Daniel Berglind

Research problem and specific questionsMore than half of Swedish schoolchildren do not meet the physical activity guidelines, which will have long-lasting effects on their health in adulthood. The school environment plays a crucial role in establishing healthy physical activity behaviors for a population. By reconstructing physical activity promoting schoolyards with greenery, physical activity levels among children can be increased at the population level and also mitigate health and environmental risks resulting from rising climate changes in urban areas. Research questions:How does schoolyard reconstruction affect physical activity levels, blood pressure, BMI, mental health and sleep in schoolchildren?Which components of schoolyard reconstruction are associated with changes (if any) in physical activity levels, blood pressure, BMI, mental health and sleep in schoolchildren?Are there components in the schoolyard reconstruction that affect the health outcomes of girls and boys differently?What would be the cost-effectiveness of schoolyard reconstruction on the physical activity and health outcomes of school children, and its impact on the microclimate and CO2-emissions in urban areas, if the project would be extended to other schools in Stockholm, and possibly Sweden as a whole? Data and MethodThe project will be designed as a quasi-experimental stepped-wedge trial, with schools serving as both intervention and control schools. Over the course of four years (2024-2027), a total of 20 schoolyard reconstructions will be evaluated, with five reconstructions per year. This project will include second and fifth grade children, totaling 3 600 children. Societal Relevance and UtilizationThe majority of schoolyards in Stockholm lack appealing play areas and are instead dominated by concrete and asphalt surfaces. As school participation is not segregated by socioeconomic factors, schoolyard reconstructions that promote physical activity can benefit children from all socioeconomic groups. Additionally, reconstructing schoolyards with greenery can mitigate health and environmental risks associated with increasing climate changes in urban areas. Plan for Project RealizationA formal decision has been made by the City of Stockholm to reconstruct 20 Stockholm public schoolyards from 2024 to 2027. The proposed project is a co-creation effort between the City of Stockholm, Cancerfonden, Arwidssonstiftelsen and Karolinska Institutet evaluating the effects of this decision.

BackgroundThe school environment plays a crucial role in establishing healthy physical activity behaviors for a population. Unfortunately, most schoolyards in Stockholm lack appealing play areas and sun protective areas and are instead dominated by concrete and asphalt surfaces. Reconstructing schoolyards with greenery is a promising primary prevention strategy to increase physical activity levels among children at the population level and mitigate environmental risks resulting from increasing climate changes in urban areas.Project aimsIncrease physical activity levels among school children, independent of socioeconomic factorsEstablish an evidence-based bottom-up approach for schoolyard reconstructionsEvaluate the cost-effectiveness of schoolyard reconstructions with greenery on health outcomes and its environmental impact Methods A formal decision has been made by the City of  Stockholm to reconstruct 20 Stockholm public schoolyards from 2024 to 2027. This project is a co-creation effort between the City of Stockholm, Cancerfonden, Arwidssonstiftelsen and Karolinska Institutet evaluating the effects of this decision. The project will be designed as a stepped-wedge trial, with schools serving as both intervention and control schools. Over the course of 4 years, a total of 20 schoolyard reconstructions will be evaluated, with 5 reconstructions per year. The units of observation will be second and fifth grade children, totaling 3,600 children.

This is a co-creation project between the City of Stockholm, Cancerfonden, Arwidssonstiftelsen and Karolinska Institutet with the aim to establish an evidence-based approach for schoolyard reconstruction and investigate how schoolyard reconstructions influences physical activity levels and wellbeing among school children.The following research questions will be addressed:What is the causal effect of schoolyard reconstruction on the physical activity, wellbeing and sick leave of school children?What components in the schoolyard reconstruction interventions are associated with school children’s changes (if any) in physical activity, wellbeing and sick leave?The project will be designed as a non-randomized intervention with two conditions: intervention schools (schoolyard reconstruction) and control schools (no schoolyard reconstruction). Units of observation will be 2ndand 5th grade children (in total 3,600 children.The schoolyard reconstruction intervention components will all include greening but vary by the school (e.g., increase schoolyard size etc.), reflecting the local needs. In total, five schoolyard reconstructions per year in Stockholm public schools, will be included in the project during the years 2022-2025 (in total 20 schools).This project has the potential to improve physical activity and markers of health in children, across all socioeconomic groups, and perhaps population health in the long run, by physical activity promoting schoolyard reconstructions.