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.
- physical activity
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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.
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