A Cluster-randomized Controlled Trial Evaluating the Effect of Increased Physical Education and Physical Activity on Adolescents' Physical and Mental Health, Academic Performance and Learning Environment
Phase: NA
Conditions: Physical Activity, Academic Achievement, Mental Health
Sponsor: Norwegian School of Sport Sciences

 
 
 
 
The Effect of Increased Physical Activity on Adolescent's health and 
Academic Performance: 
 
The School in motion "ScIM" 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study protocol 
 
Norwegian School of Sport Sciences, 1. Aug 2016 
 
Unique Protocol ID: 2207 ScIM 
 
 

 
 
LIST OF CONTENT  
 
1.0 Introduction .......................................................................................................................... 3 
2.0 Methods ................................................................................................................................ 4 
2.1 Design ............................................................................................................................... 4 
2.2 Intervention models .......................................................................................................... 5 
2.3 Outcome measures ........................................................................................................... 5 
2.4 Data collection .................................................................................................................. 9 
2.5 Power calculations and statistical analysis ....................................................................... 9 
3.0 Pilot study ........................................................................................................................... 10 
4.0 Implementation ................................................................................................................... 11 
5.0 Project manangement, organization and collaboration ...................................................... 12 
6.0 Quality assurance ............................................................................................................... 13 
References ................................................................................................................................ 14 
 

3 
 
1.0 INTRODUCTION 
As part of creating a better knowledge base for future work on physical activity among 
adolescents, the "Folkehelsemeldingen - Mestring og muligheter" has defined a trial with a 
selection of secondary schools where students will receive about four hours of physical 
activity and physical education during the week.1 The experiment should be organized so as to 
best study the effects of increased physical activity (PA) and/or physical education (PE) on 
the participants physical and mental health, learning and learning environment and, if 
possible, how it affects the development of PE as a subject. 
 
The main aim of this project is thus defined to find models of PA/PE that can be used in 
Norwegian lower secondary schools. These models are intended to have an impact on the 
adolescents' physical health, mental health, learning and learning environment. The fact that 
the intervention models should affect four different outcomes will make this project very 
challenging. However, as we face a global trend with increased prevalence and premature 
deaths caused by non-communicable diseases such as cardiovascular disease, type 2 diabetes, 
chronic lung disease and cancer this project is timely. Worldwide, these diseases cause two 
thirds of all deaths and one of four deaths among those below 60 years of age. 
Non-communicable diseases are partly due to increased sedentary lifestyle,2 and physical 
inactivity is defined as a significant public health problem for people of all ages.3 Globally, 
physical inactivity is referred to as one of the four leading causes of mortality.2 According to 
the World health organization, 10% of all deaths in Europe are related to inactivity.4 In May 
2012, the World Health Assembly (WHA) adopted the target of reducing premature death of 
non-communicable diseases by 25% by 2025. WHO has identified four overall indicators and 
targets to reach this target. One of the goals is that the proportion that is physically inactive 
should be reduced by ten percent. 
 
Among adults, the literature shows a strong association between physical activity and the risk 
of non-communicable diseases,5,6 however, this relationship is not as clear among children 
and adolescents.7 This might be due to the fact that these diseases usually manifest in 
adulthood. At the same time, pathological processes are known to start already in early 
childhood,8 and cross-sectional studies show that physical activity is related to risk factors for 
non-communicable diseases already at a young age.9-11 Furthermore, a review has shown that 
physical activity interventions carried out in the primary school affects some components of 
physical health.12 However, it is important to emphasize that this knowledge is inadequate 
among adolescents in upper secondary school. Early adolescence is characterized by major 
biological, psychological and social challenges. Results from the "ungdata" report show that 
the proportion reporting mental disorders in adolescence is high and that the extent of mental 
disorders increases through adolescence.13  
 
The main aim of this study is to investigate whether participation in this project leads to 
increases in objectively measured physical activity level in 14-year-old boys and girls after a 
one-year school-based physical activity intervention compared to the control group.  
 
In addition, secondary aims are to investigate whether participation in a one-year school-
based physical activity intervention results in changes to the following outcomes when 
comparing the adolescents in the intervention groups with the adolescents in the control 
group:  

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1. 
Higher objectively measured moderate-to-vigorous physical activity (MVPA) 
2. 
An increase in the proportion adolescents meeting physical activity guidelines 
(measured objectively) 
3. 
Reductions in time spent sedentary (measured objectively and self-reported). 
4. 
Improvements in muscle strength and cardiorespiratory fitness 
5. 
Improvements in mental health variables including overall psychosocial 
problems and strengths, quality of life, self-evaluation of competence or 
adequacy and symptoms of anxiety and depression. 
6. 
Improvements in academic performance in reading and numeracy. 
7. 
Improved learning environmen 
 
2.0 METHODS 
School in motion (ScIM) is a school-based cluster-randomized controlled trial (RCT) with 
three arms. The study last two years, where the first year is used to pilot the models, and the 
RCT will be completed in the school year 2017-18. 
 
The study is initiated by the Norwegian Directorate for Education and Training.  
 
2.1 Design  
Adolescents in 9th grade will be invited to participate in the study. This is a multi-center study 
and four universities and colleges in Norway are included (Norwegian School of Sport 
Sciences, Sogn and Fjordane University College, University of Agder and University of 
Stavanger). The Norwegian School of Sport Sciences is the coordinating unit.  
Schools located in municipalities in the geographical area around the four universities will be 
invited to participate. This will be a cluster sample with schools as the primary unit. When a 
school agree to participate, all adolescents in 9th grade will be invited to participate in the 
study. After inclusion, schools will be randomly allocated to either one of the intervention 
arms or the control arm. The randomization will be conducted by a neutral third part not 
affiliated with the project team. 
 
Some schools already arrange for extended time for physical activity during the school day. 
Schools that already are working systematically with PA or extended PE as an integrated part 
of their curriculum will be excluded from participation in the study. However, this does not 
apply to schools that have organized specific events e.g. activity days, school tournaments and 
mountain hikes. 
 
The project was reviewed by the Regional Committee for Medical and Health Research Ethics 
(REK) in Norway, who according to the Act on medical and health research (the Health 
Research Act 2008) concluded that the study did not require full review by REK. We will 
therefore apply for approval from The Norwegian Social Science Data Services (NSD) for 
permission to collect personal data. From an ethical point of view, upper secondary school 
pupils are not able to give valid consent to participation in surveys. We will therefore obtain 
written consent from the pupils' parents/caregivers before inclusion in the study. Both 
parents/caregivers and the adolescents will receive information about the goals of the study, 
any disadvantages or discomfort that may arise, that participation is voluntary and that they 
may withdraw from the study at any time and without justification.  

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2.2 Intervention models 
The planned intervention will be implemented during one school year. The schools in the two 
intervention arms will provide one extra hour each week to do physical activity. In addition, 
these schools will also redistribute 5% of the remaining hours of the school week to one extra 
PE-lesson each week. 
 
The schools randomized to the intervention arms are allocated to one of two models. 
 
The first model is called "Physical Active Learning" and consists of the components: 
• 
Additional physical education: All activity will be conducted in accordance with the 
current curriculum. The school's physical education teacher will lead this activity. 
• 
Physical active learning: The curriculum of the subjects (i.e. maths, English, 
Norwegian) will be taught in a physically active manner. The term "Physical active 
learning" should be stated on the pupils' schedule as 30 minutes per week, preferably 
not on the same day as the PE-lessons. This activity should be led by the teacher of the 
current subject.    
• 
Physical activity: Without a connection to any specific subject "Physical activity" 
should be performed 30 minutes a week, preferably on days without PE-lessons and 
physical active learning. A teacher in collaboration with the pupils should lead the 
activities, and pupil involvement should be emphasized. The activities should be 
joyful, and the pupils' well-being should be in focus. 
 
The second model is called "Don't worry-Be happy", and is also based on two extra lessons 
of PA and PE each week. The lessons must have their own names not associated with PE or 
PA. Examples of such terms are "don't worry" (PE) and "be happy" (PA). 
 
The Be Happy lessons are self-organized activity groups of at least three pupils, developed 
according to activity preferences.  In the initial phase of the model, the pupils should, in 
collaboration with the teachers, discover different activity contexts for the "be happy" lesson. 
The main aim of this phase is that all pupils should be able to find a desirable activity context. 
Examples of activity contexts are dance/choreography, traditional sports, outdoor activities, 
drama, yoga and hiking groups. An activity context should be defined as a group of young 
people who will develop and exchange interests and values with peers through a clear form of 
activity during school hours (and possibly beyond school hours). They will develop goals for 
the activity, as well as both annual and period plans for the activity. The social dimension of 
friendship in motion should be central in all groups. The "don't worry" lesson should take 
place within the class (like other PE lessons), but this lesson should be related to the "be 
happy" activities. The adolescents work individually or in smaller groups with the teacher as 
support. 
 
 
2.3 Outcome measures 
All participants will be tested at baseline and at the end of the intervention period. The 
variables are described below.  
 

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In this project, physical health is defined as good bodily health achieved through a balance of 
regular physical activity, ability to perform daily activities with excess and the presence of 
physiological features and qualities associated with low risk of developing lifestyle diseases 
and disorders. 
 
 Physical activity 
Physical activity is the main outcome variable. The participants physical activity level will be 
assessed by ActiGraph accelerometers (model GT3X+) (ActiGraph, LLC, Pensacola, Florida, 
USA). The GT3X measures acceleration in three individual plans of motion. ActiGraph 
accelerometer is widely accepted as a valid and reliable too for measuring physical activity in 
adolescents.14-16. Participants will be asked to wear the accelerometer at the right hip for seven 
consecutive days.  Outcomes for physical activity levels are mean physical activity level 
(counts/min) and time spent in different PA intensities using established cut-offs (sedentary 
time, light physical activity, moderate physical activity, moderate-to-vigorous physical 
activity and vigorous physical activity). Further, a questionnaire will be developed to gain 
information on type of activity that is performed as well as information regarding the activity 
context.  
 
 Health-related physical fitness 
Health-related physical fitness is defined as physiological features and qualities that are 
associated with low risk of development of lifestyle diseases and disorders and include 
components such as cardiovascular fitness, muscular endurance, muscular strength and body 
composition. 
 
Cardiorespiratory fitness  
Cardiorespiratory fitness is one of the most important components of the term health-related 
physical fitness and studies clearly shows that individuals with good cardiorespiratory fitness 
have better physical health compared to those with poorer cardiorespiratory fitnes.17-19 
Cardiorespiratory fitness will be measured with an intermittent practicable running field test 
(the Andersen-test).20,21 The Andersen-test is a practical field test that requires minimal 
equipment and is of low cost. It is particularly practical in a school setting because it is easy to 
administer and a relatively large number of participants can be tested at the same time. The 
use of endurance tests to exhaustion has previously been used in large population studies in 
Norway22-24 and experience indicates that there is a low dropout from such tests. The 
participants will run from one end line to another (16 m apart) in an intermittent to-and-from 
movement, with 15-seconds running and 15-seconds breaks (standing still) for a total of 10 
minutes. The distance covered (in meter) will be recorded as the outcome for analysis. 
 
Muscle strength 
Muscle strength is required to move the body, and the level of muscle strength can affect both 
the activities of daily living as well as the inclination to participate in various types of 
activities. Recently, research has also shown that muscle strength is an important factor in 
prevention of development of chronic diseases among adults25, and muscle strength have also 
been associated with risk factors for non-communicable diseases among children and 
adolescents.26 Therefore, muscle strength is an important part of an individual's health-related 
physical fitness and the participant's (sustained, isometric and explosive) muscle strength will 

7 
 
be measured using reliable and validated tests from the EUROFIT test battery: i) Abdominal 
strength and endurance: sit-ups, ii) Upper body isometric strength: handgrip strength, and iii) 
Lower body explosive strength: standing long jump. 
 
Anthropometry 
Overweight and obesity is a strong predictor of chronic diseases such as high blood pressure, 
poor lipid profile and type 2 diabetes. Furthermore, we know that placement of adipose tissue 
is of major importance for disease development. Abdominal obesity is considered as a better 
measure of risk of developing chronic disease than body mass index.27 The following 
anthropometric measurements will therefore be included: participants' height, body weight 
and waist circumference. From each individuals height and body weight, their body mass 
index will be calculated.  
 
 
MENTAL HEALTH concerns whether a person manages to use his cognitive and emotional 
skills to function in society and meet everyday demands. In research literature, mental health 
is often related to the chosen goals of mental health. In this study, the aim is to measure 
mental health by both symptoms of various mental disorders and quality of life that deals with 
physical and emotional well-being, self-esteem and relationships with family, friends and 
school. When selecting instruments for measuring mental health, the best instruments for this 
age group with official Norwegian translations have been chosen.  
 
 Strength and Difficulties Questionnaire (SDQ) 
The Strength and Difficulties Questionnaire (SDQ) will be used. This is a short screening tool 
for assessing young people's mental health.28 The instrument has 25 questions and covers five 
scales (emotional, conduct, hyperactivity, peer problems and prosocial behavior). SDQ has 
previously been used in both population-based and clinical studies in several countries 
(Youthinmind) including Norway.29,30  
 
 Hopkins symptom check list (HSCL) 
Hopkins symptom check list (HSCL) will also be included in the questionnaire. HSCL is 
considered as a good tool for mental health surveying, and the short version consisting of 10 
questions is included (HSCL-10). Each question is answered on a four-part scale: "not 
bothered", "a little bothered", "quite bothered" and "very bothered". Not bothered gives 1 
point, while very bothered gives 4 points, and when the points are summed, a score between 
10 and 40 is gained where 40 means very bothered. 
 
 Quality of life 
KIDSCREEN is a questionnaire that measures health-related quality of life in children and 
adolescents aged 8-18 years. In this study KIDSCREEN-27 is used that includes five Rasch 
scaled dimensions: physical well-being, psychological well-being, autonomy & parents, peers 
& social support and School Environment. The questions are answered on a five-point Likert 
scale that indicates either the frequency or intensity of a behavior or feeling.31 This instrument 
has also been used in the Active Smarter Kids (ASK) study.23 
 
 

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 Self-evaluation of competence or adequacy 
The Norwegian revised edition of Harter's Self-Perception Profile for Adolescents (SPPA) 
will be used.32 The instrument contains 35 questions, and the questions are related to 
scholastic competence, social acceptance, athletic competence, physical appearance, romantic 
appeal, close friendship and global self-worth. Each question is answered on a 4-point scale 
indicating whether the statement is really true, sort of true, sort of un true or really untrue for 
the participant. 
 
LEARNING is often defined as a relatively lasting change in experience and action as a 
result of past experience, and it is often distinguished between learning as a process and as a 
product. Research on how children and young learn are many and varies depending on the 
theoretical starting point for understanding learning, eg. whether it is behaviorist, humanistic, 
cognitive, or socio-cultural learning theories. In today's school, in-depth learning, 
metacognition and that the pupils themselves contribute to their own learning are central 
concepts. 
 
• 
The Pupil Survey 
The pupil survey is part of the national quality assessment system, and it contains questions 
related to learning and well-being at the school. The survey is compulsory for pupils in 7th 
grade, 10th grade and at upper secondary level 1 and optional for the rest. The Directorate of 
Education and Training is responsible for carrying out the survey. In the pupil survey, it is 
possible to identify the pupils personally, and we will apply to receive data from the national 
educational base. The questions of interest are, among other, those that concern the well-being 
of the pupils at the school, motivation, working and learning condition, support from teachers, 
pupil participation and school environment.  
 
 Academic performance – national tests 
Academic performance in reading and numeracy will be measured using specific standardized 
Norwegian National tests designed and administrated by The Norwegian Directorate for 
Education and Training. The tests are carried out during the fall semester for pupils in the 8th 
and 9th grade. The Norwegian Directorate for Education and Training will assist in designing 
an appropriate test that can be used post intervention.   
 
 Marks 
The use of marks in lower secondary school is authorized in the Regulations for the Education 
Act, and the pupils receive in numerical grades from 1-6 in the various subjects. The mark 
shall be determined on the basis of an assessment of the pupil's competence based on the 
competence goals set in the curriculum for the individual subjects. In the questionnaire we 
will ask students about grades in central subjects. 
 
LEARNING ENVIRIONMENT can be defined as the total cultural, relational and physical 
conditions in the school that are important for the pupils' learning, health and well-being.33 
 
The Classroom Climate Scale instrument will be used to investigate learning environment. 
This is a form consisting of 22 questions answered on a 4-point scale. The questions are 

9 
 
related to intrinsic and extrinsic motivation, anticipation and teacher-student relations.34 
Teachers will also answer a teacher's version of this form, which consists of 14 different 
questions. 
 
2.4 Data collection 
Data will be collected both objectively and through a self-reported questionnaire. The 
questionnaire will include questions about background factors, type of activity, transport to 
and from school, as well as sedentary behaviour (sedentary activities, PC and TV habits). 
There will also be questions related to sleep and health habits such as smoking and alcohol 
use. 
 
The data collection will be school-based and the various tests will be carried out during school 
hours. A team of experienced testers will visit the participating schools to carry out the tests. 
The computer based questionnaire will also be answered during school hours. All pupils 
participating in the study will be tested before the intervention starts and at the end of the 
intervention period. 
 
2.5 Power calculations and statistical analysis 
Power calculations are done to examine how many participants it should be in each group, if a 
given difference between groups should be significant at a given level (for example, p <0.05) 
and with a given power (for example, 90% probability of rejecting a false null hypothesis). 
The required size of the sample depends on how small differences one can detect over time, as 
well as how large the variation of the current variable is in the population. 
 
In this project, the power calculations are based on the main outcome variable (mean physical 
activity level [counts/min]). As can be seen in table 1, the number of participants required to 
detect a specific difference between the groups increases significantly the smaller the 
difference. Data for SD and mean value of the physical activity variable is based on previous 
studies conducted in the Norwegian adolescent population.35 The power calculation is 
performed as a two-sided calculation with an α = 0.05 and 1-β = 0.9. Since this is a cluster 
sample, the sample size is adjusted for an inflation factor that will be determined by the 
number of members in the cluster and the intra-class correlation. The correlation is assumed 
to be small as the cluster is school, therefore the inflation factor is set to 1.1. 
 
 
 

10 
 
Table 1. Power calculations based on the main outcome variable (physical activity expressed 
as mean counts/min). The column "minimum difference" refers to the level of difference that 
can be detected between groups. 
Variable 
Minimum Difference 
Variation (SD) 
N 
Physical activity level 
(accelerometer) 
10 % (70 counts/min) 
150 counts/min 
246 
Physical activity level 
(accelerometer) 
7 % (49 counts/min) 
150 counts/min 
492 
Physical activity level 
(accelerometer) 
5 % (35 counts/min) 
150 counts/min 
984 
Physical activity level 
(accelerometer) 
3 % (21 counts/min) 
150 counts/min 
2706 
 
In this project, it was considered important to be able to detect (or reject) 7% differences in 
the mean physical activity level between the intervention and control groups. This meant it 
was necessary to examine 492 pupils in each group. Further, during the trial a drop-out rate of 
20% at the individual level should be expected, consequently 590 individuals in each group 
should be included. However, there should be at least 10 schools per intervention arm (ie per 
model to be tested) in order for the randomization to have effect. The strategy is then to 
include schools up to at least 10 schools per intervention arm, and a minimum of 590 
individuals will be included in each arm.  
 
Data will be described with suitable measures of central tendency and variability, along with 
confidence intervals. Mixed models with school as random effect, adjusted for class, 
individual and baseline values, will be used to investigate the difference in the different 
variables when comparing the pupils in the two intervention groups with the pupils in the 
control group. By building up a mixed model, all participants who have data at baseline and 
everyone who has data at the post- test is included, and thus all data in the project are utilized. 
Further, per protocol analysis will also be conducted. In these analysis, participants in schools 
that completed at least 80 % of the intervention program will be compared with the pupils in 
the control group. A two-sided p-value < 0.05 is considered statistically significant. 
 
 
3.0 PILOT STUDY 
During the school year 2016-17, this project will be pilot tested. One of the main goals is to 
pilot the implementation of the two intervention models, in addition it will include piloting the 
measuring instruments and the various tests/examinations. It will also be a test of the logistics 
with regards to inclusion of participants, collection of data and processing of data, so that 
when the RCT is rolled out during fall 2017, the actual intervention will have been thoroughly 
tested. Implementation research suggests that successful implementation of a school-based 
intervention requires that the researchers include partners at an early stage, and stakeholders 
(school leaders, teachers, pupils and parents) should be active participants in the development 
of design, implementation and dissemination of the intervention model.36 Interventions are 
more likely to be successful when most or all individuals in the setting are committed to the 
intervention and feel ownership for it. In particular, experience from previous studies shows 

11 
 
better implementation of school-based interventions if the school is committed to the 
intervention through national, regional and local school policies. Therefore, the pre-planning 
phase as well as the implementation of the intervention models are an important part of the 
pilot study. 
 
Six schools in the Oslo area will be included in the pilot study. There is assumingly around 
100 pupils in 9th grade at these schools, which means that approximately 600 pupils will be 
invited to participate. The sample in the pilot study will be a convenience sample. In the pilot 
study, each intervention model will be tested in two schools (a total of four schools) and two 
schools will be included as control schools. The two intervention models are planned to be 
implemented over 16 weeks, and the pupils will be tested both pre- and post-intervention.  
 
 
4.0 IMPLEMENTATION 
According to implementation research, four essential phases are important to achieve a 
successful implementation of extended physical activity at the lower secondary level.36 
 
1) Pre-planning 
This project is initiated and has support from key stakeholders including the Ministry 
of Education and Research and the Ministry of Health and Care Services. Close 
cooperation with the aforementioned authorities can give the project group valuable 
access to established meeting places for dialogue with national, regional and local 
school policy bodies, the school health service, the parent committee for primary 
education and school leaders at the selected schools. In addition, the school 
management must feel committed to participation in the study as they play a crucial 
role in the successful implementation of health promotion measures both as initiator, 
and as responsible organizational facilitator.37 The teachers also play a key role in the 
pre-planning phase. 
 
2) Planning of the program and activities 
There will be arranged focus groups with pupils where the aim is to develop an 
understanding of what preferences they have when it comes to both type of activity 
and the context where the physical activity should take place. This will ensure pupil 
participation, and consequently the target group prefers the content of the program. 
Through information meetings and training of teachers, the aim is to improve 
adherence to the program from key personnel (principals and teachers). 
 
3) Program delivery 
In this phase, the planned program is implemented. It is important to make sure the 
program is included in the school's curriculum. Teachers are an important factor for 
program delivery, and training of teachers will be performed. Further, parents are 
important and they will be invited to information meetings at the school. At these 
meetings written and oral information about the project will be provided, and they will 
also be informed of potential risks or discomfort when participating in the study.  
 
4) Monitoring and evaluation of the implemented program 

12 
 
In this phase, the program will continuously be evaluated to assess whether the 
program work as planned. School leaders and teachers will through logbooks, 
questionnaires and interviews provide data related to; 1) the extent to which the 
program and its elements is implemented as planned (fidelity); 2) how much of the 
program is delivered (dose delivered);  3) how well different program components are 
delivered (quality);  4) how responsive participants were to the program 
(responsiveness); and 5) changes made to the program during implementation that 
enhance its fit with the context (adaptation). Furthermore, parents and pupils will be 
asked general questions about the school's communication on physical activity and in 
addition there will be specific questions for participants in the intervention groups 
about the dosage of the program and the utility value of the various components. 
 
All of these sub-elements will create a common understanding of the premises of the project 
and thus create a mutual commitment to the implementation of the program. This approach 
allows a certain degree of local adaptation of the program to ensure implementation, while at 
the same time there is a need to limit local variation from a research perspective. Good 
dialogue enables both conditions. 
 
5.0 PROJECT MANANGEMENT, ORGANIZATION AND COLLABORATION 
The subject group includes persons from five national research institutions: 
 Norwegian school of sport sciences (NSSS)  
 Sogn og Fjordane University College (HiSF)   
 University of Agder (UiA) 
 University of Stavanger (UiS) 
 Centre for Child and Adolescent Mental Health, Eastern and Southern Norway 
(RBUP) 
 
Researchers from the Department of Sports Medicine, NSSS, will coordinate the study. There 
will be a working group consisting of the most central researchers:  
Elin Kolle (primary investigator, NSSS), Sigmund Anderssen (NSSS), Reidar Säfvenbom 
(NSSS), Ulf Ekelund (NSSS), Jostein Steene-Johannessen (NSSS), May Grydeland (NSSS), 
Geir Kåre Resaland (HiSF), Sveinung Berntsen (UiA), Sindre Dyrstad (UiS) and Åse Sagatun 
(RBUP). This group will meet regularly during the study period.  
 
All contributors will be included to a greater or lesser extent in different phases of the project. 
For example, some will only be involved in the planning phase and selection of measurement 
methods for the different outcome variables, while others will mainly participate in the 
implementation of the programs.  
 
Employees at the National Center for Food, Health and Physical Activity will also be a part of 
the project group. The project will be completed in close collaboration with the working 
group at the Norwegian Directorate for Education and Training.   
 
 
 
 

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6.0 QUALITY ASSURANCE 
The researchers involved in this project have extensive experience in carrying out major 
research projects. This in itself contributes as a basis for good routines for quality assurance 
of the various phases of the project. Valid and reliable assessment instruments will be used, 
and all involved personnel will conduct extensive training. To reduce measurement errors, a 
multi-level quality control is added: 
 
a) All assessment instruments will be calibrated according to specific procedures. 
b) A detailed manual for the data collection procedures is prepared. When using an 
accelerometer to measure physical activity, a template is prepared for programming 
and downloading data. If some employees in the project group team quit their job 
during the project period, they will be replaced as soon as possible. The project group 
as a whole has broad experience and somewhat coherent knowledge; this means that if 
a leading person in the project quit the job, others can take over this role. 
c) In order to control systematic measurement errors, either due to different test 
personnel or different test instruments, systematic inter- and intratester tests will be 
performed 
d) The use of electronic questionnaires reduces the risk of data entry errors. 
 
All sensitive data (digital and non-digital) generated through the trial are confidential and will 
be processed in accordance with standards set by the Data Inspectorate and in accordance 
with the Act on Health Research and the Personal Data Act. Appropriate data protection 
measures will be applied to ensure total confidentiality of computer files. The project group 
have extensive experience and professional expertise in protection of data using database 
structures. In this project there is a strive for a population-based approach that focuses on and 
treats, all pupils equally and thoughtfully, regardless of race, gender, size or form.  
 
 
 

14 
 
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