What happened in the ‘Move for Well-being in School’: a process evaluation of a cluster randomized physical activity intervention using the RE-AIM framework
Smedegaard et al. International Journal of Behavioral Nutrition and Physical Activity
What happened in the 'Move for Well- being in School': a process evaluation of a cluster randomized physical activity intervention using the RE-AIM framework
Søren Smedegaard 0 1 2 4
Ruben Brondeel 3
Lars Breum Christiansen 0 2
Thomas Skovgaard 0 1 2
0 SDU, University of Southern Denmark , Campusvej 55, 5230 Odense M , Denmark
1 FIIBL, Research and Innovation Centre for Human Movement and Learning , Odense M , Denmark
2 IOB, Department of Sports Science and Clinical Biomechanics , Campusvej 55, 5230 Odense M , Denmark
3 Centre de recherche du CHUM , 900 St Denis St, Montréal, QC H2X 0A9 , Canada
4 UCL, University College Lillebaelt, UCL Campus Odense , Niels Bohrs Allé 1, 5230 Odense M , Denmark
Background: The aim of this study was to address the gap in the translation of research into practice through an extensive process evaluation of the Move for Well-being in School programme using the RE-AIM framework. The purpose was to gain insight into the extent by which the intervention was adopted and implemented as intended and to understand how educators observed its effectiveness and maintenance. Methods: Public schools located in seven municipalities in Denmark were invited to enroll their 4th to 6th grade classes in the project. Of these, 24 school decided to participate in the project in the school-year 2015-16 and were randomly (cluster) allocated to either intervention or control group. A process survey was completed online by school personnel at the start, at midterm, and at the end of the school year. Additionally, informal interviews and observations were conducted throughout the year. Results: At the 12 intervention schools, a total of 148 educators were involved in the implementation of the programme over the school-year. More than nine out of ten educators integrated brain breaks in their lessons and practically all the physical education teachers used the physical education lesson plans. The educators delivered on average 4.5 brain breaks per week and up to 90% of the physical education teachers used the project lesson plans for at least half of their classes. Half of the educators initiated new recess activities. A total of 78%, 85% and 90% of the educators believed that the implemented recess, brain break and physical education components 'to a high degree' or 'to some degree' promoted the pupils' well-being, respectively. Conclusions: This study shows that it is possible to design a school-based PA intervention that educators largely adopt and implement. Implementation of the PA elements was stable throughout the school year and data demonstrate that educators believed in the ability of the intervention to promote well-being among the pupils. Finally, the study show that a structured intervention consisting of competence development, set goals for new practices combined with specific materials, and ongoing support, effectively reached a vast majority of all teachers in the enrolled schools with a substantial impact. Trial registration: Date of registration: retrospectively registered on 24 April 2015 at Current Controlled Trials (DOI 0.1186/ISRCTN12496336 - named: “The role of physical activity in improving the well-being of children and youth”).
Physical activity; Well-being; School; Process evaluation; Cluster RCT; Implementation; RE-AIM
School-based approaches promoting physical activity
(PA) are recommended because in most countries the
majority of children and adolescents spend many hours
in school every day [
]. A school setting also makes it
possible to reach children and young people who are
fairly inactive during their leisure time. Furthermore, in
many countries health and well-being are an integrated
part of the state school curriculum, which means that
there are qualified educators in the form of teachers,
pedagogues and other adults teaching at the school,
alongside existing cultures and infrastructures for
teaching and learning about activities that relate to health,
well-being and PA [
]. Well-being can be defined in
different ways, but in the Danish school system,
wellbeing is most often understood in relation to social and
academic factors, which are focus areas in the annual
‘school well-being survey’. The understanding of
wellbeing used in this project is based on the
selfdetermination theory, where self-realization and vitality
are central aspects . Well-being is enhanced if the
three innate psychological needs: autonomy, competence
and social relatedness is satisfied [
]. Engaging in
physical activity can be more or less conducive for fulfilling
the three psychological needs, which is dependent on
the context and the social environment [
Lubans and colleagues offered a conceptual model
describing three possible mechanisms between PA and
various mental health outcomes. The model suggests
three hypotheses: a neurobiological; a psychosocial; and a
behavioral hypothesis which could explain the rationale
and possible impact of PA on well-being [
]. In recent
years, a number of school-based interventions have been
conducted with a focus on PA and well-being with small
to moderate positive effects [
]. Many of these studies
were small-scale studies; conducted over a relatively short
period of time (4–20 weeks intervention); lacking a
control group; or used a cross-sectional design [
3, 16, 17
In order to construct evidence applicable to real-world
settings, it is crucial to evaluate the feasibility of the
intervention programme, and this is no easy task [
Several studies have addressed the implementation of
physical activity programmes in schools, identifying
several determinants of a successful implementation [
In a systematic review, Naylor et al. described the
most common categories used in previous studies,
such as 1) provider characteristics, 2) characteristics
of the innovation, 3) the delivery system and 4) the
support system, all of which is critical to consider
when designing school-based PA interventions .
Many programmes however fail to evaluate the
process of the interventions, which could be an
explanation for their general low effectiveness and, more
importantly, could hinder the flow of information to
future interventions that might improve
The RE-AIM framework (Reach, Effectiveness,
Adoption, Implementation, and Maintenance) has been
developed to guide the evaluation of issues relating to the
external validity that is, ´finding out which populations
it works for and how best to make it work in those
]. The framework has been used to assess
school-based PA interventions [
] and to guide
process evaluations in cluster randomized controlled
]. The RE-AIM framework encourages planners,
evaluators, and policy-makers to pay more attention to
essential programme elements, including external
validity. In this way, the sustainable adoption and
implementation of effective, generalizable, evidence-based
interventions can be improved [
The Move for Well-being in School intervention
(MWS) aimed to improve psychosocial well-being
among school-aged children and youths from 4th to 6th
grade (10–13 years) through the development,
implementation, and evaluation of a multicomponent,
schoolbased, physical activity intervention. The objective of
this paper is to evaluate the implementation of MWS
from the implementer’s point of view (the educator),
using the RE-AIM framework.
The Move for Well-being in School programme
The programme was designed, piloted and implemented
in accordance with the study protocol published
]. In brief, the programme consisted of a
fourphased intervention – design, pilot, randomized
controlled trial (RCT), and evaluation – guided by The
Medical Research Council [
] framework for the
development of complex interventions. A CONSORT
checklist for the intervention has been produced and is added
as an Additional file 1.
In the design phase, the preliminary development
processes entailed conducting a scoping review, interviews
with members of the target group and the execution of
four workshops including a broad selection of key
stakeholders. Informed by the design phase, an initial
intervention programme was assembled. Also, the main
theoretical driver of the programme development
originated from the area of motivation, as construed by
Edward Deci and Richard Ryan’s self-determination
]. The pilot phase encompassed the assessment of
the initial intervention programme in four schools over
a four-month period, to evaluate the feasibility of the
implementation in a real-world setting.
The RCT included the implementation of the final
intervention programme. Based on initial screening
municipalities were selected from the following criteria a)
geographic and demographic variation, b) variation in
schools size and c) variation without extremes in
municipal budgets for public schools [
]. A total of 11 of 98
Danish municipalities were contacted and seven agreed
to participate either by contacting schools themselves or
by allowing the research team to contact schools in the
]. The research team held individual
meetings with all interested schools and a total of 24
schools were enrolled. A stratified randomization was
conducted with three strata and with the constraint of
an even distribution of schools from each municipality
in the intervention group and the control group
respectively. The three strata were defined by school typology,
based on school size and district socioeconomic status
], see Fig. 1.
The intervention consisted of, (i) a competence
development programme for educators consisting of four
workshops with both practical and theoretical content
(Fig. 2); (ii) inspiration material on the MWS website
]; and (iii) the coordination between the schools and
the research team, primarily via local coordination
groups consisting of representatives from 4th, 5th, and
6th grades, often physical education teachers, and a
member of the school management [
]. Two process
meetings, by the research team, were conducted at each
school (Fig. 2). The PA program included physical
education, recess, theme days and brain breaks. In short, the
educators should conduct two daily brain breaks lasting
five minutes per class; facilitate new activities during
recess three times per week lasting 30 min; complete three
theme days focusing on well-being and PA; and finally,
half of physical education classes should be taught
according to the special MWS lesson plans designed for
the intervention [
At the 12 intervention schools, a total of 148
educators were involved in the implementation of the MWS
program over the school year of which 48 were PE
teachers. The average number of involved educators per
school was 12 (range 5–17), and three of these were
physical education teachers (range 1–6).
The programme evaluation phase contains a joint
evaluation of the entire project period, guided by the
RE-AIM framework [
Data collection featured administrative data, online
surveys, informal interviews, and observations. Administrative
data on municipalities and schools were obtained from the
Ministry of Economic Affairs and the Interior and from
the municipalities. Educators were asked to complete an
online questionnaire three times during the intervention:
two months (T1), five months (T2) and nine months (T3)
after commencement (Fig. 2). At T1, 141 educators
answered of whom 42 were PE teachers, at T2, 135 educators
answered of whom 48 were PE teachers and at T3, 139
educators answered of whom 39 were PE teachers.
Educators were included in analyses if they responded
on at least two of the time points. The questionnaire
encompassed items related to the educators, the
intervention, the delivery of the intervention, the support system
and open ended question related to experienced barriers
in the intervention delivery. The three rounds of
selfadministered online questionnaires were used to collect
data on the subsequent RE-AIM components:
effectiveness, adoption, implementation, and maintenance [
Structured observation of PE lessons and qualitative
interviews with PE teacher from four schools were conducted
as part a master thesis which were part of the project [
Finally, during the process meetings (Fig. 2), the
research team retrieved information on implementation
progress, barriers, and facilitators. Informal interviews
with coordination groups focused on statements related
to the role of the CG [
]. Data from observation and
interviews with PE teachers and open ended answers
from the questionnaire is included in the discussion
section to add insights and perspectives.
RE-AIM elements (Table 1)
Since the 24 participating schools can be described as
a convenience sample, the ‘reach’ of the intervention
is understood as the representativeness of the schools
compared to the national average. As part of ‘reach’
evaluation, we looked at characteristics of the schools
to ensure representativeness in relation to the number
of educators and PE teachers.
Schools’ representativeness was assessed using
data on gross revenue from the schools and
expenses per pupil, retrieved from the Ministry of
Social Affairs and the Interior, and information on
municipalities’ budget and budget prerequisites.
Data on family social class, collected and coded
from the pupil’s survey [
], is compared to data
from the Danish contribution to the international
study on family social class, Health Behaviour in
School-aged Children [
Refers to the extent to which intervention
implementation was maintained throughout the
school year – short-term maintenance. Additionally,
indicators of sustainability were identifying at the
aDK average is based on statistics from all Danish schools from Ministry of Economic Affairs and the Interior
bBased on 4534 pupils from 5. to 9.th grade in 48 schools distributed in all regions of Denmark, 11% not classified, 5% economic inactive [
cParents’ average yearly income. If parents are divorced, data are generated from the cohabiting adults and not the biological parents
dDanish kroner (1 kr = 0.14 USD/0.13 Euro)
eExpenses are net expenses for the public school
Most commonly effectiveness is evaluated as the impact
of an intervention on primary outcome measured at
end-user level, but due to the implemetation focus in
this study, we used the educators’ perceptions of
effectiveness of the intervention. Educators were asked to
what degree they believed in an effect of the intervention
components on pupils’ well-being; and whether they had
noticed an improvement in pupil well-being due to the
project as a whole. In this way, we capture the educator’s
perception, which is highly relevant in process
evaluations at this level and has an influence on the degree of
implementation and maintenance [
]. The effect
evaluation of potential outcomes on end-user level is
addressed elsewhere [
Despite the consent from school management to
participate, there was no guarantee that the educators would
adopt the program. Educators could be reluctant to
change and continue their normal practice without
consequences. Adoption of the program was operationalised
at the school level as the proportion of educators who
reported conducting any elements of the MWS at the
Implementation refers to the intervention agents’ fidelity
to the various elements of the intervention’s protocol,
including the consistency of delivery as intended and the
Fidelity was measured for the three main PA
components. Each class should receive two brain breaks each
day, and educators were asked how many brain breaks
they did in average for each class. Data were summarised
at class level. Regarding physical education, six of the
eight tailored MWS physical education courses should
be part of the curriculum. This equals approximately
half of the available lessons. These data were
summarised at year level. For recess, the educators should
actively facilitate activities during recess three days per
week. Teachers were asked for how many days they
initiated activities or helped pupils initiate activities. Data
were aggregated on school level because educators are
responsible for all three-year levels during recess.
Additionally, as an indicator of implementation quality, the
educators were asked to rate their level of preparedness
in working with physical education, recess and brain
breaks in the project [
Maintenance The schools were followed for an entire
school year, and the final survey (T3) was conducted at
the end of the school year – four months after the last
competence development programme workshop (Fig. 2).
This continuation of programme delivery until the last
process survey is defined as short-term maintenance.
Based on literature review additional indicators of
intervention sustainability were operationalized and asked at
]. The educators were asked to rate questions
regarding school priorities; the adaptability of the program
to their everyday work day; and whether the approach in
the project was consistent with their self-image as
educators. Finally, two questions on whether they would
recommend MWS to other schools and overall effect at
school level were asked.
The process surveys were completed by 100 of 141
educators at Time 1(T1) (69%, range 47–100%), by 109 of
135 possible educators at Time 2 (T2) (81%, range 60–
100%) and finally, 93 of 139 possible educators at Time
3 (T3) (67%, range 50–88%), averaging as a 72%
response rate. Only educators that completed at least two
process surveys were included in the analyses.
Table 2 compares school characteristics from the
intervention and control groups with national averages. The
families from the enrolled schools have a little lower
gross revenue compared to the Danish average, which is
more profound for the families at the control schools.
The expenses per pupil are lower at the enrolled schools,
and the control schools are a little larger compared to
intervention schools and the national average.
At T3, more than eight out of ten educators believe that
brain breaks improved pupils’ well-being ‘to a high
degree’ or ‘to some degree’ (Fig. 3a). As for the physical
education teachers, 12% reported that the physical
education lessons designed for this project improved the
pupils’ well-being ‘to a high degree’, while close to 80%
reported this to be the case ‘to some degree’ (Fig. 3b).
Recess initiatives improved pupils’ well-being ‘to a high
degree’ according to 28% of the educators at T3, and ‘to
some degree’ according to 50% of the educators (Fig. 3c).
Finally, when asked about the impact of the physical
activity interventions as such, 75% of the educators
answer that this improved well-being among their pupils
‘to a high degree’ or ‘to some degree’, (Fig. 3d).
More than nine out of ten educators integrated brain
breaks in their lessons, and all physical education
teachers used the lesson plans at least once (Table 3).
Around half of the educators initiated activities during
The set goal for the intervention was: two brain breaks
per day; approximately half of the physical activity
lessons organized according to the MWS programme; and
initiated/facilitated recess activities three times a week
lasting at least 30 min each [
On average, the educators delivered 4.1, 4.5 and 4.8
brain breaks per week at T1, T2, and T3 respectively.
There were large differences between schools. Teachers at
the school with the lowest implementation conducted
approximately three brain breaks, while teachers at the
schools with the highest implementation conducted twice
as many (Table 4). The average number of brain breaks
per class per week is estimated multiplying the average 4.5
brain breaks/week with the average 138 educators, divided
by the 72 enrolled classes. This gives an overall average of
8.6 brain breaks per class per week if the non-responding
educators did as many brain breaks as the responders.
Between 80% and 90% of the physical education
teachers used the project lesson plans for at least half of
their physical education classes with variation between
schools. Finally, there were no differences between the
three time-points for recess activities initiated.
As for a more general implementation quality
indicator, we asked: “To what degree do you feel prepared to
work with physical education/brain breaks/recess in the
Table 5 show that educators to a large extent perceived
themselves as prepared for working with the project’s
physical activity elements. Approximately 95% of the
educators felt that they ‘to a high degree’ or ‘to some
degree’ were prepared for the brain breaks part. The
educators felt more prepared for the new physical
education practice at the end of the school year. At T1
around 80% indicated being prepared ‘to high degree’ or
‘to some degree’. This number increased to more than
90% at T2, and 100% at T3. Recess was the area with the
lowest level of self-perceived preparedness. The
percentage of educators feeling prepared ‘to a small degree’
increased from 6% to more than 23% from the first to the
last process survey. At the same time, there was nearly a
20% decrease in educators answering that they felt
prepared ‘to some degree’.
The project intended to increase the feeling of
preparedness by having the educators participate in the
competence development programme. The workshops
had a high participation rate, as the majority of
educators attended at least one workshop. Collectively, 85% of
the educators, that completed the surveys, participated
in at least one workshop. The participation rate per
school ranged from 70 to 100% of the educators
participating at least once – except for one school that had a
29% participation rate. A total of 95% of the physical
education teachers participated at least once in a
workshop, while only two schools had physical education
teachers who did not participate. Finally, 79% of the
educators participated in the recess workshop, which was
held at the local schools. Participation rates ranged from
45% to 100% between the participating schools.
As seen in Tables 3 and 4 the change over time in
delivered activities was very small. There was a minor
decrease from T1 to T3 in the proportion of educators
doing any brain breaks (94% to 91%), but on the
contrary, the educators who did brain breaks, did a little
more. The question regarding physical education asked
about the proportion of physical education devoted to
MWS during the whole school year. Thus, it is not
possible to detect if they increased or decreased the use of
the MWS-lessons. As for recess, a decline between
educators initiating recess activities between T1 and T3
(57% to 49%) was observed. However, the compliant
educators maintained the number of days at 1.6 days per
week. All in all, the overall trend of implementation did
not seem to decrease throughout the school year.
In the final survey, the educators were asked about five
indicators of programme sustainability. As seen in
Tables 6, 85% of the educators reported that the project fits
the school’s other priorities ‘to a high degree’ or ‘to some
degree’. A total of 93% answered that PA, and movement
in general, is prioritized at the school ‘to a high degree’
or ‘to some degree’. Asked whether the initiatives in the
Question: To what degree do you feel prepared to work with PE/brain breaks/recess?
aResponse categories: 1 = to a high degree, 2 = to some degree, 3 = to a small degree, 4 = not at all, 5: not relevant (some educators were omitted for recess duty)
project were adaptable to their everyday work, 16%
answered ‘to a high degree’ and 70% ‘to some degree’. The
clear majority of educators answered that the project
was favourable compared to other initiatives, and they
found it to be consistent with their own self-image as
educators. Finally, approximately nine out of ten
educators would recommend MWS to other schools and felt
that participation in the project had improved their
school (data not shown).
The objective of this study was to evaluate the
implementation of Move for Well-being in School using the
RE-AIM framework. Often, as is the case with MWS,
interventions address several outcomes simultaneously
and are comprised of a number of components that
interact and affect outcomes. Moore et al. [
that interventions are often delivered in systems that are
complex and respond unpredictably. In order to contain
this complexity, intervention evaluations have to move
beyond a focus on effectiveness alone. Process evaluation
is one way to investigate other important dimensions in
As stated in the results section, schools were selected to
ensure comparability to most Danish schools in terms of
number of pupils, expenses per pupil, and
socioeconomic status of the pupil’s parents. We included 24
schools but had difficulties reaching schools through the
municipal authorities. Municipalities were reluctant to
put pressure on schools due to a recent extensive school
reform and consequently increased workload. Therefore,
with permission from the municipalities, the schools
were contacted directly. The schools agreeing to
participate could be grouped into two basic categories: 1)
schools that already had a consolidated focus on school
PA and were interested in improving the already high
standards; and 2) schools with low experience and
capabilities regarding school PA and with obvious
challenges meeting the target of 45 min of school PA per
day. This variation could contribute to understanding
the differences in school management and educators’
motivation for participating in the project and capacities
for taking on MWS. According to Scaccia et al. the
ability to take on a particular innovation depends on “a) the
motivation to implement an innovation, b) the general
capacities of an organization, and c) the
innovationspecific capacities needed for a particular innovation”,
also referred to as organisational readiness [
‘organisational readiness’ could be reflected in the response
rates, which showed that some schools only achieved
answers from half of the educators, while other schools
had a response rate of 100%. Presumably,
nonresponding educators were less involved in the
programme and implemented fewer activities and
components. The differences in response rates between
schools might, therefore, bias the results.
As an indicator of effectiveness, we used the educators’
perception of the pupils’ change in well-being. The
definition of well-being and introduction to the key
elements of the self-determination theory was presented in
the available materials and during the competence
development program. Still, it is uncertain whether the
..consistent with their own self-image as educators
educators’ perceptions accurately reflect actual changes
in pupils’ well-being. Nonetheless, the overall belief in
the positive effects of the intervention is evident and it is
essential to the educators’ motivation to implement and
maintain the programme.
The adoption rates for both physical education and brain
breaks were high, but the adoption rate of the recess
activities was much lower, which may reflect the fact that
not all educators are appointed for recess duty. Recess is
used by many educators as a time for preparation and
coordination or having a break and an informal talk with
colleagues. Having ‘recess duty’ is tantamount to just ensuring
pupils are not getting in trouble or injured. Some teachers
also hold the view, that recess is free time for the pupils
and should not be influenced in any way by the adults.
The recess activities could, therefore, be experienced
as a rather radical change compared to previous
practices in the area. In general, the literature holds that the
more radical a change is, the more uncertainty it creates
and the more difficult the implementation is [
Whereas the educators generally found it difficult to
intervene during recess due to time constraints, the
challenges for brain breaks revolved around spending
time away from the key academic subject. Two reasons
why adoption in physical education might be less
challenging is that physical education teachers have PA
competences and education, and secondly that the physical
education lessons should be conducted anyway [
that sense the physical education component and the
lesson plans could be regarded as a help to an existing task
and not as extra work, which was stated by some of the
PE teachers involved in the competence development
program. This finding is also supported in the proces
evaluation by Steeinhuis et al., where an intervention that
involved extra work on top of a heavy workload of regular
duties were seen as a barrier for implementation [
The fact that no school withdrew from the project,
together with the high response rates for the process
survey, lends confidence in the representativeness of the
presented data. The role of the coordination groups at each
school consisting of educators and management
representatives could partly explain the high participation and
adoption rate. Active management participation and involvement
have in previously process evaluations been stated as
facilitator for engaging in project interventions [
The implementation of brain breaks was 4.5 per
educator per week with major differences between educators
and an overall average of 8.6 brain breaks per class per
week for all intervention schools. Barriers for conducting
brain breaks relates to difficulties integrating it to the
normal practice. Finally, some brain breaks lasted more
than 5 min, which might let the educators settle for one
per day of longer duration.
Overall, the physical education set goal was met, with
at least half of physical education lessons being MWS
lessons. This was probably because physical education
teachers perceived it as a help to their planning, and
because this element is directed at teaching and learning
and thus resembles normal school practice and is related
to the academic subject [
] . Interventions that
align directly with a school’s mission are easier to
integrate into the school’s policy and practices and are more
likely to be prioritised, implemented with due care and
quality, and sustained over time .
The observations of and interviews with the physical
education teachers supported the findings that the MWS
lessons plans were positively received. They also
indicated that lack of time for preparation; lack of
coordination between teachers; and challenges with some pupils’
acceptance of the new physical education practice were
among the biggest barriers to the implementation [
The physical education teachers that attended the
workshops emphasised these as highly significant for their
preparation and for their motivation for the project. The
educators stated that the practical learning of brain
breaks and physical education, and the opportunity to
meet with their colleagues were pivotal [
findings are reported by Castelli et al. in their
examination of the strength of evidence from studies of
professional development effectiveness [
Several studies have previously reported barriers and
facilitators in implementing school-based PA
]. Answers from the open ended question in
the process survey on “Where do you experience the
biggest challenges in implementing the intervention
components?” confirm the general findings in the process
literature . ‘Lack of time’ and ‘time for preparation’
being the most common answers with 26 unique
comments out of collectively 33 comments. The remaining
comments revolves around change in PE culture with
four comments, challenges in recess with four
comments and finally one comment on ‘lack of commitment
among colleagues’, ‘pupils avoid academic for more brain
break time’ and ‘noise during brain breaks’ respectively.
These factors affecting implementation in MWS
matched the categories by Nayor et al. presented earlier.
The two most common facilitators in the project were
the competence development program and the
opportunity for local tailoring [
19, 41, 45, 46
Both adoption and implementation are relatively stable
between T1 and T3. During the school year the
coordination group received bi-weekly information letters by
email; received two follow-up visits from the research
team; conducted a mid-term theme day; and were
invited to attend the fourth workshop half way through
the school year. The relatively low level of input from
the research team required for ongoing implementation
provided an important enticement for the maintenance
of the MWS initiatives. Furthermore, the fact that the
intervention was conducted over a whole school year
and employed teacher-delivered strategies is in the
process evaluation literature perceived as facilitators for
increasing maintenance [
]. Finally, the fact that nine
out of ten educators would recommend the MWS
programme to other schools and felt that participation
had improved their school, lead us to believe that the
intervention can be maintained over time [
This study have shown that it is possible to design a
school-based PA intervention that educators largely
adopt and implement. Implementation of the PA
elements was stable throughout the school year and data
demonstrate that educators believed in the ability of the
intervention to promote well-being among the pupils.
There were, however, large differences between schools
in implementation, which can be explained by
differences in existing capabilities and motivation. Finally, the
MWS show that a structured intervention consisting of
competence development, set goals for new practices
combined with specific materials, and ongoing support,
effectively reached a vast majority of all teachers in the
enrolled schools with a substantial impact.
Additional file 1: CONSORT checklist. (DOCX 58 kb)
BB: Brain Breaks; MWS: Move for Wellbeing in School; PA: Physical Activity;
PE: Physical Education; RCT: Randomized Controlled Trial; RE: Recess
Pernille Lund-Cramer & Anne-Didde Holt, scientific assistants, for their
participation in the project, data collection, distribution and daily
Jacob Nørgaard for his data collection and analysis from his master thesis:
Challenges for physical education teachers in the implementation of new
- A case study of experiences of physical education teachers by participating in”
Move for Well-being in Schools”.
The authors would also like to thank Research and Innovation Centre for
Human Movement and Learning (FIIBL), University College Lillebaelt (UCL)
and the schools, educators and children involved.
The study is funded by a donation from the non-profit foundation TrygFonden,
Denmark. The funding body has no role or authority in the conduct of
the research project, except acceptance of adjustments to the research
The study was approved by the Danish Data Protection Agency (J.nr:
2014–540693) and the Danish Health Research Ethics Committee.
Availability of data and materials
The datasets collected and/or analyzed during the current study are available
from the corresponding authors upon reasonable request.
SS initiated this paper and wrote the draft. All of the authors contributed to
writing the manuscript and critically reviewing its content. All authors
approved the final version before submission.
Ethics approval and consent to participate
Prior to the data collection, pupils and their parents received information
about the nature and procedure of the study. Consent took the form of
written passive consent from the parents and both written and oral passive
consent from the pupils. It was emphasized that participation was voluntary,
that respondents could withdraw consent at any time, and that data would
be treated confidentially and anonymously. These points were also
emphasized at the beginning of each questionnaire session. All data are
stored and treated in accordance with Danish law for data protection, and
the project is notified and approved by the Danish Data Protection Agency
(J.nr: 2014–54-0693) and the Danish Health Research Ethics Committee (De
Videnskabsetiske Komitéer for Region Syddanmark) and is on the ISRCTN
registry (DOI https://doi.org/10.1186/ISRCTN12496336).
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
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