Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial

• Published in: PLoS medicine 2020-07, Vol.17 (7), p.e1003210-e1003210
• Main Authors: Corder, Kirsten, Sharp, Stephen J, Jong, Stephanie T, Foubister, Campbell, Brown, Helen Elizabeth, Wells, Emma K, Armitage, Sofie M, Croxson, Caroline H D, Vignoles, Anna, Wilkinson, Paul O, Wilson, Edward C F, van Sluijs, Esther M F
• Format: Article
• Language: English
• Subjects: Accelerometry - methods; Adolescent; Adolescents; Biology and Life Sciences; Child development; Cost analysis; Cost-Benefit Analysis; Epidemiology; Exercise; Exercise - psychology; Female; Funding; Health Promotion - economics; Health Promotion - methods; Health sciences; Humans; Male; Medicine and Health Sciences; Participation; People and Places; Physical activity; Physical fitness; Physical training; Program Evaluation; Public health; School effectiveness; School Health Services - economics; Schools; Social environment; Social Sciences; Students; Supervision; Teenagers; United Kingdom
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003210

Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school's social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents. Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] -1.91 minutes [-5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample. In th