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      Effectiveness of active school transport interventions: a systematic review and update


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          Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review.


          Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size.


          Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities.


          Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions.

          Trial registration

          Registered in PROSPERO: CRD42016033252

          Electronic supplementary material

          The online version of this article (10.1186/s12889-017-5005-1) contains supplementary material, which is available to authorized users.

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          Most cited references55

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          Statistical Power Analysis for the Behavioral Sciences

          <i>Statistical Power Analysis</i> is a nontechnical guide to power analysis in research planning that provides users of applied statistics with the tools they need for more effective analysis. The Second Edition includes: <br> * a chapter covering power analysis in set correlation and multivariate methods;<br> * a chapter considering effect size, psychometric reliability, and the efficacy of "qualifying" dependent variables and;<br> * expanded power and sample size tables for multiple regression/correlation.<br>
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            Active transportation to school: trends among U.S. schoolchildren, 1969-2001.

            Rising rates of overweight children have focused attention on walking and biking to school as a means to increase children's physical activity levels. Despite this attention, there has been little documentation of trends in school travel over the past 30 years or analysis of what has caused the changes in mode choice for school trips. This article analyzes data from the 1969, 1977, 1983, 1990, 1995, and 2001 National Personal Transportation Survey conducted by the U.S. Department of Transportation to document the proportion of students actively commuting to school in aggregate and by subgroups and analyze the relative influence of trip, child, and household characteristics across survey years. All analyses were done in 2006. The National Personal Transportation Survey data show that in 1969, 40.7% (95% confidence interval [CI]=37.9-43.5) of students walked or biked to school; by 2001, the proportion was 12.9% (95% CI=11.8-13.9). Distance to school has increased over time and may account for half of the decline in active transportation to school. It also has the strongest influence on the decision to walk or bike across survey years. Declining rates of active transportation among school travelers represents a worrisome loss of physical activity. Policymakers should continue to support programs designed to encourage children to walk to school such as Safe Routes to School and the Centers for Disease Control and Prevention's KidsWalk. In addition, officials need to design policies that encourage schools to be placed within neighborhoods to ensure that the distance to school is not beyond an acceptable walking distance.
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              Associations between active school transport and physical activity, body composition, and cardiovascular fitness: a systematic review of 68 studies.

              The impact of active school transport (AST) on daily physical activity (PA) levels, body composition and cardiovascular fitness remains unclear. A systematic review was conducted to examine differences in PA, body composition and cardiovascular fitness between active and passive travelers. The Medline, PubMed, Embase, PsycInfo, and ProQuest databases were searched and 10 key informants were consulted. Quality of evidence was assessed with GRADE and with the Effective Public Health Practice Project tool for quantitative studies. Sixty-eight different studies met the inclusion criteria. The majority of studies found that active school travelers were more active or that AST interventions lead to increases in PA, and the quality of evidence is moderate. There is conflicting, and therefore very low quality evidence, regarding the associations between AST and body composition indicators, and between walking to/from school and cardiovascular fitness; however, all studies with relevant measures found a positive association between cycling to/from school and cardiovascular fitness; this evidence is of moderate quality. These findings suggest that AST should be promoted to increase PA levels in children and adolescents and that cycling to/ from school is associated with increased cardiovascular fitness. Intervention studies are needed to increase the quality of evidence.

                Author and article information

                1-604-822-2990 , guy.faulkner@ubc.ca
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1 February 2018
                1 February 2018
                : 18
                : 206
                [1 ]ISNI 0000 0000 9402 6172, GRID grid.414148.c, Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, ; Ottawa, ON K1H 8L1 Canada
                [2 ]ISNI 0000 0000 9471 0214, GRID grid.47609.3c, Faculty of Health Sciences University of Lethbridge, ; 4401 University Drive, office M3049 Lethbridge, Alberta, T1K 3M4 Canada
                [3 ]Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 1001 Queen St West, Toronto, ON M6J 1H4 Canada
                [4 ]ISNI 0000000121138138, GRID grid.11984.35, School of Psychological Sciences and Health, University of Strathclyde, ; 16 Richmond St, Glasgow G1 1XQ, Glasgow, UK
                [5 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, School of Kinesiology, University of British Columbia, ; D H Copp Building 4606, 2146 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
                [6 ]ISNI 0000 0001 1302 4958, GRID grid.55614.33, Center for Hip Health and Mobility, Robert H.N. Ho Research Centre, ; 5th Floor, 2635 Laurel St, Vancouver, BC V5Z 1M9 Canada
                Author information
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                : 28 April 2017
                : 20 December 2017
                Research Article
                Custom metadata
                © The Author(s) 2018

                Public health
                active travel,physical activity,children,safe routes to school,school travel plans,walking school buses


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