Process evaluation of a classroom active break (ACTI-BREAK) program for improving academic-related and physical activity outcomes for students in years 3 and 4

BACKGROUND: Active breaks in the classroom have been shown to be effective for increasing children's physical activity, while simultaneously improving classroom behaviour outcomes. However, there is limited evidence on the feasibility and fidelity of these programs outside of the research context. The purpose of this study was to conduct a process evaluation to explore factors associated with feasibility and fidelity of a classroom active break (ACTI-BREAK) program designed to improve classroom behaviour and physical activity outcomes for children in primary (elementary) school Years 3 and 4. METHODS: Six schools (3 intervention; 3 control) and 374 children (74% response) were included in the ACTI-BREAK pilot cluster randomised controlled trial. The intervention involved teachers implementing 3 × 5-minute moderate-intensity ACTI-BREAKS into their classroom routines, daily. This study focuses on the responses of students (n = 138) and their teachers (n = 7) who participated in the ACTI-BREAK intervention group. Intervention fidelity was assessed by number of ACTI-BREAKS completed per class per day; minutes spent in moderate-intensity physical activity (accelerometry) per ACTI-BREAK; change in physical activity from baseline to mid- and end- intervention. Intervention feasibility was explored through telephone interviews (teachers), questionnaires and focus groups (students), and teacher observations of acute effects on classroom behaviour. Qualitative data were analysed using thematic analyses; acute effects on classroom behaviour and change in physical activity were explored using paired t-tests; questionnaire data were described as frequencies. RESULTS: Teachers implemented two ACTI-BREAKS/day on average, mostly of light-intensity physical activity. Physical activity increased from baseline to mid-, but not baseline to end-intervention; classroom behaviour improved immediately following ACTI-BREAKS. Barriers to implementation included ability for students to return to task and scheduling. Facilitators included ease of implementation, flexible delivery options and student enjoyment. Students were largely satisfied with the program and enjoyed ACTI-BREAKS that incorporated choice, imagination and challenge but did not enjoy ACTI-BREAKS that evoked silliness or were perceived as too difficult and some did not like doing ACTI-BREAKS in the confined space of their classroom. CONCLUSIONS: Results indicated the ACTI-BREAK program was acceptable for students and feasible for teachers, however, some minor modifications in terms of required frequency and intensity could improve fidelity. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ( ACTRN12617000602325 ). Retrospectively registered on 27 April 2017.