The Effect of Increased Physical Activity on Adolescents' Health and Academic Performance: The School in Motion Study

Study Overview
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Brief Summary
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This study evaluates the effect of 120 minutes extra of physical education (PE) or physical activity (PA) on adolescents' physical health, mental health, academic performance and learning environment. This is a cluster-randomized controlled trial with three arms, where the participants in two of the groups will have different models of increased PE/PA during the school week, whereas the participants in the third arm is the control group including current practice.

Detailed Description
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This is a school-based, three-arm cluster randomized controlled trial (RCT) recruiting adolescents from secondary schools in Norway. Adolescents (aged 14-15 years) were the unit of analysis, and schools (clusters) were randomly assigned to one of three conditions: the physical active learning group (PAL-group), where the schools each week include one additional physical education (PE) lesson, 30 minutes of physical active learning, and 30 minutes of physical activity (intervention condition); the don't worry - be happy group (DWBH-group), where the schools include one new activity class (60 minutes: Be Happy class) and one additional PE-class (60 minutes: Don't Worry class) per week (intervention condition);or current practice (control condition). An identical set of outcome measures are taken from all participants at baseline, and approximately 12 months after the baseline measures, when the participants were at the end of year 9

Official Title
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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

Conditions
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Physical Activity, Academic Achievement, Mental Health

Intervention / Treatment
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* Behavioral: Physical education
* Behavioral: Physical active learning
* Behavioral: Physical activity
* Behavioral: Be happy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects enrolled in 9th grade Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is a cluster-randomized trial with three parallel arms
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physical active learning (PAL)<br>Three components: Physical education (60 minutes) Physical active learning (30 minutes) Physical activity (30 minutes) | Behavioral: Physical education<br>* Physical education (60 minutes): In addition to the ordinary PE-lessons. The pedagogical activities taught in this lesson should be in line with the curriculum of 9th grade and led by the PE-teacher. In the Don't worry - be happy intervention this class was also organized by the students. The students practiced their Be Happy-activities, or they introduced their class peers to their Be Happy-activity. A PE-teacher was present to support the students if necessary.<br>* Other names: PE-intervention;Behavioral: Physical active learning<br>* The curriculum of the subjects (i.e. maths, English, Norwegian) were taught in a physically active manner. The lesson should last 30 minutes and be led by the teacher of the current subject.<br>Behavioral: Physical activity<br>* Without a connection to any specific subject Physical activity should be performed as 30 minutes a week. There are no specific aims to be taught in this lesson, but physical activities that stimulates mastery, joy and well-being should be in focus.<br>|
| Experimental: Don't worry - be happy<br>Two components: Physical education (60 minutes) - don't worry class Physical activity (60 minutes) - be happy class | Behavioral: Physical education<br>* Physical education (60 minutes): In addition to the ordinary PE-lessons. The pedagogical activities taught in this lesson should be in line with the curriculum of 9th grade and led by the PE-teacher. In the Don't worry - be happy intervention this class was also organized by the students. The students practiced their Be Happy-activities, or they introduced their class peers to their Be Happy-activity. A PE-teacher was present to support the students if necessary.<br>* Other names: PE-intervention;Behavioral: Be happy<br>* The Be Happy classes were self-organized activity groups of at least three students, developed according to activity preferences across regular classes. The Be Happy groups practiced traditional sports and physical activities, lifestyle sports, dancing, out-door recreation, drama etc. - inside or outside school.<br>|
| No Intervention: Control group<br>Current practice | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean physical activity level | The participants mean physical activity level measured by accelerometers | Measured baseline and after 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time spent in moderate-to-vigorous physical activity (MVPA) | Mean minutes spent in MVPA per day | Measured baseline and after 12 months | 
| Time spent sedentary | Mean minutes spent sedentary each day, measured both objectively using accelerometers | Measured baseline and after 12 months | 
| Sedentary behaviour | Self-reported in a questionnaire. There are questions related to minutes spent in front of a screen. The answers are categorized into seven alternatives ranging from No time at all to More than 6 hours per day. There are also questions about which screen activity they perform. The answers are categorized into six alternatives ranging from No time at all to More than 3 hours per day. There are also questions about time spent doing homework. The answers are categorized into nine alternatives ranging from No time at all to  More than 7 hours per day. | Measured baseline and after 12 months | 
| Upper limb strength | Handgrip strength using a hand dynamometer. The participants will use the dominant hand, with the arm completely extended and squeeze the dynamometer with maximum isometric effort, for about 2-3 seconds. | Measured baseline and after 12 months | 
| Explosive strength in the lower body | Standing broad jump. The participants will stand behind a line with feet slightly apart. They will be instructed to perform a two-foot take-off and landing, and to jump as far as possible, landing on both feet without falling backwards. The distance from the take-off line to the nearest point of contact on the landing (back of the heels) will be measured, and the better of two attempts will be used for analyses. | Measured baseline and after 12 months | 
| Abdominal muscle endurance | Abdominal muscular endurance will be measured by a sit-up test. The participant will start in a lying position with hands clasped behind the neck, knees bent at a 45° angle with the heels and feet flat on the floor and held down by the tester. The subject then rise to a position with the elbows pointed forward until they touched the knees. The total number of correctly performed and completed sit-ups within 30 seconds is counted. | Measured baseline and after 12 months | 
| Cardiorespiratory fitness | Intermittent running test. Participants run for 10 minutes, and the distance covered (in meters) is recorded. | Measured baseline and after 12 months | 
| Academic performance in reading | Specific standardized Norwegian National tests in reading.The test is designed and administrated by The Norwegian Directorate for Education and Training. | Measured baseline and after 9 months | 
| Academic performance in numeracy | Specific standardized Norwegian National tests in numeracy. The test is designed and administrated by The Norwegian Directorate for Education and Training. | Measured baseline and after 9 months | 
| Overall psychosocial problems and strengths | Assessed with the Strength and Difficulties Questionnaire (SDQ). This is a short screening instrument consisting of 25 items equally divided across five scales measuring emotional symptoms, conduct problems, hyperactivity-inattention, peer problems, and prosocial behavior. Each statement is answered as Not true, Somewhat true and Certainly true. Some questions have reversed form, which is reversed in the scoring of the instrument. Replies were scored from 0 to 2, and the subscales are summed to a score ranging from 0-10 for each subscale. Added together, the first four scores generate a total difficulties score, ranging from 0 to 40. Higher scores indicate more problems. | Measured baseline and after 12 months | 
| Adolescents' subjective health and well-being | Adolescent's subjective health and well-being is assessed using the Kidscreen-27 questionnaire. The instrument consists of 27 items covering the following five quality of life dimensions: 1) physical well-being (5 items), 2) psychological well-being (7 items), 3) parents/guardians relations & autonomy (7 items), 4) social support & peers (4 items), and 5) school environment (5 items). The questions are answered on a 5-point likert scale. Scores can be created for each of the five dimensions. The methodology given in the developers manual will be used to obtain the T-scores; mean (±SD) scores of 50 ± 10 define normality for children and adolescents aged 8-18 years across Europe. Higher scores indicate a better health-related quality of life. | Measured baseline and after 12 months | 
| The adolescents domain specific self-evaluation of competence or adequacy | Assessed through Harter's Self-perception Profile for Adolescents (SPPA). The instrument consists of seven subscales covering the following domains: 1) scholastic competence, 2) social competence, 3) athletic competence, 4) physical appearance, 5) job competence, 6) close friendship, and 7) romantic appeal. Each subscale contains four items, each having four options: 1 (Describes me very poorly), 2 (Describes me fairly poorly), 3 (Describes me fairly well), and 4 (Describes me very well), providing a mean score of perceived competence in that area, ranging from 1 (lowest level of self-esteem) to 4 (highest level of self-esteem). | Measured baseline and after 12 months | 
| Symptoms of anxiety and depression | Assessed by the short version of Hopkins Symptom Checklist (HSCL-10). HSCL-10 consists of 10 symptoms or problems that people sometimes have in which adolescents answered how much the symptoms have bothered or distressed them during the last week. All 10 questions have 4 response categories: 'Not at all', 'A little', 'Quite a bit' and 'Extremely'. The responses are summarized across all items and the mean score is used as a measure of psychological distress. Higher values indicates higher psychological distress. | Measured baseline and after 12 months | 
| Learning environment in the classroom | The Classroom Climate Scale is used to assess learning environment. This instrument consist of 22 questions related to intrinsic and extrinsic motivation, anticipation and teacher-student relations. All questions are answered on a four-point scale: Strongly agree, Somewhat agree, Somewhat disagree, Strongly disagree. All points are summed to a total score. Higher scores indicates higher classroom environment. | Measured baseline and after 12 months | 
| School environment | Learning environment at school in general is self-reported in a questionnaire. It consist of three separate questions, and the questions are answered on a 7-point likert scale ranging from totally disagree to totally agree. A mean score from the three questions will be made, and a higher score indicates better school environment. | Measured baseline and after 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Accelerometer, Adolescents, Physical activity, Physical fitness, Academic performance, Cluster RCT, Mental health, Secondary school, Physical education, Physical active educational lessons