Background: Youth physical inactivity is a major public health concern, particularly in schools serving socioeconomically disadvantaged children. Classroom-based physical activity (PA) interventions offer structured, equitable opportunities for movement, but adoption-fidelity gaps persist. Implementation science frameworks can support schools in aligning interventions with local context and sustaining delivery.
Purpose: This study examined the feasibility of using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, paired with facilitation by trained regional school health coordinators, to guide classroom PA implementation in a Michigan elementary school.
Methods: An EPIS-aligned implementation guide was developed and refined through a two-phase process to ensure theoretical grounding and practical applicability. Six coordinators were trained and evaluated the training using validated measures of acceptability, appropriateness, and feasibility. One coordinator facilitated InPACT implementation at a single school over 18 months, supporting pre-implementation, rollout, and early sustainment. Implementation was documented using the Hexagon Tool, RE-AIM, Plan-Do-Study-Act cycles, and routine administrative data.
Results: Coordinators rated the training highly on all measures. In the pilot school, teachers delivered an average of three PA breaks per day, with lower-elementary classrooms averaging four and upper-elementary classrooms averaging two. Fidelity was supported through structured ramp-up, teacher training, technical assistance, and classroom tracking. Integration into school systems helped to fill gaps in the school district wellness policy. Behavioral referral data indicated a 34% reduction in minor classroom incidents over the first year of implementation.
Conclusions: EPIS-guided implementation with facilitation is feasible for supporting adoption, fidelity, and early sustainment of classroom PA. Structured pre-implementation planning, phase-specific support, and alignment with school priorities are critical. Multi-site studies are needed to examine grade-specific strategies, fidelity variability, and long-term sustainment.
Keywords: exercise; health promotion; implementation science; program sustainability; schools.
Many children do not get enough physical activity (PA) during school, especially in under-resourced settings. This inactivity can negatively affect physical, emotional, and cognitive development. We tested whether the EPIS framework—Exploration, Preparation, Implementation, and Sustainment—combined with facilitation provided by trained regional school health coordinators, could help schools adopt and maintain InPACT (Interrupting Prolonged Sitting with Activity), a classroom-based PA intervention. Facilitation means hands-on support for teachers and leaders, including strategic thinking and problem-solving, and guidance on using EPIS-aligned tools. InPACT encourages teachers to provide short activity breaks throughout the school day. Six coordinators were trained to use the guide combining EPIS with facilitation. One elementary school piloted the approach for over 18 months. Teachers delivered an average of three activity breaks daily, with younger grades averaging more than older ones. Teachers and administrators also reported improved student behavior, and the school embedded activity breaks into staff onboarding to ensure long-term use. Our findings show that EPIS with facilitation can help schools plan, deliver, monitor, and sustain classroom activity breaks. Larger studies are needed to strengthen evidence and support wider adoption.
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