y Range: 9–12 y Level: Primary Grade: 4, 5, and 6 | EXP (n = 97) PLUNGE | See Miller et al34 in Table 3 within this systematic review | 6 wk | The athletic competence subscale | Perceiving sporting competence | No significant intervention effects for perceiving sporting competence (P > .05) | PLUNGE was no efficacious for improving perceiving sporting competence |
| CON (n = 71) The Games and Sports strand of the syllabus | |||||||||
| Collard et al40 | To investigate the effects of a school-based PA-related injury prevention program on risk behavior and neuromotor fitness | No of children: 2210 Schools: 40 Country: Dutch Mean age: 10.7 (0.8) y Range: 10–12 y Level: primary Grade: 5 and 6 | EXP (n = 1015) iPlay | See Collard et al40 in Table 4 within this systematic review | One academic year | MOPER fitness test Questionnaire about injuries Stadiometer | Self-reported injury prevention behaviorSelf-reported behavioral determinants (knowledge, attitude, social influence, self-efficacy, and intention) Neuromotor fitness Anthropometrics | iPlay significantly improve knowledge and attitude (2 determinants of behavior). The effect of the program on behavior appeared to be significantly mediated by knowledge and attitude Improved scores on attitude, social norm, self-efficacy, and intention were significantly related to changes in injury preventing behavior | iPlay did significantly improved behavioral determinants The results confirm that injury preventing behavior is determined by intention, attitude, social norm, and self-efficacy |
| CON (n = 996) Regular PE classes | |||||||||
Abbreviations: ANT, The Attention Network Test; CANTAB, The Cambridge Neuropsychological test battery; CAS, The Cognitive Assessment System; CI, confidence interval; CON, control group; CPRS:S, The Connor’s Parent Rating Scale; EXP, experimental group; FMS, fundamental motor skills (eg, throw, catch); HIIT, high-intensity interval training; MOPER, Motor Performance Test; MVPA, moderate-to-vigorous physical activity; NS, not specified; PA, physical activity; PE, physical education; PLUNGE, the professional Learning for Understanding Games Education; RAVRT, the Rey Auditory Verbal Memory Recall test; SOFIT, the System for Observation of Fitness Instruction Time.
Interventions to Improve PS Levels and FMS
Descriptive information: Seventeen articles were found. However, a subdivision was made depending on the type of program and its effects. In 10 articles, the effect on physical fitness was analyzed. All of them were divided depending on the intervention main ideas: intensive interval training,25–27 jumping and strength,28,29 teaching styles,14,30,31 and other.18,32 On the other hand, 7 articles showed effect on both PA level and FMS. Depending on the intervention type, they were divided among: team sports-based interventions,33–35 community engagement,4,13 and others.12,36
Qualitative synthesis: All studies that analyzed the effects of intensive interval training identified positive effects in some of the metrics.25–27 Jumping and strength programs are effective in 2 studies,28,29 although no immediate effects were declared.28 Regarding teaching styles, the studies showed positive effects in PA level in 2 studies,14,31 but did not in another one.30 A community-based approach in schools has shown positive effects.4,13 Finally, involving students in activities with greater cognitive function have shown positive effects to improve FMS.33,34,36,37
The Effect of School-Based Intervention Programs on Illness and Injury Prevention
Descriptive information: Eleven articles were found. However, a subdivision was made depending on the type of program and its effects: weight gain and obesity prevention programs,4,6,21,28,38 bone health-related programs,7,8,39 and injury prevention programs.32,40,41
Qualitative synthesis: Five studies reported positive effects in weight gain or other obesity-related variables,4,6,21,28,38 although in 1 study premature conclusions are declared.6 Three studies reported positive effects of jump and strength exercises in bone health.7,8,39 Finally, 3 studies declared that inclusion of stretching or balance exercises had positive effects in the prevention of muscle injuries.32,40,41
The Effect of School-Based Intervention Programs on Psychological Factors
Descriptive information: Fourteen articles were found. However, a subdivision was made depending on the type of program and its effects: the effects of intervention programs on cognitive executive function or academic performance2,26,32,42–44 and the effects of intervention programs on psychosocial function, well-being, mental health, and enjoyment.4,6,11,12,27,32,34,35,40,43
Qualitative synthesis: PE have positive effects in cognitive functions and academic achievement,2,26,32,42 although, depending on the test used for assessment, one of them did not find positive effects.26 However, 2 studies did not report differences between groups.43,44 On the other hand, regarding psychosocial function, well-being, mental health, and enjoyment, 7 studies found positive effects after the main intervention in some of the considered metrics,4,11,12,27,32,37,40 while 4 studies did not.6,32,34,43
Discussion
The present article aimed to systematically summarize primary school-based intervention programs and their effects evaluated through RCT design. The main findings were: (1) intensive interval training may positively influence children’s physical fitness, even in a period of 8 to 10 weeks with short bouts of exercise at the beginning of the PE classes; (2) jump- and strength-based exercises may be beneficial for children in elementary school, at least, with interventions lasting 8 months; (3) teaching styles related to psychological needs, challenging tasks, and guided styles have shown positive effects in PA levels; (4) providing theoretical information about health and nutrition, involving children’s social environment (eg, parents, teachers), and changing the physical context (classroom, playground, school cafeteria, and home) may be beneficial in PE classes, at least, when used together with school-based interventions; (5) games that demand more cognitive function (eg, team sports) seem more beneficial than exercises based on repetitive aerobic exertion to improve FMS; (6) jumping (impact) and strength exercises are beneficial to develop bone area and bone mineral density; (7) flexibility and balance-based interventions are suitable to reduce muscle-related injuries; and (8) programming a greater dose of moderate-to-vigorous PA (MVPA) seems to be related to positive effects in core executive function and academic performance.
PE is involved in a great challenge aimed at making every child physically, mentally, and emotionally fit, in addition to developing intrapersonal and interpersonal qualities that will help them to live happily with others.9 In this scenario, school-based PE programs are a key opportunity to improve children’s PA. The present article aimed to systematically summarize primary school-based interventions under RCT design, providing a mark of reference to PE teachers and researchers on the topic under solid scientific evidence. Following the coherence with the tables’ main distribution and subsections, works have been divided into: (1) interventions to improve physical fitness, PA levels, and FMS, (2) interventions to reduce the risk of illness or prevent injuries, and (3) interventions to develop psychological aspects.
The Effect of School-Based Intervention Programs on Physical Fitness, PA Level, and FMS
The Effects of High-Intensity Interval Training on Physical Fitness
A growing body of literature has highlighted the positive effects of interval training on physical fitness parameters in different populations,45 and school-age children are not an exception.25–27 The main appeal of high-intensity interval training (HIIT) is that it can be completed in a short period of time (compared to others based on aerobic training), while resulting in equivalent physiological adaptations.45
At the elementary school level, Reznik et al25 designed the CHAM JAM program, recruiting 988 children for an experimental group (EXP) and a control group (CON) for 3 times/week during 2 months. During the intervention, EXP did interval training, while CON continued with usual PE classes. The results showed that EXP achieved a greater mean number of steps than CON (2839 [SD, 1262] vs 2545 [SD, 1153]; P = .0048), being equally effective independently of gender, grade within elementary education, or morphology. Similarly, Fisher et al26 recruited 64 students into an aerobic intense group (EXP), who performed 1 hour per week of training for 10 weeks, and a standard PE group (CON). The findings showed significantly better improvements in PA in EXP than in CON (P < .0001). In a third study, Harris et al27 recruited 84 children from fifth and sixth grades, and involved them in 15 minutes of HIIT twice a week for 2 months. The results showed a trivial difference between groups for cardiorespiratory fitness (effect size 0.02).
In summary, these studies suggested that intensive interval training may positively influence children’s physical fitness, even in a period of 8 to 10 weeks with short bouts of exercise at the beginning of the PE classes, allowing its compatibility with the syllabus. However, it is of interest to train teachers to facilitate the HIIT sessions using supportive, active, autonomous, fair, and enjoyable delivery principles27 to boost its benefits.
The Effects of Jumping and Strength-Based Interventions on Physical Fitness
Following the previous idea of short bouts in programs, jumps and strength exercises have been highlighted as effective in elementary education.28,29 In this regard, Meyer et al28 recruited 502 children into EXP and CON. Both groups participated in PE classes (following the school curriculum), but EXP did 2 lessons more than CON for 9 months, where the participants performed 3 to 5 short activity bouts (2–5 min each) of exercise (eg, jumping on 1 leg). The results showed an immediate higher average level of fitness at follow-up in EXP than in CON (P = .001), although it was not sustained at a 3-year follow-up. The results of immediate effects were supported in a second study, where Escriva-Boulley et al29 analyzed the effectiveness of jumping and strength training in PA levels with a sample of 293 children for 8 months. In this study, the teacher from EXP adopted a need-supportive (ie, autonomy, support, structure, and involvement) and 3 need thwarting (ie, control, chaos, and hostility) motivation styles. The results demonstrated that the MVPA of EXP students increased, while the MVPA of CON students decreased.
Therefore, 2 RCTs supported that jump- and strength-based exercises may be beneficial for children in elementary school, at least with interventions lasting 8 months, where motivation styles taking care of psychological needs may boost their effect. As a piece of advice, to achieve adherence to PA through motivation may be of special interest since the benefits were not sustained once the intervention had finished.28
The Effects of Teaching Styles on Physical Fitness
Beyond these studies that analyzed some teaching styles during the main intervention, 3 studies considered the effects of teaching styles as a main independent variable on physical fitness, which may be interesting for PE teachers because of the possibility to combine them with another intervention program and boost their positive effects.
In this respect, Crotti et al30 recruited 360 children during 15 weeks, administering different pedagogical models: linear pedagogy (repetition of a standard with continuous feedback), nonlinear pedagogy (task variability and children exploration), and usual PE program (CON). However, PE interventions based on linear and nonlinear pedagogies alone might not be effective in improving habitual PA in children, measured through MVPA and acceleration variables.30 In the line of these pedagogies, Coolkens et al31 examined the effect of supervised (free to play) and organized (teacher provide challenging task) recess, but in this case with positive effects. Especially, the results showed how children spent more time in activity games during organized than supervised recess (59% vs 46%, P = .01; 59% vs 47%, P = .001). These findings highlight that an organized recess attracted more children and made the largest contribution to daily MVPA.
On the other hand, Teldford et al14 investigated the effect of a program guided by a specially trained teacher using the guided discovery teaching style. The program lessons were game play, fitness activities, skill practice, and core movement, and lasted for 4 years with two 45-minute sessions per week. The results showed 6.5 minutes more at MVPA (16.7 vs 10.2, P < .001). Although the intervention increased steps in the days when the program was carried out, it did not increase habitual steps when the groups were compared. It is of interest that when EXP children were 11 years old they were 20 minutes less sedentary than CON children. Well-designed specialist-taught PE can improve students’ PA during classes, but not improve habitual PA. It suggests the need of daily classes, maybe with a wider multicomponent strategy.
Thus, in addition to the aforementioned motivation styles taking care of psychological needs, and although the effects of teaching styles on physical fitness and activity level are not clear, a slight trend leads the author to conclude that guided styles (guided discovery or organized recess) could induce greater PA levels. However, future studies are necessary for free-play styles because they did not achieve positive changes.
The Effects of Other Interventions on Physical Fitness
Some other interventions have been designed to enhance physical fitness. Pinto-Escalona et al32 designed one academic year of a karate and mind movement program, dividing 721 children into EXP (n = 388) and CON (n = 333). The results showed that EXP achieved small significant benefits for cardiorespiratory fitness (d = 0.36; P = .001), together with other benefits such as balance and flexibility that will be discussed in the next section. Interestingly, Eather et al18 designed the Fit4Fun program focused on health-related fitness, cardiorespiratory fitness, muscular fitness, and flexibility. Unlike other programs, these authors provided theoretical lessons and home activities, in addition to the practical PA. The results showed that EXP improved in most health-related fitness parameters with significant group × time effects (P < .05), but not in the beep test, basketball throw, and PA. Therefore, these programs may enhance PA level, although the duration of 8 weeks of Fit4Fun and the nonsignificant group per time effect in some variables may question if longer programs may induce greater effects.
The Effects of Team Sports-Based Interventions on PA Level and FMS
Working collaboratively with and through groups of people may encourage children along the road to greater participation in PA.22 In this line of thought, Schmidt et al33 tried to compare the effectiveness of team sports, as high-cognitive stimuli and high-exercise exertion practice, to repetitive aerobic exercises (high physical exertion, but low cognitive demand), and to low physical exertion and low cognitive demanding exercises. The results showed that children involved in both high physical exertion groups had a positive impact on aerobic fitness in the children involved (4%–5% ↑VO2max). However, those that participated in team sports experienced improvements in shifting performance (executive functions), while CON did not. Miller et al34 proposed the PLUNGE program based on game play, team tactics, and decision making. The results showed significant intervention effects (P < .05) for throwing (effect size: d = 0.9), catching (d = 1.6), decision making (d = 0.7), support (d = 0.9), and in-class PA (d = 1.6).34 These results were supported by the other study, where the authors found significant intervention effects (all P < .05) in object control competency (effect size: d = 0.9) and in-class step/minute (d = 1.0).37
Thus, team sports-based interventions are suitable to develop physical fitness and PA levels in primary school children through PE interventions.
The Effects of Community Engagement on PA Level and FMS
Regarding team sports, the positive benefits in working collectively may be enhanced by engaging school agents in a school community.22 In fact, it has been highlighted that social cognitive and social ecological theories are necessary to complete the Bienestar Health Program.21 Thus, the Fit4Fun program was based on 2 components: a family-centered education lifestyle program (PA and nutrition education) and school-level environmental activities in school (dietary changes, staff development, health, and mental health services). As a result of this intervention program, the participants in EXP experienced a significant influence in daily PA.4 On the other hand, Nathan et al13 based the intervention on 2 initiatives: PA support to increase MVPA and lunchbox support (designed to encourage parents to improve nutritional quality). The results in this study showed significant increases in school day counts/minute (97.5; 95% confidence interval [CI], 64.5 to 130.4; P < .001) and MVPA (3.0; 95% CI, 2.2 to 3.8; P < .001) and a greater decrease in sedentary time (−2.1; 95% CI, −3.9 to −0.4; P = .02) per school day. In addition, teachers in EXP schools delivered significantly more minutes (36.6 min) of PA to their students at follow-up (95% CI, 2.7 to 70.5; P = .04).13
Therefore, according to the guidelines, theoretical information about health and nutrition, involving children’s social environment (eg, parents, teachers), and changing the physical context (classroom, playground, school cafeteria, and home) may be quite beneficial to complement a school-based intervention.
The Effects of Different Interventions on PA Level and FMS
Interestingly, some programs support the improvements of PA levels together with FMS. For example, Sit et al12 allocated 131 children into EXP (n = 35 and 29 with coordination disorder) and CON (n = 34 and 33 with coordination disorder). The program proposed training based on the 5 FMS (running, jumping, catching, kicking, and throwing). The findings showed improvements in EXP in both FMS and PA level, highlighting short- and long-term benefits in children with coordination disorders. In a second proposal, Van der Fels et al36 showed the effect of complex exercises such as team sports (high-cognitive engagement) that may induce lower MVPA than aerobic exercises (repeated drills that did not demand high cognitive engaging), but may boost the development of FMS. Therefore, both high-cognitive engaging and high physical exertion exercises may induce improvements in PA level, while the first option may boost the development of FMS.
The Effect of School-Based Intervention Programs on Illness and Injury Prevention
Greater PA is especially important during childhood to avoid both short- and long-term negative consequences. Among others, increasing PA could reduce cardio metabolic risk, improve quality or life, and reduce all-cause mortality.15
Weight Gain and Obesity Prevention Programs
Childhood obesity has become a global pandemic aggravated after COVID-19,46 with a greater incidence in some places such as low-income communities.4,21 Interestingly, some forecasting classified an excess body weight during early ages as a predictor of obesity, morbidity, and even mortality in adult life,5 and an elevated blood lipid during childhood as a predictor of dyslipidemia in adults.38 Considering that not all children participate in extracurricular activities,15,17 PE is a unique opportunity to involve them in doing exercise. Therefore, there is a need to support PE teachers in this aim, summarizing the intervention programs applied in PE.5
Among the RCT aimed to prevent weight gain, Telford et al38 proposed the Bluearth Approach in 2 classes per week during 4 years. The main idea of the program was focused on game play using guided discovery as the teaching style, although it included fitness activities, skills practice, and core movements. As a result, EXP showed greater MVPA than CON (23% vs 14%, P = .02), leading to a greater decrease in low-density lipoprotein-cholesterol. Interestingly, positive effects were also seen by Meyer et al28 in a shorter time period of 9 months. These authors proposed 3 to 5 short activity bouts (2–5 min) per week where they perform jumps or strength training (eg, jumping on one leg). After this period, children in EXP experienced a shift from the 50th to the 60th percentile, but did not experience continued positive effects after 3-year follow-up.
Fortunately, the Bluearth Approach and jump/strength training can be easily implemented, even transversally, during different didactic units. However, a current intervention trend includes coordinated school programs as another interesting way, with the main idea of community engagement. In this respect, Wright et al4 proposed Kids N Fitness© during an academic course, where in addition to PA (eg, prepare champions, conduct educational outreach), a lunchbox was organized to inform parents about how to improve the nutritional quality of children’s food. Interestingly, EXP achieved decrements in body mass index scores, mainly in the girls. The second alternative was proposed by Treviño et al.21 In this case, the authors designed a community-engaged program (Bienestar Health Program) based on 4 components that should be cohesively addressed: (1) personal factors (health knowledge), social system (family, peers, and teachers), behaviors (dietary intakes and PA), and changing the physical context (classroom, playground, cafeteria, and home). The results showed that EXP decreased fasting capillary glucose levels, while CON increased these levels (−2.24 mg/dL [0.12 mmol/L]; 95% CI, −6.53 to 2.05 [−0.36 to 0.11 mmol/L]; P = .03). In addition, the program led to an increase in fiber intake in EXP and a decrease in CON (P = .009). Therefore, PE teachers may consider PA programs which follow the previously mentioned social cognitive theory and social ecological theory to improve health-related knowledge. However, not all community engagement programs have been very successful. In the case of APPLES, the authors included teacher training, modification of school meals, and the development of school action plans targeting curriculum (PE, tuck shops, and playground activities). Unlike others, children did not experience improvements in body mass index. Moreover, the EXP showed greater vegetable consumption (50% more than in baseline children), although it was not the case of overweight children from EXP who reduced their fruit consumption and increased their sedentary behavior.6 However, the author declared that it is premature to conclude that it was unsuccessful in reducing the risk of obesity.
In brief, the Bluearth Approach and jump/strength training, as well as community engagement programs may result in interesting programs for PE teachers to implement. However, they should focus on overweight students who could experiment lower improvements.
Bone Health-Related Programs
PE may induce some changes in children’s anatomy that will be beneficial in adulthood.7,8 The convergence of 2 factors that greatly promote bone health has been highlighted: (1) the critical period of bone accrual during childhood and (2) the importance of bone loading through specific PA. In fact, some authors alluded to the possibility that adult osteoporosis has its antecedents in childhood, underlining the necessity of well-designed school-based interventions for preventing osteoporosis in mature adults.47
To date, 3 RCTs have been carried out, mainly focusing on jumps and muscle strength training.7,8,39 Daly et al8 assigned 398 children from the second grade to EXP and 329 to CON before a program. During 4 years, EXP followed a specialized-led PE consisting of more MVPA combined with postural activities involving muscle strength, while CON continued with habitual PE. The results showed that girls in the EXP had greater gains in cortical area (5.0%; [95% CI, 0.2% to 1.9%]) and cortical thickness (7.5% [95% CI, 2.4% to 12.6%]) and at the mid-tibia (cortical area, 9.3% [95% CI, 3.5% to 15.1%] and mid-radius (cortical thickness, 14.4% [95% CI, 6.1% to 22.7%]), while EXP boys had a 5.2% (95% CI, 0.4% to 10.0%) greater gain in mid-tibia cortical thickness. The improvements in cortical bone structure may be reduced endocortical expansion. The authors challenge the notion that periosteal apposition is the predominant response of bone to loading during the prepubertal and early-pubertal period.8 Similarly, Meyer et al7 divided 502 children into EXP and CON, who continued with the usual school curriculum. The results after 10 minutes of these types of exercises at the beginning of PE classes for 9 months induced significant increases in body mineral content in total body (5.5%), femoral neck (5.4%), and lumbar spine (4.7%; all P < .05), and increases in body mineral density of total body (8.4%) and lumbar spine (7.3%; both P < .01). Finally, Fuchs et al39 involved 89 third-grade children in jump training (EXP) and nonimpact stretching exercises (CON) in 3 classes per week for 7 months. The dual-energy X-ray absorptiometry revealed a significantly greater change at the femoral neck (4.5%) and lumbar spine (3.1%), greater bone mineral density (2.0%) at the lumbar spine than CON, and approached statistical significance at the femoral neck (1.4%; P = .085). In addition, EXP had significantly greater increases in the bone area at the femoral neck area (2.9%) than CON, although not significant at the spine.
In brief, PE teachers may program jumping (impact) and strength-based exercises to increase bone health in both genders, particularly before puberty, for reducing the risk of osteoporosis in adult life.
Injury Prevention Programs
At the muscle and joint level, school-based PE interventions could act as a prevention PA to reduce the risk of muscular injuries. Mayorga-Vega et al41 assigned 140 children to first EXP (one academic year of 4-min stretching), the second EXP (one semester of stretching + 1 semester of maintenance through 1 min stretching), and CON (no activity, only tests). Analyzing with the sit and reach test, both EXP significantly improved hamstring extensibility (P < .001), but they did not find significant differences between EXP 1 and EXP 2. Similarly, Pinto-Escalona et al32 designed a sensory-motor stimuli program (including karate intervention) for one academic year. The results showed significant benefits for both balance (d = 0.24; P = .015) and flexibility (d = 0.24; P = .056) in the children from EXP compared with those from CON, although they were small. Additionally, Collard et al40 designed the iPLAY program based on weekly 5-minute exercise and other informational strategies such as monthly newsletters for parents and children or posters in the school trying to improve knowledge about attitude and self-efficacy toward the prevention of PA-related injuries. The results showed that the iPLAY resulted in small nonsignificant improvements in neuromotor fitness in favor of EXP, suggesting the implementation of some strategies to induce new outcomes.
Therefore, neuromuscular injury-related episodes may be reduced with interventions based on flexibility (at least one semester followed by a maintenance period) and balance, and although a communityapproach could be of interest, a monthly newsletter and posters were not effective enough in combination with 5-minute exercise at the beginning and the end of each PE class. Further studies may assess the use of these community-engaged strategies with longer activity breaks or with balance/flexibility-based exercises.
The Effect of School-Based Intervention Programs on Psychological Factors
The World Health Organization provides recommendations to maintain PA at school age, not only to achieve physical benefits, but also psychological improvements.2
The Effects of Intervention Programs on Cognitive Executive Function or Academic Performance
One of the mental benefits that have been found is the improvement of core executive function. This term refers to higher cognitive processes that allow children planning, forethought, and goal-directed action. According to current theories, performance on complex executive tasks is underpinned by 3 core executive functions: working memory (ability to keep and update information in mind), inhibition (select task-relevant and goal-directed information rather than habitual actions or prepotent responses), and flexibility (ability to shift between cognitive rules or modes of thought).48 With this aim, Fisher et al26 recruited 64 students from the first grade (EXP = 34; CON = 30) and programmed 1 hour per week of intense aerobic PE classes for EXP, while CON performed standard PE. The Cognitive Assessment System Test scores, the Attention Network Test, and the Cambridge Neuropsychological Test Battery revealed differences in EXP in spatial span and spatial working memory errors, as well as in attention accuracy.26 Hence, although more studies are necessary in this line, the effect of PA on these factors may suppose the main rationale for those studies that have found a positive impact of PE and academic achievements.2,32,42
In this sense, one academic year of a karate-based movement program achieved small significant benefits for academic achievement in EXP compared with CON (d = 0.16; P = .003). But, although the outcomes supported this practice to enhance academic achievement, higher intensity/volume exercise has resulted in clearer results. For example, De Bruijn et al42 divided a sample of 891 third and fourth grade students into EXP 1 (aerobic intervention), EXP 2 (cognitively-engaging exercises, for example, team sports, exercises with complex coordination and fast-changing rules to engage cognitive skills), and CON (habitual PE classes). The results showed a higher volume of MVPA resulted in better mathematical achievement in EXP 1 and EXP 2, and better spelling in the cognitively engaged group. In addition, PE teachers, with the intention of designing a school-based interdisciplinary program, may involve lower achievers in reading in cognitive-engaging exercises because it seems effective for them.42 Another study with the same group distribution was made by Meijer et al44 who, although they did not find differences between groups in overall neurocognitive function, highlighted a dose of MVPA positively correlated to verbal working memory and attentional abilities independently of groups. Furthermore, Takehara et al2 supported the consideration that PA to enhance academic achievement may be useful for schools located in urban areas since they achieved a 8.36-point improvement (95% CI, 6.06 to 10.66, when compared with CON) after 10 weeks of a 10- to 25-minute class based on HIIT. However, a HIIT-based intervention seems quite beneficial for students in mixed residential areas (showed 9.55-point improvement [95% CI, 6.58 to 12.51]). The consideration of 4-minute HIIT seems not to have an acute main effect on improving alertness and memory recall in fifth-grade girls (
Therefore, PE could induce improvements in core executive function or academic performance in primary schools, especially when programming a greater dose of MVPA. However, although some programs have found positive benefits in some cognitive function variables at the initial stages of primary education with 1 hour per week of aerobic exercise, another RCT indicated nonshort-term effects (3 wk) considering three 60-second series and 20 of rest (work: rest ratio 1:3). Thus, future studies should assess if the dose–response relationship should be relative to the grade to improve cognitive executive function or academic performance.
The Effects of Intervention Programs on Psychosocial Function, Well-Being, Mental Health, and Enjoyment
High-intensity exercises not only may be beneficial for academic achievement, but also for psychological needs such as support, active, autonomous, fair and enjoyment.12,27,37 In fact, Harris et al27 found positive satisfaction in fifth- and sixth-grade participants after 8 weeks (2 classes/week) of 15 minutes of HIIT at the beginning of each PE class. But in addition to this type of training, the implementation of exercise based on 5 FMS (ie, running, jumping, catching, kicking, and throwing) could improve enjoyment, even in children with developmental coordination disorder, in the short and long term. In another RCT, Chua et al43 concluded that the implementation of HIIT during a short period of 3 weeks seems not to induce changes in the fifth-grade girls’ mood. Thus, the effectiveness of a HIIT-based program with a duration of less than 8 weeks has not been assessed. Therefore, although the short intervention program may not induce benefits, Olive et al11 found that in a 4-year mental health-based program, the benefits such as a reduction of depressive symptoms that EXP experienced (−0.71) while CON recorded increases (3.01) were only shown in the first year (P = .005), at least in the boys. Therefore, future studies should analyze the effective duration of a mental health program on elementary education children, while for the moment one academic year seems effective but 3 weeks is not sufficient.
Again, involving the school in a community seems to be effective. Sahota et al6 did not find psychological well-being changes after one academic year program that modified school meals and the school action plans targeting curriculum (PE, tuck shops, and playground activities). However, involving agents out of schools seems effective after 4 months of the Kids N Fitness© program.4 This program was based on 2 components: a family-centered education lifestyle program (PA and nutrition education classes; one class of 45 min weekly) and school-level environmental activities in school (dietary changes, staff development, health, and mental health services). This program has resulted in significant results for students in EXP, including decreases in TV viewing for boys and increases in daily PA for girls from baseline to the 12-month follow-up. Pinto-Escalona et al32 designed a karate-based 1-year intervention. The authors showed small significant benefits for the conducting problems variable in EXP compared to CON (d = −0.28; P = .003), while no significant benefits were found for other variables (psychosocial difficulties, emotional symptoms, hyperactivity in attention, peer problems, and prosocial behavior [all P > .05]). Therefore, although slight clues may lead to future interventions in PE, a systematic review of the influence of PE in emotional intelligence is needed to highlight how teachers may develop children’s personalities.
Conclusions and Practical Applications
Nowadays, PA is one of the leading modifiable causes of death and disease. School-based PE programs are a key opportunity to improve children’s PA. However, there is a lack of evidence about how pedagogical approaches might affect health-related parameters in primary school-aged children. Due to the variety of articles found, these works have been divided into: (1) interventions to improve PA levels and FMS, (2) interventions to reduce the risk of illness and improve injury prevention, and (3) interventions to develop psychological aspects.
Physical Activity Level and Fundamental Motor Skills
The implementation of short bouts of activity based on intensive interval training at the beginning of PE classes during 8 to 10 weeks may positively influence children’s PA level, as well as the implementation of jump- and strength-based exercise, which seems to be effective, at least for programs lasting for 8 months. The effects of these interventions may be boosted with teachers leading classes with motivation styles based on children’s psychological needs, challenging tasks, or guided styles. Complementarily, community-engaged programs which sustain the social cognitive and social ecological theories to involve theoretical information about health and nutrition, the participation of children’s social environment (eg, parents, teachers), and changes in the physical context (classroom, playground, school cafeteria, and home) are suitable programs to enhance benefits. Finally, although aerobic PA is beneficial for improving physical fitness, cognitively engaging games such as team sports may be more beneficial to improve FMS.
Illness and Injuries
As a consequence of a greater level of PA, jumping and strength training may boost positive effects, preventing weight gain as well as bone health-related factors. On the other hand, implementing flexibility and balance-related programs may be beneficial for reducing the risk of muscle injuries.
Psychological Factors
Finally, there is a relationship between a greater dose (intensity/volume) of MVPA and school-based interventions in core executive function or academic achievement. However, this dose could depend on the elementary education grade. To date, HIIT and mental health-based programs may be effective, although no interventions shorter than one academic year have demonstrated positive effects.
References
- 1.↑
Posadzki P, Pieper D, Bajpai R, et al. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health. 2020;20(1):1724. doi:10.1186/s12889-020-09855-3
- 2.↑
Takehara K, Togoobaatar G, Kikuchi A, et al. Exercise intervention for academic achievement among children: a randomized controlled trial. Pediatrics. 2021;148(5):2021052808. doi:10.1542/peds.2021-052808
- 3.↑
Rosenkranz RR, Lubans DR, Peralta LR, Bennie A, Sanders T, Lonsdale C. A cluster-randomized controlled trial of strategies to increase adolescents’ physical activity and motivation during physical education lessons: the Motivating Active Learning in Physical Education (MALP) trial. BMC Public Health. 2012;12(1):834. doi:10.1186/1471-2458-12-834
- 4.↑
Wright K, Giger JN, Norris K, Suro Z. Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: a parallel-group, randomized control trial. Int J Nurs Stud. 2013;50(6):727–737. doi:10.1016/j.ijnurstu.2012.09.004
- 5.↑
Xu F, Ware RS, Tse LA, et al. A school-based comprehensive lifestyle intervention among Chinese kids against obesity (CLICK-Obesity): rationale, design and methodology of a randomized controlled trial in Nanjing city, China. BMC Public Health. 2012;12(1):316. doi:10.1186/1471-2458-12-316
- 6.↑
Sahota P, Rudolf MCJ, Dixey R, Hill AJ, Barth JH, Cade J. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ. 2001;323:1019–1032. doi:10.1136/bmj.323.7320.1029
- 7.↑
Meyer U, Romann M, Zahner L, et al. Effect of a general school-based physical activity intervention on bone mineral content and density: a cluster-randomized controlled trial. Bone. 2011;48(4):792–797. doi:10.1016/j.bone.2010.11.018
- 8.↑
Daly RM, Ducher G, Hill B, et al. Effects of a specialist-led, school physical education program on bone mass, structure, and strength in primary school children: a 4-year cluster randomized controlled trial. J Bone Miner Res. 2016;31(2):289–298. doi:10.1002/jbmr.2688
- 9.↑
Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, et al. Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports Med. 2019;49(9):1383–1410. doi:10.1007/s40279-019-01099-5
- 10.
Lubans DR, Morgan PJ, Weaver K, et al. Rationale and study protocol for the supporting children’s outcomes using rewards, exercise and skills (SCORES) group randomized controlled trial: a physical activity and fundamental movement skills intervention for primary schools in low-income communities. BMC Public Health. 2012;12(1):427. doi:10.1186/1471-2458-12-427
- 11.↑
Olive L, Byrne D, Cunningham RB, Telford RM, Telford RD. Can physical education improve the mental health of children? The LOOK study cluster-randomized controlled trial. J Educ Psychol. 2019;111:1331–1340. doi:10.1037/edu0000338
- 12.↑
Sit CH, Yu JJ, Wong SH, Capio CM, Masters R. A school-based physical activity intervention for children with developmental coordination disorder: a randomized controlled trial. Res Dev Disabil. 2019;89:1–9. doi:10.1016/j.ridd.2019.03.004
- 13.↑
Nathan NK, Sutherland RL, Hope K, et al. Implementation of a school physical activity policy improves student physical activity levels: outcomes of a cluster-randomized controlled trial. J Phys Act Health. 2020;17(10):1009–1018. doi:10.1123/jpah.2019-0595
- 14.↑
Telford RM, Olive LS, Cochrane T, Davey R, Telford RD. Outcomes of a four-year specialist-taught physical education program on physical activity: a cluster randomized controlled trial, the LOOK study. Int J Behav Nutr Phys Act. 2016;13(1):64. doi:10.1186/s12966-016-0388-4
- 15.↑
Ricci JM, Clevenger KA, Sellers S, Davenport S, Pfeiffer KA. Associations between extracurricular activity participation and health-related variables in underrepresented children. Sports Med Health Sci. 2020;2(2):102–108. doi:10.1016/j.smhs.2020.06.001
- 16.↑
Barnett TA, Kelly AS, Young DR, et al. Sedentary behaviors in today’s youth: approaches to the prevention and management of childhood obesity: a scientific statement from the American Heart Association. Circulation. 2018;138(11):e142–e159. doi:10.1161/CIR.0000000000000591
- 17.↑
LaForge-MacKenzie K, Tombeau Cost K, Tsujimoto KC, et al. Participating in extracurricular activities and school sports during the COVID-19 pandemic: associations with child and youth mental health. Front Sports Act Living. 2022;4:936041. doi:10.3389/fspor.2022.936041
- 18.↑
Eather N, Morgan PJ, Lubans DR. Improving health-related fitness in children: the fit-4-fun randomized controlled trial study protocol. BMC Public Health. 2011;11(1):902. doi:10.1186/1471-2458-11-902
- 19.↑
Lonsdale C, Sanders T, Cohen KE, et al. Scaling-up an efficacious school-based physical activity intervention: study protocol for the ‘internet-based professional learning to help teachers support activity in youth’ (iPLAY) cluster randomized controlled trial and scale-up implementation evaluation. BMC Public Health. 2016;16(1):873. doi:10.1186/s12889-016-3243-2
- 20.↑
González-Ruíz K, Correa-Bautista JE, Izquierdo M, et al. Effects of an exercise program on hepatic metabolism, hepatic fat, and cardiovascular health in overweight/obese adolescents from Bogotá, Colombia (the HEPAFIT study): study protocol for a randomized controlled trial. Trials. 2018;19(1):330. doi:10.1186/s13063-018-2721-5
- 21.↑
Treviño RP, Yin Z, Hernandez A, Hale DE, Garcia OA, Mobley C. Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: a randomized controlled trial. Arch Pediatr Adolesc Med. 2004;158(9):911. doi:10.1001/archpedi.158.9.911
- 22.↑
Levin MB, Bowie JV, Ragsdale SK, Gawad AL, Cooper LA, Sharfstein JM. Enhancing community engagement by schools and programs of public health in the United States. Annu Rev Public Health. 2021;42(1):405–421. doi:10.1146/annurev-publhealth-090419-102324
- 23.↑
Page MJ, McKenzie JE, Bossuyt PM, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021;134:103–112. doi:10.1016/j.jclinepi.2021.02.003
- 24.↑
Rico-González M, Pino-Ortega J, Clemente FM, Los Arcos A. Guidelines for performing systematic reviews in sports science. Biol Sport. 2022;39(2):463–471. doi:10.5114/biolsport.2022.106386
- 25.↑
Reznik M, Wylie-Rosett J, Kim M, Ozuah PO. A classroom-based physical activity intervention for Urban Kindergarten and first-grade students: a feasibility study. Child Obes. 2015;11(3):314–324. doi:10.1089/chi.2014.0090
- 26.↑
Fisher A, Boyle JM, Paton JY, et al. Effects of a physical education intervention on cognitive function in young children: randomized controlled pilot study. BMC Pediatr. 2011;11(1):97. doi:10.1186/1471-2431-11-97
- 27.↑
Harris N, Warbrick I, Atkins D, Vandal A, Plank L, Lubans DR. Feasibility and provisional efficacy of embedding high-intensity interval training into physical education lessons: a pilot cluster-randomized controlled trial. Pediatr Exerc Sci. 2021;33(4):186–195. doi:10.1123/pes.2020-0255
- 28.↑
Meyer U, Schindler C, Zahner L, et al. Long-term effect of a school-based physical activity program (KISS) on fitness and adiposity in children: a cluster-randomized controlled trial. PLoS One. 2014;9(2):87929. doi:10.1371/journal.pone.0087929
- 29.↑
Escriva-Boulley G, Tessier D, Ntoumanis N, Sarrazin P. Need-supportive professional development in elementary school physical education: effects of a cluster-randomized control trial on teachers’ motivating style and student physical activity. Sport Exerc Perform Psychol. 2018;7(2):218–234. doi:10.1037/spy0000119
- 30.↑
Crotti M, Rudd JR, Roberts S, et al. Effect of linear and nonlinear pedagogy physical education interventions on children’s physical activity: a cluster randomized controlled trial (SAMPLE-PE). Children. 2021;8(1):49. doi:10.3390/children8010049
- 31.↑
Coolkens R, Ward P, Seghers J, Iserbyt P. The effect of organized versus supervised recess on elementary school children’s participation, physical activity, play, and social behavior: a cluster randomized controlled trial. J Phys Act Health. 2018;15(10):747–754. doi:10.1123/jpah.2017-0591
- 32.↑
Pinto-Escalona T, Gobbi E, Valenzuela PL, et al. Effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness: a multi-country cluster randomized controlled trial. J Sport Health Sci. 2021 Jun 29;S2095-2546(21)00071-5. doi:10.1016/j.jshs.2021.06.005
- 33.↑
Schmidt M, Jäger K, Egger F, Roebers CM, Conzelmann A. Cognitively engaging chronic physical activity, but not aerobic exercise, affects executive functions in primary school children: a group-randomized controlled trial. J Sport Exerc Psychol. 2015;37(6):575–591. doi:10.1123/jsep.2015-0069
- 34.↑
Miller A, Christensen EM, Eather N, Sproule J, Annis-Brown L, Lubans DR. The PLUNGE randomized controlled trial: evaluation of a games-based physical activity professional learning program in primary school physical education. Prev Med. 2015;74:1–8. doi:10.1016/j.ypmed.2015.02.002
- 35.↑
Miller A, Eather N, Gray S, et al. Can continuing professional development utilizing a game-centred approach improve the quality of physical education teaching delivered by generalist primary school teachers? Eur Phys Educ Rev. 2017;23(2):171–195. doi:10.1177/1356336X16642716
- 36.↑
van der Fels IMJ, Hartman E, Bosker RJ, et al. Effects of aerobic exercise and cognitively engaging exercise on cardiorespiratory fitness and motor skills in primary school children: a cluster randomized controlled trial. J Sports Sci. 2020;38(17):1975–1983. doi:10.1080/02640414.2020.1765464
- 37.↑
Miller A, Christensen E, Eather N, et al. Can physical education and physical activity outcomes be developed simultaneously using a game-centered approach? Eur Phys Educ Rev. 2016;22(1):113–133. doi:10.1177/1356336X15594548
- 38.↑
Telford RD, Cunningham RB, Waring P, Telford RM, Olive LS, Abhayaratna WP. Physical education and blood lipid concentrations in children: the LOOK randomized cluster trial. PLoS One. 2013;8(10):76124. doi:10.1371/journal.pone.0076124
- 39.↑
Fuchs RK, Bauer JJ, Snow CM. Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res. 2001;16(1):148–156. doi:10.1359/jbmr.2001.16.1.148
- 40.↑
Collard DC, Chinapaw MJ, Verhagen EA, Bakker I, van Mechelen W. Effectiveness of a school-based physical activity-related injury prevention program on risk behavior and neuromotor fitness a cluster randomized controlled trial. Int J Behav Nutr Phys Act. 2010;7(1):9. doi:10.1186/1479-5868-7-9
- 41.↑
Mayorga-Vega D, Merino-Marban R, Manzano-Lagunas J, Blanco H, Viciana J. Effects of a stretching development and maintenance program on hamstring extensibility in schoolchildren: a cluster-randomized controlled trial. J Sports Sci Med. 2016;15:65–74. PubMed ID: 26957928
- 42.↑
De Bruijn AGM, Kostons DDNM, Van Der Fels IMJ, et al. Effects of aerobic and cognitively-engaging physical activity on academic skills: a cluster randomized controlled trial. J Sports Sci. 2020;38(15):1806–1817. doi:10.1080/02640414.2020.1756680
- 43.↑
Chua T, Aziz AR, Chia M. Four minutes of sprint interval training had no acute effect on improving alertness, mood, and memory of female primary school children and secondary school adolescents: a randomized controlled trial. JFMK. 2020;5(4):92. doi:10.3390/jfmk5040092
- 44.↑
Meijer A, Königs M, van der Fels IMJ, et al. The effects of aerobic versus cognitively demanding exercise interventions on executive functioning in school-aged children: a cluster-randomized controlled trial. J Sport Exerc Psychol. 2021;43(1):1–13. doi:10.1123/jsep.2020-0034
- 45.↑
Costigan SA, Eather N, Plotnikoff RC, et al. Preliminary efficacy and feasibility of embedding high intensity interval training into the school day: a pilot randomized controlled trial. Prev Med Rep. 2015;2:973–979. doi:10.1016/j.pmedr.2015.11.001
- 46.↑
Chang TH, Chen YC, Chen WY, et al. Weight gain associated with COVID-19 lockdown in children and adolescents: a systematic review and meta-analysis. Nutrients. 2021;13(10):3668. doi:10.3390/nu13103668
- 47.↑
McKay H, Smith E. Winning the battle against childhood physical inactivity: the key to bone strength? J Bone Miner Res. 2008;23(7):980–985. doi:10.1359/jbmr.080306
- 48.↑
Shields GS, Sazma MA, Yonelinas AP. The effects of acute stress on core executive functions: a meta-analysis and comparison with cortisol. Neurosci Biobehav Rev. 2016;68:651–668. doi:10.1016/j.neubiorev.2016.06.038
- 49.↑
Eather N, Morgan PJ, Lubans DR. Feasibility and preliminary efficacy of the Fit4Fun intervention for improving physical fitness in a sample of primary school children: a pilot study. Phys Educ Sport Pedagogy. 2013;18(4):389–411. doi:10.1080/17408989.2012.690375
- 50.↑
Zahner L, Puder JJ, Roth R, et al. A school-based physical activity program to improve health and fitness in children aged 6–13 years (“Kinder-Sportstudie KISS”): study design of a randomized controlled trial [ISRCTN15360785]. BMC Public Health. 2006;6(1):147. doi:10.1186/1471-2458-6-147
- 51.↑
Rudd JR, Crotti M, Fitton-Davies K, et al. Skill acquisition methods fostering physical literacy in early-physical education (SAMPLE-PE): rationale and study protocol for a cluster randomized controlled trial in 5–6-year-old children from deprived areas of North West England. Front Psychol. 2020;11:1228. doi:10.3389/fpsyg.2020.01228
- 52.↑
Collard DCM, Chinapaw MJM, van Mechelen W, Verhagen EALM. Design of the iPlay study: systematic development of a physical activity injury prevention programme for primary school children. Sports Med. 2009;39(11):889–901. doi:10.2165/11317880-000000000-00000
