Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Front Public Health. 2023 Apr 13;11:1149883. doi: 10.3389/fpubh.2023.1149883. eCollection 2023.
Physical activity is important for children's health. However, evidence suggests that many children and adults do not meet international physical activity recommendations. Current school-based interventions have had limited effect on physical activity and alternative approaches are needed. Context, which includes school setting, ethos, staff, and sociodemographic factors, is a key and largely ignored contributing factor to school-based physical activity intervention effectiveness, impacting in several interacting ways.
Current programs focus on tightly-constructed content that ignores the context in which the program will be delivered, thereby limiting effectiveness. We propose a move away from uniform interventions that maximize internal validity toward a flexible approach that enables schools to tailor content to their specific context.
Evaluation of context-specific interventions should explicitly consider context. This is challenging in cluster randomized controlled trial designs. Thus, alternative designs such as natural experiment and stepped-wedge designs warrant further consideration.
A collective focus on average minutes of moderate-to-vigorous intensity physical activity may not always be the most appropriate choice. A wider range of outcomes may improve children's physical activity and health in the long-term. In this paper, we argue that greater consideration of school context is key in the design and analysis of school-based physical activity interventions and may help overcome existing limitations in the design of effective interventions and thus progress the field. While this focus on context-specific interventions and evaluation is untested, we hope to stimulate debate of the key issues to improve future physical activity intervention development and implementation.
体育活动对儿童的健康很重要。然而，有证据表明，许多儿童和成年人都没有达到国际体育活动的建议标准。目前基于学校的干预措施对体育活动的效果有限，需要寻找替代方法。背景，包括学校环境、风气、员工和社会人口因素，是影响学校体育活动干预效果的一个关键且在很大程度上被忽视的因素，以多种相互作用的方式产生影响。
目前的项目侧重于精心构建的内容，而忽略了项目将被实施的背景，从而限制了效果。我们建议不再采用最大限度地提高内部有效性的统一干预措施，而是采用灵活的方法，使学校能够根据自己的具体情况定制内容。
对特定于背景的干预措施的评估应明确考虑背景。这在集群随机对照试验设计中具有挑战性。因此，自然实验和逐步楔形设计等替代设计值得进一步考虑。
对中等至剧烈强度体育活动平均分钟数的集体关注可能并不总是最合适的选择。更广泛的结果可能会长期提高儿童的体育活动和健康水平。在本文中，我们认为，在设计和分析基于学校的体育活动干预措施时，更充分地考虑学校背景是关键，这可能有助于克服现有干预措施设计中的局限性，从而推动该领域的发展。虽然这种针对特定于背景的干预措施和评估的关注尚未经过测试，但我们希望激发对关键问题的辩论，以改善未来的体育活动干预措施的发展和实施。
