Background
Physical activity during childhood is associated with multiple short and long term health benefits [
1]. However, population based studies indicate less than 50% of primary (elementary) school-aged children attain the recommended 60-min of moderate- to vigorous- intensity physical activity per day required to accrue health benefits [
2]. Schools are regarded as an ideal setting for the promotion of physical activity to children as children spend the majority of their waking hours at school [
3]. However, physical activity interventions targeting the school environment can be difficult to implement, often due to competing time demands associated with academic accountability [
4]. Active breaks are short bursts of physical activity performed in the classroom as a break from learning tasks [
5]. Meta-analyses and systematic reviews show children’s classroom behaviour improves following participation in such sessions [
6‐
8]. For example, active breaks as short as 4-min have been shown to have a positive effect on classroom behaviour immediately following participation [
5,
9,
10]. Thus, active breaks may provide an attractive strategy for teachers to incrementally increase children’s daily physical activity during school hours [
9,
11], while simultaneously improving classroom behaviour outcomes. While these outcome evaluation studies provide valuable insight into the effectiveness of such programs, process evaluation studies are important for exploring factors associated with intervention fidelity and feasibility [
12].
Studies have explored general perceptions of active break strategies, reporting that active breaks that were short (e.g. < 5-min) and quick and easy to implement would be more likely to be adopted in daily practice [
4,
13‐
16]. Only one previous active break intervention has performed a process evaluation to accompany the outcome evaluation [
17]. That study indicated that although 10- and 20-min active breaks were effective for improving classroom behaviour, while 5-min active breaks were not, teachers considered active breaks longer than 5-min to not be feasible within a crowded curriculum [
17]. This finding highlights the importance of process evaluation to provide insights into whether interventions would be feasible and implemented with high fidelity outside of the research context.
This study was conducted to explore the fidelity and feasibility of a classroom-based physical activity (ACTI-BREAK) program through process evaluation. Outcomes of the intervention have been reported separately [
18].
Discussion
This study is one of the first to report a process evaluation of a classroom-based active break intervention aimed at improving academic and physical activity-related outcomes. The intervention was shown to be feasible and generally a positive experience for teachers and students. However, some minor modifications in terms of the required frequency and intensity of ACTI-BREAKS could improve fidelity. Two major barriers to implementation identified by teachers were scheduling and ability for students to return to task. Facilitators to implementation were flexible delivery options, ease of implementation, and student enjoyment. Teacher reports of classroom behaviour showed on-task behaviour improved immediately following ACTI-BREAKS. Students were largely satisfied with the program, and particularly enjoyed ACTI-BREAKS that incorporated choice, imagination and challenge. Students did not enjoy ACTI-BREAKS that evoked silliness or were perceived as too difficult, and some did not like doing ACTI-BREAKS in the confined space of their classroom.
Data from teacher logs showed that fidelity was fair in terms of meeting the required frequency of ACTI-BREAKS. Scheduling was consistently identified as a barrier to achieving all three active breaks every day, and similar to previous studies was often associated with time constraints (e.g. fitting active breaks in around learning in other key curriculum areas) [
13,
14,
17]. During the ACTI-BREAK development phase, teachers considered three short active breaks per day to be feasible. However, in practice teachers stated it was not always necessary to perform an active break (e.g. due to transition to specialist classes forming a natural break in the schedule, or students were working well). Consequently, consistent with findings from a previous study [
14] teachers stated implementation would work better on an as needs basis. Thus, some flexibility around implementation (i.e. structured vs. incidental) and usage frequency may be necessary when developing future active break interventions.
Teachers suggested that the option to integrate ACTI-BREAKS into lesson content could help overcome time constraints associated with academic accountability. Such interventions have been shown to improve classroom behaviour [
26,
27] and physical activity levels [
28,
29] following participation, and can achieve the same physical activity intensity as active breaks [
28‐
31]. However, it was thought that curriculum-focussed active breaks or physically active lessons would require teachers to change their teaching practices which could be met with resistance, and thus this was decided against. Additionally, due to known time constraints within busy teacher schedules, during the development phase it was decided for active breaks to be conducted inside the classroom to avoid taking children to another location which takes time [
14]. However, some students and one teacher commented that having to perform activities within the confined space of the classroom was a limitation of the program. Thus, it may be necessary to provide teachers with a range of options for integrating physical activity into school day, including outdoor options, and the incorporation of academic content so that they can choose the option(s) that best suits their needs.
In addition to not meeting the prescribed frequency, teachers also generally did not achieve the prescribed moderate-intensity for the active break. This may be due to a failure of the intervention development as teachers could choose less intense options (e.g. ask children to creep around the room rather than gallop around). Thus, the program may need to be more prescriptive to ensure examples are all moderate intensity physical activity. Additionally, it may be important to provide further support for teachers so that they have the skills and confidence to manage classes during active breaks at a higher intensity, as physical activity of at least moderate-intensity is preferable to light-intensity physical activity in terms of health benefits [
1].
An alternative explanation for implementation at a mainly light-intensity may relate to teacher concerns for moderate-intensity active breaks to have an adverse effect on behaviour. While in the development phase teachers considered moderate-intensity active breaks to be feasible [
19], results of this study suggest that in practice teachers prefer light-intensity active breaks, perhaps due to the perception that came out in the interviews that students (particularly those with behavioural challenges) were easier to settle following light-, compared with moderate-intensity active breaks. In contrast, previous studies have consistently reported moderate- to vigorous-intensity active breaks had a positive acute effect on behaviour [
6] and one indicated that behaviour improved most for those the most off task prior to active break sessions [
27]. However, as that study [
27] did not explore fidelity of implementation it is unclear whether the prescribed moderate-to vigorous-intensity physical activity was met – it is possible that intervention was also implemented at a mainly light-intensity. No other studies have considered the effect of light-intensity active breaks on behaviour, and only one has compared intervention effects based on behaviour prior to active break sessions [
27]. Thus, future studies may consider comparing the effect of light- versus moderate-intensity active breaks on behaviour, as well as whether effects differ by behaviour prior to such sessions.
While teachers suggested the ability for students to return to task following ACTI-BREAKS was due to intensity of active break and whether or not students had behavioural challenges, students suggested that tiredness was key to settling back to work (or not) following ACTI-BREAKS. Some students reported that tiredness helped, while others reported that tiredness hindered their ability to return to task following ACTI-BREAKS. While in the current study active breaks were mostly implemented at a light-intensity, there was considerable variation in between students in the actual physical activity intensity achieved. The cognitive effects of acute bouts of physical activity have been shown to differ with physical activity intensity [
32]. Specifically emerging research suggests light- to moderate- intensity physical activity benefits, while vigorous- intensity physical activity has no effect [
32] or an adverse effect [
33] on cognitive function immediately following sessions, perhaps due to exercise induced fatigue [
34]. Thus, in the current study greater levels of tiredness may be associated with performing ACTI-BREAKS as a higher physical activity intensity and consequently an impaired ability to return to task, while lower levels of tiredness may be associated with performing ACTI-BREAKS as a lower physical activity intensity and increased ability to return to task. However, this assertion remains speculative.
In addition to ACTI-BREAKS that did not cause behaviour disruptions, similar to previous studies [
35] teachers had an affinity to ACTI-BREAKS that students enjoyed. Students reported enjoying ACTI-BREAKS that incorporated choice, imagination and challenge, and disliking activities that were perceived as too difficult, evoked silliness, and some did not like performing ACTI-BREAKS in the confined space of their classroom. Additionally, the preferred dose of active break was different for different students. These findings are mostly new to the active break literature, with only one previous process evaluation exploring student perceptions of active breaks [
17]. Similar to findings from a the current study, that study [
17] also reported that some students wanted longer duration active breaks (10 to 20 min), while others wanted shorter active breaks (5 min). However, longer duration active breaks may not be feasible due to time constraints [
13,
14,
17]. Thus, active breaks may need to be differentiated in other ways to cater to different student preferences. For example, the incorporation of outdoor activities, as well as different levels of movements so students can choose the movement that best suits their ability (e.g. including movements that all students can do, as well as more challenging movements for those students who desire extension).
Strengths and limitations
A limitation of this study was that fidelity and classroom behaviour data were reported by the same teachers as those implementing the program, so there was potential for reporting bias. While the intensity of ACTI-BREAKS was collected objectively, there was potential for inaccuracy in teacher reported times that ACTI-BREAKS were conducted. This was overcome by analysing data with a 5-min window either side of each reported ACTI-BREAK time to ensure the entire ACTI-BREAK was captured. However, this method meant that movement superfluous to the ACTI-BREAK was also captured. A further limitation was that not all children were represented in the focus groups due to the high number of participating children. However, all children were represented in the other student evaluation measures and themes were mostly similar across focus groups, suggesting there was consistency of opinion across participating children. Another limitation was that teachers had the choice of which ACTI-BREAK activities to implement, so not all classes participated in the same activities. The current study had several strengths, including the use of data from both students and teachers to ensure a comprehensive assessment of feasibility and fidelity, and the objective assessment of physical activity intensity.