Interventions promoting active transport to school in children: A systematic review and meta-analysis.

The systematic review investigated the effectiveness of active travel (AT) interventions on physical activity and fitness in primary school children. The review assessed intervention effectiveness, design, complexity, and study quality. Searches were conducted in five databases on 30/08/2018. Studies with an AT intervention compared to an inactive control, in 4 to 11 year olds, measuring AT or fitness outcomes were included. Two-stage screening identified relevant studies. Relevant data were extracted using Cochrane Extraction Form, Quality Assessment Tool for Quantitative Studies, Active Living by Design model, and intervention Complexity Assessment Tool for Systematic Reviews. Meta-analysis and Cohen's D effect size assessed effectiveness. Seventeen eligible studies were included. Effectiveness assessment found a statistically significant standardised mean difference (SMD) in AT outcomes in favour of the intervention (continuous AT - SMD 0.78 (CI 0.11-1.46); frequency AT - SMD 1.87 (CI 0.88-2.86)). Cohen's D calculation concurred with this finding. Fifteen studies had SMD favouring the intervention - two studies had SMD favouring the control. Sixteen studies received a weak quality rating - one study rated moderate. Active travel shows promise in increasing physical activity in primary school children. The review found walking school buses and educational strategies most effective for increasing relevant outcomes, although overall study quality was weak. Effect size did not associate with the complexity of an intervention, therefore supporting efforts to promote active travel through interventions may be easier to scale. Further intervention studies of greater methodological quality are necessary to confirm these findings due to the limited evidence available.