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Background  The objective of this study was to investigate the effect of a 4-year specialist-taught Physical Education (PE) program on physical activity (PA) among primary school children.    Methods  A 4-year cluster randomised controlled trial was conducted in children (initially aged 8 years) from 29 primary schools (13 Intervention, 16 Control). Intervention students ( N  = 457) received 2 × 45 min PE lessons per week from specialist-trained PE teachers (68 lessons per year, 272 lessons over 4 years). Control group students ( N  = 396) received usual practice PE from generalist classroom teachers. PA during PE lessons was examined using the System for Observing Fitness Instruction Time (SOFIT). Pedometers (steps/day) were worn for 7 days each year, and accelerometers were worn concurrently in the final two years to assess moderate to vigorous (MVPA) and sedentary activity. Linear and generalized mixed models were used to determine differences in Intervention and Control student PA and the proportion of students meeting PA guidelines.    Results  The intervention increased SOFIT-observed student MVPA during PE lessons by 6.5 mins (16.7 v 10.2,  p  < 0.001). Within intervention schools, participants increased their whole-day step counts (boys = 449 [CI,140 to 756]; girls = 424 [CI,222 to 626]) and minutes of MVPA (boys = 8.0 [CI,6.8 to 9.2]; girls = 3.5 [CI,1.7 to 5.4]) on PE days. However, compared to the Control group the Intervention did not: increase habitual steps/day or MVPA when averaged over 7 days; elicit greater improvements in these measures over time; or increase the odds of meeting step/day or MVPA recommendations. At age 11 years Intervention group boys were 20 mins less sedentary per day (380 [CI,369 to 391] vs 360 [CI,350 to 369]) and this effect was sustained at age 12 years.    Conclusions  Well-designed specialist-taught PE can improve student PA during PE lessons. However for PE to be a significant contributor to improving habitual PA in pre-adolescent children, daily classes are likely to be required, and even this would need to be supplemented with a wider multicomponent strategy. Our finding of a reduction in sedentary time among Intervention boys warrants further investigation into the potential role PE could play in influencing sedentary behaviour.    Electronic supplementary material  The online version of this article (doi:10.1186/s12966-016-0388-4) contains supplementary material, which is available to authorized users.

Outcomes of a four-year specialist-taught physical education program on physical activity: a cluster randomized controlled trial, the LOOK study