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BackgroundDespite growing evidence of deleterious health outcomes associated with sedentary behavior, prolonged static sitting in classrooms remains ubiquitous in primary schools. Sedentary behavior is associated with the development of cardio-metabolic conditions and poor back health. Preventative strategies to reduce sedentary behavior and its negative health effects may be required in a resource-constrained environment such as South Africa. ObjectiveThe primary objective of this study is to assess the feasibility of conducting a full trial to evaluate the effects of a multifaceted intervention comprising novel multifunctional classroom furniture and a video-based curriculum versus usual care on sedentary behavior among students aged 10-11 years in primary schools. The secondary objective is to assess the preliminary effects of the intervention on sedentary behavior and postural dynamism. MethodsEighty grade 5 or 6 students, aged 10 and 11 years, in mixed-gender schools within the Western Cape metropolitan urban area in Cape Town, South Africa are eligible to participate in this pilot cluster stepped-wedge trial design with classroom as the unit of randomization. Data will be collected at the schools. The intervention will comprise multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum on sedentary behavior. Usual practice is the absence of the intervention. The primary outcomes assessed will be (1) adherence to the intervention and (2) project pragmatics. The secondary outcomes will be (1) sedentariness measured using activPAL3 microsensors and (2) postural dynamism measured using Noraxon Myomotion inertial measurement units. We randomized the school to the first or second start of the intervention. This is an open-label trial and therefore blinding will not be possible for any group. Descriptive analysis of the feasibility and physiological outcomes will be presented. We will report the preliminary estimates of the effects of the intervention on sedentariness and postural dynamism using the mean difference and 95% CI. ResultsAt the time of submission, two classrooms have been recruited into the study. Baseline physical activity and postural dynamism data have been collected from 10 participants from each class. ConclusionsThe results of this feasibility stepped-wedge cluster randomized controlled trial will be useful in informing the design of the main trial to assess whether this multifaceted intervention of multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum versus usual care has any effect on sedentary behavior in low-resource-setting primary schools. Trial RegistrationPan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID)RR1-10.2196/18522

Background: Noncommunicable diseases (NCDs) resulting from sedentary behavior (SB) are adding a further strain on the South African health system, which is already struggling to manage infectious diseases. Some countries have enabled children to reduce SB at school by substituting traditional furniture with sit-stand classroom furniture, allowing learners to interrupt prolonged bouts of sitting with standing without interrupting their school work. Alternating between sitting and standing also benefits spinal health by interrupting prolonged periods of high spinal loading, but no such intervention has been trialed in South Africa. The potential to reduce strain on the health system by reducing the incidence of NCDs and improving spinal health requires further consideration. Before embarking on a large classroom-based trial, it is essential to determine the acceptability of the intervention, its impact on teachers' practices, and the logistical and pragmatic considerations of data collection., Objective: This study aimed to assess the feasibility of implementing a classroom-based intervention to reduce SB and improve spinal health in primary school learners, to assess the pragmatics of delivering and adherence to the intervention, and assess the pragmatics of measuring physical activity and postural dynamism data with wearable sensors., Methods: We used a stratified, closed-cohort, randomized, 2-cluster, stepped-wedge design with a pragmatic approach. One grade 5 and grade 6 class each was recruited from contrasting socioeconomically categorized, state-funded primary schools in the Western Cape province, South Africa. Classroom furniture was substituted with sit-stand desks, and health education and movement videos (HEMVs) were shown during class time. Skin-mounted activPAL physical activity monitors were used to measure SB and postural topography and Noraxon myoMOTION inertial measurement units (IMUs) to measure spinal movement. The study was evaluated for feasibility by tracking school retention, successful delivery of the HEMVs, the use of sit-stand desks, compliance with the wearable sensors, and data accuracy. We deductively analyzed teachers' interviews and learners' focus groups using Atlas.ti 9 software. Descriptive analysis of quantitative data was performed using Microsoft Excel., Results: Cluster 1 withdrew from the study before follow-up SB, postural topography, and spinal movements were measured. All feasibility outcomes, namely (1) classroom retention, (2) delivery of HEMVs, (3) learner and teacher acceptance and usage of sit-stand classroom furniture, (4) 100% compliance with wearing skin-mounted sensors for the duration of the intended measurement period, and (5) minimum 80% eligibility of sensor data gathered included in data analysis, were met in cluster 2. The study found that it is feasible to conduct a larger trial with minor modifications to the methodology., Conclusions: We recommend a whole-school approach to support the intervention and a monitoring strategy to track the impact of the intervention on the classroom. Furthermore, we recommend contextualized teacher training on how sit-stand desks and HEMVs can be used as classroom management tools., Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8., International Registered Report Identifier (irrid): RR2-10.2196/18522., (©Dominic Fisher, Rentia Maart, Lehana Thabane, Quinette Louw. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.02.2025.)