CONTEXT: The majority of children do not participate in sufficient amounts of daily, health-enhancing physical activity. One strategy to increase activity is to promote it within the after-school setting. Although promising, the effectiveness of this strategy is unclear. A systematic review was performed summarizing the research conducted to date regarding the effectiveness of after-school programs in increasing physical activity. EVIDENCE ACQUISITION: Databases, journals, and review articles were searched for articles published between 1980 and February 2008. Meta-analysis was conducted during July of 2008. Included articles had the following characteristics: findings specific to an after-school intervention in the school setting; subjects aged <= 18 years; an intervention component designed to promote physical activity; outcome measures of physical activity, related constructs, and/or physical fitness. Study outcomes were distilled into six domains: physical activity, physical fitness, body composition, blood lipids, psychosocial constructs, and sedentary activities. Effect sizes (Hedge's g) were calculated within and across studies for each domain, separately. EVIDENCE SYNTHESIS: Of the 797 articles found, 13 unique articles describing findings from 11 after-school interventions were reviewed. Although physical activity was a primary component of all the tested interventions, only eight studies measured physical activity. From the six domains, positive effect sizes were demonstrated for physical activity (0.44 (95% CI 0.28 to 0.60)); physical fitness (0.16 (95% CI 0.01 to 0.30)); body composition (0.07 (95% CI 0.03 to 0.12)); and blood lipids (0.20 (95% CI 0.06 to 0.33)). CONCLUSIONS: The limited evidence suggests that after-school programs can improve physical activity levels and other health-related aspects. Additional studies are required that provide greater attention to theoretical rationale, levels of implementation, and measures of physical activity within and outside the intervention.

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