HOPP Learning will be implemented in elementary schools in the Horten municipality and will assess the effect of a combined pedagogical approach, active learning, on a large student population. Students are to increase their amount of physical activity with learning, during a school day by one hour.

Background It has for many decades been a discussion whether the proportion of hours of physical activity should be increased in the Norwegian primary school. In light of the evolution of inactivity, overweight and obesity, both internationally and in Norway, it is now time to implement measures that can provide improved health and preventing lifestyle diseases among children and adolescents. Until now, one in Norwegian society based on the fact that children are active enough in their spare time, with sport as an arena. This assertion has had its validity, but not with the tendency of children are significantly more sedentary than their parents were in their infancy. Thus, the community must take more responsibility. One of the measures is to increase the physical activities offered in primary schools. Then all the children get the opportunity to form healthy habits with regular physical activity.

HOPP Learning will be implemented in elementary schools in the Horten municipality and will assess the effect of a combined pedagogical approach, active learning, on a large student population. Students are to increase their amount of physical activity, during a school day by one hour. To evaluate the effect of HOPP Learning Horten municipality contacted University College of Health Sciences - Campus Kristiania.

Aims The primary aim is to chart and assess the effect of active learning through analysis of dietary intake (Ungkost 2000 questionnaire), quality of life (ILC questionnaire), cognitive tests (computer based measurements of reaction time using Flanker and Stroop test), academic performance (grades in national tests) and physiological factors as activity level (accelerometer measurements), aerobic capacity (Andersen shuttle run test and oxygen uptake), balance (Balance Y-test) and strength (Jamar handgrip). In addition medical variables as blood pressure, peak expiratory flow and blood work (total cholesterol, HDL, iron, feritin, CRP, blood sugar, Hb, Hematocrit, RBC).

Sample The project has a prospective clinical controlled study design and involves seven elementary schools in Horten Municipality with the estimated number of children in 1-6 grade being 1,822. The 12 year olds in the current schools will not be tested when they go over to their respective secondary schools in 2016 so will not participate in the intervention. Similarly, those children who start 1st grade in 2015 not be included in the intervention as they are enrolled in kindergarten during the first round of tests in Spring 2015. Consequently there will be a calculated "drop off" of one school grade per year based on the selection from the initial testing during spring 2015, and from the second round of testing in 2016. Based on an analysis of socioeconomic status between municipalities in Norway, Loerenskog and Baerum municipality has a socioeconomic composition as Horten. Given health inequalities in children are directly related to parents' socioeconomic status, and in particular education, Loerenskog and Baerum municipality were chosen as the control population. Two elementary schools were contacted and agreed to participate as control schools, ca. 500 pupils at each school. Similarly calculated dropout rates will occur at the control school. The total inclusion sample is approximately 2,800 pupils. Inclusion criteria: Students from Grade 1-6 from all elementary schools in Horten municipality and from two control schools. Exclusion criteria: Students with psychological or physical disabilities that prevent them participating in the tests, students afflicted with sickness/disease during the testing period and students who do not wish to participate in the test.

Implementation of the intervention A large activity learning library within reading, mathematics and english within the academic guidelines for grades 1-7 has been established. There is thus a total of 32 sites where it is 510 activities within each step. This means that it is unique exercise sets distributed on grades and subjects the individual teachers will have at least one hour per class they are responsible for every day. The range of exercises are based both on the teachers' own ideas, proposals from the Education directorate and www.skolesekken.no. Horten Municipality has distributed this exercise library to the individual schools. The activity is organized as different activity programs of 15 minutes for each subject they wish to teach.

Combining physical activity and learning (basic subjects) exercise sets are stored in boxes with the accompanying learning tools: a crate for english 1st grade, a crate for English 2nd grade, etc., thus making it easy to begin a lesson by simply bringing a box to each class.

Inclusion Criteria:

• Students from Grade 1-6 (2015) from all elementary schools in Horten municipality and two schools from Loerenskog and Baerum municipality.

Exclusion Criteria:

• Students with psychological and physical disabilities preventing them participating in the tests
• Students afflicted with sickness/disease during the testing period
• Students who do not wish to participate in the test