Background: School physical activity (PA) programs that have demonstrated effectiveness on a small scale need to be scaled-up to achieve population level health outcomes. We report the development, piloting, adaptation and scale-up trial of Physical Activity 4 Everyone (PA4E1), a 24-month program targeting adolescents attending schools located in low socioeconomic areas.
Methods: PA4E1 has undertaken a four step scale-up process (from 2012-2019): 1) Development of PA4E1 pilot trial (2012), inclusive of both evidence-based school PA practices and implementation support strategies to support schools to embed these practices; 2) Conduct of pilot randomised controlled trial (RCT) (from 2012-2014) in 10 secondary schools, evaluating the effectiveness (student PA and weight status) and cost-effectiveness; 3) Adaptation of PA4E1 for a scale-up trial (2016); 4) A scale-up hybrid implementation effectiveness RCT (n=49) to evaluate practice uptake by schools (primary outcome), device-measured student PA (secondary outcome) and a comprehensive process evaluation (from 2017-2019).
Results: 1) The pilot program comprised of seven PA practices and six implementation support strategies; 2) Pilot RCT found positive intervention effects on student PA and unhealthy weight gain, and was deemed cost-effective; 3) 20 adaptations were made for scale-up, resulting in seven PA practices and seven support strategies. A minority of adaptations (n=2) were fidelity inconsistent; 4) At 24-month follow up of the scale-up trial, school uptake of 4 or more practices (primary outcome) was significantly higher in the program group (16/23, 69%) than the control group (0/25, 0%) (p<0.001). Analysis of student and process evaluation outcomes in progress.
Conclusion: PA4E1 has been developed, piloted, adapted and subsequently scaled-up. Results of the scale-up trial indicate that schools can be supported to implement the seven PA supportive practices. Policy-makers and practitioners responsible for advocating PA in schools should consider this implementation approach.