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Purpose To describe physical activity (PA) intensity across a school day and assess the percentage of girls and boys achieving recommended guidelines. Methods The authors measured PA via accelerometry in 380 children (8–11 years) and examined data representing (1) the whole school day, (2) regular class time, (3) recess, (4) lunch and (5) scheduled physical education (PE). Activity was categorised as sedentary (SED), light physical activity (LPA) or moderate to vigorous physical activity (MVPA) using age-specific thresholds. They examined sex differences across PA intensities during each time period and compliance with recommended guidelines. Results Girls accumulated less MVPA and more SED than boys throughout the school day (MVPA −10.6 min; SED +13.9 min) recess (MVPA −1.6 min; SED +1.7 min) and lunch (MVPA −3.1 min; SED +2.9 min). Girls accumulated less MVPA (−6.2 min), less LPA (−2.5 min) and more SED (+9.4 min) than boys during regular class time. Fewer girls than boys achieved PA guidelines during school (90.9% vs 96.2%), recess (15.7% vs 34.1%) and lunch (16.7% vs 37.4%). During PE, only 1.8% of girls and 2.9% of boys achieved the PA guidelines. Girls and boys accumulated similar amounts of MVPA, LPA and SED. Conclusion The MVPA deficit in girls was due to their sedentary behaviour as opposed to LPA. Physical activity strategies that target girls are essential to overcome this deficit. Only a very small percentage of children met physical activity guidelines during PE. There is a great need for additional training and emphasis on PA during PE. In addition schools should complement PE with PA models that increase PA opportunities across the school day.

Background Investment in scale-up and sustainment of effective health-promoting programs is often hampered by competing demands on scarce health dollars. Thus, optimizing programs to reduce resource use (e.g., delivery costs) while maintaining effectiveness is necessary to promote health at scale. Using a phased approach (2015–2024), we adapted and scaled-up an evidence-based, health-promoting program for older adults (Choose to Move; CTM). For CTM Phase 4 we undertook a systematic, data-driven adaptation process to reduce resource use. In this paper we: 1) describe the CTM Phase 4 program (‘CTM Phase 4’) and assess its 2) implementation and 3) effectiveness. Methods For CTM Phase 4 (30-min one-on-one consultation and 8, 60-min group meetings with an activity coach), we reduced activity coach hours by 40% compared to Phase 3. To evaluate effectiveness of CTM Phase 4 we conducted a type 2 hybrid effectiveness-implementation study involving 137 programs (1126 older adults; 59–74 years, 75 + years) delivered by 29 activity coaches. We assessed implementation indicators (e.g., dose, fidelity, adaptation, participant responsiveness, self-efficacy) via survey in activity coaches and older adults. We assessed older adults’ physical activity (PA), mobility, social isolation, and loneliness before and after (0, 3 months) the program. Results Implementation indicators demonstrated that CTM Phase 4 was delivered successfully. Post-intervention, PA (+ 1.5 days/week; 95% CI 1.3, 1.6), mobility limitations (-6.4%), and scores for mobility (+ 0.7; 95% CI: 0.4, 1.3), social isolation (+ 0.69; 95% CI: 0.50, 0.89), and loneliness (-0.24; 95% CI: -0.34, -0.13) were improved in those < 75 years. Among those ≥ 75 years, PA (+ 1.0 days/week; 95% CI, 0.7, 1.2), mobility score (+ 1.1; 95% CI: 0.4, 1.8), and social isolation score (+ 0.31; 95% CI: 0.002, 0.61) were improved post-intervention. Overall, participant-level benefits were comparable to those observed in Phase 3. Conclusions CTM was co-designed as a flexible program, adapted over time based on user group needs and preferences. This flexibility enabled us to reduce activity coach delivery hours without compromising implementation or benefits to older adults’ health. Optimizing effective health-promoting programs to enhance their scalability and sustainability provides an important pathway to improved population health. Trial Registration ClinicalTrials.gov, NCT05678985. Registered 10 January 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT05678985 .

Action Schools! BC (AS! BC) was scaled-up from an efficacy trial to province-wide delivery across 11 years (2004–2015). In this study we: (1) describe strategies that supported implementation and scale-up; (2) evaluate implementation (teachers’ physical activity (PA) delivery) and student’s PA and cardiorespiratory fitness (CRF) within a cluster randomized controlled trial during years 2 and 3 of scale-up; and (3) assess relationships between teacher-level implementation and student-level outcomes. We classified implementation strategies as process, capacity-building or scale-up strategies. Elementary schools (n = 30) were randomized to intervention (INT; 16 schools; 747 students) or usual practice (UP; 14 schools; 782 students). We measured teachers’ PA delivery (n = 179) using weekly logs; students’ PA by questionnaire (n = 30 schools) and accelerometry (n = 9 schools); and students’ CRF by 20-m shuttle run (n = 25 schools). INT teachers delivered more PA than UP teachers in year 1 (+33.8 min/week, 95% CI 12.7, 54.9) but not year 2 (+18.8 min/week, 95% CI −0.8, 38.3). Unadjusted change in CRF was 36% and 27% higher in INT girls and boys, respectively, compared with their UP peers (year 1; effect size 0.28–0.48). Total PA delivered was associated with change in children’s self-reported MVPA (year 1; r = 0.17, p = 0.02). Despite the ‘voltage drop’, scaling-up school-based PA models is feasible and may enhance children’s health. Stakeholders must conceive of new ways to effectively sustain scaled-up health promoting interventions if we are to improve the health of students at a population level. Clinical Trials registration: NCT01412203.

To improve the health of populations, effective interventions from research settings must be implemented at scale. Further, physical activity reduces the risk of chronic disease and improves older adult health. Despite this, we know little about delivery of physical activity interventions at scale. Thus, with key partners we developed, implemented and assessed an evidence-based intervention (Choose to Move; CTM) that aimed to increase physical activity and social connectedness of low active older adults across BC. We describe our conceptual framework for implementation and evaluation of CTM at scale and share findings from our mixed methods implementation evaluation, with a focus on delivery partners. At baseline for decision makers at delivery partner organizations (semi-structured interviews); funding, relationships and infrastructure were perceived as key facilitators to delivering CTM at scale. Choose to Move has potential to be delivered more broadly as a feasible, scalable model for community-wide physical activity among older adults.

Despite the many benefits of physical activity (PA), 85% of older adults in Canada do not meet PA guidelines. With community partners, we implemented a scalable, activity coach supported, evidence- and choice-based PA intervention (Choose to Move (CTM)) for low active (self-identified or <150 mins PA/wk) older adults (age>65 y). CTM supports the older adult priority within British Columbia’s PA strategy. We conducted a 3-month pre-post evaluation of cycle 1 delivery of CTM at scale across BC. We assessed PA and social connectedness (loneliness, social exclusion and interaction) by questionnaire. We found that participants (n=51) were significantly more active (mean +2.2 ± 2.5 days/wk) following the intervention. Social exclusion (n=53) did not change; however, both loneliness and social interaction improved slightly. In conclusion, a choice-based model of PA designed for scalability and delivered at scale may be one strategy to enhance PA and social connectedness in previously low active older adults.

Objectives To describe Action Schools! BC (AS! BC) from efficacy to scale-up. Participants/setting Education and health system stakeholders and children in grades 4–6 from elementary schools in British Columbia, Canada. Intervention At the provincial level, the AS! BC model reflected socioecological theory and a partnership approach to social change. Knowledge translation and exchange were embedded as a foundational element. At the school level, AS! BC is a comprehensive school health-based model providing teachers and schools with training and resources to integrate physical activity (PA) and healthy eating (HE) into the school environment. Our research team partnered with key community and government stakeholders to deliver and evaluate AS! BC over efficacy, effectiveness and implementation trials. Results On the basis of significant increases in PA, cardiovascular fitness, bone and HE in AS! BC schools during efficacy trials, the BC government supported a provincial scale-up. Since its inception, the AS! BC Support Team and >225 trained regional trainers have delivered 4677 teacher-focused workshops (training approximately 81 000 teachers), reaching approximately 500 000 students. After scale-up, PA delivery was replicated but the magnitude of change appeared less. One (HE) and 4 (PA) years after scale-up, trained AS! BC teachers provided more PA and HE opportunities for students even in the context of supportive provincial policies. Conclusions Whole school models like AS! BC can enhance children's PA and health when implemented in partnership with key stakeholders. At the school level, adequately trained and resourced teachers and supportive school policies promoted successful scale-up and sustained implementation. At the provincial level, multisectoral partnerships and embedded knowledge exchange mechanisms influenced the context for action at the provincial and school level, and were core elements of successful implementation. Trial registration number Clinical Trials Registry NCT01412203.

South Asian immigrants in western countries are at a high risk for metabolic syndrome and associated chronic disease. While a physically active lifestyle is crucial in decreasing this risk, physical activity (PA) levels among this group remain low. The objectives of this study were to explore social and cultural factors that influence PA behavior, investigate how immigration process intersects with PA behaviors to influence PA levels and to engage community in a discussion about what can be done to increase PA in the South Asian community. For this qualitative study, we conducted four Focus Group Discussions (FGDs) among a subset of participants who were part of a larger study. FGD data was coded and analysed using directed content analysis to identify key categories. Health promoters need to consider social, cultural, and structural contexts when exploring possible behavior change interventions for South Asian immigrants.

Background Despite the many known benefits of physical activity (PA), relatively few older adults are active on a regular basis. Older adult PA interventions delivered in controlled settings showed promising results. However, to achieve population level health impact, programs must be effectively scaled-up, and few interventions have achieved this. To effectively scale-up it is essential to identify contextual factors that facilitate or impede implementation at scale. Our aim is to describe factors that influence implementation at scale of a health promotion intervention for older adults (Choose to Move). This implementation evaluation complements our previously published study that assessed the impact of Choose to Move on older adult health indicators. Methods To describe factors that influenced implementation our evaluation targeted five distinct levels across a socioecological continuum. Four members of our project team conducted semi-structured interviews by telephone with 1) leaders of delivery partner organizations ( n  = 13) 2) recreation managers ( n  = 6), recreation coordinators ( n  = 27), activity coaches ( n  = 36) and participants ( n  = 42) [August 2015 – April 2017]. Interviews were audio-recorded and professionally transcribed and data were analyzed using framework analysis. Results Partners agreed on the timeliness and need for scaled-up evidence-based health promotion programs for older adults. Choose to Move aligned with organizational priorities, visions and strategic directions and was deemed easy to deliver, flexible and adaptable. Partners also noted the critical role played by our project team as the support unit. However, partners noted availability of financial resources as a potential barrier to sustainability. Conclusions Even relatively simple evidence-based interventions can be challenging to scale-up and sustain. To ensure successful implementation it is essential to align with multilevel socioecological perspectives and assess the vast array of contextual factors that are at the core of better understanding successful implementation.