Abstract
Background: In-classroom physical activity breaks (IcPABs) are a pragmatic strategy to reduce sedentary time and promote movement during instructional lessons. However, evidence from primary schools operating within a high-stakes examination-focused education system, where academic achievement in national assessments is prioritized in classroom instruction is limited from low-and middle-income countries. This study aimed to examine the preliminary effects and feasibility of a teacher-led, in-classroom physical activity break intervention on school-time movement behaviors, academic performance, and selected health-related outcomes among Sri Lankan fifth-grade students. Methods: 220 students from two government primary schools in Sri Lanka (mean age = 9.48 years ± 0.5, 61% male) were randomly assigned to (1) an intervention group (n = 100): attending thrice-a-day, 5-minute IcPAB for 12 weeks; and (2) a control group (n = 120). Pre-and post-intervention assessments were conducted for academic achievement (standardized tests), movement behaviors (ActiGraph Gt3X), body-mass-index (anthropometric data), aerobic fitness (20m shuttle run test), and perceived stress (PSQ8-11). Generalized Linear Mixed Models were used for statistical analyses at exploratory level. Feasibility was evaluated using teacher logs, classroom observations and process evaluation records. Results: Significant group-by-time effects were observed for reading performance (82.2 ± 13.9 to 88.0 ± 12.9 vs 76.7 ± 10.5 to 77.6 ± 13.0 in controls), MVPA (27.2 ± 9.4 to 44.3 ± 9.9 vs 31.1 ± 8.4 to 24.3 ± 9.4), step count (5609 ± 1019 to 7769 ± 1339 vs 7998 ± 1023 to 3942 ± 1046), and sedentary school time (1490.7 ± 53.1 to 1475.4 ± 59.4 vs 1485.0 ± 22.9 to 1655.1 ± 40.8). The study fidelity assessment confirmed 1 to 4 times daily activity implementation. The process evaluation indicated satisfactory participant engagement and smooth implementation, suggesting the study was conducted as intended. Conclusion: This school level randomized preliminary study observed improvements in reading performance, while effects on mathematics and health-related outcomes were limited. However, in-classroom physical activity breaks were feasible to implement in an academically intensive Sri Lankan primary school context and were associated with favorable changes in school-time movement behaviors. Yet larger multi-school trials are expected to confirm these findings.
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