School-based Physical Education in Bhutan for Physical Fitness and Socio-emotional Competencies in Adolescents

Official title

From Classrooms to Playgrounds in Bhutan: Evaluating the Role of School-based Physical Education on Physical Fitness, Socio-emotional Competencies and Well-being in Young Adolescents

Overview

Despite global evidence supporting the benefits of PE in promoting socio-emotional skills, much of the research has focused on countries where PE is a mandatory part of the curriculum. In contrast, Bhutan's Health and Physical Education (HPE) program is limited, with many schools lacking a structured curriculum and dedicated PE educators. This project aims to evaluate the impact of an enhanced school-based physical education (PE) program on physical fitness, socio-emotional competencies, and well-being among upper primary school students in Bhutan. This project is a methodological collaboration between the Centre Hospitalier Universitaire Vaudois in Switzerland and the Paro College of Education and Royal Thimphu College in Bhutan. Two public urban schools will be randomly assigned to either the "enhanced physical education program" or "standard curriculum" condition. An additional "control school", with no physical education, will be included in the study but not in the randomisation process for feasibility concern. A total of 360 young adolescents (120 per school, aged 12-14) will be enrolled. Baseline data on individual characteristics such as age, gender, and socio-economic status will be collected through self- and parent-reported questionnaires. Primary outcome measures include physical fitness assessed by PE teachers using various metrics, as well as socio-emotional competencies and well-being evaluated through standardised self- and parent-reported questionnaires. Data will be analysed using an intention-to-treat approach. This project offers a unique opportunity to explore the international impact of PE within Bhutan's socio-cultural context.

Detailed description

Evidence shows that physical activity, including school-based physical education (PE), supports children's socio-emotional competencies and well-being, including enhancing self-regulation and reducing anxiety and depression. These positive outcomes often vary based on individual factors, including gender and socio-economic status. Given the amount of time children spend in school, this setting provides an ideal platform for enhancing their socio-emotional competencies and well-being through diverse PE opportunities. To date, most research on the association between PE and socio-emotional competencies has been conducted in countries where PE is a mandatory component of the school curriculum, such as those in Europe, the United States, and Australia. Bhutan, a Himalayan Buddhist country with a rich cultural heritage, has seen rapid social changes over the past 20-30 years. Rapid modernisation has led to lifestyle changes among youth, contributing to increasing social issues, sedentary habits and mental health challenges. School-based PE, known as Health and Physical Education (HPE), is limited to a single weekly hour and is highly dependent on the motivation of individual teachers and schools. Anecdotal evidence suggests that many schools do not have a dedicated time slot for HPE. HPE also faces obstacles, including the absence of a structured curriculum, limited trained PE educators, and a lack of prioritisation compared to other subjects.

This project aims to evaluate the impact of a school-based enhanced PE program on physical fitness, socio-emotional competencies and well-being in upper primary school students in Bhutan, compared to a school with HPE standard curriculum and a school with no PE.

This project is a methodological collaboration between the Centre Hospitalier Universitaire Vaudois in Switzerland (Dr Vanessa Siffredi, Dr Russia Hà-Vinh Leuchter) and the Paro College of Education and Royal Thimphu College in Bhutan (Prof. Kezang Sherab and Dr Pema Chopel). The Bhutanese team will implement the intervention and oversee on-site data collection, with the Swiss team providing methodological and statistical support.

Using a randomised controlled trial design, we will assign two urban public schools to either an "enhanced PE", grounded in Bhutan's health and physical education curriculum, or a "HPE standard curriculum" group. An additional "control school", without PE classes, will be included outside of the randomisation for feasibility concern. The study anticipates enrolling n=120 young adolescents per school (total n=360, ages 12- to 14-year-old). The enhanced PE group will receive two 90-minute sessions weekly for 5 months. The enhanced PE program incorporate both PE with socio-emotional competencies, such as self-regulation, self- and social-awareness, empathy-building exercises, and cooperation activities. Baseline individual characteristics (e.g., age, gender, socio-economic status, frequency of physical activity) will be collected pre-intervention via self- and parent-reported questionnaires. Primary outcomes, including physical fitness, socio-emotional skills, well-being, will be measured pre- and post-intervention. Physical fitness will be assessed by PE teachers (muscular strength, muscular endurance, flexibility, cardiorespiratory endurance, balance, coordination, agility, speed and power). Socio-emotional competencies and well-being will be evaluated in the young adolescents using standardised self- and parent-reported questionnaires.

This project offers a unique opportunity to evaluate the international impacts of PE on adolescents' socio-emotional competencies and well-being, especially within Bhutan's distinctive socio-cultural context. Given PE's low prioritisation, findings from this study will be valuable for guiding the Bhutanese national sport curriculum. More broadly, i will contribute to global research on PE and its role in fostering socio-emotional competencies and well-being in youth.

Interventions

• Behavioral Enhanced physical education
  The "Enhanced physical education" is based on the Health and Physical Education (HPE) Curriculum Framework developed by the Bhutanese Ministry of Education and well-document in the 2022 edition, www.education.gov.bt. The enhanced PE group will follow closely the description of the HPE curriculum and receive two 90-minute sessions weekly for 5 months. According to the HEP curriculum, the enhanced PE program incorporate both PE with socio-emotional competencies, such as self-regulation, self- and
• Behavioral HPE Standard curriculum
  Health and physical education (HPE) standard curriculum includes roughly one hour per week of general physical education, typically involving activities like football and basketball.

Primary outcome measures

• Socio-emotional competencies: Self-reported, Strength and Difficulty Questionnaire (SDQ) [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Socio-emotional competencies: Self-reported, Self-Compassion Scale [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Socio-emotional competencies: Self-reported, Empathy Questionnaire for children and adolescents [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Socio-emotional competencies: Self-reported, Self-Efficacy Questionnaire for Youth [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Socio-emotional competencies: Parent-reported, Strength and Difficulty Questionnaire (SDQ) [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Socio-emotional competencies: Parent-reported, Behaviour Rating Inventory of Executive Function (BRIEF) [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Socio-emotional competencies: Parent-reported, Social Skills Improvement System (SSIS) [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Well-being: Self-reported, KIDSCREEN-27 [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Well-being: Parent-reported, KIDSCREEN-27 [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]
• Push-up measurement [Time frame: Pre-intervention (baseline) and 16 weeks post-intervention]

Eligibility criteria

Inclusion criteria

• Enrolment in participating schools: Students must be enrolled in upper primary school classes (grades 7 and 8) in one of the three participating school.
• Regular school attendance: Students must attend school regularly to ensure consistent exposure to the intervention (min 80% of the courses).
• Parental consent: Written informed consent from a parent or guardian.
• Verbal assent from the child, indicating their willingness to participate.

Exclusion criteria

• Inability to participate in physical education courses: Students unable to participate in physical education classes due to medical or other significant reasons.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

Bhutan · 1 center

• Paro College of Education, Bhutan — Paro

Publications

• Spruit A, Assink M, van Vugt E, van der Put C, Stams GJ. The effects of physical activity interventions on psychosocial outcomes in adolescents: A meta-analytic review. Clin Psychol Rev. 2016 Apr;45:56-71. doi: 10.1016/j.cpr.2016.03.006. Epub 2016 Apr 3. PMID 27064552
• Choden U, Sherab K, Howard J. Experience of bullying among Bhutanese college students: implications for teacher formation programmes. Int J Adolesc Med Health. 2019 Nov 25;34(1). doi: 10.1515/ijamh-2019-0087. PMID 31760378
• Lubans D, Richards J, Hillman C, Faulkner G, Beauchamp M, Nilsson M, Kelly P, Smith J, Raine L, Biddle S. Physical Activity for Cognitive and Mental Health in Youth: A Systematic Review of Mechanisms. Pediatrics. 2016 Sep;138(3):e20161642. doi: 10.1542/peds.2016-1642. Epub 2016 Aug 19. PMID 27542849

Identifiers

NCT: NCT06820632 · CIRSport2025

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗