Symposium title: Scaling fitness and resistance training in schools: From implementation support to system-level integration
Chair(s): Lars Breum Christiansen (University of Southern Denmark); Thomas Skovgaard (University of Southern Denmark)
Background and aim of the symposium
European and international policies increasingly emphasize muscle-strengthening activities and physical fitness monitoring as central components of health-enhancing physical activity (HEPA) for adolescents. However, embedding evidence-based resistance training and fitness surveillance into school systems remains challenging. Barriers include limited teacher capacity, insufficient structural support, fragmented monitoring systems, and policy–practice gaps.
This symposium addresses how evidence-based resistance training and fitness promotion can be scaled across educational systems, cultural contexts, and policy environments. It aims to bridge effectiveness research, implementation science, and policy infrastructure to inform sustainable system-level integration.
Summary of Contributions
- An Australian hybrid cluster randomized controlled trial compares three levels of implementation support for the Resistance Training for Teens programme, demonstrating how structured external support and resource investment influence reach, sustainment, and cost at scale.
- A Danish cluster randomized stepped wedge trial examines cross-context transfer of the same evidence-based programme, evaluating both effectiveness and real-world implementation following co-adaptation to a new national education system.
- The European FitBack network presents a large-scale fitness monitoring and surveillance initiative based on eight million test results from 34 countries, providing harmonized reference values and implementation frameworks to strengthen data-informed HEPA promotion.
- A Finnish intervention protocol responds to upcoming national education reform mandating promotion of physically active lifestyles, outlining how evidence-based school programmes can align with legislative change and national policy priorities.
Added Value
The symposium integrates effectiveness research, implementation intensity comparisons, cross-national transfer, surveillance infrastructure, and policy reform within one coherent scaling framework. It offers a multi-level perspective spanning classroom delivery to European policy systems.
Conclusion and Key Take-Home Messages
Participants will gain insight into:
- How varying levels of implementation support influence reach, sustainment, and cost.
- What enables successful cross-context adaptation of evidence-based programmes.
- How fitness surveillance systems can strengthen policy–practice alignment.
- How educational reform creates windows of opportunity for HEPA integration.
Together, the presentations demonstrate how muscle-strengthening and fitness-based initiatives can move from evidence to scalable, system-level HEPA impact.
Presentations of the Symposium
Comparing implementation support models for scaling school-based resistance training in secondary schools
David Lubans
University of Newcastle, Australia
Purpose:
Schools can provide foundational resistance training opportunities, but implementation is often constrained by limited teacher capacity, expertise and structural support. This study compared three implementation support models to determine their effects on reach and sustainment of the evidence-based Resistance Training for Teens programme, identifying scalable strategies for system-wide delivery.
Methods:
A hybrid cluster randomized controlled trial was conducted in 58 secondary schools in New South Wales, Australia. Schools were randomized to Low (training and resources), Moderate (+external support), or High (+equipment) implementation support. The primary outcome was reach. Secondary outcomes included dose delivered, fidelity, sustainment, perceived impact and cost. Teacher surveys were administered at baseline and 18-month follow-up. Ordinal generalized linear models were used, with Low support as reference. Semi-structured interviews were conducted with project officers (n=10) and teachers (n=11).
Results:
Compared with Low support, Moderate (OR=5.45, 95% CI: 1.52–19.56) and High (OR=8.12, 95% CI: 2.03–32.58) support significantly increased reach. Sustainment was higher in the High support group (OR=10.74, 95% CI: 1.91–60.31). Teachers in Moderate and High groups reported greater perceived student impact (p<0.05). Qualitative findings highlighted local adaptation, teacher leadership and student engagement as sustainment mechanisms. Mean per-school costs increased stepwise (AUD $1,098–$2,474).
Conclusions:
Structured external implementation support substantially increased programme reach and sustainment. Scaling school-based resistance training requires system-level investment, with important implications for policy and resource allocation in health-enhancing physical activity initiatives.
Funding: National Health and Medical Research Council Partnership Grant (APP2010866) and NSW Department of Education
Keywords: Implementation support; Scaling-up; Resistance training; School-based intervention
Scaling school-based resistance training across contexts: Effectiveness and implementation in Danish secondary schools
Sofie Koch1; Trine Top Klein-Wengel1; Marianne Friis Andersen1; Jesper Sandfeld Melcher2; Malte Nejst Larsen1; Thomas Bredahl1; Lars Breum Christiansen1
1: University of Southern Denmark; 2: University College Copenhagen
Purpose:
This study evaluates the effectiveness and real-world implementation of a co-adapted school-based resistance training programme transferred from the Australian Resistance Training for Teens intervention to the Danish lower secondary school context. Beyond effectiveness, the study examines whether an evidence-based programme can be scaled across national, cultural and educational systems through systematic co-adaptation while maintaining feasibility, fidelity and acceptability.
Methods:
A two-period cluster randomized stepped wedge trial is being conducted in 20 lower secondary schools (approximately 1,000 students, grades 7–9). Schools are randomized to early or delayed implementation. The programme is delivered by the teachers during eight physical education lessons, including two sessions for assessment. Teachers receive a structured manual, exercise cards, equipment and participate in a full-day professional development workshop to support implementation. The primary outcome is resistance training self-efficacy. Secondary outcomes include muscular strength, cardiorespiratory fitness, motivation and well-being. Implementation outcomes—fidelity, feasibility, acceptability and appropriateness—are assessed using mixed methods to examine contextual adaptation and scalability.
Results:
Data collection concludes in March 2026. Effectiveness analyses will estimate intervention effects on psychosocial and physical outcomes. Implementation analyses will identify mechanisms facilitating teacher uptake, programme delivery and contextual transferability beyond the original Australian setting.
Conclusions:
This study contributes evidence on cross-context scaling of school-based resistance training within public education systems. Findings will inform policy and practice on sustainable integration of muscle-strengthening activities into secondary physical education, strengthening system-level approaches to health-enhancing physical activity.
Funding sources: The study was funded by the Danish Heart Foundation.
Keywords: resistance training, adolescents, competencies, implementation, physical education
A hybrid type 2 implementation–effectiveness trial to promote physical activity and student health in Finnish primary schools
Timo Jaakkola; Mikko Huhtiniemi
University of Jyväskylä
Purpose:
In 2026, the Finnish Parliament will revise the Basic Education Act to mandate promotion of a physically active lifestyle as a core aim of basic education (preschool and Grades 1–9). This reform creates a need for evidence-based, scalable school programmes. This study presents the protocol of a one-academic-year hybrid type 2 implementation–effectiveness trial designed to increase students’ physical activity and improve their physical, social and mental health, while simultaneously evaluating implementation processes within schools.
Methods:
A three-arm cluster randomized controlled trial will be conducted in 30 schools involving approximately 1,800 Grade 5 students. Schools will be allocated to high implementation support, low implementation support or control conditions. The intervention follows the WHO whole-of-school framework for physical activity promotion. The primary effectiveness outcome is students’ cardiorespiratory fitness. The primary implementation outcome is teachers’ capability, opportunity and motivation to deliver the programme. Secondary outcomes include physical activity behaviour, psychosocial well-being and implementation fidelity. A mixed-methods approach will be applied, and cost-effectiveness will be assessed.
Results:
The trial will generate comparative evidence on intervention effectiveness, implementation support strategies, cost-effectiveness and contextual determinants influencing adoption and sustainability across schools.
Conclusions:
This study leverages national education reform as a policy window for advancing health-enhancing physical activity in schools. By integrating effectiveness and implementation evaluation, it will provide actionable evidence to guide scalable, system-level integration of physical activity promotion within statutory education frameworks.
Founding sources: National public funding
Keywords: Hybrid implementation–effectiveness trial; Education policy; Cardiorespiratory fitness, Physical activity promotion; Scalability
Physical fitness monitoring and surveillance systems as catalysts for health-enhancing physical activity promotion
Gregor Jurak
University of Ljubljana
Purpose:
European policy frameworks emphasize monitoring schoolchildren’s physical fitness as a key indicator of long-term health and cognitive development. However, implementation of fitness surveillance systems remains fragmented across countries. The international FitBack network was established to harmonize approaches and strengthen the use of fitness monitoring as a catalyst for health-enhancing physical activity (HEPA) promotion across Europe.
Methods:
FitBack applied a comprehensive data-driven approach. The network compiled more than eight million fitness test results from 34 countries to establish European reference values and map population-level fitness patterns. Causal associations between fitness indicators and health outcomes were examined to define health-related cut-off points. Existing national monitoring systems were analysed to identify best practices. Based on this work, a multilingual digital platform and toolkit were developed and validated to support educators in interpreting fitness data and promoting physical literacy through structured feedback.
Results:
FitBack launched an open-access web-based platform featuring standardized reporting tools, European reference values and a practitioner-oriented digital toolkit. A 10-step implementation framework and best-practice guidelines were produced to support regional and national adoption of sustainable fitness monitoring and surveillance systems.
Conclusions:
FitBack demonstrates how harmonized fitness surveillance can bridge policy and school-level practice, enabling data-informed HEPA promotion across sectors and countries. The initiative provides a scalable model for integrating monitoring into national education and health systems. Addressing data governance and privacy challenges will be critical for strengthening longitudinal surveillance and informing future European HEPA policy.
Funding sources: Erasmus+ Sport
Keywords: Fitness surveillance; Health monitoring; Policy–practice integration; Physical literacy; European collaboration
Experiences of implementing the Finnish Move! fitness monitoring system in schools
Mikko Huhtiniemi; Timo Jaakkola
University of Jyväskylä
Purpose:
The Finnish Move! system has been embedded in the Curriculum for Physical Education since 2016 and annually assesses health-related fitness and motor competence among Grade 5 and Grade 8 students nationwide. The system aims to integrate feedback, home–school communication and healthcare collaboration to support health-enhancing physical activity (HEPA). This study examined stakeholder experiences of the Move! process to evaluate large-scale pedagogical implementation and identify strengths and gaps in system integration.
Methods:
Nationwide survey data were collected from 4,712 pupils and 5,832 parents. Items assessed experiences related to preparation, testing, feedback practices, home discussions, motivational impact and follow-up support. Descriptive analyses were conducted to examine implementation quality across stages.
Results:
Pupils reported clear instructions (4.3/5), strong effort (4.4/5) and smooth peer interaction (4.2/5). Pre-test information was rated positively (4.1/5), although independent familiarization with online resources was low (1.8/5). Post-measurement pedagogical integration was weaker. While result reports were considered clear (4.0/5), individualized feedback (2.3/5), structured reflection (2.3/5) and guidance for improvement (2.3/5) were limited. Parents reported high awareness of participation (≈90%) and home discussion of results (>90%), yet perceived motivational impact (≈10%) and integration with school healthcare (≈5%) were low.
Conclusions:
At national scale, the Move! system achieves strong measurement reach and procedural fidelity. However, strengthening adoption and maintenance of pedagogical feedback and cross-sector collaboration is essential to translate monitoring into sustained HEPA promotion. Findings highlight critical leverage points for enhancing system-level impact of school-based fitness surveillance.
Funding sources: National public funding
Keywords: National monitoring system; Fitness assessment; School health
