Active Smarter Kids: A Cluster-randomized Controlled Trial

Study Overview
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Brief Summary
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The relationship between physical activity and academic performance has received widespread attention owing to the pressure on schools to graduate pupils who meet accepted academic standards. As important, there are global concerns regarding the increased prevalence of lifestyle-related non-communicable diseases (NCDs). First, Norway has a history of mediocre scores on international comparative academic performance tests such as Trends in International Mathematics and Science Study (TIMSS) and the Programme for International Student Assessment (PISA) [1]. It is therefore important to develop and evaluate strategic programs that may enhance pupil's academic performance. It is increasingly evident that a physical activity strategy that brings about enhanced cognitive function, better blood flow, and more, plays a key role in this effort [2]. Second, the prevalence of NCDs, such as diabetes mellitus type 2, is increasing worldwide, and such NCDs affect people of all ages [3]. Hence, healthcare costs are escalating to unaffordable levels. The best means to deal with this immense problem is through primary prevention, and physical activity is a powerful common denominator known to play a key role in preventing a host of NCDs [4]. Consequently, both World Health Organization (WHO) and the Norwegian health authorities call for effective primary prevention strategies to promote physical activity in children and adolescents [5, 6]. Prop. 90 L (2010-2011) Act on public health work [6] emphasizes that physical activity in school can benefit both the learning process and public health prevention. Therefore, the objective of the ASK-study is to investigate the effects on academic performance of 60 minutes of daily physical activity during one school year. Furthermore, due to the complexity in the relationship between physical activity and academic performance, it is necessary to identify possible mediating and moderating variables as cognitive performance, quality of life (QoL), classroom behavior, motor skills and motivation. Also, we aim to investigate changes in risk factors related to NCDs and factors that influence NSDs, such as physical activity, sedentary behavior and health-related fitness. In addition a qualitative part of the ASK-Study will be conducted to get an in-depth understanding of the children's embodied experiences and the meaning of the social learning culture in school physical activity (PA). This will give us an in-depth description of the intervention context, offer insight in how the intervention possibly influences children's overall development and enables us to estimate potential long term effects of the intervention. If successful, the ASK cluster-randomized controlled trial (RCT) could provide much needed solutions to enhancing schoolchildren's academic performance and position the school as an effective setting for a massive public health intervention concerning the prevention of NCDs.

Official Title
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Active Smarter Kids: A Cluster-randomized Controlled Trial Investigating the Effect of Daily Physical Activity on Children's Academic Performance and on Risk Factors for Lifestyle-related Non-communicable Diseases

Conditions
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Academic Performance; Primary Prevention; Physical Activity

Intervention / Treatment
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* Behavioral: Physical activity


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all children attending 5th grade at the invited schools in Sogn og Fjordane county (Norway) during the school-year 2014/2015 Exclusion Criteria: those children whom for language barriers are unable to perform national tests in Numeracy, Norwegian and English

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 11 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

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
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physical activity<br>60 minutes of daily physical activity during one school year | Behavioral: Physical activity<br> <br> |
| No Intervention: Control<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Academic performance | Academic performance will be measured by Norwegian national tests in Numeracy, Norwegian and English | October 2014 - June 2015 (8 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Risk factors for lifestyle-related non-communicable diseases (NCDs) | We will measure physical activity, sedentary behavior, health-related physical fitness, measures of adiposity, blood pressure and biomarkers for metabolic health | August 2014 - June 2015 (10 months) | 
| Executive functions | Inhibition, working memory and cognitive flexibility will be assessed by pen-and-paper testing | August 2014 - June 2015 (10 months) | 
| Qualitative study of embodied experiences and interpersonal relations | Qualitative methods will be used to explore how children act in the context of physical education and the ASK-intervention, and how their experiences are constructed in the interaction between individual and social factors. We will also explore to what extent children are capable to reflect over their bodily and social experiences. | August 2014 - June 2015 (10 months) |