Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial

Abstract

Background

Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school’s social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents.

Methods and findings

Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools ( n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] −1.91 minutes [−5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample.

Conclusions

In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. 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

ISRCTN Registry ISRCTN31583496.

Abstract

Kirsten Corder and colleagues report the findings from of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity among adolescents in the UK.

Author summary

Why was this study done?

• Regular physical activity in adolescence is associated with mental and physical health benefits, but adolescent physical activity levels are low.

• Schools offer a way of promoting physical activity in all adolescents, but interventions need to consider the out-of-school period as well.

• There is limited previous research evaluating adolescent physical activity promotion in large samples with device-measured physical activity and long-term follow-up.

What did the researchers do and find?

• We conducted a cluster randomised controlled trial of the GoActive intervention, a feasibility-tested physical activity promotion programme co-designed with adolescents.

• After recruiting 2,862 adolescents aged 13–14 years, we found that the GoActive intervention was no more effective than the control condition in preventing declines in adolescent physical activity at 10-month follow-up.

• The process evaluation data show that GoActive was not implemented as intended.

What do these findings mean?

• Consistent with previous studies, this research-driven approach to school-based physical activity promotion was not effective, with implementation challenges likely playing an important role in the lack of effect.

• Improved understanding of the implementation and delivery challenges of public health interventions in secondary schools is required to improve the effectiveness of physical activity promotion approaches.