The mindful movement program in primary schools: a single-arm pilot intervention study

Abstract

Background

The early primary school years provide a unique opportunity for improving executive functions on a classroom-wide scale. While mindfulness, music, and movement have each demonstrated effectiveness in enhancing executive functions in early primary classrooms, no previous studies have integrated these modalities into a single program. The aim of this study was to assess the feasibility, acceptability, and preliminary impact of a novel program that combines mindfulness with movement to music: the Mindful Movement Program (MMP).

Methods

This single-arm within-subjects study evaluated the feasibility of teachers delivering the MMP within the early primary years classroom setting. The program was integrated into the classroom curriculum and delivered across two school terms, to seven primary school classes, with a total of 133 students (mean age 6.61 years; standard deviation 0.90).

Results

High rates of student recruitment (91%), and both student and teacher retention were obtained (98% and 100% respectively). Fidelity of implementation was moderate for core practices (68%) and video resource use (66%); and acceptability of the intervention high, despite teacher absences due to COVID-19 restrictions. Mixed-effects modelling showed that teacher-reported global executive functioning (b = -2.95, p < .001), externalising (b = -1.06, p < .001), and internalising (b = -0.52, p < .01) behaviour problems significantly reduced from baseline after receiving the intervention. A subset of students (n = 50) who were directly assessed on general motor skill and specific body coordination skills also showed significant improvements (p < .001) with medium to large effects.

Conclusions

This study demonstrated the feasibility and acceptability of a structured approach to movement and mindfulness developed by an experienced dance teacher, and delivered by teachers within the existing classroom setting. The program showed encouraging findings of improvement in a pre-post assessment. Further research is warranted to establish effectiveness in a controlled study design.

Background

The development of executive functions (EFs) during early childhood establishes the critical foundations for socio-emotional development and academic success both in childhood [1] and across the lifespan [2]. EF development is characterised by the specialisation of inhibitory control, working memory, and cognitive flexibility in the prefrontal cortex [3]. These functions support the planning and execution of goal-directed behaviour and attainment, including self-control, evaluation, and action [2]. During the early school years, children show rapid development of a range of EFs including attentional and emotional control, behavioural inhibition, working memory, and slightly later, cognitive flexibility, suggesting these years as an optimal period for intervention [4, 5].

Extensive empirical evidence supports the effectiveness of interventions targeting EF that are integrated into the school curriculum, including mindfulness interventions [6,7,8], movement-based interventions [9,10,11,12], and music-based interventions [13]. While these approaches have shown considerable promise separately, integration of these intervention strategies into a single program may confer additional benefits – a possibility that has yet to be investigated. This gap is addressed by examining the feasibility of a novel intervention designed for the early years’ classrooms (Preparatory to Year 2) by a dance expert. This program integrates mindfulness with complex-coordinated movement and rhythmic movement to music and is delivered by classroom teachers. Evidence for each of these components is compelling, raising a reasonable question around the potential added value of having a program that integrates these components.

The impact of mindfulness-based programs on child functioning

There has been widespread evaluation of mindfulness-based programs for young children at home and in classrooms [14, 15]. Mindfulness-based interventions delivered in the classroom have shown effectiveness with significant, albeit small, effects for cognitive (EFs, cognition, attention, memory) and socioemotional (emotional regulation, social skills, self-esteem, internalising behaviours, anxiety, stress) outcomes [7]. More recent systematic reviews synthesise this evidence across both clinical and classroom settings with significant improvement found in measures of attention and EFs with medium to large effect sizes [6]. However, across reviews, only two studies [16, 17] were included that focused on children with a mean age under 8 years suggesting that mindfulness interventions with this age group is an under-researched area. More recently, a systematic review focused on this young age group (specifically 3–5 years) and found preliminary evidence that mindfulness in combination with yoga (i.e. with incorporation of a mindful-movement element), was associated with improvements in EFs, social-emotional functioning, and self-regulation in children [18].

The impact of complex movement and rhythmic movement-based programs on child functioning

Complex movement programs that include both a physical coordination component [19] and a cognitive component, i.e., the technical execution of a movement that demands a cognitive challenge, are also associated with improvements in EFs [20]. Notably, EF improvement has been most evident when the intervention used a mindful-movement component such as Taekwondo or Tai Chi compared to repetitive automated movement such as resistance training [21, 22]. Schmidt and colleagues [23, 24] have experimentally tested the differences in EF benefits associated with complex physical movements. They directly compared cognitively complex and physically demanding movements (team games with memorization and rule changes) to movement that was cognitively-low/simple and physically-demanding (running track or circuit exercise) or cognitive-low and physical-low conditions (PE curriculum or waitlist). These comparisons found that the greatest EF improvement in kindergarten children aged 4–6 years old [24] and preadolescent children aged 10–12 years old [23], for the cognitively and physically demanding conditions.

There are also benefits for EFs following engagement in movement to music. Movement to music that is rhythmic (regular beat and patterning of movement), involving engagement in music production (e.g., playing an instrument), dance or other movement accompanied by music (e.g. clapping), have demonstrated EF improvements in children [25]. A key putative mechanism of change in movement to music is beat entrainment, which refers to the tendency of human systems, including motor and physiological functions (e.g. heart rate), to synchronize with a patterned beat [26, 27]. Recent reviews have documented the cognitive benefits of both instrumental music instruction for children and adolescents aged up to 16 years [13] and broader music training including rhythmic movement benefits for inhibitory control in children aged up to 10 years [28].

There is emerging evidence for the role of rhythmic movement in relation to cognitive development, including EFs. When compared to pitch-based music activities and sports training, beat synchronised movement activities such as clapping or tapping have been found to support inhibitory improvement in children aged 5—6 years [29]. A specific preschool intervention of rhythmic coordinated movement with embedded cognitive challenges has been effective in improving self-regulation and inhibitory control in children aged 3—4 years [30,31,32]. Finally, a systematic review of studies with children aged 18 years or younger found diverse dance forms to be associated with improved youth psychological functioning including EF and memory. Of note, the authors of this systematic review highlighted an underrepresentation of children 7 years or younger across studies [33]. Recent intervention studies have included the use of street-dance training for preschool children [34]¸ learning and memorization of dance choreography in children aged 6–7 years [35], an aerobic dance program for children aged 9–11 years [36], and rhythmic physical activity for children aged 6–11 years [37], all yielding evidence for EF improvements, suggesting these effects may generalise to children over 7 years as well, and across multiple dance formats/genres. Each of these dance-based interventions were delivered by experts and used specialized settings or resources specific for dance instruction. Whether it is feasible to have non-specialists implement these interventions in non-specialised classroom settings is unclear. Taken together, the inclusion of rhythmic-supported dance and movement activities in interventions consistently supports improvement in EFs for preschool children [38]. Further investigation of the potential for an intervention that combines complex-coordinated movement with rhythmic engagement in the early years is warranted.

The current study

There is converging evidence indicating that programs focusing on one of three key components – mindfulness, complex movement, and beat synchronization – are associated with improvements in EFs in school-age children. However, it remains unclear whether a program that combines these elements into a single intervention for younger school-age children is feasible. Addressing this uncertainty is a crucial first step in evaluating the potential utility of a larger-scale research study, as it allows for the identification of potential challenges and the modification of the research protocol as needed. The Mindful Movement Program, which incorporates these key elements, has been designed as a unique program intended for delivery by teachers in early years classrooms. This study is a single arm, pre-post pilot and feasibility study of the Mindful Movement Program (MMP). The primary aim of the study was to determine feasibility outlined by Orsmond and Cohn [39] as assessed by (i) recruitment, (ii) data collection procedures and outcome measures, (iii) acceptability and suitability of intervention and study procedures, (iv) resources and implementation of study and intervention. The secondary aim of the study was (v) to determine whether there was evidence of preliminary change to indicate that there was potential for the intervention when taken to a full randomized controlled trial design [40].

Methods

Participants

Students were recruited from seven classrooms (ranging from the first year of formal education, Preparatory, to the third year of formal education, Year 2) across two inner city primary schools located in Southeast Queensland, Australia. Classrooms participating in School 1 were three classrooms (Preparatory, Year 1, Year 2). School 1 had 104 enrolments total across Preparatory to Year 6, had 30% of students with English as an additional language (EAL), and had a school Index of Community Socio-Educational Advantage (ICSEA) of 1063, or the 74 th percentile, where the higher the percentile the more socio-economically advantaged the school [41]. Classrooms participating in School 2 were four classrooms (2 Preparatory, 2 combined Year 1/2). School 2 had 256 enrolments total across Preparatory to Year 6, had 38% of students with English as an additional language, and had a school ICSEA value of 1078, or the 78 th percentile [41]. One hundred and forty-eight students across both schools were invited to participate in the research activities and their parents/carers were provided information and consent forms. Of these, 134 (91%) consent forms were returned. All students were provided the opportunity to participate in the research activities, regardless of student specialised needs, such as disabilities. Students with additional supports in the classroom, such as receiving special education services or teacher aide services, were included, see Table 1 for further information. Participant and teacher demographic details are provided in Table 1. Participating teachers were all female, had a mean age of 36.71 years (SD = 5.44), had on average 10.64 years teaching experience (SD = 7.49), and had classroom sizes averaging 19 students per class (SD = 3.46).

Table 1 Participant characteristics of students and teachers at baseline (N = 133)

Procedure

Ethical approval was granted by relevant university and education ethical committees (Approval number GUHREC: 2021/587; BCE: 471 respectively). Three primary school principals were contacted to assess their willingness to participate in research, with two agreeing to take part. Early consultation with the principals and teachers included a discussion of existing wellbeing programs being delivered. Several teachers were familiar with mindfulness and had made some attempts to introduce these concepts into their classroom. Both schools had implemented an unstructured form of mindful eating during morning tea break. The opportunity to have a structured program specifically designed for the early years was a key motivator for engaging in the research. After obtaining informed consent, teachers participated in training sessions focused on the concepts and delivery of the MMP, which took place over two sessions. They also received weekly emails detailing the program’s delivery schedule and timing requirements, along with reminders for exercises and daily checklist prompts. Additionally, weekly visits were conducted at each school to collect completed checklists, check in with the teachers, and provide support or address any queries.

Consent forms were distributed to the parents and carers of students, requesting permission for the school to share basic demographic information on their child with the research team, as well as to complete teacher-reports on their child’s behaviour and executive functioning. For a subsample of students, parents provided consent for their child to participate in a motor assessment, which was conducted in a designated quiet space outside of the classroom. Students included in the subsample for the direct motor assessment were asked for their verbal assent prior to conducting each of the assessments at two time points.

A single arm pre-post design was used to evaluate the feasibility and initial student responses to the Mindful Movement Program in an early year’s classroom setting. Teachers in all the participating classrooms implemented the Mindful Movement Program to their class across Terms 3 and 4, 2022 spanning a total of 19 school weeks. All teacher-reported measures on child outcomes were collected at two time points: pre-intervention (Time 1) and post-intervention (Time 2). For a subsample of students, a direct assessment of general motor and specific body coordination was conducted at both Time 1 and Time 2 with school permission granted to undertake direct assessment with partial COVID- 19 pandemic restrictions still in place. The participation of students across the two schools is illustrated in Fig. 1.

Fig. 1

Participant and data flow chart

The Mindful Movement Program intervention

The Mindful Movement Program (MMP) is a teacher-led program targeting the key areas of mindfulness, music, and movement in an age-appropriate manner that aims to be engaging for students in the early years of school. The MMP was developed by a professionally trained dancer (BT) with an Advanced Diploma of Teaching and Elite Performance in Classical Ballet, Royal Academy of Dance endorsed Benish Notator, and over 12 years of youth dance education experience, and education obtained including a Bachelor of Psychological Science (Honours), Master of Professional Psychology, and undertaking a PhD in Psychology.

The goal of the program was to embed specific mindfulness and movement exercises into the existing classroom curriculum. The MMP has two concurrent practices: core and secondary. The core practice consists of mindful breathing and slow movement which both children and teachers participate in three times a day. The primary aim is to help children return to a state of calm during transition periods, such as after snack time and after lunch or play. Teachers facilitated this practice by sounding a gong using a singing bowl and ensuring at least three repetitions of sustained breathing, accompanied by rising sun arm movements. Entrainment of movement and breath to the sound of a low tone may stimulate a physiological process that supports students in developing self-regulation [27].

The secondary practices consist of individual mindfulness activities, which are outlined in a story book developed to support the MMP, as well as a series of filmed movements set to music and demonstrated by researcher/developer (BT) along with accompanying children. Each music-movement exercise was filmed, starting with simple instructions that gradually increased in complexity across a two-week period. There were two videos for each of the nine activity progressions. The first was an instructional video that provided information on the target movement that was broken down slowly and explicitly and practiced in repetitions, then added in a sequence to music to be memorised. The second was a movement to music video that supported the practice and performance of each activity in a choreographed short sequence cued by music, and without including the broken-down instructional elements.

Each of the nine music-movement exercise blocks are linked to an animal or nature concept, the music and movement are reflective of this and are mirrored in the storybook. For example, the ‘Marching Ants’ exercise is depicted in the storybook with ants marching in a line. The movement is set to a 2/4 marching time signature, with the first week focusing on marching action and timing requiring rhythmic control using half notes and quarter notes beat synchronization. In the second week difficulty is increased by including direction changes, introducing oppositional control with opposite arm movements, and increasing memorization of sequence length. See OSF Supplementary Material 1 for an example of exercise progression. Each music-movement exercise was intended to be delivered at least once per day. Each fortnight a new movement exercise was introduced, to engage and challenge various aspects of EFs. Across the 19-week intervention, movements built in difficulty across the intervention, from basic marching and jumping on two feet to skips and weaving traveling steps.

Teachers were instructed to deliver the following activities of the MMP daily to their classrooms: three repetitions of the core practice (‘The Sun’ self-regulation breathing and controlled movement, 2–3 min each totalling 6 to 9 min per day), one mindful eating moment (‘Munch and Crunch’ during fruit break each morning), however as the schools’ already engaged in mindful eating practices prior to intervention, this was a secondary goal for practice and not emphasised. With the secondary practice, teachers were instructed to introduce the secondary practice exercise at the start of each fortnight using the corresponding storybook page. Teachers had access to an instructional video for each of the nine secondary practice exercises. These ranged from 1–3 min in duration. The music-movement exercise videos were used immediately following the instructional video (or on their own once the instructional video was not required at the teacher’s discretion) to deliver the music-movement activities. These ranged from 2–6 min in duration.

The following resources were provided to teachers: Teacher Manual that included definitional terms, an explanation of each exercise, the target motor and executive function outcomes, instructions for introducing their class to the exercise, and the corresponding resources (i.e. colouring in book page or active resource); Mindful Movement Program colouring-in book ‘A Mindful Moment with Missy and Milo’; This storybook follows the mindful journey of two children on a nature walk. Each page can be coloured in, and corresponds to a secondary MMP exercise with an animal or nature theme; The Sun Singing Bowl is a resource for the core exercise ‘The Sun’ and when struck with a mallet, creates a gong-like sound that helps children maintain long, steady breaths and smooth arm movements; The Mindful Movement Program Video Exercises have one instructional and one music-movement exercise per week. Each exercise progresses in difficulty across a fortnight, challenging the child to recall the previous week’s exercise, and adding complexity in one or more of the following areas: increased memorization sequence, increased tempo of music or movement, increased movement difficulty, longer video durations. To see an overview of program exercises, see OSF Supplementary Material 2.

Evaluation of feasibility

Feasibility was evaluated using the comprehensive framework developed by Orsmond and Cohn [39] outlining the objectives of a feasibility study. Data was collated from standardised assessment measures completed by teachers, performance-based motor assessments, and reports from teachers via the self-reported fidelity daily checklist. Semi-structured exit interviews were conducted with the seven classroom teachers at the end of the intervention period. These interviews were conducted by a researcher who was independent of the study team. The questions were framed and guided by the Orsmond and Cohn’s [39] feasibility guide as outlined in the study aims. Table 2 displays the five objectives of a feasibility study in columns, and the data sources for the study in rows. In each cell, for each objective, the criteria for evaluation are provided.

Table 2 Feasibility objectives evaluated and sources of information

Thresholds were established a priori to assess feasibility for the present study. For participant recruitment, a threshold of ≥ 75% was set for proportion of invited students who were successfully recruited. Attrition thresholds for students and teachers were set at ≤ 10%. Fidelity of implementation for the intervention was monitored through daily checklists recorded by teachers, a common practice in school-based research [42]. The goal was to achieve three core sun practices per day and one secondary practice per day. Fidelity of implementation thresholds were set as high fidelity (≥ 80%), moderate fidelity (50—79%), and low fidelity (< 50%) [42]. For outcome data, missing and incomplete data threshold (≤ 10%) was set for all student outcome data. Changes in participant data were predicted to be in the direction of improved EF and behaviour, reflected by lower standardised scores for teacher-report measures, and improved motor performance, reflected by an increase in standardised scores.

Participant and outcome measures

Demographics

School administrative data for children’s date of birth, gender, year level, student’s language spoken at home and whether the student received any specialist education or teacher aide services was provided by the administrative staff and schoolteacher.

Executive functioning: Behaviour Rating Inventory of Executive Function (BRIEF- 2)

The BRIEF- 2 Teacher Form is a teacher-reported measure of executive function with eight subscales: inhibit, self-monitor, shift, emotional control, initiate, working memory, plan/organize, task-monitor, and organization of materials [43]. The form yields eight T-scores for each subscale and provides three index T-scores: Behaviour Regulation Index (BRI), Emotion Regulation Index (ERI) and Cognitive Regulation (CRI); and a total T-score for Global Executive Composite (GEC). Items are rated on a three-point Likert scale, with higher scores indicating greater executive function difficulties. The internal consistency (α = 0.80–0.98) and test–retest reliability (r = 0.87) of the Teacher form have been reported as satisfactory [43]. The BRIEF has demonstrated high sensitivity in capturing EF across clinical and non-clinical presentations, thus deeming it appropriate for a school study context [44]. The GEC, with a possible range of 60 to 180, was selected as the primary outcome for the current study given it provides an overall representation of global executive functioning. Cronbach’s alpha for the current study demonstrated excellent internal consistency for the GEC (α = 0.95).

Internalising and externalising behaviour: Strengths and Difficulties Questionnaire (SDQ)

The teacher-reported SDQ was used to measure behavioural and socio-emotional functioning [45]. The SDQ includes five subscales (five items per scale): emotional problems, conduct problems, hyperactivity scale, peer problems, and prosocial scale [45]. Items are rated on a three-point scale, with higher scores indicative of greater difficulties. Possible scores for the subscales range from 0 to 20. The SDQ can be scored using two composites, internalising subscale (combining emotional and peer subscales) and externalising subscale (combining behavioural and hyperactivity subscales) [46,47,48]. The two composite scales of internalising and externalising are used for the present study because they demonstrate overall behavioural change across larger groupings of internal and external behaviour [46]. The SDQ has satisfactory internal consistency for the five individual subscales (ranging α = 0.70 to 0.88) [45], and the internalising (α = 0.80) and externalising (α = 0.88) teacher reports [47]. In the current study, the SDQ scales had good internal consistency for the externalising (α = 0.87) and internalising (α = 0.87) behaviour subscales.

Motor skills: The Bruininks-Oseretsky Test of Motor Proficiency second edition (BOTMP- 2)

BOTMP- 2 – Brief Form is widely used to evaluate an array of motor skills in children from ages 4–21 years using a range of direct, objective measures of gross and fine motor skills. These include tracing visual patterns on paper, hand–eye coordination with a ball, balancing and walking on a line, and hopping on one leg. It allows for the assessment of children with typical and atypical motor development [49]. The internal consistency (α = 0.95 to 0.96), test–retest reliability (r = 0.79) and inter-rater reliability (k = 0.98) are satisfactory for the brief total score [50]. The test has been deemed suitable for clinical and school setting assessment and assesses a wide range of motor tasks including motor precision, integration, manual dexterity, bilateral coordination, balance, agility, and strength. Items are rated from 0–3 or 0–10, with higher scores indicative of greater motor ability or precision. Possible scores for the brief total score range from 0 to 72. The BOTMP- 2 is an acceptable motor measure to assess children within the general population, and those with a clinical diagnosis, including autism and ADHD [51]. In the current study, the BOTMP- 2 – Brief total score had acceptable internal consistency for a small sample (α = 0.71).

To measure specific targeted outcomes of the MMP’s motor components, an additional two subtests of the full length BOTMP- 2 were administered, Balance and Bilateral Coordination, which together create the BOTMP- 2 – Body Coordination subscale. Items are rated based on physical ability on tasks, ranging from 0–3 or 0–5, with higher scores indicative of greater motor ability or precision. Possible scores for the Body Coordination subscale range from 0 to 61. Previous studies measuring targeted outcomes for a physical activity intervention in children have also extracted the same BOTMP- 2 subtests to detail a more sensitive outcome of their program [52]. In the current study, the BOTMP- 2 Body Coordination subscale score had acceptable internal consistency for a small sample (α = 0.70).

Approach to analysis

Feasibility

Feasibility analysis included compiling information from four sources: quantitative data, teacher implementation checklist, teacher exit interviews, and reports from the research team. Qualitative data was coded to determine agreement to specific feasibility objectives, and interview quotes were extracted to represent teacher views.

Outcomes

Preliminary analysis included descriptive statistics for socio-demographics and outcome measures. T-tests were used to compare sample characteristics and baseline outcome measures for students across the two schools recruited to help understand the extent to which clustering at the school level needed to be accounted for in the final models. Confidence intervals, p-values, partial eta-square values and Cohen’s d (conventional interpretation of small 0.20, medium 0.50, and large 0.80 effect sizes used) were included in the reporting of the analyses [53]. The two school sites did not differ across class size, sex distribution, English as a additional second language, specialist services (as required based on special education needs or a developmental diagnosis), or baseline scores, further justifying our primary model approach which does not include an effect for school. See Table 1 for further detail.

In the primary analyses changes over time were determined with outcome measures of executive functioning (BRIEF- 2 General Executive Composite), externalising behaviour (SDQ Externalising Scale), and internalising behaviour (SDQ Internalising Scale). Given the hierarchical structure of the data (student within classrooms within schools), multilevel modelling was used to account for potentially clustered error distributions using the R package “lme4” [54]. Clustering was assessed by computing intraclass correlations (ICC). Errors did not cluster by school in any model (ICCs < 0.001) but did so by student and classroom. A random intercept model was specified where Time (Level 1) was nested within Student (Level 2) and Classroom (Level 3). Random-intercept models were specified to account for the non-independence of students’ scores at baseline. Parameters were estimated using maximum likelihood estimation (REML) as it produces less biased variance estimates with small samples [55].

For each outcome, the random intercept model (Model 1) was estimated before comparing it to progressively nested models that included Level 1 (Time) and Level 2 (Child Age, Gender) fixed effects. A series of more complex models were tested for each outcome: time (pre, post) was entered as a fixed effect (Model 2), then child age (Model 3), gender (male, female) (Model 4) and the time x gender interaction term (Model 5). An alpha value of 0.05 was used to determine statistical significance. Given the exploratory nature of the initial evaluation, family-wise error was not controlled as the risk of Type 2 errors. Due to a small sample size, motor outcomes were assessed using significance testing. Levels of missing data were minimal, with overall attrition less than 2.25%, see Fig. 1.

Results

Feasibility

Objective 1: Recruitment capability

There was a high consent rate (91%) by parents indicating feasibility and suitability; no children were excluded for intervention delivery indicating appropriate inclusion criteria for an early years’ classroom, and the classrooms were reflective of the primary school’s population in terms of EAL and classroom size. Teacher quotes that are illustrative of the appropriateness of the intervention and its activities for the age group targeted include:

Participant 5: “Well I have a multi age classroom. I have year one and year two in here, they were fine. It was all readily accessible for that age group.”

Participant 1: “They are six and seven [Interviewer—is that a suitable age?] Yeah, definitely. Some of those discussions around fine motor and gross motor, when we started with the little hand exercises, but then getting into things like skipping, oh that's a fun one. I think it's good to start learning those sort of mindfulness and self-soothing practices and being modelled breathing. I think it's suitable and I yeah, I think it's appropriate for this age.”

Objective 2: Data collection procedures and outcome measures

Data collection was complete and with the exception of attrition (n = 2), no missing data was present, suggesting that the data collection processes were manageable within the school settings, with some teachers referencing adequate release time provided for data completion. Internal reliability for all measures was excellent indicating that teachers were consistent in their reporting of key constructs. Finally, changes in the direction predicted (see outcomes results below), suggests sensitivity in detecting meaningful differences in future studies. Teacher quotes that illustrate the manageability of the research procedures include:

Participant 5: “Yeah, it [data collection] was a manageable task … All in all, it was fine, and with having the day to get it done that really helped having that time to be able to sit down and focus just on that [data task].”

Participant 7: “I found it [data collection measures] quite easy to follow. I didn't have any trouble with understanding what we were doing and the actual process itself, it's a simple process.”

Objective 3: Acceptability and suitability of intervention and study procedures

Retention of both teachers (100%) and students (98%) in the study was high at the end of the 19 weeks. Adherence to protocol and intervention delivery instructions indicated moderate fidelity [42], with teachers reporting implementation of core practice (the Sun exercise) occurring on 68% of required occasions and the music-movement video shown on 66% of required occasions (see Table 3). Of the 644 school days (across seven classrooms), delivery of the program was not possible on 134 school days (teacher absence, 71 days; teacher whole day substitution, 42 days; school events, 21 days). Semi-structured interviews with teachers reported high student engagement and participation, that the MMP suited their teaching style and that it could be integrated into the existing school curriculum with ease. Teachers highlighted suitability, acceptability, and usability of intervention resources. No safety or other concerns were raised when explicitly questioned. Teachers also highlighted key barriers for program implementation, with extended teacher absences related to the COVID- 19 pandemic discussed across most participants. Teacher quotes that are illustrative of the suitability and usability of the intervention include:

Table 3 Implementation by teachers in the classroom

Participant 7: “It [teacher manual] was really handy. I love the idea of removing extra load from teachers. And so, the teacher manual was very easy to follow, it had everything there that you needed so it wasn't extra work. I found that was the best part of it. It was just something that you could just pick up and you could run with and very simple, explicit.”

Participant 1: “So the sun breath, the mindfulness exercise, it's been really great and we use that throughout the day and sometimes even some of the kids will say ‘I think we need a sun breath’ which is really good.”

Participant 5: “Yeah, that [video exercises] was really easy for the kids to follow through because it had the modelling first and especially for some of them, they needed the modelling first, and it had a slower pace and then it brought it all together with music. So it was good, they all loved it.”

Participant 4: “The kids never lost interest. I know that we did the movement each day, but and I thought some they might lose some sort of enthusiasm to want to do it. But no, not at all. They really enjoyed it.”

Participant 2: “What was difficult? The relief teachers. We could leave the sun for the relief teacher. It was really the easy the kids could be like, this is what you have to do, and they could do it. But the video links and they [relief teachers] don't get computers. So it was impossible.”

Objective 4: Resources and implementation of study and intervention

Data collection was conducted in a timely fashion and in accordance with the protocol, indicating that the research team had the necessary resources, expertise, and administrative capacity to carry out the study. No ethical issues were raised by participants, and all ethical requirements set by the relevant human research ethical committees were adhered to. The available budget was realistic and adhered to, although this study was undertaken as part of a PhD program and thus future studies need to consider costs associated with training/implementation covered by the PhD researcher time. Teacher release time associated with data collection was provided by the individual school sites. There was adequate access to technology, storage, and software for data collection and analysis. Teachers reported that they had adequate support from the research team and school regarding implementation of the research procedures and intervention, and sufficient access to resources, equipment, and technology in the classroom. A key barrier identified was the disruption of relief teachers in the face of the COVID- 19 pandemic, requiring longer than typical teacher absences due to government sanctioned isolation periods, which led to additional barriers such as limited technology access, thus inaccessible video links for the secondary practices. Teacher quotes that are illustrative of the appropriateness of the resources and support provided include:

Participant 2: “The activities with the YouTube links, those were really helpful. They could just follow along on the big screen.”

Participant 5: “It was engaging because it was on the interactive TV. It had music, it had the explicit instruction, and it was perfect the way it was. I think they thought of a lot of things to make it so easy to use.”

Participant 2: “We had plenty of school support. Our principal was really interested in it [The Mindful Movement Program].”

Participant 3: “Yeah, the daily checklist was good, and I always liked that I could just put a little comment down the bottom… that was easy. As soon as you did it, it was just a tick in a flick. So that was great.”

Participant 6: “I had a week out for COVID and so there was no programme done. It was just tough for the relief teacher to access the technology or access the programme, it's challenging.”

Objective 5: Preliminary evaluation of participant responses

The preliminary evaluation of participant responses through quantitative analysis across three domains (EF, behaviour, motor) indicated feasible and appropriate measures were chosen, with outcome change in expected directions with significant findings and medium to large effect sizes (see outcome results presented below). Furthermore, all teachers reported viewing the intervention as successful, data collection procedures as manageable and acceptable, and evaluated the target outcome of emotion regulation as appropriate. No major adaptations were made to intervention or data procedures to indicate the need for further feasibility evaluations, with preliminary findings indicating high feasibility from the present pilot study. Teacher quotes that illustrate teachers’ views of the outcomes of the program for children include:

Participant 3: “I think that it helped emotion regulation for the bouncier kids. I have a few students that are just, you know, little rockets. They're just hyper, so they were into it because it's moving, so for those kids it's hard to just lie down and meditate. So those kids find it hard to just regulate their body it was very helpful.”

Participant 6: “I do think the program was successful. But I'd probably say beyond emotion regulation to some of that kind of executive function. So like where we mentioned the impulse control, like their ability to stop when they need to be stopping.”

Outcomes

Executive functioning: BRIEF- 2 GEC

See Table 4 for results for the models of the BRIEF- 2 General Executive Composite. The null model predicting students yielded an Intra-Class Correlation (ICC) of 0.791. The ICC for classroom was 0.062, suggesting a small correlation between students within the same class and that most of the variance was explained by variation within students over time.

Table 4 Results from linear mixed model of BRIEF- 2 general executive composite T-scores

There was a significant effect of Time, such that General Executive Composite Standardised T-scores reduced by 2.95 from pre- to post-intervention assessments indicating a reduction in EF difficulties. Child age did not significantly predict GEC Index scores, nor did child gender. The Time x Gender interaction was non-significant, but with a medium/large effect.

Externalising behaviour: SDQ externalising scale

See Table 5 for results for the models of the SDQ Externalising Standardised Scale. The null model predicting students yielded an ICC of 0.713, such that scores within students were highly correlated. Similar to the GEC Index, the ICC for classroom was 0.082, suggesting a small correlation between students within the same class and that most of the variance was explained by variation within students over time.

Table 5 Results from linear mixed model of SDQ Externalising scores

There was a significant effect of Time, such that SDQ Externalising scores reduced by 1.06 from pre- to post-intervention assessments. Child age did not significantly predict SDQ Externalising. Child gender significantly predicted SDQ Externalising scores overall, with boys scoring 2.51 higher than girls. The Time x Gender interaction was not statistically significant.

Internalising behaviour: SDQ internalising scale

See Table 6 for results for the models of the SDQ Internalising Standardised Scale. The null model that did not include any fixed effects (Model 1) predicting students yielded an ICC of 0.811. The ICC for classroom was 0.040, suggesting a small to negligible correlation between students within the same class and that most of the variance was explained by variation within students over time.

Table 6 Results from linear mixed model of SDQ Internalising scores

There was a significant effect of Time, such that SDQ Internalising scores reduced by 0.52 from pre- to post-intervention assessments. Child age did not significantly predict SDQ Internalising, nor did child gender. The Time x Gender interaction was not statistically significant.

Motor performance: BOTMP- 2 brief scale and body coordination subscale

A paired samples t-test was used for the subsample of 50 students for the BOTMP- 2-Brief and BOTMP- 2-Body Coordination Subscale (Bilateral and Balance subscales). A significant increase in motor abilities was observed across all four motor assessments (p < 0.001), with medium to large effects (Cohen’s D 0.74–1.00), see Table 7.

Table 7 Paired samples t-test for BOTMP- 2 scores

Discussion

The aim of the present study was to assess the feasibility of a novel intervention program, the MMP, using a single arm pre-post design and the feasibility framework outlined by Orsmond and Cohn [39]. The unique element of the MMP program was the integration of mindfulness, movement and music into a single program, accompanied by a suite of resources designed for delivery by teachers within the existing curriculum. This study represents the essential first step in a program of research, providing critical information on the feasibility of moving to a randomised controlled trial.

Feasibility of the program was assessed against the five criteria: (i) recruitment, (ii) data collection procedures and outcome measures, (iii) acceptability and suitability of intervention and study procedures, (iv) resources and implementation of study and intervention. The secondary aim of the study was (v) to determine whether there was evidence of preliminary change to indicate that there was potential for the intervention when taken to a full randomized controlled trial design. There was strong evidence supporting the feasibility of recruitment and retention, with high parental consent rates and retention across the 19 weeks, a finding consistent with similar research studies [56]. The data collection and outcome measure procedures were acceptable to teachers, who returned data with high completion rates at the time points required. Schools were also able to provide release time for completion of the measures, adding further to feasibility. The measures selected showed strong internal consistency, consistent with a other studies that have used these measures in similar settings e.g. [50, 57]. The study procedures were highly feasible, as demonstrated by low attrition rates, no overall teacher/classroom drop out, and 100% data collection rate (excluding attrition). Acceptability of the MMP was further supported by teacher exit interviews, which indicated satisfaction with the program, ease of integration into the classroom curriculum, and high levels of student engagement in the activities. Fidelity checklists, completed by teachers, documented the frequency in which a core practice or movement exercise was delivered, resulting in a ‘moderate’ fidelity rating. However, there was notably high rates of teacher absences across this COVID- 19 period, which meant that the number of occasions that regular classroom teachers were available to deliver the MMP content was substantially impacted. Challenges of implementation by relief staff including sufficient handover and access to required resources (computers to access video links) were raised. What is not clear is whether the occasions on which the MMP content was delivered were consistent with the program manual as classroom observations were not possible given the resourcing for this study. Future intervention evaluations should include observational fidelity checks.

The resources and management for overall implementation of the study and intervention demonstrated adequate support from the research team, which included reminder emails and weekly check-ins during checklist pick-up, school support, adequate teacher release time and access to technology/equipment. All teachers reported having sufficient classroom space to implement the intervention activities. The administrative load was considered manageable and did not require specialised knowledge of dance or movement. Ethical protocols were followed, and no adverse events were reported. Furthermore, the budget set was realistic and adhered to, with no unknown costs arising, and the research team had sufficient technology, storage, and software access to complete, collect and analyse data.

The preliminary evaluation of student outcomes found significant changes in EF, internalising behaviour, externalising behaviour, and motor skill (general and specific body coordination skills) in expected directions, where reported EF and behaviour difficulties decreased, and motor skill increased. This adds to a growing literature that report on similar EF improvements in young children following music [30, 29], mindfulness [57, 58], and dance-based intervention programs [34, 36, 37, 59,60,61]. These intervention genres are wide ranging, with some involving a creative choreographic element [60, 61], others using structured dance classes [34], and others defining the intervention as rhythmic movement to music, focusing on fundamental gross motor skills [37]. Notably, these interventions were all delivered by an expert instructor trained in dance, and delivered in a group dance class format (requiring sufficient space accommodations). However, in the one study in which the dance intervention was brief (10-min) and implemented by a non-trained dancer (classroom teacher) in video format with animated avatars, improvements on EF and motor functions were not found [62]. The findings from the current study suggest that delivery by teachers who are using resources developed and demonstrated by a trained dancer may be a way of integrating specialist skill without direct instruction. Scaffolding of movements and rhythmic patterns, with explicit teaching and repetition followed by memorization of sequences to music, provide opportunity for skill mastery; compared to van den Berg and colleagues [62], where students are simply following along to movements and copying physical actions without cognitive engagement.

The students also showed improvements in scores of internalising and externalising behaviours. Dance-movement psychotherapy interventions for primary school students have also yielded similar findings for students with mild behavioural difficulties [63], and with an autism spectrum disorder diagnosis [64], but have yet to be investigated in routine classroom settings. Observed internal and external behavioural and emotional change has occurred following movement to music intervention in preschool classrooms [30,31,32] and mindfulness interventions in early to middle primary school classrooms [57].

Contrary to previous findings where movement to music demonstrated non-significant changes in motor outcomes [60, 62], students included in the present study improved on general motor skills (combined fine and gross motor), as well as specifically targeted motor skills (balance and bilateral coordination). The careful progression of introducing simple movements for foundational skill development, then progressing with difficulty across physical and rhythmic domains, and then progressing across the program to coordinatively complex physical movements allowed for effective motor acquisition with the MMP intervention. Rhythmic-movement interventions have shown some preliminary evidence of an improvement in balance skills, but this did not differ from standard physical education [37]. Within the MMP, concepts such as balance skills were specifically targeted, where a cognitively complex movement, cued by music, required a student to inhibit other movements and sustain focus on physical feedback of balance and make appropriate corrections to master the desired length of balance. This process of structured simultaneous system engagement is proposed to allow for optimal cognitive engagement, that in turn, has an influence on both EF and motor skills.

Limitations and future directions

The key strength of this study is the demonstration of the feasibility and potential utility of a mindfulness-based movement to music program that can be integrated into routine classroom activities and delivered by teachers. The MMP did not require specialization of resources, equipment, or instructors. The movement to music exercises were cognitively challenging with incremental difficulty in movement and sequencing, while remaining within an achievable reach of mastery. All of which are features of approaches associated with enhancement of cognitive functions [4, 20, 65,66,67].

However, there are a number of limitations that need to be addressed in future research. First and foremost, there was no control group and therefore quantitative findings can only be interpreted as indicative trends. More rigorous designs need to be considered, such as a stepped wedge designs, with a larger pool of schools to draw from. Notably, the research was conducted in two schools that fell within a moderate SES band, and thus it is not possible to ascertain whether the program would have appeal to children from lower SES groups and who face greater challenges; potentially the group who could benefit most from exposure to programs that enhance EF development. Further, specific information on family SES would also help in identifying potential predictors of change. Identifying children with special educational needs would also help in determining predictors of change, allowing for the investigation of mediators including indicators of atypical child developmental needs.

There was moderate fidelity, that is delivery of the program at the dose intended. The constraints imposed by COVID- 19 created a unique set of challenges for schools as periods for relief teaching were longer and more frequent due to government mandated isolation periods. In reflection, delivery of the program could be enhanced by ensuring that the resources were available for relief teachers and teacher aids in the form of downloaded mp4 files and preparation of relief teacher resources including a pre-written handover script to facilitate efficient transition. Further consideration could also be given to the measurement of fidelity, that could including observations of teachers delivery of the MMP [68]. Similarly, the benefits of having a standardised time schedule for the practise compared to allowing teachers to implement the exercises as they chose should be considered. The measures were suitable and sensitive to change. However, there is always value in reviewing measures. Clearly, the constraints of COVID on direct assessment in School 1 meant only a proportion of children had a direct motor assessment. Maximising the potential for direct measurement would strengthen study findings and these could include both EF e.g. [57] and motor assessments.

Conclusion

There is a strong evidence base indicating that EF in young children can be enhanced by engagement in a range of programs that involve mindfulness, complex movement, and beat synchronization. Thus, it is reasonable to propose that integration of these constructs may confer even greater benefit. The primary purpose of the MMP was to develop such a program, accompanied by a suite of resources that could be delivered within a classroom setting by non-specialist teachers. A feasibility study was then undertaken with a view to identifying processes for delivery and procedures for evaluation. The objectives of the feasibility pilot study were met. Recruitment and retention, combined with acceptability and delivery of the intervention and trial processes, all support the recommendation for a further rigorous controlled trail for the innovative MMP.