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Effects of school-based before-school physical activity programmes on children’s physical activity levels, health and learning-related outcomes: a systematic review
  1. James Woodforde1,
  2. Tahlia Alsop2,
  3. Jo Salmon3,
  4. Sjaan Gomersall1,2,
  5. Michalis Stylianou1
  1. 1 School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
  2. 2 School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
  3. 3 Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
  1. Correspondence to James Woodforde, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland 4072, Australia; j.woodforde{at}


Objective To review and evaluate the impact of school-based, before-school physical activity (PA) programmes on children’s PA levels, health and learning-related outcomes.

Design Systematic review.

Data sources PubMed, PsycINFO, Scopus, Embase and ERIC were searched in January 2021.

Eligibility criteria for selecting studies (1) Original research published in English, (2) sample included typically developing school-age children and/or adolescents, (3) examined school-based PA programmes delivered before school, (4) included a comparator and (5) reported associations with PA, physical health, learning-related and/or psychosocial outcomes. Studies examining before-school active transport or sport were excluded.

Results Thirteen articles representing 10 studies were included (published 2012–2020); seven conducted in primary schools. Programmes ranged between 3 weeks and 6 months, primarily operating daily and for 25–40 min. One study examined a programme informed by theory; six incorporated fidelity measures. Data synthesis, considering consistency of findings, showed indeterminate associations for the domains of physical health, learning-related and psychosocial outcomes. Among subdomains, synthesis showed positive associations with before-school and daily PA, cardiorespiratory and muscular fitness, readiness to learn and an inverse association with adiposity. Risk of bias was high/serious or insufficiently detailed across studies and outcome domains, except PA, which included moderate-risk studies.

Conclusion There is limited available evidence on school-based, before-school PA programmes, with some positive associations at domain and subdomain levels. Continued research is justified to understand the role of before-school programmes for facilitating PA. Future research should follow recommended practice for intervention design and process evaluation, and address under-represented contexts, including secondary schools.

PROSPERO registration number CRD42020181108.

  • adolescent
  • child
  • physical activity
  • review
  • school

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  • Twitter @James_Woodforde, @profjsalmon

  • Contributors JW, MS, SG and JS developed the concept and protocol. JW conducted the search; JW, MS, SG and JS were involved in study screening and selection. JW, TA, MS, SG and JS were involved in data extraction and synthesis and risk of bias assessment. JW prepared the first draft of the manuscript; all authors contributed to manuscript revisions and reviewed the final manuscript.

  • Funding JW is supported by Australian Government and University of Queensland Research Training Programme (RTP) Scholarships. JS is supported by a National Health and Medical Research Council Leadership Level 2 Fellowship (APP 1176885).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.