The research team, led by Janaka Godevithana and Champa Jayalakshmie Wijesinghe of the University of Ruhuna, together with Millawage Supun Dilara Wijesinghe of Sri Lanka’s Health Promotion Bureau, set out to address a growing public health problem. Unhealthy diets are a key risk factor for non-communicable diseases such as diabetes, cardiovascular disease and certain cancers, and office workers, with their long sedentary hours and easy access to convenience foods, are particularly exposed. The resulting burden is both medical and economic, straining health systems and reducing productivity across working populations in low- and middle-income countries.

At the heart of the intervention lies a well-known behavioural framework: the transtheoretical model, and specifically its Stage of Change construct, sometimes called the stages of readiness. Rather than treating all participants as a uniform group, the programme classified each worker according to whether they were precontemplating change, contemplating it, preparing for it, actively changing, or maintaining new habits. The content and intensity of the advice each participant received were then tailored to that stage, a principle known as stage matching. The idea is intuitive: someone who has never considered eating more vegetables needs a different conversation from someone already trying to do so.

The trial’s design gave the question unusual rigour for a workplace nutrition study. Rather than randomising individuals, which risks contamination when colleagues share meals and conversation, the researchers randomised whole clusters, meaning entire offices or administrative units, to either the intervention or a control condition. Control clusters received no intervention during the study period. Dietary intake was measured objectively at baseline and again after three months using a 24-hour dietary recall method, supplemented by a picture guide to help participants estimate portion sizes and by computer software to convert reported foods into nutrient and food-group data. Readiness to change was assessed with a validated staging algorithm.

After three months, the results were unambiguous. Both groups showed some positive movement in their stage of change, which the authors note may reflect natural progression or the effect of simply being assessed, but the change was far stronger in the intervention group, where it reached a p-value below 0.001 compared with a more modest p-value of 0.04 among controls. More importantly, the intervention group recorded significant improvements in cereal, fruit and vegetable intake alongside a reduction in unhealthy food consumption, all at the same stringent significance threshold.

The statistical strength of the effect is what makes the trial remarkable. In regression analyses, receiving the intervention was a significant predictor of progressing in stage of change, with an odds ratio of 12.2, and an even stronger predictor of achieving a measurably healthier dietary intake, with an odds ratio of 25.3. In plain terms, participants in the intervention arm had roughly twelve times the odds of advancing in their readiness to change and about twenty-five times the odds of actually improving their diet compared with controls. For a relatively brief, low-cost workplace programme, those are unusually large effects.

The analysis also revealed who benefited most. Being a clerical worker predicted a positive change in stage of change, with an odds ratio of 1.7 at the threshold of significance, suggesting that the programme resonated particularly with staff in routine administrative roles. Meanwhile, participants who were already in the action or maintenance stages at baseline were significantly more likely to achieve improvements in dietary intake, with an odds ratio of 3.5. This pattern fits the logic of the underlying theory: people who have already begun changing have the momentum to convert readiness into measurable behaviour, while those at earlier stages may need longer or more intensive support before their diets shift.

Why should a stage-matched approach outperform generic healthy-eating campaigns? Behavioural science offers several explanations. Generic messages often fail because they mismatch the recipient’s psychological state: a person in precontemplation, who sees no problem with their diet, is likely to dismiss advice framed for someone already trying to change. Stage-matched interventions meet people where they are, using consciousness-raising for the unmotivated, decisional balance exercises for the ambivalent, and concrete planning and relapse-prevention strategies for those already acting. The Sri Lankan programme also grounded its dietary targets in the Food Based Dietary Guidelines for Sri Lankans, translating international nutritional science into culturally familiar foods and portions, which likely strengthened its acceptability in local workplaces.

The trial was conducted with careful attention to research governance. It was registered in the Sri Lanka Clinical Trial Registry under registration number SLCTR/2020/025, ethical approval came from the Ethics Review Committee of the Faculty of Medicine at the University of Ruhuna, and administrative approval was obtained from the District Secretariat and health authorities in Galle. All participating office workers gave informed written consent, and the study was carried out in accordance with the Declaration of Helsinki. Workers identified with health problems during the study were referred to the nearest healthcare facility. The authors declare no competing interests, and the study was self-funded by the corresponding author.

The findings arrive at a moment when employers and governments worldwide are searching for scalable ways to curb non-communicable diseases, which now dominate the global burden of disease. Workplace interventions are attractive because they reach adults where they already gather, require little additional infrastructure, and can be delivered repeatedly. This trial suggests that the missing ingredient in many past workplace programmes may not be money or technology but psychological tailoring: asking each employee a simple question about their readiness to change and building the message around the answer. The authors caution that their results come from a single district and a three-month follow-up, and they recommend further studies assessing the intervention’s effectiveness in a more pragmatic manner across different settings. Longer follow-up would also show whether early gains persist once the programme ends. Even so, the size of the effects, the rigour of the cluster-randomised design and the simplicity of the underlying approach make this one of the most encouraging workplace nutrition results in recent years, and a template that health ministries far beyond Sri Lanka may soon want to test in their own offices.

Subject of Research: A stage of change–based dietary intervention for sedentary office workers evaluated in a cluster-randomised trial in Southern Sri Lanka

Article Title: Transforming diet in the workplace: effectiveness of a stage of change–based dietary intervention for sedentary office workers in Southern Sri Lanka – a cluster randomised trial

Article References: Godevithana, J., Wijesinghe, C. J., & Wijesinghe, M. S. D. (2026). Transforming diet in the workplace: effectiveness of a stage of change–based dietary intervention for sedentary office workers in Southern Sri Lanka – a cluster randomised trial. BMC Public Health. https://doi.org/10.1186/s12889-026-29843-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29843-3

Keywords: dietary intervention, healthy eating, sedentary office workers, stage of change theory, cluster-randomised controlled trial, non-communicable diseases, workplace health, nutrition, Sri Lanka, behaviour change, public health, BMC Public Health

The stakes are surprisingly high for such a young age group. International guidelines recommend that toddlers accumulate at least 180 minutes of physical activity per day, including structured activity, while limiting restraint and screen time and securing 11 to 14 hours of good-quality sleep within every 24-hour period. Yet the evidence suggests most toddlers fall dramatically short. In an Australian study cited by the research team, fewer than 9 percent of toddlers met the full suite of national 24-hour movement guidelines for the early years. While 96.5 percent met the physical activity target and 79.7 percent met the sleep target, a mere 11.4 percent stayed within recommended sedentary screen time limits. Data from Singapore tell a similar story: around 82 percent of toddlers met sleep recommendations, but only about half met physical activity guidelines and fewer than 39 percent stayed within screen time limits. Canadian studies echo the pattern, with adherence to sleep and activity guidelines generally high but the majority of two-year-olds exceeding screen time recommendations.

Why does this matter so much? Because the early years are a period of extraordinary neural plasticity, when the foundations of motor competence, cognition, and emotional regulation are laid down. Research shows that toddlers’ gross motor skills are positively associated with cognitive development, and that shorter naps combined with a higher proportion of nighttime sleep correlate with better cognitive outcomes. Conversely, the prevalence of below-average motor skills in young children appears to be higher than normative samples would predict—a red flag that targeted developmental programmes can potentially address, since studies have shown such programmes can improve gross motor skills in toddlers. Music, meanwhile, is far more than entertainment at this age. When caregivers receive music training, children in their care show increased visual, vocal, and physical engagement, and music training in kindergartens has been shown to improve inhibitory control, a core executive function. Musical workshops built around sound-producing objects have been found to enhance toddlers’ natural exploratory drive.

Despite this converging evidence, no study to date has evaluated a holistic programme in early childhood education and care settings that integrates physical activity, sedentary behaviour, sleep, and motor and musical skills simultaneously. That gap is what MoviMusi is designed to fill. The trial will run over 24 months in the capital cities of three Spanish regions—Valencia, Murcia, and Toledo—chosen because they reflect the diversity of the Spanish educational system. In total, 24 public early childhood education and care centres will participate, split evenly between an intervention group and a control group: five centres per arm in Valencia, four per arm in Murcia, and three per arm in Toledo. With an average class size of 13 toddlers, this translates to roughly 312 children, distributed as 130 toddlers in Valencia, 104 in Murcia, and 78 in Toledo.

The trial’s design reflects the statistical realities of studying children in group settings. Because children within the same classroom behave more similarly to one another than to children in other classrooms—an effect quantified by an intraclass correlation—the researchers used cluster-randomisation formulas to calculate their sample. They powered the study to detect an expected increase of 8 minutes of moderate-to-vigorous physical activity per school day, building on their own previous accelerometry work showing that children aged two to three accumulate about 40 minutes of such activity during childcare hours. With a significance level of 5 percent, 90 percent statistical power, and an intraclass correlation of 0.35, 24 centres emerged as the required sample. Randomisation will occur only after baseline measurements are complete, at the end of the first year, performed by an independent researcher using a computer-generated sequence—a blinded procedure that protects against allocation bias.

What makes MoviMusi genuinely distinctive is its participatory philosophy. Rather than imposing a rigid, top-down curriculum, the researchers will work with each intervention centre’s principals, educators, and families to co-design a programme tailored to that centre’s specific realities. Previous research suggests these horizontal, dialogic interventions are more effective at changing school culture around physical activity than vertical, prescriptive ones. The programme unfolds along three axes. First, training: educators and families attend seminars and workshops on promoting physical activity as healthy behaviour and using music as a didactic resource. Second, participation: over two months, each institution designs its own movement and music programme, supported by baseline data on the personal, social, and environmental correlates of the children’s movement behaviours. Third, implementation: the specific actions run for six months, after which the team evaluates effectiveness against the control group, whose centres continue their usual curriculum.

The measurement toolkit is remarkably comprehensive for a population so young. Children will wear ActiGraph wGT3X-BT accelerometers on their right hip for one full week, from waking to bedtime, with data processed in 15-second epochs and scored using validated cutoffs for two-year-olds. Sleep will be captured through the Spanish-adapted Brief Infant Sleep Questionnaire, supplemented by teacher-recorded nap times during school hours. Motor skills will be assessed with the Peabody Developmental Motor Scales, third edition, a standardised instrument validated for Spanish children from six months to five years. Musical skills will be measured with MUSKITO—a new scale the research team itself is developing—covering listening, singing, instrumental interpretation, improvisation or composition, and movement. Direct observation during unstructured outdoor play will use a modified version of the OSRAC-P system, in which trained coders record a child’s activity state every 25 seconds in five-second observation windows, with intercoder reliability verified using Cohen’s kappa.

Beyond the child-level outcomes, the study casts a wide net across the entire educational ecosystem. Researchers will assess the quality of each centre using the Infant/Toddler Environment Rating Scale, measure playground area and density using satellite imagery and geographic information systems, and classify playgrounds as low or high density based on free space per child. Parents will complete validated questionnaires on their children’s after-hours activity, screen time, and modes of transport to school, alongside a dedicated scale measuring barriers to active commuting. Focus groups with educators and families, conducted at baseline and after implementation, will probe perceptions of barriers and facilitators to embedding movement and music in daily practice. The team will even analyse official curriculum documents to understand how public authorities promote—or fail to promote—movement and music in early childhood education, and will invite education authorities to result-dissemination meetings.

The researchers are candid about the challenges ahead. Interventions must respect each centre’s internal culture rather than dictate activities; family engagement with questionnaires cannot be taken for granted; accelerometer data will inevitably be lost to the absences that are common in toddler classrooms; and coordinating a project across three cities with different administrative rhythms demands dedicated local leads. The statistical plan anticipates these realities, using mixed-effects longitudinal models that adjust for baseline values, age, sex, and body mass index, with random effects for cities, groups, and participants, and multiple imputation for missing data handled by a blinded analyst. Ethical approval has been granted by the University of Valencia’s ethics committee, and written informed consent will be required from all participating families.

If MoviMusi succeeds, the implications could ripple well beyond the 24 participating nurseries. The team plans to share results at three levels—within each centre, at public events in the three cities, and through an open conference—culminating in a set of good-practice guidelines for promoting movement and music opportunities that could inform curriculum design and teacher training nationally and internationally. The study also answers a call from leading movement-behaviour researchers, who have identified interventions for children under three as a critical frontier. In a world where toddler screen time is quietly eroding the building blocks of healthy development, the idea that songs and structured play, delivered through the everyday curriculum, could shift the trajectory of an entire generation is a proposition worth testing rigorously. MoviMusi is now positioned to deliver exactly that test.

Subject of Research: A cluster-randomised controlled trial of a movement and music programme on movement behaviours and motor and musical skills in toddlers

Article Title: Effectiveness of a movement and music programme on activity, sedentary, and sleep behaviours and motor and musical skills in young children: protocol for the MoviMusi cluster randomised controlled trial

Article References: del Mar Bernabé-Villodre, M., Martínez-Bello, V. E., Vega-Perona, H., Díaz-Barahona, J., García-Ochoa, Y. C., Molines-Borrás, S., Gértrudix-Barrio, F., Montoya-Rubio, J. C., Fernández-Vilar, M. Á., Azorín-Delegido, J. M., Filenko, N., Martínez-Rojas, Á., & Martínez-Bello, D. A. (2024). Effectiveness of a movement and music programme on activity, sedentary, and sleep behaviours and motor and musical skills in young children: protocol for the MoviMusi cluster randomised controlled trial. Journal of Activity, Sedentary and Sleep Behaviors, 3(1), Article 28. https://doi.org/10.1186/s44167-024-00065-5

Image Credits: AI Generated

DOI: 10.1186/s44167-024-00065-5

Keywords: early childhood education, physical activity, sedentary behaviour, sleep, motor skills, musical skills, cluster randomised controlled trial, toddlers, MoviMusi, accelerometry, 24-hour movement guidelines, Spain

The intervention, called Happy Homework 2.0, is a digital application designed to weave movement-based activities into the routines children already follow at home. Rather than adding another demand to crowded school timetables, the programme exploits a slot that already exists in every child’s evening. The concept builds on a growing body of evidence that school-based interventions, while scalable, often lose their impact once children leave the school gates. Homework, the researchers reasoned, could act as a bridge, extending the reach of classroom health messaging into the living room, the garden and the bedroom, where most sedentary time and sleep actually occur.

To test whether the idea could work in practice, the team conducted an eight-week pilot cluster randomised controlled trial across four primary schools in the West of Scotland. In a cluster randomised design, entire classes rather than individual children were allocated to either the intervention or the control condition, a method that reduces the risk of contamination between participants who see each other every day. A total of 82 children aged between 8 and 12 years took part, representing 60 percent of those invited, and 87 percent of them were still providing data at follow-up. Those retention figures, the researchers report, indicate good feasibility for a trial of this kind, which is precisely what a pilot study is designed to establish before larger, fully powered trials are attempted.

The evaluation went beyond simple attendance numbers. Feasibility, usability and acceptability were assessed through basic app-usage analytics and questionnaires completed by three separate constituencies: the children themselves, their parents, and their teachers. Gathering perspectives from all three groups matters because a digital health intervention for children sits at the intersection of competing interests. Children must find the app engaging enough to open it voluntarily, parents must be willing to accommodate it in the evening routine, and teachers must see enough value to integrate it into their homework expectations without it becoming a burden.

The study also collected objective data on the outcomes that matter most. Children wore activPAL devices, small sensors attached to the thigh that distinguish between sitting, standing and stepping based on posture rather than relying on self-report. This technology provided multiple posture- and movement-based metrics, giving the researchers a far more reliable picture of sedentary behaviour than questionnaires alone could offer. Sleep was measured through self-report questionnaires, and children’s motivation was assessed using instruments based on basic psychological need satisfaction, a framework rooted in self-determination theory, which holds that motivation flourishes when people feel autonomous, competent and connected to others.

The statistical analysis used linear mixed-effects models, a technique well suited to this kind of trial because it accounts for two sources of dependency in the data: the clustering of children within schools, and the fact that each child was measured repeatedly over time. By modelling group-by-time interactions, the researchers could ask whether children in the intervention arm changed differently from those in the control arm, rather than simply comparing average values at the end of the study. This approach is now standard in behavioural trials, but its careful application in a small pilot is notable, because it demonstrates that the study design can detect genuine signals even before scaling up.

What did those signals show? The most striking finding concerned sedentary behaviour. The activPAL data revealed a significant group-by-time difference, with sedentary time increasing more in the intervention group than in the control group, a difference of 66.2 minutes per day that reached statistical significance. Self-reported sleep also showed a significant interaction, with smaller increases in reported sleep duration among children using the app relative to controls. No other secondary outcomes, including measures of physical activity, showed significant group-by-time differences. Taken at face value, these results are not the triumphant headline one might hope for from a movement intervention: the app did not reduce sitting or boost activity in the intended direction during this pilot period.

The researchers are candid about the most likely explanation: engagement. The app-use analytics showed repeated engagement among participants, but overall use was modest, defined by declining frequency and duration of interactions over the eight weeks. In other words, children tried the app, returned to it for a while, and then gradually drifted away, a pattern familiar to anyone who has downloaded a fitness app with good intentions in January and abandoned it by March. When the dose of an intervention falls, its effects tend to attenuate with it. The team concludes that Happy Homework 2.0 was feasible and acceptable as a homework-based health intervention, but that engagement levels likely limited its effectiveness, and the unexpected shifts in sedentary time and sleep may reflect this weak implementation rather than any inherent failure of the concept.

That interpretation is where the real scientific value of the study lies. Pilot trials are not meant to deliver definitive answers; they are meant to expose the practical friction points that would otherwise sabotage a large trial. Here, the friction is clear: sustaining children’s voluntary engagement with a digital health tool over weeks, not days, remains the central challenge of mHealth interventions for young people. The authors emphasise the need to strengthen implementation strategies, sustain engagement, and enhance the involvement of parents and teachers, the two adult groups whose encouragement could counteract the natural decay of novelty. The study was retrospectively registered as NCT07631754, funded through a University of the West of Scotland Vice-Chancellor’s Studentship Scheme, and published open access in the Journal of Activity, Sedentary and Sleep Behaviors.

The broader lesson extends well beyond one Scottish app. Digital interventions promise scale and personalisation that classroom programmes cannot match, but they also compete for attention in an ecosystem saturated with far more compelling screen content. The paradox is sharp: an app designed to pull children away from screens must first win a battle for screen time. Future iterations of Happy Homework, and similar tools now in development through co-design studies with children and families, will need to treat engagement not as an afterthought but as the primary design target, using gamification, family involvement and curriculum integration to keep the dose high enough for biology to respond. The 24-hour movement behaviours of children remain a modifiable target, and the homework slot remains an underexploited opportunity. What this pilot establishes is that the pipeline from idea to evidence works; what it also establishes is that the hardest variable to move is not the child’s body, but the child’s attention.

Subject of Research: A pilot cluster randomised controlled trial testing the feasibility, acceptability and usability of a digital homework app targeting physical activity, sedentary behaviour and sleep in primary school children.

Article Title: Happy Homework 2.0: effects on 24-hour movement behaviours in children—findings from a pilot cluster randomised controlled trial

Article References: Forrest, A., Buchan, D. S., Sculthorpe, N., & Robinson, S. (2026). Happy Homework 2.0: effects on 24-hour movement behaviours in children—findings from a pilot cluster randomised controlled trial. Journal of Activity, Sedentary and Sleep Behaviors. https://doi.org/10.1186/s44167-026-00111-4

Image Credits: AI Generated

DOI: 10.1186/s44167-026-00111-4

Keywords: physical activity, sedentary behaviour, sleep, children, homework, digital intervention, mHealth, cluster randomised controlled trial, 24-hour movement behaviours, app development, school-based intervention, activPAL