title: Implementation of school based physical activity interventions: a systematic review.
abstract: OBJECTIVE
  Implementation science is an emerging area in physical activity (PA) research. We sought to establish the current state of the evidence related to implementation of school-based PA models to explore 1) the relationship between implementation and health outcomes, and 2) factors that influence implementation.
  
  
  METHODS
  We searched 7 electronic databases (1995-2014) and included controlled studies of school-based PA programmes for healthy youth (6-18 y) measuring at least one physical health-related outcome. For objective 1, studies linked implementation level to student-level health outcome(s). For objective 2, studies reported factors associated with implementation.
  
  
  RESULTS
  There was substantial variability in how health outcomes and implementation were assessed. Few studies linked implementation and health outcomes (n=15 interventions). Most (11/15) reported a positive relationship between implementation and at least one health outcome. Implementation factors were reported in 29 interventions. Of 22 unique categories, time was the most prevalent influencing factor followed by resource availability/quality and supportive school climate.
  
  
  CONCLUSIONS
  Implementation evaluation supports scale-up of effective school-based PA interventions and thus population-level change. Our review serves as a call to action to 1) address the link between implementation and outcome within the school-based PA literature and 2) improve and standardize definitions and measurement of implementation.
authors.affiliation: School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3015 STN CSC, Victoria BC V8W 3P1, Canada. Electronic address: pjnaylor@uvic.ca.
authors.forename: Patti-Jean
authors.initials: PJ
authors.lastname: Naylor
authors.affiliation: Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver BC V5Z 1M9, Canada. Electronic address: lindsay.nettlefold@hiphealth.ca.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Nettlefold
authors.affiliation: Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver BC V5Z 1M9, Canada. Electronic address: douglas.race@hiphealth.ca.
authors.forename: Douglas
authors.initials: D
authors.lastname: Race
authors.affiliation: Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver BC V5Z 1M9, Canada. Electronic address: christa.hoy@alumni.ubc.ca.
authors.forename: Christa
authors.initials: C
authors.lastname: Hoy
authors.affiliation: Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver BC V5Z 1M9, Canada; Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver BC V6T 1Z3, Canada. Electronic address: maureen.ashe@ubc.ca.
authors.forename: Maureen C
authors.initials: MC
authors.lastname: Ashe
authors.affiliation: School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3015 STN CSC, Victoria BC V8W 3P1, Canada. Electronic address: jwharfhi@uvic.ca.
authors.forename: Joan
authors.initials: J
authors.lastname: Wharf Higgins
authors.affiliation: Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver BC V5Z 1M9, Canada; Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver BC V6T 1Z3, Canada; Department of Orthopaedics, University of British Columbia, 910 West 10th Avenue, Vancouver BC V5Z 1M9, Canada. Electronic address: heather.mckay@ubc.ca.
authors.forename: Heather A
authors.initials: HA
authors.lastname: McKay
mesh_terms: D000293:Adolescent; D002648:Child; D015444:Exercise / Q000502:physiology; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012572:School Health Services
keywords: Adolescent; Child; Diffusion of innovation; Health promotion; Implementation; Physical activity; Schools