Implementation of a school environment intervention to
increase physical activity in high school girls
D. S. Ward1*, R. Saunders2, G. M. Felton3, E. Williams4,
J. N. Epping4and R. R. Pate4
Physical activity levels begin to decline in
childhood and continue falling throughout ad-
olescence, with girls being at greatest risk for
inactivity. Schools are ideal settings for helping
girls develop and maintain a physically active
lifestyle. This paper describes the design and
implementation of ‘Lifestyle Education for Ac-
tivity Program’, or LEAP. LEAP used a health
team approach with participatory strategies
to provide training and support, instructional
capacity building and opportunities to adapt
supports to local needs. The social–ecological
model, based on social cognitive theory, served
as the organizing framework for the LEAP in-
tervention and elements of the coordinated school
health program model as intervention channels.
For the 12 intervention schools, LEAP staff
documented 191 visits and interactions with 850
individuals over the 2-year period. Teachers re-
ported successful implementation of most com-
ponents of the intervention and demonstrated
optimism for sustainability. These results indicate
that a facilitative approach to intervention im-
plementation can be used successfully to engage
school personnel, and to change instructional
programs and school environments to increase
the physical activity level of high school girls.
A physically active lifestyle is important to health,
but a majority of individuals do not maintain one.
Inactivity is common and contributes to higher
rates of obesity, heart disease, stroke and diabetes
lescents worldwide are not spared the impact of sed-
of youth, young people are increasingly inactive and
unfit [3–7]. The World Health Organization recently
advocated for strategies to increase physical activity
participation worldwide .
A decline in activity begins in late elementary
school and continues throughout high school and
young adulthood [4, 9, 10]. Interventions that pro-
vide opportunities and motivation for young people
whichserve 95% ofAmericanyoungpeople,maybe
the ideal settings for such programs [11–13] because
can be leveraged to support increased physical ac-
tivity. Health educators based inschools and those in
community agencies, physical educators and other
schoolpersonnel can worktogetheronprogramsthat
help boys and girls adopt and maintain physically
Recommendations presented in the Centers
for Disease Control and Prevention publication,
1Department of Nutrition, University of North Carolina at
Chapel Hill, Chapel Hill, NC 28599-7461, USA,
2Department of Health Promotion, Education and Behavior,
Arnold School of Public Health,3College of Nursing,
4Department of Exercise Science, Arnold School of Public
Health, University of South Carolina, Columbia,
SC 29208, USA
*Correspondence to: D. S. Ward.
HEALTH EDUCATION RESEARCH
Theory & Practice
Vol.21 no.6 2006
Advance Access publication 10 November 2006
? The Author 2006. Published by Oxford University Press. All rights reserved.
For permissions, please email: email@example.com
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Guidelines for School and Community Programs to
Promote Lifelong Physical Activity among Young
People, highlight a wide range of school programs
and components, not just PE, that can be imple-
mented to increase physical activity in youth [12,
14]. Many of these recommendations can be in-
tegrated into a school-wide intervention using the
eight-component coordinated school health (CSH)
program model, an organizational framework de-
signed to encourage health-promoting behaviors in
students [15–18]. Researchers have found that in-
volving several school components (e.g. PE, health
education, school nurse) in a health promotion
program increases the likelihood that students will
adopt healthy behaviors [13, 19]. A similar ap-
proach, referred to as ‘health promoting schools’,
has been adopted among many countries around
the world, and shows much promise for the use of
the school setting for health promotion [20–22].
A majority of the previously studied school-
based health promotion programs has focused on
training teachers to implement, with high fidelity,
a curriculum developed by the research team. This
approach, however, often fails to consider contex-
tual issues (social, cultural and political) that affect
program success [23, 24]. Research reveals that
implementation of school programs is often influ-
enced more by context and interaction with the
local school organization than by the overall pro-
gram design or intervention characteristics .
Therefore, it may be more important to convey the
relevant theoretical orientation and focus of the
intervention than to prescribe adherence to a speci-
fic model .
Previous research in educational reform has
focused on what is needed to create and sustain
change in the complex school environment, with an
emphasis on building local capacity . Rather
than thinking of the school simply as a setting for
implementing a program, this approach views the
school as an ecosystem that responds and adapts
to a program or intervention . Further, change
at the school level is as much of an outcome of the
intervention as is change at the individual level.
Based on data from both population-based
studies that use self-report surveys and smaller
studies with objective physical activity monitoring,
girls at all ages are less active than boys, and their
activity levels decline at a greater rate than do boys’
[25, 26]. US Title IX legislation, enacted in 1972,
produced marked growth in school sports programs
for girls, however, national data sources indicate
that smaller percentage of girls than boys partici-
pate in interscholastic sports . Also, evidence
indicates that girls are less likely than boys to elect
PE when it is not required  and report less
positive attitudes toward PE than boys . For
some girls, school physical activity experiences are
quite negative .
LEAP—Lifestyle Education for Activity Program,
was designed to promote physical activity in high
school girls. Although in this implementation,
LEAP was employed to increase physical activity
among girls, this approach could be used with male
and female students. The program is designed to
be inclusive and address individual needs and inter-
ests of all students. These schools were encouraged
to implement the LEAP program at their individual
settings, and where possible, provide specific at-
tention to female students by addressing the barriers
to physical activity identified by girls (e.g. separat-
ing females from males in PE and having female-
oriented activities) . The intervention was
found to be successful based on a significant
increase in the percentage of girls in the interven-
tion schools who met a vigorous physical activity
standard . LEAP also included extensive pro-
cess evaluation methods that enabled researchers
to examine differences in the study outcome
based on level of implementation in individual
The purpose of this paper is 2-fold: (i) to describe
a comprehensive school-based intervention, de-
signed to promote physical activity in high school
girls through changes in the instructional program
and school environment, and (ii) to document the
implementation process conducted by LEAP staff
and to describe how the intervention was carried
at the school level. In this paper, we report
staff activities (dose-delivered), reach (schools
and school teachers and staff) and teacher- and
Physical activity intervention
by guest on May 30, 2013
staff-reported levels of LEAP intervention imple-
mentation, including barriers to implementing some
aspects of the intervention.
The LEAP intervention sought to test the effective-
ness of a school-based program that targeted
changes in instructional programs and school en-
vironment. Twenty-four high schools in South
Carolina were recruited into the study. To insure
that the schools were comparable at baseline, they
were pair-matched by size and other demographics,
and were randomly assigned to intervention and
control groups. Twelve schools received a compre-
hensive intervention to increase physical activity,
while 12 control schools received no treatment.
The intervention was implemented >2 years, and
two different groups (or waves) of ninth grade girls
were exposed to the PE component of LEAP and
changes in the school environment.
The intervention used a social–ecological model
drawn primarily from SCT [32, 33]. This theoretical
approach is based on the proposition that social
behavior, cognition and the environment are re-
ciprocal, interactive determinants of health behav-
iors that include perceived self-efficacy, outcome
expectations, evaluation of outcomes and behav-
ioral and environmental factors. Accordingly, the
LEAP intervention focused on changing personal,
social and environmental factors hypothesized to
increase physical activity. Central to the interven-
tion was a program of physical activities set in
a gender-sensitive PE program that included act-
ivities designed to be fun and age appropriate.
LEAP also emphasized the enhancement of phys-
ical activity self-efficacy and the mastery of phys-
ical activity self-management skills in a school
environment that promoted and supported physical
activity for young women.
Table I shows that six of the eight components of
the CSH program (PE, health education, school
environment, school health services, faculty/staff
health promotion and family/community involve-
ment) were used as intervention channels and
included a focus on changing the school’s organ-
izational infrastructure in order to sustain the in-
tervention impact . These six channels became
the six key components of LEAP. The other two
components of the CSH program, food service and
school counseling and social services, were not
addressed in this intervention.
CSH has been used to address specific disease
issues such as adolescent obesity, but prior to
LEAP, no program has used CSH specifically to
promote physical activity . A similar approach
was used in Canada to prevent obesity using seven
aspects of the CSH program . Although coor-
dination and collaboration among the components
Table I. Six components of LEAP based on coordinated
school health program
LEAP PEProvide girls with the physical and
behavioral skills needed to adopt
a physically active lifestyle during
their teenage years and to maintain
that active lifestyle into adulthood.
Reinforce messages delivered in PE
concerning the benefits of physical
activity, provide training in
behavioral skills that will enable
students to initiate and maintain
a physically active lifestyle.
To institute school-wide policies and
practices that promote the physical
activity within and outside of
To increase the involvement of
school health services in the creation
of a school and community
environment that supports and
reinforces physical activity among
To create a supportive school
environment that provides physically
active adult role models.
To assist students in being physically
active outside of school by enhancing
parental support and by linking
students to physical activity
opportunities outside of school.
Faculty and staff
Family and community
D. S. Ward et al.
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Received on April 1, 2006; accepted on September 14, 2006
The checklist illustrated below was provided to the school staffs and they were to answer ‘yes’, ‘partial’ or
‘no’ to each question.
Is physical education gender separate and provide a safe and supportive environment for girls?
n Does the program provide girls with fun, enjoyable, and successful experiences?
n Overall, are students physically active for at least 50% of class time?
n Does health education teach decision-making skills to enhance physical activity participation?
n Does health education teach students how to identify and overcome barriers to physical activity?
Physical activity intervention
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Does health education emphasize the personal relevance and application of physical activity
behavioral skills outside of class?
Does your school have a team that regularly plans, implements, and evaluates student and faculty physical
n Does your school promote physical activity through school media?
n Does the school nurse counsel students about physical activity?
n Does the school have an active wellness program?
Are families provided information about physical activity?
D. S. Ward et al.
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