Developing a multi-component implementation strategy to increase physical activity in pre-kindergarten classrooms

The National Heart, Lung, and Blood Institute awarded the University of Texas Health Science Center at Houston $153,063 on September 1, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to develop and evaluate a multi-component implementation strategy for increasing physical activity in pre-kindergarten classrooms.

The recipient will develop classroom-based physical activity interventions—specifically physical activity breaks (PABs) and physically active lessons (PALs)—targeting individual- and school-level barriers that prevent pre-kindergarten teachers from effectively delivering physical activity instruction. The work includes three training objectives to build investigator independence: gaining knowledge of the early childhood education system and early childhood development support; enhancing proficiency in community-engaged research; and improving skills in clinical trials and mixed-methods research. The study aims to develop an implementation strategy to increase PAB and PAL use, evaluate its feasibility and preliminary effectiveness for increasing students' physical activity, and develop and validate a measure of implementation fidelity.

Dr. Craig leads the research with a mentorship team including Dr. Maria Fernandez (primary mentor, implementation science), Dr. Bijal Balasubramanian (co-mentor, implementation science), Dr. Tricia Zucker (co-mentor, early childhood), and Dr. Timothy Walker (co-mentor, school-based physical activity research).

Performance occurs in Houston, Texas through August 31, 2031. The award is a Project Grant (assistance type K01 Mentored Research Scientist Development Award equivalent structure).

Abstract

Physical activity promotion during early childhood is critical to preventing obesity and cardiovascular disease later in life. Prekindergarten (PREK) programs offered by independent school districts reach underprivileged children and play an important role in improving physical health and kindergarten readiness. Classroom-based physical activity interventions (e.g., physical activity breaks, pabs, and physically active lessons, pals) are effective in increasing students' physical activity; however, implementation challenges are common. This highlights the need for implementation strategies that help PREK teachers provide pabs and pals consistently and effectively. This proposal includes three training objectives that will help DR. Craig achieve research independence: 1) gain knowledge and skills to understand the early childhood education system and how to support early childhood development; 2) enhance proficiency for conducting community-engaged research; and 3) improve knowledge and skills in conducting clinical trials and mixed-methods research. DR. Craig has assembled a mentorship team of experts in implementation science (DR. Maria fernandez, primary mentor, DR. Bijal balasubramanian, CO-mentor), early childhood (DR. Tricia zucker, CO-mentor), and school-based physical activity research (DR. Timothy walker, CO-mentor) to address the individual- and school-level barriers that prevent PREK teachers from effectively providing physical activity in the classroom. The study aims are to: 1) develop an implementation strategy to increase the use of classroom-based physical activity interventions, specifically pabs and pals, 2) evaluate the feasibility of the implementation strategy and preliminary effectiveness for increasing students' physical activity, and 3) develop and assess the validity of a measure of implementation fidelity. Aim 1 will use implementation mapping to develop a theoretical and evidence- informed implementation strategy to support the use of two classroom-based physical activity interventions: pabs and pals. For aim 2, we will conduct a hybrid type 2 pilot study to examine the feasibility of the implementation strategy and its preliminary effectiveness for increasing student physical activity levels. We will use a pre/post design with four PREK sites to evaluate the changes in students' physical activity over time. In aim 3, we will develop a self-report measure of implementation fidelity (e.g., implementation logs) and conduct a series of analyses to assess concurrent validity with other established measures of fidelity. This study is significant because IT addresses physical inactivity among young children, a major public health issue that contributes to health disparities. The proposal is innovative given that IT will take place in the PREK setting and focus on increasing children's physical activity by improving the implementation of existing evidence-based interventions. Findings will advance our knowledge of how classroom-based physical activity interventions are implemented in real-world settings (e.g., PREK sites) and inform any refinements needed before scaling up the implementation strategy in a future R01 grant.