The effectiveness of JU:MP a whole system approach to improve physical activity of children aged 5 to 11 years living in multi-ethnic and socio-economically deprived communities: a non-randomised controlled trial

Whole system approaches to public health challenges such as low physical activity levels have the potential to create sustained behaviour change at a population level and tackle health inequalities. However, there is currently little evidence of the nature or effectiveness of adopting whole system approaches. This study evaluated whether a whole system physical activity intervention (JU:MP), was effective at improving accelerometry measured physical activity in five- to eleven-year-olds. A non-randomised controlled trial with two-arms (JU:MP intervention and control), was conducted in multi-ethnic and socioeconomically deprived areas of Bradford, UK with data collected at baseline and 24-months follow-up. Habitual physical activity was measured via accelerometry. Mixed effects regression models identified group differences at 24 months. The primary outcome was moderate-to-vigorous intensity physical activity (MVPA). Secondary outcomes included: accelerometery measured - sedentary time (ST), counts per minute (CPM); BMI z-score, waist circumference, and children’s social, emotional and behavioural health, and quality-of-life via parental and teacher completed questionnaires. An exploratory analysis compared intervention effects between sub-groups. 1,453 children were recruited. 330 children with valid wear-time at baseline and 24-months (JU:MP group n = 175, control group n = 155) were included in the final analysis of physical activity outcomes. The JU:MP group improved levels of MVPA (+ 4.99 min/day, (CI = 1.01, 8.96), standardised mean difference (SMD) = 0.29), ST ( -8.69 min/day, CI = -16.76, -0.61), SMD = -0.20) and CPM (+ 32.72, CI = 5.93, 59.53, SMD = 0.28) compared to controls. There were minor differences between groups in all secondary outcomes, favouring the JU:MP group. Exploratory sub-group analysis revealed that MVPA improved for boys (+ 7.34 min/days, CI = 0.70, 13.99, SMD = 0.36) and South Asian heritage children (+ 7.20 min/day, CI = 1.67, 12.72, SMD = 0.52) in the JU:MP group compared to the control group. This study provides evidence that a whole system, community-based intervention can improve physical activity levels in primary school-aged children, particularly among boys and South Asian children, in deprived and ethnically diverse settings. The findings suggest that whole systems approaches may be effective in mitigating age-related declines in activity and addressing inequalities at scale. This study was retrospectively registered with the ISRCTN registry (ISRCTN14332797) on 17/02/2022. Available at: https://www.isrctn.com/ISRCTN14332797.