Testing Products to Increase Children's Physical Activity in the Classroom: Identifying What Works and What Doesn't
Phase: EARLY_PHASE1
Conditions: Physical Activity
Sponsor: University of South Carolina

Testing Products to Increase Children's Physical Activity in the Classroom: Identifying 
What Works and What Doesn't   
Identifiers:NCT03394846   Unique Protocol ID: Pro00069012 
5/26/2022

Study setting and participants 
Study protocols were approved by the University of South Carolina IRB prior to enrollment of the 
first participant. Data were collected from five elementary schools in two separate school districts. 
Both school districts served a major metropolitan area in one southeastern state in the United 
States. Table 1 presents the participating schools’ characteristics. These schools were identified to 
participate because they served a large number of minoritized children from families that are low 
income. These students often experience disproportionately fewer opportunities to participate in 
PA [18]. At regularly scheduled faculty meetings, teachers in the participating schools were 
provided with information about the study and invited to participate. Teachers who agreed to 
participate were provided with and signed an informed consent form. A total of 57 (60%) of 
teachers consented. For students in the consented teachers’ classes, a passive consent procedure 
was employed due to the noninvasive and low-risk nature of the study. Letters with information 
about the study were sent home to the parents of children in the participating classes. If a parent 
did not wish for their child to participate, the letter informed them to sign and return the form to 
their child’s classroom teacher. A total of 123 (5.2%) parents opted out of their child wearing the 
activity monitor. Prior to data collection, all children provided verbal assent.  
 
Study design/procedure 
The COVID-19 pandemic impacted this study and caused changes to the design. Prior to the 
COVID-19 pandemic, this pre-post study was designed to assess teachers’ intact classrooms for a 
total of five weeks, at two separate timepoints in the spring (i.e., January and February) and fall 
(September and October) of 2020. The intention was to provide all teachers with three MI 
products to test in their classroom for one week each. The teachers would also be observed for 

one week (i.e., baseline) when they were asked to go about their regularly schedule classroom 
activities like any other typical week. The decision was made not to include a comparison group 
of teachers based on feedback from school administrators indicating they desired all participating 
teachers to receive a MI product and would not participate if that was not the case. One baseline 
week was allocated for the spring and fall. Following the baseline week, teachers were to receive 
one MI product to use (i.e., intervention). Teachers were to try one MI product in the spring and 
two products in the fall. The order of product testing was counterbalanced at the school level to 
minimize contamination and potential timing effects. However, due to disruptions of the 
COVID-19 pandemic, the study was not able to be executed as designed, and the provision of the 
MI products and measures were not completed in the fall of 2020. Thus, we collected one 
baseline week and one intervention week in spring of 2020, prior to the onset of the COVID-19 
pandemic related school closures. This meant that each school only received one MI product for 
testing (see Table 1 for the product that each school tested).  
The intention of this study was to maximize ecological validity [19]. Therefore, to simulate off-
the-shelf conditions, no orientation or training related to MI product implementation was 
provided by the study team. Associated product orientation materials were provided to the 
teachers to review at their discretion one week prior to the intervention week. Teachers were 
allowed to determine the times and duration of product use and there were no restrictions or 
guidance from the research team. Teachers were informed that they were free to use any feature 
of the product to implement in their classroom as often or infrequently as they preferred. All 
teachers were informed of the study’s purpose and that the study staff were not affiliated with the 
MI products. The three MI products were selected for this study because in a previous product 

testing study conducted by our research team [20], teachers rated these products the highest and 
indicated that these products maximized facilitators of use while minimizing barriers to use. 
Sample Size Considerations 
A power analysis using G*Power (v.3.1.7) was performed to determine the sample size.  With a 
power of 0.8 and an alpha of 0.05 and a sample of 60 teachers, the study had the ability to detect 
an effect size of 0.32 which translates to an 8.3 minute increase in MI use per day. This was 
deemed sufficient given past MI work showing similar increases in MI use per day [14, 21] and 
that 0.32 is commonly considered a small effect [22]. 
Movement Integration Products 
ABC for Fitness is a free guidebook designed to provide teachers with ideas to intersperse 
physical activity bursts throughout the school day. Each activity burst has three components: A. 
Warm-up, B. Core Activity (e.g., exercise, stretching), and C. Cool Down lasting a maximum of 
five minutes. This resource contains academic content which teachers are encouraged to 
integrate into their lesson plans. 
Take 10 is a classroom-based guidebook that provides teachers with grade-specific academic 
lessons that are integrated with PA. Each lesson offers an opportunity for the students to be 
physically active while learning academic content in one of five subject areas: language arts, 
math, science, social studies, or general health. Each activity is designed to last for a maximum 
of ten minutes. Take 10 employs a tiered pricing scheme based on grade level and ranges in cost 
from $85-$112. 
GoNoodle is a free, online resource that contains a series of videos integrating grade-specific 
academic content with a variety of physical activities (e.g., dance, exercise, yoga) set to music 

and activity breaks. These activities are non-teacher led and incorporate elements of social and 
emotional wellness to support child development. Video length tends to run between 5-10 
minutes. For a cost (i.e., $99 per year), GoNoodle Plus offers extended curricula videos, more 
learning games, and includes printable activities. Teachers were provided with the GoNoodle 
Plus version during product testing. 
Outcomes 
Teacher-reported MI strategy and MI Product use. 
For each day that teachers participated in the study, they were asked to complete a daily log at 
the end of the school day indicating total uses of MI strategies (e.g., use of any MI product, 
provided or otherwise), uses of the specific MI product that they were provided, and the amount 
of time they used these products/strategies. In addition to use of the MI product, teachers were 
asked to provide information about their daily classroom schedule and out of classroom activities 
(e.g., physical education, recess, Art/Music, lunch). The log was collected from the teacher daily 
at the end of the school day by a trained research assistant. 
Sedentary behaviors and Physical Activity. 
Each teacher was observed on five school days during baseline and intervention weeks. In 
classrooms with 20 students or fewer (n=34) all students received an accelerometer. In 
classrooms with more than 20 students (n=23, mean number of students=24, SD=1.4) the first 20 
students to arrive to school received an accelerometer each observation day. Random selection of 
students in classes with more than 20 students was not deemed necessary for because, this study 
focused on classroom level estimates of SB and PA, and classrooms with more than 20 students 
had a mean of 24 (SD=1.4) students. Thus, the vast majority of students were measured on any 

given day. At the end of the school day, accelerometers were collected by trained research staff. 
Accelerometers (ActiGraph GT3X+ Shalimar, FL) were affixed to students’ non-dominant wrist. 
Students’ engagement in SB, light PA (LPA), and moderate-to-vigorous PA (MVPA) were 
calculated using previously developed cutpoint thresholds for elementary age children’s 
sedentary behavior, LPA and MVPA [23]. Accelerometer epochs were set to five seconds to 
account for the intermittent and transitory nature of youth PA [24]. A valid day of accelerometer 
wear was defined as total time in attendance of at least 70% of the school day (260 mins) [25]. 
Age, sex, and race of all students were collected using school records. 
 
Statistical analyses 
Analyses were conducted on children that had at least one accelerometer wear day [26-28]. 
Descriptive means, standard deviations, and percentages (for dichotomous variables) were 
calculated for demographic characteristics, SB and PA, and teacher MI uses. Mixed effects 
general linear models were used to evaluate the impact of providing teachers access to MI 
products on their MI strategy use. Days measured were nested within teachers, and teachers were 
nested within schools. The dependent variables were number of overall MI strategy uses/day, the 
amount of time implementing MI per day, and the number MI product uses/day for the specific 
product provided. The independent variable was a dichotomous baseline or intervention week 
variable. To evaluate the impact of providing teacher access with MI products on students’ SB 
and PA, mixed effects general linear models were estimated with days measured nested within 
children, children, nested within teachers, and teachers nested within schools. Separate models 
were estimated with SB, LPA, and MVPA as the dependent variables and the dichotomous 
baseline or intervention week variable as the independent variable. PA models controlled for 

children’s age (years), race, sex, and time in attendance at school. Additionally, all analytic 
models controlled for school day level factors (i.e., physical education vs. non-physical 
education day, recess vs. non-recess day).