The Great Unknown: Best Practices for the Implementation of Comprehensive School Physical Activity Programs
Justin B. Moore, PhD, MS, FACSM
Although few things are known in science, as it relates to public health practice, we know with a high degree of certainty about physical activity and youth. For example, physical activity promotes health in youth, most youth spend a considerably amount of time at school, and schools present opportunities for the promotion of physical activity in youth (and, potentially, families). We also know a few things that are problematic; promoting physical activity at any age can be challenging, schools are increasingly burdened to address a plethora of issues with limited funding, and physical activity promotion isn’t always considered central to the mission of schools.
In light of the benefits and opportunities mentioned above, strategies have been developed to promote physical activity throughout the day, including those from Let’s Move, Active Schools, the Alliance for a Healthier Generation’s Healthy Schools Program, and the Centers for Disease Control and Prevention’s Comprehensive School Physical Activity Program (CSPAP). While these organizations, often in partnership with each other, have created wonderful resources for increasing opportunities for youth physical activity throughout the school day, the implementation and effectiveness of these strategies have been sub-optimal based up the available evidence.
If we have excellent resources, talented public health practitioners, and dedicated school “Champions” working to promote physical activity in schools, why is implementation not more successfully achieved? The answers, I believe, are to be found in the field of implementation science. Implementation science “is the study of factors that influence the full and effective use of innovations in practice.” Implementation science is important to school physical activity promotion (or any intervention or program) because of two words in that definition; full and effective. Full alludes to the dose and fidelity to which a program is implemented. In the context of in-class physical activity, fidelity might refer to the adherence by a classroom teacher to an Energizer activity plan. Dose might refer to the number that are delivered. Both are important. For example, a lesson might call for a teacher to lead the class in 10 minutes of movements related to an academic concept, but he/she might sit down the whole time, only give verbal encouragement, and cut the lesson short at five minutes. This would be low fidelity, and I’m not convinced it would have a meaningful impact on physical activity levels if it were done twice a day, five days per week. However, at the same time, a perfectly executed Energizer that is offered once per year isn’t going to move the needle either. Hence without being full (or close to it), an intervention is unlikely to be effective. The unknown of implementation science in the context of school-based physical activity promotion relates to the manner in which we work with schools to build capacity, commitment, and collective efficacy to implement the strategies.
It is for this reason that my colleagues and I have been working with school officials and the public health practice community to develop implementation strategies and resources to help facilitate the uptake of the school-based strategies and utilization of available tools that comprise a CSPAP. Our project called Be a Champion! is a project funded by the National Institutes of Health to develop a framework and tools for the implementation of a CSPAP, designed to streamline planning and delivery for public health practitioners and school officials. While still in progress, the preliminary results have been promising, and has illuminated a number of gaps in the available resources. Moving forward, we will be working with state and local public health practitioners and school officials to further develop and refine the emerging resources. In the interim, I encourage you to visit Policy to Practice in Youth Programs for currently available resources for healthy eating and physical activity promotion. The results and resources of Be a Champion! will be posted there in the future for free download and dissemination. I hope you will stay tuned for more.
Justin B. Moore, PhD, MS, FACSM is the Associate Editor of the Journal of Public Health Management & Practiceandan Associate Professor in the Department of Family & Community Medicine of the Wake Forest School of Medicine at the Wake Forest Baptist Medical Center in Winston-Salem, NC, USA. He contributes regularly to JPHMP Directand you can follow him at Twitter @justinbmoorephd and Instagram justinbmoorephd, or reach him at firstname.lastname@example.org or via his consulting company Cerus Consulting, LLC.