Implementation, Outcomes, and Sustainability of a School‐Based Physical Activity Initiative

BACKGROUND: Childhood physical inactivity is a major public health concern in Quebec. In 2018, Quebec launched "Let's Move at School!," a policy targeting 60 min of daily moderate-to-vigorous physical activity (MVPA) during the elementary school day, yet implementation and sustainability challenges persist. METHODS: In 21 schools, this 5-year qualitative study (2018-2023) conducted 258 interviews and 40 focus groups with 258 school staff and 134 pupils. Data were analyzed thematically to examine how schools implemented the measure, what facilitated or hindered implementation, perceived impacts, and factors supporting sustainability. RESULTS: Implementation was supported by structured governance (committees, clear roles, coordination), strong principal support, sufficient staff, and physical education and health (PEH) teachers' leadership. Pupil involvement in choosing activities enhanced motivation and ownership. Perceived benefits included improved concentration, behavior, and well-being, but were constrained by funding cuts, staff turnover, disengagement among some pupils, and limited alignment with the PEH curriculum. IMPLICATIONS FOR SCHOOL HEALTH POLICIES, PRACTICE, AND EQUITY: Policies should protect time and support for teachers, formalize governance, strengthen pupil voice, and provide stable, equity-sensitive funding to reduce implementation gaps across schools. CONCLUSIONS: The 60-min target alone is unlikely to produce equitable benefits without coherent organizational conditions and long-term support.