A school-based, peer-led programme to increase physical activity among 13- to 14-year-old adolescents: the GoActive cluster RCT

Abstract

Background Adolescent physical activity levels are low and are associated with rising disease risk and social disadvantage. The Get Others Active (GoActive) intervention was co-designed with adolescents and teachers to increase physical activity in adolescents. Objective To assess the effectiveness and cost-effectiveness of the school-based GoActive programme in increasing adolescents’ moderate-to-vigorous physical activity. Design A cluster randomised controlled trial with an embedded mixed-methods process evaluation. Setting Non-fee-paying schools in Cambridgeshire and Essex, UK (n = 16). Schools were computer randomised and stratified by socioeconomic position and county. Participants A total of 2862 Year 9 students (aged 13–14 years; 84% of eligible students). Intervention The iteratively developed feasibility-tested refined 12-week intervention trained older adolescents (mentors) and in-class peer leaders to encourage classes to undertake two new weekly activities. Mentors met with classes weekly. Students and classes gained points and rewards for activity in and out of school. Main outcome measures The primary outcome was average daily minutes of accelerometer-assessed moderate-to-vigorous physical activity at 10 months post intervention. Secondary outcomes included accelerometer-assessed activity during school, after school and at weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness; well-being and a mixed-methods process evaluation. Measurement staff were blinded to allocation. Results Of 2862 recruited participants, 2167 (76%) attended 10-month follow-up measurements and we analysed the primary outcome for 1874 (65.5%) participants. At 10 months, there was a mean decrease in moderate-to-vigorous physical activity of 8.3 (standard deviation 19.3) minutes in control participants and 10.4 (standard deviation 22.7) minutes in intervention participants (baseline-adjusted difference –1.91 minutes, 95% confidence interval –5.53 to 1.70 minutes; p = 0.316). The programme cost £13 per student compared with control. Therefore, it was not cost-effective. Non-significant indications of differential impacts suggested detrimental effects among boys (boys –3.44, 95% confidence interval –7.42 to 0.54; girls –0.20, 95% confidence interval –3.56 to 3.16), but favoured adolescents from lower socioeconomic backgrounds (medium/low 4.25, 95% confidence interval –0.66 to 9.16; high –2.72, 95% confidence interval –6.33 to 0.89). Mediation analysis did not support the use of any included intervention components to increase physical activity. Some may have potential for improving well-being. Students, teachers and mentors mostly reported enjoying the GoActive intervention (56%, 87% and 50%, respectively), but struggled to conceptualise their roles. Facilitators of implementation included school support, embedding a routine, and mentor and tutor support. Challenges to implementation included having limited school space for activities, time, and uncertainty of teacher and mentor roles. Limitations Retention on the primary outcome at 10-month follow-up was low (65.5%), but we achieved our intended sample size, with retention comparable to similar trials. Conclusions A rigorously developed school-based intervention (i.e. GoActive) was not effective in countering the age-related decline in adolescent physical activity. Overall, this mixed-methods evaluation provides transferable insights for future intervention development, implementation and evaluation. Future work Interdisciplinary research is required to understand educational setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale. Trial registration Current Controlled Trials ISRCTN31583496. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information. This work was additionally supported by the Medical Research Council (London, UK) (Unit Programme number MC_UU_12015/7) and undertaken under the auspices of the Centre for Diet and Activity Research (Cambridge, UK), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation (London, UK), Cancer Research UK (London, UK), Economic and Social Research Council (Swindon, UK), Medical Research Council, the National Institute for Health Research (Southampton, UK) and the Wellcome Trust (London, UK), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (087636/Z/08/Z; ES/G007462/1; MR/K023187/1). GoActive facilitator costs were borne by Essex and Cambridgeshire County Councils.

Feasibility of a peer-led, after-school physical activity intervention for disadvantaged adolescent females during the COVID-19 pandemic: results from the Girls Active Project (GAP)

“…Steady support and commitment from the school, and the enthusiastic project leaders, were cited as factors that helped intervention implementation. This highlighted the importance of stakeholder buy-in, as found in previous school-based PA initiatives [79,80]. Finally, tailoring interventions to the individual school context is important for scaling up [79,81].…”

“…Similar to Jago et al [ 52 ], stakeholders in this study recommended extra emphasis on enjoyment of classes when pitching the programme to increase participation. Using a parental/guardian, passive (opt-out) approach has allowed for greater recruitment of adolescents in previous low-risk, nonintrusive, school-based PA interventions [ 32 , 34 , 44 , 74 , 79 ], such as the Girls-Peer Activity (G-PACT) [ 32 ] (94% using passive consent vs 26% using active consent) and the GoActive programme [ 87 ] (78% using passive consent vs 23% using active consent). This refinement, however, is dependent on ethical approval from the institutional research ethics board and agreement from the participating school.…”

“…Furthermore, while many of the evaluation tools used in this study allowed for specificity, a limitation of this approach is the lack of evidence for the reliability or validity of the scores that such scales generate. This limitation has been acknowledged in similar evaluations of school-based adolescent PA interventions [ 72 , 79 ].…”

“…This highlighted the importance of stakeholder buy-in, as found in previous school-based PA initiatives [79,80]. Finally, tailoring interventions to the individual school context is important for scaling up [79,81]. Stakeholders' willingness to modify the intervention suggested that they were engaged and felt empowered to tailor the programme to suit their context.…”

Do socioeconomic inequities arise during school-based physical activity interventions? An exploratory case study of the GoActive trial

“…The results of the main GoActive trail analysis reported no overall intervention effect on average daily MVPA 25. Subgroup analyses conducted as part of the trial evaluation reported a suggestion of a positive intervention effect among students of a low/middle-SEP. Across all MVPA outcomes, those of high-SEP appeared to benefit least when compared with low/middle-SEP students.…”