Effects of Physically Active Learning (PAL) Interventions on Physical Fitness, Physical Activity, and Sedentary Behavior in Primary School Children: A Systematic Review

Background: Insufficient physical activity has become a significant public health problem. Currently, physical education classes alone are insufficient to meet the physical activity levels recommended by the World Health Organization. Physically Active Learning (PAL), as a novel curriculum, promotes physical activity by teaching new knowledge in various school subjects. Objective: To systematically evaluate the effects of PAL interventions on primary school students’ physical fitness, physical activity, and sedentary behavior, characterize the key features of PAL interventions, identify research gaps, and provide evidence-based recommendations for practice. Methods: Following the PRISMA guidelines, four electronic databases—Web of Science, ProQuest, Ebsco, and Embase—were searched, and English-language controlled intervention studies that met the PICOS eligibility criteria were included. Two researchers independently screened the literature and extracted and cross-checked the data. Results: This study included 17 studies from 8 countries published between 2009 and 2025. These studies involved primary school students aged 6 to 12. PAL most consistently increased MVPA (moderate-to-vigorous physical activity) or number of steps during the targeted academic lesson, whereas effects on whole-school-day, daily, or weekly physical activity were inconsistent. Lesson-level sedentary behaviour generally decreased or was replaced by walking, standing, or sit-to-stand transitions, but effects on whole-day sedentary time were mixed. Physical fitness interventions yielded varied outcomes, demonstrating significant improvements in upper body strength and explosive muscle strength and endurance, while showing inconsistent effects on aerobic capacity, and no significant changes in BMI or agility indicators. Conclusions: Our findings indicate that PAL has the potential to improve students’ physical activity levels in the classroom. However, its effects on physical fitness indicators remained equivocal across evaluated outcomes. PAL should be considered part of a broader school strategy to promote physical activity rather than as a standalone approach. To maximize health benefits, stronger integration of PAL with active recess, active commuting, and structured physical education is recommended.