The Daily Mile as a public health intervention: a rapid ethnographic assessment of uptake and implementation in South London, UK

Abstract

Background Existing evidence identifies health benefits for children of additional daily physical activity (PA) on a range of cardiovascular and metabolic outcomes. The Daily Mile (TDM) is a popular scheme designed to increase children’s PA within the school day. Emerging evidence indicates that participation in TDM can increase children’s PA, reduce sedentarism and reduce skinfold measures. However, little is known about the potential effects of TDM as a public health intervention, and the benefits and disbenefits that might flow from wider implementation in ‘real world’ settings. Methods We aimed to identify how TDM is being implemented in a naturalistic setting, and what implications this has for its potential impact on population health. We undertook a rapid ethnographic assessment of uptake and implementation in Lewisham, south London. Data included interviews ( n = 22) and focus groups ( n = 11) with stakeholders; observations of implementation in 12 classes; and analysis of routine data sources to identify school level factors associated with uptake. Results Of the 69 primary schools in one borough, 33 (48%) had adopted TDM by September 2018. There were no significant differences between adopters and non-adopters in mean school population size (means 377 vs 397, P = 0.70), mean percentage of children eligible for free school meals (16.2 vs 14.3%, P = 0.39), or mean percentage of children from Black and Minority Ethnic populations (76.3 vs 78.2%, P = 0.41). Addressing obesity was a key incentive for adoption, although a range of health and educational benefits were also hypothesised to accrue from participation. Mapping TDM to the TIDierR-PHP checklist to describe the intervention in practice identified that considerable adaption happened at the level of borough, school, class and pupil. Population health effects are likely to be influenced by the interaction of intervention and context at each of these levels. Conclusions Examining TDM in ‘real world’ settings surfaces adaptions and variations in implementation. This has implications for the likely effects of TDM, and points more broadly to an urgent need for more appropriate methods for evaluating public health impact and implementation in complex contexts. Electronic supplementary material The online version of this article (10.1186/s12889-019-7511-9) contains supplementary material, which is available to authorized users.

An evaluation of the implementation of a UK school-based running programme

“…This is perhaps not surprising given that pre-programme a higher percentage of boys were meeting the physical activity recommendations, and gender differences in physical activity participation is one of the most pervasive ndings in the literature (28). Systematic gender differences in how schoolbased running programmes are received has also recently been reported elsewhere (29). Research further suggests potential differences in how much physical activity children gain from interventions, with a greater tendency for girls to (verbally and physically) interact together while participating (30).…”

The Effect of The Daily Mile on Primary School Children’s Aerobic Fitness Levels After 12 Weeks: A Controlled Trial

“…Both the intervention and intervention-plus group had a relatively high intervention implementation rate. However, previous research has shown that adherence to the intended protocol for The Daily Mile can vary considerably [17,18]. This suggests that additional personal support may be superfluous for intervention implementation in the first 12 weeks of the intervention period.…”

“…Teachers perceive The Daily Mile as beneficial for their students' health and fitness [16]. In practice, there is a large variation in implementation between schools [17,18]. Not all schools adhere to the minimum performance frequency (three times per week), duration (15 minutes), and intensity (moderate to vigorous intensity) when performing The Daily Mile.…”

The Daily Mile Is Able to Improve Cardiorespiratory Fitness When Practiced Three Times a Week

“…Regular physical activity is considered a milestone for health promotion and wellbeing, especially throughout childhood and adolescence [1,2]. International guidelines point out that children and adolescences (aged [5][6][7][8][9][10][11][12][13][14][15][16][17] should perform at least 60 min of moderate-to vigorous-intensity physical activity (MVPA) per day [3,4] to prevent and/or reduce the incidence of overweight [5,6] and non-communicable diseases in adulthood [7]. Importantly, one out of the nine global targets stated by the World Health Organization for improving the prevention and treatment of non-communicable diseases is to reduce the prevalence of insufficient physical activity by 10% by 2025 [3,8].…”

“…The activity is successfully implemented and accepted within the school day schedule of primary schools in different educational contexts [15][16][17]. Given the simple intervention characteristics (e.g., the short execution time and relatively low cost) and the flexible organization that supports the teacher's autonomy, The Daily Mile appears to be acceptable and feasible [18].…”