Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

Authors: Dana Lee Olstad, Elizabeth J Campbell, Kim D Raine, Candace IJ Nykiforuk

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children’s opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact.

Methods

We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies.

Results

Five of Canada’s 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children’s PA levels or BMI.

Conclusions

This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies.
Appendix
Available only for authorised users
Literature
1.
Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40.CrossRefPubMedPubMedCentral
2.
3.
4.
5.
6.
Hohepa M, Schofield G, Kolt GS. Physical activity: what do high school students think? J Adolesc Health. 2006;39(3):328–36.CrossRefPubMed
7.
Humbert ML, Chad KE, Spink KS, Muhajarine N, Anderson KD, Bruner MW, et al. Factors that influence physical activity participation among high- and low-SES youth. Qual Health Res. 2006;16(4):467–83.CrossRefPubMed
8.
Veugelers PJ, Schwartz ME. Comprehensive school health in Canada. Can J Public Health. 2010;101 Suppl 2:S5–8.PubMed
9.
Hobin EP, Leatherdale ST, Manske SR, Burkhalter R, Woodruff SJ. A multilevel examination of school and student characteristics associated with physical education class enrollment among high school students. J Sch Health. 2010;80(9):445–52.CrossRefPubMed
10.
Hobin E, Leatherdale S, Manske S, Dubin J, Elliott S, Veugelers P. A multilevel examination of factors of the school environment and time spent in moderate to vigorous physical activity among a sample of secondary school students in grades 9–12 in Ontario, Canada. Int J Public Health. 2012;57(4):699–709.CrossRefPubMed
11.
Myers L, Strikmiller PK, Webber LS, Berenson GS. Physical and sedentary activity in school children grades 5–8: the Bogalusa Heart Study. Med Sci Sports Exerc. 1996;28(7):852–9.CrossRefPubMed
12.
Lowry R, Lee SM, Fulton JE, Demissie Z, Kann L. Obesity and other correlates of physical activity and sedentary behaviors among US high school students. J Obes. 2013;2013:276318.CrossRefPubMedPubMedCentral
13.
Nettlefold L, McKay HA, Warburton DE, McGuire KA, Bredin SS, Naylor PJ. The challenge of low physical activity during the school day: at recess, lunch and in physical education. Br J Sports Med. 2011;45(10):813–9.CrossRefPubMed
14.
Janzen H. Daily physical education for K-12: is government legislation in sight? Phys Health Educ J. 2003;69(4):4–10.
15.
16.
Allison KR, Adlaf EM. Structured opportunities for student physical activity in Ontario elementary and secondary schools. Can J Public Health. 2000;91(5):371–5.PubMed
17.
Dwyer JJ, Allison KR, Barrera M, Hansen B, Goldenberg E, Boutilier MA. Teachers’ perspective on barriers to implementing physical activity curriculum guidelines for school children in Toronto. Can J Public Health. 2003;94(6):448–52.PubMed
18.
19.
Centers for Disease C, Prevention. Participation in high school physical education--Ontario, Canada, 1999–2005. MMWR Morb Mortal Wkly Rep. 2007;56(3):52–4.
20.
Dwyer JJ, Allison KR, LeMoine KN, Adlaf EM, Goodman J, Faulkner GE, et al. A provincial study of opportunities for school-based physical activity in secondary schools. J Adolesc Health. 2006;39(1):80–6.CrossRefPubMed
21.
22.
Strained Schools Face Bleak Future. Districts Foresee Budget Cuts, Teacher Layoffs, and a Slowing of Education Reform Efforts. [file:///C:/Users/dwilkins/Downloads/KoberRentner_Report_StrainedSchools_063011.pdf]
23.
Amis JM, Wright PM, Dyson B, Vardaman JM, Ferry H. Implementing childhood obesity policy in a new educational environment: the cases of Mississippi and Tennessee. Am J Public Health. 2012;102(7):1406–13.CrossRefPubMedPubMedCentral
24.
25.
Slater SJ, Nicholson L, Chriqui J, Turner L, Chaloupka F. The impact of state laws and district policies on physical education and recess practices in a nationally representative sample of US public elementary schools. Arch Pediatr Adolesc Med. 2012;166(4):311–6.CrossRefPubMed
26.
Perna FM, Oh A, Chriqui JF, Masse LC, Atienza AA, Nebeling L, et al. The association of state law to physical education time allocation in US public schools. Am J Public Health. 2012;102(8):1594–9.CrossRefPubMedPubMedCentral
27.
Chriqui JF, Eyler A, Carnoske C, Slater S. State and district policy influences on district-wide elementary and middle school physical education practices. J Public Health Manag Pract: JPHMP. 2013;19(3 Suppl 1):S41–8.CrossRefPubMed
28.
Taber DR, Chriqui JF, Perna FM, Powell LM, Slater SJ, Chaloupka FJ. Association between state physical education (PE) requirements and PE participation, physical activity, and body mass index change. Prev Med. 2013;57(5):629–33.CrossRefPubMed
29.
Cawley J, Meyerhoefer C, Newhouse D. The impact of state physical education requirements on youth physical activity and overweight. Health Econ. 2007;16(12):1287–301.CrossRefPubMed
30.
Sanchez-Vaznaugh EV, Sanchez BN, Rosas LG, Baek J, Egerter S. Physical Education Policy Compliance and Children’s Physical Fitness. Am J Prev Med. 2012;42(5):452–9.CrossRefPubMed
31.
Singh A, Uijtdewilligen L, Twisk JW, van Mechelen W, Chinapaw MJ. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatr Adolesc Med. 2012;166(1):49–55.CrossRefPubMed
32.
Trost SG, van der Mars H. Why we should not cut P.E. Educ Leadersh. 2009;67(4):60–5.
33.
34.
Rasberry CN, Lee SM, Robin L, Laris BA, Russell LA, Coyle KK, et al. The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature. Prev Med. 2011;52 Suppl 1:S10–20.CrossRefPubMed
35.
Ahamed Y, Macdonald H, Reed K, Naylor PJ, Liu-Ambrose T, McKay H. School-based physical activity does not compromise children’s academic performance. Med Sci Sports Exerc. 2007;39(2):371–6.CrossRefPubMed
36.
Robertson-Wilson JE, Dargavel MD, Bryden PJ, Giles-Corti B. Physical activity policies and legislation in schools: a systematic review. Am J Prev Med. 2012;43(6):643–9.CrossRefPubMed
37.
Shipan CR, Volden C. The mechanisms of policy diffusion. Am J Polit Sci. 2008;52(4):840–57.CrossRef
38.
Nykiforuk C, Eyles J, Campbell H. Smoke-free spaces over time: a policy diffusion study of bylaw development in Alberta and Ontario, Canada. Health Soc Care Community. 2008;16(1):64–74.CrossRefPubMed
39.
Shipan CR, Volden C. Policy diffusion: Seven lessons for scholars and practitioners. Public Adm Rev. 2012;72(6):788–96.
40.
Taber DR, Chriqui JF, Chaloupka FJ. Association and diffusion of nutrition and physical activity policies on the state and district level(*). J Sch Health. 2012;82(5):201–9.CrossRefPubMed
41.
Eyler AA, Nguyen L, Kong J, Yan Y, Brownson R. Patterns and predictors of enactment of state childhood obesity legislation in the United States: 2006–2009. Am J Public Health. 2012;102(12):2294–302.CrossRefPubMedPubMedCentral
42.
Boehmer TK, Brownson RC, Haire-Joshu D, Dreisinger ML. Patterns of childhood obesity prevention legislation in the United States. Prev Chronic Dis. 2007;4(3):A56.PubMedPubMedCentral
43.
Boehmer TK, Luke DA, Haire-Joshu DL, Bates HS, Brownson RC. Preventing childhood obesity through state policy. Predictors of bill enactment. Am J Prev Med. 2008;34(4):333–40.CrossRefPubMed
44.
Freudenberg N, Bradley SP, Serrano M. Public health campaigns to change industry practices that damage health: an analysis of 12 case studies. Health Educ Behav. 2009;36(2):230–49.CrossRefPubMed
45.
Rogers E. Diffusion of Innovations. 5th ed. New York: Free Press; 2003.
46.
47.
48.
Mersky RM. Fundamentals of legal research. 8th ed. New York: Foundations Press; 2002.
49.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.CrossRef
50.
Carlson JA, Sallis JF, Chriqui JF, Schneider L, McDermid LC, Agron P. State policies about physical activity minutes in physical education or during school. J Sch Health. 2013;83(3):150–6.CrossRefPubMed
51.
52.
53.
54.
55.
Kingdon JW. Agendas, alternatives and public policies. New York: Harper Collins Publishers; 1995.
56.
Gladwin CP, Church J, Plotnikoff RC. Public policy processes and getting physical activity into Alberta’s urban schools. Can J Public Health. 2008;99(4):332–8.PubMed
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
Robinson DB, Melnychuk NE. Discourse, teacher identify, and the implementation of daily physical activity. J Educ Res. 2008;3:245–57.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
Naylor PJ, Macdonald HM, Reed KE, McKay HA. Action Schools! BC: a socioecological approach to modifying chronic disease risk factors in elementary school children. Prev Chronic Dis. 2006;3(2):A60.PubMedPubMedCentral
89.
Naylor PJ, Macdonald HM, Zebedee JA, Reed KE, McKay HA. Lessons learned from Action Schools! BC–an ‘active school’ model to promote physical activity in elementary schools. J Sci Med Sport / Sports Med Aust. 2006;9(5):413–23.CrossRef
90.
Reed KE, Warburton DE, Macdonald HM, Naylor PJ, McKay HA. Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Prev Med. 2008;46(6):525–31.CrossRefPubMed
91.
Naylor PJ, Macdonald HM, Warburton DE, Reed KE, McKay HA. An active school model to promote physical activity in elementary schools: action schools! BC. Br J Sports Med. 2008;42(5):338–43.CrossRefPubMed
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
Brownson RC, Chriqui JF, Burgeson CR, Fisher MC, Ness RB. Translating epidemiology into policy to prevent childhood obesity: the case for promoting physical activity in school settings. Ann Epidemiol. 2010;20(6):436–44.CrossRefPubMedPubMedCentral
117.
Lagarde F, LeBlanc C. Policy options to support physical activity in schools. Can J Public Health. 2010;101 Suppl 2:S9–13.PubMed
118.
Belansky ES, Cutforth N, Delong E, Ross C, Scarbro S, Gilbert L, et al. Early impact of the federally mandated Local Wellness Policy on physical activity in rural, low-income elementary schools in Colorado. J Public Health Policy. 2009;30 Suppl 1:S141–60.CrossRefPubMed
119.
Masse LC, Naiman D, Naylor PJ. From policy to practice: implementation of physical activity and food policies in schools. Int J Behav Nutr Phys Act. 2013;10:71.CrossRefPubMedPubMedCentral
120.
Health Canada and the Canadian Society for Exercise Physiology. Canada’s physical activity guide for youth. Cat. No. H39-611/2002-IE. Ottawa, Ont: Minister of Public Works and Government Services Canada; 2002. p. 122.
121.
Health Canada and the Canadian Society for Exercise Physiology. Canada’s physical activity guide for children. Cat. No. H39-611/2002-2E. Ottawa, Ont: Minister of Public Works and Government Services Canada; 2002.
122.
Eyler AA, Brownson RC, Aytur SA, Cradock AL, Doescher M, Evenson KR, et al. Examination of trends and evidence-based elements in state physical education legislation: a content analysis. J Sch Health. 2010;80(7):326–32.CrossRefPubMed
123.
Greenhalgh T, Russell J. Evidence-based policymaking: a critique. Perspect Biol Med. 2009;52(2):304–18.CrossRefPubMed
124.
Gollust SE, Kite HA, Benning SJ, Callanan RA, Weisman SR, Nanney MS. Use of research evidence in state policymaking for childhood obesity prevention in Minnesota. Am J Public Health. 2014;104(10):1894–900.CrossRefPubMedPubMedCentral
125.
Hays SP. Patterns of reinvention: The nature of evolution during policy diffusion. Policy Stud J. 1996;24(4):551–66.CrossRef
126.
Glick HR, Hays SP. Innovation and reinvention in state policymaking: theory and the evolution of living will laws. J Polit. 1991;53(3):835–49.CrossRefPubMed
127.
128.
129.
130.
131.
Kelder SH, Springer AS, Barroso CS, Smith CL, Sanchez E, Ranjit N, et al. Implementation of Texas Senate Bill 19 to increase physical activity in elementary schools. J Public Health Policy. 2009;30 Suppl 1:S221–47.CrossRefPubMedPubMedCentral
132.
Walker JL. The diffusion of innoations among the American states. Am Polit Sci Rev. 1969;63:880–99.CrossRef
133.
Faulkner G, Zeglen L, Leatherdale S, Manske S, Stone M. The relationship between school physical activity policy and objectively measured physical activity of elementary school students: a multilevel model analysis. Arch Public Health. 2014;72(1):20.CrossRefPubMedPubMedCentral
134.
Leatherdale ST, Manske S, Faulkner G, Arbour K, Bredin C. A multi-level examination of school programs, policies and resources associated with physical activity among elementary school youth in the PLAY-ON study. Int J Behav Nutr Phys Act. 2010;7(1):6.CrossRefPubMedPubMedCentral
135.
Patton I. Teachers’ perspectives of the daily physical activity program in Ontario. Phys Health Educ J. 2012;78(1):14–21.
136.
Stone MR, Faulkner GE, Zeglen-Hunt L, Bonne JC. The Daily Physical Activity (DPA) policy in Ontario: is it working? an examination using accelerometry-measured physical activity data. Can J Public Health. 2012;103(3):170–4.PubMed
137.
Watts AW, Masse LC, Naylor PJ. Changes to the school food and physical activity environment after guideline implementation in British Columbia, Canada. Int J Behav Nutr Phys Act. 2014;11:50.CrossRefPubMedPubMedCentral
138.
Langille JL, Rodgers WM. Exploring the influence of a social ecological model on school-based physical activity. Health Educ Behav. 2010;37(6):879–94.CrossRefPubMed
139.
140.
141.
Evenson KR, Ballard K, Lee G, Ammerman A. Implementation of a school-based state policy to increase physical activity*. J Sch Health. 2009;79(5):231–8. quiz 244–236.CrossRefPubMed
142.
Agron P, Berends V, Ellis K, Gonzalez M. School wellness policies: perceptions, barriers, and needs among school leaders and wellness advocates. J Sch Health. 2010;80(11):527–35. quiz 570–522.CrossRefPubMed
143.
144.
Howie EK, Newman-Norlund RD, Pate RR. Smiles count but minutes matter: responses to classroom exercise breaks. Am J Health Behav. 2014;38(5):681–9.CrossRefPubMed
145.
Leatherdale ST. A cross-sectional examination of school characteristics associated with overweight and obesity among grade 1 to 4 students. BMC Public Health. 2013;13:982.CrossRefPubMedPubMedCentral
146.
Hobin EP, Leatherdale ST, Manske SR, Robertson-Wilson J. A multilevel examination of school and student characteristics associated with moderate and high levels of physical activity among elementary school students (Ontario, Canada). Can J Public Health. 2010;101(6):495–9.PubMed
147.
Leatherdale ST. School characteristics and physical activity among grade 1–4 students. Am J Health Behav. 2014;38(2):200–7.CrossRefPubMed
148.
Hobin E, So J, Rosella L, Comte M, Manske S, McGavock J. Trajectories of objectively measured physical activity among secondary students in Canada in the context of a province-wide physical education policy: a longitudinal analysis. J Obes. 2014;2014:958645.CrossRefPubMedPubMedCentral
149.
Kimm SY, Glynn NW, Kriska AM, Barton BA, Kronsberg SS, Daniels SR, et al. Decline in physical activity in black girls and white girls during adolescence. N Engl J Med. 2002;347(10):709–15.CrossRefPubMed
150.
Caspersen CJ, Pereira MA, Curran KM. Changes in physical activity patterns in the United States, by sex and cross-sectional age. Med Sci Sports Exerc. 2000;32(9):1601–9.CrossRefPubMed
151.
Nelson MC, Neumark-Stzainer D, Hannan PJ, Sirard JR, Story M. Longitudinal and secular trends in physical activity and sedentary behavior during adolescence. Pediatrics. 2006;118(6):e1627–34.CrossRefPubMed
152.
Gordon-Larsen P, Nelson MC, Popkin BM. Longitudinal physical activity and sedentary behavior trends: adolescence to adulthood. Am J Prev Med. 2004;27(4):277–83.CrossRefPubMed
153.
Sallis JF. Age-related decline in physical activity: a synthesis of human and animal studies. Med Sci Sports Exerc. 2000;32(9):1598–600.CrossRefPubMed
154.
Long MW, Sobol AM, Cradock AL, Subramanian SV, Blendon RJ, Gortmaker SL. School-day and overall physical activity among youth. Am J Prev Med. 2013;45(2):150–7.CrossRefPubMed
155.
Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.CrossRefPubMed
156.
Cradock AL, Barrett JL, Carter J, McHugh A, Sproul J, Russo ET, et al. Impact of the Boston Active School Day policy to promote physical activity among children. Am J Health Promot. 2014;28(3 Suppl):S54–64.CrossRefPubMed
157.
Vander Ploeg KA, McGavock J, Maximova K, Veugelers PJ. School-based health promotion and physical activity during and after school hours. Pediatrics. 2014;133(2):e371–8.CrossRefPubMed
158.
159.
160.
161.
162.
163.
164.
Alberta Community Development. Alberta Active Living Strategy Discussion Paper. 1998.
165.
Leatherdale ST. The association between overweight and school policies on physical activity: a multilevel analysis among elementary school youth in the PLAY-On study. Health Educ Res. 2010;25(6):1061–73.CrossRefPubMed
166.
Robertson-Wilson JE, Levesque L. Ontario’s daily physical activity policy for elementary schools: is everything in place for success? Can J Public Health. 2009;100(2):125–9.PubMed
Metadata
Title
A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools
Authors
Dana Lee Olstad
Elizabeth J Campbell
Kim D Raine
Candace IJ Nykiforuk
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1669-6

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Diabetes, hypertension and mobility among Brazilian older adults: findings from the Brazilian National Household Sample Survey (1998, 2003 and 2008)

Research article

Food habits, physical activities and sedentary lifestyles of eutrophic and obese school children: a case–control study

Study protocol

A theory-based behavior-change intervention to reduce alcohol consumption in undergraduate students: Trial protocol

Reviewer acknowledgement

Reviewer acknowledgement 2014

Research article

Noncommunicable Disease Prevention and Control in Mongolia: A Policy Analysis

Research article

A cross-sectional survey and latent class analysis of the prevalence and clustering of health risk factors among people attending an Aboriginal Community Controlled Health Service