The Southeast Colorado PE Academy: Implementation and Outcomes in Rural Elementary Schools, 2014-16

This paper describes the implementation and outcomes of the Southeast Colorado Physical Education Academy (SECPEA). The SECPEA intervention aimed to improve the quality of physical education taught by 21 teachers in 19 rural schools in Southeast Colorado over a two-year period by supporting the implementation of an enhanced physical education program (EPE). The System for Observing Fitness Instruction Time was used to evaluate the effectiveness of the intervention at baseline, post year one, and post year two. Post year one, a moderate and significant increase was observed in overall MVPA% per lesson. The largest increase was observed in the MVPA% during the first five minutes of lessons. Significant increases were also observed in girls’ MVPA% and for teacher promotion of MVPA. Post year two, significant positive increases were observed in the percentage of vigorous physical activity and energy expenditure rate. The SECPEA was a successful model for implementation of an EPE. Continued testing of the model in diverse settings is warranted.


Introduction
Prevention of childhood obesity is an important public health priority. The prevalence of obese children increased from 4% to 18% worldwide since 1975 (WHO, 2018a), and currently nearly 20% of the United States (U.S.) children Advances in Physical Education poverty region from 2011-2013 as part of the Healthy Eaters, Lifelong Movers (HELM) project. HELM was comprised of two main components including Assess-Identify-Make it Happen (AIM) and the SLVPEA. While AIM was an evidence-based intervention for realizing environmental and policy changes to increase physical activity and healthy eating in schools (Belansky et al., 2013), the primary goal of the SLVPEA was to improve the quality of physical education in participating schools by supporting the successful implementation of an EPE program. The SLVPEA resulted in significant gains in MVPA% and improvements in time devoted to fitness, skill practice, and time management in physical education (Belansky et al., 2016).
While the SLVPEA demonstrated effectiveness, it was only tested in one rural region. McKenzie and colleagues (2016) have suggested that what works in one region may not work in another. Thus, more research is needed to assess the effectiveness of models like the SLVPEA in other contexts that differ in regards to ethnicity, geography, extent to which districts share resources, and access to physical activity opportunities outside of schools.
From 2014-16, researchers implemented HELM in Southeast Colorado including AIM and the PE Academy components. Similar to the SLVPEA, the primary aim of the Southeast Colorado PE Academy (SECPEA) was to improve the quality of physical education in the region by attempting to replicate the SLVPEA. The intent was to implement the same components (i.e., SPARK curricular resources, equipment, professional development workshops, and site support) as the SLVPEA, but with some modifications to accommodate implementation in a much larger, decentralized geographic region with different teachers in different schools and by different personnel (i.e., different perspectives and expertise). The purpose of this paper is to describe the implementation of the SECPEA and the extent to which the SECPEA led to improvements in the quality of physical education post year one and post year two. The study was guided by the following research questions: 1) To what extent did the SECPEA lead to increased MVPA% and higher quality instruction (i.e., changes in lesson context % and teacher promotion of MVPA) post year one?
2) To what extent did the second year of the SECPEA lead to additional changes in MVPA, lesson contexts, and teacher promotion of MVPA?

Methods
The study protocol and Memorandum of Understanding (MOU) were approved by the Colorado Multiple Institutional Review Board.

Eligibility and Recruiting
All public schools in the region that offered grades K-6 were eligible to participate in HELM (i.e., the SECPEA and AIM). Recruiting was accomplished via phone or email. Schools could choose to participate in the SECPEA and AIM components simultaneously or could choose to participate in one component or the other as a stand-alone intervention. Principals were presented with a detailed Memorandum of Understanding (MOU) to explain the goals, expectations, and benefits of participation. Schools that agreed to participate in the SECPEA were provided with SPARK curricular resources, equipment for implementing SPARK, professional development, and site support from a trained master teacher up to two times per month. Physical education teachers agreed to implement SPARK in at least one grade level in year one and at least one additional grade level in year two. They also agreed to attend four two-day SPARK workshops over the two-year period and additional SPARK booster sessions and workshops to support implementation of SPARK and physical education curriculum enhancements in their school. Principals were encouraged to attend professional development workshops and agreed to meet with master teachers monthly. Lastly, schools agreed to participate in annual data collection including completing principal and teacher surveys and allowing observations of physical education lessons. 64% of students participating in free and reduced meal programs. Ten of the schools offered lower and upper primary grades (e.g., PK-6th grade), five offered lower primary grades (PK-2nd grade) or upper primary grades (3 -6th grade), one school offered PK-8th grades, and three schools offered grades K-12. A community-based participatory approach was used to build relationships, grow support for the project, and shape the SECPEA (Israel et al., 2010). Awareness raising began in early spring 2014 when key stakeholders were invited  A cadre of wellness training specialists lead booster workshop related to technology and best practices related to high quality physical education  Two master teachers from SLVPEA receive SPARK Train the Trainer certification to build capacity for sustainability initiatives to participate in an initial planning meeting. These stakeholders represented different levels of influence and included regional superintendents, principals, physical education teachers, school nurses, and public health practitioners. After the initial planning meeting, stakeholders were invited to participate on the HELM steering committee which met quarterly over the two-year project. The steering committee was instrumental in helping form positive and supportive relationships in the region and played an important advisory role related to implementation and evaluation of the SECPEA over the two-year period.

PE Academy Intervention
In year one (Fall 2014-Spring 2015), two master teachers provided site support to principals and physical education teachers. In year two (Fall 2015-Spring 2016), as we discuss later in the paper, site support was scaled back to one master teacher due to unexpected changes in personnel. In spring 2016, the focus of the project shifted to sustainability initiatives to build local capacity for professional development and allow teachers to take ownership over quality physical education in the region. Two sustainability strategies were used: in spring 2016, a cadre of wellness training specialists provided a workshop on instructional technology; and in fall 2017, two master physical education teachers from the original SLVPEA, who were certified as SPARK Regional Trainers, provided a booster session on SPARK PE.

Rubric for High Quality Physical Education
The original SLVPEA rubric for "High Quality Physical Education" which defined characteristics and indicators of high quality physical education was introduced to principals and teachers during the initial "happy visit" (Belansky et al., 2016). Master teachers referred to the rubric during subsequent site support visits with principals and physical education teachers. For the SECPEA, the original rubric was modified by splitting skill instruction and assessment into two distinct categories. Table 3 identifies the eight categories, lists the total number of indicators for each, and provides keywords for indicators of quality physical education by category.

SPARK Curricular Resources and Equipment
All SECPEA schools received the SPARK K-2 and 3 -6 curricula including SPARK Folios and access to SPARK Family online resources. Schools also received sufficient equipment for implementing the complete SPARK curriculum.
Equipment packages were distributed in sets of 12 and the total package per school was based on the largest class size offered with a limit of up to 36 students. Including curricular resources, online access, and equipment the cost was approximately $5,500 -$10,500 per school and varied due to differences in class size among schools (average = $9,936 per school; data not shown).  Two additional professional development workshops were led by a cadre of wellness training specialists from the SLVPEA in year two. The topics of these workshops were related to instructional technology (Day 1) and highly effective physical education practices (Day 2). Teacher participation in all professional development workshops was supported by paying for substitute teachers and a one-night hotel stay for teachers traveling greater than 75 miles one way, and reimbursing mileage.

Site Support
In year one, two master teachers were hired to provide site support to the 21 teachers participating in the SECPEA. At the time of being hired, the master teachers held teaching positions in nearby schools. Both had master's level degrees, were up to date with current best practices, and had strong track records as effective physical education teachers. In year two, both master PE teachers left their positions and a third master teacher was hired to provide site support to all the PE teachers. This master PE teacher was a long-time resident of the community, retired, and well respected among coaches and PE teachers across the re- The goal of site support visits was to promote teachers' growth by supporting SPARK implementation, curriculum development, and application of pedagogical strategies associated with high quality physical education, and provide strategies to advocate for quality physical education (i.e., the link between physical activity and academic achievement). Master teachers accomplished this goal by helping teachers unpack the SPARK curriculum and equipment, observing teacher practices, and co-teaching and/or modeling best practices during visits. Master teachers observed one to three lessons per visit and met with the physical education teacher afterwards for a 30 -45 minute reflective debrief conversation. Master teachers led with positive feedback and encouraged teachers to identify the lessons' strengths and opportunities for improvement. Teachers were encouraged to have a growth mindset, to take a leadership role in reflective conversations, and to set personal goals for improvement. Table 4 lists the scope and sequence of site support meetings delivered by master teachers. In year one, the master teachers provided site support to every physical education teacher 8 -9 times and met with every principal four times. Master teachers followed the scope and sequence in fall 2014 (i.e., visits 1 -4); however, in spring 2015 they tailored the focus depending on the needs of each teacher. The tailored approach provided the master teacher with greater flexibility to make choices on the meeting content based on the progress of each teacher. Tailoring allowed master teachers to slow down with teachers who were less experienced and accelerate with teachers who were more experienced. In year two, teachers received 2 -5 visits from one master teacher but no principal visits were held. The tailored approach was also utilized in year two.

Data Collection: Outcome Measurement
The System for Observing Fitness Instruction Time (SOFIT) was used to describe physical education lessons at baseline, post year one, and post year two. SOFIT assesses physical activity, lesson contexts, and teacher interactions during physical education lessons (McKenzie, 2015). SOFIT is frequently cited in studies of physical education and its utility, validity, and reliability are well documented in peer-reviewed studies conducted in the U.S. (McKenzie & Smith, 2017) and international schools (Smith et al., 2019). A detailed protocol and standardized training videos are publicly available for no cost and explain the tool's utility and methods for conducting observations (McKenzie, 2015).
SOFIT is a systematic observation tool that uses momentary time sampling methods to simultaneously record physical activity levels (i.e., lying, sitting, standing, walking, vigorous), lesson context (i.e., management, knowledge, fitness, skill practice, game play, and other), and teacher promotion of MVPA (i.e., promotion "in" PE, promotion "out" of PE, or no promotion observed). Four students are randomly selected and observers are paced by an audio prompt at a 10-seconds observe and 10-seconds record pace. The physical activity level of the  number of boys and girls present (i.e., class size), and the apparent gender of each target student observed (i.e., male, female). atypical days (e.g., shortened, modified, or cancelled lessons).

Observation Training
Two data collectors were certified prior to the start of data collection at baseline

Data Collection: Physical Education Teacher Survey
Physical education teachers completed a brief survey prior to the start of the intervention. The survey was conducted electronically. The purpose was to collect basic information about each teacher in relation to their educational background, years of experience, involvement in professional organizations, current job duties, and overall perceptions about their physical education program.

Data Analyses
All analyses were completed using Statistics Analysis Software (SAS/STAT) Version 9.3 for Windows; Copyright © 2002-2010 SAS Institute Inc. The unit of analyses was teacher (i.e., average lesson profile per teacher). The analyses were limited to teachers who completed a survey prior to the start of intervention and were observed (i.e. SOFIT observations) at baseline (n = 21), post year one (n = 21), and at post year two (n = 16). Means and standard deviations were used to describe continuous variables and percent frequency was used to describe categorical variables of interest. Average lesson profiles were created for teachers during each observation period (i.e., baseline, post year one, post year two). Lesson summaries were created by summing total intervals for all physical activity, lesson context, and teacher promotion of MVPA variables. MVPA was computed by summing moderate and vigorous intervals. Minutes were computed by multiplying the sum for all physical activity and lesson context variables by 1/3. Percentages were computed by dividing the total intervals observed for individual variables by the total intervals observed in the lesson and multiplying by 100. Energy expenditure rate and total energy expenditure were computed using conversion factor estimations for energy cost ( (Cohen, 1988) assessed the significance (i.e., p value) and magnitude (i.e., effect size) of changes in dependent variables of interest between baseline and post year one, and between post year one and post year two. Teacher was selected as a random effect and observation period was selected as a fixed effect in the regression model. This accounted for repeated measures on teachers and allowed us to include five teachers who were not evaluated at the end of year two. The five teachers without SOFIT data at the end of year two were not included in year one vs year two Cohen's d calculation because Cohen's d requires matched observations (Cohen, 1988). Significance was established at p < 0.05 and effect sizes (i.e., Cohen's d) were interpreted as 0.2 small, 0.5 medium, and 0.8 large. Table 5 presents the results for SOFIT observations at baseline, post year one, and post year two.

Research Question One
To what extent did the SECPEA lead to increased MVPA% and higher quality instruction (i.e., changes in lesson context % and teacher promotion of MVPA) post year one?

Research Question Two
To what extent did the second year of the SECPEA lead to additional changes in MVPA, lesson contexts, and teacher promotion of MVPA?

Discussion
For more than 20 years researchers have attempted to develop effective interventions for increasing health-enhancing MVPA in school environments, and while several EPE programs have demonstrated effectiveness (Lonsdale et al., 2013), models for successful dissemination are needed, especially in undeserved rural schools. It is important to test models in a variety of settings in order to learn more about how to effectively disseminate and implement EPE. Our goal was to implement the PE Academy in 19 schools with 21 teachers in a large rural region of Southeast Colorado (i.e., the SECPEA). We elaborate on the potential of the PE Academy model, describe modifications related to site support, and suggest implications of the results for future efforts to disseminate EPE programs in the discussion.

The Potential of the PE Academy Model
There is evidence that the PE Academy model is effective for increasing health-enhancing MVPA. In the SECPEA, MVPA% and VPA% increased significantly in years one and two respectively (Table 5). By the end of year two, students engaged in MVPA% for nearly 65% of lesson time including 28.1% VPA. They accumulated more than 20 minutes of MVPA, one-third of the daily MVPA recommendation. These results are promising and illustrate why EPEs are essential.
The results from the SECPEA compare favorably with other U.S. studies. Students in both Academies accumulated similar amounts of MVPA (20.3 minutes SECPEA vs 21.5 minutes SLVPEA). Overall MVPA% increased in both Academies (∆ + 8.8 MVPA% SECPEA vs ∆ + 16.2 MVPA% SLVPEA), but was nearly twofold greater in the SLVPEA (i.e., Belansky et al., 2016). The MVPA outcomes of both Academies are higher than other interventions in elementary school physical education which reported between 50% -53% MVPA at outcome (Lonsdale et al., 2013). These findings suggest that efforts to replicate the PE Academy model would be worthwhile.
Teachers attempted to change their instructional practices by applying lessons learned from professional development workshops and site support visits.
MVPA% increased ∆ + 21.1% during the first five minutes of lessons overall (Table 5), slightly less than the SLVPEA (∆ + 22.6%). Together these results illustrate that the PE Academy model has been highly successful in motivating teachers to change their practices at the start of lessons. The increases imply that teachers were engaging students in "activity as soon as possible" (ASAP), dynamic warm-up, and/or using high activity management strategies, although the SOFIT data fall short of identifying specific strategies that were employed, and we did not analyze MVPA during lesson contexts. There is also evidence that the learning environment was becoming more supportive of MVPA. Girls' MVPA% and teacher promotion of MVPA increased in year one (Table 5). The significant increases in VPA% and EER post year two (Table 5) imply that teachers were improving lesson design and engaging students in activities with greater potential to improve fitness longer-term, although it is unclear if fitness was disguised (e.g., fun activities vs. running laps).
There was weaker evidence that the SECPEA inspired significant and sizable changes in how time was spent in lesson contexts (Figure 1) although the positive trends imply a greater emphasis on fitness and it appears that teachers were more prepared and used time more efficiently. However, in comparison, the SLVPEA resulted in a greater number of statistically significant changes in lesson context time (e.g., less free play, more skill practice, less management; Belansky et al., 2016).

Site Support Modifications
Like the San Luis Valley Physical Education Academy, the SECPEA brought an ting. Both Academies sought to achieve similar outcomes (i.e., increases in MVPA%, changes in lesson context % and increases in teacher promotion of MVPA) by implementing the same components (i.e., SPARK curricular resources, equipment, professional development workshops, and site support) and using the same observation tool to assess outcomes. However, there was a substantial difference between the delivery of the SECPEA and the SLVPEA, particularly related to site support (e.g., tailoring of site support in the SECPEA, scope and sequence of visits) which we elaborate on below. Table 6 compares the SECPEA and the SLVPEA interventions (i.e., scale, personnel, adoption process, and intervention components). Decisions related to the delivery of the site support component were largely influenced by the size of the region and logistics related to the coordination and expertise of personnel (e.g., proximity and familiarity with teachers in the region). Table 6 illustrates that the SECPEA region was nearly twice as large as the SLVPEA region (41,352 km 2 vs. 21,207 km 2 ), but the intervention was administered with fewer personnel (i.e., no project manager and only one master teacher in year two). The exact implications of modifying site support are not precisely clear; however, arguably, modifications played a role in shaping the outcomes of the SECPEA and the lessons learned have implications for future interventions and iterations of the PE Academy.
Challenges emerged with staffing over the two-year project that undoubtedly influenced delivery of the site support component. One master teacher was a veteran teacher from the northeast region of Colorado. The other master teacher was less experienced, but had closer proximity to the region. The travel demands were high in year one given the size of the region and lack of master teacher proximity to schools. At the end of year one, one of the master teachers returned to his teaching position in northeast Colorado due to the end of his one-year leave of absence, the other master teacher moved away from the area when his spouse obtained a job elsewhere, and the project manager took a position in an educational foundation out of state. In year two, a new master teacher was hired from the region, but site support was scaled back considerably to make the workload more feasible for him. The project manager wasn't replaced and one of the principal investigators took on those responsibilities. This new configuration of personnel resulted in modifications to the scope and sequence of the site support component.
Three modifications to the SECPEA in year one likely influenced the smaller magnitude and number of significant changes in comparison to the SLVPEA. First, more time was dedicated to relationship building at the start of the intervention because, unlike in the SLVPEA, the master teachers were unfamiliar with most teachers and schools in the region. This may have delayed teacher progress in year one and may explain why there were fewer significant changes post year one because master teachers did not attempt to intervene on practices   Belansky et al., 2016. until later in fall of 2014. Second, master teachers adopted the tailored approach in the second half of year one and thus had greater flexibility in making choices on the topics that would be covered. They could slow down or speed up depending on the performance and goals of the teacher. This introduced variability in the focus of site support visits between teachers. Third, the site support component was scaled down resulting in fewer site support visits in years one and two. The modifications to site support resulted in changes to the scope and sequence of content in meetings with teachers and principals and altered how each category of the rubric for "high quality physical education" was addressed in the intervention. The SLVPEA teachers received site support on each category of the rubric systematically but the SECPEA teachers received less exposure to the rubric and the site support intervention due to the scaling back of site support in year two. The SLVPEA did not use a tailored approach until after all teachers had received 11 visits in year one. As a result, there was much greater consistency in the site support provided to teachers in the SLVPEA compared to those in the SECPEA.
Some modifications in site support were also attributed to challenges with coordinating master teacher and physical education teacher schedules. As shown in Table 1, teachers in the SECPEA spent an average of 54% of their day teaching physical education (SD = 27.4%), were responsible for an average of 3.0 duties (SD = 0.9) including teaching physical education, and taught 6 -7 grade levels in physical education (SD = 3.2). These data illustrate how busy some teachers were and have implications for the amount of time teachers had to prepare. In some cases, teachers mentioned it was difficult to balance all their duties while also being responsible for engaging in the SECPEA and attempting to make changes to their physical education program and practices. one-third of the daily requirement for MVPA in physical education, it is easy to make a case for expanding elements of the model to target other physical activity opportunities in the school day (e.g., classroom brain boosters, recess, before, and after-school opportunities). If future efforts include other physical activity opportunities, support from classroom teachers and principals will be important in order to maximize MVPA outcomes beyond physical education. This would be a worthwhile investment given the benefits associated with regular participation and meeting guidelines for MVPA (e.g., healthy growth and development and academic achievement).

Implications for Future Dissemination Efforts
The study's results also have implications for providing site support and professional development to physical education teachers. It appears that modifications to site support in terms of the number of visits and modifications to the tive in the SECPEA, and in consideration of the effectiveness of the SLVPEA, the results suggest that it may be more effective for master teachers to deliver site support uniformly while they build their own skills. Perhaps tailored approaches to site support can be more successful once master teachers have greater mastery in their role and once relationships with teachers are more firmly established.

Limitations
The results of this study were limited to the observations of 21 teachers from 19 small remote rural schools and may not generalize to other settings. Observations were limited to what data collectors could see and hear. We did not conduct analyses of how active students were during each lesson context. This limited our ability to know precisely how teacher practices changed when students were engaged in MVPA and VPA (e.g., first five minutes of lessons). The lack of significant findings may have been influenced by lack of statistical power due to attrition of five teachers post year two. There was a ceiling effect for MVPA% at baseline which was much greater than the 36% -37% MVPA commonly reported in studies of elementary physical education (McKenzie et al., 1995). This ceiling effect may be due to reactivity which is commonly reported as a limitation of observation research. Teachers and students may have reacted to observers by changing their behavior. In this study, it was challenging to employ strategies to minimize reactivity given the large region (41,352 km 2 ) and the ethical obligation to communicate with teachers for scheduling observations).
Due to the size of the region and the distance traveled by observers to conduct SOFIT observations teachers knew when SOFIT observers were coming.

Conclusion
The PE Academy has now demonstrated effectiveness in two different rural settings. The results illustrate the EPE's potential to contribute to public health goals for MVPA (i.e., one third of the daily recommendation). The results also highlight the importance of continuing to study implementation of EPE across a broad range of contexts (e.g., culturally and ethnically diverse settings). Future efforts to replicate the model should consider both place (e.g., size and culture of the region) and implementation strategies (e.g., the expertise and deployment of master PE teachers, the standardization versus tailoring of site support). Lastly, it would be worth conducting studies that use the Consolidated Framework for Implementation Research as a rubric to identify the contextual factors that facilitate and/or inhibit successful dissemination and implementation of EPEs (Damschroder et al., 2009). Findings from those studies will speed up the process of successfully implementing EPEs across diverse settings.