背景

长期规律的身体活动有助于儿童身心健康发展。世界卫生组织建议5~17岁的儿童青少年每天累计参加至少60分钟的中等至高等强度身体活动（简称，中高强度身体活动）。然而，我国4~12年级农村儿童达到WHO推荐标准的，约为29.0%，低于我国城市儿童（33.6%）。体育学习兴趣是指个体积极认识、愿意参与且愿意再次参与体育活动的心理倾向，是推动和维系儿童参与身体活动的现实动力因素。已有研究显示，学校是促进儿童身体活动和体育学习兴趣的理想场所。当前，促进儿童身体活动和体育学习兴趣的学校干预研究集中在发达国家或地区，因此，在中低收入地区开展改善儿童身体活动和体育学习兴趣的研究，有助于为这些地区提供干预指导，是促进全球健康公平性的有益探索。

本研究以川渝农村地区的小学生为研究对象，在调研其身体活动和体育学习兴趣现状的基础上，探索基于我国农村小学的身体活动干预方案，并评估其对改善儿童身体健康（两周呼吸系统疾病患病率）、心理健康（抑郁症状）和社会适应能力（同伴关系满意度）的效果，为改善我国农村儿童的中高强度身体活动水平与体育学习兴趣、促进儿童健康发展提供科学依据。

 

目的

1.评估川渝农村儿童的中高强度身体活动水平和体育学习兴趣现状及其相关因素。

2.为改善农村儿童的中高强度身体活动水平和体育学习兴趣，以川渝农村地区为试点，探索构建川渝农村小学潜在有效且可行的身体活动干预措施与干预实施方案。

3.评估已构建的干预项目对促进川渝农村儿童中高强度身体活动水平和体育学习兴趣的有效性，并探索其对促进儿童身体健康（两周呼吸系统疾病患病率）、心理健康（抑郁症状）和社会适应能力（同伴关系满意度）的效果。

4.厘清促进和阻碍体育教学改进干预项目实施的因素，为改进项目实施提出建议。

 

方法

本研究在对川渝农村儿童身体活动水平和体育学习兴趣横断面调查的基础上，构建了体育教学改进干预方案，采用整群随机对照试验设计，检验其对儿童身体活动等方面的干预效果，并对影响干预实施的因素进行评价（伦理审查文号：ChiECRCT20200016，研究注册号：ChiCTR2000038927）。首先，采用横断面调查，了解川渝农村儿童的中高强度身体活动水平和体育学习兴趣现状，并分别探索其相关因素。其次，以改善儿童中高强度身体活动水平和体育学习兴趣为目的，依据国内外学校身体活动干预实证研究经验，结合儿童身体活动和体育学习兴趣相关理论，基于川渝农村小学体育教育现实条件，探索构建适合川渝农村小学的潜在有效且可行的身体活动干预策略与措施。再次，采用整群随机对照实验，评估构建的体育教学改进干预项目对改善儿童中高强度身体活动水平和体育学习兴趣的有效性，并探索其对促进川渝农村儿童身体—心理—社会适应能力发展的效果。最后，采用实施科学研究方法，对影响干预实施的因素进行评价，探索促进和阻碍体育教学改进干预项目实施的因素，为该项目的迭代实施与推广应用提供经验总结。

 

1.采用横断面调查研究设计，通过方便抽样并结合分层抽样与整群抽样，以川渝地区8所农村小学（四川省和重庆市各4所）901名4~5年级儿童为研究对象，通过问卷调查，评估川渝农村儿童的中高强度身体活动水平和体育学习兴趣现状。

采用目的抽样，以15所农村小学体育教学相关人员为研究对象，通过访谈法和观察法，以促进青少年身体活动的社会生态学模型为框架，探索川渝农村小学生中高强度身体活动的相关因素；并以内部动机的激发和基本心理需要理论为框架，探索农村儿童体育学习兴趣的相关因素。

 

2. 以改善儿童中高强度身体活动水平和体育学习兴趣为目标，基于促进青少年身体活动的社会生态学模型、体育学习兴趣相关的激发内部动机和满足基本心理需要的理论，对国内外既往小学运动干预项目分别就其促进儿童身体活动和体育学习兴趣的有效性展开讨论，并结合川渝农村小学体育教育现实条件，以及促进青少年身体活动的扩大、延伸、增强理论（The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion, TEO），构建川渝农村小学潜在有效且可行的运动干预措施与干预递送方案。

 

3.采用整群随机对照实验研究设计，将征募到的11所农村小学1546名儿童（四年级=736，五年级=810），以学校为单位，随机分配到实验组或对照组。对实验组（学校=5，学生=765）儿童实施体育教学改进干预。对照组（学校=6，学生=781）儿童接受常规体育教学，不对其施加额外干预。分别于2020年10月和2021年6月进行前测和后测，2020年12月至2021年6月期间为干预实施阶段，其中2021年4月中旬至2021年6月上旬为强化干预阶段。

主要结局为中高强度身体活动水平，采用《儿童身体活动问卷（PAQ-C）》进行评估。次要结局包括身体活动相关心理特征、身体状况、心理状况和社会适应能力。其中，①身体活动相关心理特征包括体育学习兴趣和身体活动自我效能感，分别采用《体育学习兴趣问卷—小学生版》中的积极兴趣维度、和《身体活动自我效能感量表》进行评估。②身体状况为儿童两周呼吸系统疾病患病情况，采用自编问卷进行调查。③心理状况为儿童抑郁情绪，采用《儿童抑郁调查量表—简版》进行评估。④社会适应状况为同伴关系满意度，采用《多维学生生活满意度量表》中的朋友维度进行评估。

使用SPSS软件，主要按照意向性分析集（Intention-To-Treat，ITT），对所有结局变量在学生个体水平进行估计（经检验，本研究数据结构不存在学校水平聚集性），同时，也根据符合方案分析集（Per-Protocol, PP）和修正的意向性分析集（Modified Intention-To-Treat, mITT）进行补充分析。①正态分布的连续性资料采用均数（标准差）进行描述，组间比较通过多重回归模型、采用双重差分法进行分析。即，将结局变量的后测值减去前测值所得的差值作为因变量，组别作为解释变量，儿童基本人口学特征、和结局变量对应的基线测量值作为控制变量进行分析。②分类资料采用频数（构成比）进行描述，组间比较采用卡方检验。

 

4.采用实施科学研究方法，基于实施研究整合框架（Consolidated Framework for Implementation Research, CFIR），对体育教学改进干预项目的干预特征、外部因素、内部因素、个人特征和实施过程进行全面评价。

 

结果

1.横断面调查研究发现：①川渝农村儿童中高强度身体活动水平平均分为2.39分（SD=0.67），体育学习兴趣平均分为3.40分（SD=0.94）。②限制川渝农村儿童身体活动的相关因素有：基本人口学特征——性别、年龄和民族分布，倾向因素——较低的体育学习兴趣，促成因素——部分小学建设落后的运动设施建设。③限制川渝农村儿童体育学习兴趣的相关因素为，薄弱的体育师资与欠佳的体育教学无法激发儿童参与身体活动的内部动机，并无法使儿童的自主需要、能力需要和关系需要在身体活动中得到满足。

 

2.改进体育教学及其相关因素是促进川渝农村儿童中高强度身体活动和体育学习兴趣的潜在有效策略。潜在有效且可行的心理行为改变策略包括：①以中等强度身体活动水平的运动为主，并且，开展基本运动技能训练；②提升身体活动内容的趣味性和多样性；③对儿童即将参与的身体活动类型给予更大的自主选择权；④倡导教师对儿童的身体活动行为进行鼓励和正向引导；⑤身体活动过程中需要进行人际互动与合作。要求每班每周至少实施1节改进后的体育教学干预。具体干预措施为，将趣味性体育游戏元素融入到身体活动中，开展多种多样的团队体育游戏竞赛，如“春种秋收”、“五子棋篮球赛”和“松鼠搬家”等。这些活动以中等强度的身体活动构成，穿插了诸如跑、跳、掷、平衡力等基本运动技能的训练，趣味性强。此外，鼓励儿童在团队中积极讨论赢取比赛的策略，自行选择在小组中承担的游戏角色，引导儿童在游戏过程中相互支持与合作。同时，通过开展教师教学培训、教学观摩研讨会完成干预知识和技能的递送服务，并通过实施教学打卡激励活动促进干预实施。

 

3.整群随机对照实验研究的ITT分析集结果显示，主要结局方面，后测时，两组儿童的中高强度身体活动水平得分均较前测提升，实验组提升比例为6.72%，高于对照组2.68%，但两组提升幅度无统计学差异（P＞0.05）。次要结局方面，后测时，两组儿童的体育学习兴趣得分均较前测上升，实验组提升比例为5.76%，高于对照组5.07%，但上升幅度无组间统计学差异（P＞0.05）。两组的身体活动自我效能感较前测值下降且下降幅度存在组间统计学差异（P＜0.05），实验组的身体活动自我效能感比对照组少下降0.14分（调整均值差95%CI:0.05,0.22）；两组的抑郁症状得分均较前测上升且上升幅度有组间统计学差异（P＜0.05），对照组比实验组多上升0.36分（调整均值差95%CI:-0.64,-0.09）；相较前测，实验组后测时的同伴关系满意度得分上升，对照组下降，两组变化幅度存在组间统计学差异，实验组比对照组少下降0.10分（调整均值差95%CI:0.04,0.15）。实验组儿童两周呼吸系统疾病患病率下降0.92%，对照组上升3.97%，但两组的变化幅度无统计学差异（P＞0.05）。

补充分析部分，PP分析集结果显示，主要结局方面，后测时，两组儿童的中高强度身体活动水平得分均较前测提升，且两组提升幅度存在统计学差异（P＜0.05），实验组比对照组多提升0.07分（调整均值差95%CI:0.01,0.13）。次要结局方面，后测时，两组儿童的体育学习兴趣得分均较前测上升，实验组上升6.56%，高于对照组5.07%，但两组上升幅度无统计学差异（P＞0.05）。两组的身体活动自我效能感较前测值下降，且两组下降幅度存在统计学差异（P＜0.05），实验组的身体活动自我效能感比对照组少下降0.15分（调整均值差95%CI:0.07,0.24）。两组的抑郁症状得分均较前测上升，且两组上升幅度有统计学差异（P＜0.05），对照组比实验组多上升0.39分（调整均值差95%CI:-0.67,-0.10）。相较前测值，实验组的同伴关系满意度后测值上升，对照组下降，两组变化幅度存在统计学差异，实验组比对照组少下降0.10分（调整均值差95%CI:0.04,0.16）。实验组儿童两周呼吸系统疾病患病率下降0.56%，对照组上升3.97%，但两组的变化情况无统计学差异（P＞0.05）。

mITT分析集结果显示，主要结局方面，后测时，两组儿童的中高强度身体活动水平得分均较前测提升，且两组提升幅度存在统计学差异（P＜0.05），实验组比对照组多提升0.29分（调整均值差95%CI:0.22,0.35）。次要结局方面，后测时，两组儿童的体育学习兴趣得分均较前测上升，实验组上升6.04%，高于对照组的5.09%，但两组儿童的上升幅度无统计学差异（P＞0.05）。相较前测值，实验组的身体活动自我效能感后测值上升，对照组下降，两组变化幅度存在统计学差异（P＜0.05），实验组比对照组少下降0.18分（调整均值差95%CI:0.09,0.27）。两组的抑郁症状得分均较前测上升，且两组上升幅度有统计学差异（P＜0.05），对照组比实验组多上升0.45分（调整均值差95%CI:-0.75,-0.15）。相较前测值，实验组的同伴关系满意度后测值上升，对照组则下降，两组变化幅度存在统计学差异，实验组比对照组少下降0.10分（调整均值差95%CI:0.04,0.16）。实验组儿童两周呼吸系统疾病患病率下降1.74%，对照组上升2.94%，但两组的变化情况无统计学差异（P＞0.05）。

 

4.对体育教学改进干预方案实施的影响因素评估后发现，促进实施的因素主要有：①高质量的干预课程基于川渝农村小学体育教育的现实困境，回应了川渝农村儿童提升身体活动水平和体育学习兴趣的客观需要。②干预知识和技能递送的有效性和干预实施的灵活性促进了干预的执行。③项目积极拥护者对教学干预的经验分享对当地教师开展教学干预发挥了示范引领作用。阻碍项目实施的因素包括：轻视体育教学的现象普遍存在；川渝农村小学的体育师资以兼职和非体育专业为主，并时有人事或岗位变动发生。中性因素为因人而异的体育任课教师个人特征。

 

结论

1.（1）川渝农村儿童的中高强度身体活动水平和体育学习兴趣在我国同龄儿童中均处于较低水平。（2）薄弱的体育师资及其开展的质量欠佳的体育教学是形成川渝农村儿童身体活动水平和体育学习兴趣现状的重要原因。

 

2.体育教学改进干预是促进川渝农村儿童中高强度身体活动水平和体育学习兴趣的潜在有效策略。核心干预措施为在心理行为改变策略指导下改进现有体育课程教学的内容与质量。干预知识和技能的递送与促进干预执行由教学培训、教学观摩研讨会和教学打卡激励活动共三个环节构成。

 

3.体育教学改进干预项目能有效改善川渝农村儿童的中高强度身体活动水平、身体活动自我效能感、抑郁症状和同伴关系满意度；并且，干预效果随着干预实施程度的增加而增强。同时，体育教学改进干预有改善儿童体育学习兴趣和两周呼吸系统疾病患病状况的趋势。

 

4.促进项目实施的核心要素分别是建构在理论基础之上能激发儿童运动兴趣的干预课程，良好的干预递送服务设计，以及基于里程碑式的干预目标设定与监管。促进项目实施的可调整要素包括对干预课程内容、干预递送服务以及干预实施过程的本土化适应性改造。厘清和解决干预实施过程中的障碍，优化项目实施相关环节，是成功在川渝农村小学推行该项目、以及将该项目成功推广至中国其他广大农村地区乃至全球其他中低收入地区的关键所在。为了进一步提升干预措施采纳度与干预实施的可持续性，建议完善学校体育教学相关制度建设。

Background

Regular physical activity (PA) contributes to physical and mental health.  The World Health Organization recommends that children and adolescents aged 5~17 cumulatively participate in at least 60 minutes of moderate to- vigorous-intensity physical activity (MVPA) per day. However, Chinese children generally lack MVPA, especially for rural children. Interest in physical activities is the most active and realistic driving factor to promote and maintain students' participation in physical activities. However, Chinese children's interest in physical activities is relatively low, especially for rural children. Schools are ideal places to promote children's physical activity and interest. Therefore, in order to improve rural children's MVPA and interest in physical activities, it is necessary to explore school-based physical activity interventions for rural area. This study takes the rural areas of Sichuan and Chongqing as a pilot study.

Objectives

1. To investigate the status and factors related to MVPA and interest in physical activities among rural children in Sichuan and Chongqing.

2. To explore effective and feasible school physical activity intervention and its implementation for improving rural childen's MVPA and interest in physical activities.

3. To evaluate the effectiveness of the improved physical education teaching intervention in improving MVPA, interest in physical activities, and physical-psychological-social adaptability among rural children in Sichuan and Chongqing.

4. To explore the factors that affect the implementation of the improved physical education teaching intervention.

Methods

Based on a cross-sectional survey of physical activity and interest in physical activity among rural children in Sichuan and Chongqing, this study constructed a school-based physical activity intervention. A cluster randomized controlled trial was conducted to test the effectiveness of school-based physical activity intervention and evaluate the factors that affect the implementation of the intervention (Ethics approval: ChiECRCT20200016, trial registration: ChiCTR200038927).

 

1. A cross-sectional study was conducted to investigate the status of MVPA and interest in physical activities among 901 students grade 4~5 in rural Sichuan and Chongqing, by questionnaire, interview and observation. Qualitative research methods was used to evaluate the related factors of the physical activity interest. Mixed method was used for exploring factors related to the MVPA. Based on the social ecological model, this paper explores the relevant factors of physical activities among students from the dimensions of children's basic demographic characteristics, tendency factors, reinforcement factors and contributing factors. Based on the theory of basic psychological needs and internal motivation, this paper explores the degree of children's enjoyment, and the extent to which children's relatedness, competence, autonomy are met in the physical education.

 

2. Based on the literature review of school-based physical activities and relevant theories, as well as the actual physical education situation in rural Sichuan and Chongqing, exploring the potential effective and feasible school-based physical activity intervention and its implementation for rural primary schools.

 

3. A cluster randomized controlled trial was conducted in 11 rural primary schools in Sichuan and Chongqing. The 1546 students grade 4~5 in 11 schools were randomly assigned to the intervention group or the control group. The children in the intervention group (school=5, students=765) received the improved physical education teaching intervention. The control group (school = 6, students =781) received the regular physical curriculum, without any additional intervention. Pre-test and post-test were conducted in October 2020 and June 2021 respectively. The intervention period is from December 2020 (pre-test) to June 2021 (post-test). The intensive intervention period is from December 2020 to June 2021.

The primary outcome was the overall level of MVPA, which was assessed by Physical Activity Questionnaire for Children (PAQ-C). Secondary outcomes included the level of MVPA in PE class and break, psychological characteristics related to physical activities, physical-psychological-social adaptability. ①The psychological characteristics related to physical activities include the interest in physical activities and physical activity self-efficacy, which were evaluated by the positive interest dimension in the interest questionnaire of physical learning for pupils and the physical activity self-efficacy scale. ②The physical status was the prevalence of respiratory diseases in the past two weeks, which was investigated by the self-made questionnaire. ③The psychological status was children's depressive symptoms, which was assessed the short form of the Children's Depression Inventory. ④Social adaptability was the peer relationship, which was evaluated by the friend dimension of Multidimensional Students’ Life Satisfaction Scale.

All outcome variables were estimated at the student level (after testing, there was no school level clustering of this study) according to the Intention-To-Treat (ITT) analysis set with SPSS (IBM SPSS Statistics 26). Additionally, supplementary analysis was conducted by the PP (Per-Protocol) analysis set and the mITT (Modified Intention-To-Treat) analysis set. ①Normally distributed continuous data are described by mean (standard deviation), and difference-in-difference (DID) was used for comparison between groups by multi-regression analysis. The difference obtained by subtracting the pre-test value from the post-test value of outcome variables was used as the dependent variable, the group was taken as the independent variable, and the children's gender, age, nationality, and the baseline line score of the outcome variable were taken as the control variables. ②Categorical data was described by frequency (constituent ratio), and the comparison between groups was conducted by chi-square test.

 

4. Implementation science research methods was used to explore factors associated with the intervention, which including the intervention characteristics, external factors, internal factors, personal characteristics and implementation process of the improved physical education teaching intervention, by the Consolidated Framework for Implementation Research.

 

Results

1. The cross-sectional study found that the overall level of MVPA among rural children in Sichuan and Chongqing was 2.39 points (standard deviation 0.67), and the interest in physical activities was 3.40 points (standard deviation 0.94). Girls, age, and Han nationality in rural areas of Sichuan and Chongqing, as well as low level of interest in physical activity and outdated sports facilities in some primary schools, have limited their MVPA. Related factors to children's interest in physical activities was that children's enjoyment of physical activities, relatedness, competence, autonom could not be met.

 

2. The potential effective intervention strategy on improving children's MVPA and interest in physical activity is to improve physical education teaching and its related factors. Potential effective and feasible psychological and behavioral change strategies include: ①Conducting Moderate-intensity Physical Activity (MPA) and fundemental moving skill training. ②Enhance the fun and diversity of activities. ③Give children more autonomy in choosing their physical activity types. ④Advocate teachers to encourage children on their physical activity behavior. ⑤Physical activity should include elements of interpersonal interaction and cooperation. Require each class to implement at least one improved physical education teaching intervention per week. The intervention is to integrate sports game elements into physical activities and carry out various team sports game competitions, such as "Spring Seed and Autumn Harvest" and "Squirrel Moving". These activities are composed of MPA, interspersed with basic motor skills such as running, jumping, throwing, and balance training. They are highly entertaining, such as the "Spring Seed and Autumn Harvest" activity, which is accompanied by music and simulates agricultural activities such as sowing and harvesting. It combines jumping, squatting, and running movements to provide physical activity training for children. In addition, encourage children to actively discuss strategies for winning competitions in the team, choose their own game roles to play in the group, and guide children to support each other and cheer for each other during the game process. What is more, intervention skills delivery will be completed by teaching training and seminars. Promoting intervention implementation through the incentive activities.

 

3. The results of the ITT analysis set of the cluster randomized controlled trial found that, the post scores of the MVPA in both groups were improved compared to the pre test, but there was no statistically significant difference in the change of the two groups (P>0.05). The interest in physical activity in both groups increased compared with those in the pre-test, but there was no statistical difference in the change of the two groups (P > 0.05). The physical activity self-efficacy of the experimental group decreased by 0.14 points (adjusted mean difference 95% CI: 0.05,0.22) less than that of the control group (P < 0.05).The post scores of depressive symptoms in both group increased compared with those in the pre-test, and the increase range was statistically different (P < 0.05) between the two groups, the control group increased by 0.36 points more than the experimental group (adjusted mean difference 95% CI: - 0.64, - 0.09). There was statistical difference between the two groups in the change of peer relationship (P < 0.05), and the control group decreased by 0.10 points more than the experimental group (adjusted mean difference 95% CI: 0.04,0.15). There was no statistical difference in the two-week prevalence of respiratory diseases between the two groups (P > 0.05).

The results of the PP analysis set showed that, the post scores of the MVPA in both group increased compared with those in the pre-test, and the increase range was statistically different (P < 0.05) in the two groups, the experimental group increased by 0.07 points more than the control group (adjusted mean difference 95% CI: 0.01, 0.13).

According to the PP analysis set, the post scores of the MVPA in both group increased compared with those in the pre-test, and the increase range was statistically different (P < 0.05) in the two groups, the experimental group increased by 0.07 points more than the control group (adjusted mean difference 95% CI: 0.01, 0.13). The interest in physical activity in both groups increased compared with those in the pre-test, but there was no statistical difference in the change of the two groups (P > 0.05). The physical activity self-efficacy of the experimental group decreased by 0.15 points (adjusted mean difference 95% CI: 0.07,0.24) less than that of the control group (P < 0.05). The post scores of depressive symptoms in both group increased compared with those in the pre-test, and the increase range was statistically different (P < 0.05) between the two groups, the control group increased by 0.39 points more than the experimental group (adjusted mean difference 95% CI: - 0.67, - 0.10). There was statistical difference between the two groups in the change of peer relationship (P < 0.05), and the control group decreased by 0.10 points more than the experimental group (adjusted mean difference 95% CI: 0.04,0.16). There was no statistical difference in the two-week prevalence of respiratory diseases between the two groups (P > 0.05).

The results of the mITT analysis set showed that, the post scores of the MVPA in both group increased compared with those in the pre-test, and the increase range was statistically different (P < 0.05) in the two groups, the experimental group increased by 0.29 points more than the control group (adjusted mean difference 95% CI: 0.22, 0.35). The interest in physical activity in both groups increased compared with those in the pre-test, but there was no statistical difference in the change of the two groups (P > 0.05). The physical activity self-efficacy of the experimental group decreased by 0.18 points (adjusted mean difference 95% CI: 0.09,0.27) less than that of the control group (P < 0.05).The post scores of depressive symptoms in both group increased compared with those in the pre-test, and the increase range was statistically different (P < 0.05) between the two groups, the control group increased by 0.45 points more than the experimental group (adjusted mean difference 95% CI: - 0.75, - 0.15). There was statistical difference between the two groups in the change of peer relationship (P < 0.05), and the control group decreased by 0.10 points more than the experimental group (adjusted mean difference 95% CI: 0.04,0.16). There was no statistical difference in the two-week prevalence of respiratory diseases between the two groups (P > 0.05).

 

4. After evaluating the influencing factors of the implementation of the intervention plan for improving physical education teaching, it was found that, ① the factors promoting implementation include: ① high-quality intervention courses based on practice of physical education in rural primary schools in Sichuan and Chongqing, responding to the objective needs of rural children in Sichuan and Chongqing to improve their physical activity and interest. ② The effectiveness of intervention knowledge and skill delivery and the flexibility of intervention implementation. ③The experience sharing of active supporters of the project has played a leading role for local teachers. The factors that hinder project implementation include: the widespread phenomenon of neglecting physical education, the physical education teachers in rural primary schools in Sichuan and Chongqing are mainly part-time and non sports majors, and there are occasional personnel or job changes. Neutral factors are individual characteristics of physical education teachers which vary from person to person.

 

Conclusions

1. (1) The interest in medium to high intensity physical activity and physical education learning among rural children in Sichuan and Chongqing is at a relatively low level among children of the same age in China. (2) Weak physical education teachers and poor quality physical education teaching are  important factors related to the physical activity level and interest in physical education learning of rural children in Sichuan and Chongqing.

 

2. Improving physical education teaching is a potential effective strategy to promote MVPA and interest in physical activity among rural children in Sichuan and Chongqing. The core intervention is to improve the existing physical education curriculum under the guidance of psychological and behavioral change strategies. The intervention delivery and implementation consist of three stages: teaching training, teaching observation seminars, and incentive activities.

 

3. The physical education teaching improvement intervention can effectively improve children's MVPA, self-efficacy of physical activity, depressive symptoms and peer relationship satisfaction. Moreover, the intervention effect increases with the enhancement of implementation. At the same time, there is a trend of improving children's interest in physical activity and alleviating the two-week prevalence of respiratory diseases.

 

4. The core elements to promote the implementation are respectively the intervention curriculum that can stimulate children's sports interest based on theory, the intervention delivery service design with multiple measures, the intervention goal setting and supervision based on milestone. The adjustable elements that promote project implementation include localizing and adapting the intervention course content, intervention delivery services, and intervention implementation process. The key to successfully implementing the project is to clarify and solve the obstacles in the intervention implementation. In order to enhance the adoption of sustainability of intervention implementation, it is recommended to improve the construction of school physical education teaching related systems and recognize the achievements of teacher physical education teaching.