Physical Activity and Wellbeing in Schools

Lead Research Organisation: Durham University
Department Name: Education


It is estimated that about one in ten school-aged children suffer from problems such as anxiety, depression and conduct disorders. National attempts to impact on this problem have not so far met with great success. One important factor in psychological wellbeing appears to be regular physical exercise and there is concern that inactive lifestyles are undermining their mental health. This problem is the focus of this proposal.

To be successful, interventions must change behaviour and the importance of utilising powerful peer relationships whilst drawing upon a broad range of social influences in young people's local communities is now widely recognised. Psychological research has shown that offering commitment in front of others is a particularly powerful mechanism for sustaining a course of action. The proposed interventions build on such ideas.

Proposed work

One of the most promising pathways to improving mental health is to increase levels of physical activity and there is an impressive body of work suggesting a positive impact on self-esteem, cognitive function, stress and anxiety. We propose two school-based interventions linked to the secondary school curriculum. The research will involve a multi-site clustered factorial randomised control trial with 60 schools allocated to one of the interventions or both or to a control group which receives a delayed intervention.

The first approach, the 'participative learning' strategy, will be situated in Geography lessons; the second the 'personal coach' strategy, will feature in Physical Education classes. Both employ collaborative work linked to ways of capturing data about children's physical activity. Physical activity monitors (accelerometers) will be used for both approaches and, for the participative learning strategy only, Geographical Positioning receivers will be used to track children's locations during and outside school time.

In the Geography lessons, students will be encouraged to work together to gain a greater self-understanding of their environment. This activity will be informed by the data about their movements during the day. This will allow individuals and groups to explore their own levels of physical activity and those of others. Technological equipment will be used to encourage discussion about the data; the students will come to understand their environment in more sophisticated ways. The Physical Education lessons will employ the powerful cross-age peer tutoring paradigm in which older children teach younger children. Research has shown that both tutors and tutees gain greater knowledge and understanding. Agreeing upon and regularly reviewing personal targets for increased physical activity are key to the intervention.

The primary research questions are:
* What impact do these school-based interventions have separately and together on students' levels of moderate to vigorous physical activity?
* What impact do the interventions have separately and together on students' mental health?
The secondary research questions are:
* Are the interventions effective in improving students' knowledge, motivation and sense of efficacy? (And why?)
* Do the interventions provide a useful adjunct to teaching resources from the teachers' point of view? (And how?)
* To what extent do the interventions improve social interactions amongst the participants?
* To what extent do the interventions increase the time spent in meaningful physical activity outdoors? (And how are these related to context?)

If this ambitious project is successful, the pay-off is enormous in terms of improving the lives of many children and the wellbeing of families and communities. Identifying effective approaches will enable resources to be targeted cost-effectively. U.K. children have been identified as having some of Europe's greatest mental health problems and large-scale interventions that involve and engage young people would appear to be essential.

Planned Impact

The proposal offers the potential to impact on the nation's health and wealth. The work is designed to lead to national school-based interventions which have a direct impact on the mental health of children. If successful this will have implications for many young people and their families. A sizable proportion of the population's lives is blighted by mental health problems and this is not only an individual source of great distress, but at a societal level, it has a significant negative impact on the economy. (One recent estimate to the national economy of depression alone, via lost working days, deaths and NHS resources, put the cost at £9 billion pounds per year, Thomas and Morris, 2003).

In recognition of the importance of the issues tackled by this proposal, the Government has spent millions of pounds on the Targeted Mental Health in Schools and the Social and Emotional Aspects of Learning (SEAL) projects. There is considerable national interest on mental health in schools and this research speaks directly to that interest, although our focus is very different from those initiatives.
The proposed research also has the potential to inform our understandings of how to effect large-scale changes in young people's behaviour and findings are likely to be of significant interest to policymakers. Insights obtained are likely to be particularly welcomed by such bodies as the Government's new Behavioural Insight Team (colloquially known as the "nudge" unit), which seeks to use insights from behavioural economics to assist individuals to make better choices for themselves. Many of the elements of our proposed project (e.g. the importance of social norms, and aligning long and short-term preferences through the use of self-commitment devices) draw upon similar principles and mechanisms to those outlined in the 'nudge' choice architecture literature. Thus, the study seeks to introduce an intervention that maps on closely to those approaches recently identified by Government as helping to fulfil its 'big society' agenda.
Staff working on the project will gain significant experience of working with leading international researchers across a variety of academic disciplines. They will gain opportunities to utilise and evaluate the potential contribution of different research methods. They will gain valuable experience of collaborating with students and staff in schools in developing fully participatory forms of action and evaluation. Such experience will be valuable for a variety of future professional roles in education. Exploration of the research potential of different forms of leading-edge electronic equipment will provide staff with valuable skills for similar future research projects.

Timescale: Following the dissemination of findings from a successful project, it is reasonable to expect other research and professional groups, as well as the original team, to build on that success in the following few years. An active national policy could incorporate the message from the research into policy within five years.

Thomas C, Morris S. (2003). Cost of depression among adults in England in 2000. British Journal of Psychiatry, 183: 514-519
Description We have now completed the main paper and are completing other papers for publication and the key findings, so far, are outlined below.
A) From the BMJ Open paper
Main findings
This intervention study sought to modify the MVPA levels of children in their first year of secondary school, with the intention of enhancing feelings of well-being. We found no evidence of a significant effect of either intervention alone, or in combination, on these outcomes. When adjusting for covariates, the largest difference in PA was observed between the participative learning group and control, with these children doing an average of 3 min more of MVPA per day. Similarly the largest effect on total well-being scores was observed for the participative learning intervention.
Although Bonell et al call for greater attention to mental and physical health in schools, it is becoming increasingly clear that relatively modest classroom initiatives on the present scale are insufficient to change children's levels of PA. A multicomponent PA intervention targeting the home, school and wider neighbourhood environment may prove to be a more promising approach and might be usefully informed by the kinds of information collected through the interventions reported above. This could include structural changes to enable adolescents to travel safely in their environment and the provision of exclusion zones around schools where motorised transport is prohibited. Changes to educational policy to shift the accountability focus away from test results may also help. However, in identifying possible local solutions to low levels of PA among children, one must be cognisant of broader, and complex, ecosystemic influences that result in patterns of behaviour that are far from easy to address or resolve.B)

B) Children see different outdoor spaces and places as being 'good' for physical activity. Thoughts about more formalised outdoor activity spaces elicited comments about 'lots of space' as well as enjoyment of equipment and social networking opportunities.
Factors which were felt to prevent the children engaging in more physical activity included roads, dark nights, weather, local gangs and lack of peers.
C) Using GIS as a tool in schools

The participatory intervention involved GIS techniques incorporated into Geography lessons. Preliminary results show: how pupils' knowledge and skills in GIS were improved; how pupils interpreted their movement in their daily action space and related this to their physical activity level and their vision of how their environment could be changed to help them enhance their physical activity levels.
Exploitation Route In four broad ways:
1) The quantitative findings from the interventions may be used by
a. schools, local authorities and policy makers in deciding whether to adopt the interventions or not (see the objectives listed above).
b. researchers wishing to show find how physical activity levels can be increased either by primary research or through meta-analyses and other research syntheses in looking at attempts to increased levels of physical activity and feelings of well-being
2) The inherent educational value of introducing GIS into Year 7 may be built on by schools
3) There are two methodological issues which were addressed which will be useful to other researchers
a. How data from RCTs in social science which are considered to be missing not at random (MNAR) can be analysed.
c. We succeed in collecting the data from many secondary schools but it was by no means easy and other researchers will befit from knowing of the difficulties and how we solved them.
4) One relationship in the data, which the project did not set out to explore, which will be useful for workers seeking to improved physical activity levels and feeling of wellbeing is:
The amount of sedentary behaviour among Year 7 students: Preliminary analyses show this population of Year 7 students spend 7 hours per day sedentary, with very few meeting daily MVPA recommendations.
Sectors Education,Healthcare

Description Update Feb 2018: The impact of this ESRC grant has been and/or will be in three areas: Schools, academic discourse and policy. The greatest impact has been in the schools with which we worked and in the impact on academic discourse the main BMJ Open paper which reported the results has been cited 7 times already. Schools: The project involved two different interventions in schools, a participative learning approach which was taught in geography lessons, and a peer mentoring approach, often linked to PE. Bespoke materials were created for the lessons by the research team and were made available to schools after the project finished. In a survey to the teachers at the end of the trial, 75% of peer mentoring teachers considered using the materials in the future, and 57% of the geography teachers would use the materials again. This response is promising and shows the materials may well be used again in some schools involved in the trial. Academic discourse: We have presented 13 papers at conferences and more presentations are planned. Policy: At this stage we are working on publications and the main paper is now published. We did not feel that we should attempt to influence policy until that paper had been accepted for publication, but it has now been sent to a key education policy adviser in England (Tim Leunig, Chief Scientific Adviser and Chief Analyst at the Department for Education) and Scotland (Laura Farquhar). The paper has also been sent to the Youth Sports Trust and Public Health England. More broadly, at this stage the results have mainly been used locally and on a small scale to feedback information to the schools and local authorities which were involved with the project. We are now working on the data which will also lead on to publications. One important impact has been the passing on of GIS expertise from the Durham University to schools.
First Year Of Impact 2016
Sector Education
Impact Types Societal

Title School, physical activity and well-being Also know as MOVE 
Description The data, which have been deposited and under discussion with ReShare, are the quantitative data from the trial. It include pre-and post test measures collected by questionnaire and accelerometers. It also includes data matched in from the National Pupil Data Base and the School Census. Additional observational ratings of the fidelity-to-treatment are recorded 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact The data have just been deposited and is being discussed with ReShare. It is too early to describe impacts. 
Description Fuse: The UKCRC Centre for Translational Research in Public Health 
Organisation UK Clinical Research Collaboration
Department FUSE Centre for Translational Research in Public Health
Country United Kingdom 
Sector Academic/University 
PI Contribution Summerbell is a co-applicant on the Fuse UKCRC and SPHR grants
Collaborator Contribution Partners on this research project who are based in the North East of England are members of Fuse
Impact Please see Fuse website for list of all outputs
Start Year 2008