Background: UK and global policies recommend whole-school approaches to improve childrens' inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure 'systems' change, a framework is required that identifies all components of a whole-school PA approach. The study's aim was to codevelop a whole-school PA framework using the double diamond design approach (DDDA).Methodology: Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one 'initial' framework. Next, stakeholders reviewed the 'initial' framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.Results: Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers' capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder wholeschool PA.Summary: To the authors' knowledge, this is the first time practitioners, policymakers and researchers have codesigned a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives 'with' schools, while abandoning outdated traditional approaches of implementing interventions 'on' schools.

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Background UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies all components of a whole-school PA approach. The study’s aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA). Methodology Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n=9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n=6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one ‘initial’ framework. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire. Results Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers’ capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA. Summary To the authors’ knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

Background UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective and sustainable interventions which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies the many components of a whole-school PA approach. The aim of this paper was to co-develop a whole-school PA framework using the double diamond design approach (DDDA); a four-stage reflective process to discover, define, develop, and deliver an innovative solution to a problem. Framework development process Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n=9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n=6) stakeholder groupings. Six draft frameworks were created before stakeholders selected one ‘initial’ framework through an individual voting process. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, the original stakeholders voted on eight proposed modifications using an online questionnaire. Following voting, the final Creating Active Schools (CAS) Framework was designed. Summary To the authors knowledge, this is the first time practitioners, policy makers and researchers who understand the powerful driving agents of school systems and teacher and pupil PA behaviour, have co-designed a whole-school PA framework from initial conception. The novelty of the CAS framework resides in formally identifying the multitude of interconnecting elements of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The CAS framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, the CAS framework presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

Background Physically active learning (PAL) - integration of movement within delivery of academic content - is a core component of many whole-of-school physical activity approaches. Yet, PAL intervention methods and strategies vary and frequently are not sustained beyond formal programmes. To improve PAL training, a more comprehensive understanding of the behavioural and psychological processes that influence teachers’ adoption and implementation of PAL is required. To address this, we conducted a meta-synthesis to synthesise key stakeholders’ knowledge of facilitators and barriers to teachers’ implementing PAL in schools to improve teacher-focussed PAL interventions in primary (elementary) schools. Methodology We conducted a meta-synthesis using a five-stage thematic synthesis approach to; develop a research purpose and aim, identify relevant articles, appraise studies for quality, develop descriptive themes and interpret and synthesise the literature. In the final stage, 14 domains from the Theoretical Domain Framework (TDF) were then aligned to the final analytical themes and subthemes. Results We identified seven themes and 31 sub-themes from 25 eligible papers. Four themes summarised teacher-level factors: PAL benefits, teachers’ beliefs about own capabilities, PAL teacher training, PAL delivery. One theme encompassed teacher and school-level factors: resources. Two themes reflected school and external factors that influence teachers’ PAL behaviour: whole-school approach, external factors. Ten (of 14) TDF domains aligned with main themes and sub-themes: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, Beliefs about Consequences, Reinforcement, Goals, Environmental Context and Resources, Social influences and Emotion. Conclusions Our synthesis illustrates the inherent complexity required to change and sustain teachers’ PAL behaviours. Initially, teachers must receive the training, resources and support to develop the capability to implement and adapt PAL. The PAL training programme should progress as teachers’ build their experience and capability; content should be ‘refreshed’ and become more challenging over time. Subsequently, it is imperative to engage all levels of the school community for PAL to be fully integrated into a broader school system. Adequate resources, strong leadership and governance, an engaged activated community and political will are necessary to achieve this, and may not currently exist in most schools.

Moderate-to-vigorous physical activity (MVPA) levels in children are at an alltime low (1,2). In response, the UK government's Primary Physical Education (P.E.) and Sport Premium fund (~£320 million) supports primary schools to provide 30 min of in-school MVPA for all pupils (3,4). However, challenges persist with schools receiving little evidence-based guidance on how best to allocate resources. One approach to increasing MVPA that is gaining traction through practice and research alike is physically active learning (PAL), the integration of movement within academic lessons (5-7). In the recent Creating Active Schools Framework, PAL was highlighted as a premium opportunity for increasing MVPA because of the expansion of MVPA into a traditionally highly sedentary segments of the school day (8-10).Recent systematic reviews and metaanalyses support the positive impact of PAL on MVPA and subsequently enhanced time on task ( 11), yet findings on academic performance are often varied and lack consensus (12). Thus, empirical research has yet to sufficiently demonstrate the efficacy of PAL lessons in improving pupils' learning (6,11).To advance the evidence base on the effects of PAL, there is a need to move beyond studies that assess the reinforcement of previously learnt concepts (13) to understand the potential effects of PAL in regard to learning new academic content (12). With reference to maths, PAL has shown beneficial effects in both acute and chronic studies of varied durations (14-16). Although qualitative studies on teachers often highlight perceived pupil enjoyment and engagement (17,18), there is a limited understanding of the children's perspectives of PAL engagement. Studies that have explored the perspectives of primary school children engaging in PAL interventions have focused on specific interventions such as virtual field trips (19) or an outdoor learning program (20).

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