Conclusion
Our intervention was especially effective in improving high-intensity PA during school hours among less active children. It also improved cardiovascular risk factors, while benefit was higher for healthy children compared to at-risk children. Because we saw a deterioration in the long-term health outcomes of high-risk children, future studies should identify interventions that target the specific needs of vulnerable subgroups. Furthermore, intervention effects were lost in the long-term, possibly due to the program discontinuation during the COVID-19 pandemic. Moving forward, policymaking should provide for the integration of evidence-based interventions into resilient frameworks. This is of paramount importance if we aim to translate short-term benefits into long-lasting impact, especially for vulnerable populations living in challenging environments. In conclusion, schools are key settings to promote PA and improve health, but structural changes are necessary to ensure that effective interventions reach marginalized school populations and achieve sustainable impact.