'It's not because we don't believe in it...': Headteachers' perceptions of implementing physically active lessons in school.

INTRODUCTION: Implementation of school-based physical activity (PA) programmes has proven to be difficult, particularly due to schools' focus on academic performance and lack of organisational support for PA interventions. However, physically active lessons (PA integrated into academic lessons) holds promise as a teaching method that increases children's PA levels without reducing academic time. Headteachers play a significant role in facilitating change in school, but little is known about headteachers' attitudes towards physically active lessons and their benefits. The purpose of this study was to explore headteachers' perceptions of physically active lessons, and identify factors affecting headteachers' acceptance or rejection of physically active lessons implementation. METHOD: A total of 29 semi-structured telephone interviews were conducted with headteachers in primary and secondary schools in the city of Stavanger, Norway. Adopting a phenomenological approach, qualitative data were analysed using inductive content analysis. RESULTS: Although most of the headteachers believed that physically active lessons could contribute positively to pupils' health and learning, only four of 29 schools decided to proceed with implementation. Physically active lessons were more likely to be adopted when the intervention addressed a clearly defined priority area at the school. Change overload and lack of in-depth knowledge of physically active lessons' function and intent appeared to be the most important factors for choosing not to implement physically active lessons. CONCLUSION: One of the major challenges for headteachers was deciding which of the many proposed changes the school should prioritise. If physically active lessons was to be prioritised by headteachers it is very important to communicate thoroughly to the headteachers what the schools can achieve by implementing physically active lessons and how the innovation aligns with school policies and goals. Given the flexibility inherent in physically active lessons and the schools' differing needs and priorities, it was important to emphasise to headteachers that physically active lessons could be adapted to different local school contexts.

Physically active academic lessons: acceptance, barriers and facilitators for implementation.

BACKGROUND: To improve health and academic learning in schoolchildren, the Active School programme in Stavanger, Norway has introduced physically active academic lessons. This is a teaching method combining physical activity with academic content. The purpose of this paper was to evaluate the response to the physically active lessons and identify facilitators and barriers for implementation of such an intervention. METHODS: Five school leaders (principals or vice-principals), 13 teachers and 30 children from the five intervention schools were interviewed about their experiences with the 10-month intervention, which consisted of weekly minimum 2 × 45 minutes of physically active academic lessons, and the factors affecting its implementation. All interviews were transcribed and analysed using the qualitative data analysis program NVivo 10 (QSR international, London, UK). In addition, weekly teacher's intervention delivery logs were collected and analysed. RESULTS: On average, the physically active academic lessons in 18 of the 34 weeks (53%) were reported in the teacher logs. The number of delivered physically active academic lessons covered 73% of the schools' planned activity. Physically active lessons were well received among school leaders, teachers and children. The main facilitators for implementation of the physically active lessons were active leadership and teacher support, high self-efficacy regarding mastering the intervention, ease of organizing physically active lessons, inclusion of physically active lessons into the lesson curricula, and children's positive reception of the intervention. The main barriers were unclear expectations, lack of knowledge and time to plan the physiclly active lessons, and the length of the physically active lessons (15-20 min lessons were preferred over the 45 min lessons). CONCLUSION: Physically active academic lessons were considered an appropriate pedagogical method for creating positive variation, and were highly appreciated among both teachers and children. Both the principal and the teachers should be actively involved the implementation, which could be strengthened by including physical activity into the school's strategy. Barriers for implementing physically active lessons in schools could be lowered by increasing implementation clarity and introducing the teachers to high quality and easily organized lessons. TRIAL REGISTRATION: Clinicaltrail.gov ID identifier: NCT03436355 . Retrospectively registered: 16th of Feb, 2018.

Implementation of physically active lessons: A 2-year follow-up.

Combining physical activity and academic content is a promising way to improve health and academic learning in schoolchildren. This paper examined the continuation of physically active lessons (PAL) in five Norwegian elementary schools, two years after a 10-month intervention period, which consisted of weekly minimum 2 x 45 min of PAL. Data were collected through semi-structured interviews with nine teachers and five school leaders. The Level of Use instrument was used to assess how the teachers integrated PAL into the school day. Two years after the intervention period, seven of nine teachers conducted PAL regularly, on average one lesson per week. Teachers' implementation progress varied from struggling with logistics, to stable routine and creative adaption. Perceived benefits for the children, active leadership, and ongoing implementation support seem important for continuation. Introduction of PAL as a school development project, systematic planning from the onset and a gradual introduction of PAL, can be an effective strategy for continuation and long-term sustainability. In addition, the Level of Use instrument was useful to better understand which support mechanisms are needed at different stages in the implementation of PAL.

Physically active academic lessons and effect on physical activity and aerobic fitness. The Active School study: A cluster randomized controlled trial.

The Active School program was designed to positively impact health and academic-related outcomes in school. The core intervention component was physically active academic lessons, a teaching activity that combines physical activity and educational content. The purpose of this study was to investigate the effect of a 10-month, cluster-randomized controlled trial on physical activity level and aerobic fitness conducted in the city of Stavanger, Norway, in 2014-15. The physical activity level during physically active academic lessons was also studied. A total of 447 children (9-10 years) participated. The weekly intervention consisted of physically active academic lessons, physically active homework and physically active recess. Physical activity level and aerobic fitness were measured objectively by accelerometry and a 10-minute interval running test. Intervention effects were found for time in moderate to vigorous physical activity (MVPA) (adjusted mean difference of 8 min/day, 95% CI: 3.4-13, p < 0.001) and total physical activity (60 counts/min, 95% CI: 15-105, p = 0.009). Children with low aerobic fitness increased their running distance compared to controls (d = 0.46; p = 0.001). During physically active academic lessons children spent 26% of the time in MVPA, which was comparable to physical education lessons. The Active School program successfully increased physical activity for the intervention group and aerobic fitness for the least fit children. The activity level during physically active academic lessons was as high as in physical education lessons. Clinicaltrail.gov ID identifier: NCT03436355.