Schoolyard upgrade in a randomized controlled study design-how are school interventions associated with adolescents' perception of opportunities and recess physical activity.

School recess physical activity is important for adolescent s health and development, and several studies have established evidence based on cross-sectional studies that it is influenced by the environment in the schoolyard. The aim of this study was to investigate the effect and variation across schools of a school-based intervention on students perceived opportunities for physical activity in the schoolyard, and to evaluate if an improved collective perception of opportunities was followed by an increase in PA during recess for the 13-15 year-old students. The intervention components included schoolyard renovation; mandatory outdoor recess; and increased adult supervision and support. Students collective perceptions were evaluated by a newly developed Schoolyard index (SYi) with seven items, and physical activity was objectively measured with accelerometer. We found variations in the change of student perceptions across the intervention schools, and that a one unit increase in the Schoolyard index (SYi) led to a 12% increase in recess PA. This study shows that adolescent PA during recess can be increased through a multicomponent intervention. The prospect for making an impact is low and according to the process analysis dependent on direct involvement; active and supportive adults; and varied, connected and well located facilities.