Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial


Autoři: Kirsten Corder aff001;  Stephen J. Sharp aff001;  Stephanie T. Jong aff001;  Campbell Foubister aff001;  Helen Elizabeth Brown aff001;  Emma K. Wells aff001;  Sofie M. Armitage aff001;  Caroline H. D. Croxson aff004;  Anna Vignoles aff005;  Paul O. Wilkinson aff006;  Edward C. F. Wilson aff008;  Esther M. F. van Sluijs aff001
Působiště autorů: UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom aff001;  MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom aff002;  Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom aff003;  Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom aff004;  Faculty of Education, University of Cambridge, Cambridge, United Kingdom aff005;  Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom aff006;  Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom aff007;  Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom aff008
Vyšlo v časopise: Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003210
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003210

Souhrn

Background

Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school’s social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents.

Methods and findings

Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] −1.91 minutes [−5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample.

Conclusions

In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational-setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale.

Trial registration

ISRCTN Registry ISRCTN31583496.

Klíčová slova:

Adolescents – Body weight – Ethnicities – Exercise – Physical activity – Schools – Teachers – Sedentary behavior


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