Summary of main findings
The primary goals of the Action 3:30 project were to assess the feasibility of conducting a cluster randomised controlled trial of the Action 3:30 project and to assess the evidence of promise in terms of potential for positively affecting the weekday physical activity of boys and girls. Four out of five stated progression criteria were met. There was a high level of interest in the project, with 44% of the approached schools agreeing to join the project and 43% of eligible pupils expressing an interest in the study by returning consent forms. We were also able to show that the programme appealed to boys and girls, as 50% of the pupils who were consented to join the study were girls, and that pupils would attend, with 70% of pupils attending at least half of the 30 sessions. Thus, in terms of running a trial, the first four progression criteria were all met. It is, however, important to highlight that the intervention ran in only four out of the six schools that were randomly allocated to receive the intervention. In one school, this was because the school was unable to release two TAs to attend the training programme owing to limited capacity within the school, whereas the other school withdrew from the study and did not engage in any correspondence about the project. This may suggest that, in the current challenging financial climate, some schools may find providing support for TAs to attend additional training programmes more difficult. Thus, although recognising this important limitation, the evidence shows that it is possible to conduct a trial and that the first four progression criteria, all of which were focused on the practicalities of conducting a trial, were all met. The fifth progression criterion focused on evidence of promise for increasing weekday MVPA for both boys and girls in the intervention arm when compared with the control arm. The data presented in this study have shown that children who attend the Action 3:30 clubs engage in levels of MVPA comparable with those of children who engage in other activities, thereby suggesting that Action 3:30 replaced current provision, but there was no evidence that it provided additional MVPA. The lack of evidence of promise in terms of weekday MVPA indicates that, although all other progression criteria were met, and although it was feasible to run a trial of the Action 3:30 intervention, there is insufficient evidence of additional physical activity to warrant further examination of the Action 3:30 programme in a larger, more expensive, cluster randomised controlled trial. In the light of the challenges and expense of such approaches, it could be that further information on the utility of the Action 3:30 in relation to usual provision could be useful if it were provided using less resource intensive evaluation approaches, such as natural experiment designs.
Physical activity profile of participants
Physical inactivity is a leading risk factor for mortality,1 and, therefore, an aim of this study was to appeal to and recruit less active pupils who may be at highest risk in later life. Table 9 shows that, among those schools that participated in the ‘opt-out accelerometer’ phase, there was only a small difference in mean MVPA between those who consented to join the study and those who did not, which is in line with previous literature.64–66 Although mean MVPA was relatively high at baseline, only 60% of control pupils and 62% of intervention pupils met the current physical activity guidelines at baseline (see Table 14). Together, these findings indicate that a range of pupils across the physical activity spectrum were recruited, including less active children. The qualitative results support this conclusion, as TAs in all four intervention schools felt that their clubs included children with a range of abilities and habitual physical activity levels. This contrasts with the previous Action 3:30 feasibility study18 and the work of others,67 in which participating children were already very active, and highlights that the changes made to the recruitment methods for this feasibility trial to engage more less active children were implemented effectively. Process evaluation measures of perceived exertion during the intervention suggest that pupils found the sessions harder at the beginning of the intervention than they did later (see Figure 4), which can be interpreted in a number of ways. Conceivably, pupils could have found later sessions easier because they had increased their fitness. However, as fitness was not measured, this cannot be established with any confidence. It should be noted that the perceived exertion scale used has been validated in a similar age group using a cycle ergometer exercise test and, therefore, the measure may not be generalisable to the mode of exercise in Action 3:30.68
Previous research suggests that enjoyment and being active with friends are key determinants of physical activity in children.69,70 Intervention pupils in this study listed reasons such as ‘inclusivity’ and ‘something fun to do with friends’ for signing up to the study, highlighting that focusing on enjoyment seems to have had a positive effect on recruitment. McGoey et al.11 conducted a systematic review evaluating physical activity interventions in children using the RE-AIM framework and concluded that too few studies report evidence of external validity, such as representativeness of participants. In this study we have addressed this limitation by comparing baseline physical activity levels of consenters with those of non-consenters to the study, showing evidence of a representative sample of pupils as well as a recruitment method effective at engaging less active children to an after-school physical activity programme.
Qualitative data showed that some TAs perceived the activities in Action 3:30 to be different from activities in PE lessons because the former were centred around having fun rather than learning specific skills. In addition, some girls expressed that they enjoyed Action 3:30 more than PE because they felt more confident in their abilities. These findings add to the work of Cairney et al.,71 whose results suggested that higher perceived competence was associated with greater enjoyment of PE and that enjoyment of PE declined among girls from the ages of 9 to 12 years. Together this evidence suggests that activities that promote competence and are enjoyable, such as those in Action 3:30, could be incorporated into PE lessons to increase pupil enjoyment. More recent work by Cairney et al.72 also highlights that there is a positive relationship between participation in organised physical activity and participation in discretionary free-play over time. A suggested explanation for this association is that participating in organised physical activity supports the development of physical literacy and fundamental movement skills, which in turn enables children to participate in more free-play pursuits. With a longer follow-up period, it might also be observed that participants in Action 3:30 increase their discretionary physical activity levels over time as a result of increased physical literacy; however, our follow-up period was too short to allow us to observe this.
With the recent doubling of the PE and Sport Premium, primary schools are expected to develop or add to the physical activity provision they already offer in order to help pupils achieve the government-recommended guideline of at least 60 minutes of MVPA per day (30 minutes of which should be in school).63 This key focus was highlighted in our qualitative findings, as some key contacts stated that they adopted Action 3:30 to help their schools meet targets. Addressing gaps in provision is a main consideration for schools when spending their PE and sport premium73 and is consistent with the theory of expanded, extended and enhanced opportunities in after-school programmes.74 Therefore, primary schools may wish to adopt Action 3:30 because it helps to meet key government targets, in particular adding to their provision and engaging a range of pupils with a broad range of enjoyable activities.
Appeal of the Action 3:30 programme to girls
Despite the benefits of physical activity, it is well documented in the literature that girls are less active than boys6,75 and that the age-related decline in physical activity occurs earlier in girls than in boys.5 Therefore, an aim of the study was to appeal to girls at the recruitment stage and increase MVPA as a result of the intervention. Our results indicate that Action 3:30 appealed to girls as well as boys and was successful in engaging girls throughout. Table 7 shows that 49% of the pupils recruited to the study were girls and Table 18 demonstrates that, on average, girls attended a similar average number of sessions to boys (19 vs. 20 out of 30, respectively).
Previous literature suggests that enjoyment, self-efficacy and perceived competence are positively associated with physical activity in girls.76 Figure 4 indicates that pupils enjoyed the Action 3:30 sessions, which was reinforced in the focus groups with girls. We should note that because enjoyment was assessed quantitatively at only three time points in each school, this may fail to reflect the views of pupils who did not attend those sessions; however, children selected for the focus groups had varied attendance rates and so the views of pupils with low attendance were captured. In addition, our qualitative findings suggest that girls and boys felt a sense of autonomy support and improved competence to participate in other physical activities, although this was not borne out in the questionnaire-based measures of these SDT constructs. Together the evidence above indicates good intervention fidelity. Thus, the data presented show that the recruitment method was appropriately pitched and that the activities included in the sessions were suitable for both girls and boys. Therefore, Action 3:30 could be recommended to schools wanting to provide a physical activity offer that appeals to girls as well as boys.
Factors affecting attendance
Efforts were made to increase pupil attendance based on the findings from the previous Action 3:30 feasibility trial18 by identifying the days of the week that the club would run during recruitment and ensuring that schools held the agreed time slots in their extracurricular timetables. Overall, attendance across all schools was good. Table 18 shows that, on average, pupils attended 19 out of the 30 sessions, with 74% of pupils attending > 50% of the sessions. Attendance was similar to that in other studies11 and much higher than for another after-school-based programme, in which only 5% of children attended 50% of sessions.77 Our attendance results indicate successful reach and fidelity of the intervention and confirm the utility of Action 3:30 as a scalable physical activity intervention.
The qualitative findings revealed that scheduling conflicts with other clubs was the main barrier to pupil attendance. Some pupils stopped attending Action 3:30 sessions on one or both days because they were doing other extracurricular activities; however, in interviews, TAs and key contacts expressed that this was the norm within schools. This suggests that children may prefer to switch between after-school programmes. Our quantitative results add to this, as pupils in intervention schools attended slightly fewer after-school clubs (excluding Action 3:30) than control pupils (1.70 ± 1.38 vs. 1.44 ± 1.28, respectively). Findings should be interpreted with caution, however, as the 95% CI for the adjusted difference in means included zero. Together, this may suggest that Action 3:30 replaced pupil’s existing provision rather than adding to it. Owing to the above findings, any intervention effect is likely to be attenuated and this may partly explain why an increase in MVPA was not achieved. Our previous work with primary school children18 and adolescent girls44 also found scheduling conflicts with other clubs to be the main reason for non-attendance. Our study is one of the few that documents reasons for non-attendance to after-school physical activity interventions in children. It is important for future studies to include measures to capture reasons for non-compliance and to perhaps consider when designing future interventions that children may prefer to switch between different activities.
Utility of Action 3:30 for continuing professional development
We have established through this study and our previous work18 that training TAs to deliver an after-school programme is feasible within primary schools. The qualitative results revealed that TAs and schools valued the training because it equipped TAs with the knowledge, resources and qualification to provide a range of physical activity sessions, which they could continue to use after the intervention had finished. Although TAs in the four intervention schools liked the training format, one school was not able to provide the intervention as it could not release staff for 5 full days. Some external stakeholders also expressed that they thought that 5 days was too much of a commitment for schools. More work may be needed to establish the minimum time required to adequately train school staff to deliver Action 3:30 or similar after-school programmes.
The government now expects primary schools to use their PE and Sport Premium to provide their staff with CPD and resources to help them teach PE and sport more effectively.63 In 2014/15, upskilling and training staff was the most common use of the PE and Sport Premium, with less emphasis on employing new sports coaches.73 This suggests that schools may prefer to develop their own workforce rather than employ external companies to run their after-school clubs. Therefore, Action 3:30 could be adopted by schools to offer CPD to their staff and help meet government expectations.
Impact of the Action 3:30 programme on motivation
There was evidence that the TA training reinforced and potentially increased TAs adoption and implementation of autonomy-supportive teaching/coaching practices and styles. Observations showed that this style could be maintained throughout the intervention programme. This supports previous research showing that teachers (including PE teachers) can be trained to teach in a way that creates a positive motivational climate.78,79 Furthermore, pupils also perceived their TAs to be using an autonomy-supportive style. However, there was no evidence that the intervention held promise to affect the motivation variables measured (motivation types or need satisfaction). This may be a true finding and the intervention may hold no promise to affect these outcomes. However, the pupil’s scored their TAs as consistently highly autonomy-supportive and there was strong qualitative evidence from pupils and TAs for positive motivational outcomes. This conflict in findings may reflect a number of measurement issues. First, the scale used was validated in children in Years 5 and 6 (aged 9–11 years) but used in this project where children were aged 8–10 as it was impractical to further validate the scale in this age group prior to measurement. As such, the items may not have been clear to younger pupils and may not have been sufficiently worded to tap the qualitatively different types of motivation in this age group nor be sensitive to change.
Second, the baseline mean values for autonomous motivation and need satisfaction were high. This may indicate that the scales are not sufficiently sensitive to variation (i.e. being able to capture a diverse range of true scores) and that any potential effect on these variables could be limited by a ceiling effect.
Third, the measures assessed children’s motivation and need satisfaction at the contextual level (i.e. thinking about physical activity in general), which is one of three levels of motivation hypothesised within Vallerand’s hierarchical model of intrinsic and extrinsic motivation,80 in addition to situational and global. Situational motivation refers to the motivation and need satisfaction that children felt towards and when experiencing the Action 3:30 sessions. Given the consistent qualitative quotations that point towards situational need satisfaction within the Action 3:30 intervention, the lack of promise seen using the quantitative measures may be indicate either (1) a mismatch in the way motivation was influenced (situational level) and measured (contextual level) or (2) that any effect on situational motivation was not sufficient to effect broader motivation for physical activity. It could be argued that, as Action 3:30 sessions form only a small part of a child’s experience of physical activity (which includes school sport, PE, out-of-school sport, and being active with family and friends), they might not be expected to be able to shift broader motivation.
Overall, there is great need to develop more robust measures of the constructs within SDT for use with children to facilitate a better understanding of the effects of interventions which target them. Unfortunately, the funding landscape makes securing funds specifically to create and test these measures with children very difficult – yet without them our ability to measure the effects of our interventions on potential mediators is limited.
Cost of delivery compared with existing provision
The Action 3:30 intervention was found to be low-cost, with an estimated mainstream cost per school of £1482 per school and £62 per pupil, based on a class of 30 attending 30 1-hour sessions (£1.64 per pupil per session). The costs associated with children’s physical activity interventions are rarely reported, but the estimated costs of Action 3:30 are comparable with those that have been reported in recent years.57,61,62 The majority of extracurricular physical activity provision provided by schools in this study was funded by the school or parents and this finding is comparable with the results of an audit of after-school club provision for children in Years 5 and 6 from primary schools in England.19 Notably, estimated Action 3:30 costs were found to compare favourably with the costs associated with existing extra-curricular physical activity delivered in study schools. In the UK, many primary schools fund external agencies to provide extracurricular physical activity. These findings are therefore likely to appeal to schools as they suggest that Action 3:30 is economically viable and helps to engage children in non-sedentary activities. As Action 3:30 was not shown to be effective at increasing MVPA, nor was the study statistically powered to, it is not possible to comment on intervention cost-effectiveness. This study identified no difference between the intervention arm and the control arm responses to HRQoL measures. This finding is consistent with previous studies in which HRQoL measures were found to be unresponsive among school children with ‘healthy’ profiles,57 and supports the case for considering alternative HRQoL measures that are appropriate for a young and healthy population.
Implications for after-school delivery in the UK
Action 3:30 is a theory-informed intervention that is well liked by pupils and staff. Importantly, the programme was able to engage a wide range of pupils and it therefore provides a broader offer than existing provision, which tends to be dominated by team sports.19 Including one-off training costs for staff, to deliver Action 3:30 costs approximately £2 per child per session, with this falling to £1.64 per child per session after the first year when the initial training and set-up costs have been met. This cost is considerably lower than the £5.90 per child per session average cost of existing provision that we found in this study. The findings, therefore, suggest that Action 3:30 is considerably less expensive than current provision, and as examination of the accelerometer data shows that children who attend Action 3:30 had levels of physical activity comparable with those of children who did not attend, it might be inferred that Action 3:30 achieves the same physical activity benefits as other clubs at a lower cost. A key focus of Action 3:30 is training TAs to build capacity within schools, thereby enabling the TAs to contribute to other aspects of physical activity provision, such as helping with or leading PE sessions within the school. This is an added benefit to schools that cannot be conferred by external providers. This approach is also consistent with a recent Office for Standards in Education, Children’s Services and Skills (Ofsted) report that highlighted that extracurricular programmes, such as Action 3:30, are a good way to broaden opportunities for children to learn new skills and be physically active.81 As such, the results of this study provide evidence that training existing staff to deliver physical activity via schemes such as Action 3:30 is a viable approach for primary schools that is consistent with Ofsted guidance, appealing to schools and staff members because it counts as professional development, and is less expensive than existing provision, with the added benefit of developing the skills of key workforce members.
Comparison with international data
A previous systematic review of physical activity interventions delivered in the after-school period has reported a pooled intervention effect of approximately 5 additional minutes per day of MVPA for children who attend after-school physical activity interventions.82 The results reported here suggest that the Action 3:30 did not lead to additional MVPA and that children who attended Action 3:30 engaged in the same amount of MVPA as children in control schools. However, comparisons with the current evidence base are challenging as the bulk of the work in the extended school day has occurred in the USA, a different context in which after-school provision is dominated by several large organisations such as the Young Men’s Christian Association (YMCA). The US programmes have therefore focused on maximising the quality of the provision by training staff and providing resources as part of policy-level interventions to increase after-school staff’s engagement with physical activity. 83 For example, Weaver et al.84 assessed the effect of a professional development programme with the YMCA after-school staff and showed that the training programme increased the proportion of staff engaged in physical activity with children from 26% to 37%. The same study also highlighted that greater implementation of the strategies to help children to be physically active and consume better-quality snacks in the after-school period was associated with a greater percentage of boys engaging in 30 minutes of MVPA after school, with 42% of high-implementing settings meeting the threshold compared with 27% in low-implementing settings85 (there were no differences in the MVPA of girls in high- and low-implementing settings). Collectively, this body of evidence supports improving the quality of the provision to help children be as active as possible during the after-school period. Translating these findings to the UK is challenging because the provision is very different, with multiple external and internal providers that are school specific and a range of revenue models in which some programmes are revenue-neutral, some cost money to provide and some provide income for the school. It is also important to highlight that there is a lack of a quality assessment framework for physical activity in the after-school setting in the UK and, as a result, there is no current mechanism for translating the US-based evidence to the UK context.
Implications for research
The data presented in this report have shown that training existing staff to deliver an after-school physical activity programme is a viable approach for schools but that the programme did not yield any increases in physical activity levels, with the process data suggesting that this is because the children may have simply switched from one programme to another. As previous research has shown that activities in the after-school period are important for helping children to meet the Chief Medical Officer recommendation of 1 hour of MVPA per day, the challenge is how to maximise physical activity in the programmes that children already attend.17 Thus, it may be the case that research should focus on maximising the quality of the current provision by using approaches such as those adopted in the USA as opposed to creating new provision such as Action 3:30. Therefore, there is a need to identify the types of current provision, the quality of that provision and how it could be improved. TAs do not routinely receive training in physical activity provision and so the Action 3:30 approach is novel and shows that TAs delivering physical activity programmes is a viable method that is likely to be more cost-effective than using external sports coaches. It is, however, also important to recognise that Action 3:30 is a flexible approach in terms of delivery mode, and it may be that elements of the programme structure could be changed, such as delivering only once per week, which may be a useful option for a number of schools. We have used the RE-AIM framework as an overarching structure to inform the study design and guide the process evaluation. Use of the framework for the process evaluation has facilitated breaking down the analysis into all of the key issues that are essential to increasing the external validity of research. Future studies should consider using the RE-AIM framework12 to evaluate interventions and present process evaluation results, as has been demonstrated in this study.
Utility of the opt-out consent and complier-average causal effect analyses
A novel aspect of this study was the use of a CACE analysis to incorporate data from participants who joined the study at a later enrolment point. This method was used to examine the feasibility of this alternative design, which was intended to mimic the usual organisational practices of schools, thereby increasing external validity. Those schools in which baseline and outcome data were collected for the whole year group contributed to a demonstration of how any benefit for those children joining the programme at the second enrolment could be estimated without bias. Those children who volunteered and were selected to join the programme at the first enrolment (determined prior to random allocation and so known for schools in both arms) were excluded from this analysis. A CACE approach was taken, which analysed those enrolling at the second opportunity in the intervention schools against a comparable group of children in the control schools. It is not possible to identify that ‘comparable group of children’ using observed measures; the CACE approach uses a statistical model with the following assumptions to estimate the outcome in that group of children: (1) owing to the random allocation of schools to intervention and control arms, the proportion of children observed to enrol at the second opportunity in the intervention arm would have been mirrored by children in the control schools had they been given the opportunity; (2) children observed not to enrol in the intervention arm would have the same outcome as children in the control arm who would not have enrolled had their school been in the intervention arm; that is, outcome in these ‘non-enrollers’ is not affected by allocation to the intervention or control arm. Consideration was given to whether or not it was useful to combine this estimate with that for the first enrolment children using meta-analytic methods. Thus, the analyses have shown that the method is feasible and that such approaches can be conducted. However, as very few children were re-enrolled in the one intervention school with complete data, the utility of this method for this project was limited. Furthermore, as noted above, this approach was reliant on opt-out consent data. Collecting physical activity data using an opt-out consent approach yielded excellent recruitment rates of > 98% (see Table 6) and added only a very small, and acceptable, burden to schools (see Chapter 6). However, this approach may not be feasible in primary schools in the future as the new General Data Protection Regulation legislation limits the use of opt-out consent processes in the European Union.86 Thus, the approach is technically feasible, but it is unlikely to be useful and relevant in this current legislative context.
School context
Although no meaningful differences were observed between the overall school context scores of intervention and control schools in this study, between-school variation in school context scores was high in relation to the physical environment component scores. With only four schools delivering the intervention in this study, it is hard to assess what impact the school context components may have had on intervention implementation or effectiveness. However, context has the potential to greatly influence aspects of intervention delivery and impact58 and should be considered in large-scale school-based interventions. A key consideration for future research is how best to utilise school context data in ways that provide insight into the effect of school context on young people’s physical activity and on the delivery or effectiveness of interventions.
Specific research recommendations
- Research should invest in interventions that maximise the quality of existing after-school physical activity provision rather than create new opportunities in an already-saturated market.
- Work is needed to develop a standardised quality assessment framework for after-school physical activity provision in the UK that would make comparison with international research (e.g. from the USA) more feasible and make it possible to evaluate the quality of existing after-school provision.
- Further exploration is needed of the impact that school context components may have on physical activity intervention implementation in educational settings.
- The RE-AIM framework should be used to evaluate interventions and present process results in order to promote rigour and provide a platform to more reliably examine the external validity of research.
Strengths and limitations
The major strength of this study is the rigorous design, which has enabled the assessment of clear research questions that have been mapped onto specific progression criteria. Rigour and transparency were further enhanced by reporting the study in accordance with the TIDieR (Template for Intervention Description and Replication) framework,87 the COREQ guidelines53 and the CONSORT criteria.88
A strength of the study was its reach. A whole-year-group approach was taken, as the study included all pupils in Years 4 (aged 8–9 years) and 5 (aged 9–10 years) in the 12 schools involved in the study. Physical activity data (either self-reported plus accelerometer or self-reported only) were collected for > 98% of eligible pupils pre baseline in the ‘opt-out’ phase of the study in order to compare pupils who did and pupils who did not sign up to the study. Both schools with a high percentage and schools with a low percentage of free school meals, indicating low and high deprivation, respectively, were recruited. Pupil recruitment rates at baseline were relatively high, a range of pupils consented to join the study, including less active children and girls, and attendance rates were high throughout the intervention. Further strengths are that an objective measure of physical activity (accelerometers worn for 7 days) was used and data provision rates were high for all measures at both baseline and follow-up. A re-enrolment point was offered approximately half-way through the intervention to increase the external validity of the study, which was received well by schools. Throughout the study, local advisory group meetings were held to take account of and learn from external stakeholders who had knowledge of local primary schools, and Children’s Advisory Group meetings were held with participating pupils to ascertain how the programme was being received in the intervention schools.
A notable strength is that an extensive and robust mixed-methods process evaluation was conducted using the RE-AIM framework.12 Engagement with a range of well-informed external stakeholders to explore the potential sustainability of a programme such as Action 3:30 provided valuable insights into the ‘real world’ suitability of the design and applicability of the programme; information that would be beneficial to anyone designing after-school interventions. The process evaluation results revealed that the intervention had good fidelity. Direct observations were used to strengthen the assessment of intervention fidelity, which aligned with the process evaluation results. One limitation of the process evaluation was that insights from stakeholders extolled the value of evidence for programmes such as Action 3:30 without actually describing what counts as evidence, which would be useful to guide future applied research in this area. This perhaps reinforces the importance of working to enhance existing provision rather than creating new provision without clear guidance on the type of evidence of most value to commissioners.
The small number of participating schools meant that the study was not powered to detect differences between the intervention arm and the control arm and cannot be deemed fully representative of the population of all schools. However, this was inherent in the feasibility randomised controlled trial design of the study, which looked only for evidence of promise. Two schools that were allocated to the intervention arm were unable to deliver the intervention and so their data could not be used in the follow-up analyses, which reduced the sample size further and the representativeness of the intervention arm. In one instance this was because of a lack of capacity to release staff for training owing to challenges in the school. We do not know why the other school withdrew from the study, as it ceased communication with the project team. Qualitative data were collected from the first of those schools to determine its reasons for dropping out, but data could not be collected from the other school and so its reasons for dropping out are unclear and the ability to learn from the situation in this school is removed. It therefore seems plausible that limited capacity may have also been a reason why other schools did not agree to join the study, but we do not have data to confirm this assumption. The study was limited to only two areas in the south-west region of the UK and within this region there was variation in interest in and response to the programme and so generalisability to other areas of the UK and a wider range of schools may also be limited.
Where possible, objective measures were used. However, by necessity, a reliance on self-reported data to measure SDT constructs and HRQoL, and to collect demographic information from parents, made our data susceptible to reporting bias. The self-report measures of SDT-based constructs showed no evidence of change. It is not clear if this is a function of the lack of an intervention effect or a weakness of the scales and, therefore, more work may be needed to assess whether or not these measures can be improved. It is also important to note that although accelerometers provide objective assessments of physical activity, we assessed only 1 week of behaviour at each assessment, and other activities outside these periods will be under-represented. Similarly, accelerometers do not provide information on the actual behaviours that participants perform and can under-represent some activities, such as cycling.89 There are also limitations in the qualitative focus groups that were conducted with the participants in that these could not cover all possible topics as the time was limited. It would have been helpful to have been able to garner more information about other activities in which the children engaged and the impact that participating in additional activities may had on attendance and overall levels of physical activity.