Open Access Highly Accessed Study protocol

Physical activity and academic achievement across the curriculum (A + PAAC): rationale and design of a 3-year, cluster-randomized trial

Joseph E Donnelly19*, Jerry L Greene2, Cheryl A Gibson3, Debra K Sullivan4, David M Hansen5, Charles H Hillman6, John Poggio5, Matthew S Mayo7, Bryan K Smith8, Kate Lambourne1, Stephen D Herrmann1, Mark Scudder6, Jessica L Betts1, Jeffery J Honas1 and Richard A Washburn1

Author Affiliations

1 Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

2 Department of Health, Sport, and Exercise Science, The University of Kansas, 1301 West Campus Road, Lawrence, KS, 66045, USA

3 Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

4 Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

5 Department of Psychology and Research in Education, The University of Kansas, 1122 West Campus Road, Lawrence, KS, 66045, USA

6 Department of Kinesiology and Community Health, The University of Illinois Urbana-Champaign, 906 South Goodwin, Urbana, Il, 61801, USA

7 Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

8 Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Vadalabene Center, Box 1126, Edwardsville, IL, 62026, USA

9 The University of Kansas-Lawrence, Robinson Center, Rm. 100, 1301 Sunnyside Avenue, Lawrence, KS, 66045, USA

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BMC Public Health 2013, 13:307  doi:10.1186/1471-2458-13-307

Published: 8 April 2013



Improving academic achievement and reducing the rates of obesity in elementary school students are both of considerable interest. Increased physical activity during academic instruction time during school offers a potential intervention to address both issues. A program titled “Physical Activity Across the Curriculum” (PAAC) was developed in which classroom teachers in 22 elementary schools were trained to deliver academic instruction using physical activity with a primary aim of preventing increased BMI. A secondary analysis of data assessed the impact of PAAC on academic achievement using the Weschler Individual Achievement Test-II and significant improvements were shown for reading, math and spelling in students who participated in PAAC. Based on the results from PAAC, an adequately powered trial will be conducted to assess differences in academic achievement between intervention and control schools called, “Academic Achievement and Physical Activity Across the Curriculum (A + PAAC).”


Seventeen elementary schools were cluster randomized to A + PAAC or control for a 3-year trial. Classroom teachers were trained to deliver academic instruction through moderate-to-vigorous physical activity with a target of 100+ minutes of A + PAAC activities per week. The primary outcome measure is academic achievement measured by the Weschler Individual Achievement Test-III, which was administered at baseline (Fall 2011) and will be repeated in the spring of each year by assessors blinded to condition. Potential mediators of any association between A + PAAC and academic achievement will be examined on the same schedule and include changes in cognitive function, cardiovascular fitness, daily physical activity, BMI, and attention-to-task. An extensive process analysis will be conducted to document the fidelity of the intervention. School and student recruitment/randomization, teacher training, and baseline testing for A + PAAC have been completed. Nine schools were randomized to the intervention and 8 to control. A random sample of students in each school, stratified by gender and grade (A + PAAC = 370, Control = 317), was selected for outcome assessments from those who provided parental consent/child assent. Baseline data by intervention group are presented.


If successful, the A + PAAC approach could be easily and inexpensively scaled and disseminated across elementary schools to improve both educational quality and health. Funding source: R01- DK85317. Trial registration: US NIH Clinical Trials, http://NCT01699295 webcite.

Physical activity; Children; Academic achievement; Cluster-randomized trial; Cognitive function; Fitness; Attention to task