Scientific and policy background

Physical activity is important for health across the life span. Evidence now suggests that this activity does not need to include sport or exercise to achieve health benefits, but could involve increasing the time spent in more moderate activities, such as walking, or reducing time spent sitting. Many young people are not active for the government-recommended 60 minutes per day, and they also sit for long periods. This is particularly true for adolescents. This unhealthy lifestyle is heavily influenced by the environment in which they live and spend most of their time.

The Creating Active School Environments (CASE) project aimed to find ways to help adolescents be more active and sit less, and to increase our understanding of how secondary schools can help achieve this. This is in line with Department of Health physical activity policies, the overall government goal that good schools will be active promoters of health in childhood and adolescence, and is complementary to the Change4Life initiative. The CASE project focuses on environmental approaches to behaviour change. We define the school environment as the physical and aesthetic surroundings of the school and/or the social climate and culture of the school. The focus is therefore on using automatic rather than conscious processes to behaviour change – this is sometimes referred to as the ‘nudge’ approach.

CASE project objectives

The overall aim was to identify and evaluate opportunities within the school environment to change activity levels in secondary school students. Objectives included:

1. To identify potential avenues for school-level intervention strategies by reviewing the existing literature and analysing existing data;
2. To include children, teachers, parents, public health professionals and other experts in the prioritisation of promising interventions;
3. To test the feasibility of promising interventions.

Research methods

This multi-disciplinary project consisted of five research activities:

• A systematic review of the published quantitative and qualitative literature, and of UK-based non-academic publications, aiming to provide information on what school-environmental factors are associated with adolescent physical activity and sedentary behaviour.
• Secondary data analyses of a UK-based longitudinal cohort study, following children over the transition from primary to secondary school. We assessed how their school environment changed over this transition, and whether this was associated with objectively-measured sedentary time and physical activity during school hours.
• Using an online pre-specified stakeholder-led consensus method, an intervention prioritisation study allowed us to meaningfully engage with stakeholders (including young people) in the process of prioritising secondary school-environment focused interventions that aim to increase physical activity.
• In line with the results from the stakeholder prioritisation process, we conducted a feasibility study and a pilot study of an active lessons teacher training programme. The training programme was developed with external experts and delivered in two schools. Mixed-methods evaluations assessed the acceptability and feasibility of the programme, as well as indications of whether the project worked to influence activity levels.
• We developed a purpose-built decision analytic model aimed at quantifying the potential long-term costs and quality-adjusted life-year (QALY) implications of changes in activity levels during adolescence. This contribution built on a previous model and included updated evidence on the dose-response relationship between activity and disease/mortality. We then applied the model to two example intervention programmes to illustrate some of the practical implications of taking a longer-term perspective.