Title: Opportunities within the school environment to shift the distribution of activity intensity in adolescents.
Funder: Department of Health and Social Care

Abstract: Background In young people, physical activity is positively associated with healthy weight, improved metabolic indicators, mental health and academic performance. In addition, sedentary behaviours may be detrimental for health, independent of physical activity. Only 30-40% of young people undertake sufficient physical activity, and the amount of time spent sedentary is high, particularly in adolescence. Relatively, more time at school than out-of-school is spent sedentary. Previous secondary school-based efforts to increase physical activity have been somewhat effective, although their impact on overall activity may be limited. Interventions have typically relied on conscious, reflective processes to bring about behaviour change, such as through increasing knowledge. The potential of the school s physical and policy environment to aid change in activity intensity is not well understood. This project seeks to identify ways in which the school environment might influence young people s distribution of activity intensity. Aims The specific objectives of the project are: 1. To identify potential school-level activity-related policy and physical environmental interventions through a systematic review of the evidence. 2. To further inform intervention opportunities by examining temporal patterning of, and school-level determinants of change, in adolescents sedentary behaviour and physical activity. 3. To prioritise potential intervention approaches using a pre-specified, stakeholder-led consensus method. 4. To test the feasibility of two promising interventions to improve the activity distribution of adolescents in secondary schools. Research plan To identify potential intervention strategies, we will first review the experimental, observational and qualitative literature assessing school-level influences on activity-related behaviour. Literature will be identified through electronic searching; citation checking; and contacting experts to identify grey literature. Two reviewers will assess papers against inclusion criteria, extract data and assess quality. To further inform intervention avenues, we will then utilise existing data resources of large population-based samples (ICAD and SPEEDY) with time-stamped data on objectively-measured physical activity to assess 1) key intervention times and locations through an investigation of patterns of activity intensity during the school day; and 2) potential intervention targets by studying the association between changes in the school environment (e.g. school ground facilities) on changes in activity intensity. Third, eight promising intervention strategies will be further developed (including estimating cost-effectiveness) and taken forward into a stakeholder-led prioritisation process. We will conduct a Delphi process, a majority consensus technique involving experts and stakeholders (including teachers, parents and adolescents). Prioritisation will be based on multiple criteria, including potential behavioural effect, reach, equality and cost-effectiveness. We will subsequently further develop two top-ranking strategies to test feasibility, acceptability, cost and preliminary (cost-)effectiveness. An indicative example is an evaluation of the introduction of standing desks in classrooms, which is hypothesised to decrease sedentary time. The studies will aim to establish feasibility of intervention implementation and evaluation. We will establish recruitment and retention rates, barriers and facilitators for intervention implementation, suitable and relevant outcome measures, intervention costs, exposure, preliminary (cost-)effectiveness and potential for sustainability, wider implementation and evaluation. Research team The multi-disciplinary team of applicants works together in the UKCRC Centre for Diet and Activity Research (CEDAR), and has expertise in behavioural epidemiology, measuring activity in young people, systematic reviewing, health economy, and stakeholder and policy engagement. We will appoint a full-time 3-year post-doc to conduct the project and a part-time health economist will undertake the economic work. Potential impact/stakeholder influence This work has the potential to identify novel ways in which schools can promote health, beyond physical education, which could result in population-level positive changes in the distribution of activity intensity in adolescents as well as their well-being and academic performance. It involves active stakeholder engagement throughout the project.

Lay abstract: Doing more physical activity and sitting less is important for health and wellbeing in young people. However, many are not active for the government-recommended time of 60 minutes per day, and they also sit for long periods. This is particularly true for adolescents. This unhealthy lifestyle is heavily influenced by the environment in which they live and spent most of their time. This project aims to find ways to help young people be more active and sit less. This is in line with Department of Health physical activity policies, the overall government goal that good schools will be active promoters of health in childhood and adolescence (Health Lives, Healthy People White Paper, 2010), and is supportive of the Change4Life initiative. It will increase our understanding of how secondary schools can help young people to move more and sit less throughout the school day. It will help us find out what strategies would be most effective, acceptable, and provide the best value for money. The strategies will focus on using automatic rather than conscious processes &ndash; this is sometimes referred to as the nudge approach. We will approach this project by: identifying potential intervention strategies by reviewing the existing literature and analysing existing data from open access resources; including children, teachers, parents, school architects and other experts in the prioritisation of promising interventions; testing the feasibility of two interventions. Throughout the 3-year project, we will engage with young people, parents, those who work in schools and have experience in bringing about changes in schools. We will seek their advice on study design, interpreting the results and prioritising potential strategies. During the project, we will recruit schools and young people as study participants. We will ensure that our protocol is approved by an ethical committee, parental consent and student assent are obtained before the start of the study, and measurement sessions are done by experienced researchers with enhanced Criminal Records Bureau checks. Our research team has considerable experience in large-scale activity-related research in schools, economic analysis and in engaging with young people and other stakeholders throughout research projects.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: ORAL AND GASTROINTESTINAL;STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR