Abstract: In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects. In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years. Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review. The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.

Plain-language summary: This review included 44 studies that evaluated the impact of school-based interventions focused on increasing physical activity among 36,593 children and adolescents. Participants were between the ages of six and 18 living in Australia, South America, Europe, China, and North America. Duration of interventions ranged from 12 weeks to six years. No two school-based physical activity promotion programs had the same combination of interventions. Furthermore, the duration, frequency, and intensity of interventions varied greatly across studies. Data collection methods for outcomes were reported to be valid and reliable in a little over half of the included studies. There is some evidence that school-based physical activity interventions are effective in increasing duration of physical activity from five to 45 min more per day, reducing time spent watching television from five to 60 min less per day, and increasing maximal oxygen uptake or aerobic capacity, reflecting physical fitness level of an individual. The evidence also suggests that children exposed to school-based physical activity interventions are approximately three times more likely to engage in moderate to vigorous physical activity during the school day than those not exposed. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity during school hours result in positive effects for these outcomes. School-based interventions are not effective in increasing physical activity rates among adolescents, or in reducing systolic and diastolic blood pressure, blood cholesterol, body mass index, and pulse rate.