A quasi-experimental examination of how school-based physical activity changes impact secondary school student moderate- to vigorous- intensity physical activity over time in the COMPASS study

Background: Adolescence is characterized by low moderate-to vigorous-intensity physical activity (MVPA) levels. Targeting the school setting can increase MVPA among a large proportion of adolescents. However, school-based physical activity interventions for adolescents remain largely ineffective. Therefore, the purpose of this study was to examine how naturally-occurring changes to school physical activity policy, recreational programming, public health resources, and the physical environment, impact adolescent MVPA over a 1-year period. Methods: Quasi-experimental longitudinal data from 18,777 grade 9-12 students (mean age = 15.1 +/- 0.02 years), and 86 principals from 86 schools, participating in year 2 (2013-2014) and year 3 (2014-2015) of the COMPASS study (Ontario and Alberta, Canada) was used. Total MVPA over the previous week was self-reported at both time points using the COMPASS Student Questionnaire and average daily MVPA was calculated. Changes to physical activity policies, recreational programming, public health resources, and the physical environment were self-reported by school principals. Changes to the number and condition of physical activity facilities were objectively measured during school audits using the COMPASS School Environment Application. Multi-level modeling was used to examine change in student MVPA between schools that made changes and schools that did not. Models were adjusted for several student and school level confounders. Results: Over the 1-year period, 61 of 86 schools made physical activity related changes. Of these, 9 significantly changed student MVPA. However, only 4 of 9 schools' changes increased student MVPA, including opening the fitness centre at lunch (beta = 17.2, 95 % CI: 2.6-31.7), starting an outdoor club (beta = 17.8, 95 % CI: 7.4-28.1), adding a bike rack (beta-14.9, 95 % CI: 0.7-29.1), and adding weightlifting and run/walk clubs, archery, figure skating, increased access to the sports field, and improved condition of the outdoor basketball court (beta = 15.5, 95 % CI: 5.2-25.7). Conclusions: Changes such as adding or increasing access to facilities, and adding multiple recreational programs, seemed to be effective for increasing student MVPA over the 1-year period. However, given the specificity of results, a one-size fits all approach may not be effective for increasing MVPA. Instead, school principals need to consider the resources within and surrounding their school, and the interests of the students.