RESEARCH QUARTERLY FOR EXERCISE AND SPORT
2016, VOL. 87, NO. 4, 342–353
http://dx.doi.org/10.1080/02701367.2016.1214665
Before-School Running/Walking Club and Student Physical Activity Levels:
An Efficacy Study
Michalis Stylianou,1 Hans van der Mars,2 Pamela Hodges Kulinna,2 Marc A. Adams,2 Matthew Mahar,3
and Eric Amazeen2
1
The University of Queensland; 2Arizona State University; 3East Carolina University
ABSTRACT
Purpose: Before-school programs, one of the least studied student-related comprehensive school
physical activity program (CSPAP) components, may be a promising strategy to help youth meet the
physical activity (PA) guidelines. This study’s purpose was to examine: (a) how much PA children
accrued during a before-school running/walking club and during the school day, (b) whether
children compensated for the PA accumulated in the before-school program by decreasing their
school-day PA, and (c) potential sex and body mass index (BMI) differences. Method: An alternating
treatments design with a baseline phase was first conducted at a private school (School A) and was
subsequently replicated at a public school (School B). Participants (N ¼ 88) were 3rd- and 4th-grade
children. The before-school program involved a running/walking club that met twice per week
(School A: 20 min; School B: 15 min). PA was measured using the NL-1000 pedometer. Data analysis
included multilevel modeling and visual analysis. Results: Children accumulated substantial
amounts of PA in the before-school programs (School A: 1,731 steps, 10:02 moderate-to-vigorous PA
minutes or 50% of program duration; School B: 1,502 steps, 8:30 moderate-to-vigorous PA minutes or
57% of program duration). Additionally, children did not compensate by decreasing their school-day
PA on days they attended the before-school program. Sex differences were found in before-school
program PA only for School B and in school-day PA for both schools. No BMI differences were found.
Conclusions: Before-school programs, as part of CSPAPs, can help children increase their PA
without resulting in decreased school-day PA and without taking time away from academics.
Despite public health concerns and the extensive health
benefits of physical activity (PA; Janssen & LeBlanc,
2010), a large proportion of American youth do not meet
the national PA guidelines (Troiano et al., 2008). Schools
have been identified as primary PA promotion sites
(Institute of Medicine [IOM], 2013) because they can
reach the vast majority of school-aged youth, and they
often have the needed facilities as well as personnel
who, with sufficient training, can define PA policies and
facilitate PA programs. However, youth spend most of
their time in school being sedentary (i.e., sitting; Abbott,
Straker, & Mathiassen, 2013). Additionally, school PA
opportunities (i.e., physical education and recess) have
decreased in the last few years due to an increased
emphasis on boosting academic performance (Center on
Education Policy [CEP], 2007). Thus, it is unlikely that
youth can meet the PA guidelines through physical
education (PE) and/or recess alone.
Multifaceted and coordinated school-based programs
(often called comprehensive or whole-school programs)
CONTACT Michalis Stylianou
Australia.
q 2016 SHAPE America
[email protected]
ARTICLE HISTORY
Received 5 August 2015
Accepted 20 June 2016
KEYWORDS
Before-school physical
activity programming;
elementary school;
pedometers; physical
activity compensation
have been identified as a promising approach for
increasing PA in youth (e.g., IOM, 2013). One such
program is the comprehensive school physical activity
program (CSPAP; Centers for Disease Control and
Prevention [CDC], 2013), which includes five components, one of which is PA before and after school.
Relevant research, however, has largely focused on afterschool programs, possibly because they are more
prevalent.
Before-school physical activity programs
Before-school PA programs refer to any school-based
program that targets PA promotion before the start of the
school day. In the CSPAP Policy Continuum document
(National Association for Sport and Physical Education
[NASPE], 2012), the optimal policy related to beforeschool and after-school programs requires the provision
of 30 min to 60 min of PA, of which 50% should be spent
in moderate-to-vigorous PA (MVPA). However, based
School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072,
BEFORE-SCHOOL PHYSICAL ACTIVITY PROGRAM
on relevant study findings, organized activities rarely
occurred before school in elementary and middle schools
(McKenzie, Marshall, Sallis, & Conway, 2000; Turner,
Johnson, Slater, & Chaloupka, 2014), and only a small
proportion of students visited activity areas before school
(McKenzie et al., 2000). Yet, evidence from descriptive
studies supports the potential of before-school time to
significantly contribute to children’s PA (McKenzie,
Crespo, Baquero, & Elder, 2010; McKenzie et al., 2000;
Tudor-Locke, Lee, Morgan, Beighle, & Pangrazi, 2006).
Further, there is preliminary evidence that children can
accumulate substantial MVPA during a campus-based,
before-school program using an interactive multimedia
PA training system (Mahar, Vuchenich, Golden, DuBose,
& Raedeke, 2011). However, the specific intervention
required a significant financial investment, which may
make it a less feasible option for schools.
A practical and cost-effective alternative for a campusbased before-school PA program may be a running/walking
club. Running and walking are lifetime activities and
generate important health and other benefits (Lambiase,
Barry, & Roemmich, 2010; Schnohr, Marott, Lange, &
Jensen, 2013). The purpose of running/walking clubs is “to
help children improve their ability to sustain continuous
running and walking, identify walking and running as
beneficial cardiorespiratory exercise, and participate in
daily walking and running outside of regularly scheduled
physical education class” (Ratliffe & Bostick, 2001, p. 24).
There has been substantial interest in assessing the
efficacy of campus-based running/walking club programs
(e.g., Foshay & Patterson, 2010; Ratliffe & Bostick, 2001;
Xiang, McBride, & Bruene, 2006). However, student
outcomes in relevant studies were mostly physiological
and motivational in nature, and the interventions were
delivered mainly during school-day PE and recess. One
running/walking club study focused on PA (Stylianou,
Kulinna, & Kloeppel, 2014), but it did not use an
objective measure. Hence, there is a need to further study
the potential contributions of running/walking clubs to
students’ PA.
343
There is some evidence that youth do not compensate
for increased school-based PA opportunities by engaging
in less school-day PA (Mahar et al., 2011) or after-school
and daily PA (Alderman, Benham-Deal, Beighle, Erwin,
& Olson, 2012; Long et al., 2013). Similarly, there is
evidence that youth do not compensate for restricted
school-based PA opportunities by engaging in more
school-day PA (Morgan, Beighle, & Pangrazi, 2007) or
after-school PA (Dale, Corbin, & Dale, 2000). Further,
children have been found to engage in more after-school
and daily PA on days with increased school-based PA
(Alderman et al., 2012; Dale et al., 2000; Long et al.,
2013). Collectively, it appears that expanded schoolbased PA opportunities can significantly help youth meet
and/or exceed PA guidelines.
Research on PA compensation during the school day
is limited. However, given that about 35% to 40% of U.S.
youth’s daily PA occurs during school hours (Brusseau
& Hannon, 2013) and that recess, a discretionary PA
period, is a significant contributor to youth’s school-day
and daily PA (Erwin et al., 2012), it is important to
further examine PA compensation during the school day.
Purpose
Given the scarcity of studies focusing on before-school
PA programs as well as running/walking clubs, the
purpose of this efficacy study was to examine: (a) how
much PA (i.e., steps and MVPA) children received
during a before-school running/walking club and the
school day, and (b) whether children compensated for
the PA they received in the before-school running/
walking club by being less active during the school day
(excluding the before-school program). Further, a
secondary purpose of this study was to examine sex
and body mass index (BMI) differences in participants’
before-school program and school-day PA.
Methods
Participants and settings
Physical activity compensation
An issue related to the value of school-based PA programs
is the potential of children’s “PA compensation”—that is,
whether children engage in less school-day or after-school
PA on days with increased school-based PA programming, or, on the other hand, if children engage in increased
after-school PA on school days with low PA. The concept
of compensation is based on the biological basis of
PA (Rowland, 1998), which suggests that compensatory
changes occur to maintain a stable level of PA or energy
expenditure.
This study’s participants were third- and fourth-grade
students from two schools in the Southwestern United
States. The two schools were a purposive sample of
schools that were interested in participating in the study
and represented two different settings (i.e., private vs.
public). The goal was not to compare the two schools, but
rather to replicate the study across the two settings.
School A
School A was a K–8 private school with a total enrollment
of 273 students (primarily Caucasian). From this school,
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M. STYLIANOU ET AL.
39 students provided parental consent and assent forms
to participate in the study (third grade ¼ 16, fourth
grade ¼ 23; boys ¼ 14, girls ¼ 25; 89.74% Caucasian,
10.26% Other). About one quarter of the participants
(23.68%) were overweight or obese (i.e., $85th percentile,
based on the CDC’S BMI-for-age growth charts for boys
and girls). At this school, students received two 45-min PE
lessons per week, as well as daily recess during lunchtime
(45 min for both lunch and recess). Other PA opportunities
at this school included various after-school sport clubs (e.g.,
soccer, etc.). According to student reports, active commuting to/from school was nonexistent among study
participants at this setting.
School B
School B was a K–6 public school with a total enrollment of
451 students (57.43% Caucasian, 33.92% Hispanic, 8.65%
Other), of whom 60% were eligible for free or reduced-price
lunch. From this school, 56 students provided parental
consent and assent forms to participate in the study (third
grade ¼ 28, fourth grade ¼ 28; boys ¼ 31, girls ¼ 25;
53.57% Caucasian, 35.71% Hispanic, 10.71% Other).
Twenty of the participants (43.49%) were overweight or
obese (i.e., $85th percentile, based on the CDC’S BMIfor-age growth charts for boys and girls). At this school,
students received two 30-min PE lessons per week and daily
recess at lunchtime (40 min for both lunch and recess).
Other PA opportunities at this school included an extra
recess period per week and a Fit Kids Club once a week.
About 10% of this school’s participants reported actively
commuting to/from school occasionally.
Research design
This study employed a two-phase design with an initial
baseline phase followed by an alternating treatments (AT)
phase. AT designs originate from applied behavior analysis
and single-case experimental designs (Barlow & Hersen,
1984; Cooper, Heron, & Heward, 2007). They test the
relative effectiveness of two (or more) treatments/
conditions and are an alternative to the traditional
between-group comparison designs. In AT designs, a
person (or a group) serves as its own control (i.e., the same
participants receive all conditions), which helps control for
most threats against internal validity (Barlow & Hersen,
1984), including selection, history, and maturation. Moreover, the initial baseline phase helps control for regression
to the mean as well as for testing effects, which constitute
particular threats in designs with repeated measures. This
design combined with the replication of the study in two
different settings can provide strong evidence for both
internal and external validity, as well as program efficacy.
Phases, conditions, and number of data points
The two phases used in the study (i.e., baseline and AT)
lasted 2 and 5 weeks, respectively, although the number
of data points collected was different at each school.
The conditions compared in the AT phase included a
non-treatment/control condition (no before-school program as in the baseline phase) and a treatment condition.
The baseline phase included 5 data points for School A
(1 week for each grade level) and 9 data points for School
B (2 weeks; 1 day was a holiday). During the AT phase,
at School A, 1 treatment data point (i.e., Tuesday or
Thursday) and 1 non-treatment/control data point (i.e., a
day before or after a treatment point) were collected for
each grade level each week for 5 weeks, resulting in a total
of 10 data points. At School B, data were collected daily
for 5 weeks during the AT phase except for 1 week with a
holiday, resulting in a total of 24 data points. Specifically,
at School B, 2 treatment data points (i.e., Tuesdays
and Thursdays) and 3 non-treatment/control data points
(i.e., the remaining days) were collected each week. The
number of data points for each phase was decided based
on practical considerations (e.g., predetermined program-starting day, natural school breaks).
Condition sequencing and discrete conditions
The fact that the before-school programs occurred on
specific weekdays did not allow for randomly counterbalancing the non-treatment and treatment conditions,
which can control for order effects. Such limitations are not
unusual when conducting research in schools. However, at
School A, non-treatment data points were manipulated so
they occurred both on days before and after treatment data
points (at least two times before and two times after).
At School B, treatment data points occurred both before
and after non-treatment data points every week. Also, the
two conditions were clearly discrete, which helps control for
potential order effects and minimize possible carryover
effects (Barlow & Hersen, 1984).
Intervention: Before-school physical activity
program
The before-school program in both schools involved a
running/walking club that occurred two times a week.
For this study, students were considered to have
participated in the before-school program if they had
accumulated at least 5 min of MVPA.
School A
At School A, the program lasted 20 min each time. At this
school, the PE teacher used a reinforcement system that
BEFORE-SCHOOL PHYSICAL ACTIVITY PROGRAM
rewarded students for participating in the program. The
teacher monitored the distance students covered in the
program and the students received “shoe”-shaped tokens
for their shoestrings or backpacks for every 8 kilometers
(5 miles) they covered.
School B
At School B, the program lasted 15 min each time. The
PE teacher at this school also used a reinforcement
system to reward students for participating in the
program. Specifically, students received a pencil for every
two laps completed as well as a “caught being good” ticket
(part of the school accountability system) each time they
participated in the program.
Data collection and procedures
Institutional review board approval as well as district and
principal approvals were obtained prior to starting the
study. Also, student assent and parental consent forms
were collected. Data were collected on: (a) before-school
PA participation, (b) PA levels during the before-school
program and the school day, and (c) anthropometric
measures (height and weight).
345
Prior to data collection, students were instructed in
how to use the pedometer and had the opportunity to use
it during two PE lessons to avoid reactivity effects.
Graphics that were posted in the school also served to
visually remind students where to place their pedometer
and how to use it. Proper placement of the instrument
was on the right hip in line with the midline of the thigh.
Elastic belts were also available for students who had a
difficult time adjusting the pedometer to their attire.
Shake tests were conducted prior to the start of the study
as well as every 2 weeks during the study to evaluate
pedometers for calibration problems.
Anthropometric measures
Height and weight measurements were obtained without
shoes and heavy clothing using a calibrated digital scale
(Seca 882 Digital Scale) and stadiometer (Seca 214 Portable
Stadiometer). These measurements were taken during the
first 2 weeks of the study at each school and were used to
calculate students’ BMI (weight [kg]/height [m] squared)
and BMI-for-age percentile using the CDC’s BMI tool for
schools. Subsequently, BMI-for-age percentiles were used
to classify students as normal-weight (,85th percentile) or
overweight/obese ($85th percentile) based on the CDC’s
BMI-for-age growth charts for boys and girls.
Before-school PA participation
Every morning during the study, participants completed a
before-school PA participation log, where they reported
whether they participated in any PA before school. This
information was used to determine fidelity to the two
conditions (e.g., whether participants engaged in any PA
before school on baseline or non-treatment/control days).
Physical activity levels
In both schools, steps and MVPA time were assessed
during: (a) the running/walking club and (b) the school
day. For the running/walking club, steps and minutes
were recorded right before students started running/
walking as well as at the end of the program or when they
discontinued participation. For school-day PA, steps and
minutes were recorded at the beginning of homeroom
time and the end of the school day.
PA was measured using the New Lifestyles NL-1000
pedometer, which uses a piezoelectric mechanism that is
similar to accelerometers. This instrument was set to
record activity greater than 3.6 metabolic equivalents,
and the sampling interval was 4 s, which is considered
suitable for children’s sporadic PA patterns. This device
has been shown to provide valid and reliable estimates of
PA in children (Hart, Brusseau, Kulinna, McClain, &
Tudor-Locke, 2011).
Data analysis
Statistical analysis
Analyses were performed for both steps and MVPA time
within a multilevel modeling framework, with daily
observations as the Level 1 variable (subscript i in
equations) and person-level variables (e.g., sex, BMI status)
as Level 2 variables (subscript j in equations). Analyses were
conducted separately for each school because the purpose
was to replicate the study in two different settings. Analyses
were performed using the IBM Statistical Package for the
Social Sciences software (Version 21).
To quantify the magnitude of potential effects, the
pseudo-R 2 effect size was calculated (Raudenbush & Bryk,
2002; Singer & Willett, 2003), which is interpreted as the
proportion reduction in variance for a parameter estimate
that results from comparing the variance component (i.e.,
residual/Level 1 variance, intercept/Level 2 variance) in a
baseline model to the same variance component in a fuller
model (i.e., a model with more/all predictor variables).
This statistic is analogous to the R 2 statistic in multiple
regression and is estimated through the formula
Pseudo 2 R 2 ¼ s2BASE 2 s2FULL =s2BASE ;
ð1Þ
where s2BASE and s2FULL are the dependent variable
variances in the baseline model and the full model,
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M. STYLIANOU ET AL.
respectively. For interpreting pseudo-R 2 values, Cohen’s
criteria for R 2 values were used (i.e., .02, .13, and .26
represent small, medium, and strong effects, respectively;
Cohen, 1988).
Running/walking club PA. To determine the mean
number of steps and MVPA time accumulated within
the running/walking club, a model with no predictors
was tested,
yij ¼ B0 þ u0j þ eij :
ð2Þ
In this model, B0 represents the mean values of the
dependent variable, u0j reflects variation in dependent
variable means across students (between-person variance), and eij is leftover variability across observations
(within-person variance).
School-day PA. To examine the mean number of steps
and MVPA minutes accumulated during the school day,
the same analyses were conducted as described above.
Sex and BMI status differences. To examine potential
differences in before-school program and school-day PA,
two different models were tested, one with sex and one
with BMI status. For example, the model with sex was,
yij ¼ B0 þ B1 ðSexj Þ þ u0j þ eij ;
ð3Þ
where B0 is the expected number of steps or MVPA time
for boys (sex ¼ 0), B1 is the change in PA for girls
(sex ¼ 1), and u0j reflects variation in PA means across
students not captured by sex.
Compensation. To determine if students compensated
on days they attended the before-school program by
engaging in reduced school-day PA, a random intercept
model was tested,
yij ¼ B0 þ B1 ðtreatmentij Þ þ u0j þ eij ;
ð4Þ
which allows intercepts (i.e., mean steps or MVPA time)
to vary across individual students but assumes constant
slopes (i.e., same influence of treatment). In this model,
B0 reflects the expected number of steps or MVPA time
in the absence of treatment (treatment ¼ 0), B1 is the
change in school-day PA for a 1-unit change in treatment
(i.e., participation in the program), u0j reflects variation
in PA means across students, and eij is leftover variability
not captured by treatment.
Building toward this model, some preliminary
analyses were conducted. These analyses included testing
for the influence of PE and extra recess (School B only)
on day-to-day PA,
yij ¼ B0 þ B1 ðPEij Þ þ B2 ðextra recessij Þ u0j þ eij ;
ð5Þ
to determine if they needed to be included in subsequent
models. Preliminary analyses also included testing for
potential effects of the variables of phase and order on
day-to-day PA over and above treatment to determine if
they needed to be included as covariates in subsequent
models. These variables were tested in separate models
because order was only present during the AT phase. For
instance, the equation for the model including phase was:
yij ¼ B0 þ B1 ðtreatmentij Þ þ B2 ðphaseij Þ þ u0j þ eij : ð6Þ
Visual analysis
A visual analysis was also conducted to examine the PA
compensation question. For the visual analysis, graphs of
average school-day PA (excluding before-school program
PA) were developed by phase and condition for each
school. The visual analysis of the graphically plotted data
was based on the following criteria: variability and trends
within and between phases/conditions, data overlap
between phases/conditions, immediacy of change from
one phase/condition to the next, and distance between
data paths of the different conditions (Cooper et al., 2007).
Evidence for compensatory effects would include a clear
and consistent reduction in school-day PA with the
introduction of the treatment condition, a clear distance
between the data paths of the treatment and nontreatment conditions, and a lack of overlap between the
data paths of the two conditions. A large overlap of data
paths would reflect the absence of a compensatory effect.
Results
At School A, all 39 students who agreed to participate in
the study attended the before-school program at least
once and thus were all included in the analyses. At School
B, however, 7 students who initially provided consent and
assent forms to participate in the study did not attend the
program at all and were thus excluded from analyses,
resulting in a final sample of 49 students from this school.
There were no significant differences between the
number of students who did and did not attend the
program in School B in terms of sex (Fisher’s Exact test,
p ¼ .22) and BMI status (Fisher’s Exact test, p ¼ .51).
Also, multilevel models showed that attending the
program during the AT phase was not a significant
predictor of, and explained small percentages of variance
in, baseline school-day PA when controlling for sex and
BMI status (steps, p ¼ .15, pseudo-R 2 ¼ .02; MVPA,
p ¼ .22, pseudo-R 2 ¼ .02).
Before-school PA participation
According to the before-school PA logs, in about 97% of the
cases, participants did not engage in any PA before school
on days without the program, which is not surprising given
BEFORE-SCHOOL PHYSICAL ACTIVITY PROGRAM
the early school start times and that sunrise (in late fall/
winter) was close to the school start times.
Running/walking club and school-day physical
activity
Mean steps and MVPA minutes accumulated in the beforeschool program and during the school day at each school
are available in Tables 1 and 2, respectively. These tables
also present PA data by sex and BMI status. Additionally,
Table 1 provides information about the percentage
of program duration spent in MVPA, as well as the
percentages of daily PA guidelines (12,000 steps/day
[Adams, Johnson, & Tudor-Locke, 2013]; 60 min/day [U.S.
Department of Health and Human Services (USDHHS),
2008]) and school-day PA that the before-school program
steps and MVPA time represent. Similarly, Table 2 includes
information about the percentages of daily PA guidelines
that the school-day steps and MVPA time represent, as well
as the percentages of daily PA guidelines that the combined
school-day and before-school program steps and MVPA
time represent.
Sex and BMI status differences
Tables 3 and 4 present the results of sex and BMI status
models, respectively. BMI status was not a significant
predictor for before-school program or school-day PA in
either school and explained less than 5% of variance in
relevant models. Sex was a significant predictor for
before-school program PA only for School B and
explained about 23% of variance in both steps and
MVPA. Sex was a significant predictor for school-day PA
in both schools but explained different proportions of
variance for each school (see Table 3). In all models
with significant sex differences, boys were more active
than girls.
Compensatory effects
According to the results of preliminary analyses, PE (for
both schools) and extra recess (only for School B) both
significantly contributed to the prediction of school-day
PA when controlling for each other. Additionally, when
examining the confounding variables of phase and order,
only phase significantly contributed to the prediction of
school-day PA when controlling for treatment, PE, and
extra recess. Therefore, the variables of PE, extra recess
(only for School B), and phase were included in
subsequent models.
Based on the random intercept model results (see
Table 5), before-school program participation did not
significantly contribute to, and explained very small
proportions of variance in, school-day steps or MVPA
time (excluding before-school program PA) over and
above PE and phase at School A, thus suggesting a noncompensatory effect on days students attended
the program. At School B, before-school program
Table 1. Running/walking club physical activity levels by school, sex, and body mass index (BMI) status.
School A
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
School B
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
M
WPSD
BPSD
1,731
1,953
1,620
1,760
1,645
1,502
1,645
1,297
1,506
1,491
567
686
493
564
583
372
389
343
375
368
473
398
479
432
604
341
346
206
378
275
Running/walking club steps
% of daily step guideline
14.43
16.28
13.50
14.67
13.71
12.52
13.71
10.81
12.55
12.43
% of school-day stepsa
30.74
34.68
28.76
31.25
29.21
31.02
33.97
26.79
31.10
30.79
Running/walking club MVPA time (minutes)
School A
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
School B
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
347
M
WPSD
BPSD
% of program duration
% of daily MVPA rec.
% of school-day MVPAa
10:02
11:00
09:32
10:09
09:40
08:30
09:23
07:13
08:36
08:26
3:20
3:49
3:02
3:17
3:31
2:24
2:36
2:02
2:18
2:27
2:59
2:37
3:07
2:46
3:45
2:07
2:10
1:13
2:09
2:08
50.00
55.00
47.67
50.75
48.33
56.67
62.56
48.11
57.33
56.22
16.72
18.33
15.89
16.92
16.11
14.17
15.64
12.03
14.33
14.06
47.03
51.56
44.69
47.58
45.31
42.50
46.92
36.08
43.00
42.17
Note. Daily step guideline ¼ 12,000 steps (Adams et al., 2013); daily moderate-to-vigorous physical activity (MVPA) recommendation ¼ 60 min
(USDHHS, 2008); M ¼ mean; WPSD ¼ within-person standard deviation; BPSD ¼ between-person standard deviation; PCTL ¼ percentile;
Rec. ¼ recommendation.
a
Based on school-day PA on treatment days.
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M. STYLIANOU ET AL.
Table 2. School-day physical activity levels by school, sex, and body mass index (BMI) status.
M
School A
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
School B
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
Baseline phase
WPSD
BPSD
6,612
7,706
6,038
6,666
6,452
4,388
4,604
4,081
4,670
4,226
1,129
1,361
1,008
1,161
1,024
1,317
1,447
1,107
1,407
1,262
1,647
1,865
1,191
1,812
1,070
666
726
423
713
594
School-day steps
Alternating treatments phase
Non-treatment
Treatment
M
WPSD
BPSD
M
WPSD
BPSD
5,868
6,969
5,335
6,002
5,510
4,517
4,739
4,193
4,823
4,342
1,287
1,297
1,291
1,347
1,170
1,236
1,348
1,054
1,418
1,109
1,332
1,533
834
1,393
1,162
713
725
577
744
648
5,632
6,605
5,103
5,879
4,766
4,842
5,018
4,584
5,322
4,555
1,241
1,320
1,251
1,297
1,006
1,043
1,142
856
1,126
993
% of daily step
a
guideline
1,159
1,408
926
1,163
604
1,372
1,496
1,162
1,498
1,240
% of daily step
a
guideline w/ RWC steps
46.93
55.04
42.53
48.99
39.72
40.35
41.82
38.20
44.35
37.96
61.36
71.32
56.03
63.66
53.43
52.87
55.53
49.01
56.90
50.38
School-day MVPA time (minutes)
Alternating treatments phase
Baseline phase
M
School A
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
School B
Boys
Girls
BMI , 85 PCTL
BMI $85 PCTL
24:37
30:26
22:03
24:54
23:49
18:03
19:35
15:47
19:29
17:13
Non-treatment
WPSD
BPSD
M
6:41
8:47
5:38
6:50
6:11
6:32
7:17
5:13
7:11
6:07
6:40
4:20
5:47
7:15
4:52
3:41
3:38
2:24
3:56
3:21
21:27
27:24
18:47
22:11
19:34
18:26
20:04
16:03
20:07
17:29
Treatment
WPSD
BPSD
M
6:07
6:49
5:49
6:04
6:16
6:35
7:18
5:24
8:03
5:29
6:28
8:07
3:01
7:02
4:37
4:26
4:39
2:46
5:25
3:30
21:20
28:11
17:49
22:40
16:56
20:00
21:36
17:35
22:04
18:45
WPSD
BPSD
6:33
7:34
6:09
6:56
4:49
6:25
6:06
4:04
6:14
4:54
5:59
5:04
4:12
6:29
3:42
7:19
8:20
4:43
8:24
6:19
% of dailya
MVPA rec.
a
% of daily guideline
w/ RWC PA
35.56
46.97
29.69
37.78
28.22
33.33
36.00
29.31
36.78
31.25
52.28
65.31
45.58
54.69
44.33
47.50
51.64
41.33
51.11
45.31
Note. Daily step guideline ¼ 12,000 steps (Adams et al., 2013); daily moderate-to-vigorous physical activity (MVPA) recommendation ¼ 60 min (USDHHS, 2008);
M ¼ mean; WPSD ¼ within-person standard deviation; BPSD ¼ between-person standard deviation; RWC ¼ running/walking club; PCTL ¼ percentile;
Rec. ¼ recommendation.
a
Based on school-day PA on treatment days.
participation was found to significantly contribute to the
prediction of school-day steps and MVPA time when
controlling for PE, extra recess, and phase. Specifically,
students at School B accumulated a significantly higher
number of steps (B1 ¼ 328) and MVPA time
(B1 ¼ 1:25 min) on days they attended the before-school
program, but program participation explained very small
proportions of the variance in school-day PA (pseudoR 2 , .02 [small]).
Visual analysis
Figures 1 and 2 present graphs of average school-day steps
and MVPA across phases and conditions for each school
Table 3. Sex differences in before-school program and school-day physical activity.
School A
Before-school RWC PA
B0 (Intercept)
B1 (Sex)
School-day PA
B0 (Intercept)
B1 (Sex)
Estimate
SE
Steps
p
1,924
2295
157
195
.139
6.60%
10:52
201:18
00:59
01:14
.295
1.10%
7,201
21,693
318
393
,.001
36.19%
28:24
208:51
01:24
01:42
,.001
46.54%
Variance explained
Estimate
SE
MVPA (minutes)
p
Variance explained
School B
Steps
Before-school RWC PA
B0 (Intercept)
B1 (Sex)
School-day PA
B0 (Intercept)
B1 (Sex)
Estimate
SE
p
1,646
2356
63
100
4,795
2583
169
216
MVPA (minutes)
p
Variance explained
Estimate
SE
Variance explained
.001
22.59%
09:23
202:12
00:24
00:38
.001
23.02%
.024
10.49%
20:01
203:45
00:47
01:14
.004
16.30%
Note. MVPA ¼ moderate-to-vigorous physical activity; RWC ¼ running/walking club; PA ¼ physical activity; SE ¼ standard error.
BEFORE-SCHOOL PHYSICAL ACTIVITY PROGRAM
349
Table 4. BMI status differences in before-school program and school-day physical activity.
Before-school RWC PA
B0 (Intercept)
B1 (BMI Status)
School-day PA
B0 (Intercept)
B1 (BMI Status)
Estimate
SE
School A
Steps
p
Variance explained
Estimate
1,754
298
110
226
.666
3.04%
10:07
200:25
00:41
01:23
.765
3.28%
6,270
2695
263
517
.187
1.93%
23:22
203:17
01:13
02:22
.176
2.21%
SE
MVPA (minutes)
p
Variance explained
School B
Steps
Before-school RWC PA
B0 (Intercept)
B1 (BMI Status)
School-day PA
B0 (Intercept)
B1 (BMI Status)
MVPA (minutes)
Estimate
SE
p
Variance explained
Estimate
SE
p
Variance explained
1,508
217
69
114
.882
2.24%
08:26
200:11
00:26
00:43
.814
2.61%
4,534
2246
180
216
.260
4.30%
19:15
202:27
00:48
01:19
.069
5.44%
Note. BMI ¼ body mass index; MVPA ¼ moderate-to-vigorous physical activity; RWC ¼ running/walking Club; PA ¼ physical activity;
SE ¼ standard error.
Table 5. School-day physical activity random intercept model results.
School A
Steps
B0
B1
B2
B3
(Intercept)
(Treatment)
(Physical education)
(Phase)
Estimate
SE
6,181
2138
1,008
2594
242
155
123
132
p
MVPA (minutes)
Variance explained
Estimate
SE
p
Variance explained
2.70%
14.29%
6.19%
22:30
200:06
04:58
202:28
01:08
00:48
00:38
00:41
.901
,.001
,.001
1.14%
12.89%
2.87%
.375
,.001
,.001
School B
Steps
B0
B1
B2
B3
B4
(Intercept)
(Treatment)
(Physical education)
(Extra recess)
(Phase)
Estimate
SE
3,658
328
1,009
1,958
209
128
72
56
80
63
p
MVPA (minutes)
Variance explained
,.001
,.001
,.001
.001
1.41%
9.24%
21.44%
.70%
Estimate
14:30
01:25
04:55
09:05
00:48
SE
p
Variance explained
00:43
00:24
00:19
00:27
00:21
,.001
,.001
,.001
.024
0.83%
8.28%
16.95%
0.29%
Note. MVPA ¼ moderate-to-vigorous physical activity; SE ¼ standard error.
(excluding before-school program PA). According to the
graphs, there is substantial overlap between baseline and
non-treatment data paths for both step counts and MVPA
time across both schools. Moreover, in the AT phase, there
is complete overlap between the treatment and nontreatment condition data paths (including the standard
deviation bars) for both schools. Collectively, based on the
graphs, children did not compensate for the PA they
received in the before-school running/walking club by
being less active during the school day.
Discussion
This study aimed to examine the efficacy of a before-school
running/walking club and focused on the PA (i.e., steps
and MVPA) accumulated in the before-school program,
whether children compensated for the PA they received in
the program by being less active during the school day,
and potential sex and BMI status differences. The study
was first conducted at a private school (School A) and was
subsequently replicated at a public school (School B).
Physical activity in the before-school program
Children from both schools accumulated substantial
amounts of PA in the before-school program (1,731
steps, 10:02 MVPA minutes at School A [20-min
program]; 1,502 steps, 8:30 MVPA minutes at School B
[15-min program]). The PA levels accumulated in both
programs met or exceeded the standard of 50% of beforeschool program time spent in MVPA (50% at School
A and 56.67% at School B), as identified in the CSPAP
Policy Continuum document (NASPE, 2012). These
results are comparable to the results of Mahar et al.
350
M. STYLIANOU ET AL.
Figure 1. School-day steps (excluding before-school program steps) during the baseline and alternating treatment (ATP) phases.
(2011), who found that children participating in a beforeschool program using an interactive multimedia PA
training system spent an average of 46.4% (9.3 min) of
their time in the program in MVPA.
The PA accumulated through the two programs
represents substantial portions of the daily step guideline
and MVPA recommendation (14.43% and 12.52% of
the daily step guideline for Schools A and B, respectively;
16.72% and 14.17% of the daily MVPA recommendation
for Schools A and B, respectively). The importance
of these numbers lies in the short duration of these
programs (20 min and 15 min, respectively) and is further
highlighted when considered relative to the school-day
PA levels of children at the two schools (for School A,
30.74% and 47.03% of school-day steps and MVPA time,
respectively; for School B, 31.02% and 42.50% of schoolday steps and MVPA time, respectively). Moreover, when
combining the before-school program and school-day
PA (see Table 2), it is clear that the running/walking club
has the potential to help children meet and/or exceed at
least half of the daily step guideline and MVPA time
recommendation.
The contribution of the before-school program to
children’s PA should also be considered in light of the
current realities of schools. Although schools are
considered ideal PA promotion sites (IOM, 2013), school
PA opportunities have decreased during the last few years
(CEP, 2007). The two schools that participated in this
study provided students with daily recess but only two
periods of PE each week. Further, active commuting to/
from school was nonexistent at School A and very limited
at School B. It is not surprising, therefore, that the beforeschool program was a significant source of these children’s
daily PA, which points to the importance of providing
expanded PA programming for all school-aged students.
Compensatory effects
In this study, participation in the before-school program
did not have a compensation effect on school-day PA.
BEFORE-SCHOOL PHYSICAL ACTIVITY PROGRAM
351
Figure 2. School-day MVPA (excluding before-school program MVPA) during the baseline and alternating treatment (ATP) phases.
In other words, children did not engage in less school-day
PA on days when they attended the before-school
program. On the contrary, there was a small and
statistically significant increase in the PA children at
School B accumulated on days they attended the program
(328 steps, 01:25 MVPA minutes). However, the
magnitude of this effect was small and should be
interpreted with caution. Mahar et al. (2011) also found
no significant differences in school-day PA between days
children did and did not attend a before-school program.
This study’s results contradict the hypothesis of
compensatory changes to maintain a stable level of PA or
energy expenditure at the school-day level, but they may
also be a function of other factors, including the
participants’ age, the fact that the study focused on
MVPA and not on vigorous or total PA, and the relatively
short duration of the study. Further, children may still
compensate after school, although the findings of relevant
studies suggest that youth do not compensate for decreased/
increased school-based PA opportunities by increasing/
decreasing their after-school or daily PA (Alderman et al.,
2012; Dale et al., 2000; Long et al., 2013). Further, there is
evidence that children may engage in more after-school
and daily PA on days with increased school-based PA
(Alderman et al., 2012; Dale et al., 2000; Long et al., 2013).
Sex and BMI status differences
In this study, sex was a significant predictor of, and
explained a substantial proportion of variance in, schoolday PA. Sex differences are common in the literature (e.g.,
Troiano et al., 2008) and highlight the need to particularly
focus on girls’ PA patterns from a young age. Results about
sex differences in before-school program PA were mixed
and should be further investigated in the future. Similarly,
some descriptive studies have shown no sex differences in
352
M. STYLIANOU ET AL.
before-school PA (McKenzie et al., 2010; Tudor-Locke
et al., 2006), whereas McKenzie et al. (2000) found that boys
engaged in more MVPA than girls before school. BMI
status was an insignificant predictor of, and explained
minimal proportions of variance in, both before-school
program and school-day PA. Related studies suggest that
body fat but not BMI may be associated with PA in youth
and that body fat may correlate with vigorous but not
moderate PA (e.g., Abbott & Davies, 2004).
Strengths and limitations
This study does have limitations, including that the exact
duration of participation in the before-school program
was not monitored and that data on before-school PA
levels on days without the program were not collected.
However, fidelity to the two conditions was examined
through a daily before-school PA log. Additionally, 24-hr
PA levels and potential compensation effects after school
were not examined, the sample size was small, and the
study did not account for aerobic fitness and motivation
to participate in the program. Given that the program
only included a running/walking club, it might not have
catered to all students’ interests.
The study’s strengths include its design, which combined
a baseline phase with an AT phase, as well as the fact that the
study was replicated in a second setting. Combined, these
features provide support both for internal and external
validity and the efficacy of the study. However, additional
replicative studies are needed to support the generalizability
of this study’s results further across different contexts.
Finally, this cost-effective intervention in no way reduced
academic instruction time during the school day. This
finding represents an attractive dimension of the particular
program, especially for school administrators and classroom
teachers who may be reluctant to give up class time for PA in
light of the pressures of high-stakes testing.
Conclusion and recommendations for future
research
This efficacy study provides preliminary evidence that a
before-school running/walking program can significantly
contribute to children’s PA levels and can help them meet
the daily PA guidelines. The contribution of the program
to children’s PA is further highlighted by the fact that
the participants did not compensate by decreasing their
school-day PA on days they attended the program.
Walking and running are lifetime PAs that generate
important health benefits, and a running/walking
program is simple and cost-effective. Before-school
programs are also an attractive option for schools because
they do not take time away from academic instruction.
Before-school programs may be the least studied
student-related component of CSPAPs. Thus, it is
recommended that additional studies focus on various
types of before-school programs (e.g., structured vs.
unstructured) and examine resulting participation rates,
PA levels, and sex and weight status differences. Future
studies should also focus on other relevant outcomes,
such as school attendance, classroom behavior (e.g.,
Stylianou et al., 2016), and cognitive or academic
performance. Finally, there is a need for further
investigation of the compensation question as a function
of individual differences and overall PA levels.
What does this article add?
This article focuses on the efficacy of a before-school PA
program, which is perhaps the least studied student-related
component of CSPAPs, and therefore addresses a gap in the
literature examining the various CSPAP components and
associated outcomes. Specifically, this article focuses on a
before-school running/walking club, which is cost-effective
and incorporates simple, inclusive lifetime activities. While
several studies have investigated running/walking programs
and associated outcomes, this study was one of the first to
focus on objectively measured PA levels accumulated
through a school-based running/walking program. This
study provides preliminary evidence that short (15-min
to 20-min) sessions of running/walking before school can
significantly contribute to elementary-aged children’s PA
levels and can help them meet the daily PA guidelines
without resulting in decreased school-day PA. From the
perspective of policymakers, before-school PA programs
may be a more attractive option for schools than other PA
programs that occur during the school day because they do
not take away from academic instruction time. Demonstrating the positive student outcomes associated with beforeschool programs may encourage more schools to establish
such programs. At a time when many elementary school
children have limited PA opportunities during the school
day, PA programming before and after school is invaluable.
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