Given the direct and indirect effects of physical activity on multiple domains of life, promoting regular opportunities for movement from an early age is considered a vital investment for sustainable societies. However, countries in the Global South, such as Brazil, often face limited capacity and resources to respond to the global call for promoting physical activity. Vulnerable children in Brazil are accumulating less physical activity than the recommended amount during school hours. This Lemann Lecture Series presents results from a call to action focused on unlocking and accelerating physical activity opportunities for low-income children in Arapiraca, Alagoas, Brazil. The project comprised three interconnected studies. The first study, using a cross-sectional design, mapped organizational, political, and cultural factors within four schools and assessed physical activity levels among children (n = 250) during school hours. The second study aimed to develop a school-based physical activity policy through a mixed-methods co-creation process. A two-round Delphi methodology, consisting of an online survey and semi-structured interviews with principals, teachers, administrative staff, and superintendents, was employed to refine the policy and identify perceived barriers and facilitators for its adoption and implementation. The third study was a natural experiment with follow-up measures to evaluate the impact of partial policy adoption in two schools. Results revealed a significant association between school organization and built environment factors, explaining approximately 22% of the variance in children’s physical activity levels. The school-based policy integrates evidence-based guidance with local, context-specific insights to enhance feasibility and relevance. On average, at least 80% of policy items were rated highly in terms of importance, adoption, and implementation by stakeholders. Schools that adopted specific policy components—such as playground renovation and inclusion of a certified Physical Education teacher—showed a significant increase (p < 0.05) in children’s physical activity. Future directions include scaling the policy to additional schools, evaluating its long-term impact on children’s physical activity patterns, and strengthening intersectoral collaboration across education, health, and urban planning sectors to ensure sustainable implementation.
Rafael Tassitano is an Assistant Professor with 15 years of experience in physical activity epidemiology, focusing on underserved youth populations in Brazil. His research employs mixed methods to identify and implement sustainable physical activity solutions within structured settings.