Grant Number:	1R01CA309441-01A1 Interpret this number
Primary Investigator:	Hasson, Rebecca
Organization:	University Of Michigan At Ann Arbor
Project Title:	Optimizing the Delivery of Classroom Physical Activity Interventions: Adaptive Strategies to Enhance Fidelity and Health Outcomes in Michigan Elementary Schools
Fiscal Year:	2026

PROJECT SUMMARY/ABSTRACT Physical inactivity during childhood is a major, modifiable risk factor for several cancers and chronic diseases. Regular physical activity (PA) can reduce the risk of breast, colon, and endometrial cancers by up to 25% by improving immune regulation, reducing inflammation, and supporting healthy weight maintenance. Classroom- based PA programs—where teachers integrate short, structured activity breaks into the school day—offer a scalable, evidence-based strategy to increase children’s daily activity by up to 20 minutes and improve physical, cognitive, and emotional well-being. Modeling studies estimate that if all U.S. elementary students engaged in just 15 additional minutes of daily PA, five times per week, it could prevent $62.3 billion in lifetime medical costs and lost wages and reduce overweight or obesity in 1.2 million youth. Despite their potential, only one in five teachers delivers these programs as intended due to limited training, insufficient administrative support, and low organizational capacity. This project will test an adaptive implementation approach to determine the most effective and cost-efficient ways to help schools deliver classroom PA programs with fidelity. Using a clustered Sequential Multiple Assignment Randomized Trial (SMART) design in 40 Michigan elementary schools, we will evaluate four combinations of three evidence-based implementation strategies: Replicating Effective Programs (REP), a low-cost training and technical assistance package to enhance teacher confidence; Implementation Teams (TEAMS), a collaborative model guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to strengthen leadership and organizational readiness; and Facilitation, a tailored, expert-guided strategy delivered by regional school health coordinators to address persistent barriers. Schools will be randomized to receive REP or REP + TEAMS, and those not meeting predefined benchmarks after 18 weeks will be re-randomized to continue their initial strategy or add Facilitation. The primary outcome is the average daily minutes of classroom PA delivered by teachers, with secondary outcomes assessing teacher use of REP program materials, and school-level PA measured via the Youth Activity Profile. Implementation costs will be analyzed using activity-based micro-costing and distributional cost-effectiveness analysis to assess effectiveness and efficiency across schools with different resource levels. Moderator analyses (e.g., teacher self-efficacy, administrator support, and organizational capacity) will identify which strategy combinations work best for different school contexts. By integrating rigorous experimental methods with established state education infrastructure, this study will identify scalable, cost-effective strategies to enhance classroom PA delivery, improve child health, and reduce long-term cancer risk—advancing NIH and National Cancer Institute goals to enhance health, lengthen life, and reduce illness and disability.





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