Are school-based physical activity interventions effective and equitable? A systematic review and meta-analysis of cluster randomised controlled trials. (November 2018)

• Record Type: Journal Article
• Authors: Love, Rebecca; Adams, Jean; van Sluijs, Esther M F
• Is Part Of: Lancet. Volume 392(2018)Supplement 2
• Page Start: S53
• Publication Date: 2018-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(18)32174-3
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: Childhood obesity is increasing globally, with widening inequalities by socioeconomic status and sex. The aim of this study was to assess the efficacy of school-based physical activity interventions on children's daily moderate-to-vigorous physical activity (MVPA), and variations in efficacy by sex and socioeconomic status. Methods: We systematically searched six electronic databases (ERIC, EMBASE, OVID Medline, PsycINFO, Scopus, SPORTDiscus) from inception to Feb 24, 2017. Search terms included "children", "physical activity", "cluster-randomized controlled trial", and "accelerometer". Inclusion was restricted to trials published in English of school-based physical activity interventions with accelerometer-assessed MVPA across the full day. After duplicate data extraction and quality assessment, lead authors were sent re-analysis requests. For each trial a mean change score from baseline to follow-up was calculated for daily minutes of accelerometer-assessed MVPA, for the main effect, by sex, and by socioeconomic status. Effects were pooled in random effects meta-analyses. Heterogeneity was explored with meta-regressions and subgroup meta-analyses. This study is registered with PROSPERO, CRD42017062565. Findings: 25 trials met the inclusion criteria; 17 trials (9044 participants) of predominantly multicomponent (88%), multisetting interventions (77%) provided relevant data and were included in meta-analyses. There was no effect of activity interventions on MVPA (standardised mean difference [SMD] 0·02, 95% CI −0·07 to 0·11). There was no evidence of differential efficacy by sex (SMD girls 0·07, 95% CI −0·07 to 0·21; boys 0·05, −0·09 to 0·19) or socioeconomic status (low −0·01, −0·12 to 0·11; middle −0·06, −0·17 to 0·05; high −0·01, −0·13 to 0·11). Interpretation: This review provides strong evidence that current school-based efforts do not increase young people's daily physical activity, with no difference in effect across sex and socioeconomic status. This is the first meta-analysis, to our knowledge, of children's physical activity interventions to pool accelerometer data with comparable outcome metrics. Our findings conflict with most previous syntheses, which have included substantial self-report data and reported positive effects. Further assessment, maximisation of implementation fidelity, and consideration of wider (including health) benefits is needed before these interventions can be concluded to have no contribution to make to children's health promotion. Until then we recommend that interventions are limited to research contexts. Funding: Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Research Council, National Institute for Health Research, Wellcome Trust, Gates Cambridge.