Evaluation of school-based interventions of active breaks in primary schools: A systematic review and meta-analysis

Objectives: To provide a systematic review of studies that investigated the effects of Active Break (AB) school-based interventions on Physical Activity (PA) levels, classroom behavior, cognitive functions, and academic performance in primary school children. Design: Systematic review and meta-analysis. Methods: Searches of electronic databases and grey literature, with no time restriction and up to April 2019, resulted in 22 intervention studies meeting the inclusion criteria. Quality assessment of the studies was performed in accordance with the Cochrane Tool for Quality Assessment for RCTs and the STROBE tool for observational studies. Results: Four AB related outcomes were analyzed: (i) AB interventions had a significant effect in increasing PA levels in primary school children, both in terms of increased moderate to vigorous PA and step count. The meta-analysis seems to confirm this trend, showing a statistically significant result for the step count (p < 0.00001, CI95% −0.71,1.21) (random model I² = 0%). (ii) Regarding classroom behavior, time spent on task (TOT) during lessons significantly increased in each of the included studies. On the other hand, the effects on (iii) cognitive functions (attention components, working memory, executive functions) and (iv) academic achievements (mathematics, reading) were not conclusive. Conclusions: Positive effects were found for PA levels and classroom behavior, while the conflicting results for cognitive functions and academic achievements suggest that the effect could be more evident with curriculum focused active breaks and active lessons that integrate ABs with key learning aspects and cognitive engagement.