Qualitative measures.

A qualitative approach is regarded the most suitable methodology in exploring barriers and facilitators of programme implementation[39]. In order to explore the primary aim of this research study, semi-structured 1:1 interviews with headteachers and teachers and focus groups with pupils were employed to gain an insight into implementation and experience of TDM in the primary school setting. This consisted of focus groups with pupils at baseline (n = 2) and follow-up (n = 4), 1:1 interviews with teachers at baseline (n = 3) and follow-up (n = 6) and 1:1 interviews with headteachers at follow-up (n = 2). A further breakdown of interviews and focus group participation by school can be found in the supporting information (S2 Appendix). Interviews with headteachers and teachers were conducted by one researcher during the school day either by telephone or face to face on the school premises according to individual preference. Pupil focus groups were completed during the school day within a private room at the school setting, with two researchers present. The lead researcher (EM) was female and had previous experience in conducting interviews and focus groups with both adults and children in the field of school-based research. The researchers ensured that interviews and focus groups were conducted with minimal disruption to the school day and at a time that was convenient for teachers and pupils.

Each focus group was conducted by year group and consisted of between six and eight pupils[40] aged 9–11 years of mixed physical activity ability and gender. Class teachers were provided with a list of consented pupils and selected pupils fulfilling this criteria. Teachers were reminded of the need to include pupils of a range of physical activity abilities. This list was discarded following selection of pupils and a final list of pupils participating in focus groups was not recorded to ensure anonymity. All interviews and focus groups followed a semi-structured topic guide, initially developed by EM and CT and reviewed by SB to address the qualitative research aims. In order to explore participants’ experiences of TDM, it is important to consider the barriers, facilitators and factors affecting sustainability. These factors are consistently included in other research evaluating school-based interventions, and therefore framed the topics guides for this study[33]. The use of semi-structured topic guides facilitated a deeper exploration of subjects and allowed topics to form naturally during the interview process[41]. These topic guides were not piloted prior to data collection but were based on previous school-based programme research through HAPPEN[42]. Example questions included “How do you feel about implementing the Daily Mile?” (teacher) and “Would you like to carry on with the Daily Mile and why?” (pupil). Full topic guides for interviews and focus groups can be found in the supporting information (S3 Appendix). The duration of interviews ranged between 5 and 21 minutes and focus groups between 23 and 48 minutes. The lead researcher (EM) facilitated the interview process, whilst the other researcher provided technical support (digitally recording) and made field notes on key responses. At the start of each interview and focus group, researchers reminded the participants of the study aims, guidelines on anonymity and confidentiality and encouraged participants’ personal viewpoints. In order to achieve neutrality, researchers emphasised that they remained impartial and there were no right or wrong answers. In order to gain respondent validation, these notes were verbally summarised through member checking with interviewees at the end of each interview. To ensure trustworthiness, the researcher’s interpretation of responses were summarised for corrections, clarification or confirmation by participants[43,44].

Quantitative measure.

In order to examine the secondary aim of this research study, children’s CRF was assessed using the 20m shuttle run test (20m SRT). The 20m SRT was conducted at the University’s indoor athletics facilities and followed procedures outlined in the Eurofit Battery[45]. During this continuous running test, participants run between cones placed 20m apart in time with bleeps recorded on an audiotape. The initial running velocity of 8.5 km/h increases by 0.5 km/h each minute[46]. The time between consecutive bleeps decreases as the test progresses and the last shuttle a child is able to run is recorded. Cut points classifying children as fit and unfit were assigned according to total number of shuttles (fit: boys > = 33 shuttles, girls > = 25 shuttles) as these thresholds reflect cardiometabolic risk scores in children of this age group[47]. Prior to completing the 20m SRT, researchers provided verbal instruction about the test and a demonstration. Children were reminded of the study aims, their right to withdraw and provided additional verbal consent prior to participating.

Qualitative analysis.

The qualitative component of this research study adopted an interpretive approach through thematic analysis in order to gain an understanding of participants’ experiences of implementing TDM. All interviews and focus groups were digitally recorded and transcribed verbatim in Microsoft Word. The process of analysing the interview and focus group data followed the steps outlined by Burnard (1991)[48]. To begin, each transcript was independently read several times by two researchers (EM and CT) to facilitate immersion in the data. The researchers (EM and CT) then followed an independent open coding process to allow participants’ views to be summarized by assigning words or phrases to quotes or paragraphs. This initial list of freely generated categories following review of the transcripts aimed to encapsulate interviewees’ responses and were subsequently grouped according to the overarching theme. Through this process, broader categories were combined to produce one higher-order heading that captured the overall meaning of responses. This process was repeated whereby similar categories were synthesised to produce a final list of themes and sub-themes. Both researchers (EM and CT) compared their lists of themes and sub-themes to ensure accuracy and consistency. If there was a discrepancy or disagreement in coding, a third researcher (SB) adjudicated. This method enhances the validity of categories assigned and attempts to reduce researcher bias[48]. The written notes taken on the day of the interview or focus group were compared with these topics to ensure an accurate account of participants’ responses. Following this, the two researchers worked together through an extensive process to discuss codes and categorise them under final themes and sub-themes (S4 Appendix). The lead researcher (EM) then manually worked through each transcript and coded the responses according to the final list of themes and sub-themes. All responses grouped by themes and sub-themes were compiled to a master copy document that was used for reference to write up the findings.

Quantitative analysis.

Analyses were performed in STATA (version 15). Multiple linear model regression analyses was used to examine the association of TDM on children’s CRF. Schools provided date of birth (to calculate age) and postcodes (to calculate individual level deprivation) for consented pupils. Discrepancies in numbers within results tables are due to missing age and postcode data. The explanatory variable (individual pupil deprivation) was adjusted for confounders (baseline age, gender). Analyses were also clustered by school to account for school-level differences. Deprivation was assigned as an area-based socio-economic measure using the Welsh Index of Multiple Deprivation (WIMD)[49]. Weighted scores for eight domains of deprivation are calculated as a WIMD score for each LSOA. WIMD scores are ranked from most to least deprived and grouped into quintiles (1 = most deprived, 5 = least deprived). For the purpose of this study, a binary deprived (WIMD quintiles 1, 2) and non-deprived (WIMD quintiles 3, 4, 5) variable was assigned representing low and high socio-economic groups.

A constraint of school-based research is the potential for missing data due to pupil absentee at random, through illness or other school commitments that prevent them from participating in data collection, contributing to bias in results [50]. To overcome this, missing data in this sample were imputed. The Multivariate Imputation by Chained Equation (MICE) method in STATA using baseline and follow-up data (shuttles, age, deprivation) was used to impute missing data for those missing at either time-point. Data were assumed to be missing at random (e.g. probability of being missing does not depend on the missing value) on the basis that there was no significant difference of baseline shuttles between groups (missing at follow up, present at follow up).

The Daily Mile implementation.

Flexible vs rigid principles. This theme relates to the varying implementation style adopted by schools; either demonstrating flexibility and adaptability or following the original principles set out by TDM. School A suggested that it required flexibility from individual classes within the school and implementation reflected this;

Yes, different classes do different things, so what works for one class doesn't necessarily work for another class. In Year 2, we tend to run it about two o'clock in the afternoon because we don't get an afternoon play, so we do it then and it breaks the afternoon up, which is quite nice. Other classes have been doing it first thing in the morning, other classes have done it last thing, quarter past three, different things work for different classes. (Teacher, School A, Follow-up, T12)

This view was mirrored by school D who supported an ‘anything is better than nothing’ perspective;

I think it is do what suits you. Don’t worry about what anyone else is doing. Even if it is 5 minutes it’s 5 minutes it is better than nothing. I just think just to think carefully about it is worth the infants doing it and then just finding that time slot really, try looking a bit differently at your school time table to free up a bit of time that is maybe non-productive time at the moment. (Headteacher, School D, Follow-up, T3)

In addition, implementation that encouraged any form of movement as opposed to enforcing running was discussed positively by both teachers and pupils in relation to the importance of participation;

One thing about it is that you’re meant to try and do your best in it, do what you can, like run it, walk it, or jog it, doesn’t really matter, as long as you actually do it, as long as you do it. (Pupil, School E, Follow-up, T14)

There's a couple of, a couple of girls I'm thinking of who I think they've just skipped [laughs] about, I don't think they've done any running, they've skipped the mile every day, but at least they were doing it. (Teacher, School A, Follow-up, T12)

In comparison, school B believed maintaining a consistent implementation method based on the original Daily Mile principles was important;

What happens with these initiatives is they get put into school and then the school change them, so then it doesn’t stick really to the principles of TDM which were there in the first place it doesn’t really fit with the core principles that TDM set out. (Teacher, School B, Follow-up, T10)

In order to ensure that schools do not deviate from these principles, this teacher suggested an external Daily Mile advisor for schools;

So I think that there needs to be somebody, an advisor that schools can go to to make sure that they are sticking to their original Daily Mile plan and not turning it into something else…it just takes away from the whole point of it … there are 10 core principles set out in TDM documentation, I just think it needs to be you know, stuck to that original plan. (Teacher, School B, Follow-up, T10)

However, a consistent implementation method that maintained the original principles was associated with a lack of enthusiasm and engagement by many participants;

If the children are doing something like that every day and it’s the same thing day-in-day-out I feel they…the novelty wears off … I think it’s like a lot of initiatives, you know, when we first have these initiatives the children are all up and ready and keen and love doing these things, but unless it changes or unless something is added to it, or unless they get something out of it, it’s just a day-in-day-out thing. (Teacher, School A, Follow-up, T6)

A rigid implementation of TDM and lacking variety disengaged pupils. In order to maintain enthusiasm, pupils incorporated elements of play;

I don’t mind it now because I try and mix play and TDM together somehow. We do like tapping on the head while run around the yard. (Pupil, School F, Follow-up, T16)

In addition, pupils suggested a number of ways in sustaining their engagement such as utilising sports equipment and varying the location;

I also think that they could put sports equipment in the middle because some people might want to do a different sport and not running. (Pupil, School F, Follow-up, T16)

We could change it by going like a different place, not just the same place because it’s quite boring if you just go round the same place (Pupil, School E, Follow-up, T13)

Therefore, incorporating flexibility lead to a more positive experience and increased engagement from most pupils.

Curriculum time vs playtime. There were conflicting approaches adopted by schools with regards to the time allocated for TDM. This comprised of either implementation during the taught curriculum or an additional/replacement of pupils’ playtime. One of the main concerns for all headteachers and teachers was the curriculum pressure by educational inspectorates. Although schools wanted to implement TDM, finding 15 minutes within the narrow curriculum was a challenge;

We were all sort of a bit sceptical when it first come out, sort of just timings it is in school, it’s not that we didn’t feel it would be a good thing to do, it’s just we’ve got so much to do in school it was sort of timing that was our issue as a class teacher, to fit everything in and to do it not to take up their playtime. (Teacher, School B, Baseline, T9)

For some schools, this curriculum pressure forced them to find alternative opportunities in the day to deliver TDM. The headteacher from school F explained that curriculum and parental pressure influenced their decision in replacing pupils’ playtime;

There are so many pressures on schools these days with their drilling with welsh and this that and the other it is so difficult. We have tried to get it that it doesn’t eat into lesson time. I think there were some concerns with parents with regard to would this 15 minutes eat into lesson time which is why we tried to put it into playtime. (Headteacher, School F, Follow-up, T15)

For many pupils, the replacement of their playtime was a negative factor associated with their experience;

If it wasn’t taking up our play time which is one of the fun moments of the day, then I would do it, because it is during play I don’t really want to do it. (Pupil, School F, Follow-up, T16)

However, this headteacher recognised pupils’ frustration and utilized their pupil voice group to incorporate pupils’ suggestions and maintain engagement;

One thing that has gone well, we have got a portable speaker so we put music on for the children to run around to music, they quite like that. One suggestion…we have a ‘Healthy Pupil Voice’ group, is that they are going to create different playlists to try and put a bit of variety in it. (Headteacher, School F, Follow-up, T15)

In contrast, schools without an afternoon playtime coordinated TDM to be delivered as an additional playtime through a restructure of the school day;

We thought there is no point in doing it in the morning because it is usually afternoon when they dip … So we actually changed the lunch hour, we shaved 10 minutes off the junior lunch hour, so they go back into class 10 minutes earlier, so that means they were not missing any of their lesson time. So we have actually put the 10 minutes into the afternoon break and they seem to find that this doesn’t bother them at all …I think everyone enjoys the 10 minutes of fresh air and the break. They all go back a bit more replenished and bit ready for the next hour challenge. (Headteacher, School D, Follow-up, T3)

The addition of an afternoon playtime to participate in TDM was supported by all pupils;

All the infants [younger Key Stage] get their play, they put TDM in as basically our third play, which is good. (Pupil, School D, Baseline, T1)

With curriculum pressure being highlighted by schools, some overcame this by integrating TDM within Physical Education (PE) lessons;

We looked at the time tables for everybody and realised that was the only spot that we had. But what we tend to do is if the key stage 2 staff have PE on a particular day they won’t do their Daily Mile at 12.50 they will do it during their PE session. So they tag it on twice at the beginning of the PE session or the end. (Teacher, School C, Follow-up, T11)

In addition, school B used TDM in achieving the weekly recommended guidelines for PE provision;

We work quite smartly here so we link, we try to link everything in as best as we can, as I said fits in with my topic…That’s not the same with every class but, you know, there are opportunities to link it with curriculum, yeah, with curriculum target skills, so that’s good. And it will help to count towards our overall PE time for the week as well. (Teacher, School B, Baseline, T7)

Overall, the addition or replacement of pupils’ playtime for TDM was a significant contributing factor to pupils’ experience.

Delivering TDM as an extra afternoon playtime and an additional break from lessons was a positive factor influencing pupils’ experience. However, replacing scheduled play caused a significant problem for pupils who enjoyed the autonomy and freedom of playtime. Although TDM was not intended to act as a replacement to PE, for some schools this was the only opportunity in the school day that did not take away from curriculum time.

Competitive vs non-competitive. Conflicting messages regarding competition within TDM were conveyed by participants. Teachers discussed the challenge that existed in balancing competition. For some pupils, the competitive element fostered participation and enthusiasm whereas for others, competition completely disengaged them. This teacher felt that children thrived in competitive environments, but this was at odds with the original Daily Mile principles;

I think they like the competitive element, which is not what it’s meant to be. Then some of them, they’re just not enthusiastic for sport and that’s the negative isn’t it? We’ve got the ones who are very enthusiastic and then the ones who really can’t be bothered…And I know it’s not meant to be competitive but that’s the sort of, that’s what children like. They like to do their best. They like to win. So it’s difficult. (Teacher, School B, Baseline, T5)

However, finishing last was a cause of concern for some pupils who associated this with ability, suggesting that a continuous bout of 15 minutes of activity was favoured than the completion of an actual mile;

Well some of them don’t like just running in general, but some of them, and some of them are desperate not to be last, like no-one wants to be the worst runner in the class. (Pupil, School E, Follow-up, T14)

Many teachers also recognised the need for rewarding pupils to encourage their participation, stating that the wider benefits of participation were not valued by pupils;

I know it’s not meant to be a competitive thing but there needs to be some sort of reward. They need to see some sort of purpose in doing it. Yeah okay, I’m doing it to see if it affects my performance in school, but that doesn’t mean anything to our children. (Teacher, School B, Baseline, T5)

To overcome this challenge, another teacher from this school suggested incorporating goal setting and enabling competition through personal targets;

On Healthy Schools week I did for Year 6 because it’s Healthy Schools week so we did record times for one week as the children were not against each other, but they were recording their own personal best and that was the week that really worked well with my class particularly, just because they were, not being competitive with anybody else, but they were setting a target for themselves, do you know what I mean? (Teacher, School B, Follow-up, T6)

Overall, implementation that incorporated goal setting as a means of highlighting progress and personal achievement fostered engagement and motivation to participate in TDM. Findings regarding competition were mixed and depended on the individual pupil and their perception of competition, either thriving or disengaging in this environment.

Active teachers vs passive teachers. The involvement and role of teachers during TDM was discussed by participants. Two clear themes emerged; active teacher involvement and participation or passive and disengaged teachers. Participants discussed the positive effects of teacher involvement in the implementation of TDM. For pupils, teacher encouragement and participation influenced their engagement;

They [teachers] actually try and like do it, they would tell us and in encouraging and inspiring way. They’re like, come on, come on, go on, you can do it, come on! (Pupil, School D, Baseline, T2)

Teachers were also aware of the enabling role they played in pupils’ participation and supporting children that found TDM challenging. In addition, this teacher also acknowledged the benefit of participation on teachers’ fitness;

Staff are good, I am trying to encourage them to run it at the same time as the children. Some members of staff will run it as well; I like to join in as well. Even if it’s a case of just walking around with them for those children who are struggling. I am keen that the staff don’t just stand around watching them, that they try and get involved as much as possible for our own fitness levels as well …I think I would encourage other schools to take it on and try to keep it up. To try to get the staff more involved. You get the staff to encourage the children to run and obviously set a good example by them doing as well. (Teacher, School C, Follow-up, T11)

In contrast, some pupils from other schools discussed the passive involvement of teachers and the negative effect this had on participation. For pupils, disengaged teachers resulted in disengaged pupils and rule breaking;

I think that the teachers should start running it, because they’re just like standing there while we’re doing all the running and I feel like they should be doing it…If they joined in I would run more. (Pupil, School E, Follow-up, T14)

I think that the teacher should actually watch because everyone usually cheats, [teacher] is usually just on her phone [all laugh]. (Pupil, School E, Follow-up, T14)

The importance of role modelling was also recognised by teachers in reference to the correlation between the lack of teacher enthusiasm and pupil engagement;

I just get the feeling that they’re [teachers] really not that into it so they haven’t then passed on their enthusiasm to the children and I think that staff have been supervising the children but not joining in, and then it becomes something that children are being told to do instead of something children and staff are doing together. (Teacher, School B, Follow-up, T10)

Teachers seeing value and benefit to pupils was crucial to gaining their support and enthusing pupils. However, some schools discussed the conflict that existed between the engagement of teachers from different year groups;

I think some can definitely see the benefit of it, others I think feel that it is something else, another initiative, and that’s probably been the difference between Foundation phase [ages 4–7] and Key Stage 2 [ages 7–11] as well is that the Foundation phase staff have been quite enthusiastic about it, Key stage 2 have been a little bit apathetic if you towards it and if it doesn’t come with enthusiasm from the staff the children will pick up on that won’t they? (Headteacher, School F, Follow-up, T15)

This view was reflected by school B who felt that TDM favoured the lower key stages in which the curriculum is delivered through play;

The foundation stage staff are more engaged I think because it’s easier to fit in their daily routine, because the children there are learning through play anyway. It’s not a big chunk out of the curriculum when that is something that they [foundation phase] do anyway, and I definitely have better engagement from foundation stage staff, even at the idea stage than I had from Key Stage 2 staff. (Teacher, School B, Follow-up, T10)

Teacher buy-in and active participation in TDM was important in modelling behaviour and motivating pupils. However, concerns were raised by some participants regarding the engagement of teachers from the higher key stage of primary school.

Supported vs unsupported. The varying level of support from staff, parents, stakeholders and the wider community were discussed by many participants. The importance of headteacher support was identified as a critical factor in gaining the support of parents. Communication through social media facilitated this;

Initially the first week we had a few grumbles on Facebook [by parents] on the social side, basically complaining that their children were feeling sick after doing the run…But our Head, was quick to reply to that message and basically said that we were out and none of them complained about feeling unwell so, we think it is the parents job to try and support the school in new initiatives and that we are doing it for their children’s health and wellbeing, so stop moaning about it basically and we haven’t have any problems since. (Teacher, School C, Follow-up, T11)

In addition to parental support, engaging with sporting role models within the community acted as a way of inspiring pupils about physical activity and fitness;

We've had [professional footballer] and another [football team] player came in to talk about, to run with the children, and talk about the importance of running and fitness. And we also had the, the physiotherapist, the physio from [football team], he came in as well. So they've had a lot of encouragement and from parents and from the community really. (Teacher, School A, Follow-up, T12)

However, a lack of wider support and the difficulty in maintaining children’s engagement with TDM was discussed as a barrier to sustainability by other schools;

No, we’ve not seen anybody, I’m just chatting to my colleague, nobody’s come to join in, I know it’s difficult but I think we probably could have done with a bit of support, and not just a one-off, somebody turning up for a day and saying, “Come on children,” because I’m just speaking, I’m the deputy head here, I’m speaking on behalf of my junior staff here, we have found it quite a challenge ourselves then really day-in-day-out to get children doing something that they don’t all want to be doing. (Teacher, School B, Follow-up, T6)

Linking to discussions of the varying engagement by teachers of different years, this school believed that external support was necessary for the older key stages, highlighting a decline in local authority support;

No, and we were supposed to [have support], initially there was a lady from [local authority sport team] the, is it the [local authority initiative]? Yeah they were supposed to be involved but she dropped off after the first lot of data collection and never came back so I think that might have made a difference… I think in the upper end of the school definitely, you know in the Key Stage 2 [year 3–6] I just think that they’ll need that extra support I think. (Teacher, School B, Follow-up, T10)

Therefore, supporting schools with the implementation of TDM would encourage sustainability. This includes support from parents and the wider community and backing from local authority sport and health teams through the provision of staff members dedicated to Daily Mile implementation.

Summer vs winter. Some teachers questioned the seasonal effects of TDM for pupils, speculating that pupils’ enthusiasm was dependent on the weather;

To be honest, with the weather I'm not sure whether it would have the same effect in the spring and autumn term, like it was the summer term which was fantastic term to do it. We could certainly give it a go, but I'm not sure it would have the same effect. (Teacher, School A, Follow-up, T12)

However, despite summer being seen as an ideal term to implement, hot weather also created additional concerns around health and safety for a few teachers;

The only problem I can really think of is when the temperature was very hot, you know, just making sure that they were hydrated and that we were, you know, they weren't too tired running in the heat and they weren't exhausted. (Teacher, School A, Follow-up, T12)

The pressure of parental concerns regarding weather and safety were also highlighted, with parents expressing apprehension about their child engaging in physical activity in the heat;

I don’t know how it would, what would happen in the winter, like you know, and we had parents complain actually, “Don’t let them run in the heat,” so I can’t imagine what would happen in the winter. (Teacher, School B, Follow-up, T6)

Wet weather posed a problem in relation to clothing, finding alternative opportunities for physical activity (teachers) and safety concerns (pupils);

When it is like drizzling, raining, a little bit, we still have to go out and sometimes the yard is really slippery and I have seen a lot of people falling over doing TDM when it has been raining because it is winter now and the terrible weather came and we are still doing it and lots of people are falling over and hurting themselves. (Pupil, School F, Follow-up, T16)

This weather also created a practical barrier regarding clothing. Although TDM does not require specific clothing for implementation, reliance on school uniform posed a problem to schools. This included inappropriate footwear and issues related to hygiene, requiring schools to consider ways of overcoming this barrier;

We have been out there on days that are drizzly but the children slip and slide on the grass and then if you do it on the yard, they, our yard tends to puddle so they're coming in with wet shoes. We have to look into really bringing in separate shoes for running (Teacher, School A, Follow-up, T12)

Impact on learning, health and wellbeing.

The majority of participants discussed the impact of TDM on pupils’ learning, health and wellbeing. Conflict existed between participants’ perceptions of the impact on behaviour and concentration. However, discussions on health and wellbeing were generally positive, covering the physical, psychological and social domains.

Behaviour and concentration. Participants’ views of the effect of TDM on the subsequent behaviour and concentration of pupils were mixed. Some teachers observed improvements in pupils’ behaviour and concentration following participation in TDM.

Just generally they have been much better, calmer coming into class in the afternoon because of it. They are coming in and ready to start working and that has been great, we have noticed a big difference there. In terms of concentration levels as well, they seem a bit more perkier…I do think it has a positive effect and I think it has had a positive effect on energy levels and that knocks on into class time then. We’ve seen an improvement in behaviour in class definitely. (Teacher, School C, Follow-up, T11)

This finding was also reflected by some pupils who felt that participating in TDM resulted in more efficient class work;

Well, I wouldn't say it affects me but like, normally, I would just be really, like just doing my work, but now that I've done TDM it gives me a bit of a boost and now I'm starting to do my work a bit quicker. (Pupil, School D, Baseline, T1)

This was supported by a teacher from school D who discussed this in relation to the theme of curriculum time vs playtime. The introduction of an additional afternoon break to participate in TDM was a conscious decision by this school who observed the positive impact on pupils’ concentration;

We have noticed an improvement in fitness and concentration. Our lunch time goes into 12.50pm which starts the first lesson, so by 2.00pm the children are flagging. So to have the Daily Mile is a god send at the moment. When they come back in after their 10–15 minutes because the time is going less and less the more they are doing it, there are ready for their last lesson then. Whereas before it would have been so difficult to teach that last lesson. (Teacher, School D, Follow up, T4)

However, some pupils suggested that the perceived improvements in behaviour resulted from a reduction in energy levels following participation;

I think it’s improving the behaviour a bit because people don’t have as much energy to mess around. (Pupil, School D, Baseline, T2)

In addition, pupils highlighted a negative association between energy levels and concentration;

I think there might be one [problem] when it gets you, when it gets you so tired when you go back into class, that you lose all your concentration until you regain it (Pupil, Baseline, School D, T2)

In contrast, other teachers raised the challenge of settling pupils back into lessons following TDM, who felt that pupils returned to class over-excited;

But we have found to do the run and come back into class has had the opposite to the desired effect, that it didn’t settle them, it just made them more hyper. (Teacher, School B, Follow-up, T6)

Overall, the effect of TDM on behaviour and concentration is largely dependent on the individual pupil. For those reporting positive improvements, longer-term sustainability is likely to be encouraged in order to foster school-wide benefits to learning. However, the conflicting statements of over-excitement and tiredness that result in a negative impact on learning are likely to discourage schools from sustaining TDM.

Physical activity and sport. Many pupils believed participating in TDM improved their attitude towards physical activity;

I actually think it’s had an effect on me because it actually gets me going when … Well if I’m not doing very well in school it’s usually PE day so then we just go out and do PE so it like gives me positive attitude to my learning and physical activity. (Pupil, School E, Follow-up, T13)

Teachers also discussed pupils’ positive attitudes towards physical activity and elements of behaviour change;

Their attitude towards fitness has improved and what we have noticed also is that most of them after Christmas have come back to school with fitbits. They are tracking their steps now, so hopefully that will have a long term effect on them you know. (Teacher, Follow-up, School D, T4)

Pupils were positive about the additional opportunities to be physically active and the contribution towards structured sports participation;

I thought it was a good thing, I don’t really get to do much running at home. (Pupil, School F, Follow-up, T16)

Very much. I really like TDM because it keeps me active and it like helps me like to train in the week for my football and all that. (Pupil, School D, Baseline, T1)

Furthermore, some pupils and teachers attributed improvements in pupils’ sporting achievements to participating in TDM;

It has changed the way like girls only like to do gymnastics is has changed the way of my gymnastics skills are getting better and better. But then it is not just gymnastics there is also other sports like tennis, hockey and football sometimes. All types of sports are getting easier for lots of the girls and boys because they do TDM. (Pupil, School F, Follow-up, T16)

We've been in sort of local competitions and we've brought medals home from there and, you know, the children are saying 'oh it's because we've been practising every day' and they're putting it down to practice makes perfect which is quite nice as well. (Teacher, School A, Follow-up, T12)

Psychological benefits. Many pupils acknowledged the associations between physical activity and wellbeing;

So we get, even though we got active, our brains are getting healthier, so it's better for our minds as well, in the work after TDM. (Pupil, School D, Baseline, T1)

Both pupils and teachers commented on feelings of happiness;

Um, yeah, I think so because sometimes some of my friends are a little bit tired and angry in the morning and then when they do TDM they’re kind of happy and stuff. (Pupil, School E, Follow-up, T13)

Well, happy children learn, so if they're happy they're going to learn, and they're certainly happy after running TDM! (Teacher, School A, Follow-up, T12)

In addition, feelings of improved self-esteem and school competency were reported;

Um, yeah, it makes me more confident, so I do better in school. (Pupil, School E, Follow-up, T13)

Regular participation in TDM acted as a stress relief and in alleviating the pressures of exams at this Key Stage;

Um, I think it just takes your mind off things and it really just helps. (Pupil, School E, Follow-up, T13)

I actually think it’s better doing it as Key Stage 2 because you get more support and so it keeps you with a positive mindset. (Pupil, School E, Follow-up, T13)

Social benefits. Many pupils reported a number of social benefits to participating in TDM. This included the opportunity to interact with peers and the positive subsequent effect during lessons;

You also get to chill, at the same time talk to your friends which stops you from wanting to talk to your friends in lesson, since you’ve talked to them, you know what they want to say to you, they know what you want to say to them, so you don’t really need to talk to them. (Pupil, School D, Baseline, T2)

Teachers also reported the social improvements through group participation such as team-work and cooperation;

I’m thinking of a couple of girls in my class now because they’re doing it together and I said, well go together, encourage each other, they are enjoying it a bit more now and they get out and they’re all bringing their water bottles in and things like that now, so they are enjoying it more than the first sort of day when I said right, well you’ve got to go out, it’s not just seven laps, you’ve got to keep moving for 15 minutes and you could see some grumbles, they’re a lot more positive the more we’re doing it and it’s becoming routine. (Teacher, School B, Baseline, T9)

And not only has sort of their health and fitness improved, but their social skills have improved as well, because they were doing it together, yeah, they really loved it. (Teacher, School A, Follow-up, T12)

Therefore, these positive discussions covering the physical, psychological and social domains are likely to encourage schools to continue delivering TDM in order to elicit the range of benefits observed on pupils’ health and wellbeing.