Implementation Quality Impacts Fourth Grade Students' Participation in Physically Active Academic Lessons.

It is important to assess implementation of active learning interventions to maximize their impact. Implementation quality, or how well one engages program participants, has been less studied than other implementation components (e.g., dose, fidelity). This cross-sectional, exploratory study examined associations between teacher engagement behaviors, quality of teacher engagement (i.e., teacher feedback), and student physical activity outcomes during active classroom lessons. This study used data from the Texas Initiatives for Children's Activity and Nutrition (I-CAN!) randomized controlled trial. Fixed effects regressions investigated the impact of teacher engagement behaviors on student physical activity outcomes. Bivariate correlations examined associations between teacher feedback and student physical activity outcomes. A latent profile analysis explored whether there were subsets of teachers with similar feedback profiles. The final analytic sample included 82 teachers. Teacher-directed changes and teacher participation in physical activity were each associated with higher ratings for how many and how often children were active during lessons. Teacher participation in physical activity was also significantly related to higher ratings for student physical activity intensity (all p < .05). Physical Activity Reinforcement and Technical Instruction feedback were positively associated with activity intensity (r = - .20, p < .05 and r = .34, p < .01, respectively). Technical Instruction feedback was positively associated with how many (r = .25, p < .01) and how often (r = .41, p < .01) students were active during lessons. Negative feedback was negatively associated with how often (r = - .25, p < .05) students were active and activity intensity (r = - .25, p < .05). Game Instruction was negatively related to how often students were active (r = -.23, p < .05). All teachers were represented by high levels of Game Instruction and Classroom Management feedback, moderate levels of Content Reinforcement and Content Instruction feedback, and low levels of Negative, Technical Instruction, and Physical Activity Reinforcement feedback. These data did not indicate the existence of multiple feedback profiles. Findings suggest that teacher engagement and feedback to students during active lessons can promote student physical activity. Teachers are primarily responsible for implementing school-based interventions, so it is critical to develop strategies that increase their ability to implement them successfully. Opportunities to maximize intervention delivery, such as co-designing with teachers, should be utilized when designing school-based, physical activity interventions.