Active school environments and inequalities in children’s physical activity and wellbeing in London

Background

School environments are key settings for promoting lifelong positive health behaviours and reducing health inequalities. We examined whether real-world implementation of the WHO whole-school approach to physical activity (PA) was associated with children’s PA, mental health, and educational performance, across sociodemographic and health subgroups in Greater London, England.

Methods

Cross-sectional data (Oct 2023-Dec 2024) were collected from 21 state-funded primary schools. Schools reported implementation of WHO‑aligned PA practices, producing an Active Environment Score (AES; 0-20). Children aged 7-8 years (n = 603) provided accelerometer‑measured PA, total difficulties scores from the Strengths and Difficulties Questionnaire (SDQ; 0-40), and teacher-rated educational performance in reading, writing, and maths. Mixed-effects regression models estimated associations between AES and each outcome. Interaction terms tested differences by ethnicity, area deprivation, general health status, and long-term health condition.

Results

Higher AES was associated with fewer emotional and behavioural difficulties (SDQ B = 0.39, 95% CI: -0.63, -0.16), with no evidence of association with school-hours PA or educational performance. AES showed stronger associations with PA intensities for children from Black ethnic groups compared with White ethnic groups (difference in moderate-to-vigorous activity B = 1.71, 95% CI: 0.05, 3.38). Associations with educational performance were weaker for children with a long‑term condition (ORs 0.67-0.69, 95% CI: 0.47-0.99). No variation in associations was observed by health status or area deprivation.

Conclusions

Supportive whole-school PA environments were associated with better mental health, but not with PA or educational performance. Variation across ethnic and health groups suggests differences in access or benefit from available PA opportunities, highlighting the need to promote equitable engagement with school‑based PA provision.

Key messages

• WHO whole‑school physical activity environments may support children’s mental health, but implementation alone may not be sufficient to increase physical activity or improve educational performance.

• PA opportunities need equitable access and engagement as children respond differently across ethnic and health groups despite similar provision.