Preventive Medicine 48 (2009) 332334

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Preventive Medicine
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / y p m e d

Promoting physical activity during school break times: Piloting a simple,

low cost intervention
Constantinos A. Loucaides a,b,, Russell Jago c, Ioannis Charalambous d
a
Centre for Educational Research and Evaluation, Ministry of Education and Culture, Nicosia, Cyprus
b
The Open University of Cyprus, Nicosia, Cyprus
c
Department of Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
d
15th Elementary School, Lemesos, Ministry of Education and Culture, Cyprus

a r t i c l e i n f o a b s t r a c t

Available online 12 February 2009

Objective. The purpose of this pilot study was to examine the effectiveness of two interventions on
children's physical activity during the 20-min school break.
Keywords:
Methods. Children from three schools participated in this study. In the rst intervention school (n = 89)
Intervention
Physical activity the school's courts were allocated to different children on alternate days of the week, playground markings
School break were painted in the school's yard and jump ropes were provided. In the second intervention school (n = 89)
Children the school's courts were just allocated to different children on alternate days of the week. The third school
served as the control group (n = 69). Physical activity was measured with a pedometer during the 20-min
break (09:0509:25) and during the after school period (13:05 till bed time). Data were collected in Cyprus,
between January/April of 2007.
Results. A signicant time by group interaction indicated a change in break-time activity. Four weeks after
the intervention, mean steps in the rst (1427 499) and second (1331 651) intervention schools were
signicantly higher than steps in the control school (1053 447). Non-signicant increases were observed in
the after-school activity of children in the intervention schools.
Conclusions. Implementing simple, low-cost interventions during break periods could help increase
children's activity.
2009 Elsevier Inc. All rights reserved.

Introduction
Break times are important periods during school days where
children's physical activity (PA) can be promoted. Strategies used to
promote PA during school breaks have included markings (Stratton
and Mullan, 2005; Ridgers et al., 2007), game equipment (Verstraete
et al., 2006; Hannon and Brown, 2008) and tness breaks (Scruggs et
al., 2003). It is not clear if providing equipment and markings and
increased space yields greater increases than just the provision of
space.
No PA promotion interventions have been implemented in Cyprus.
As there is a lack of PA promotion funds in Cyprus, interventions need
to be simple and inexpensive. Cost is a major determinant of the
sustainability of programs (Owen et al., 2006). Recent reviews have
also suggested that children may compensate for increased PA at
school by reduced activity away from school (van Sluijs et al., 2007).
Thus it is important to assess if promoting activity at school affects
after-school PA.
Corresponding author. 77 Larnaca Avenue, Aglanjia, 2102 Nicosia, Cyprus.
E-mail address: conlou@avacom.net (C.A. Loucaides).
Therefore, the purposes of this pilot study were to: 1) examine the
effectiveness of allocating space and allocating space plus markings
and jump ropes on boys' and girls' activity levels during the 20-min
school break period, and 2) examine the intervention's effect on boys'
and girls' after school PA.
Methods
Sample and study design
Cypriot children in grades 5 and 6 (mean age 11.1 0.3) from three
inner city schools participated in this study (N = 247). The three
schools were similar with respect to the number of children and
playground facilities with each school having four game courts
including a basketball court, two volleyball courts and one soccer
pitch (play space approximately 8.9 m2 per child). The Cyprus
Pedagogical Institute and the Cyprus Research Promotion Foundation
approved this study and informed consent was obtained from
participants.
The schools were randomly assigned to two interventions and one
control group. The intervention in the rst school (n = 89) focused on
allocating play space for team games, playground markings and long

0091-7435/$ see front matter 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.ypmed.2009.02.005
 C.A. Loucaides et al. / Preventive Medicine 48 (2009) 332334 333

Table 1
Means and standard deviations of steps and steps per minute during the 20-min break period across time (pre and 4 weeks after intervention), gender and group in Cypriot children
in January/April of 2007

Pre-intervention Four weeks after intervention

Boys Girls Total Boys Girls Total
Mean (SD) Mean steps Mean (SD) Mean steps Mean (SD) Mean steps Mean (SD) Mean steps Mean (SD) Mean steps Mean (SD) Mean steps
(n) per min (SD) (n) per min (SD) (n) per min (SD) (n) per min (SD) (n) per min (SD) (n) per min (SD)
Intervention 1385 (450) 69 (22) 1224 (403) 61 (20) 1313 (435) 66 (22) 1650 (498) 82 (25) 1150 (339) 57 (17) 1427 (499) 71 (25)
school 1 (n = 45) (n = 36) (n = 81) (n = 45) (n = 36) (n = 81)
Intervention 1484 (513) 74 (26) 852 (384) 43 (19) 1176 (553) 59 (28) 1643 (609) 82 (30) 1004 (525) 50 (26) 1331 (651) 67 (33)
school 2 (n = 41) (n = 39) (n = 80) (n = 41) (n = 39) (n = 80)
Control 1233 (368) 62 (18) 1055 (421) 53 (21) 1129 (407) 56 (20) 1179 (392) 59 (20) 962 (466) 48 (23) 1053 (447) 53 (22)
school (n = 28) (n = 39) (n = 67) (n = 28) (n = 39) (n = 67)

Note. F-values of interaction effects.

Time by school interaction effect: F(2,222) = 3.08, p b 0.05.
Time by gender interaction effect: F(1,222) = 2.86, p = 0.09.
School by gender interaction effect: F(2,222) = 7.16, p b 0.01.
Time by school by gender interaction effect: F(2,222) = 2.04, p = 0.13.

ropes for group jump rope and short ropes for solo jump rope. The
courts were allocated to either fth or sixth grade children on
alternate days of the week. Children of the same grade were divided
into teams and played a game of their choice in the four game courts.
Children were taught rules for proper and safe play equipment use and
two children were assigned to distribute and collect balls. Markings
were also painted in the school's inner yard including hopscotch,
animals, clock face, smiley face and fun and tness trails. Finally, jump
ropes were available in a box inside each classroom for children's use.
Children were free to choose between playing organized games on the
courts or playing with the jump ropes and markings. Children in other
grades played anywhere in the playground except in the game courts.
Balls were only allowed in the game courts and jump ropes in any
other spaces of the school's playground. Teachers in both intervention
schools were instructed not to encourage children to participate in the
activities.
The second intervention school (n = 89) tested the allocation of
play space for team games without the playground markings or jump
ropes. The third school served as the control group (n = 69). No games
were organized or equipment handed out in this school.
Instruments and procedures
PA was assessed with an electronic pedometer (DW-200, Yamax
Corporation, Tokyo, Japan) which has been shown to be valid and
reliable (Eston et al., 1998). Children recorded their steps at 09:05, just
before the 20-min break and at 09:25, just after the end of the break.
The difference between these two values represented the 20-min
recess activity. Children also recorded their steps at 13:05 just before
the end of the school day and again at the end of the day just before
bed. The difference between these two values represented after school
activity. Details of data collection procedures are reported elsewhere
where baseline data of this intervention study were presented
(Loucaides and Jago, 2008). PA was measured in all three schools for
4 days prior to the implementation of the intervention (January/
February). The intervention took place in February/March and PA was
measured again for 4 days, 4 weeks after the intervention began.
Statistical analyses
Out of the 247 children who had complete data for the 4 days of
measurement pre-intervention, 228 (92.3%) had complete data for the
20-min break period and 232 (93.9%) had complete data for the after
school period at follow-up. Missing data were due to children being
absent from school (n = 7), and forgetting to wear the pedometer
(n = 3) or to record specic step count periods (n = 9).
Means and standard deviations were computed for pre-test and
follow-up step counts for the 20-min break and the after school
period. Two three-way ANOVAs were conducted to examine potential
differences in steps during the 20-min break period and after school
period across time, group and gender. Alpha was set at 0.05 and
analyses were conducted in SPSS, Version 15.0.
Results
Table 1 presents means and standard deviations for steps taken
during the 20-min break period and steps per minute across time,
gender and group. Results revealed a signicant interaction between
school and gender (p b 0.01, 2 effect size = 0.06). Follow-up tests
indicated that boys in the two intervention schools had higher means
than boys in the control school but girls in intervention school 1 had
higher step counts than girls in the other two schools. There was also a
signicant time by group interaction (p b 0.05, 2 effect size = 0.03).
Follow-up tests failed to show differences between the three schools
at pre-intervention but in the follow-up measurement, mean steps in
intervention schools 1 and 2 were higher than the control school

Table 2
Means and standard deviations of steps during the after school period across time (pre and 4 weeks after intervention), gender and group in Cypriot children in January/April of 2007

Pre-intervention Four weeks after intervention

Boys Girls Total Boys Girls Total
Mean (SD) (n) Mean (SD) (n) Mean (SD) (n) Mean (SD) (n) Mean (SD) (n) Mean (SD) (n)
Intervention school 1 7691 (3118) (n = 47) 5618 (2019) (n = 37) 6778 (2868) (n = 84) 8664 (4423) (n = 47) 5798 (3125) (n = 37) 7402 (4138) (n = 84)
Intervention school 2 8364 (3547) (n = 41) 6499 (2953) (n = 39) 7455 (3383) (n = 80) 8679 (4047) (n = 41) 6537 (3223) (n = 39) 7635 (3801) (n = 80)
Control school 7325 (2943) (n = 29) 5543 (2509) (n = 39) 6265 (2811) (n = 68) 7245 (2962) (n = 29) 5323 (2375) (n = 39) 6143 (2790) (n = 68)

Note. F-values of interaction effects.

Time by school interaction effect: F(2,226) = 1.19, p = 0.31.
Time by gender interaction effect: F(1,226) = 1.43, p = 0.23.
School by gender interaction effect: F(2,226) = 0.26, p = 0.77.
Time by school by gender interaction effect: F(2,226) = 0.26, p = 0.77.
334 C.A. Loucaides et al. / Preventive Medicine 48 (2009) 332334
(p b 0.001 and p b 0.01 respectively). No differences between the two
intervention schools were observed at follow-up (p = 0.50).
Table 2 presents means and standard deviations of steps taken
during the after school period across time, gender and group. Results
revealed a signicant main effect for gender, (p b 0.001, 2 effect
size = 0.12), with boys registering higher step counts in comparison to
girls.
Discussion
This study showed that the allocation of playground space may
have positive effects on children's activity levels during school break
periods. A study among preschoolers indicated that more space per
child was associated with more PA during recess (Cardon et al., 2008).
Although in the present study the play space in the school stayed
constant, allocating children to different spaces in effect spreads
children out, perhaps supporting a more wide-ranging activity.
Interestingly, while it was hypothesized that the addition of
multiple intervention components would yield the greatest change in
PA, no signicant difference between the two intervention conditions
was observed. This may suggest that the provision of any intervention
component is sufcient to change PA and that the allocation of play
space, the most basic intervention, is sufcient to change behavior.
Another potential explanation may be that children's interest in
markings and jump ropes diminished by the time of follow-up
measurements. Previous studies indicated that the effect of markings
was stronger on younger children's (mean age 8.1 1.7) PA (Ridgers et
al., 2007). This may be the case in the present study with markings
stimulating younger than older children's PA participation. Further,
previous intervention studies included more than two game equip-
ment (Verstraete et al., 2006; Hannon and Brown, 2008).
Although there were statistically signicant increases in children's
step counts after the implementation of the program the magnitude of
change was small, 8.7% and 13.2% in intervention schools 1 and 2
respectively, a nding that is comparable to other studies (Stratton
and Mullan, 2005; Verstraete et al., 2006; Ridgers et al., 2007; Hannon
and Brown, 2008). Further, steps per minute were lower in
comparison to another intervention using tness breaks (Scruggs et
al., 2003). This may be attributed to the relatively short duration of the
break time. Previous studies support the idea that longer break times
are associated with higher PA participation (Verstraete et al., 2006;
Ridgers et al., 2007) as children have more time to organize games
(Verstraete et al., 2006). A stronger intervention effect during the
longer versus the shorter break was observed by Verstraete et al.
(2006). Physical education and class time may be utilised to further
promote Cypriot children's low levels of PA participation (Loucaides
and Jago, 2008).
Positive but non-signicant results were revealed for after school
PA with children in intervention schools 1 and 2 increasing their steps
by 9.2% and 2.4% respectively and children in the control school
decreasing their steps by 1.9%. More studies are needed to examine
the impact of multiple intervention components over breaks of longer
duration on children's break time and especially after school PA.
Study limitations and strengths
Although ndings from this study suggest that allocating play
space to children may help increase PA, some limitations are worth
noting. First, the use of only one school in each condition is a major
limitation of the present study. More schools would enhance
generalizability as well as enable hierarchical analyses that account
for the effects of clustering of children within schools. Second the self-
recording of pedometer steps by the children would be a source of
error but as the same protocol was used in all schools this error is
likely to be equitable across all schools.
Conclusions
This study suggested that by allocating the school playground to
different children during different days may help increase children's
PA. The intervention was of low cost (280/$359) and simple to
implement indicating that schools with limited resources may
facilitate children's PA.
Conict of interest statement
The authors declare that there are no conicts of interest.
Acknowledgments
Special thanks to the children who participated in this study and to
physical education teachers, Lambros Stephanou and Michalis
Stylianou. This research was conducted as part of an elementary
school research competition MERA, supported by the Cyprus
Research Promotion Foundation.
References
Cardon, G., van Cauwenberghe, E., Labarque, V., Haerens, L., De Bourdeaudhuij, I., 2008.
The contribution of preschool playground factors in explaining children's physical
activity during recess. Int. J. Behav. Nutr. Phys. Act. 5, 11.
Eston, R., Rowlands, A., Ingledew, D., 1998. Validity of heart rate, pedometry, and
accelerometry for predicting the energy cost of children's activities. J. Appl. Physiol.
84, 362371.
Hannon, J.C., Brown, B.B., 2008. Increasing preschoolers' physical activity intensities: an
activity-friendly preschool playground intervention. Prev. Med. 46, 532536.
Loucaides, C.A., Jago, R., 2008. Differences in physical activity by gender, weight status
and travel mode to school in Cypriot children. Prev. Med. 47, 107111.
Owen, N., Glanz, K., Sallis, J.F., Kelder, S.H., 2006. Evidence-based approaches to
dissemination and diffusion of physical activity interventions. Am. J. Prev. Med. 31,
S35S44.
Ridgers, N.D., Stratton, G., Fairclough, S.J., Twisk, J.W.R., 2007. Children's physical activity
levels during school recess: a quasi experimental intervention study. Int. J. Behav.
Nutr. Phys. Act. 4, 19.
Scruggs, P.W., Beveridge, S.K., Watson, D.L., 2003. Increasing children's school time
physical activity using structured tness breaks. Pediatr. Exerc. Sci. 15, 156169.
Stratton, G., Mullan, E., 2005. The effect of multicolor playground markings on children's
physical activity level during recess. Prev. Med. 41, 828833.
van Sluijs, E.M.F., McMinn, A.M., Grifn, S.J., 2007. Effectiveness of interventions to
promote physical activity in children and adolescents: systematic review of
controlled trials. BMJ 335, 703715.
Verstraete, S.J.M., Cardon, G.M., De Clercq, D.L.R., De Bourdeaudhuij, I.M.M., 2006.
Increasing children's physical activity levels during recess periods in elementary
schools: the effects of providing game equipment. Eur. J. Public Health 16,
415419.