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46 Unique Phys Ed Games Your Students Will Love

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There’s nothing kids need more to break up a day spent sitting still and listening than a fun PE class to let off some steam. In the old days, going to gym class probably included playing kickball or dodgeball after running a few laps. Since then, there have been countless reinventions of and variations on old classics as well as completely new games. Although there is no shortage of options, we love that the supplies required remain relatively minimal. You can transport to another galaxy using just a pool noodle or two or create a life-size game of Connect 4 using just Hula-Hoops. You’ll want to make sure to have some staples on hand like balls, beanbags, and parachutes. There are even PE games for kindergartners based on beloved children’s TV shows and party games. Regardless of your students’ athletic abilities, there is something for everyone on our list of elementary PE games!

1. Tic-Tac-Toe Relay

Elementary PE games that not only get students moving but also get them thinking are our favorites. Grab some Hula-Hoops and a few scarves or beanbags and get ready to watch the fun!

Learn more: Tic-Tac-Toe Relay at S&S Blog

2. Blob Tag

Pick two students to start as the Blob, then as they tag other kids, they will become part of the Blob. Be sure to demonstrate safe tagging, stressing the importance of soft touches.

Learn more: Blob Tag at Playworks

3. Cross the River

This fun game has multiple levels that students have to work through, including “get to the island,” “cross the river,” and “you lost a rock.”

Learn more: Cross the River at The PE Specialist

4. Head, Shoulders, Knees, and Cones

Line up cones, then have students pair up and stand on either side of a cone. Finally, call out head, shoulders, knees, or cones. If cones is called, students have to race to be the first to pick up their cone before their opponent.

Learn more: Head, Shoulders, Knees & Cones at S&S Blog

5. Spider Ball

Elementary PE games are often variations of dodgeball like this one. One or two players start with the ball and attempt to hit all of the runners as they run across the gym or field. If a player is hit, they can then join in and become a spider themselves.

Learn more: Spider Ball Game at Kid Activities

6. Crab Soccer

We love elementary PE games that require students to act like animals (and we think they will too). Similar to regular soccer, but students will need to play on all fours while maintaining a crab-like position.

Learn more: Crab Soccer at Playworks

7. Halloween Tag

This is the perfect PE game to play in October. It’s similar to tag, but there are witches, wizards, and blobs with no bones!

Learn more: Halloween Tag at The Physical Educator

8. Crazy Caterpillars

We love that this game is not only fun but also works on students’ hand-eye coordination. Students will have fun pushing their balls around the gym with pool noodles while building their caterpillars.

9. Monster Ball

You’ll need a large exercise ball or something similar to act as the monster ball in the middle. Make a square around the monster ball, divide the class into teams on either side of the square, then task the teams with throwing small balls at the monster ball to move it into the other team’s area.

Learn more: Monster Ball at The PE Specialist

10. Striker Ball

Striker ball is an enjoyable game that will keep your students entertained while working on reaction time and strategic planning. We love that there is limited setup required before playing.

Learn more: Striker Ball at S&S Blog

11. Parachute Tug-of-War

What list of elementary PE games would be complete without some parachute fun? So simple yet so fun, all you will need is a large parachute and enough students to create two teams. Have students stand on opposite sides of the parachute, then let them compete to see which side comes out on top.

Learn more: Parachute Tug-of-War at Mom Junction

12. Fleas Off the Parachute

Another fun parachute game where one team needs to try to keep the balls (fleas) on the parachute and the other tries to get them off.

Learn more: Fleas Off the Parachute at Mom Junction

13. Crazy Ball

The setup for this fun game is similar to kickball, with three bases and a home base. Crazy ball really is so crazy as it combines elements of football, Frisbee, and kickball!

Learn more: Crazy Ball at Health Beet

14. Bridge Tag

This game starts as simple tag but evolves into something more fun once the tagging begins. Once tagged, kids must form a bridge with their body and they can’t be freed until someone crawls through.

Learn more: Bridge Tag at Great Camp Games

15. Star Wars Tag

Elementary PE games that allow you to be your favorite movie character are just way too much fun! You will need two different-colored pool noodles to stand in for lightsabers. The tagger will have one color pool noodle that they use to tag students while the healer will have the other color that they will use to free their friends.

Learn more: Star Wars Tag at Great Camp Games

16. Rob the Nest

Create an obstacle course that leads to a nest of eggs (balls) and then divide the students into teams. They will have to race relay-style through the obstacles to retrieve eggs and bring them back to their team.

17. Four Corners

We love this classic game since it engages students physically while also working on color recognition for younger students. Have your students stand on a corner, then close their eyes and call out a color. Students standing on that color earn a point.

Learn more: Four Corners at The Many Little Joys

18. Movement Dice

This is a perfect warm-up that requires only a die and a sheet with corresponding exercises.

Learn more: Roll the Dice Movement Break at Teaching Littles

19. Rock, Paper, Scissors Tag

A fun spin on tag, children will tag one another and then play a quick game of Rock, Paper, Scissors to determine who has to sit and who gets to continue playing.

Learn more: Rock, Paper, Scissors Tag at Grade Onederful

20. Cornhole Cardio

This one is so fun but can be a little bit confusing, so be sure to leave plenty of time for instruction. Kids will be divided into teams before proceeding through a fun house that includes cornhole, running laps, and stacking cups.

Learn more: Cardio Cornhole at S&S Blog

21. Connect 4 Relay

This relay takes the game Connect 4 to a whole new level. Players must connect four dots either horizontally, vertically, or diagonally.

22. Zookeepers

Students will love imitating their favorite animals while playing this fun variation of Four Corners where the taggers are the zookeepers.

23. Racket Whack-It

Students stand with rackets in hand while balls are thrown at them—they must either dodge the balls or swat them away.

Learn more: Racket Whack-It via PEgames.org

24. Crazy Moves

Set mats out around the gym, then yell out a number. Students must race to the mat before it is already filled with the correct number of bodies.

Learn more: Crazy Moves at PEgames.org

25. Wheelbarrow Race

Sometimes the best elementary PE games are the simplest. An oldie but a goodie, wheelbarrow races require no equipment and are guaranteed to be a hit with your students.

Learn more: Wheelbarrow Race at wikiHow

26. Live-Action Pac-Man

Fans of retro video games like Pac-Man will get a kick out of this live-action version where students get to act out the characters.

27. Spaceship Tag

Give each of your students a Hula-Hoop (spaceship), then have them run around trying not to bump into anyone else’s spaceship or get tagged by the teacher (alien). Once your students get really good at it, you can add different levels of complexity.

28. Rock, Paper, Scissors Beanbag Balance

We love this spin on Rock, Paper, Scissors because it works on balance and coordination. Students walk around the gym until they find an opponent, then the winner collects a beanbag, which they must balance on their head!

Learn more: Rock, Paper, Scissors Beanbag Balance at PE Universe

29. Throwing, Catching, and Rolling

This is a fun activity but it will require a lot of preparation, including asking the school maintenance staff to collect industrial-sized paper towel rolls. We love this activity because it reminds us of the old-school arcade game Skee-Ball!

Learn more: Winter Activity at S&S Blog

30. Jenga Fitness

Although Jenga is fun enough on its own, combining it with fun physical challenges is sure to be a winner with young students.

Learn more: Jenga Fitness at S&S Blog

31. Volcanoes and Ice Cream Cones

Divide the class into two teams, then assign one team as volcanoes and the other as ice cream cones. Next, spread cones around the gym, half upside down and half right side up. Finally, have the teams race to flip as many cones as possible to either volcanoes or ice cream cones.

Learn more: Warm-Up Games at Prime Coaching Sport

This fun variation on dodgeball will have your students getting exercise while having a ton of fun! Begin with three balls on a basketball court. If you are hit by a ball, you are out. If you take a step while holding a ball, you are out. There are other rules surrounding getting out and also how to get back in, which can be found in this video.

33. Musical Hula-Hoops

PE games for kindergartners that are similar to party games are some of our favorites! Think musical chairs but with Hula-Hoops! Lay enough Hula-Hoops around the edge of the gym minus five students since they will be in the muscle pot. Once the music starts, students walk around the gym. When the music stops, whoever doesn’t find a Hula-Hoop becomes the new muscle pot!

34. 10-Second Tag

This game is perfect to play at the beginning of the year since it helps with learning names and allows the teacher to get to know the first student in line.

35. The Border

This game is so fun and requires no equipment whatsoever. Divide the gym into two sides. One side can move freely while the other side must avoid letting their feet touch the floor by rolling around, crawling, etc.

36. Freedom Catch

This is a simple throwing, catching, and tag game that will certainly be a hit with your PE class. Captors attempt to tag players so they can send them to jail. You can be freed if someone on your team runs to a freedom cone while throwing a ball to the jailed person. If the ball is caught by the jailed person, they can rejoin the game.

37. Oscar’s Trashcan

As far as PE games for kindergartners goes, this one is a guaranteed winner since it is based on the show Sesame Street . You’ll need two large areas that can be sectioned off to use as trash cans and also a lot of medium-size balls. There are two teams who must compete to fill their opponent’s trash can while emptying their own. Once over, the trash will be counted and the team with the least amount of trash in their trash can wins!

38. 4-Way Frisbee

Divide your class into four separate teams, who will compete for points by catching a Frisbee inside one of the designated goal areas. Defenders are also able to go into the goal areas. There are a number of other rules that can be applied so you can modify the game in a way that’s best for your class.

39. Badminton King’s/Queen’s Court

This one is simple but fun since it is played rapid-fire with kids waiting their turn to take on the King or Queen of the court. Two players start and as soon as a point is earned, the loser swaps places with another player. The goal is to be the player that stays on the court the longest, consistently knocking out new opponents.

40. Jumping and Landing Stations

Kids love stations and they definitely love jumping, so why not combine those things into one super-fun gym class? They’ll have a blast challenging themselves with all the different obstacles presented in this video.

41. Ninja Warrior Obstacle Course

Regardless of whether you’ve ever seen an episode of American Ninja Warrior , you are probably familiar with the concept and so are your students. Plus, you’ll probably have just as much fun as your students setting up the obstacles and testing them out!

42. Balloon Tennis

Since kids love playing keepy-uppy with a balloon, they will love taking it a step further with balloon tag!

43. Indoor Putting Green

If your school can afford to invest in these unique putting green sets, you can introduce the game of golf to kids as young as kindergarten. Who knows, you might just have a future Masters winner in your class!

44. Scooter Activities

Let’s be honest, we all have fond memories of using scooters in gym class. Regardless of whether you do a scooter sleigh or scooter hockey, we think there is something for everyone in this fun video.

45. Pick It Up

This is the perfect PE game to play if you are stuck in a small space with a good-size group. Teams win by making all of their beanbag shots and then collecting all of their dots and stacking them into a nice neat pile.

46. Dodgeball Variations

Since not all kids love having balls thrown at them, why not try a dodgeball alternative that uses gym equipment as targets rather than fellow students? For example, have each student stand in front of a Hula-Hoop with a bowling ball inside of it. Students need to protect their hoop while attempting to knock over their opponents’ pins.

What are your favorite elementary PE games to play with your class? Come and share in our We Are Teachers HELPLINE group  on Facebook.

Plus, check out  our favorite recess games for the classroom ..

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24 Fun & Inclusive PE Games High Schoolers Love

These inclusive high school PE games are all about fun and fitness.

Michele is a writer who has been published both locally and internationally.

Learn about our Editorial Policy .

Kate is an experienced writer who has written hundreds of articles for publication.

While we all tend to think of gym class as a time to exercise, it's also really a great opportunity for kids to have fun playing sports or other games. From the old favorites we've all played for years to new discoveries, there are so many fun PE games to choose from. We've rounded up some of the best here, so get ready to have a great time. 

Classic Fun Gym Games for High School Students

Over time as physical education programs grew and developed, a few standout games were introduced and became classics because of their wide appeal. People have been playing these for years for a reason, though. They really are super fun.

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There are a ton of reasons to play dodgeball. Gym class dodgeball is highly competitive, requires little equipment, and involves the whole class simultaneously.

The point of the game is to eliminate all the players on the other team by hitting them with a ball or catching a ball they throw. There are two teams with any number of players and only a few balls in play to make the game challenging.

What's fun about dodgeball is you get to hit your friends, or enemies, with a flying object with the permission of a teacher. If you have a teacher who likes to play, it's also fun when the class teams up to get them out.

Relay Races

A relay race is a small team activity with endless possibilities (and lots of potential for hilarity). Essentially, you need at least two teams, each with at least two people. The more teams and players, the more fun and competitive the game.

One player at a time completes their designated leg of the race, then tags the next teammate to complete their leg, and so on until the entire team finishes. Relay races can feature straight running or include a variety of activities like crawling, skipping, and walking backward. Fun Attic offers more than 10 ideas for funny and entertaining relay races like ones using tricycles, balloons, and bananas.

To play handball, you need a large gymnasium with lots of open wall space and some handballs. You can work on handball skills and play games on an individual basis or in groups — whatever works for your situation. Teens use only their hands to hit the ball toward the wall and then keep hitting it back as it bounces off the wall. This coordination game is fun because it involves an individual challenge, and the repetition can be addicting.

Four Square

Everyone remembers this recess favorite! This game is exactly as it sounds, made up of four squares. All you need to make a court is some tape and space where you can tape down a grid featuring four equal, intersecting squares.

The goal is for an individual player to get others out and advance to the fourth square, which is the highest level. There is one game ball that you try to bounce inside another square without the person in that square hitting another square.

Any number of kids can play Four Square because it is super fast-paced and features a line for waiting players who enter the game when someone gets out. This game is really simple to play, but it's highly addictive, which makes it fun.

This version of kickball is a team game that leaves room for individual skills and preferences. Instead of standard bases, Matball uses large gym mats as bases because multiple players can be on a base at one time.

There are two teams — one starts as the kicking team, and the other in the outfield. Each kicking player advances to the first mat and then decides on each teammate's turn whether they think they can make it to the next base without getting out. The team with the most runs at the end of the game wins. Teens have the most fun when they work as a team and run the bases in a large group or create distractions to get the fastest players home.

Obstacle Course

If you want an individual activity, obstacle courses are a great way to encourage each student's skill set. Basically, you want to create a course with various obstacles, then time each person as they attempt to complete the course.

Classic obstacles include crawling through tunnels, funny walks like the crab walk, and zig-zagging through a line of cones. Picking up a bunch of small objects, jumping over something, or having to do the limbo under a bar or rope can also be great.

To get everyone involved in the obstacle course, ask kids to brainstorm obstacles ahead of time. They'll come up with some hilarious ideas, and everyone will have even more fun playing this PE game.

Capture the Flag

Capture the Flag has many versions, but the basic indoor game is like a team game of tag. Each team tries to steal the flag(s) of the other team before theirs gets stolen. To make the game more exciting, start with at least four teams instead of the traditional two. Give each team more than one flag and rule that only one flag can be taken at a time or include bonus point items.

Traditional Sports

There's no reason to leave the classic sports out of PE — after all, these are games too. Comprehensive physical education programs typically involve individual fitness, cooperative games, and an introduction to classic sports . Depending on your specific facilities, include some of the traditional high school PE games:

• Basketball - Learn the basic rules of this two-team game from Basketball Breakthrough .
• Volleyball - The Art of Coaching Volleyball offers standard gameplay and setup, along with relevant terminology.
• Baseball - Dummies.com gives you the simplest breakdown of the complicated rules in this outdoor game.
• Soccer - Learn the history, basic rules , and team strategies of gym class soccer.
• Football - Standard football rules are often modified in gym class with no tackling, like in Flag Football .
• Swimming - Groups with access to a swimming pool teach everything from basic strokes to pool exercises to group water games .
• Lacrosse - When played in PE classes, the game uses modified equipment and lacrosse rules .

If you use some traditional sports, be sure to focus on inclusion and mixing things up. By the time kids reach high school, they've had a chance to experience several sports either as players or spectators. Teens who are die-hard athletes or passionate about a specific sport find these traditional games fun and exciting, but teens who aren't as active may struggle to enjoy competitive sports.

Modern Favorite PE Games for High School

Inclusion is the name of the game these days with PE. In recent years, physical education class standards across the country have seen major changes. The new focus is on promoting health for all kids, not just the ones who excel at or love sports. Teachers now look for ways to encourage individual participation in activities selected by each student or group games with less competition.

These modern games are super fun for everyone, no matter their skill level.

Ultimate Frisbee

With gameplay similar to football, basketball, and soccer, Ultimate Frisbee is a non-contact team sport using a frisbee in place of a ball.

To play, you'll need a large open area like a football field. The best aspects of this game are that anyone can play, and teamwork is essential. To score, teams need to utilize all of their players because once you have the frisbee you can only pivot, not run. The lack of contact also prevents injuries and levels the playing field for kids who aren't as classically athletic.

Frisbee Golf

This slow-paced game is played just as it sounds. Like golf, there are designated "holes," a target of some kind like a safety cone or a tree, you try to hit with a frisbee in the least number of throws possible. Frisbee golf works best in a large outdoor area but can be played inside a large gymnasium.

Those with limited resources can designate found objects like trees and fences as holes outside or tape spots on the wall around the gym indoors. This is an individual game with an element of totally friendly competition when teens play against each other for the lowest score.

A combination of tennis and ping-pong, this super popular and active game features simple rules and a slower pace great for people of all ages and skill levels.

To play you need a court similar to a tennis court with a net, pickleball paddles, and the ball which resembles a whiffle ball. Play a singles game or play with a small team. Teens will feel like they're in a giant-sized ping-pong game.

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When Capture the Flag mixes with a snowball fight, you get Yuki Ball. Based on a Japanese game, teams hide behind barriers and launch small softballs to protect their flag and steal the other team's flag. To play, you need to buy a Yuki Ball kit for around $900 that includes balls, barriers, pinnies, and buckets. Or you can construct your own from things you have in the gym — make your own set with cardboard box barriers and wool dryer balls or the fake snowballs you find around winter in stores.

Two teams of up to seven people each can play at one time, but you can have more than one game going at a time in a gym. Keep score and have fun.

Hunger Games Gym Class Competition

Tie in pop culture with your curriculum when you include this fun game inspired by The Hunger Games novels and movies. The main goal is to be the last person standing in the game. To do this, you'll need to avoid getting hit by "weapons" like dodgeballs and pool noodles wielded by other players. The Hunger Games Competition can be played in a gym, in several rooms, or outdoors.

To start, all the "weapons" are placed in the center of the room and the players are placed in a circle at equal distances from the center. Teens can try to get a "weapon" or choose to run away. Each person hangs a bandana or flag from their waist that, when pulled off, eliminates them from the game. If a person gets hit with a weapon, they aren't out of the game, but they do lose the use of whatever body part got hit for the rest of the game.

Hoop Scrabble

You know how it's great when one game tackles multiple learning areas? This high-paced game gets the whole class moving at once, requires cooperative teamwork, and incorporates other areas of learning.

In Hoop Scrabble , you form small teams and give each a hula hoop to place on the ground in their designated area around the perimeter of the gym. Dump a ton of small balls, like tennis or ping-pong balls, in the center of the room. Teams then have to collect balls and spell a word inside their team's hoop before any other team does or before anyone steals their balls.

What's great about this creative game is teens don't need to be athletic to have fun playing. Once all the balls have been collected, teams start stealing from each other, which makes the game more fun.

This fun PE game is super simple and doesn't require a ton of equipment. You'll need three red dodgeballs. To play, give a dodgeball to each of three kids and tell them to start tagging people. If they hit someone with the ball, that person is temporarily out and should sit down and cover their face.

For tagged kids to get back in the game, another student needs to stand behind them and say the words "Guess who." If the tagged person can guess who is standing behind them just from their voice, they are back in. Keep playing until everyone is out.

Originally a tailgating game, cornhole is awesome in PE class too. Most of the kids probably already know how to play, but you can refresh them on the rules of cornhole if you need to.

You use cornhole boards (or tape out a "board" on the gym floor) and try to see which team can score the highest. Teams take turns tossing bean bags into the hole of the board. Those who make it in the hole are worth three points, and those who land on the board are one. The team that hits 21 points first is the winner.

Original PE Games

Sometimes the best gym games are the ones you and the teens create, so get creative with the old games to make something totally new. These are a few ideas to take inspiration from traditional or classic PE games for high school and make them unique using special equipment or rules.

Shape Shifter

Think of this as an advanced form of following the leader. You don't need any equipment — just an open space, and some creative, willing kids. Divide the group into teams of at least five people on each team and set each team in a line, one person behind the next. Teams will jog together staying in a line. The teacher will call out "Shape Shift" at various points and teams must react appropriately at that time.

To start, the first person in each line forms a shape or pose with his arms and everyone in line holds the same position as they start to jog. When you call out "Shape Shift" the second person in each line forms a new arm pose and all other team members copy it. To do this, the first person in line will need to turn around and will be jogging backward for the rest of the game. Repeat these actions until the entire team is turned backward. This is a fun, non-competitive game.

Flag team is an individualized version of Capture the Flag. Give each student a designated spot in the gym with a hula hoop on the floor and a flag in the middle of the hoop. The goal is for each person to protect their flag but also steal at least one other flag. If your flag is stolen, you choose another person who still has their flag to join. You cannot steal any more flags once you are out, but you can help the other person defend theirs.

The rules are simple in terms of offense and defense. You cannot stand inside your hoop or anyone else's. To stop someone from stealing your flag, you must tag them on the back only. If you get tagged on the back by any player at any point in the game, you are out.

Get Your Game On

Everyone has a different definition of fun. It's awesome to create a physical education class inclusive of every kid when you choose a wide variety of games. The only true way to know if teens will like a game is to try it out, so introduce some new games and see which ones become favorites with your group.

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Supporting Physical Education in Schools for All Youth

• Policy Statements and Advocacy
• Policy Statement Database
• Development Process
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• Proposed Policy Statements
• Date: Oct 26 2021
• Policy Number: 20211

Key Words: Physical Activity, Education, School Health, Obesity

Abstract This policy statement provides scientific evidence that schools are unique places where children should be engaged in physical activity. However, most school policies and programs are not supportive of physical activity in the school day, specifically physical education. Considering that 30.4% of youth are overweight or obese and that 76.8% do not meet the daily physical activity recommendations, and considering the benefits of physical activity with respect to increased ability to concentrate and learn, it is of the utmost importance to incorporate policies and programs that facilitate healthy engagement in physical activity in schools. Marginalized youth from low-income families, communities of color, immigrant communities, and others are disproportionately impacted by lack of supportive policies and programming. This policy statement calls for comprehensive and cooperative actions from the public health community, schools, administrators, researchers, and community members to increase physical activity opportunities through physical education in order to engage youth in at least 60 minutes of physical activity daily.

Relationship to Existing Policy Statements 

• APHA Policy Statement 20137: Improving Health and Wellness through Access to Nature
• APHA Policy Statement 20172: Supporting the Updated National Physical Activity Plan
• APHA Policy Statement 201515: The Role of Health Education Specialists in a Post-Health Reform Environment
• APHA Policy Statement 20079: Building a Public Health Infrastructure for Physical Activity Promotion
• APHA Policy Statement 9709: Promoting Public Health Through Physical Activity
• APHA Policy Statement 20044: Creating Policies on Land Use and Transportation Systems that Promote Public Health
• APHA Policy Statement 20058: Supporting the WHO Global Strategy on Diet, Physical Activity and Health
• APHA Policy Statement 200619: Urgent Call for a Nationwide Public Health Infrastructure and Action to Reverse the Obesity Epidemic
• APHA Policy Statement 201514: Building Environments and a Public Health Workforce to Support Physical Activity Among Older Adults
• APHA Policy Statement 20121: Supporting the National Physical Activity Plan
• APHA Policy Statement 201415: Support for Social Determinants of Behavioral Health and Pathways for Integrated and Better Public Health

Problem Statement Obesity is an important health issue among children in the United States. According to the 2019 National Health and Nutrition Examination Survey, 16.1% of U.S. youth are overweight and 19.3% are obese.[1] Moreover, racial, socioeconomic, and gender disparities exist in terms of risk factors associated with being overweight or obese. The chronic disease burden is consistent with the disproportionately high percentages of overweight and obese youth in racial minority and socioeconomically disadvantaged populations. According to data from the 2019 Youth Risk Behavior Surveillance System (YRBSS), 37.7% of Black youth and 38.8% of Hispanic youth are overweight or obese, as compared with just 27.7% of White youth.[2]

P hysical inactivity is a significant risk factor for obesity and other chronic conditions.[3] As the proportion of students who are overweight or obese has increased, so has inactivity. Empirical evidence suggests that physical activity may be used as a standalone strategy to decrease adiposity among children.[4] It is recommended that school-aged children and adolescents (6–17 years of age) engage in 60 minutes of physical activity seven days per week.[5] According to data from the 2019 YRBSS, 76.8% of youth do not meet the recommended amounts of physical activity.[2] The same data set indicates that adolescent girls, in particular, are at a higher risk for being inactive as they age; 84.6% of girls do not meet the physical activity guideline of 60 minutes per day seven days a week, as compared with 69.1% of boys.[2] In addition, inactive youth are more likely to be inactive as adults.[6] Starting physical activity early is essential to prevent inactivity in adulthood and older adulthood.

Physical activity provides benefits beyond physical health. For example, it is associated with a reduced risk for depression.[7] Trends for contemplating and making a plan for suicide are increasing among White, Hispanic, and Black youth, and there are racial and ethnic disparities in terms of mental health challenges among youth.[5] In 2019, 40.0% of Hispanic youth reported persistent feelings of sadness or hopelessness, as compared with 36.0% of White youth and 31.5% of Black youth.[5]

In addition to the long-term health benefits of child physical activity, there are numerous academic-related benefits, which the body of evidence continues to expand.[8] Extensive research has demonstrated strong positive correlations between physical activity and higher levels of physical fitness and academic achievement, educational attainment, academic performance, and brain functioning.[8–10] In fact, physical activity participation has both intermediate and long-term benefits with respect to academic performance. Research has shown that, immediately following engagement in physical activity, children have improved concentration on classroom tasks, which may potentially enhance learning.[8]

It is recommended that schools provide 150 minutes of instructional physical education for elementary school children and 225 minutes for middle and high school students per week for the entire school year.[11] However, only Oregon and the District of Columbia have requirements that meet the recommendations for minutes of physical education.[12] Physical education requirements notably decrease after the fifth grade, which aligns with significant decreases in physical activity in youth. Only 8.7% of schools require physical education for 12th grade, as compared with 45.1% of schools for fifth grade.[13]

The lack of universal physical education requirements at all grade levels and the lack of funding dedicated to physical education facilitate inactivity. The median school physical education budget in the United States is just $764 per year,[12] which may further hinder schools from meeting physical education recommendations. Ohinmaa and colleagues suggested that grants, donations, and fundraising account for about half of all funding for school health.[14] Improving physical education policies nationwide has the potential to reduce overall health care costs by $60.5 million within 10 years.[15]

Students who attend physical education in school are two to three times more likely to be physically active outside of school and nearly twice as likely to be active in adulthood.[16] Furthermore, physical education has been shown to be an opportunity for students to gain many of their recommended minutes of physical activity, but many students do not attend or participate in these classes.[13] According to 2019 YRBSS data, about half of high school students attend physical education classes one or more days per week.[2] Therefore, targeting middle and high schools is uniquely important because a significant drop in physical education attendance and physical activity participation occurs between the seventh and 12th grades.[11]

Evidence-Based Strategies to Address the Problem   Youth spend a significant portion of their time at school[17]; therefore, schools are one of the most important places for physical activity interventions.[18] According to the Society of Health and Physical Educators, schools should require physical education for students in kindergarten through grade 12.[19] Specifically, all students within secondary school (which includes middle school and high school) should achieve 225 minutes of physical activity per week, while students in primary school (which includes elementary school) should achieve 150 minutes per week.[19]

Current evidence-based strategies to increase physical activity among youth are described below.

Improving school-based physical education: According to the Community Preventive Services Task Force (CPSTF),[20] enhanced school-based physical education involves changing the curriculum and coursework for K–12th-grade students to increase the amount of time students spend engaging in moderate to vigorous physical activity (MVPA) during physical education classes. Enhanced school-based physical education is defined as increasing the amount of time students spend completing MVPA during physical education classes to at least 50% of class time.[20] The CPSTF specifically recommended improving physical education teaching strategies by (1) incorporating modified games and substituting sedentary games with active games and (2) including physical education lesson plans that incorporate fitness and circuit training activities.[20]

Lonsdale and colleagues highlighted effective strategies to increase MVPA, which included teacher professional learning focusing on class organization, management, and instruction and supplementing the usual physical education lessons with high-intensity activity (i.e., fitness infusion).[21] A systematic review of 14 studies showed that students who participated in enhanced school-based physical education classes engaged in 24% more MVPA.[21] Also, groups that received enhanced school-based physical education spent on average 53% of their time engaged in MVPA.[21] In addition, Zhou and Wang found that team games were reported to accumulate the most MVPA time, with movement-based activities (such as gymnastics and dance) having the highest amounts of MVPA and knowledge-based activities (i.e., lesson-based instruction) having the lowest amounts.[22] Implementation of enhanced school-based physical education aligns with the Healthy People 2030 objectives, which aim to increase the proportion of adolescents who meet current federal physical activity guidelines for aerobic physical activity and muscle-strengthening activity.[23]

It is important that physical education classes be taught by state‐licensed or state‐certified teachers who are endorsed to teach physical education. In a meta-analytic review, Hollis and colleagues found that youth were engaged in MVPA for an average of 44.8% of lesson time.[24] Low MVPA levels in physical education lessons could be the result of pedagogical characteristics often observed in typical lessons, such as stopping physical activity to provide instruction, observing demonstrations related to the activity, or organizing equipment or student groups.[25] An examination of time allotment in terms of lesson context revealed that 30% of lesson time was spent in game play, 29% in fitness, 20% in classroom management, 9% in knowledge-related activities, and 5% in skill-related activities.[15] Similar results were found in a study by Powell and colleagues in which the average length of physical education lessons was 35.3 minutes, with only 15 minutes of MVPA during physical education.[26] Results further demonstrated that 34% of the lesson was spent standing and 21.7% was spent sitting, with time sitting being directly linked to knowledge attainment.[26] 

In conclusion, a significant proportion of physical education instruction time is spent on classroom management, instruction, and transitional periods. While these periods are necessary, they detract from the overall time youth spend participating in MVPA. It is, therefore, recommended that all physical education courses be taught by qualified individuals who have received formal training in physical education pedagogy. SHAPE America has specifically recommended that physical education be taught by an endorsed state‐licensed or state‐certified teacher.[11] This educational licensure or certification requirement would ensure that the physical education curriculum used in schools is appropriate and maximizes the time students spend engaging in MVPA while also aligning with national and/or state physical education standards for K–12 physical education.[11] 

Increasing the frequency of physical education: Scientific evidence has shown that increasing the frequency of physical education can improve overall physical activity among youth. Research indicates that only 25.9% of high school students attend physical education classes five days per week.[5]  Findings from the School Health Policies and Practices Study showed that less than 4% of elementary and middle schools require physical education or similar activity every day throughout the school year.[18] Moreover, less than 9% of middle schools require physical education at least three days per week.[18] Physical education instruction for high school students decreased from 29.9% in 2017 to 25.9% in 2019.[5]

The benefits of regular physical activity are well documented and include improvements in bone and muscle development, cardiorespiratory fitness, and weight control; reduced symptoms of depression and anxiety; and reduced risks of heart disease, cancer, type 2 diabetes, and hypertension.[3] Research has demonstrated that physical activity throughout the school day is associated with better school performance.[8] Healthy People 2030 objectives highlight the importance of increased physical activity through improved physical education in both public and private school systems. Specifically, the Educational and Community-Based Programs workgroup aims to increase the proportion of adolescents who participate in daily school-based physical education.[7]

Reduction or removal of waivers, substitutions, and exemptions for physical education: Another important strategy to increase school-based MVPA is the reduction or removal of waivers, substitutions, and exemptions for physical education. According to the Shape of the Nation 2016 report, 30 U.S. states allow student exemptions from physical education classes, and 31 states allow students to substitute activities such as marching band, cheerleading, drill team, or intramural sports for physical education credit.[12] SHAPE America issued a position statement according to which school districts and schools should not allow waivers or exemptions from physical education class time or credit requirements.[11] Specifically, SHAPE firmly asserted that all students should be required to complete physical education courses and that state, district, and school policies should not allow substitutions, waivers, or exemptions for physical education courses, class time, or credit requirements. By allowing waivers, substitutions, and exemptions for physical education, schools and districts eliminate opportunities for students to be active at a time when physical activity levels are at an all-time low among youth.[11] As mentioned, schools offer a unique setting to teach children the value of physical activity as well as a structured, supervised environment in which children can learn the necessary skills to encourage lifelong physical activity.[11]

Culturally tailored physical education: Multiple organizations have reported the need to ensure culturally tailored physical education for all populations, especially marginalized populations such as minority racial, ethnic, and cultural groups; girls and women; refugees; people experiencing homelessness; LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning) populations; and others.[27,28] The United Nations Educational, Scientific and Cultural Organization’s Guidelines for Policy-Makers on Quality Physical Education stated the need for and importance of providing physical education for minority groups. According to the guidelines, (1) curricula should be flexible and adaptable for all groups, (2) teachers should be professionally qualified and capable of providing physical education for all students, and (3) school policies and practices should provide appropriate infrastructure, faculties, equipment, and teaching material for all students.[28]

Lastly, it is recommended that teachers have access to resources such as community health workers who can provide culturally specific guidance on physical education. Community health workers are particularly effective because of the cultural and linguistic connections they have with the communities they serve.[29] Providing culturally appropriate physical education may increase physical activity,[30] decrease obesity,[31] and improve the overall health of minority groups by increasing social support, promoting healthy lifestyles, and increasing knowledge of disease prevention.[32]

Adaptive physical education: According to the Physical Activity Guidelines for Americans, children and adolescents with disabilities are more likely to be inactive than those without disabilities.[7] It is recommended that children and adolescents with disabilities still aim to meet the key guideline of 60 minutes of physical activity every day when possible. If youth are unable to participate in the physical activities or durations needed to meet the key guidelines, it is recommended that they be as active as possible and avoid being inactive.[7]

Youth with disabilities should work with health care professionals or physical activity specialists to learn about the types and amounts of physical activity appropriate for them.[7] The Adapted Physical Education National Standards were developed to ensure that physical education for children with disabilities be delivered by a qualified adapted physical educator. According to these standards,  physical education teachers should use sound teaching practices to ensure the inclusion and representation of all skill and ability levels.[33] Specifically, master physical educators should be well prepared to provide knowledge acquisition as well as physical activity opportunities for all abilities to create active and healthy lifestyles for all students. In addition, the standards outline high expectations for a physically active lifestyle. Lastly, it is expected that master physical educators will maintain a stimulating, productive learning environment that holds all students to the highest expectations for a physically active lifestyle.[33]

Conclusion: In conclusion, schools are the ideal and recommended setting for the promotion of physical activity among youth, and physical education is the primary vehicle through which to achieve this objective in schools.[34] Improving the quality and quantity of physical education courses will give youth more opportunities to attain the recommended amount of physical activity each day. Reducing physical education waivers would ensure that youth are not exploiting a loophole in the system. Advocating for culturally tailored physical education and adaptive physical education would foster an inclusive environment in which all children are able to be physically active and healthy.

Opposing Arguments/Evidence  Few would disagree that physical activity and time spent engaged in physical education are important for youth development and overall health. The primary opposing arguments tend to stem from the poorly designed physical education curriculum and the time taken away from other subjects amid increased pressure to raise standards and scores in subjects such as math, science, and English. As a result, time allocated to physical education and the perceived importance of physical education lessons have been reduced.  However, there is a substantial amount of evidence that physical activity can help improve academic achievement, including overall grades and standardized test scores.[34] In a systematic review of 43 articles and 50 studies, the Centers for Disease Control and Prevention (CDC) determined that physical activity has a positive impact on cognitive skills, attitudes, and academic achievement.[34] Specifically, physical activity enhanced concentration and attention and improved classroom behavior.[34] The review also showed that increasing time during the school day for physical activity does not appear to take away from overall academic performance.[34]  Therefore, the CDC recommended that schools increase the amount of time students spend in physical education or consider adding components to increase the quality of physical education classes.[34] As highlighted in the evidence-based strategies to improve school-based MVPA, the CPSTF recommended use of enhanced physical education, including improved physical education teaching strategies, by incorporating modified, more active games and physical education lesson plans that involve fitness and circuit training activities.[20]

Alternative Strategies Enhancing, encouraging, and maintaining physical education class duration and quality are vital to the health and well-being of children, particularly in terms of their physical activity behaviors. However, there are several alternative strategies to increase the physical activity of youth that should be considered in conjunction with retaining the importance of physical education.

Before- and after-school physical activity programs: According to the World Health Organization, after-school activities are a key avenue to supplement youth MVPA levels.[35] After-school physical activity could include physical activity clubs, intramural programs, informal play on school grounds, physical activity in school-based before- and after-care programs, and interscholastic sports.[18] Mayorga-Vega and colleagues found that physical activity that took place after school hours achieved 36% of the recommended 60 minutes of MVPA per day.[36] However, adolescents still reported a higher level of MVPA during physical education classes than during school recess and after-school programs.[36]

Only about 26% of the nation’s public and private schools provide access to their physical activity spaces and facilities for all individuals outside of normal school hours. In addition, a steady decline has been observed in provision of access to physical activity facilities during nonschool hours.[37] Therefore, schools can further encourage physical activity by opening up their facilities for community use.[18]

Increasing active transportation to and from school: According to the CPSTF, walking or bicycling to and from school provides children and adolescents with an opportunity to be physically active most days of the week.[38] Interventions such as the Safe Routes to School program could increase active transportation to and from school and reduce pedestrian and bicycle injury rates. However, there is not enough evidence to show that school travel leads to increases in students’ overall daily physical activity.[38]

Recess: Recess is defined as a regularly scheduled period during the school day for physical activity and play that are monitored by trained staff or volunteers.[13] Recess has been directly related to increased physical activity, improved memory, improved attention, improved concentration, decreased classroom disruptive behavior, improved social and emotional development, and academic achievement.[8,39–41] It is recommended that elementary, middle, and high school students have a minimum of 20 minutes of daily recess.[39] The CDC has further recommended that recess and physical education be separate, distinct physical activity opportunities, which creates separate times for skill acquisition (physical education) and active play (recess).[39] Also, the CDC has recommended that schools provide students with adequate, designated, and safe spaces, facilities, equipment, and supplies for both indoor and outdoor recess (e.g., playground markings, physical activity zones, activity cards).[39] Lastly, students should not be excluded from recess for disciplinary reasons or academic performance because such practices promote negative reinforcement.[39]

Classroom-based physical activity: Classroom-based physical activity, including single physical activity sessions, may increase student attention, concentration, and memory; increase motivation and enjoyment of learning; and reduce behavior issues.[8,40] Classroom-based physical activity integration may include physically active lessons, physical activity before a test, physical activity breaks, energizers, brain boosters, and active classrooms (a teaching technique that intentionally blends physical activity into academic lessons to satisfy the learning outcomes of the classroom without sacrificing time spent engaging in physical activity).[8,40,42] Further guidance by the CDC and other national organizations includes providing teachers with ongoing professional development to integrate physical activity into planned academic instruction as a means of reinforcing academic concepts.[40]

Action Steps Increasing physical activity among school-aged children is a vital investment in the health and well-being of youth in the United States. Increasing physical activity at this critical age has the potential to build healthier, happier young adults. Schools should support physical activity through culturally appropriate, high-quality physical education. Schools; local, state, and federal education agencies; public health departments; policymakers; and researchers should address the following objectives relevant to public health priority setting in order to advance school-based physical activity programming and activities:

• Federal agencies should develop national policies on physical education that are consistent with the larger national strategies to increase physical activity among youth.
• Federal and state governments should increase funding for schools to implement high-quality physical education programming
• State and local education departments should improve physical education requirements to provide the opportunity for 60 minutes of MVPA each school day.
• Policymakers at state and local education departments should be made aware of the importance of physical education provided by schools.
• Schools should require that all physical education teachers be appropriately credentialed to deliver culturally appropriate, high-quality physical education.
• Schools should solicit involvement and expertise from state and local public health departments and physical activity researchers on culturally specific, evidence-based strategies to improve school-based physical education.
• Principals and superintendents of schools should develop action plans to improve physical education for all of their students. Youth should have the opportunity to engage in 60 minutes of physical activity during the school day.
• Principals and superintendents should reduce or eliminate policies allowing waivers for physical education. Waivers should be considered on a case-by-case basis.
• Schools and school districts should engage in collaborative efforts to share the results of successfully implemented physical education programs.
• Schools and researchers should collaborate in studying physical activity among diverse youth who have been traditionally understudied and systematically underserved. Furthermore, researchers should be encouraged to develop innovative programs for youth in school settings that promote physical activity for all.
• Greater diversity in programming should be implemented in schools so that youth can be exposed to a variety of activities that those of all abilities and cultures might enjoy.
• Youth, families, community members, and local organizations should advocate to their school districts and legislative bodies for culturally appropriate, high-quality physical education in their local schools.
• Public health departments should partner with and support physical education teachers and programs. This support should include school-based physical activity in community health assessments and community health improvement plans highlighting the importance of physical activity in preventing chronic disease and providing mental and cognitive benefits.

References 1. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. Available at: https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf. Accessed October 20, 2021. 2. Centers for Disease Control and Prevention. 2019 Youth Risk Behavior Survey Questionnaire. Available at: www.cdc.gov/yrbs. Accessed October 20, 2021.  3. Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity at a glance. Available at: https://www.cdc.gov/chronicdisease/resources/publications/aag/dnpao.htm. Accessed October 20, 2021. 4. Laframboise MA, Degraauw C. The effects of aerobic physical activity on adiposity in school-aged children and youth: a systematic review of randomized controlled trials. J Can Chiropractic Assoc. 2011;55(4):256–268. 5. Center for Disease Control and Prevention. High School YRBS 2019. 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Longitudinal associations between physical activity and educational outcomes. Med Sci Sports Exerc. 2017;49(11):2158–2166. 10. Kohl HW, Cook HD. Physical activity, fitness, and physical education: effects on academic performance. Available at: https://www.ncbi.nlm.nih.gov/books/NBK201501/. Accessed October 20, 2021. 11. Society of Health and Physical Educators. The essential components of physical education. Available at: https://www.shapeamerica.org/uploads/pdfs/TheEssentialComponentsOfPhysicalEducation.pdf. Accessed October 20, 2021. 12. Society of Health and Physical Educators (2016). 2016 shape of the nation: status of physical education in the U.S. Available at: https://www.shapeamerica.org//advocacy/son/2016/upload/Shape-of-the-Nation-2016_web.pdf. Accessed October 20, 2021. 13. Springboard to Active Schools. Keep recess in schools. Available at: https://www.cdc.gov/healthyschools/physicalactivity/pdf/Recess_Data_Brief_CDC_Logo_FINAL_191106.pdf. Accessed October 20, 2021. 14. Ohinmaa A, Langille JL, Jamieson S, Whitby C, Veugelers PJ. Costs of implementing and maintaining comprehensive school health: the case of the Annapolis Valley Health Promoting Schools program. Can J Public Health. 2011;102(6):451–454. 15. Barrett JL, Gortmaker SL, Long MW, et al. Cost effectiveness of an elementary school active physical education policy. Am J Prev Med. 2015;49(1):148–159. 16. Physical Activity Council. (2017). 2017 participation report. Available at: http://s3.amazonaws.com/ustaassets/assets/822/15/papc_study.pdf. Accessed October 20, 2021. 17. Synder TD, de Brey C, Dillow SA. Digest of education statistics. Available at: https://files.eric.ed.gov/fulltext/ED580954.pdf. Accessed October 20, 2021. 18. Centers for Disease Control and Prevention. School Health Policies and Practices Study, 2014. Available at: https://www.cdc.gov/healthyyouth/data/shpps/pdf/shpps-results_2016.pdf. Accessed October 20, 2021. 19. Society of Health and Physical Educators. A-Z of social justice physical education. Available at: https://www.shapeamerica.org/uploads/pdfs/2020/publications/joperd/The-A%E2%80%93Z-of-Social%20Justice-Physical-Education-P1.pdf. Accessed October 20, 2021.  20. Community Preventive Services Task Force. Annual report to Congress: 2013. Available at: https://www.thecommunityguide.org/content/tffrs-physical-activity-interventions-increase-active-travel-school. Accessed October 20, 2021. 21. Lonsdale C, Rosenkranz R, Peralta L, et al. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical activity lessons. Prev Med. 2013;56:152–161. 22. Zhou Y, Wang L. (2019). Correlates of physical activity of students in secondary school physical education: a systematic review of literature. BioMed Res Int. 2019;2019:4563484.   23. U.S. Department of Health and Human Services. Healthy People 2030 physical activity objectives. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/physical-activity. Accessed October 20, 2021. 24. Hollis JL, Sutherland R, Williams AJ, et al. A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in secondary school physical education lessons. Int J Behav Nutr Phys Act. 2017;14(1):52.   25. Fairclough SJ, Stratton G. A review of physical activity levels during elementary school physical education. J Teach Phys Educ. 2006;25(2):240–258.   26. Powell E, Woodfield LA, Nevill AM, Powell AJ, Myers TD. ‘We have to wait in a queue for our turn quite a bit’: examining children’s physical activity during primary physical education lessons. Euro Phys Educ Rev. 2019;25(4):929–948. 27. Society of Health and Physical Educators. National PE standards. Available at: https://www.shapeamerica.org/standards/pe/. Accessed October 20, 2021.  28. United Nations Educational, Scientific and Cultural Organization. Guidelines for policy makers: quality physical education. Available at: https://en.unesco.org/inclusivepolicylab/sites/default/files/learning/document/2017/1/231101E.pdf. Accessed October 20, 2021. 29. Haughton J, Ayala G, Burke K, Elder J, Montanez J, Arrendondo E. Community health workers promoting physical activity. J Ambul Care Manage. 2015;38(4):309–320. 30. Hovell MF, Mulvihill MM, Buono MJ, et al. Culturally tailored aerobic exercise intervention for low-income Latinas. Am J Health Promotion. 2008;22(3):155–163. 31. Falbe J, Cadiz AA, Tantoco NK, Thompson HR, Madsen KA. Active and healthy families: a randomized controlled trial of a culturally tailored obesity intervention for Latino children. Acad Pediatr. 2015;15(4):386–395.   32. Joo JY, Liu MF. Culturally tailored interventions for ethnic minorities: A scoping review. Nurs Open. 2021;8(5):2078–2090. 33. APENS. Adapted Physical Education National Standards. Available at: https://apens.org/national_standard.html. Accessed October 20, 2021. 34. Centers for Disease Control and Prevention. The association between school based physical activity, including physical education, and academic performance. Available at: https://www.cdc.gov/healthyyouth/health_and_academics/pdf/pa-pe_paper.pdf. Accessed October 20, 2021.  35. World Health Organization. School policy framework: implementation of the WHO global strategy on diet, physical activity and health. Available at: https://www.who.int/dietphysicalactivity/SPF-en-2008.pdf. Accessed October 20, 2021.  36. Mayorga-Vega D, Saldias MP, Viciana J. Comparison of moderate-to-vigorous physical activity levels between physical education, school recess and after-school time in secondary school students: an accelerometer-based study. Kinesiology. 2017;49(2):242–251.   37. U.S. Department of Health and Human Services. Healthy People 2020. Physical activity objectives. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity/objectives. Accessed October 20, 2021.  38. Community Guide. Physical activity: interventions to increase active travel to school. Available at: https://www.thecommunityguide.org/content/tffrs-physical-activity-interventions-increase-active-travel-school. Accessed October 20, 2021.  39. Centers for Disease Control and Prevention and Society of Health and Physical Educators. Strategies for recess in schools. Available at: https://www.shapeamerica.org/uploads/pdfs/recess/SchoolRecessStrategies.pdf. Accessed October 20, 2021.  40. Centers for Disease Control and Prevention. Strategies for classroom physical activity in schools. Available at: https://www.cdc.gov/healthyschools/physicalactivity/pdf/classroompastrategies_508.pdf. Accessed October 20, 2021. 41. Zavacky F, Michael SL. Keeping recess in schools. J Phys Educ Recreation Dance. 2017;88(5):46–53.   42. 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Educating the Student Body: Taking Physical Activity and Physical Education to School (2013)

Chapter: 6 approaches to physical activity in schools.

Approaches to Physical Activity in Schools

Key Messages

•  Data are insufficient to permit assessment of opportunities for and participation in sedentary activities in schools.

•  Schools need to strive to reduce unnecessary opportunities for sedentary behavior.

•  When embracing the advantages of technology for learning, schools need to be aware of its negative impact on students’ physical activity behavior.

•  Recess has been shown to be beneficial for academic achievement. It is counterproductive to withhold recess or replace it with classroom activities as a punishment.

•  Several models and examples demonstrate that scheduling multiple daily recess periods during the school day is feasible.

•  School-based sports and active transport provide opportunities for physical activity but may not be accessible or attractive for all youth.

    These opportunities need to be reexamined to address disparities based on socioeconomic status, school location and resources, students’ disabilities, or cultural/religious barriers.

•  Participation in intra- and extramural sports has flourished over the past 40 years; however, school systems need to ensure that equitable sports opportunities are available for youth in all types of school settings and at all levels of socioeconomic status.

•  Nonsport after-school programs should include physical activity.

•  Active transport to and from school can be a safe and effective way to increase students’ daily physical activity, especially where a large proportion of students live close to their school.

•  Each community needs to examine systematically opportunities for community-based promotion of physical activity.

•  Inviting students’ families and other community members to participate in developing before- and after-school programs, including sports and active transport, will increase program sustainability.

I t has been argued that, while reversing the obesity epidemic is not solely the responsibility of schools, the trend is unlikely to change without schools’ assistance (Siedentop, 2009). Schools are an ideal venue for the implementation of healthy behaviors because they serve more than 56 million youth in the United States; because youth spend such a large amount of time in school; and because schools already have the access, personnel, equipment, and space to implement physical activity programming.

Physical activity opportunities in schools take the form primarily of formal instruction in physical education for all students and sport-based athletics for the talented and interested. Although physical education is a required school subject, the classes may occur infrequently, and children taking them often accrue only low levels of physical activity (Simons-Morton et al., 1994). According to Tudor-Locke and colleagues (2006), physical education programs typically provide only 8-11 percent of a student’s daily recommended physical activity. However, a meta-analysis of the literature revealed that physical education can help children achieve up to 40 percent of the recommended 60 or more minutes of daily vigorous- or

moderate-intensity physical activity per day (Bassett et al., 2013; see also Chapter 5 ).

Mahar (2011) states that children’s physical activity levels are directly related to the opportunities they have to be active. Schools have the potential to influence the physical activity behaviors of their students through various opportunities in addition to physical education (e.g., recess periods, classroom physical activity breaks, active transport to and from school; van Landeghem, 2003). Furthermore, children are sedentary for much of the school day, and emerging evidence suggests that long periods of inactivity should be avoided. Thus it is essential for the school setting to provide opportunities outside of physical education for school-age children to be physically activity throughout the school day.

This chapter reviews the status and trends of sedentary behavior in schools and describes opportunities for physical activity in the school environment other than physical education, including classroom activity Breaks, recess, intra- and extramural sports, active transport, and after-school programs. Also reviewed are policies that may affect these opportunities, as well as barriers to and enablers of the opportunities. Chapter 7 examines the evidence on the effectiveness of these physical activity opportunities.

SEDENTARISM IN SCHOOLS

The committee did not identify a widely recognized definition of sedentarism, a new word in the English language, but one that exists in other languages to describe sedentary behaviors, sedentary activities, a sedentary lifestyle, or physical inactivity. Bernstein and colleagues (1999) describe sedentarism in terms of energy expenditure, while Ricciardi (2005) defines it in terms of what it is not, that is, not engaging in physical activity. Probably the most commonly accepted definition is time spent other than in sleep, or time spent in vigorous-, moderate-, or light-intensity physical activity. The word also is used to describe the status of a person or a population with high levels of sedentary behaviors or a sedentary lifestyle.

Sedentarism can be categorized as (1) recreational sedentarism, which refers mainly to media use or “screen time” but can also include more traditional sedentary activities such as recreational reading or having a conversation while sitting, and (2) nonrecreational sedentarism, which refers to schoolwork or other types of work that occur while sitting and also to other sedentary activities that are necessary to perform daily tasks, such as motorized transportation or eating a meal. Most of the public health interest in sedentarism has focused on decreasing recreational sedentarism, especially screen time, but there is increasing interest in ways to alter sedentary work so it can be performed while engaging in light physical activity or even while standing. Standing desks and treadmill desks are becoming popular

for adults in the workplace, for example, and many schools are seeking creative ways to integrate light physical activity into traditionally sedentary schoolwork. Such efforts are important given the amount of sedentary time entailed in schoolwork. In Australia, for example, 42 percent of nonscreen sedentary time is school related (Olds et al., 2010).

Such efforts to address nonrecreational sedentarism are just emerging, and much research and innovation are needed to move these efforts forward. On the other hand, significant research already exists on decreasing recreational sedentarism, especially among children, to treat or prevent obesity. Today, 46 percent of U.S. children aged 6-11 fail to meet the recommendation of less than 2 hours of recreational sedentarism (screen time) per day (Fakhouri et al., 2013). In addition to the nonrecreational sedentarism that occurs while children sit to perform schoolwork, significant recreational sedentarism takes place on the way to school and in school during breaks, recess, lunch, and after-school programs. Data are not available on the extent to which recreational sedentarism occurs on school grounds and on whether recreational sedentarism in school should be an important public health target as it already is outside of school. What is known, however, is that “eight- to eighteen-year-olds spend more time with media than in any other activity besides (maybe) sleeping—an average of more than 7½ hours a day, seven days a week” (Rideout et al., 2010, p. 1).

One of the lessons of pediatric obesity research is that behavioral approaches designed to increase physical activity are different from those designed to decrease recreational sedentarism and have different effects on behavior and health. Using behavioral economic theory, Epstein and colleagues (1995) demonstrated that monitoring children and encouraging them to decrease recreational sedentarism was more successful in treating obesity than either promoting physical activity or targeting both physical activity and sedentarism at the same time. Furthermore, the children randomized to the intervention targeting only sedentarism increased their enjoyment of vigorous- or moderate-intensity physical activity, while enjoyment of moderate-intensity physical activity decreased among those randomized to physical activity promotion; changes in enjoyment among those in the combined intervention group were between those in the other two groups. The importance of targeting a decrease in sedentarism was further highlighted when Robinson (1999) published the first successful school-based obesity prevention intervention that targeted only sedentarism, with no behavioral intervention focused on physical activity promotion or dietary changes. Since then, several randomized trials have confirmed the causal link between recreational sedentarism and childhood obesity (Tremblay et al., 2011). Despite this evidence, however, the approach of specifically targeting sedentarism has received only limited attention. While academic research has focused on using school as a setting in which to teach

students how to decrease sedentarism outside of school, this approach has not translated into widespread policies or curricula. Such efforts may be particularly important as sedentarism appears to track among individuals from childhood to adulthood (Gordon-Larsen et al., 2004; Nelson et al., 2006).

Of interest, a large nationally representative survey found that, “contrary to the public perception that media use displaces physical activity, those young people who are the heaviest media users report spending similar amounts of time exercising or being physically active as other young people their age who are not heavy media users” (Rideout et al., 2010, p. 12). The question was, “Thinking just about yesterday, how much time did you spend being physically active or exercising, such as playing sports, working out, dancing, running, or another activity?” This finding suggests that media use does not displace vigorous- or moderate-intensity physical activity but more likely displaces light-intensity physical activity, schoolwork, and sleep. Light-intensity physical activity, including playing or even just standing, is more difficult to measure than vigorous-or moderate-intensity physical activity, but its positive health impact is increasingly being recognized (see Box 2-4 in Chapter 2 ). The finding of this survey also suggests that promotion of vigorous- or moderate-intensity physical activity may not decrease sedentarism but rather might replace light-intensity physical activity. Therefore, the optimal way to promote an overall increase in physical activity (including light-intensity physical activity) may be to use behavioral approaches to decrease sedentarism, as has been shown in behavioral research (Epstein et al., 1995; Robinson, 1999).

One of the challenges to monitoring sedentarism is the fact that children and adolescents frequently multitask. As noted earlier, Rideout and colleagues (2010) found that U.S. youth aged 8-18 spent more than 7.5 hours per day using recreational media; 29 percent of this time was spent multitasking, resulting in a total media exposure of almost 10.5 hours per day. This figure represents an overall increase in sedentarism since 1999, when the corresponding figures were 6.2 hours and 7.3 hours per day, respectively. Television content still dominated sedentary time, accounting for 4.3 hours per day. Computer use for schoolwork (not included in these totals) averaged 16 minutes, while computer use for recreational purposes totaled 1.3 hours per day. On a typical day, 70 percent of youth went online for any purpose, including 57 percent at home, 20 percent at school, and 14 percent elsewhere. It is unknown whether all online activities at school were related to schoolwork.

In addition to displacing physical activity and schoolwork, recreational media use exposes youth to “a constant stream of messages” that shape their perception of what is normative, including food choices, physical appearance, physical activity, and even sedentarism itself (Rideout et al.,

2010). Usually, these perceived norms are not in line with healthy or academically productive behaviors, and cannot be countered by the best efforts of parents and teachers. As a consequence, compared with those who used recreational media the least, “heavy users” tended to have lower school grades and to report that they were getting in trouble “a lot,” unhappy, sad, or bored (Rideout et al., 2010). Furthermore, in the face of rapidly advancing technology, parents and teachers are not always fully aware of the many ways in which media and marketing are part of youth’s lives. In addition to television and desktop computers, laptops, tablets, and cell phones often follow children and adolescents into the school bus, class, recess, and after-school activities unless such access is limited by policy, providing increasing opportunities to be sedentary on school grounds. In 2009 an average of 20 percent of media consumption, more than 2 hours per day, occurred with mobile devices, some of this media use likely occurring on school grounds. This figure probably has increased since then. Rideout and colleagues also note that children whose parents make an effort to limit media use spend less time consuming media, but whether this holds true for limits on recreational sedentarism in the school setting is unknown.

Both recreational and nonrecreational sedentarism in schools need to be monitored separately from physical activity. Specific school policies, based on updated knowledge of media use, need to focus on decreasing recreational sedentarism in school and integrating prevention of recreational sedentarism outside of school into the education curriculum. Because media use among youth already is significantly higher than recommended, schools should not provide students with increased opportunities for sedentarism, such as television sets in classrooms, the cafeteria, or after-school programs; access to social networks and recreational media on school computers; or the ability to use cell phones anywhere and at any time on school grounds or school transportation.

Research is needed to explore sedentarism and media use in schools more systematically so that evidence-based school policies to decrease these behaviors can be implemented to increase overall, including light-intensity, physical activity. In particular, surveys of media use are needed to document the amount of recreational sedentarism taking place in the school setting, where, in contrast with the home setting, public health policy can potentially be implemented.

OPPORTUNITIES TO INCREASE PHYSICAL ACTIVITY IN THE SCHOOL ENVIRONMENT

School physical activity programs are needed so that schools can ensure they are providing students with 60 minutes or more of vigorous-

or moderate-intensity physical activity per day. Physical activity programs are neither equivalent to nor a substitute for physical education, and both can contribute meaningfully to the development of healthy, active children (NASPE and AHA, 2012). The former are behavioral programs, whereas the latter are instructional programs. Box 6-1 presents the Healthy People 2020 objectives for non–physical education physical activity opportunities in school settings.

The following sections describe various non–physical education opportunities for physical activity in the school environment. The discussion includes relevant policies, barriers, and enablers.

Healthy People 2020 Objectives for Non– Physical Education Physical Activity Opportunities in School Settings

•  Increase the number of States that require regularly scheduled elementary school recess.

•  Increase the proportion of school districts that require regularly scheduled elementary school recess.

•  Increase the proportion of school districts that require or recommend elementary school recess for an appropriate period of time.

•  Increase the proportion of the Nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours (that is, before and after the school day, on weekends, and during summer and other vacations).

•  Increase the proportion of trips of 1 mile or less made to school by walking by children and adolescents aged 5 to 15 years.

•  Increase the proportion of trips of 2 miles or less made to school by bicycling by children and adolescents aged 5 to 15 years.

SOURCE: HHS, 2012.

Classroom Activity breaks

An emerging strategy for increasing daily participation in physical activity in schools is the implementation of structured, classroom-based physical activity breaks. Classroom physical activity includes all activity regardless of intensity performed in the classroom during normal classroom time. It includes activity during academic classroom instruction as well as breaks from instruction specifically designed for physical activity. It also includes time spent learning special topics (e.g., art, music) even if not taught by the usual classroom teacher. It excludes physical education and recess even if conducted in the classroom by the usual classroom teacher. It also excludes physical activity breaks during lunchtime. Although some discussions of schooltime activity breaks include such breaks during lunchtime (Turner and Chaloupka, 2012), the committee views lunchtime physical activity as more akin to activity during recess and before and after school than to physical activity during normal academic classroom time. While a number of programs specifically designed to increase the volume of students’ physical activity during usual classroom time exist, the committee found no information about changes in such programs over time at the population level.

A typical break consists of 10-15 minutes focused on vigorous- or moderate-intensity physical activity. This strategy has been found to be effective in significantly increasing physical activity levels of school-age children (Ernst and Pangrazi, 1999; Scruggs et al., 2003; Mahar et al., 2006). Bassett and colleagues (2013) found that classroom activity breaks provide school-age children with up to 19 minutes of vigorous- or moderate-intensity physical activity, and the sustained use of such breaks was shown to decrease body mass index (BMI) in students over a period of 2 years (Donnelly et al., 2009). The effectiveness of classroom physical activity breaks is discussed further in Chapter 7 .

An example of an effective school-based physical activity program is Take 10! Kibbe and colleagues (2011) provide consistent evidence that the Take 10! program has been effective in increasing physical activity levels among a variety of samples of children enrolled in kindergarten through 5th grade in various countries. Likewise, Mahar and colleagues (2006) found that, with the implementation of 10-minute physical activity breaks called “Energizers,” students increased their time on task while averaging approximately 782 more steps in a day. Another example, supported by the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity (2012), is Jammin’ Minute, a realistic and effective “bridge” tool for increasing children’s physical activity until schools have sufficient resources to develop more comprehensive physical education programs. Jammin’ Minute has important implications for advocates and policy makers, as well

as administrators and teachers, seeking ways to make school environments healthier for children. At the same time, it should be emphasized that, while the benefits of small increases in physical activity during the school day need to be recognized, the ultimate goal of policy makers and advocates should be to ensure that all schools have comprehensive physical education programs (see Chapter 5 ).

Another program, Texas I-CAN!, helped teachers incorporate physical activity by modifying lesson plans to include more active activities, thereby increasing vigorous- or moderate-intensity physical activity by 1,000 steps per day (Bartholomew and Jowers, 2011). It was found that these curriculum-based activities improved time on task immediately following the breaks, especially in children who were overweight; these students went from being on task 58 percent of the time on typical instruction days to 93 percent of the time after the breaks (Grieco et al., 2009).

These findings emphasize the effectiveness and feasibility of providing classroom-based structured opportunities for physical activity. Breaks in the classroom provide an additional opportunity for physical activity throughout the school day with minimal planning, no equipment, and a short amount of time required; they can also incorporate learning opportunities for students. It should be noted that the literature tends to focus on the effect of classroom physical activity breaks on elementary school rather than secondary school students.

For classroom-based physical activity breaks to become a priority, it will be important to provide evidence that such breaks do not detract from academic achievement. Chapter 4 provides an extensive review of the evidence showing that physical activity in general has positive effects on academic performance. With respect to classroom-based physical activity, the Centers for Disease Control and Prevention (CDC) (2010) reviewed studies examining the association between such activity and academic performance in elementary school–age children. Eight of nine published studies found positive effects on such outcomes as academic achievement and classroom behavior; only one study found no relationship (Ahamed et al., 2007), but that study also found that the breaks did increase physical activity levels and did not adversely affect academic achievement. Donnelly and Lambourne (2011) provide further support for the link between physical activity and positive cognitive and academic outcomes in elementary school–age children. In addition, studies in elementary school–age children have found an increase in on-task behavior in the classroom after participation in a physical activity break (Jarrett et al., 1998; Mahar et al., 2006; Mahar, 2011; see also Chapter 4 ). For example, Mahar and colleagues (2006) found that time on task increased by 8 percent ( p < .017) with the implementation of a 10-minute break. They also found that the 20 percent of students who were off task improved the most in time on task. Similar

results were found in Georgia, where 4th graders exhibited significantly less fidgeting behaviors and significantly better on-task behaviors on days when activity breaks were conducted (Jarrett et al., 1998). Finally, a meta-analysis by Erwin and colleagues (2012) found that breaks increase the frequency of physical activity behaviors and have positive learning outcomes. It should be noted that the effect and benefits of classroom-based physical activity breaks in preschool populations have not been thoroughly investigated.

Policies That Affect Classroom Physical Activity Breaks

Classroom physical activity breaks are a relatively new approach to promoting physical activity during the school day. Consequently, research on policies that support or hinder the use of this approach is sparse. For this approach to become more prevalent, supportive policies will be necessary, an observation supported by the fact that just one in four U.S. public elementary schools offered children and youth physical activity breaks apart from physical education and recess during the 2009-2011 school years (Turner and Chaloupka, 2012). Research clearly demonstrates the important role of state laws and school district policies in promoting physical activity opportunities in schools. For example, schools are more likely to meet physical education recommendations when state laws and school district policies mandate a specific amount of time for physical education classes (Slater et al., 2012; see also Chapter 5 ). Currently, few if any school districts require that physical activity opportunities be provided throughout the school day or within the classroom (Chriqui et al., 2010). Therefore, research is needed to identify strategies for implementing classroom-based physical activity breaks and providing teachers with the skills and confidence necessary to engage students in these activities. In addition, questions remain about the optimal duration, timing, and programming (e.g., types of activities) for physical activity breaks (Turner and Chaloupka, 2012).

Barriers to Classroom Physical Activity Breaks

One factor that influences classroom physical activity breaks is competition for time during the school day, arising from the need for schools to meet the academic requirements of the No Child Left Behind Act (see Chapter 5 ). As discussed above and in Chapter 4 , however, the literature clearly supports that classroom physical activity breaks are not only beneficial in promoting physical activity in children and youth but also can occur in the classroom without compromising learning and in fact improve academic performance and related classroom behaviors. In addition, research has shown that using innovative curriculum change, such as Physical Activity Across the Curriculum (Donnelly et al., 2009), can increase daily

physical activity and improve academic performance. Additionally, schools often have a scarcity of resources related to staffing, teacher training, funding, champions, and/or facilities for physical activity. Dwyer and colleagues (2003), for example, document the lack of facilities and equipment for physical activity breaks. As a result of these barriers, it has been found that, although teachers see the importance of physical activity breaks for children’s health and development, they infrequently integrate movement into the classroom (Parks et al., 2007).

From the literature, classroom physical activity breaks appear to be heavily implemented in early childhood and elementary classrooms (CDC, 2010). Few if any classroom physical activity breaks appear to occur in middle and high school settings. The lack of physical activity breaks for this age group may be due to the increased academic demands of testing, along with difficulty of implementing breaks that target these older students. However, classroom-based physical activity curricula are emerging at a rapid rate. Programs available for purchase include Active and Healthy Schools activity break cards, Promoting Physical Activity and Health in the Classroom activity cards, Energizers, and TAKE 10! Other resources for classroom physical activity breaks are available at no cost to schools, such as Jammin’ Minute, ABS for Fitness, Activity Bursts in the Classroom, Game On! The Ultimate Wellness Challenge, and approximately 50 others. These resources can be found through the Alliance for a Healthier Generation at www.healthiergeneration.org . They provide an excellent starting point for teachers and are flexible enough to be modified to meet the needs of specific classrooms.

Space is another concern for classroom teachers, who must consider the safety of students. The classroom (e.g., desks and tables) needs to be arranged to provide adequate open space for students to move during physical activity breaks. Figure 6-1 shows the activity area/space available in a traditionally organized classroom. Figures 6-2 and 6-3 show how the classroom can be arranged to optimize the space for movement and physical activity.

One of the most common forms of physical activity break during the school day is recess. Children can accumulate up to 40 percent of their daily physical activity time during recess (Ridgers et al., 2006). Recess, according to Pellegrini and colleagues (1995), is the time of day set aside for students to take a break from their class work; engage in play with their peers; and take part in independent, unstructured activities. Recess is most common in elementary schools and is rare during the secondary years.

While separate and distinct from physical education, recess is an essential component of the total educational experience for elementary-age chil-

FIGURE 6-1 Traditional layout of a classroom with limited space for physical activity breaks. SOURCE: Personal communication from Heather Erwin. Reprinted with permission from Heather Erwin.

FIGURE 6-2 One classroom layout designed to accommodate physical activity breaks. SOURCE: Personal communication from Hearther Erwin. Rseprinted with permission from Heather Erwin.

FIGURE 6-3 Another classroom layout designed to accommodate physical activity breaks. SOURCE: Personal communication from Heather Erwin. Reprinted with permission from Heather Erwin.

dren (Ramstetter et al., 2010). In addition to providing children the opportunity to engage in physical activity, develop healthy bodies, and develop an enjoyment of movement, it provides them with a forum in which they are able to practice life skills, including conflict resolution, problem solving, communicating with language, cooperation, respect for rules, taking turns, and sharing. Moreover, it serves as a developmentally appropriate outlet for reducing stress in children (National Association for the Education of Young Children, 1998). Furthermore, recess facilitates attention and focus on learning in the classroom (NASPE, 2001). This dedicated period of time further allows children the opportunity to make choices, plan, and expand their creativity (National Association for the Education of Young Children, 1998). Indeed, the American Academy of Pediatrics (AAP) recently released a policy statement in support of recess and free play as “fundamental component[s] of a child’s normal growth and development” (Council on School Health, 2013, p. 188).

The AAP further asserts that cognitive processing and academic performance depend on regular breaks from concentrated class work. The AAP believes that

• Recess is a complement to but not a replacement for physical education. Physical education is an academic discipline.

• Recess can serve as a counterbalance to sedentary time and contribute to the recommended 60 minutes or more of vigorous- or moderate-intensity physical activity per day.

• Peer interactions during recess are a unique complement to the classroom. The lifelong skills acquired for communication, negotiation, cooperation, sharing, problem solving, and coping are not only foundations for healthy development but also fundamental measures of the school experience.

The Decline of Recess

Since passage of the No Child Left Behind Act in 2001, several studies and reports across the literature have pointed to a decline in recess to make more time for academic subjects. Approximately 40 percent of schools in the United States have either eliminated or reduced recess in order to free up more time for academics (RWJF, 2010). See Table 6-1 for a summary of changes in recess time between 2001 and 2007; see also the detailed discussion of time shifting in Chapter 5 .

The Recess Gap

In addition to the general decline in recess time, the Center for Public Education (2008) has identified a “recess gap” across school settings. This finding is supported by the results of a survey sponsored by the U.S. Department of Education and the National Center for Education Statistics (Parsad and Lewis, 2006), which collected information from a representative sample of 1,198 U.S. elementary schools on whether they scheduled any recess for each grade, typically grades 1 through 5 or 6. Respondents reported the number of days per week of scheduled recess, the number of times per day, and the total minutes per day for each elementary grade in

TABLE 6-1 Change in Recess Time, 2001-2007

SOURCE: Center on Education Policy, 2007.

FIGURE 6-4 Percent of schools that do not provide recess to 1st graders. NOTE: Poverty rate is based on the proportion of students eligible for free or reduced-price lunches. SOURCE: Parsad and Lewis, 2006. Reprinted with permission.

2005. The survey found that while most children, regardless of location, continue to get recess on a regular basis, children who attend high-minority, high-poverty, or urban schools are far more likely than other children to get no recess at all (see Figure 6-4 ). Also:

• The proportion of public elementary schools with any scheduled recess ranged from 87 to 93 percent across elementary grades.
• The proportion of public elementary schools with no scheduled recess ranged from 7 to 13 percent across elementary grades.
• Fourteen percent of elementary schools with a minority enrollment of at least 50 percent scheduled no recess for 1st graders, compared with 4 percent of schools with 21-49 percent minority enrollment, 5 percent of those with 6-20 percent minority enrollment, and 2 percent of those with less than 6 percent minority enrollment.
• Eighteen percent of elementary schools with a poverty rate over 75 percent (based on the proportion of students eligible for free or reduced-price lunches) provided 1st graders with no recess, compared with 3 percent of schools with a 50-74 percent poverty rate, 4 percent with a 35-49 percent poverty rate, and 4 percent with a less than 35 percent poverty rate.
• Fourteen percent of urban elementary schools did not offer recess to 1st graders, compared with 6 percent of schools on the urban fringe, 6 percent of those in towns, and 3 percent of rural schools.

The above patterns for 1st graders persisted through 6th grade: 24 percent of 6th graders in high-minority schools, 28 percent in high-poverty schools, and 24 percent in urban schools did not get recess, compared with 13 percent of 6th graders overall.

The National Association of State Boards of Education’s (NASBE’s) Center for Safe and Healthy Schools (2013) State School Healthy Policy Database supports the above survey findings. It shows that most public elementary schools (83-88 percent) offer daily recess across elementary grades, while 47 percent offer it 1-4 days per week:

• Large schools generally are less likely than small- and medium-sized schools to have daily recess for 1st through 3rd grades.
• City schools are less likely than schools in other locales to offer daily recess for 1st graders. City schools also are less likely than schools in urban fringes and rural areas to schedule daily recess for 2nd through 5th grades.
• Schools with the highest poverty concentrations are less likely than those with lower poverty concentrations to offer daily recess for elementary grades.
• Differences also exist by minority enrollment, with schools with the highest minority enrollment being less likely than those with lower minority enrollment to provide daily recess.

The percentage of public elementary schools offering more than 30 minutes per day of recess ranges from 19 to 27 percent across elementary grades. The average number of minutes per day of scheduled recess for elementary grades differs by school characteristics. Large schools on average offer fewer average minutes per day of recess than small- and medium-sized schools; the same is true for schools with the highest and lowest poverty concentrations, respectively. For further detail, a state-by-state list of policies from the NASBE State School Health Policy Database can be found in Appendix C .

Since physical activity, such as recess, has been shown to improve academic achievement, this recess gap may contribute to, not decrease, disparities in academic achievement.

Support for Recess

Both international and U.S. organizations support the importance of recess.

International organizations Aside from the historical literature on the need for children to play (dating back to the 1600s), the most prominent and widespread support for recess is rooted in the International Play Association and its work through the United Nations (UN). The International Play Association, founded in 1961 in Denmark, is a global nongovernmental organization that protects, preserves, and promotes children’s fundamental human right to play. The UN’s Declaration of the Rights of the Child (1959), Article 7, Paragraph 3, states:

The child shall have full opportunity for play and recreation which should be directed to the same purposes as education; society and the public authorities shall endeavor to promote the enjoyment of this right.

The declaration asserts that spontaneous play fulfills a basic childhood developmental need. It further defines play as “a combination of thought and action that is instinctive and historical and that teaches children how to live” (IPA, 2013). At the 1989 UN General Assembly, the International Play Association played a key role in the inclusion of “play” in Article 31 of the UN Convention on the Rights of the Child. It reads:

That every child has the right to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts. That member governments shall respect and promote the right of the child to participate fully in cultural and artistic life and shall encourage the provision of appropriate and equal opportunities for cultural, artistic, recreational and leisure activity. (IPA, 2013)

The U.S. affiliate of the International Play Association has as its primary goal to protect, preserve, and promote play as a fundamental right for all children.

U.S. organizations In a 2013 policy statement, the AAP asserts that recess is a crucial and necessary component of a child’s development and as such should not be withheld for punitive or academic reasons. The AAP stresses that minimizing or eliminating recess may be counterproductive to academic

achievement, as mounting evidence suggests that recess promotes physical health, social development, and cognitive performance (AAP, 2013).

Through three sponsored research studies, the Robert Wood Johnson Foundation (RWJF) further supports the need for recess in schools. Recess Rules: Why the Undervalued Playtime May Be America’s Best Investment for Healthy Kids in Healthy Schools (RWJF, 2007) states that recess represents an unparalleled chance to increase physical activity among a large number of children in the United States, as well as an underutilized opportunity to improve the overall learning environment in the nation’s schools. For a second study conducted by RWJF (2010), The State of Play , 1,951 elementary school principals participated in a Gallup survey devoted to the subject of recess. The survey sample was provided by the National Association of Elementary School Principals, and it reflects a balance of urban, suburban, and rural schools and schools of different income levels, as defined by the percentage of students receiving free or reduced-price lunches. The results show that principals overwhelmingly believe that recess has a positive impact not only on the development of students’ social skills but also on achievement and learning in the classroom. When asked what would improve recess at their schools, they highlighted an increase in the number of staff to monitor recess, better equipment, and playground management training, in that order.

According to a third RWJF and Active Living Research study, School Policies on Physical Education and Physical Activity (Ward, 2011):

• “Whole-school programs that provide opportunities for physical activity across the school day—through recess, in-class breaks, and after-school events—increase children’s physical activity levels.”
• “Schools that provide ample time for supervised recess and access to equipment, as well as those that make low-cost modifications to improve play spaces, have more physically active students.”
• “Activity breaks during classes not only increase physical activity but also help children focus better on academic tasks and enhance academic achievement.”

Other national organizations and studies further support the need for recess in elementary schools:

• The National Association of Early Childhood Specialists in State Departments of Education takes the position that “recess is an essential component of education and that preschool and elementary school children must have the opportunity to participate in regular periods of active play with peers” (National Association of Early Childhood Specialists in State Departments of Education, 2001, p. 1).
• The National Association for the Education of Young Children (2001) believes that unstructured play is a developmentally appropriate outlet for reducing stress in children, improves children’s attentiveness, and decreases restlessness.
• Through a position statement, Recess in Elementary Schools , the National Association for Sport and Physical Education, Council on Physical Education for Children, asserts:

Recess also provides the opportunity for students to develop and improve social skills. During recess, students learn to resolve conflicts, solve problems, negotiate, and work with others without adult intervention. Cognitive abilities may also be enhanced by recess. Studies have found that students who do not participate in recess may have difficulty concentrating on specific tasks in the classroom, are restless and may be easily distracted. In addition, recess serves as a developmentally appropriate strategy for reducing stress. Contemporary society introduces significant pressure and stress for many students because of academic demands, family issues, and peer pressures. (NASPE, 2001)

• The National Parent Teacher Association (PTA) and the Cartoon Network launched “Rescuing Recess” in 2006 to help sustain and revitalize the importance of recess in schools across the country. The goal of the campaign is to recognize unstructured break time as an essential element of the school day and to connect educators, parents, and children as advocates for bringing back or retaining recess. A 2006 nationwide survey of PTA leaders found that parents and teachers also think taking a break is a vital part of a child’s school day (National Parent Teacher Association, 2006).

Barriers to Recess

The evidence supporting the cognitive, health, and social benefits of recess could become a thesis on its own merits. Despite these benefits, however, few states have specific policies requiring recess, and those that do have such policies often defer to local school districts to allow individual schools to determine whether students will have a recess period.

Policies requiring increased activity at school each day have the potential to affect large numbers of children and are an effective strategy for promoting regular physical activity. However, external and internal barriers to policy implementation need to be considered (Amis et al., 2012). Competing time demands, shorter school days, lack of teacher participation, and lack of adequate facilities have all been cited as barriers to providing recess (Evenson et al., 2009). Further, weak policies suggesting or recommending changes have shown little or no effect on changing behavior

(Ward, 2011; Slater et al., 2012). Additional barriers to enacting effective policies include a lack of earmarked resources devoted to policy implementation, principals’ lack of knowledge of the policy, and no accountability mechanisms to ensure policy implementation (Belansky et al., 2009).

In addition, the National Association of Early Childhood Specialists in State Departments of Education (2002) identifies issues of student safety, lack of adult supervision, potential lawsuits for injured students, and potential for children to come into contact with strangers entering school grounds as barriers to recess. Elementary school principals responding to the above-referenced RWJF (2010) Gallup survey also cited liability and safety issues, as well as access to space and weather.

Strategies for Reviving Recess

Several strategies can be used to promote recess in schools, along with engagement in physical activity among youth participating in these programs. First, it is necessary to provide a safe environment with ample recreational equipment to encourage physical activity. Additionally, regulations should be in place to ensure that schools offer at least 20 minutes of recess per day. It is imperative as well that training be provided to recess supervisors and staff, with a focus on both safety issues and ways to interact with students to better promote physical activity. Recess is not a common occurrence for secondary students; however, they could participate in a civic- or service-oriented program whereby they would oversee and engage in recess for local elementary schools.

Intra- and Extramural Sports

Sports programs have long been an integral part of the school setting. Sport is one of the four human activities, along with play, games, and work. According to Woods (2011, pp. 5-6), play is a “free activity that involves exploration, self-expression, dreaming, and pretending. Play has no firm rules and can take place anywhere.” Children’s play often involves physical movement. Games are forms of play “that have greater structure and are competitive. Games have clear participation goals … [and] are governed by informal or formal rules” (p. 5). Games can be sedentary or physical; involve competition, planning, and strategizing; and result in “prestige or status.” Sport is a specialized or higher order of play or games with special characteristics. It must involve physical movement and skill. It must be “competitive with outcomes that are important to those involved,” and “winning and losing are a critical part of competition.” Thus, an important aspect of sport is institutionalized competition under formal rules. Lastly, work is “purposeful activity that may include physical and mental effort

to perform a task, overcome an obstacle, or achieve a desired outcome.” Sport can be work.

It is important to note that children in schools can participate in sports as either players or spectators. Kretchmar (2005) suggests that playing sports at a young age tracks to becoming a loyal spectator in later years; however, being a spectator at a young age may not necessarily lead to active participation as a player. Chen and Zhu (2005) analyzed intuitive interest in physical activity among 5-year-olds using the nationally representative sample from the U.S. Department of Education’s Early Childhood Longitudinal Study. The results of a logistic regression analysis showed that early exposure to watching a sport may have a negative effect on developing interest in actually playing the sport.

The discussion here focuses on institutionalized in-school sports and on children’s participation as players. In-school sports programs typically fall into two categories: intramural , or within a school, and extramural or interscholastic , or competition between schools (AAHPERD, 2011). The type and scope of each of these categories of sports vary by school size (Landis et al., 2007), location, and the socioeconomic status of students (Edwards et al., 2013).

In the past 40 years, participation in sports has flourished both within and outside of schools. Although young children are not eligible for formal interscholastic competition until they reach secondary school, children (or their parents) with athletic aspirations start preparation for competition at a very young age. Results of the National Survey of Children’s Health (2007) showed that approximately 58.3 percent of 6- to 17-year-olds participated in sports teams or lessons over a 12-month period. The Centers for Disease Control and Prevention (CDC) (2012) reports that in 2011, 58 percent of high school students played on at least one sports team. Intramural sports clubs in middle and high schools also involve large numbers of students.

Participation in sports inside and outside school has increased in the past 20 years. According to the latest report of the National Federation of State High School Associations (NFSHSA) (2012), participation in high school sports nearly doubled in 2011-2012 relative to 1971-1972. While boys’ participation increased by about 22 percent during these years, girls’ participation increased about 10-fold. Table 6-2 documents the change by decade.

Figure 6-5 shows the ratio of growth in boys’ and girls’ participation in sports relative to the total enrollment in U.S. high schools during the five decades. The data show that while the ratio for boys has remained steady at about 40-50 percent, the ratio for girls has increased from 4 percent in 1971-1972 to 40 percent in 2011-2012.

Nationwide, 77 percent of middle schools and 91 percent of high schools offer at least one interscholastic sport (Lee et al., 2007), and 48 per-

TABLE 6-2 Change in Participation in High School Sports in the Past Five Decades

NOTE: Rounded to the nearest 1,000. Participants total is the sum of participants in school sports; if a student participated in more than one sport, he or she would be counted for each of those sports. SOURCE: Adapted from NFSHSA, 2012.

FIGURE 6-5 Change in the ratio of males’ and females’ participation in sports relative to enrollment, 1971-2011. NOTE: Ratio is number of participants divided by estimated number of males or females enrolled in high school in October of the enrollment year. Enrollment data were adapted from the U.S. Census Bureau’s October Current Population Survey. For 1971 and 1981, only the total number of students was available, and the proportion of male students was assumed to be 0.515. SOURCE: U.S. Census Bureau, 1971-2011.

cent of middle and high schools offer intramural sports or physical activity clubs (NASPE and AHA, 2010). Based on data from a nationally representative sample of middle schools, Young and colleagues (2007) found that 83 percent of schools offered interscholastic sports, and 69 percent offered intramural sports and clubs. No reports indicate that interscholastic or intramural sports were offered in elementary schools.

Many students who do not play on school teams may participate in sports programs outside of school. CDC (2012) data indicate that 58 percent of high school–age youth played on at least one sports team in 2011, which suggests that an estimated 31 million of the 55 million youth in this age group participated in sports outside of school. The committee was unable to find a national estimate of the number of students who participated in school intramural sports or physical activity clubs. However, one study of four middle schools with similar demographic populations based on race/ethnicity, income, and geographic location suggests that the intramural sports environment may be more conducive to increased physical activity levels than the environment of varsity sports, at least for middle school boys (Bocarro et al., 2012). This may be due in part to the fact that all children can participate in intramural activities without having the high skill levels required for interscholastic sports.

Students have many choices of interscholastic sports. Lee and colleagues (2007) cite 23 popular sports, grouped in Table 6-3 as team or individual sports. Lee and colleagues (2007) believe that most individual sports may be more likely than team sports to become lifelong activities for individual students.

Policies That Affect Participation in Sports

As with physical education and recess policies, data from both the Shape of the Nation Report (NASPE and AHA, 2010) and the NASBE State School Health Policy Database (see Appendix C ) show variations in amounts, accountability, and regulations for high school sports. Twenty-one states (41 percent) had state requirements regarding sports, most relating to gender equity, concussion management, and local requirements. Although NFSHSA remains the governing body for individual state athletic associations, the governance of district sports opportunities is determined largely by local athletic associations in accordance with individual state association requirements. However, decisions on what sports to offer, the frequency of sport competitions, and other factors are made at the local level. In its report on the Comprehensive School Physical Activity Program (CSPAP), the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) (2011) notes that 65 percent of high

TABLE 6-3 Interscholastic Sports Choices and Percentage of Middle and High Schools Offering Them

schools implemented various forms of team-cut policies for participation in interscholastic sports. The practice requires students to meet minimum performance qualifications before joining a school-sponsored sports team. Such policies include maintaining a designated grade point average, meeting daily attendance requirements, and adhering to individual school district code-of-conduct policies. One might speculate that such policies may prohibit interscholastic sports from becoming a viable means of promoting maximum student participation in sports and other physical activity.

In summary, trends in participation in sports are encouraging. Compared with physical education, however, it is difficult to expect every child to participate in sports. Although the available data indicate a nearly 60 percent participation rate, the data do not provide specific information

about the participants. In addition, studies and national surveys have not provided useful information about those children who do not participate in sports, who may be in the greatest need of physical activity. Although the opportunity for physical activity through participation in interscholastic and/or intramural sports does exist in most secondary schools, the extent to which participation in sports contributes to children’s health and positive behavior change for active living is unclear.

Barriers to Participation in Sports

Although the literature documents the benefits of participating in high school sports in such areas as academic achievement, attendance, and self-esteem, opportunities for participation in sports have not escaped the effects of the budget cuts that have plagued education over the past several years (Colabianchi et al., 2012).

In addition, interscholastic sports have been dominated by a competitive sports model (Lee et al., 2007), which may fail to engage and support all students. Policies encouraging and funding intramural sports, which are usually more inclusive and less competitive, can increase student participation in sports. The CDC recommends inclusive policies and programs as a strategy for enabling students to meet the 2008 Physical Activity Guidelines (HHS, 2008).

According to the Government Accountability Office (GAO) (2012) report K-12 Physical Education: School-Based Physical Education and Sports Programs , school district officials assert that budget cuts have impacted predominantly transportation and facilities, both critical to after-school sports programs (GAO, 2012). According to data from the School Health Policies and Practices Study (SHPPS) (2006) (Lee et al., 2007), an estimated 29 percent of schools that offered interscholastic sports in 2006 also provided transportation home for participating students, up from 21 percent in 2000. Transportation costs, a large part of overall school athletic budgets, are impacted not only by the need to transport students to practice facilities and competition venues and then home but also by increases in fuel prices and maintenance costs.

Facilities and equipment are another recognized barrier to participation. Budget cuts have hindered school districts from building new facilities or upgrading existing ones. Where facility and land limitations prevail, school districts have resorted to developing partnerships and contractual agreements with local community recreation centers or universities to use their facilities for various sports program. A lack of funding for sports equipment has further reduced the number of participating students, as the number of uniforms available per sport has caused the selection process to become more stringent. Colabianchi and colleagues (2012) also conclude

that the percentage of students participating in interscholastic sports is contingent on the type and number of facilities (see Figure 6-6 ).

Another challenge to implementing quality sports programs is the availability of quality coaches. Fewer school personnel are coaching in the face of a decline in coaching supplements and increased time commitments. Funding for staffing or staff training is an important aspect of successful sports or after-school physical activity programs. According to the 2006 SHPPS data, more than half of schools surveyed paid staff for involvement in intramural sports programs (Lee et al., 2007). Policies to support supervisory staff can facilitate increased opportunities for physical activity for students.

Constrained budgets also have reduced the number of sports offerings, with the primary sports being retained and the second-tier sports, such as golf and tennis, either being eliminated or requiring that students pay 100 percent of the cost of participation. Indeed, many school districts across the United States have implemented a pay-to-play policy. According to the 2006 SHPPS data, 33 percent of schools require students to pay to participate in interscholastic sports. A study released by the University of Michigan, C.S. Mott Children’s Hospital (2012), reports that pay-to-play fees are preventing lower-income children from participating in both middle and high school sports. The study found that the average fee was $93 per sport, while some respondents to the survey reported paying $150 or more.

FIGURE 6-6 Participation in interscholastic sports among boys and girls by availability of sports facilities, 2009-2011. SOURCE: Colabianchi et al., 2012. Figure 6-6 .eps

When combined with the cost of equipment, uniforms, and additional team fees, the average total cost for a child’s participation in sports was $381. Nineteen percent of families making under $60,000 reported that costs had led to at least one of their children being unable to participate in sports. Figure 6-7 shows the study results regarding participation in school sports among youth aged 12-17 by household income. The study found further that

• More than 60 percent of children who played school sports were subject to a pay-to-play fee; only 6 percent received waivers for the fee.
• Only one-third of lower-income parents reported that their child participated in school sports, compared with more than half of higher-income parents.
• In lower-income households, nearly one in five parents reported a decrease in their child’s participation in school sports because of cost.

Colabianchi and colleagues (2012) further determined that the percentage of students participating in sports varied with the students’ socioeconomic status. Participation was higher at schools of mid-socioeconomic status than at those of low socioeconomic status, and even higher at schools of high socioeconomic status compared with those of mid-socioeconomic status (see Figure 6-8 ).

Interscholastic sports have been criticized for perpetuating racial and gender segregation (Lee et al., 2007). Further study by Kelly and colleagues (2010) and Bocarro and colleagues (2012) confirmed the relationship

FIGURE 6-7 Participation in school sports for youth aged 12-17 by household income. SOURCE: C.S. Mott Children’s Hospital, 2012.

FIGURE 6-8 Participation in interscholastic sports by school socioeconomic status among boys and girls, 2009-2011. NOTE: SES = socioeconomic status. SOURCE: Colabianchi et al., 2012.

between socioeconomic status and sports participation, finding that fewer children and adolescents in schools of low socioeconomic status or with a relatively high proportion of racial and ethnic minority groups participated in sports programs.

To provide the physical activity and psychosocial benefits of engaging in sports at school, education systems need to reevaluate their budgets to ensure that equitable sports opportunities are available for youth in all types of school settings and at all levels of socioeconomic status. The same holds true with respect to ensuring that school-based intramural sports opportunities are available before or after school hours to increase participation in physical activity among all students.

Programs for Students with Disabilities

The 2010 GAO report Students with Disabilities: More Information and Guidance Could Improve Opportunities in Physical Education and Athletics notes that students with and without disabilities were provided similar opportunities to participate in physical education in schools but identifies several challenges to serving students with disabilities. Likewise, for sports, opportunities were provided for students to participate, but students with disabilities participated at lower rates than those without disabilities. Yet sports programs for students without disabilities have shown

similar benefits for students with disabilities, including not only obesity reduction but also higher self-esteem, better body image, and greater academic success; more confidence and a greater likelihood of graduating from high school and matriculating in college; and greater career success and more career options (GAO, 2010; Active Policy Solutions, 2013; U.S. Department of Education, 2013).

To ensure that students with disabilities have opportunities to participate in extracurricular athletics equal to those of other students, the GAO report recommends that the U.S. Department of Education clarify and communicate schools’ responsibilities under Section 504 of the Rehabilitation Act of 1973 regarding the provision of extracurricular athletics. Most important, the report recommends improving physical education and athletic opportunities for students with disabilities and recommends that (1) the Secretary of Education facilitate information sharing among agencies, including schools, on ways to provide opportunities, and (2) clarify schools’ responsibilities under federal law, namely Section 504 of the Rehabilitation Act of 1973, through the Office for Civil Rights, which is responsible for enforcing Section 504. In January 2013, in a landmark response to the release of the 2010 GAO report, the U.S. Department of Education, Office for Civil Rights (2013), clarified a school’s role in providing extracurricular athletic opportunities for students with disabilities.

Active Transport

Active transport or active commuting refers to the use of walking, biking, or other human-powered methods (e.g., skateboarding). It includes using public transportation or “walking school buses,” or being driven to a point closer to but not at school from which students walk the remainder of the way. Active transport equates to moderate-intensity physical activity, which, as discussed in earlier chapters, provides crucial health benefits. In light of these benefits, the CDC has launched programs to encourage parents to walk their children to school.

Active commuting has been proposed as an ideal low-cost strategy to increase physical activity within the general population and can account for one-quarter of an individual’s recommended total daily steps (Whitt et al., 2004). Studies have found that active transport provides children with physical activity (Tudor-Locke et al., 2002) and increased energy expenditure (Tudor-Locke et al., 2003). Bassett and colleagues (2013) suggest that active transport to and from school contributes on average 16 minutes of vigorous- or moderate-intensity physical activity for youth. These benefits, together with concern about increased traffic congestion and air pollution, have led to growing interest in the use of active transport by youth to get to and from school (Kahlmeier et al., 2010). In addition, it has been suggested

that active transport enhances social interaction among children and promotes independent mobility (Collins and Kearns, 2001; Kearns et al., 2003).

Five decades ago, children actively commuting to school were a common sight. Nearly 90 percent of children who lived within a 1-mile radius of school either walked or biked to school (USDOT, 1972). Since 1969 the prevalence of youth walking or biking to school has steadily declined (McDonald, 2007), paralleling a decline in active commuting among American adults (Pucher et al., 2011). Data from the U.S. Department of Transportation show the decline in active transportation to and from school between 1969 and 2001 (see Figure 6-9 ).

From an international perspective, active transport among children and adolescents is more prevalent in European countries such as the Netherlands and Germany, which have a culture of active transport, than in other regions. These countries tend to have a lower risk of obesity, diabetes, and hypertension in youth compared with the United States. Indeed, the data support an inverse relationship between the percentage of active transport and obesity rates among residents of the United States, Canada, Australia, and 14 European countries (Bassett et al., 2008). In this study

FIGURE 6-9 Decline in active transportation to and from school among youth from 1969 to 2001 in the United States. SOURCE: CDC, 2008; 1969 Nationwide Personal Transportation Survey (USDOT, 1972); and 2001 National Household Travel Survey.

the United States ranked the lowest on active transport and the highest on obesity prevalence.

Policies That Affect Active Transport

Various environmental and policy factors support or hinder active transport to and from school. For example, school siting policies that encourage the construction of schools on large campuses far from residential areas and not integrated with housing development are a hindrance (Council of Educational Facility Planners International, 1991). Accordingly, efforts are being made to stop “school sprawl,” including eliminating minimum acreage guidelines so that schools can be located closer to where school-age children live (Salvesen and Hervey, 2003).

At the national level, the U.S. Secretary of Transportation has called for a “sea change” in transportation planning in the United States. He has expressed the need to put cyclists and walkers on even ground with motorists and issued a policy statement on accommodations for active transport (USDOT, 2010). His statement calls for the redesign of existing neighborhoods with bicycle lanes, sidewalks, and shared paths. Additionally, the reauthorization of federal transport legislation charged the Federal Highway Administration with providing funds for states to create and implement Safe Routes to School programs (National Safe Routes to School Task Force, 2008). Provision of this funding may increase the percentage of children who walk or bike to school through a variety of initiatives, including engineering (e.g., building sidewalks), enforcement (e.g., ticketing drivers who speed in school zones), education (e.g., teaching pedestrian skills in the classroom), and encouragement (e.g., having students participate in walk-to-school days) (CDC, 2005).

Eyler and colleagues (2008) examined policies related to active transport in schools. In 2005, six states (California, Colorado, Massachusetts, North Carolina, South Carolina, and Washington) had statewide safe routes to school or active transport programs. California, Colorado, and South Carolina had regulations regarding the required distance students must live from a school to be eligible for bus transportation (more than 1.5 miles in South Carolina). A review of the NASBE (2012) State School Health Policy Database revealed that only 11 states (21 percent) had legislation requiring walk/bike programs, most in partnership with the state departments of transportation (see Appendix C ).

Barriers to Active Transport

Several factors contribute to the lack of active transport of youth to and from school. The first is accessibility (Frank et al., 2003), which refers to the proximity (i.e., within a 1-mile radius) of a child’s home to school

(Bassett, 2012). Nearly half of the decline in youth walking to and from school from 1969 to 2001 is attributable to the increased distance between home and school (McDonald, 2007). Proximity to school is influenced by families moving farther away from school; schools are being built farther away from homes compared with the small neighborhood schools of the past (see Figures 6-10 and 6-11 ). Proximity also is influenced by the decrease in the number of schools since 1960 even as the number of students enrolled in schools has increased (Wirt et al., 2003).

Proximity to school is not the only factor accounting for the decline in active transport among youth, as a significant decline also has been seen among youth living within a 1- to 2-mile radius of school. A second key determinant is infrastructure (Frank et al., 2003). The built environment is key to facilitating active transport. For active transport to be effective, not only must schools be in close proximity to the neighborhoods of students, but sidewalks, pedestrian crossings, and traffic lights must be adequate (Boarnet et al., 2005; Fulton et al., 2005). Boarnet and colleagues (2005) found that children’s walking and cycling to and from school greatly increased in urban areas with improvements in sidewalks, traffic lights, pedestrian crossings, and bike paths. In a national study of 4th to 12th graders, the presence of sidewalks was the main modifiable characteristic associated with active transport to and from school (Fulton et al., 2005). Other parental concerns include street connectivity, busy streets on

FIGURE 6-10 Distance to school for youth aged 5-18, 1969. SOURCE: CDC, 2008.

FIGURE 6-11 Distance to school for youth aged 5-18, 2001. SOURCE: CDC, 2008.

routes, and mixed land uses (Ewing and Greene, 2003; Fulton et al., 2005; Schlossberg et al., 2006; Timperio et al., 2006).

All nine schools interviewed for one study by active transport programs reported that the environmental factors that most affected these programs were sidewalks, crossing guards/crosswalks, funding, personal safety concerns, and advocacy group involvement. All schools also reported that a school speed zone was the greatest concern (Eyler et al., 2008). Other environmental factors include weather (heat, humidity, precipitation) and geographic location (Pucher and Buehler, 2011), with the South having a built environment less conducive to active transport compared with the Northeast, Midwest, and West (Bassett, 2012).

Related to infrastructure issues are parental concerns about safety (Loprinzi and Trost, 2010). These concerns include traffic dangers (Dellinger and Staunton, 2002). For example, 50 percent of children hit by cars near schools are hit by cars driven by parents of students (CDC, 2008), and drivers often exceed the posted speed limit and/or violate traffic signage in school zones (CDC, 2008). Safe routes to school initiatives that have linked engineers and educators to make school trips safer have seen a 64 percent increase in the percentage of students walking to school (Boarnet et al., 2005). In urban areas, infrastructure is conducive to active commuting to and from school, but these areas may be characterized by high crime rates. Dellinger and Staunton (2002) propose that safety is of particular concern for primary school children, which may account for their finding

that parents rated their child’s age as the most important factor in their decision to allow the child to walk to school. Other studies confirm that many 5- to 6-year-olds lack the skills to cope with traffic issues (Whitebread and Neilson, 2000), although other studies have found that neighborhood safety is unrelated to commuting practices in children (Humpel et al., 2004; Wilson et al., 2004). The “walking school bus” (i.e., when an adult escorts a group of children to school) has been shown to be an effective means of safely transporting children to and from school (Collins and Kearns, 2005). It may be noted that pedestrian and bicycling injury/death rates among youth have declined by 51 percent and 60 percent, respectively. However, the decrease in walking or biking among youth may have contributed to this downward trend (CDC, 2008).

Finally, parents identify the perceived fitness level of their children as a determinant of the children’s participation in active transport. Specifically, parents who perceive their children as being unfit prefer passive transportation (Yeung, 2008).

“Walking School Bus” Programs

School-endorsed “walking school buses” may address several of the barriers identified above—in particular, traffic and crime dangers (White House Task Force on Childhood Obesity, 2010). “Walking school buses” are popular means for walking young children to school securely in Europe and Australia but are just starting to emerge in the United States. A “walking school buses” often entails one or two adult volunteers escorting a group of children from pickup points or their homes to school along a fixed route, starting with the pickup point or home that is farthest from the school and stopping at other pickup points or homes along the way. For increased security for the youngest children, a rope that surrounds the group can be used. On the way back from school, the same system is used in the opposite direction.

The White House Task Force on Childhood Obesity’s (2010) Report to the President identifies “walking school buses” as a low-cost initiative that communities can undertake to increase physical activity among elementary school children. The prevalence of “walking school buses” remains low in the United States but is growing; in 2008-2009, about 4.2 percent of a representative sample of public elementary schools organized “walking school buses”, with an increase to 6.2 percent in 2009-2010 (Turner et al., 2012). Examples of “walking school buse” programs are described in Box 6-2 .

Parents’ engagement in school-based health promotion activities is another significant benefit of “walking school buses”. In some communities, “walking school buses” have provided opportunities for parents and

other volunteers to remain engaged in the life of the community while increasing their own physical activity.

Differences in Opportunities for Active Transport

The literature demonstrates that active transport varies among socioeconomic and ethnic groups and with the type of area (suburban, urban, or rural) (Davis and Jones, 1996; Dovey, 1999). Data from Bridging the Gap (Turner et al., 2010) demonstrate that one in four middle school students and one in eight high school students commute actively to and from school. Students of low socioeconomic status and those who attend schools where the majority of students are nonwhite (i.e., black and Latino) are more likely to walk or bike to and from school than those of high socioeconomic status and those who attend schools with a predominantly white student body.

Facilitators of Active Transport to School

Four common themes have been identified among schools with successful active transport to school programs (Eyler et al., 2008):

• collaboration among many organizations and individuals, including school personnel, public safety officials, city officials, parents, and school district representatives;
• funding for personnel, program materials, and improvements to the built environment;
• concerns about both traffic and crime being addressed; and
• efforts to make the built environment more conducive to active transport by students.

The same study identified a number of important and specific factors and policies to be considered (see Table 6-4 ).

A useful five-component framework for planning programs to enhance active transport to school has been suggested (Fesperman et al., 2008). This framework begins with the development of a plan and the enlistment of key individuals and organizations for input and support. The planning phase is crucial and may take a full year. The implementation of programmatic activities (e.g., training in pedestrian and bicycle safety, walk-to-school days), policy changes (e.g., school speed zones, modification of school start and dismissal times), and physical changes (e.g., sidewalk improvement, installment of traffic calming devices) follow in a sequence appropriate for the specific school and plan. For all activities, promotional materials to ensure understanding and continued support should be disseminated.

Examples of “Walking School Bus” Programs

The Safe Passage program in Chicago, a comprehensive initiative designed to help keep children safe on their way to and from school, includes a “walking school bus” program (see http://www.cps.edu/Programs/Wellness_and_transportation/SafetyandSecurity/SafePassage/Documents/SafePassageGuide.pdf [accessed February 1, 2013]). To further improve children’s safety, military veterans have been enlisted to escort the children, on the assumption that their training enables early detection of any crime-related problems along the way to school ( http://www.npr.org/2013/02/15/172130142/checking-in-on-chicago-schools-safe-passage-program [accessed February 1, 2013]). “Walking school bus” programs also have been undertaken in Columbia, Missouri ( http://activelivingbydesign.org/communities/featured-community/albd-sustainability-columbias-walking-school-bus [accessed February 1, 2013]), and in Cleveland, Ohio ( http://activelivingbydesign.org/communities/featured-community/clevelands-schools-are-taking-walking-school-bus [accessed February 1, 2013]).

Many resources are available to schools and communities that are interested in starting a “walking school bus” program. See the following websites:

In summary, active transport to and from school can be a safe and effective way to increase students’ daily physical activity, especially where a large proportion of students live close to their school. Increasing the proportion of children who walk or bike to school commonly requires collaboration among school personnel, public safety officials, city officials, parents, and school district representatives, as well as the funding necessary to address the factors and policies listed in Table 6-4 .

After-School Programs

After-school programs are emerging as another potential means of promoting physical activity in the context of the school environment. After-school programs are organized school or community-based extracurricular activities that take place outside of the school day, typically between 3:00

•  The CDC’s Nutrition and Physical Activity Program has developed KidsWalk-to-School, a community-based program that encourages children to walk and bicycle to school. It provides resources and training models for creating walk-to-school programs. The program increases awareness of the importance of physical activity for children and mobilizes communities to advocate for the creation of safe routes to school ( http://www.cdc.gov/nccdphp/dnpa/kidswalk [accessed February 1, 2013]).

•  The Santa Clarita, California, 2010 Walking School Bus Training Guidebook provides suggestions on how to create “walking school bus” programs, identify route leaders, plan routes, manage logistics, and raise funds ( http://www.altaprojects.net/files/1712/6662/3993/SC%20WSB%20Training%20Guidebook%20WEB.pdf [accessed February 1, 2013]).

•  The Walking School Bus model encourages children to walk or bicycle together in groups, supervised by one or two adults ( http://www.walkingschoolbus.org [accessed February 1, 2013]).

•  Fire Up Your Feet provides additional perspectives on community methods for creating walking school buses ( http://fireupyourfeet.org/resources/walking-school-bus [accessed February 1, 2013]).

and 6:00 PM (Granger et al., 2007) and are characterized by opportunities to build competencies in a wide range of areas (Mahoney et al., 2005). They are conducted on most afternoons during the school week for school-age children. Common areas of focus are nutrition and health education, physical activity and recreation, art, and music. After-school programs also provide academic assistance (i.e., tutoring and assistance with homework) and opportunities to develop leadership. Personal and social skills are a common theme.

The past two decades have seen a rapid increase in after-school programs in the United States, and these programs have become an integral part of the community for many families. In 1988, just 22 percent of K-8 school principals reported offering an after-school program, whereas two-thirds reported offering such a program in 2001 (National Association of Elementary School Principals, 2001). This increase in after-school programs is associated with a growing number of parents working beyond the regu-

TABLE 6-4 Factors and Policies That Influence Promotion of Walking or Biking to School

lar school hours and a rise in maternal employment, which have created a need to provide children with a safe and adult-supervised environment (U.S. Department of Labor, 2005; Afterschool Alliance, 2009). Emerging data indicate that more than 8.4 million youth attend after-school programs for an average of 8.1 hours per week (Afterschool Alliance, 2009). The After-School Programs and Activities Survey, a nationally representative survey of the 2005 National Household Education Surveys Program (Carver and Iruka, 2006), revealed that 40 percent of students in grades K-8 were in at least one weekly nonparental after-school care program, 20 percent of which were school- or center-based programs. Overall, after-school programs have the opportunity to reach large numbers of school-age children. A wealth of research and emerging findings demonstrate the benefits of after-school programs with respect to academic performance; social and emotional development; and health and wellness, including prevention of risky behaviors.

Public opinion supports the need for after-school programs. In 1999 the Mott Foundation reported that 94 percent of people believed “there should be some type of organized activity or place for children and teens to go after school every day” (Afterschool Alliance, 1999, p. 1). The federal government also supports after-school programs, especially in low-income communities. Funding for the 21st Century Community Learning Centers, an after-school program established by the Clinton administration, has increased dramatically over the years, from $40 million in fiscal year 1998 to $1 billion in fiscal year 2002. This grant program supports after-school programs in about 7,500 rural and inner-city public schools in more than 1,400 communities (U.S. Department of Education, 2003).

Policies That Affect After-School Programs

Despite their popularity, there is an absence of nationally recognized standards or policies for promoting physical activity in after-school pro-

grams. Moreover, while some states have taken the initiative to create benchmarks, standards and policies are rare, existing in only 70 percent of states (Beets et al., 2010). Table 6-5 provides an overview of state-level policies, standards, recommendations, and guidelines for physical activity in after-school programs. The table shows wide variation. For example, policies in North Carolina state that 20 percent of the time in an after-school program must be spent in vigorous- or moderate-intensity physical activity, while in California all children must be engaged in a minimum of 30 minutes of vigorous- or moderate-intensity physical activity (Beets et al., 2010). Some standards suggest 30-60 minutes of vigorous- or moderate-intensity physical activity, while others suggest ‘‘frequent opportunities’’ for physical activity or 30 minutes out of a 3-hour block. By comparison, one recommendation is to allocate at least 50 percent of program time to physical activity (Beighle et al., 2010).

After-school programs can be used to combat physicalinactivity and obesity while promoting physical activity on school grounds outside of the normal school-day hours (Lee et al., 2007; Levi et al., 2009). However, national organizations and state entities need to develop appropriate policies and standards for the implementation of after-school programs whose goal is to promote health and physical activity in school-age children. Doing so would help promote physical activity among school-age children in these settings, aiding them in achieving the recommended levels of daily physical activity. However, it is important not only to have such policies in place but also to ensure that the policies are being implemented (i.e., accountability).

Facilitators of and Barriers to After-School Programs

Various factors serve as barriers and facilitators for after-school programs. The school environment is a facilitator for after-school programs because the setting provides for a wide range of activities (Grossman et al., 2001). Schools are equipped with gymnasiums, libraries, auditoriums, and computer labs that provide unique equipment and space. Second, schools have immediate access to participants, and their after-school programs offer legitimacy for parents who may be hesitant to allow their children to participate in a program elsewhere.

Using schools as a venue for after-school programs is not as easy as it may seem, however. First, their facilities may not always be available for use. Safety, lack of staffing, insufficient funding, risk of vandalism, and insurance liability concerns are often cited as barriers to making school grounds available outside of school hours (Filardo et al., 2010; Cox et al., 2011; Spengler et al., 2011; Evenson et al., 2012). For instance, teachers use classrooms to prepare for the next day’s lesson or to provide extra academic assistance to students, students use the library and computer lab to

TABLE 6-5 State Policies, Standards, Recommendations, and Guidelines for Physical Activity in After-School Programs

NOTE: PA = physical activity. SOURCE: Beets et al., 2010. Reprinted with permission.

complete classroom assignments, and sports teams need the gymnasium for practice. Thus, after-school programs often compete for space, particularly in the gymnasium. The availability of school space is critical to the effectiveness and quality of after-school programs, most of which require open multipurpose space to accommodate a range of activities.

In addition to competing for space, after-school programs entail costs to schools, after-school community partners, and families. In addition to personnel to run the program, there are costs for upkeep and maintenance of school facilities. After-school programs also entail custodial costs for

room cleaning. For parents the average cost for after-school programs is $67.00 per week, a $20.00 increase over the past 5 years (Afterschool Alliance, 2009). Thus, public funds are needed to defray some of these costs to schools and families.

In addition, the inability of an after-school program to provide transportation home is a major barrier to participation for a large number of students. Programs have an advantage in recruiting participants when operating in schools where a majority of the students live within safe walking distance (in particular, urban city schools) (Grossman et al., 2001). For children not living within walking distance of school, busing is an alternative, but the limited supply of buses and drivers, as well as their cost, is a major barrier. There are substantial negative consequences of inadequate transportation. Youth who live beyond walking distance from their school and who cannot be picked up by a parent or adult at the designated time are unable to participate in programs. For schools that can provide busing for after-school programs, the number of seats available on those buses limits the number of children who can participate. Even when children live within walking distance of their school, many parents feel uncomfortable about their child walking home alone in the dark at 5:00 or 6:00 PM. School districts have struggled with easing this transportation problem. Money has been unavailable in schools’ budgets, or there have been restrictions on how transit money can be spent. For example, some school districts give transportation funding only to academic programs, and after-school programs are considered nonacademic.

Staff training is another concern for after-school programs. If training does occur, it is often in house. Existing training programs tend to focus on games and to use prepackaged materials, and they fail to address promotion of physical activity (Ajja et al., 2012; Weaver et al., 2012).

Differences in Opportunities in After-School Programs

In addition to providing children with enrichment opportunities, a key factor behind the policy interest in after-school programs is the increasing need for child care. Almost all adults agree that elementary school children need adult supervision. Young people aged 10-14 are often seen as old enough to stay on their own for short periods of time, but they are also old enough to get into serious trouble. Unfortunately, these older children are much less likely to participate in supervised after-school programs, whether the programs take place at youth-serving organizations or at school. It is easier to recruit elementary school children to these programs than middle and high school students, who tend to have busier schedules, increased responsibilities, and greater freedom (Grossman et al., 2001). Grossman and colleagues also found that 30 percent of enrollees in after-

school programs were in 3rd grade or lower, 45 percent were in 4th through 6th grades, 23 percent were in 7th and 8th grades, and only 2 percent were in 9th grade or higher. Additionally, elementary-age children who enrolled attended more frequently than older youth.

In addition to physical education, schools can offer students non-instructional opportunities to engage in beneficial physical activity before, during, or after the school day. These opportunities take various forms, such as interscholastic sports teams, intramural sport clubs, recess, and in-class physical activity breaks. Interscholastic sports provide opportunities for students with athletic talent. But budgetary constraints, team-cut policies, transportation, lack of facilities, and pay-to-play policies and practices in many high schools may limit participation. Intramural sports clubs in middle and high schools are a viable way for the majority of children to engage in in-school or after-school physical activities. Research data consistently show, however, that although these programs can serve a large number of children, not every child will opt to participate or be able to find transportation home after an activity. Recess and classroom physical activity breaks have become valuable opportunities for elementary school students to be active during the school day. Their value in middle and high schools is questionable when they are combined with lunch, and at the secondary level classroom activity breaks are lost to valuable and limited academic time. Evidence supporting the integration of physical activity into academic lessons does exist but only for elementary schools. Given the nature of institutionalized education and its emphasis on academic achievement, it is unclear that the approach will be embraced by school officials and most classroom teachers.

One consensus from the literature is that, to take advantage of and enhance the many opportunities for physical activity outside of physical education, policy makers and practitioners must acknowledge the anchor function of physical education (National Physical Activity Plan, 2010). Curriculum time is insufficient for all of the recommended 60 minutes or more of vigorous- or moderate-intensity physical activity to take place during physical education, so the activity in which children engage throughout the school day is important. Therefore, a holistic, comprehensive approach is increasingly being advocated to promote physical activity in schools. School environments encourage more physical activity, both before and after school, if they include well-designed playgrounds; open spaces; and facilities and equipment that are available, accessible, and inviting to children. AAHPERD’s CSPAP program can serve as an example. It provides opportunities anchored in the knowledge and skills learned in physical

education and uses a flexible programming method that allows local decision makers and teachers to integrate physical activity opportunities into relevant school activities before, during, and after the school day. It must be emphasized that, while school-based physical activity should be used to support physical activity in the school environment, it should not be used as a replacement for physical education, whose importance is explained in Chapter 5 .

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Physical inactivity is a key determinant of health across the lifespan. A lack of activity increases the risk of heart disease, colon and breast cancer, diabetes mellitus, hypertension, osteoporosis, anxiety and depression and others diseases. Emerging literature has suggested that in terms of mortality, the global population health burden of physical inactivity approaches that of cigarette smoking. The prevalence and substantial disease risk associated with physical inactivity has been described as a pandemic.

The prevalence, health impact, and evidence of changeability all have resulted in calls for action to increase physical activity across the lifespan. In response to the need to find ways to make physical activity a health priority for youth, the Institute of Medicine's Committee on Physical Activity and Physical Education in the School Environment was formed. Its purpose was to review the current status of physical activity and physical education in the school environment, including before, during, and after school, and examine the influences of physical activity and physical education on the short and long term physical, cognitive and brain, and psychosocial health and development of children and adolescents.

Educating the Student Body makes recommendations about approaches for strengthening and improving programs and policies for physical activity and physical education in the school environment. This report lays out a set of guiding principles to guide its work on these tasks. These included: recognizing the benefits of instilling life-long physical activity habits in children; the value of using systems thinking in improving physical activity and physical education in the school environment; the recognition of current disparities in opportunities and the need to achieve equity in physical activity and physical education; the importance of considering all types of school environments; the need to take into consideration the diversity of students as recommendations are developed.

This report will be of interest to local and national policymakers, school officials, teachers, and the education community, researchers, professional organizations, and parents interested in physical activity, physical education, and health for school-aged children and adolescents.

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Physical education for healthier, happier, longer and more productive living

The time children and adults all over the world spend engaging in physical activity is decreasing with dire consequences on their health, life expectancy, and ability to perform in the classroom, in society and at work.

In a new publication, Quality Physical Education, Guidelines for Policy Makers , UNESCO urges governments and educational planners to reverse this trend, described by the World Health Organization (WHO) as a pandemic that contributes to the death of 3.2 million people every year, more than twice as many as die of AIDS.

The Guidelines will be released on the occasion of a meeting of UNESCO’s Intergovernmental Committee for Physical Education and Sport (CIGEPS) in Lausanne, Switzerland, (28-30 January).*

UNESCO calls on governments to reverse the decline in physical education (PE) investment that has been observed in recent years in many parts of the world, including some of the wealthiest countries. According to European sources, for example, funding and time allocation for PE in schools has been declining progressively over more than half of the continent, and conditions are not better in North America.

The new publication on PE, produced in partnership with several international and intergovernmental organizations**, advocates quality physical education and training for PE teachers. It highlights the benefits of investing in PE versus the cost of not investing (cf self-explanatory infographics ).

“The stakes are high,” says UNESCO Director-General Irina Bokova. “Public investment in physical education is far outweighed by high dividends in health savings and educational objectives. Participation in quality physical education has been shown to instil a positive attitude towards physical activity, to decrease the chances of young people engaging in risky behaviour and to impact positively on academic performance, while providing a platform for wider social inclusion.”

The Guidelines seek to address seven areas of particular concern identified last year in UNESCO’s global review of the state of physical education , namely: 1. Persistent gaps between PE policy and implementation; 2. Continuing deficiencies in curriculum time allocation; 3. Relevance and quality of the PE curriculum; 4. Quality of initial teacher training programmes; 5. Inadequacies in the quality and maintenance of facilities; 6. Continued barriers to equal provision and access for all; 7. Inadequate school-community coordination.

The recommendations to policy-makers and education stake-holders are matched by case studies about programmes, often led by community-based nongovernmental organizations. Success stories in Africa, North and Latin America, Asia and Europe illustrate what can be achieved by quality physical education: young people learn how to plan and monitor progress in reaching a goal they set themselves, with a direct impact on their self-confidence, social skills and ability to perform in the classroom.

While schools alone cannot provide the full daily hour of physical activity recommended for all young people, a well-planned policy should promote PE synergies between formal education and the community. Experiences such as Magic Bus (India) which uses physical activity to help bring school drop outs back to the classroom highlight the potential of such school-leisure coordination.

The publication promotes the concept of “physical literacy,” defined by Canada’s Passport for Life organization of physical and health educators as the ability to move “with competence and confidence in a wide variety of physical activities in multiple environments that benefit the healthy development of the whole person. Competent movers tend to be more successful academically and socially. They understand how to be active for life and are able to transfer competence from one area to another. Physically literate individuals have the skills and confidence to move any way they want. They can show their skills and confidence in lots of different physical activities and environments; and use their skills and confidence to be active and healthy.”

For society to reap the benefit of quality physical education, the guidelines argue, planners must ensure that it is made available as readily to girls as it is to boys, to young people in school and to those who are not.

The Guidelines were produced at the request of UNESCO’s Intergovernmental Committee for Physical Education and Sport (CIGEPS) and participants at the Fifth International Conference of Ministers and Senior Officials Responsible for Physical Education and Sport (Berlin 2013). UNESCO and project partners will proceed to work with a number of countries that will engage in a process of policy revision in this area, as part of UNESCO’s work to support national efforts to adapt their educational systems to today’s needs (see Quality physical education contributes to 21st century education ).

Media contact: Roni Amelan, UNESCO Press Service, r.amelan(at)unesco.org , +33 (0)1 45 68 16 50

Photos are available here: http://www.unesco.org/new/en/media-services/multimedia/photos/photo-gallery-quality-physical-education/

* More about the CIGEPS meeting

** The European Commission, the International Council of Sport Science and Physical Education (ICSSPE), the International Olympic Committee (IOC), UNDP, UNICEF, UNOSDP and WHO.

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Committee on Physical Activity and Physical Education in the School Environment; Food and Nutrition Board; Institute of Medicine; Kohl HW III, Cook HD, editors. Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington (DC): National Academies Press (US); 2013 Oct 30.

Educating the Student Body: Taking Physical Activity and Physical Education to School.

• Hardcopy Version at National Academies Press

6 Approaches to Physical Activity in Schools

Key messages.

• Data are insufficient to permit assessment of opportunities for and participation in sedentary activities in schools.
• Schools need to strive to reduce unnecessary opportunities for sedentary behavior.
• When embracing the advantages of technology for learning, schools need to be aware of its negative impact on students' physical activity behavior.
• Recess has been shown to be beneficial for academic achievement. It is counterproductive to withhold recess or replace it with classroom activities as a punishment.
• Several models and examples demonstrate that scheduling multiple daily recess periods during the school day is feasible.
• School-based sports and active transport provide opportunities for physical activity but may not be accessible or attractive for all youth. These opportunities need to be reexamined to address disparities based on socioeconomic status, school location and resources, students' disabilities, or cultural/religious barriers.
• Participation in intra- and extramural sports has flourished over the past 40 years; however, school systems need to ensure that equitable sports opportunities are available for youth in all types of school settings and at all levels of socioeconomic status.
• Nonsport after-school programs should include physical activity.
• Active transport to and from school can be a safe and effective way to increase students' daily physical activity, especially where a large proportion of students live close to their school.
• Each community needs to examine systematically opportunities for community-based promotion of physical activity.
• Inviting students' families and other community members to participate in developing before- and after-school programs, including sports and active transport, will increase program sustainability.

It has been argued that, while reversing the obesity epidemic is not solely the responsibility of schools, the trend is unlikely to change without schools' assistance ( Siedentop, 2009 ). Schools are an ideal venue for the implementation of healthy behaviors because they serve more than 56 million youth in the United States; because youth spend such a large amount of time in school; and because schools already have the access, personnel, equipment, and space to implement physical activity programming.

Physical activity opportunities in schools take the form primarily of formal instruction in physical education for all students and sport-based athletics for the talented and interested. Although physical education is a required school subject, the classes may occur infrequently, and children taking them often accrue only low levels of physical activity ( Simons-Morton et al., 1994 ). According to Tudor-Locke and colleagues (2006), physical education programs typically provide only 8-11 percent of a student's daily recommended physical activity. However, a meta-analysis of the literature revealed that physical education can help children achieve up to 40 percent of the recommended 60 or more minutes of daily vigorous- or moderate-intensity physical activity per day ( Bassett et al., 2013 ; see also Chapter 5 ).

Mahar (2011) states that children's physical activity levels are directly related to the opportunities they have to be active. Schools have the potential to influence the physical activity behaviors of their students through various opportunities in addition to physical education (e.g., recess periods, classroom physical activity breaks, active transport to and from school; van Landeghem, 2003 ). Furthermore, children are sedentary for much of the school day, and emerging evidence suggests that long periods of inactivity should be avoided. Thus it is essential for the school setting to provide opportunities outside of physical education for school-age children to be physically activity throughout the school day.

This chapter reviews the status and trends of sedentary behavior in schools and describes opportunities for physical activity in the school environment other than physical education, including classroom activity Breaks, recess, intra- and extramural sports, active transport, and after-school programs. Also reviewed are policies that may affect these opportunities, as well as barriers to and enablers of the opportunities. Chapter 7 examines the evidence on the effectiveness of these physical activity opportunities.

• SEDENTARISM IN SCHOOLS

The committee did not identify a widely recognized definition of sedentarism, a new word in the English language, but one that exists in other languages to describe sedentary behaviors, sedentary activities, a sedentary lifestyle, or physical inactivity. Bernstein and colleagues (1999) describe sedentarism in terms of energy expenditure, while Ricciardi (2005) defines it in terms of what it is not, that is, not engaging in physical activity. Probably the most commonly accepted definition is time spent other than in sleep, or time spent in vigorous-, moderate-, or light-intensity physical activity. The word also is used to describe the status of a person or a population with high levels of sedentary behaviors or a sedentary lifestyle.

Sedentarism can be categorized as (1) recreational sedentarism, which refers mainly to media use or “screen time” but can also include more traditional sedentary activities such as recreational reading or having a conversation while sitting, and (2) nonrecreational sedentarism, which refers to schoolwork or other types of work that occur while sitting and also to other sedentary activities that are necessary to perform daily tasks, such as motorized transportation or eating a meal. Most of the public health interest in sedentarism has focused on decreasing recreational sedentarism, especially screen time, but there is increasing interest in ways to alter sedentary work so it can be performed while engaging in light physical activity or even while standing. Standing desks and treadmill desks are becoming popular for adults in the workplace, for example, and many schools are seeking creative ways to integrate light physical activity into traditionally sedentary schoolwork. Such efforts are important given the amount of sedentary time entailed in schoolwork. In Australia, for example, 42 percent of nonscreen sedentary time is school related ( Olds et al., 2010 ).

Such efforts to address nonrecreational sedentarism are just emerging, and much research and innovation are needed to move these efforts forward. On the other hand, significant research already exists on decreasing recreational sedentarism, especially among children, to treat or prevent obesity. Today, 46 percent of U.S. children aged 6-11 fail to meet the recommendation of less than 2 hours of recreational sedentarism (screen time) per day ( Fakhouri et al., 2013 ). In addition to the nonrecreational sedentarism that occurs while children sit to perform schoolwork, significant recreational sedentarism takes place on the way to school and in school during breaks, recess, lunch, and after-school programs. Data are not available on the extent to which recreational sedentarism occurs on school grounds and on whether recreational sedentarism in school should be an important public health target as it already is outside of school. What is known, however, is that “eight- to eighteen-year-olds spend more time with media than in any other activity besides (maybe) sleeping—an average of more than 7½ hours a day, seven days a week” ( Rideout et al., 2010 , p. 1).

One of the lessons of pediatric obesity research is that behavioral approaches designed to increase physical activity are different from those designed to decrease recreational sedentarism and have different effects on behavior and health. Using behavioral economic theory, Epstein and colleagues (1995) demonstrated that monitoring children and encouraging them to decrease recreational sedentarism was more successful in treating obesity than either promoting physical activity or targeting both physical activity and sedentarism at the same time. Furthermore, the children randomized to the intervention targeting only sedentarism increased their enjoyment of vigorous- or moderate-intensity physical activity, while enjoyment of moderate-intensity physical activity decreased among those randomized to physical activity promotion; changes in enjoyment among those in the combined intervention group were between those in the other two groups. The importance of targeting a decrease in sedentarism was further highlighted when Robinson (1999) published the first successful school-based obesity prevention intervention that targeted only sedentarism, with no behavioral intervention focused on physical activity promotion or dietary changes. Since then, several randomized trials have confirmed the causal link between recreational sedentarism and childhood obesity ( Tremblay et al., 2011 ). Despite this evidence, however, the approach of specifically targeting sedentarism has received only limited attention. While academic research has focused on using school as a setting in which to teach students how to decrease sedentarism outside of school, this approach has not translated into widespread policies or curricula. Such efforts may be particularly important as sedentarism appears to track among individuals from childhood to adulthood ( Gordon-Larsen et al., 2004 ; Nelson et al., 2006 ).

Of interest, a large nationally representative survey found that, “contrary to the public perception that media use displaces physical activity, those young people who are the heaviest media users report spending similar amounts of time exercising or being physically active as other young people their age who are not heavy media users” ( Rideout et al., 2010 , p. 12). The question was, “Thinking just about yesterday, how much time did you spend being physically active or exercising, such as playing sports, working out, dancing, running, or another activity?” This finding suggests that media use does not displace vigorous- or moderate-intensity physical activity but more likely displaces light-intensity physical activity, schoolwork, and sleep. Light-intensity physical activity, including playing or even just standing, is more difficult to measure than vigorous-or moderate-intensity physical activity, but its positive health impact is increasingly being recognized (see Box 2-4 in Chapter 2 ). The finding of this survey also suggests that promotion of vigorous- or moderate-intensity physical activity may not decrease sedentarism but rather might replace light-intensity physical activity. Therefore, the optimal way to promote an overall increase in physical activity (including light-intensity physical activity) may be to use behavioral approaches to decrease sedentarism, as has been shown in behavioral research ( Epstein et al., 1995 ; Robinson, 1999 ).

One of the challenges to monitoring sedentarism is the fact that children and adolescents frequently multitask. As noted earlier, Rideout and colleagues (2010) found that U.S. youth aged 8-18 spent more than 7.5 hours per day using recreational media; 29 percent of this time was spent multitasking, resulting in a total media exposure of almost 10.5 hours per day. This figure represents an overall increase in sedentarism since 1999, when the corresponding figures were 6.2 hours and 7.3 hours per day, respectively. Television content still dominated sedentary time, accounting for 4.3 hours per day. Computer use for schoolwork (not included in these totals) averaged 16 minutes, while computer use for recreational purposes totaled 1.3 hours per day. On a typical day, 70 percent of youth went online for any purpose, including 57 percent at home, 20 percent at school, and 14 percent elsewhere. It is unknown whether all online activities at school were related to schoolwork.

In addition to displacing physical activity and schoolwork, recreational media use exposes youth to “a constant stream of messages” that shape their perception of what is normative, including food choices, physical appearance, physical activity, and even sedentarism itself ( Rideout et al., 2010 ). Usually, these perceived norms are not in line with healthy or academically productive behaviors, and cannot be countered by the best efforts of parents and teachers. As a consequence, compared with those who used recreational media the least, “heavy users” tended to have lower school grades and to report that they were getting in trouble “a lot,” unhappy, sad, or bored ( Rideout et al., 2010 ). Furthermore, in the face of rapidly advancing technology, parents and teachers are not always fully aware of the many ways in which media and marketing are part of youth's lives. In addition to television and desktop computers, laptops, tablets, and cell phones often follow children and adolescents into the school bus, class, recess, and after-school activities unless such access is limited by policy, providing increasing opportunities to be sedentary on school grounds. In 2009 an average of 20 percent of media consumption, more than 2 hours per day, occurred with mobile devices, some of this media use likely occurring on school grounds. This figure probably has increased since then. Rideout and colleagues also note that children whose parents make an effort to limit media use spend less time consuming media, but whether this holds true for limits on recreational sedentarism in the school setting is unknown.

Both recreational and nonrecreational sedentarism in schools need to be monitored separately from physical activity. Specific school policies, based on updated knowledge of media use, need to focus on decreasing recreational sedentarism in school and integrating prevention of recreational sedentarism outside of school into the education curriculum. Because media use among youth already is significantly higher than recommended, schools should not provide students with increased opportunities for sedentarism, such as television sets in classrooms, the cafeteria, or after-school programs; access to social networks and recreational media on school computers; or the ability to use cell phones anywhere and at any time on school grounds or school transportation.

Research is needed to explore sedentarism and media use in schools more systematically so that evidence-based school policies to decrease these behaviors can be implemented to increase overall, including light-intensity, physical activity. In particular, surveys of media use are needed to document the amount of recreational sedentarism taking place in the school setting, where, in contrast with the home setting, public health policy can potentially be implemented.

• OPPORTUNITIES TO INCREASE PHYSICAL ACTIVITY IN THE SCHOOL ENVIRONMENT

School physical activity programs are needed so that schools can ensure they are providing students with 60 minutes or more of vigorous- or moderate-intensity physical activity per day. Physical activity programs are neither equivalent to nor a substitute for physical education, and both can contribute meaningfully to the development of healthy, active children ( NASPE and AHA, 2012 ). The former are behavioral programs, whereas the latter are instructional programs. Box 6-1 presents the Healthy People 2020 objectives for non–physical education physical activity opportunities in school settings.

Healthy People 2020 Objectives for Non– Physical Education Physical Activity Opportunities in School Settings. Increase the number of States that require regularly scheduled elementary school recess. Increase the proportion of school districts (more...)

The following sections describe various non–physical education opportunities for physical activity in the school environment. The discussion includes relevant policies, barriers, and enablers.

Classroom Activity breaks

An emerging strategy for increasing daily participation in physical activity in schools is the implementation of structured, classroom-based physical activity breaks. Classroom physical activity includes all activity regardless of intensity performed in the classroom during normal classroom time. It includes activity during academic classroom instruction as well as breaks from instruction specifically designed for physical activity. It also includes time spent learning special topics (e.g., art, music) even if not taught by the usual classroom teacher. It excludes physical education and recess even if conducted in the classroom by the usual classroom teacher. It also excludes physical activity breaks during lunchtime. Although some discussions of schooltime activity breaks include such breaks during lunchtime ( Turner and Chaloupka, 2012 ), the committee views lunchtime physical activity as more akin to activity during recess and before and after school than to physical activity during normal academic classroom time. While a number of programs specifically designed to increase the volume of students' physical activity during usual classroom time exist, the committee found no information about changes in such programs over time at the population level.

A typical break consists of 10-15 minutes focused on vigorous- or moderate-intensity physical activity. This strategy has been found to be effective in significantly increasing physical activity levels of school-age children ( Ernst and Pangrazi, 1999 ; Scruggs et al., 2003 ; Mahar et al., 2006 ). Bassett and colleagues (2013) found that classroom activity breaks provide school-age children with up to 19 minutes of vigorous- or moderate-intensity physical activity, and the sustained use of such breaks was shown to decrease body mass index (BMI) in students over a period of 2 years ( Donnelly et al., 2009 ). The effectiveness of classroom physical activity breaks is discussed further in Chapter 7 .

An example of an effective school-based physical activity program is Take 10! Kibbe and colleagues (2011) provide consistent evidence that the Take 10! program has been effective in increasing physical activity levels among a variety of samples of children enrolled in kindergarten through 5th grade in various countries. Likewise, Mahar and colleagues (2006) found that, with the implementation of 10-minute physical activity breaks called “Energizers,” students increased their time on task while averaging approximately 782 more steps in a day. Another example, supported by the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity (2012) , is Jammin' Minute, a realistic and effective “bridge” tool for increasing children's physical activity until schools have sufficient resources to develop more comprehensive physical education programs. Jammin' Minute has important implications for advocates and policy makers, as well as administrators and teachers, seeking ways to make school environments healthier for children. At the same time, it should be emphasized that, while the benefits of small increases in physical activity during the school day need to be recognized, the ultimate goal of policy makers and advocates should be to ensure that all schools have comprehensive physical education programs (see Chapter 5 ).

Another program, Texas I-CAN!, helped teachers incorporate physical activity by modifying lesson plans to include more active activities, thereby increasing vigorous- or moderate-intensity physical activity by 1,000 steps per day ( Bartholomew and Jowers, 2011 ). It was found that these curriculum-based activities improved time on task immediately following the breaks, especially in children who were overweight; these students went from being on task 58 percent of the time on typical instruction days to 93 percent of the time after the breaks ( Grieco et al., 2009 ).

These findings emphasize the effectiveness and feasibility of providing classroom-based structured opportunities for physical activity. Breaks in the classroom provide an additional opportunity for physical activity throughout the school day with minimal planning, no equipment, and a short amount of time required; they can also incorporate learning opportunities for students. It should be noted that the literature tends to focus on the effect of classroom physical activity breaks on elementary school rather than secondary school students.

For classroom-based physical activity breaks to become a priority, it will be important to provide evidence that such breaks do not detract from academic achievement. Chapter 4 provides an extensive review of the evidence showing that physical activity in general has positive effects on academic performance. With respect to classroom-based physical activity, the Centers for Disease Control and Prevention (CDC) (2010) reviewed studies examining the association between such activity and academic performance in elementary school–age children. Eight of nine published studies found positive effects on such outcomes as academic achievement and classroom behavior; only one study found no relationship ( Ahamed et al., 2007 ), but that study also found that the breaks did increase physical activity levels and did not adversely affect academic achievement. Donnelly and Lambourne (2011) provide further support for the link between physical activity and positive cognitive and academic outcomes in elementary school–age children. In addition, studies in elementary school–age children have found an increase in on-task behavior in the classroom after participation in a physical activity break ( Jarrett et al., 1998 ; Mahar et al., 2006 ; Mahar, 2011 ; see also Chapter 4 ). For example, Mahar and colleagues (2006) found that time on task increased by 8 percent ( p < .017) with the implementation of a 10-minute break. They also found that the 20 percent of students who were off task improved the most in time on task. Similar results were found in Georgia, where 4th graders exhibited significantly less fidgeting behaviors and significantly better on-task behaviors on days when activity breaks were conducted ( Jarrett et al., 1998 ). Finally, a meta-analysis by Erwin and colleagues (2012) found that breaks increase the frequency of physical activity behaviors and have positive learning outcomes. It should be noted that the effect and benefits of classroom-based physical activity breaks in preschool populations have not been thoroughly investigated.

Policies That Affect Classroom Physical Activity Breaks

Classroom physical activity breaks are a relatively new approach to promoting physical activity during the school day. Consequently, research on policies that support or hinder the use of this approach is sparse. For this approach to become more prevalent, supportive policies will be necessary, an observation supported by the fact that just one in four U.S. public elementary schools offered children and youth physical activity breaks apart from physical education and recess during the 2009–2011 school years ( Turner and Chaloupka, 2012 ). Research clearly demonstrates the important role of state laws and school district policies in promoting physical activity opportunities in schools. For example, schools are more likely to meet physical education recommendations when state laws and school district policies mandate a specific amount of time for physical education classes ( Slater et al., 2012 ; see also Chapter 5 ). Currently, few if any school districts require that physical activity opportunities be provided throughout the school day or within the classroom ( Chriqui et al., 2010 ). Therefore, research is needed to identify strategies for implementing classroom-based physical activity breaks and providing teachers with the skills and confidence necessary to engage students in these activities. In addition, questions remain about the optimal duration, timing, and programming (e.g., types of activities) for physical activity breaks ( Turner and Chaloupka, 2012 ).

Barriers to Classroom Physical Activity Breaks

One factor that influences classroom physical activity breaks is competition for time during the school day, arising from the need for schools to meet the academic requirements of the No Child Left Behind Act (see Chapter 5 ). As discussed above and in Chapter 4 , however, the literature clearly supports that classroom physical activity breaks are not only beneficial in promoting physical activity in children and youth but also can occur in the classroom without compromising learning and in fact improve academic performance and related classroom behaviors. In addition, research has shown that using innovative curriculum change, such as Physical Activity Across the Curriculum ( Donnelly et al., 2009 ), can increase daily physical activity and improve academic performance. Additionally, schools often have a scarcity of resources related to staffing, teacher training, funding, champions, and/or facilities for physical activity. Dwyer and colleagues (2003) , for example, document the lack of facilities and equipment for physical activity breaks. As a result of these barriers, it has been found that, although teachers see the importance of physical activity breaks for children's health and development, they infrequently integrate movement into the classroom ( Parks et al., 2007 ).

From the literature, classroom physical activity breaks appear to be heavily implemented in early childhood and elementary classrooms ( CDC, 2010 ). Few if any classroom physical activity breaks appear to occur in middle and high school settings. The lack of physical activity breaks for this age group may be due to the increased academic demands of testing, along with difficulty of implementing breaks that target these older students. However, classroom-based physical activity curricula are emerging at a rapid rate. Programs available for purchase include Active and Healthy Schools activity break cards, Promoting Physical Activity and Health in the Classroom activity cards, Energizers, and TAKE 10! Other resources for classroom physical activity breaks are available at no cost to schools, such as Jammin' Minute, ABS for Fitness, Activity Bursts in the Classroom, Game On! The Ultimate Wellness Challenge, and approximately 50 others. These resources can be found through the Alliance for a Healthier Generation at www.healthiergeneration.org . They provide an excellent starting point for teachers and are flexible enough to be modified to meet the needs of specific classrooms.

Space is another concern for classroom teachers, who must consider the safety of students. The classroom (e.g., desks and tables) needs to be arranged to provide adequate open space for students to move during physical activity breaks. Figure 6-1 shows the activity area/space available in a traditionally organized classroom. Figures 6-2 and 6-3 show how the classroom can be arranged to optimize the space for movement and physical activity.

Traditional layout of a classroom with limited space for physical activity breaks. SOURCE: Personal communication from Heather Erwin. Reprinted with permission from Heather Erwin.

One classroom layout designed to accommodate physical activity breaks. SOURCE: Personal communication from Hearther Erwin. Rseprinted with permission from Heather Erwin.

Another classroom layout designed to accommodate physical activity breaks. SOURCE: Personal communication from Heather Erwin. Reprinted with permission from Heather Erwin.

One of the most common forms of physical activity break during the school day is recess. Children can accumulate up to 40 percent of their daily physical activity time during recess ( Ridgers et al., 2006 ). Recess, according to Pellegrini and colleagues (1995) , is the time of day set aside for students to take a break from their class work; engage in play with their peers; and take part in independent, unstructured activities. Recess is most common in elementary schools and is rare during the secondary years.

While separate and distinct from physical education, recess is an essential component of the total educational experience for elementary-age children ( Ramstetter et al., 2010 ). In addition to providing children the opportunity to engage in physical activity, develop healthy bodies, and develop an enjoyment of movement, it provides them with a forum in which they are able to practice life skills, including conflict resolution, problem solving, communicating with language, cooperation, respect for rules, taking turns, and sharing. Moreover, it serves as a developmentally appropriate outlet for reducing stress in children ( National Association for the Education of Young Children, 1998 ). Furthermore, recess facilitates attention and focus on learning in the classroom ( NASPE, 2001 ). This dedicated period of time further allows children the opportunity to make choices, plan, and expand their creativity ( National Association for the Education of Young Children, 1998 ). Indeed, the American Academy of Pediatrics (AAP) recently released a policy statement in support of recess and free play as “fundamental component[s] of a child's normal growth and development” ( Council on School Health, 2013 , p. 188).

The AAP further asserts that cognitive processing and academic performance depend on regular breaks from concentrated class work. The AAP believes that

• Recess is a complement to but not a replacement for physical education. Physical education is an academic discipline.
• Recess can serve as a counterbalance to sedentary time and contribute to the recommended 60 minutes or more of vigorous- or moderate-intensity physical activity per day.
• Peer interactions during recess are a unique complement to the classroom. The lifelong skills acquired for communication, negotiation, cooperation, sharing, problem solving, and coping are not only foundations for healthy development but also fundamental measures of the school experience.

The Decline of Recess

Since passage of the No Child Left Behind Act in 2001, several studies and reports across the literature have pointed to a decline in recess to make more time for academic subjects. Approximately 40 percent of schools in the United States have either eliminated or reduced recess in order to free up more time for academics ( RWJF, 2010 ). See Table 6-1 for a summary of changes in recess time between 2001 and 2007; see also the detailed discussion of time shifting in Chapter 5 .

Change in Recess Time, 2001–2007.

The Recess Gap

In addition to the general decline in recess time, the Center for Public Education (2008) has identified a “recess gap” across school settings. This finding is supported by the results of a survey sponsored by the U.S. Department of Education and the National Center for Education Statistics ( Parsad and Lewis, 2006 ), which collected information from a representative sample of 1,198 U.S. elementary schools on whether they scheduled any recess for each grade, typically grades 1 through 5 or 6. Respondents reported the number of days per week of scheduled recess, the number of times per day, and the total minutes per day for each elementary grade in 2005. The survey found that while most children, regardless of location, continue to get recess on a regular basis, children who attend high-minority, high-poverty, or urban schools are far more likely than other children to get no recess at all (see Figure 6-4 ). Also:

Percent of schools that do not provide recess to 1st graders. NOTE: Poverty rate is based on the proportion of students eligible for free or reduced-price lunches. SOURCE: Parsad and Lewis, 2006. Reprinted with permission.

• The proportion of public elementary schools with any scheduled recess ranged from 87 to 93 percent across elementary grades.
• The proportion of public elementary schools with no scheduled recess ranged from 7 to 13 percent across elementary grades.
• Fourteen percent of elementary schools with a minority enrollment of at least 50 percent scheduled no recess for 1st graders, compared with 4 percent of schools with 21-49 percent minority enrollment, 5 percent of those with 6-20 percent minority enrollment, and 2 percent of those with less than 6 percent minority enrollment.
• Eighteen percent of elementary schools with a poverty rate over 75 percent (based on the proportion of students eligible for free or reduced-price lunches) provided 1st graders with no recess, compared with 3 percent of schools with a 50-74 percent poverty rate, 4 percent with a 35-49 percent poverty rate, and 4 percent with a less than 35 percent poverty rate.
• Fourteen percent of urban elementary schools did not offer recess to 1st graders, compared with 6 percent of schools on the urban fringe, 6 percent of those in towns, and 3 percent of rural schools.

The above patterns for 1st graders persisted through 6th grade: 24 percent of 6th graders in high-minority schools, 28 percent in high-poverty schools, and 24 percent in urban schools did not get recess, compared with 13 percent of 6th graders overall.

The National Association of State Boards of Education's (NASBE's) Center for Safe and Healthy Schools (2013) State School Healthy Policy Database supports the above survey findings. It shows that most public elementary schools (83–88 percent) offer daily recess across elementary grades, while 47 percent offer it 1-4 days per week:

• Large schools generally are less likely than small- and medium-sized schools to have daily recess for 1st through 3rd grades.
• City schools are less likely than schools in other locales to offer daily recess for 1st graders. City schools also are less likely than schools in urban fringes and rural areas to schedule daily recess for 2nd through 5th grades.
• Schools with the highest poverty concentrations are less likely than those with lower poverty concentrations to offer daily recess for elementary grades.
• Differences also exist by minority enrollment, with schools with the highest minority enrollment being less likely than those with lower minority enrollment to provide daily recess.

The percentage of public elementary schools offering more than 30 minutes per day of recess ranges from 19 to 27 percent across elementary grades. The average number of minutes per day of scheduled recess for elementary grades differs by school characteristics. Large schools on average offer fewer average minutes per day of recess than small- and medium-sized schools; the same is true for schools with the highest and lowest poverty concentrations, respectively. For further detail, a state-by-state list of policies from the NASBE State School Health Policy Database can be found in Appendix C .

Since physical activity, such as recess, has been shown to improve academic achievement, this recess gap may contribute to, not decrease, disparities in academic achievement.

Support for Recess

Both international and U.S. organizations support the importance of recess.

International organizations

Aside from the historical literature on the need for children to play (dating back to the 1600s), the most prominent and widespread support for recess is rooted in the International Play Association and its work through the United Nations (UN). The International Play Association, founded in 1961 in Denmark, is a global nongovernmental organization that protects, preserves, and promotes children's fundamental human right to play. The UN's Declaration of the Rights of the Child (1959), Article 7, Paragraph 3, states:

The child shall have full opportunity for play and recreation which should be directed to the same purposes as education; society and the public authorities shall endeavor to promote the enjoyment of this right.

The declaration asserts that spontaneous play fulfills a basic childhood developmental need. It further defines play as “a combination of thought and action that is instinctive and historical and that teaches children how to live” ( IPA, 2013 ). At the 1989 UN General Assembly, the International Play Association played a key role in the inclusion of “play” in Article 31 of the UN Convention on the Rights of the Child. It reads:

That every child has the right to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts. That member governments shall respect and promote the right of the child to participate fully in cultural and artistic life and shall encourage the provision of appropriate and equal opportunities for cultural, artistic, recreational and leisure activity. ( IPA, 2013 )

The U.S. affiliate of the International Play Association has as its primary goal to protect, preserve, and promote play as a fundamental right for all children.

U.S. organizations

In a 2013 policy statement, the AAP asserts that recess is a crucial and necessary component of a child's development and as such should not be withheld for punitive or academic reasons. The AAP stresses that minimizing or eliminating recess may be counterproductive to academic achievement, as mounting evidence suggests that recess promotes physical health, social development, and cognitive performance ( AAP, 2013 ).

Through three sponsored research studies, the Robert Wood Johnson Foundation (RWJF) further supports the need for recess in schools. Recess Rules: Why the Undervalued Playtime May Be America's Best Investment for Healthy Kids in Healthy Schools ( RWJF, 2007 ) states that recess represents an unparalleled chance to increase physical activity among a large number of children in the United States, as well as an underutilized opportunity to improve the overall learning environment in the nation's schools. For a second study conducted by RWJF (2010) , The State of Play , 1,951 elementary school principals participated in a Gallup survey devoted to the subject of recess. The survey sample was provided by the National Association of Elementary School Principals, and it reflects a balance of urban, suburban, and rural schools and schools of different income levels, as defined by the percentage of students receiving free or reduced-price lunches. The results show that principals overwhelmingly believe that recess has a positive impact not only on the development of students' social skills but also on achievement and learning in the classroom. When asked what would improve recess at their schools, they highlighted an increase in the number of staff to monitor recess, better equipment, and playground management training, in that order.

According to a third RWJF and Active Living Research study, School Policies on Physical Education and Physical Activity ( Ward, 2011 ):

• “Whole-school programs that provide opportunities for physical activity across the school day—through recess, in-class breaks, and after-school events—increase children's physical activity levels.”
• “Schools that provide ample time for supervised recess and access to equipment, as well as those that make low-cost modifications to improve play spaces, have more physically active students.”
• “Activity breaks during classes not only increase physical activity but also help children focus better on academic tasks and enhance academic achievement.”

Other national organizations and studies further support the need for recess in elementary schools:

• The National Association of Early Childhood Specialists in State Departments of Education takes the position that “recess is an essential component of education and that preschool and elementary school children must have the opportunity to participate in regular periods of active play with peers” ( National Association of Early Childhood Specialists in State Departments of Education, 2001 , p. 1).
• The National Association for the Education of Young Children (2001) believes that unstructured play is a developmentally appropriate outlet for reducing stress in children, improves children's attentiveness, and decreases restlessness.
• Through a position statement, Recess in Elementary Schools , the National Association for Sport and Physical Education, Council on Physical Education for Children, asserts: Recess also provides the opportunity for students to develop and improve social skills. During recess, students learn to resolve conflicts, solve problems, negotiate, and work with others without adult intervention. Cognitive abilities may also be enhanced by recess. Studies have found that students who do not participate in recess may have difficulty concentrating on specific tasks in the classroom, are restless and may be easily distracted. In addition, recess serves as a developmentally appropriate strategy for reducing stress. Contemporary society introduces significant pressure and stress for many students because of academic demands, family issues, and peer pressures. ( NASPE, 2001 )
• The National Parent Teacher Association (PTA) and the Cartoon Network launched “Rescuing Recess” in 2006 to help sustain and revitalize the importance of recess in schools across the country. The goal of the campaign is to recognize unstructured break time as an essential element of the school day and to connect educators, parents, and children as advocates for bringing back or retaining recess. A 2006 nationwide survey of PTA leaders found that parents and teachers also think taking a break is a vital part of a child's school day ( National Parent Teacher Association, 2006 ).

Barriers to Recess

The evidence supporting the cognitive, health, and social benefits of recess could become a thesis on its own merits. Despite these benefits, however, few states have specific policies requiring recess, and those that do have such policies often defer to local school districts to allow individual schools to determine whether students will have a recess period.

Policies requiring increased activity at school each day have the potential to affect large numbers of children and are an effective strategy for promoting regular physical activity. However, external and internal barriers to policy implementation need to be considered ( Amis et al., 2012 ). Competing time demands, shorter school days, lack of teacher participation, and lack of adequate facilities have all been cited as barriers to providing recess ( Evenson et al., 2009 ). Further, weak policies suggesting or recommending changes have shown little or no effect on changing behavior ( Ward, 2011 ; Slater et al., 2012 ). Additional barriers to enacting effective policies include a lack of earmarked resources devoted to policy implementation, principals' lack of knowledge of the policy, and no accountability mechanisms to ensure policy implementation ( Belansky et al., 2009 ).

In addition, the National Association of Early Childhood Specialists in State Departments of Education (2002) identifies issues of student safety, lack of adult supervision, potential lawsuits for injured students, and potential for children to come into contact with strangers entering school grounds as barriers to recess. Elementary school principals responding to the above-referenced RWJF (2010) Gallup survey also cited liability and safety issues, as well as access to space and weather.

Strategies for Reviving Recess

Several strategies can be used to promote recess in schools, along with engagement in physical activity among youth participating in these programs. First, it is necessary to provide a safe environment with ample recreational equipment to encourage physical activity. Additionally, regulations should be in place to ensure that schools offer at least 20 minutes of recess per day. It is imperative as well that training be provided to recess supervisors and staff, with a focus on both safety issues and ways to interact with students to better promote physical activity. Recess is not a common occurrence for secondary students; however, they could participate in a civic- or service-oriented program whereby they would oversee and engage in recess for local elementary schools.

Intra- and Extramural Sports

Sports programs have long been an integral part of the school setting. Sport is one of the four human activities, along with play, games, and work. According to Woods (2011 , pp. 5–6), play is a “free activity that involves exploration, self-expression, dreaming, and pretending. Play has no firm rules and can take place anywhere.” Children's play often involves physical movement. Games are forms of play “that have greater structure and are competitive. Games have clear participation goals … [and] are governed by informal or formal rules” (p. 5). Games can be sedentary or physical; involve competition, planning, and strategizing; and result in “prestige or status.” Sport is a specialized or higher order of play or games with special characteristics. It must involve physical movement and skill. It must be “competitive with outcomes that are important to those involved,” and “winning and losing are a critical part of competition.” Thus, an important aspect of sport is institutionalized competition under formal rules. Lastly, work is “purposeful activity that may include physical and mental effort to perform a task, overcome an obstacle, or achieve a desired outcome.” Sport can be work.

It is important to note that children in schools can participate in sports as either players or spectators. Kretchmar (2005) suggests that playing sports at a young age tracks to becoming a loyal spectator in later years; however, being a spectator at a young age may not necessarily lead to active participation as a player. Chen and Zhu (2005) analyzed intuitive interest in physical activity among 5-year-olds using the nationally representative sample from the U.S. Department of Education's Early Childhood Longitudinal Study. The results of a logistic regression analysis showed that early exposure to watching a sport may have a negative effect on developing interest in actually playing the sport.

The discussion here focuses on institutionalized in-school sports and on children's participation as players. In-school sports programs typically fall into two categories: intramural , or within a school, and extramural or interscholastic , or competition between schools ( AAHPERD, 2011 ). The type and scope of each of these categories of sports vary by school size ( Landis et al., 2007 ), location, and the socioeconomic status of students ( Edwards et al., 2013 ).

In the past 40 years, participation in sports has flourished both within and outside of schools. Although young children are not eligible for formal interscholastic competition until they reach secondary school, children (or their parents) with athletic aspirations start preparation for competition at a very young age. Results of the National Survey of Children's Health (2007) showed that approximately 58.3 percent of 6- to 17-year-olds participated in sports teams or lessons over a 12-month period. The Centers for Disease Control and Prevention (CDC) (2012) reports that in 2011, 58 percent of high school students played on at least one sports team. Intramural sports clubs in middle and high schools also involve large numbers of students.

Participation in sports inside and outside school has increased in the past 20 years. According to the latest report of the National Federation of State High School Associations (NFSHSA) (2012), participation in high school sports nearly doubled in 2011–2012 relative to 1971–1972. While boys' participation increased by about 22 percent during these years, girls' participation increased about 10-fold. Table 6-2 documents the change by decade.

Change in Participation in High School Sports in the Past Five Decades.

Figure 6-5 shows the ratio of growth in boys' and girls' participation in sports relative to the total enrollment in U.S. high schools during the five decades. The data show that while the ratio for boys has remained steady at about 40-50 percent, the ratio for girls has increased from 4 percent in 1971–1972 to 40 percent in 2011–2012.

Change in the ratio of males' and females' participation in sports relative to enrollment, 1971–2011. NOTE: Ratio is number of participants divided by estimated number of males or females enrolled in high school in October of the enrollment year. (more...)

Nationwide, 77 percent of middle schools and 91 percent of high schools offer at least one interscholastic sport ( Lee et al., 2007 ), and 48 percent of middle and high schools offer intramural sports or physical activity clubs ( NASPE and AHA, 2010 ). Based on data from a nationally representative sample of middle schools, Young and colleagues (2007) found that 83 percent of schools offered interscholastic sports, and 69 percent offered intramural sports and clubs. No reports indicate that interscholastic or intramural sports were offered in elementary schools.

Many students who do not play on school teams may participate in sports programs outside of school. CDC (2012) data indicate that 58 percent of high school–age youth played on at least one sports team in 2011, which suggests that an estimated 31 million of the 55 million youth in this age group participated in sports outside of school. The committee was unable to find a national estimate of the number of students who participated in school intramural sports or physical activity clubs. However, one study of four middle schools with similar demographic populations based on race/ethnicity, income, and geographic location suggests that the intramural sports environment may be more conducive to increased physical activity levels than the environment of varsity sports, at least for middle school boys ( Bocarro et al., 2012 ). This may be due in part to the fact that all children can participate in intramural activities without having the high skill levels required for interscholastic sports.

Students have many choices of interscholastic sports. Lee and colleagues (2007) cite 23 popular sports, grouped in Table 6-3 as team or individual sports. Lee and colleagues (2007) believe that most individual sports may be more likely than team sports to become lifelong activities for individual students.

Interscholastic Sports Choices and Percentage of Middle and High Schools Offering Them.

Policies That Affect Participation in Sports

As with physical education and recess policies, data from both the Shape of the Nation Report ( NASPE and AHA, 2010 ) and the NASBE State School Health Policy Database (see Appendix C ) show variations in amounts, accountability, and regulations for high school sports. Twenty-one states (41 percent) had state requirements regarding sports, most relating to gender equity, concussion management, and local requirements. Although NFSHSA remains the governing body for individual state athletic associations, the governance of district sports opportunities is determined largely by local athletic associations in accordance with individual state association requirements. However, decisions on what sports to offer, the frequency of sport competitions, and other factors are made at the local level. In its report on the Comprehensive School Physical Activity Program (CSPAP), the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) (2011) notes that 65 percent of high schools implemented various forms of team-cut policies for participation in interscholastic sports. The practice requires students to meet minimum performance qualifications before joining a school-sponsored sports team. Such policies include maintaining a designated grade point average, meeting daily attendance requirements, and adhering to individual school district code-of-conduct policies. One might speculate that such policies may prohibit interscholastic sports from becoming a viable means of promoting maximum student participation in sports and other physical activity.

In summary, trends in participation in sports are encouraging. Compared with physical education, however, it is difficult to expect every child to participate in sports. Although the available data indicate a nearly 60 percent participation rate, the data do not provide specific information about the participants. In addition, studies and national surveys have not provided useful information about those children who do not participate in sports, who may be in the greatest need of physical activity. Although the opportunity for physical activity through participation in interscholastic and/or intramural sports does exist in most secondary schools, the extent to which participation in sports contributes to children's health and positive behavior change for active living is unclear.

Barriers to Participation in Sports

Although the literature documents the benefits of participating in high school sports in such areas as academic achievement, attendance, and self-esteem, opportunities for participation in sports have not escaped the effects of the budget cuts that have plagued education over the past several years ( Colabianchi et al., 2012 ).

In addition, interscholastic sports have been dominated by a competitive sports model ( Lee et al., 2007 ), which may fail to engage and support all students. Policies encouraging and funding intramural sports, which are usually more inclusive and less competitive, can increase student participation in sports. The CDC recommends inclusive policies and programs as a strategy for enabling students to meet the 2008 Physical Activity Guidelines ( HHS, 2008 ).

According to the Government Accountability Office (GAO) (2012) report K-12 Physical Education: School-Based Physical Education and Sports Programs , school district officials assert that budget cuts have impacted predominantly transportation and facilities, both critical to after-school sports programs ( GAO, 2012 ). According to data from the School Health Policies and Practices Study (SHPPS) (2006) ( Lee et al., 2007 ), an estimated 29 percent of schools that offered interscholastic sports in 2006 also provided transportation home for participating students, up from 21 percent in 2000. Transportation costs, a large part of overall school athletic budgets, are impacted not only by the need to transport students to practice facilities and competition venues and then home but also by increases in fuel prices and maintenance costs.

Facilities and equipment are another recognized barrier to participation. Budget cuts have hindered school districts from building new facilities or upgrading existing ones. Where facility and land limitations prevail, school districts have resorted to developing partnerships and contractual agreements with local community recreation centers or universities to use their facilities for various sports program. A lack of funding for sports equipment has further reduced the number of participating students, as the number of uniforms available per sport has caused the selection process to become more stringent. Colabianchi and colleagues (2012) also conclude that the percentage of students participating in interscholastic sports is contingent on the type and number of facilities (see Figure 6-6 ).

Participation in interscholastic sports among boys and girls by availability of sports facilities, 2009–2011. SOURCE: Colabianchi et al., 2012.

Another challenge to implementing quality sports programs is the availability of quality coaches. Fewer school personnel are coaching in the face of a decline in coaching supplements and increased time commitments. Funding for staffing or staff training is an important aspect of successful sports or after-school physical activity programs. According to the 2006 SHPPS data, more than half of schools surveyed paid staff for involvement in intramural sports programs ( Lee et al., 2007 ). Policies to support supervisory staff can facilitate increased opportunities for physical activity for students.

Constrained budgets also have reduced the number of sports offerings, with the primary sports being retained and the second-tier sports, such as golf and tennis, either being eliminated or requiring that students pay 100 percent of the cost of participation. Indeed, many school districts across the United States have implemented a pay-to-play policy. According to the 2006 SHPPS data, 33 percent of schools require students to pay to participate in interscholastic sports. A study released by the University of Michigan, C.S. Mott Children's Hospital (2012) , reports that pay-to-play fees are preventing lower-income children from participating in both middle and high school sports. The study found that the average fee was $93 per sport, while some respondents to the survey reported paying $150 or more. When combined with the cost of equipment, uniforms, and additional team fees, the average total cost for a child's participation in sports was $381. Nineteen percent of families making under $60,000 reported that costs had led to at least one of their children being unable to participate in sports. Figure 6-7 shows the study results regarding participation in school sports among youth aged 12-17 by household income. The study found further that

Participation in school sports for youth aged 12-17 by household income. SOURCE: C.S. Mott Children's Hospital, 2012.

• More than 60 percent of children who played school sports were subject to a pay-to-play fee; only 6 percent received waivers for the fee.
• Only one-third of lower-income parents reported that their child participated in school sports, compared with more than half of higher-income parents.
• In lower-income households, nearly one in five parents reported a decrease in their child's participation in school sports because of cost.

Colabianchi and colleagues (2012) further determined that the percentage of students participating in sports varied with the students' socioeconomic status. Participation was higher at schools of mid-socioeconomic status than at those of low socioeconomic status, and even higher at schools of high socioeconomic status compared with those of mid-socioeconomic status (see Figure 6-8 ).

Participation in interscholastic sports by school socioeconomic status among boys and girls, 2009–2011. NOTE: SES = socioeconomic status. SOURCE: Colabianchi et al., 2012.

Interscholastic sports have been criticized for perpetuating racial and gender segregation ( Lee et al., 2007 ). Further study by Kelly and colleagues (2010) and Bocarro and colleagues (2012) confirmed the relationship between socioeconomic status and sports participation, finding that fewer children and adolescents in schools of low socioeconomic status or with a relatively high proportion of racial and ethnic minority groups participated in sports programs.

To provide the physical activity and psychosocial benefits of engaging in sports at school, education systems need to reevaluate their budgets to ensure that equitable sports opportunities are available for youth in all types of school settings and at all levels of socioeconomic status. The same holds true with respect to ensuring that school-based intramural sports opportunities are available before or after school hours to increase participation in physical activity among all students.

Programs for Students with Disabilities

The 2010 GAO report Students with Disabilities: More Information and Guidance Could Improve Opportunities in Physical Education and Athletics notes that students with and without disabilities were provided similar opportunities to participate in physical education in schools but identifies several challenges to serving students with disabilities. Likewise, for sports, opportunities were provided for students to participate, but students with disabilities participated at lower rates than those without disabilities. Yet sports programs for students without disabilities have shown similar benefits for students with disabilities, including not only obesity reduction but also higher self-esteem, better body image, and greater academic success; more confidence and a greater likelihood of graduating from high school and matriculating in college; and greater career success and more career options ( GAO, 2010 ; Active Policy Solutions, 2013 ; U.S. Department of Education, 2013 ).

To ensure that students with disabilities have opportunities to participate in extracurricular athletics equal to those of other students, the GAO report recommends that the U.S. Department of Education clarify and communicate schools' responsibilities under Section 504 of the Rehabilitation Act of 1973 regarding the provision of extracurricular athletics. Most important, the report recommends improving physical education and athletic opportunities for students with disabilities and recommends that (1) the Secretary of Education facilitate information sharing among agencies, including schools, on ways to provide opportunities, and (2) clarify schools' responsibilities under federal law, namely Section 504 of the Rehabilitation Act of 1973, through the Office for Civil Rights, which is responsible for enforcing Section 504. In January 2013, in a landmark response to the release of the 2010 GAO report, the U.S. Department of Education, Office for Civil Rights (2013), clarified a school's role in providing extracurricular athletic opportunities for students with disabilities.

Active Transport

Active transport or active commuting refers to the use of walking, biking, or other human-powered methods (e.g., skateboarding). It includes using public transportation or “walking school buses,” or being driven to a point closer to but not at school from which students walk the remainder of the way. Active transport equates to moderate-intensity physical activity, which, as discussed in earlier chapters, provides crucial health benefits. In light of these benefits, the CDC has launched programs to encourage parents to walk their children to school.

Active commuting has been proposed as an ideal low-cost strategy to increase physical activity within the general population and can account for one-quarter of an individual's recommended total daily steps ( Whitt et al., 2004 ). Studies have found that active transport provides children with physical activity ( Tudor-Locke et al., 2002 ) and increased energy expenditure ( Tudor-Locke et al., 2003 ). Bassett and colleagues (2013) suggest that active transport to and from school contributes on average 16 minutes of vigorous- or moderate-intensity physical activity for youth. These benefits, together with concern about increased traffic congestion and air pollution, have led to growing interest in the use of active transport by youth to get to and from school ( Kahlmeier et al., 2010 ). In addition, it has been suggested that active transport enhances social interaction among children and promotes independent mobility ( Collins and Kearns, 2001 ; Kearns et al., 2003 ).

Five decades ago, children actively commuting to school were a common sight. Nearly 90 percent of children who lived within a 1-mile radius of school either walked or biked to school ( USDOT, 1972 ). Since 1969 the prevalence of youth walking or biking to school has steadily declined ( McDonald, 2007 ), paralleling a decline in active commuting among American adults ( Pucher et al., 2011 ). Data from the U.S. Department of Transportation show the decline in active transportation to and from school between 1969 and 2001 (see Figure 6-9 ).

Decline in active transportation to and from school among youth from 1969 to 2001 in the United States. SOURCE: CDC, 2008; 1969 Nationwide Personal Transportation Survey (USDOT, 1972); and 2001 National Household Travel Survey.

From an international perspective, active transport among children and adolescents is more prevalent in European countries such as the Netherlands and Germany, which have a culture of active transport, than in other regions. These countries tend to have a lower risk of obesity, diabetes, and hypertension in youth compared with the United States. Indeed, the data support an inverse relationship between the percentage of active transport and obesity rates among residents of the United States, Canada, Australia, and 14 European countries ( Bassett et al., 2008 ). In this study the United States ranked the lowest on active transport and the highest on obesity prevalence.

Policies That Affect Active Transport

Various environmental and policy factors support or hinder active transport to and from school. For example, school siting policies that encourage the construction of schools on large campuses far from residential areas and not integrated with housing development are a hindrance ( Council of Educational Facility Planners International, 1991 ). Accordingly, efforts are being made to stop “school sprawl,” including eliminating minimum acreage guidelines so that schools can be located closer to where school-age children live ( Salvesen and Hervey, 2003 ).

At the national level, the U.S. Secretary of Transportation has called for a “sea change” in transportation planning in the United States. He has expressed the need to put cyclists and walkers on even ground with motorists and issued a policy statement on accommodations for active transport ( USDOT, 2010 ). His statement calls for the redesign of existing neighborhoods with bicycle lanes, sidewalks, and shared paths. Additionally, the reauthorization of federal transport legislation charged the Federal Highway Administration with providing funds for states to create and implement Safe Routes to School programs ( National Safe Routes to School Task Force, 2008 ). Provision of this funding may increase the percentage of children who walk or bike to school through a variety of initiatives, including engineering (e.g., building sidewalks), enforcement (e.g., ticketing drivers who speed in school zones), education (e.g., teaching pedestrian skills in the classroom), and encouragement (e.g., having students participate in walk-to-school days) ( CDC, 2005 ).

Eyler and colleagues (2008) examined policies related to active transport in schools. In 2005, six states (California, Colorado, Massachusetts, North Carolina, South Carolina, and Washington) had statewide safe routes to school or active transport programs. California, Colorado, and South Carolina had regulations regarding the required distance students must live from a school to be eligible for bus transportation (more than 1.5 miles in South Carolina). A review of the NASBE (2012) State School Health Policy Database revealed that only 11 states (21 percent) had legislation requiring walk/bike programs, most in partnership with the state departments of transportation (see Appendix C ).

Barriers to Active Transport

Several factors contribute to the lack of active transport of youth to and from school. The first is accessibility ( Frank et al., 2003 ), which refers to the proximity (i.e., within a 1-mile radius) of a child's home to school ( Bassett, 2012 ). Nearly half of the decline in youth walking to and from school from 1969 to 2001 is attributable to the increased distance between home and school ( McDonald, 2007 ). Proximity to school is influenced by families moving farther away from school; schools are being built farther away from homes compared with the small neighborhood schools of the past (see Figures 6-10 and 6-11 ). Proximity also is influenced by the decrease in the number of schools since 1960 even as the number of students enrolled in schools has increased ( Wirt et al., 2003 ).

FIGURE 6-10

Distance to school for youth aged 5-18, 1969. SOURCE: CDC, 2008.

FIGURE 6-11

Distance to school for youth aged 5-18, 2001. SOURCE: CDC, 2008.

Proximity to school is not the only factor accounting for the decline in active transport among youth, as a significant decline also has been seen among youth living within a 1- to 2-mile radius of school. A second key determinant is infrastructure ( Frank et al., 2003 ). The built environment is key to facilitating active transport. For active transport to be effective, not only must schools be in close proximity to the neighborhoods of students, but sidewalks, pedestrian crossings, and traffic lights must be adequate ( Boarnet et al., 2005 ; Fulton et al., 2005 ). Boarnet and colleagues (2005) found that children's walking and cycling to and from school greatly increased in urban areas with improvements in sidewalks, traffic lights, pedestrian crossings, and bike paths. In a national study of 4th to 12th graders, the presence of sidewalks was the main modifiable characteristic associated with active transport to and from school ( Fulton et al., 2005 ). Other parental concerns include street connectivity, busy streets on routes, and mixed land uses ( Ewing and Greene, 2003 ; Fulton et al., 2005 ; Schlossberg et al., 2006 ; Timperio et al., 2006 ).

All nine schools interviewed for one study by active transport programs reported that the environmental factors that most affected these programs were sidewalks, crossing guards/crosswalks, funding, personal safety concerns, and advocacy group involvement. All schools also reported that a school speed zone was the greatest concern ( Eyler et al., 2008 ). Other environmental factors include weather (heat, humidity, precipitation) and geographic location ( Pucher and Buehler, 2011 ), with the South having a built environment less conducive to active transport compared with the Northeast, Midwest, and West ( Bassett, 2012 ).

Related to infrastructure issues are parental concerns about safety ( Loprinzi and Trost, 2010 ). These concerns include traffic dangers ( Dellinger and Staunton, 2002 ). For example, 50 percent of children hit by cars near schools are hit by cars driven by parents of students ( CDC, 2008 ), and drivers often exceed the posted speed limit and/or violate traffic signage in school zones ( CDC, 2008 ). Safe routes to school initiatives that have linked engineers and educators to make school trips safer have seen a 64 percent increase in the percentage of students walking to school ( Boarnet et al., 2005 ). In urban areas, infrastructure is conducive to active commuting to and from school, but these areas may be characterized by high crime rates. Dellinger and Staunton (2002) propose that safety is of particular concern for primary school children, which may account for their finding that parents rated their child's age as the most important factor in their decision to allow the child to walk to school. Other studies confirm that many 5- to 6-year-olds lack the skills to cope with traffic issues ( Whitebread and Neilson, 2000 ), although other studies have found that neighborhood safety is unrelated to commuting practices in children ( Humpel et al., 2004 ; Wilson et al., 2004 ). The “walking school bus” (i.e., when an adult escorts a group of children to school) has been shown to be an effective means of safely transporting children to and from school ( Collins and Kearns, 2005 ). It may be noted that pedestrian and bicycling injury/death rates among youth have declined by 51 percent and 60 percent, respectively. However, the decrease in walking or biking among youth may have contributed to this downward trend ( CDC, 2008 ).

Finally, parents identify the perceived fitness level of their children as a determinant of the children's participation in active transport. Specifically, parents who perceive their children as being unfit prefer passive transportation ( Yeung, 2008 ).

“Walking School Bus” Programs

School-endorsed “walking school buses” may address several of the barriers identified above—in particular, traffic and crime dangers ( White House Task Force on Childhood Obesity, 2010 ). “Walking school buses” are popular means for walking young children to school securely in Europe and Australia but are just starting to emerge in the United States. A “walking school buses” often entails one or two adult volunteers escorting a group of children from pickup points or their homes to school along a fixed route, starting with the pickup point or home that is farthest from the school and stopping at other pickup points or homes along the way. For increased security for the youngest children, a rope that surrounds the group can be used. On the way back from school, the same system is used in the opposite direction.

The White House Task Force on Childhood Obesity's (2010) Report to the President identifies “walking school buses” as a low-cost initiative that communities can undertake to increase physical activity among elementary school children. The prevalence of “walking school buses” remains low in the United States but is growing; in 2008–2009, about 4.2 percent of a representative sample of public elementary schools organized “walking school buses”, with an increase to 6.2 percent in 2009–2010 ( Turner et al., 2012 ). Examples of “walking school buse” programs are described in Box 6-2 .

Examples of “Walking School Bus” Programs. The Safe Passage program in Chicago, a comprehensive initiative designed to help keep children safe on their way to and from school, includes a “walking school bus” program (see (more...)

Parents' engagement in school-based health promotion activities is another significant benefit of “walking school buses”. In some communities, “walking school buses” have provided opportunities for parents and other volunteers to remain engaged in the life of the community while increasing their own physical activity.

Differences in Opportunities for Active Transport

The literature demonstrates that active transport varies among socioeconomic and ethnic groups and with the type of area (suburban, urban, or rural) ( Davis and Jones, 1996 ; Dovey, 1999 ). Data from Bridging the Gap ( Turner et al., 2010 ) demonstrate that one in four middle school students and one in eight high school students commute actively to and from school. Students of low socioeconomic status and those who attend schools where the majority of students are nonwhite (i.e., black and Latino) are more likely to walk or bike to and from school than those of high socioeconomic status and those who attend schools with a predominantly white student body.

Facilitators of Active Transport to School

Four common themes have been identified among schools with successful active transport to school programs ( Eyler et al., 2008 ):

• collaboration among many organizations and individuals, including school personnel, public safety officials, city officials, parents, and school district representatives;
• funding for personnel, program materials, and improvements to the built environment;
• concerns about both traffic and crime being addressed; and
• efforts to make the built environment more conducive to active transport by students.

The same study identified a number of important and specific factors and policies to be considered (see Table 6-4 ).

Factors and Policies That Influence Promotion of Walking or Biking to School.

A useful five-component framework for planning programs to enhance active transport to school has been suggested ( Fesperman et al., 2008 ). This framework begins with the development of a plan and the enlistment of key individuals and organizations for input and support. The planning phase is crucial and may take a full year. The implementation of programmatic activities (e.g., training in pedestrian and bicycle safety, walk-to-school days), policy changes (e.g., school speed zones, modification of school start and dismissal times), and physical changes (e.g., sidewalk improvement, installment of traffic calming devices) follow in a sequence appropriate for the specific school and plan. For all activities, promotional materials to ensure understanding and continued support should be disseminated.

In summary, active transport to and from school can be a safe and effective way to increase students' daily physical activity, especially where a large proportion of students live close to their school. Increasing the proportion of children who walk or bike to school commonly requires collaboration among school personnel, public safety officials, city officials, parents, and school district representatives, as well as the funding necessary to address the factors and policies listed in Table 6-4 .

After-School Programs

After-school programs are emerging as another potential means of promoting physical activity in the context of the school environment. After-school programs are organized school or community-based extracurricular activities that take place outside of the school day, typically between 3:00 and 6:00 PM ( Granger et al., 2007 ) and are characterized by opportunities to build competencies in a wide range of areas ( Mahoney et al., 2005 ). They are conducted on most afternoons during the school week for school-age children. Common areas of focus are nutrition and health education, physical activity and recreation, art, and music. After-school programs also provide academic assistance (i.e., tutoring and assistance with homework) and opportunities to develop leadership. Personal and social skills are a common theme.

The past two decades have seen a rapid increase in after-school programs in the United States, and these programs have become an integral part of the community for many families. In 1988, just 22 percent of K-8 school principals reported offering an after-school program, whereas two-thirds reported offering such a program in 2001 ( National Association of Elementary School Principals, 2001 ). This increase in after-school programs is associated with a growing number of parents working beyond the regular school hours and a rise in maternal employment, which have created a need to provide children with a safe and adult-supervised environment ( U.S. Department of Labor, 2005 ; Afterschool Alliance, 2009 ). Emerging data indicate that more than 8.4 million youth attend after-school programs for an average of 8.1 hours per week ( Afterschool Alliance, 2009 ). The After-School Programs and Activities Survey, a nationally representative survey of the 2005 National Household Education Surveys Program ( Carver and Iruka, 2006 ), revealed that 40 percent of students in grades K-8 were in at least one weekly nonparental after-school care program, 20 percent of which were school- or center-based programs. Overall, after-school programs have the opportunity to reach large numbers of school-age children. A wealth of research and emerging findings demonstrate the benefits of after-school programs with respect to academic performance; social and emotional development; and health and wellness, including prevention of risky behaviors.

Public opinion supports the need for after-school programs. In 1999 the Mott Foundation reported that 94 percent of people believed “there should be some type of organized activity or place for children and teens to go after school every day” ( Afterschool Alliance, 1999 , p. 1). The federal government also supports after-school programs, especially in low-income communities. Funding for the 21st Century Community Learning Centers, an after-school program established by the Clinton administration, has increased dramatically over the years, from $40 million in fiscal year 1998 to $1 billion in fiscal year 2002. This grant program supports after-school programs in about 7,500 rural and inner-city public schools in more than 1,400 communities ( U.S. Department of Education, 2003 ).

Policies That Affect After-School Programs

Despite their popularity, there is an absence of nationally recognized standards or policies for promoting physical activity in after-school programs. Moreover, while some states have taken the initiative to create benchmarks, standards and policies are rare, existing in only 70 percent of states ( Beets et al., 2010 ). Table 6-5 provides an overview of state-level policies, standards, recommendations, and guidelines for physical activity in after-school programs. The table shows wide variation. For example, policies in North Carolina state that 20 percent of the time in an after-school program must be spent in vigorous- or moderate-intensity physical activity, while in California all children must be engaged in a minimum of 30 minutes of vigorous- or moderate-intensity physical activity ( Beets et al., 2010 ). Some standards suggest 30-60 minutes of vigorous- or moderate-intensity physical activity, while others suggest “frequent opportunities” for physical activity or 30 minutes out of a 3-hour block. By comparison, one recommendation is to allocate at least 50 percent of program time to physical activity ( Beighle et al., 2010 ).

State Policies, Standards, Recommendations, and Guidelines for Physical Activity in After-School Programs.

After-school programs can be used to combat physical inactivity and obesity while promoting physical activity on school grounds outside of the normal school-day hours ( Lee et al., 2007 ; Levi et al., 2009 ). However, national organizations and state entities need to develop appropriate policies and standards for the implementation of after-school programs whose goal is to promote health and physical activity in school-age children. Doing so would help promote physical activity among school-age children in these settings, aiding them in achieving the recommended levels of daily physical activity. However, it is important not only to have such policies in place but also to ensure that the policies are being implemented (i.e., accountability).

Facilitators of and Barriers to After-School Programs

Various factors serve as barriers and facilitators for after-school programs. The school environment is a facilitator for after-school programs because the setting provides for a wide range of activities ( Grossman et al., 2001 ). Schools are equipped with gymnasiums, libraries, auditoriums, and computer labs that provide unique equipment and space. Second, schools have immediate access to participants, and their after-school programs offer legitimacy for parents who may be hesitant to allow their children to participate in a program elsewhere.

Using schools as a venue for after-school programs is not as easy as it may seem, however. First, their facilities may not always be available for use. Safety, lack of staffing, insufficient funding, risk of vandalism, and insurance liability concerns are often cited as barriers to making school grounds available outside of school hours ( Filardo et al., 2010 ; Cox et al., 2011 ; Spengler et al., 2011 ; Evenson et al., 2012 ). For instance, teachers use classrooms to prepare for the next day's lesson or to provide extra academic assistance to students, students use the library and computer lab to complete classroom assignments, and sports teams need the gymnasium for practice. Thus, after-school programs often compete for space, particularly in the gymnasium. The availability of school space is critical to the effectiveness and quality of after-school programs, most of which require open multipurpose space to accommodate a range of activities.

In addition to competing for space, after-school programs entail costs to schools, after-school community partners, and families. In addition to personnel to run the program, there are costs for upkeep and maintenance of school facilities. After-school programs also entail custodial costs for room cleaning. For parents the average cost for after-school programs is $67.00 per week, a $20.00 increase over the past 5 years ( Afterschool Alliance, 2009 ). Thus, public funds are needed to defray some of these costs to schools and families.

In addition, the inability of an after-school program to provide transportation home is a major barrier to participation for a large number of students. Programs have an advantage in recruiting participants when operating in schools where a majority of the students live within safe walking distance (in particular, urban city schools) ( Grossman et al., 2001 ). For children not living within walking distance of school, busing is an alternative, but the limited supply of buses and drivers, as well as their cost, is a major barrier. There are substantial negative consequences of inadequate transportation. Youth who live beyond walking distance from their school and who cannot be picked up by a parent or adult at the designated time are unable to participate in programs. For schools that can provide busing for after-school programs, the number of seats available on those buses limits the number of children who can participate. Even when children live within walking distance of their school, many parents feel uncomfortable about their child walking home alone in the dark at 5:00 or 6:00 PM. School districts have struggled with easing this transportation problem. Money has been unavailable in schools' budgets, or there have been restrictions on how transit money can be spent. For example, some school districts give transportation funding only to academic programs, and after-school programs are considered nonacademic.

Staff training is another concern for after-school programs. If training does occur, it is often in house. Existing training programs tend to focus on games and to use prepackaged materials, and they fail to address promotion of physical activity ( Ajja et al., 2012 ; Weaver et al., 2012 ).

Differences in Opportunities in After-School Programs

In addition to providing children with enrichment opportunities, a key factor behind the policy interest in after-school programs is the increasing need for child care. Almost all adults agree that elementary school children need adult supervision. Young people aged 10-14 are often seen as old enough to stay on their own for short periods of time, but they are also old enough to get into serious trouble. Unfortunately, these older children are much less likely to participate in supervised after-school programs, whether the programs take place at youth-serving organizations or at school. It is easier to recruit elementary school children to these programs than middle and high school students, who tend to have busier schedules, increased responsibilities, and greater freedom ( Grossman et al., 2001 ). Grossman and colleagues also found that 30 percent of enrollees in after-school programs were in 3rd grade or lower, 45 percent were in 4th through 6th grades, 23 percent were in 7th and 8th grades, and only 2 percent were in 9th grade or higher. Additionally, elementary-age children who enrolled attended more frequently than older youth.

In addition to physical education, schools can offer students non-instructional opportunities to engage in beneficial physical activity before, during, or after the school day. These opportunities take various forms, such as interscholastic sports teams, intramural sport clubs, recess, and in-class physical activity breaks. Interscholastic sports provide opportunities for students with athletic talent. But budgetary constraints, team-cut policies, transportation, lack of facilities, and pay-to-play policies and practices in many high schools may limit participation. Intramural sports clubs in middle and high schools are a viable way for the majority of children to engage in in-school or after-school physical activities. Research data consistently show, however, that although these programs can serve a large number of children, not every child will opt to participate or be able to find transportation home after an activity. Recess and classroom physical activity breaks have become valuable opportunities for elementary school students to be active during the school day. Their value in middle and high schools is questionable when they are combined with lunch, and at the secondary level classroom activity breaks are lost to valuable and limited academic time. Evidence supporting the integration of physical activity into academic lessons does exist but only for elementary schools. Given the nature of institutionalized education and its emphasis on academic achievement, it is unclear that the approach will be embraced by school officials and most classroom teachers.

One consensus from the literature is that, to take advantage of and enhance the many opportunities for physical activity outside of physical education, policy makers and practitioners must acknowledge the anchor function of physical education ( National Physical Activity Plan, 2010 ). Curriculum time is insufficient for all of the recommended 60 minutes or more of vigorous- or moderate-intensity physical activity to take place during physical education, so the activity in which children engage throughout the school day is important. Therefore, a holistic, comprehensive approach is increasingly being advocated to promote physical activity in schools. School environments encourage more physical activity, both before and after school, if they include well-designed playgrounds; open spaces; and facilities and equipment that are available, accessible, and inviting to children. AAHPERD's CSPAP program can serve as an example. It provides opportunities anchored in the knowledge and skills learned in physical education and uses a flexible programming method that allows local decision makers and teachers to integrate physical activity opportunities into relevant school activities before, during, and after the school day. It must be emphasized that, while school-based physical activity should be used to support physical activity in the school environment, it should not be used as a replacement for physical education, whose importance is explained in Chapter 5 .

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• Young DR, Felton GM, Grieser M, Elder JP, Johnson C, Lee JS, Kubik MY. Policies and opportunities for physical activity in middle school environments. Journal of School Health. 2007; 77 (1):41–47. [ PMC free article : PMC2475674 ] [ PubMed : 17212759 ]
• Cite this Page Committee on Physical Activity and Physical Education in the School Environment; Food and Nutrition Board; Institute of Medicine; Kohl HW III, Cook HD, editors. Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington (DC): National Academies Press (US); 2013 Oct 30. 6, Approaches to Physical Activity in Schools.
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School-Aged Kids and Physical Activity

Christopher Futcher / Getty Images

Does your child run, play, and move for at least 60 minutes a day? For school-aged kids, physical activities are (and should be) fun, but they're also important. Kids this age need that daily hour of moderate to vigorous activity to stay fit and healthy. The time should be divided among aerobic , muscle-strengthening , and bone-strengthening activities.

Short bursts of 10 or 15 minutes count toward this daily tally, so make sure your child has lots of opportunities for physical activities before, during, and after school. 

Physical Activities at School

Academics are important, but so is finding time for fitness. When kids have the chance to run and play before school and at recess, they focus more and fidget less during class. Brain breaks also help.  Physical education (PE) provides another opportunity to move during the school day. It also exposes kids to new sports and games and introduces important health habits.

But not every child gets enough recess and PE time:

• Just five states (Alabama, Florida, Louisiana, New Jersey, and Oregon) plus the District of Columbia require the 150-minute weekly PE total in elementary schools.
• Only eight U.S. states require elementary schools to provide recess every day.

The Society of Health and Physical Educators, among other groups, recommends at least 150 minutes of PE a week for elementary schoolers — that means an average of 30 minutes a day. The association also urges schools to schedule at least one 20-minute recess period every day.

If your child's school doesn't offer enough physical activity time, ask the principal or school board to consider changes. And look for ways to help your child stay active outside of school hours.

Youth Sports

By early elementary school — age 6 or 7 — most kids have the physical coordination and attention span, plus the ability to grasp rules, which they need to play organized sports. A few years later — between ages 10 and 12 — most can handle the added pressure of team competition .

You can help your child get enough daily activity via sports and extracurricular activities if these fit your schedule and budget. Look for classes and recreational leagues that stress fitness, skill-building, fair play, and most of all, fun.

If your child enjoys team sports, try:

• Cheerleading
• Flag football
• Hockey (ice, floor, or field)
• Soccer (indoor/outdoor)
• T-ball, baseball, or softball

If your child prefers individual pursuits, consider:

• Horseback riding
• Ice skating
• Martial arts
• Rock climbing
• Skiing, snowboarding, or skateboarding
• Swimming/diving
• Track and field, or participating in a running club or 5K race

Note that many of these individually-focused sports can also be done as part of a team.

Ask your child what sports they're interested in, and give them the opportunity to try as many different activities as interest them. That means letting them quit if they discover the activity is not for them. You both might be surprised at what they're good at and love to do.

Provide kids with as much time and space to play as you can. Encourage lots of different physical activities. Mixing it up helps keep kids from getting bored, and also helps work many muscle groups. Emphasize fun and movement (rather than competition or "shoulds"). Try these family fitness ideas that are simple and accessible for many kids and adults:

• Biking or in-line skating
• Indoor dance parties
• Jumping rope or spinning a hula hoop
• Outdoor group games like tag or kickball
• Playing catch or Frisbee
• Running in the sprinkler, spraying each other with a hose, or other water play activities
• Sledding or snow-shoeing
• Visiting a playground
• Walking or hiking (make it more exciting with geocaching)

U.S. HSS. Physical activity guidelines for Americans, 2nd edition .

American Heart Association. Recess helps kids learn better in school .

Society of Health and Physical Educators (SHAPE). Shape of the Nation 2016 .

SHAPE America - Society of Health and Physical Educators and Voices for Healthy Kids. 2016 Shape of the nation report: Status of physical education in the USA , April 2016.

By Catherine Holecko Catherine Holecko is an experienced freelance writer and editor who specializes in pregnancy, parenting, health and fitness. 

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

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Open Access

Peer-reviewed

Research Article

An experimental study on the influence of healthy physical education curriculum model on sports ability of Chinese senior high school students

Contributed equally to this work with: Shengting Dai, Qian Qiu, Yuancai Zhang, Jingfei Yan, Rongbin Yin

Roles Conceptualization, Data curation, Funding acquisition, Writing – original draft

Affiliation School of Sports Science and Engineering, East China University of Science and Technology, Shanghai, China

Roles Data curation, Investigation, Methodology, Software, Writing – review & editing

Affiliation Physical Education College, Xuchang University, Xuchang, China

Roles Methodology, Resources, Supervision, Validation

Affiliation College of Physical Education and Health, East China Normal University, Shanghai, China

Roles Conceptualization, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing

* E-mail: [email protected] (JY); [email protected] (RY)

Affiliation Ministry of Physical Education, Shanghai Institute of Technology, Shanghai, China

Roles Methodology, Supervision, Validation, Writing – review & editing

Affiliation School of Physical Education, Soochow University, Suzhou, China

• Shengting Dai, 
• Qian Qiu, 
• Yuancai Zhang, 
• Jingfei Yan, 
• Rongbin Yin

• Published: May 14, 2024
• https://doi.org/10.1371/journal.pone.0298858
• Reader Comments

In recent years, the growing incidence of health issues among Chinese students, including obesity, diabetes, and other chronic diseases, has been attributed to a sedentary lifestyle, lack of physical activity, and unhealthy eating habits. Physical education (PE) classes play a crucial role in promoting physical activity and fostering healthy lifestyles among Chinese students. The purpose of this study was to investigate the influence of the healthy PE curriculum model on the sports ability of senior high school students in China. The trial adopted a quasi-experimental design with equivalent groups. The experimental group followed the healthy PE curriculum model in their PE classes, while the control group received traditional technical instruction. During the 12-week intervention, 149 senior high school students completed the sports ability test as both the pre-test and post-test measurements for this experimental study. The results indicated that the experimental group showed significant improvements in sports ability compared to the control group, highlighting the positive effects of the healthy PE curriculum model. The structural characteristics of the healthy PE curriculum model provided essential support for students’ learning and proved to be an effective way to promote physical literacy among senior high school students in China.

Citation: Dai S, Qiu Q, Zhang Y, Yan J, Yin R (2024) An experimental study on the influence of healthy physical education curriculum model on sports ability of Chinese senior high school students. PLoS ONE 19(5): e0298858. https://doi.org/10.1371/journal.pone.0298858

Editor: Preeti Kanawjia, GSVM Medical College, INDIA

Received: June 8, 2023; Accepted: February 1, 2024; Published: May 14, 2024

Copyright: © 2024 Dai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All data files are available from the DRYAD database: https://datadryad.org/stash/share/tP5af3E1HsllsF8bjCxfVtemLPPGNzDQBM0Orgn56c4 .

Funding: The funding for this research was made possible through the generous support of several grants: [East China University of Science and Technology Exploratory Research Fund Project]: This grant, awarded by [East China University of Science and Technology], grant number [JKL02222201], played a pivotal role in funding the initial stages of our research, including data collection and preliminary analyses. [Shanghai Educational Science Research Project]: We also received support from [Shanghai Municipal Commission of Education], grant number [C2023025], which significantly contributed to the development of our experimental design and the execution of specific research protocols. [contribution to study design, data curation, funding acquisition, decision to publish, and preparation of the manuscript, etc.]

Competing interests: The authors have declared that no competing interests exist.

1. Introduction

Physical education plays a crucial role in the development and well-being of students, especially during their formative years in senior high school [ 1 , 2 ]. With the growing concern for the sedentary lifestyles and poor health habits of today’s youth, there is a need for innovative physical education models that can help promote healthy lifestyles and enhance sports abilities [ 3 ]. In recent years, China has witnessed a dramatic increase in the number of students who suffer from health issues due to lack of physical activity [ 4 , 5 ]. The traditional physical education curriculum model in China is exam-oriented, which means that students focus mainly on achieving good grades rather than improving their physical fitness [ 6 ]. Therefore, there is a need to evaluate the effectiveness of physical education curricula in promoting physical activity and improving sports ability among Chinese senior high school students [ 7 ].

To effectively advance the implementation of China’s new primary and secondary school curriculum standards and foster the development of students’ core competencies in physical education and health, Professor Ji Liu, who led the 2015 National Primary and Secondary School Physical Education and Health Curriculum Standards Development and Revision Group and is associated with East China Normal University, drew inspiration from the” National Medium and Long-term Education Reform and Development Plan (2010–2020).”Guided by the fundamental principles outlined in the national “Physical Education and Health Curriculum Standards” for primary and secondary schools, Professor Ji Liu amalgamated international insights from physical education curriculum models and domestic best practices. This culminated in the proposal of a comprehensive physical education and health curriculum model, aptly named “The Healthy Physical Education Curriculum Model(HPECM),which harmoniously blends an international perspective with distinctively Chinese characteristics [ 8 ]. HPECM ( Table 1 ) plays a pivotal role in driving the implementation of the national”Curriculum Standards” in the domain of physical education and health. It not only aligns with the principles and ethos of the “Curriculum Standards” but also offers clear guidance and methodologies to address critical issues in curriculum development, as articulated by Professor Ji Liu in 2015.

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https://doi.org/10.1371/journal.pone.0298858.t001

This model adopts a comprehensive curriculum perspective, operating within the framework of curriculum discourse. It encompasses the holistic design of the curriculum, ranging from modules to individual units, with a strong emphasis on effective curriculum implementation. This approach outlines overarching requirements and specific implementation strategies."

The main purpose of the Healthy Physical Education Curriculum Model is to solve the problem of the continuous decline in the physical health level of Chinese teenagers in the past 30 years. The implementation of the Healthy Physical Education Curriculum Model requires grasping three key points: sports skills, physical fitness, and exercise load. In terms of sports skills, structured skill learning and practice are emphasized. Whether it is a new teaching or a review class, attention should be paid to activities and competitions, and single-skill teaching should be rejected, with time maintained at around 20 minutes (a 40-minute class as an example). In terms of physical fitness, diversified, interesting, and compensatory physical fitness design is emphasized, with time maintained at around 10 minutes. In terms of exercise load, it is emphasized that the average heart rate of students in the classroom should reach 140–160 times per minute, and the continuous exercise time of students should account for about 75% of the total class time. It should be noted that the exercise time of each student does not need to reach 75% of the total class time, but the teacher should arrange the entire activity time to not exceed 25% of the total class time in a static state. The structural characteristics of the Healthy Physical Education Curriculum Model not only help improve students’ sports ability but also contribute to the cultivation of students’ physical literacy [ 9 ].

Physical education curriculum models have been developed to address this issue and improve the quality of PE programs. Several studies have examined the effectiveness of the HPECM in improving sports ability outcomes among youth [ 10 , 11 ]. However, most of these studies have focused on elementary and middle school students. There is a need for research on the influence of the HPECM on sports ability among senior high school students. Therefore, the aim of this experimental study is to investigate the influence of HPECM on the sports ability of Chinese senior high school students. The study seeks to evaluate whether a curriculum model that emphasizes healthy physical activity can improve the sports ability of students and promote a more active lifestyle.

2. Materials and methods

2.1 study design.

Before the experimental research, the teacher of the experimental group was trained in the theory and practice of the healthy physical education curriculum model and achieved satisfactory training results. According to the school facilities, teachers’ characteristics, and students’ learning experience, the teaching experiment theme is basketball. Basketball teaching lasts for 12 weeks, two classes per week, for a total of 24 classes, each class lasting 80 minutes.

The experimental group firmly grasped the three key points of the healthy physical education curriculum model, and the teaching plan was jointly written between researcher and teacher after discussion. The control group implements routine teaching [ 12 ], that is, technical-traditional teaching, which has the following remarkable characteristics: The average heart rate of students in the whole class is less than 140 beats/min; Mainly adopts single movement skill teaching; There is no special physical exercise in the class. During the 12-week intervention period, all students completed the test of sports ability variables two times as the pre-test and post-test of this experimental study.

During the experiment, it is important to minimize the influence of irrelevant factors on the results. The control process mainly involves the following aspects: using identical teaching materials for both groups; ensuring that the teaching time is the same for both groups; adjusting the amount of teaching based on the weather and various school activities that may affect the experiment; to reduce experimental errors caused by differences in teaching styles and abilities among different teachers, the experimental and control groups are taught by the same teacher, and the experimental teacher is instructed to strictly follow the experimental plan while the control group should not intentionally imitate the experimental group’s teaching. Both the experimental and control groups were the students’ usual teachers. The principal investigator is present to assist and correct any problems that arise to ensure the effectiveness of the experimental teaching in the experimental group.

Inclusion/exclusion criteria :

Inclusion Criteria :

Educational Level: Participants must be currently enrolled high school students attending physical education classes.

Grade Range: Participants must specifically be high school sophomores.

Prior Physical Education Experience: Eligible participants should have successfully completed at least one year of physical education coursework.

Consent: Prior to participation, written informed consent is mandatory from both the students and their legal guardians.

Exclusion Criteria :

Medical Conditions: Participants with documented cardiovascular or respiratory conditions that may be adversely affected by physical activity will be excluded from the study.

Advanced Knowledge of Experimental Methods: Students possessing prior exposure or training in the experimental teaching methods under investigation will be excluded from participation.

These criteria aim to ensure a clear definition of the study’s target population, emphasizing the requisite educational level, grade, and prior experience in physical education. The inclusion of specific exclusion criteria serves to safeguard participant safety and maintain the integrity of the experimental design. Obtaining written informed consent further underscores the ethical considerations of the study.

Intervention condition and the control condition :

Intervention Condition: The intervention condition centers on the application of The Healthy Physical Education Curriculum Model (HPECM). Grounded in contemporary pedagogical theories, HPECM seamlessly integrates cutting-edge teaching strategies tailored to elevate student engagement, facilitate skill acquisition, and optimize overall outcomes in physical education. This intervention marks a departure from conventional didactic methods, introducing a student-centric paradigm. HPECM adopts an innovative approach by incorporating technology-assisted learning tools, personalized feedback mechanisms, and collaborative learning experiences. The overarching objective is to create an enriched educational environment that transcends traditional instructional practices.

Control Condition: To mitigate potential experimental errors arising from variations in physical education teaching methods, basketball is consistently chosen as the focal subject for this study. In addressing potential confounding factors linked to diverse teaching styles and instructor capabilities, a meticulous control strategy is implemented. Specifically, both the experimental and control classes within the same academic period are instructed by the same teacher. To ensure consistency, explicit instructions are provided to the experimental teachers, mandating adherence to the experimental plan. Conversely, the control class is advised against intentionally mimicking the experimental conditions. Throughout the teaching sessions, the experimental instructor actively engages in problem-solving, offering assistance and corrections promptly.

2.2 Participants

The research study selected second-year students from a high school in Shanghai as research objects. Class selection was conducted through a randomization procedure. A random number generator was employed to allocate classes to either the experimental or control group. This approach aimed to ensure an unbiased selection process and create comparable groups at the study’s outset. Two classes from the second grade of high school were randomly selected as Experimental Group 1 (girls class) and Experimental Group 2 (boys class) due to the influence of class division teaching. Additionally, two classes were randomly selected as Control Group 1 (girls class) and Control Group 2 (boys class). Students were asked about their past medical history, family genetics, cardiovascular disease status, etc., to rule out potential risks in sports. There were 76 students in the experimental group (36 boys and 40 girls), and 73 students in the control group (35 boys and 38 girls). Please refer to Table 2 for the mean and standard deviation of the age, height, and weight of students in each experimental class and control class. During the process of recruiting subjects, there were no refusals to participate, and all subjects participated fully in the teaching experiment.

https://doi.org/10.1371/journal.pone.0298858.t002

2.3 Ethics statement

Prior to conducting the study, ethical approval was granted by the University Committee on Human Research Protection (UCHRP) of East China Normal University. The research protocol, including the participant consent process, was reviewed and approved by the UCHRP under protocol number [Approval Number: HR 095–2019].

All participants in this study were voluntary respondents selected by the research panel. They were provided with detailed information about the study’s purpose, procedures, potential risks, and benefits. Participants were assured that their responses would be treated as strictly confidential and anonymous. The confidentiality of their data was maintained throughout the research process. Participants provided written informed consent to participate in this study. In accordance with the approved protocol, each participant confirmed their willingness to participate by endorsing the following statement on a paper questionnaire: "I voluntarily consent to participate in this research project. I understand that my participation is entirely voluntary and that I have the right to withdraw from the study at any point without any negative consequences."

2.4 Data collection

Data were collected over a period of 3 months (From October 2020 to December 2020), incorporating pre-test and post-test measurements. The data collection process comprised the following steps:

Pre-Test Assessment: Prior to the intervention, baseline measurements were obtained to assess the initial sports ability level of the participants.

Post-Test Assessment: Following the intervention period, post-test measurements were conducted to evaluate the impact of the healthy physical education curriculum model. The same assessment components used in the pre-test were administered to both the control and intervention groups. The post-test assessments use the same standardized protocols and equipment as the pre-test.

2.5 Experimental intervention program

2.5.1 motor skill intervention program..

The motor skill exercises for both the experimental and control groups were standardized to focus on basketball. This design was implemented to eliminate potential interference from varying motor skill exercises on the experimental results [ 13 – 16 ]. The design of motor skill instruction in the experimental group adhered to the guidelines set forth by the HPECM for motor skill teaching. Structured basketball skill instruction was employed to empower students to master a comprehensive set of motor skills. The approach advocated against the exclusive teaching of isolated techniques, instead emphasizing theintegration of basketball learning within practical activities and competetive scenarios. During basketball instruction, a priority was placed on minimizeing breaks, optimizing group dynamics, and enabling students to engage in supplementary exercises during idle moments. Teachers also reinforced precise movement techniques, encouraged cooperative practice, and instilled a sense of courage and initiative.

2.5.2 Physical fitness intervention program.

The principles governing physical fitness program design were aligned with the requirments of the HPECM. These princples were thougfully talored to suit the unique physical and psychological characteristics of high school students:

• Emphasis was placed on diversification and enjoyment in the methods and approaches employed for physical fitness exercises. This approach aimed to counteract the monotony often associated with endurance focused activities like running laps, repetitive exercises such as sit-ups for core strength, and sprinting for speed.
• Special attention was given to the concept of "compensatory" physical fitness exercises. Considering the distinctive demands of basketball within this study, students were encouraged to participate in supplementary exercises targeting core abdominal strength, cardiovascular endurance, and agility. This approach was integrated into the basketball curriculum, fostering a holistic and balanced approach to physical fitness development among students.
• Efforts were made to avoid transforming physical education classes into mere physical fitness testing sessions.

2.5.3 Motor cognitive ability intervention program.

The intervention principles of the motor cognitive ability intervention plan were formulated in accordance with the spirit of the HPECM and the contemporary teaching philosophy. These principles were strategically designed to accommodate the physical and psychological development characteristics inherent to high school students. Within the classroom setting, students were introduced to motor cognitive ability related knowledge through engaging PowerPoint presentations. Experimental teachers placed a strong emphasis on cultivating student’s motor cognitive ability throughout the teaching process. For instance, during warm-up exercises, teachers underscored the critical role of preparation activities in injury prevention and highlighted the benefits of relaxation in alleviating exercise-related fatigue.

2.6 Test variables

The assessment of sports ability includes three aspects: motor skills, physical fitness, and motor cognitive ability. Motor skills mainly include single skill assessment, combination skill assessment, and performance assessment in competition. Physical fitness tests mainly include indicators such as body composition, muscle strength, muscle endurance, Cardiopulmonary function, speed, flexibility, and agility. Motor cognitive ability is mainly assessed using scale tests. See Table 3 for specific details.

https://doi.org/10.1371/journal.pone.0298858.t003

2.6.1 Motor skill test.

Testing Protocol:

Single Techniques: Participants are assessed on fundamental basketball skills, including shooting. Each participant is given a specific task, and their execution is observed and rated based on established criteria.

Combination Techniques: This segment evaluates participants’ ability to seamlessly integrate various basketball skills. The task is passing and shooting, assessing the fluidity and effectiveness of their execution.

Match Performance: Participants engage in a simulated basketball game, applying their skills in a dynamic and competitive context. This allows for the assessment of strategic decision-making, teamwork, and adaptability during actual gameplay.

Evaluation Method:

Three experienced teachers serve as evaluators for each test, ensuring a comprehensive and reliable assessment. Each teacher scores participants independently based on predefined criteria for each skill and performance aspect. The final score for each participant is derived by calculating the average of the three individual scores.

Scoring Criteria:

1.Single Techniques

[85 points—100 points] Standard Attainment (70%): 6 males, 4 females; Technical Evaluation (30%): Demonstrates accurate posture and distinct finger flicking motion.

[75 points—84 points] Standard Attainment (70%): 4 males, 3 females; Technical Evaluation (30%): Exhibits relatively accurate posture with noticeable finger flicking motion.

[60 points—74 points] Standard Attainment (70%): 3 males, 2 females; Technical Evaluation (30%): Displays accurate posture with no discernible finger flicking motion.

[59 points and below] Standard Attainment (70%): 2 males, 1 female; Technical Evaluation (30%): Features inaccurate posture with no discernible finger flicking motion.

2.Combination Techniques

[85 points—100 points] Exceptional proficiency in passing and dribbling, demonstrating accurate passing, a correct and effortless shooting motion, and seamless coordination in passing, receiving, and shooting. Males complete the task within 45 seconds, and females within 56 seconds, with a successful shot count of 3 or more.

[75 points—84 points] Competent in passing and dribbling, showcasing correct shooting form and excellent coordination. Males complete the task within 50 seconds, and females within 60 seconds, with a successful shot count of 2 or more.

[60 points—74 points] Adequate execution of passing and shooting, albeit with slightly weaker coordination. Males complete the task within 55 seconds, and females within 65 seconds, with a successful shot count of 1 or more.

[59 points and below] Notable errors and significant mistakes in passing and shooting. Males complete the task in 55 seconds or more, and females in 65 seconds or more, with a successful shot count of 0.

3. Match Performance

[85 points—100 points]Personal Attack Ability: Proficient utilization of offensive skills (shooting, penetration, break, pass, and catch the ball) with a rational and skilled approach.Defensive Ability: Demonstrates strength in individual defense and cooperative defense skills.Tactical Awareness: Exhibits a robust individual tactical action ability, quick transition between attack and defense, and a keen sense of fast attack throughout the entire game.

[75 points—84 points]Personal Attack Ability: Displays a reasonable and skilled application of offensive techniques (throwing, sudden moves, passing).Defensive Ability: Strong performance in individual defense and cooperative defense. Tactical Awareness: Possesses a strong individual tactical action ability, fast attack and defense transition speed, and a heightened consciousness of fast attacks throughout the game.

[60 points—74 points]Personal Attack Ability: Demonstrates a general level of rationality and proficiency in utilizing offensive techniques (throwing, leaping, passing).Defensive Ability: Displays average individual defense and coordination defense skills. Tactical Awareness: Possesses a moderate individual tactical action ability, with a general speed in attack and defense transition, and a reasonable awareness of fast attacks throughout the game.

[59 points and below]Personal Attack Ability: Shows poor and unskilled use of offensive techniques (throwing, sudden moves, passing).Defensive Ability: Exhibits poor individual defense and cooperative defense skills. Tactical Awareness: Displays weak individual tactical action ability, slow offensive and defensive transition speed, and a poor consciousness of fast attacks throughout the entire game.

2.6.2 Physical fitness test.

The body composition test includes two indexes: Percentage of Body Fat (PBF) and Waist-Hip Ratio (WHR). PBF is measured primarily by the Jawon body composition analyzer [ 17 ]. WHR is calculated by measuring the waist and hip circumference using a soft ruler, with measurements taken twice on each side and then averaged [ 18 ].

The cardiopulmonary function test includes two indicators: vital capacity [ 19 ] and a 20-meter shuttle run test [ 20 ]. Vital capacity is measured using an electronic spirometer. The 20-meter shuttle run test requires students to run back and forth between two lines that are 20 meters apart in time with the music. As the test progresses, the music speed increases. If a student cannot reach the endpoint within the required time twice in a row, the test is stopped, and the score is recorded as the number of completed 20-meter shuttles, with the unit being "times."

The muscle strength test includes two indicators: upper limb muscle strength, measured by grip strength [ 21 ], and lower limb muscle strength, measured by standing long jump [ 22 ]. For the grip strength test, the subject stands upright with their feet shoulder-width apart, arms hanging down, and palms facing inward. They then squeeze the inner and outer handles of a dynamometer with maximum effort, and the score is recorded in "kg" units. Each subject is measured twice, and the best score is taken. For the standing long jump test, the subject stands behind the take-off line with their feet together and jumps forward as far as possible without stepping or jumping in place. The distance from the take-off line to the nearest landing point is measured vertically, and the score is recorded in "m" units. Again, two measurements are taken, and the best score is taken.

The muscle endurance test measures a student’s ability to complete as many sit-ups as possible within one minute [ 23 ]. To start, the student lies down on a soft pad with their knees bent at a 90-degree angle and their hands interlaced behind their head. The examiner holds the student’s ankles on both sides, fixing their feet to the ground. Upon hearing the ’start’ command, the student completes the sit-up motion by pulling in their stomach and touching or crossing their elbows over their knees before returning to the starting position. One point is awarded for each successful sit-up completed. The examiner records the number of completed sit-ups in one minute, using "times" as the unit of measurement.

The indicator for the flexibility test is the sit-and-reach test [ 24 ]. Firstly, the teacher explains the test requirements and demonstrates. During the test, the subject sits with their feet flat against the vertical board of the measuring device, with their legs straight and not bent, and their arms straight and extended forward, pushing the cursor with their fingertips until they can no longer reach forward. Each subject is tested twice, and the best score is recorded in "cm" units.

The indicator for the speed test is the 50-meter run [ 25 ]. Firstly, the teacher explains the test requirements and organizes the students to conduct sufficient warm-up exercises. During the test, two people are tested in each group. The subjects stand at the starting line and begin to run when they hear the "run" command. The starter waves the flag at the same time as the command is given, and the timer starts timing when the flag moves. The stopwatch stops when the subject’s chest reaches the vertical plane of the finish line, and the score is recorded in "S (seconds)." The test requires the subjects not to false start, and any false starters will be called back for a restart.

The agility test is measured by the 20-second shuttle run [ 26 ], as illustrated in Fig 1 . The subject assumes a squatting position with legs straddling the center. Upon hearing the start signal, they swiftly move to the right side and repeatedly shuttle back and forth in the order of "center→right→center→left→center…". Each time the subject crosses a line, it is counted as one, and the number of crossings completed within 20 seconds is recorded. The test is performed twice, and the best score is recorded in "times" units.

https://doi.org/10.1371/journal.pone.0298858.g001

2.6.3 Motor cognitive ability test.

This study used a Motor Cognitive Ability Scale, which was targeted at senior high school students and included two dimensions: motor cognition and physical fitness awareness, with a total of 9 items. The "motor cognition" dimension reflected senior high school students’ knowledge and methods of sports activities, appreciation of sports, and information about sports events. The "physical fitness awareness" dimension reflected information about senior high school students’ physical development. The scale used a 5-level Likert rating, where scores from 1 to 5 were calculated based on the degree of understanding of the theme, ranging from low to high, such as "I understand the competition rules of the sports I have learned." To assess internal consistency, we calculated Cronbach’s alpha for the scale. The standardized Cronbach’s α coefficient values of the two dimensions of sports cognition and physical fitness awareness of the scale are 0.897 and 0.865 respectively, and the standardized Cronbach’s of the scale is 0.918. To assess construct validity, we conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).The χ2 /df for the scale is 2.839. The goodness-of-fit indces, GFI, CFI, NFI, TLI, and IFI, are 0.977, 0.987,0.980, 0.978, and 0.987, respectively. The RMSEA is 0.058, and the RMR is 0.029. All the fitting indexes met the standard of good fit and met the statistical requirements.

2.7 Statistical analysis

The experiment utilizes a single-factor two-group pretest-posttest design, with covariance analysis applied to process the experimental data. The pretest scores of the test indicators are treated as covariates, and the group (consisting of an experimental class and a control class) is treated as the independent variable. The posttest scores of the test indicators are used as the dependent variables. By analyzing the changes in the physical literacy-related indicators of sports and health subjects in both the experimental and control classes, the effectiveness of the experimental intervention can be determined. If there is no significant difference in the changes of the related test indicators between the two classes, a paired sample t-test is conducted to examine whether there is a significant improvement in the post-test results of each class’s related indicators.

This section may be divided by subheadings. It should provide a concise and precise description of the experimental results, their interpretation, as well as the experimental conclusions that can be drawn.

3.1 Motor skill results

Table 4 provides descriptive statistics for the motor skill results of the experimental and control groups. The results are presented separately for each variable and by gender.

https://doi.org/10.1371/journal.pone.0298858.t004

For the 1-minute shooting task, the mean scores for both girls and boys in the experimental groups increased from pre-test to post-test. The girls in the experimental group improved their mean score by 8.17 points ( SD = 4.94), while the boys in the experimental group improved by 3.85 points ( SD = 11.10). The control groups also saw an increase in mean scores from pre-test to post-test, with girls improving by 5.65 points ( SD = 6.34) and boys improving by 2.06 points ( SD = 12.09). However, the experimental group showed a larger improvement in mean scores compared to the control group. For the passing and cutting coordination task, the mean scores for both girls and boys in the experimental groups increased from pre-test to post-test. The girls in the experimental group improved their mean score by 4.89 points ( SD = 4.92), while the boys in the experimental group improved by 5.39 points ( SD = 8.96). The control groups also showed an increase in mean scores from pre-test to post-test, but the improvement was smaller compared to the experimental group. The girls in the control group improved their mean score by 2.26 points ( SD = 3.43), while the boys in the control group improved by 3.85 points ( SD = 8.08). For the game performance task, the mean scores for both girls and boys in the experimental groups increased from pre-test to post-test. The girls in the experimental group improved their mean score by 5.71 points ( SD = 6.21), while the boys in the experimental group improved by 5.30 points ( SD = 4.47). The control groups also showed an increase in mean scores from pre-test to post-test, but the improvement was smaller compared to the experimental group. The girls in the control group improved their mean score by 4.132 points ( SD = 5.02), while the boys in the control group improved by 3.28 points ( SD = 5.72).

Overall, the experimental groups showed greater improvement in mean scores from pre-test to post-test compared to the control groups across all three tasks. The results suggest that the intervention had a positive impact on the motor skills of both girls and boys.

The results of the covariance analysis are shown in Table 5 . After controlling for the pre-test scores of male and female students in each class during the second year of high school, the post-test scores of the experimental group were significantly higher than those of the control group. Specifically, in terms of passing and cutting coordination, male and female students in the experimental group showed significantly higher scores than those in the control group. Moreover, in basketball games, the post-test scores of male and female students in the experimental group were also significantly higher than those in the control group after controlling for their pre-test scores. These findings suggest that adopting the Chinese Healthy Physical Education Curriculum model can effectively enhance the sports skills of second-year high school students, in comparison with traditional physical education teaching methods.

https://doi.org/10.1371/journal.pone.0298858.t005

3.2 Physical fitness results

Table 6 presents the descriptive statistics of the physical fitness results, including the pre-test and post-test mean scores and standard deviations for each dimension, variable, gender, and group.

https://doi.org/10.1371/journal.pone.0298858.t006

In terms of body composition, the experimental class 1 for girls and boys’ experimental class 2 had a slightly lower post-test mean score for percent body fat (PBF) compared to their respective control classes, although the difference was minimal. A similar trend was observed in waist-to-hip ratio (WHR), where the girls’ experimental class 1 and boys’ experimental class 2 had slightly lower post-test mean scores compared to their respective control classes. Regarding cardiopulmonary function, both the girls’ experimental class 1 and boys’ experimental class 2 had higher post-test mean scores for vital capacity compared to their respective control classes. For the 20-meter shuttle run, both girls’ and boys’ experimental classes had higher post-test mean scores compared to their respective control classes. In terms of muscle strength, the girls’ experimental class 1 and boys’ experimental class 2 had higher post-test mean scores for grip strength compared to their respective control classes. However, for standing long jump, there was no significant difference observed between the experimental and control classes. For muscle endurance, the girls’ experimental class 1 and boys’ experimental class 2 had higher post-test mean scores for 1-minute crunches compared to their respective control classes. Regarding flexibility, the girls’ experimental class 1 and boys’ experimental class 2 had higher post-test mean scores for seated forward bend compared to their respective control classes. Finally, in speed and agility, the experimental classes had slightly better post-test mean scores compared to their respective control classes.

In summary, the experimental classes showed an overall improvement in physical fitness in most dimensions, variables, genders, and groups compared to the control classes. However, the differences were sometimes minimal and not significant, indicating a need for further investigation and analysis of the results to determine the effectiveness of the physical fitness intervention.

The results of the covariance analysis are shown in Table 7 . Using pre-test scores as covariates, the study found that the post-test scores of male students in the experimental class were significantly lower than those of male students in the control class in terms of percent body fat (PBF), while there was no significant difference in PBF between female students in the experimental and control classes. The study also found that the experimental class had significantly lower waist-to-hip ratio (WHR) and significantly higher lung capacity, 20-meter shuttle run, grip strength, and standing long jump scores compared to the control class for both male and female students. Additionally, the experimental group had significantly higher scores on one-minute sit-ups and the 20-second shuttle run compared to the control group for both male and female students. However, the experimental group had significantly lower scores on the 50-meter run compared to the control group for both male and female students. The study concluded that using the Chinese Health and Physical Education Curriculum model can significantly improve physical fitness outcomes among male and female students in the second year of high school.

https://doi.org/10.1371/journal.pone.0298858.t007

3.3 Motor cognitive ability results

Table 8 presents the descriptive statistics for the motor cognitive ability results, specifically for the variables of motor cognition and physical fitness awareness.

https://doi.org/10.1371/journal.pone.0298858.t008

For the variable of motor cognition, the experimental class 1 for girls had a lower pre-test mean score compared to the control class 1, but this difference was not statistically significant. However, the experimental class 1 had a higher post-test mean score compared to the control class 1, and this difference was statistically significant. For boys, the experimental class 2 had a lower pre-test mean score compared to the control class 2, but this difference was not statistically significant. The experimental class 2 had a higher post-test mean score compared to the control class 2, and this difference was statistically significant.

For the variable of physical fitness awareness, the experimental class 1 for girls had a slightly higher pre-test mean score compared to the control class 1, but this difference was not statistically significant. The experimental class 1 had a significantly higher post-test mean score compared to the control class 1. For boys, the experimental class 2 had a lower pre-test mean score compared to the control class 2, but this difference was not statistically significant. The experimental class 2 had a significantly higher post-test mean score compared to the control class 2.

In summary, the experimental classes showed improvement in motor cognitive ability in terms of motor cognition and physical fitness awareness compared to the control classes. The differences were statistically significant for most comparisons, except for the pre-test mean scores in some cases. These results suggest that the physical fitness intervention had a positive impact on the motor cognition of the students. However, further research is needed to fully evaluate the effectiveness of the intervention.

Table 9 presents the results of a covariance analysis investigating the impact of gender and group membership on motor cognition and physical fitness awareness in experimental and control groups. The analysis revealed significant differences between the two groups in both variables. Girls in the experimental group scored higher in motor cognition and physical fitness awareness compared to girls in the control group. The same trend was observed for boys in the experimental group, who outperformed boys in the control group in both variables.

https://doi.org/10.1371/journal.pone.0298858.t009

These results suggest that incorporating motor activities into the curriculum can positively affect motor cognition in students, particularly in motor cognition and physical fitness awareness. Gender differences were also observed, emphasizing the importance of considering gender when designing interventions to enhance motor cognition in school settings. These findings can inform future instructional approaches to promote motor cognitive abilities among students.

4 Discussion

4.1 motor skill.

The study measured motor skills using three tasks: 1-minute shooting, passing and cutting coordination, and game performance. The results show that both girls and boys in the experimental groups improved their mean scores from pre-test to post-test in all three tasks, and their improvements were greater than those in the control groups.

In the 1-minute shooting task, both the experimental and control groups showed improvement from pre-test to post-test. However, the experimental group had a larger improvement in mean scores compared to the control group. This suggests that the intervention program was effective in improving shooting accuracy for both girls and boys. It is important to note that while the girls in the experimental group had a higher mean score at post-test than the boys, the boys had a higher mean score at pre-test, indicating potential gender differences in initial motor skill levels. Similarly, in the passing and cutting coordination task, both the experimental and control groups showed improvement from pre-test to post-test, but the experimental group had a larger improvement in mean scores compared to the control group. This suggests that the intervention program was effective in improving passing and cutting coordination for both girls and boys. In the game performance task, both the experimental and control groups showed improvement from pre-test to post-test, with the experimental group showing a larger improvement in mean scores compared to the control group. This suggests that the intervention program was effective in improving game performance for both girls and boys [ 27 , 28 ].

Overall, the study’s results suggest that the intervention program was effective in improving the motor skills of both girls and boys across all three tasks. The results align with previous research that has demonstrated the positive impact of intervention programs on motor skill development in children [ 29 ]. However, it is important to note that the study’s results are limited by the small sample size and the potential influence of other factors, such as natural maturation and practice effects.

4.2 Physical fitness

The findings of this study revealed that the experimental classes had an overall improvement in most variables of physical fitness compared to the control classes. The experimental classes demonstrated a slightly lower post-test mean score for PBF and WHR, indicating a trend towards healthier body composition. Moreover, the experimental classes exhibited higher post-test mean scores for vital capacity, shuttle run, grip strength, crunches, and seated forward bend, indicating improvement in cardiopulmonary function, muscle strength, muscle endurance, and flexibility, respectively. In terms of speed and agility, the experimental classes also showed a slight improvement in post-test mean scores.

The observed gender differences in initial motor skill levels in the 1-minute shooting task suggest that there may be a need to provide targeted intervention strategies for girls and boys to achieve optimal outcomes. Moreover, although the experimental classes showed an improvement in most dimensions of physical fitness, the differences were sometimes minimal and not significant, indicating a need for further investigation and analysis of the results. Therefore, it may be necessary to incorporate additional strategies or activities to enhance the effectiveness of physical fitness interventions for school-aged children [ 30 , 31 ].

These findings are consistent with previous research that has shown the positive effects of physical fitness interventions on children’s physical fitness and health outcomes [ 32 – 34 ]. The results of this study can be used to inform the development of future physical fitness interventions that can be implemented in schools or community settings.

4.3 Motor cognitive ability

The study examined the impact of HPECM intervention on motor cognition and physical fitness awareness among students in two experimental classes compared to two control classes. The results of the study indicated that the experimental groups showed improvement in both motor cognition and physical fitness awareness compared to the control groups. The differences were statistically significant for most comparisons, except for the pre-test mean scores in some cases. These findings suggest that incorporating physical activity into the curriculum can positively impact motor cognition in students, particularly in motor cognition and physical fitness awareness.

The results of the study are consistent with previous research that has shown a positive relationship between physical activity and cognitive functioning. For instance, a study by Hillman found that regular physical activity can improve cognitive performance and brain function in children [ 35 ]. Similarly, a study by Diamond and Lee reported that physical activity can enhance cognitive control and working memory in children [ 36 ].

The study also highlighted the importance of considering gender when designing interventions to enhance motor cognition in school settings. The results showed that girls in the experimental group scored higher in motor cognition and physical fitness awareness compared to girls in the control group, and the same trend was observed for boys. These findings are consistent with previous research indicating that gender differences exist in physical activity levels and that girls tend to be less physically active than boys [ 37 – 39 ].

The study has some limitations. Firstly, the sample size was relatively small, and the study was conducted in a specific cultural and geographic context. Therefore, caution should be exercised when generalizing the results to other populations. Secondly, the research exclusively focused on basketball, lacking a comparative analysis with other activities or sports projects. Future research endeavors will include comparative studies across various projects. Additionally, the study did not investigate the long-term effects of the HPECM intervention on sports ability. Future research could address these limitations by conducting larger-scale studies in diverse populations and exploring the long-term effects of HPECM intervention on sports ability.

5. Conclusions

In conclusion, this study provides evidence that healthy physical education curriculum model can effectively promote sports ability in senior high school students. The structural characteristics of a healthy physical education curriculum model provide needed support for students learning, improve students’ sports ability, and can be an effective way to promote physical literacy in senior high school students. Further research is needed to explore the long-term effects of the healthy physical education curriculum model on sports ability in students.

Acknowledgments

We would like to thank the physical education teachers, students and parents who participated in this experimental study. Without your cooperation, we could not complete this experiment.

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• Open access
• Published: 13 May 2024

The impact of the world’s first regulatory, multi-setting intervention on sedentary behaviour among children and adolescents (ENERGISE): a natural experiment evaluation

• Bai Li   ORCID: orcid.org/0000-0003-2706-9799 1 ,
• Selene Valerino-Perea 2 ,
• Weiwen Zhou 3 ,
• Yihong Xie 4 ,
• Keith Syrett 5 ,
• Remco Peters 1 ,
• Zouyan He 4 ,
• Yunfeng Zou 4 ,
• Frank de Vocht 6 , 7 &
• Charlie Foster 1  

International Journal of Behavioral Nutrition and Physical Activity volume  21 , Article number:  53 ( 2024 ) Cite this article

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Regulatory actions are increasingly used to tackle issues such as excessive alcohol or sugar intake, but such actions to reduce sedentary behaviour remain scarce. World Health Organization (WHO) guidelines on sedentary behaviour call for system-wide policies. The Chinese government introduced the world’s first nation-wide multi-setting regulation on multiple types of sedentary behaviour in children and adolescents in July 2021. This regulation restricts when (and for how long) online gaming businesses can provide access to pupils; the amount of homework teachers can assign to pupils according to their year groups; and when tutoring businesses can provide lessons to pupils. We evaluated the effect of this regulation on sedentary behaviour safeguarding pupils.

With a natural experiment evaluation design, we used representative surveillance data from 9- to 18-year-old pupils before and after the introduction of the regulation, for longitudinal ( n  = 7,054, matched individuals, primary analysis) and repeated cross-sectional ( n  = 99,947, exploratory analysis) analyses. We analysed pre-post differences for self-reported sedentary behaviour outcomes (total sedentary behaviour time, screen viewing time, electronic device use time, homework time, and out-of-campus learning time) using multilevel models, and explored differences by sex, education stage, residency, and baseline weight status.

Longitudinal analyses indicated that pupils had reduced their mean total daily sedentary behaviour time by 13.8% (95% confidence interval [CI]: -15.9 to -11.7%, approximately 46 min) and were 1.20 times as likely to meet international daily screen time recommendations (95% CI: 1.01 to 1.32) one month after the introduction of the regulation compared to the reference group (before its introduction). They were on average 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) than the reference group and reduced their daily total screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%, approximately 10 min). The positive effects were more pronounced among high-risk groups (secondary school and urban pupils who generally spend more time in sedentary behaviour) than in low-risk groups (primary school and rural pupils who generally spend less time in sedentary behaviour). The exploratory analyses showed comparable findings.

Conclusions

This regulatory intervention has been effective in reducing total and specific types of sedentary behaviour among Chinese children and adolescents, with the potential to reduce health inequalities. International researchers and policy makers may explore the feasibility and acceptability of implementing regulatory interventions on sedentary behaviour elsewhere.

The growing prevalence of sedentary behaviour in school-aged children and adolescents bears significant social, economic and health burdens in China and globally [ 1 ]–[ 3 ]. Sedentary behaviour refers to any waking behaviour characterised by an energy expenditure equal or lower than 1.5 metabolic equivalents (METs) while sitting, reclining, or lying [ 3 ]. Evidence from systematic reviews, meta-analyses and longitudinal studies have shown that excessive sedentary behaviour, in particular recreational screen-based sedentary behaviour, affect multiple dimensions of children and adolescents’ wellbeing, spanning across mental health [ 4 ], cognitive functions/developmental health/academic performance [ 5 ], [ 6 ], quality of life [ 7 ], and physical health [ 8 ]. In China, over 60% of school pupils use part of their sleep time to play mobile phones/digital games and watch TV programmes, and 27% use their sleep time to do homework or other learning activities [ 9 ]. Screen-based, sedentary entertainment has become the leading cause for going to bed late, which is linked to detrimental consequences for children’s physical and mental health [ 10 ]. Notably, academic-related activities such as post-school homework and off campus tutoring also contribute to the increasing amounts of sedentary behaviour. According to the Organisation for Economic Co-operation and Development (OECD) report, China is the leading country in time spent on homework by adolescents (14 h/week on average) [ 11 ].

The COVID-19 pandemic exacerbated this global challenge, with children and adolescents reported to have been the most affected group [ 12 ]. Schools are a frequently targeted setting for interventions to reduce sedentary behaviour [ 13 ]. However, school-based interventions have had limited success when delivered under real-world conditions or at scale [ 14 ]. School-based interventions alone have also been unsuccessful in mitigating the trend of increasing sedentary behaviour that is driven by a complex system of interdependent factors across multiple sectors [ 13 ]. Even for parents and carers who intend to restrict screen-based sedentary behaviour and for children who wish to reduce screen-based sedentary behaviour, social factors including peer pressure often form barriers to changing behaviour [ 15 ]. In multiple public health fields such as tobacco control and healthy eating promotion, there has been a notable shift away from downstream (e.g., health education) towards an upstream intervention approach (e.g., sugar taxation). However, regulatory actions for sedentary behaviour are scarce [ 16 ]. World Health Organization (WHO) 2020 guidelines on sedentary behaviour encourage sustainable and scalable approaches for limiting sedentary behaviour and call for more system-wide policies to improve this global challenge [ 8 ]. Up-stream interventions can act on sedentary behaviour more holistically and have the potential to maximise reach and health impact [ 13 ]. In response to this pressing issue, and to widespread demands from many parents/carers, the Chinese government introduced nationwide regulations in 2021 to restrict (i) the amount of homework that teachers can assign, (ii) when (and for how long) online gaming businesses can provide access to young people, and (iii) when tutoring businesses can provide lessons [ 17 ], [ 18 ]. Consultations with WHO officials and reviewers of international health policy interventions confirmed that this is currently the only government-led, multi-setting regulatory intervention on multiple types of sedentary behaviour among school-aged children and adolescents. A detailed description of this programme is available in the Additional File 1 .

We evaluated the impact of this regulatory intervention on sedentary behaviour in Chinese school-aged children and adolescents. We also investigated whether and how intervention effects differed by sex, education stage, geographical area, and baseline weight status.

Study design

The introduction of the nationwide regulation provided a unique opportunity for a natural experiment evaluation where the pre-regulation comparator group data (Wave 1) was compared to the post-regulation group data (Wave 2). Multiple components of the intervention (see Additional File 1 ) were introduced in phases from July 2021 with all components being fully in place by September 2021 [ 17 ], [ 18 ]. This paper follows the STROBE reporting guidance [ 19 ], [ 20 ].

Data source, study population and sampling

We obtained regionally representative data on 99,947 pupils who are resident in the Chinese province of Guangxi as part of Guangxi Centre for Disease Control and Prevention’s (CDC) routine surveillance. The data, available from participants in grade 4 (aged between 9 and 10 years) and higher, were collected using a multi-stage random sampling design (Fig.  1 ) through school visits by trained health professionals following standardised protocols (see Supplementary Fig.  1 , Additional File 1 ). In Wave 1 (data collected from September to November 2020), pupils were randomly selected from schools in 31 urban/rural counties from 14 cities in Guangxi. At least eight schools, including primary, secondary, high schools, and ‘vocational high schools’, were selected from urban counties. Five schools were selected from rural counties. Approximately 80 students were randomly selected from each grade at the schools selected. The same schools were invited to participate in Wave 2 (data collected from September to November 2021), and new schools were invited to replace Wave 1 schools that no longer participated. Children with available data at both Wave 1 and Wave 2 represented approximately 10% of the sample ( n  = 7,587). Paper-based questionnaires were administrated to students by trained personnel or teachers. The questionnaires were designed and validated by China National Health Commission, and have been utilised in routine surveillance throughout the country.

Flow diagram of participants included in the ENERGISE study

We used data from the age groups 7–18 years for most analyses. For specific analyses of homework and out-of-campus tutoring, we excluded high school pupils (16–18 years) because the homework and out-of-campus tutoring regulations apply to primary (7–12 years) and middle (13–15 years) school pupils only. Furthermore, participants without socio-demographic data or those who reported medical history of disease, or a physical disability were excluded. This gave us a total sample of 7,054 eligible school-aged children and adolescents with matching data (longitudinal sample).

Outcomes and subgroups

Guangxi CDC used purposively designed questions for surveillance purposes to assess sedentary behaviour outcomes (Table  1 ).

The primary outcomes of interest included: (1) total sedentary behaviour time, (2) homework time, (3) out-of-campus learning (private tutoring) time, and (4) electronic device use time (Table  1 ). We considered electronic device use time, including mobile phones, handheld game consoles, and tablets, the most suitable estimator of online game time (estimand) in the surveillance programme since these are the main devices used for online gaming in China [ 23 ]. Secondary outcomes were: (1) total screen-viewing time, (2) internet-use time, (3) likelihood of meeting international screen-viewing time recommendations, and (4) likelihood of meeting the regulation on homework time (Table  1 ).

We calculated total sedentary behaviour time as the sum of total screen-viewing time (secondary outcome), homework time, and out-of-campus learning time (Table  1 ). Total screen-viewing time represents the sum of electronic device use time per day, TV/video game use time per day, and computer use time per day (Table  1 ). Total screen-viewing time was considered as an alternative estimator of online game time (estimand) since TV/videogame console use time and computer time could also capture the small proportion of children who use these devices for online gaming (Table  1 ). The international screen-viewing time recommendations were based on the American Academy of Paediatrics guidelines [ 21 ]. We did not include internet use time (secondary outcome) in total screen-viewing time, and total sedentary behaviour time, because this measure likely overlaps with other variables.

We defined subgroups by demographic characteristics, including the child’s sex (at birth: girls or boys), date of birth, education stage [primary school or secondary school [including middle school, high school, and ‘occupational schools’]), children’s residency (urban versus rural) and children’s baseline weight status (non-overweight versus overweight/obesity). Each sampling site selected for the survey was classified by the surveillance personnel as urban/rural and as lower-, medium-, or higher-economic level based on the area’s gross domestic product (GDP) per capita. The area’s GDP per capita was measured by the Chinese Centre for Disease Control and Prevention (CDC). Trained personnel also measured height, and weight using calibrated stadiometers and scales. Children’s weight/height were measured with light clothing and no shoes. Measurements during both waves were undertaken when students lived a normal life (no lockdowns, school were opened normally). We classified weight status (normal weight vs. overweight/obesity) according to the Chinese national reference charts [ 24 ].

Statistical analyses

We treated sedentary behaviour values that exceeded 24-hours per day as missing. We did not exclude extreme values for body mass index from the analyses 25 . Additional information, justifications, and results of implausible and missing values can be found in the Supplementary Table 1 , Additional File 1 .

The assumptions for normality and heteroscedasticity were assessed visually by inspecting residuals. We assessed multicollinearity via variance inflation factors. The outcome variables for linear regression outcomes were transformed using square roots to meet assumptions. We reported descriptive demographic characteristics (age, sex, area of residence, socioeconomic status), weight status, and outcome variables using means (or medians for non-normally distributed data) and proportions [ 26 ]

We ran multilevel models with random effects nested at the school and child levels to compare the outcomes in Wave 1 against Wave 2. We developed separate models for each sedentary behaviour outcome variable. We treated the introduction of the nationwide regulation as the independent binary variable (0 for Wave 1 and 1 for Wave 2). We ran linear models for continuous outcomes, logistic models for binary outcomes, and ordered logistic models for ordinal outcomes in a complete case analysis estimating population average treatment effects [ 27 ]. For the main analysis, in which participants had measurements in both Waves (longitudinal sample), only those with non-missing data at both time points were included.

We estimated marginal effects for each sedentary behaviour outcome. With a self-developed directed acyclic graph (DAG) we identified age (continuous), sex (male/female), area of residence (urban/rural), and socioeconomic status (high/medium/low) as confounders (see Supplementary Figs. 2–4, Additional File 1 ).

We evaluated subgroup effects defined by child’s sex at birth (boys versus girls), child’s stage of education (primary school versus secondary school [including middle school, high school, and ‘occupational schools’]), children’s residency (rural versus urban), and children’s baseline weight status (non-overweight versus overweight/obesity). We also repeated the covariate-adjusted model with interaction terms (between Wave and sex; Wave and child stage of education; Wave and residency; and Wave and weight status). We adjusted for multiple testing using Bonferroni correction ( p 0.05 divided by the number of performed tests for an outcome). The resulting cut-off point of p  < 0.005 was used to determine the presence of any interaction effects.

We also conducted exploratory analyses (including subgroup analyses) by evaluating the same models with a representative, cross-sectional sample of 99,947 pupils. This cross-sectional sample included different schools and children at Wave 1 and Wave 2. We therefore used propensity score (PS) weighting to account for sample imbalances in the socio-demographic characteristics. Propensity scores were calculated by conducting a logistic regression, which calculated the likelihood of each individual to be in Wave 2 (dependent variable). Individual’s age, sex, area of residence and the GDP per area were treated as independent variables. Subsequently, inverse probability of treatment weighting was applied to balance the demographic characteristics in the sample in Wave 1 (unexposed to the regulatory intervention) and Wave 2 (exposed to the regulatory intervention). The sample weight for individuals in Wave 1 were calculated using the Eq. 1/ (1-propensity score). The sample weight for individuals in Wave 2 were calculated using the Eq. 1/propensity score [ 28 ].

We only ran linear models for continuous outcomes since it was not possible to run PS-weighted multilevel models with this sample size in Stata. We conducted all statistical analyses in Stata version 16.0.

Participant sample

In our primary, longitudinal analyses, we analysed data from 7,054 children and adolescents. The mean age was 12.3 years (SD, 2.4) and 3,477 (49.3%) were girls (Table  2 ). More detailed information on characteristics of subgroups in the longitudinal sample are presented in the Supplementary Tables 2–5, Additional File 2 .

Primary outcomes

Children and adolescents reported a reduction in their daily mean total sedentary behaviour time by 13.8% (95% CI: -15.9 to -11.7), or 46 min, on average between Waves 1 and 2. Participants were also less likely to report having increased their time spent on homework (adjusted odd ratio/AOR: 0.39; 95% CI: 0.35–0.43) and in out-of-campus learning (AOR: 0.53; 95% CI: 0.47 to 0.59) in Wave 2 in comparison to Wave 1, respectively (Tables  3 and 4 ). We did not find any changes in electronic device use time.

Secondary outcomes

Participants reported reducing their mean daily screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%), or 10 min, on average (Tables  3 and 4 ). Participants were also 20% as likely to meet international screen time recommendations (AOR: 1.20; 95% CI: 1.09 to 1.32) and were 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) compared to the reference group (before the introduction of the regulation).

Subgroup analyses

Most screen- and study-related sedentary behaviour outcomes differed by education stage ( p  < 0.005) (see Supplementary Tables 6–13, Additional File 2 ), with the reductions being larger in secondary school pupils than in primary school pupils (Tables  3 and 4 , and Table  5 ). Only secondary school pupils reduced their total screen-viewing time (-8.4%; 95% CI: -12.4 to -4.3) and were also 1.41 times as likely to meet screen-viewing recommendations (AOR: 1.41; 95% CI: 1.23 to 1.61) at Wave 2 compared to Wave 1.

Conversely, at Wave 2, primary school pupils reported a lower likelihood of spending more time doing homework (AOR: 0.30; 95%: 0.26 to 0.34) than secondary school pupils (AOR: 0.58; 95% CI: 0.50 to 0.67) compared to their counterparts at Wave 1. At Wave 2, primary school pupils also had a higher likelihood of reporting meeting homework time recommendations (AOR: 3.61; 95% CI: 3.09 to 4.22) than secondary school pupils (middle- and high school) (AOR: 2.11; 95% CI: 1.74 to 2.56) compared to their counterparts at Wave 1 (Table  5 ). There was also a residence interaction effect ( p  < 0.001) in total sedentary behaviour time, with participants in urban areas reporting larger reductions (-15.3%; 95% CI: -17.8 to -12.7) than those in rural areas (-11.2%; 95% CI: -15.0 to -7.4). There was no evidence of modifying effects by children’s sex or baseline weight status (Tables  4 and 5 ).

Findings from the exploratory repeated cross-sectional analyses were similar to the findings of the main longitudinal analyses including total sedentary behaviour time, electronic device use time, total screen-viewing time and internet use time (see Supplementary Tables 14–23, Additional File 2 ).

Principal findings

Our study evaluated the impact of the world’s first regulatory, multi-setting intervention on multiple types of sedentary behaviour among school-aged children and adolescents in China. We found that children and adolescents reduced their total sedentary behaviour time, screen-viewing time, homework time and out-of-campus learning time following its implementation. The positive intervention effects on total screen-viewing time (-8.4 vs. -2.3%), and the likelihood of meeting recommendations on screen-viewing time (1.41 vs. 1.02 AOR) were more pronounced in secondary school pupils compared with primary school pupils. Intervention effects on total sedentary behaviour time (-15.3 vs. -11.2%) were more pronounced among pupils living in the urban area (compared to pupils living in the rural area). These subgroup differences imply that the regulatory intervention benefit more the groups known to have a higher rate of sedentary behaviour [ 29 ].

Interestingly, the observed reduction in electronic device use itself did not reach statistical significance following implementation of regulation. This could be viewed as a positive outcome if this is correctly inferred and not the result of reporting bias or measurement error. International data indicated that average sedentary and total screen time have increased among children due to the COVID-19 pandemic [ 12 ]. However, such interesting finding might be explained by the absence of lockdowns in Guangxi during both surveillance waves when most school-aged students outside China were affected by pandemic mitigation measures such as online learning.

Strengths and weaknesses

Our study has several notable strengths. This is the first study to evaluate the impact of multi-setting nationwide regulations on multiple types of sedentary behaviour in a large and regionally representative sample of children and adolescents. Still, to gain a more comprehensive view of the regulatory intervention on sedentary behaviour across China, similar evaluation research should be conducted in other regions of China. Furthermore, access to a rich longitudinal dataset allowed for more robust claims of causality. The available data also allowed us to measure the effect of the intervention on multiple sedentary behaviours including recreational screen-time and academic-related behaviours. Lastly, the large data set allowed us to explore whether the effect of the regulatory intervention varied across important subgroups, suggesting areas for further research and development.

Some limitations need to be taken into consideration when interpreting our findings. First, a common limitation in non-controlled/non-randomised intervention studies is residual confounding. We aimed to limit this by adjusting our analysis for confounders known to impact the variables of interest, but it is impossible to know whether important confounding may still have been present. With maturation bias, it is possible that secular trends are the cause for any observed effects. However, this seems unlikely in our study as older children may spend more time doing homework [ 23 ] and engage more in screen-viewing activities [ 30 ]. In this study, we observed reductions in these outcomes. The use of self-reported outcomes (social desirability bias) was a limitation and might have led to the intervention effects being over-estimated [ 13 ]. However, since our data were collected as part of a routine surveillance programme, pupils were unaware of the evaluation. This might mitigate reporting bias. In addition, the data were collected in Guangxi which might not representative of the whole population in China. Another limitation is using electronic device use time as a proxy measure of online gaming time. It is possible that electronic devices can be used for other purposes. However, mobile phones, handheld game consoles and tablets are the main devices used for online gaming. In this study, electronic device use time provided a practical means of assessing the broad effects of regulatory measures on screen time behaviours, including online gaming, in a large (province level) surveillance programme. In the future, instruments specifically designed to capture online gaming behaviour should be used in surveillance and research work.

Comparisons with other studies

Neither China nor other countries globally have previously implemented and evaluated multi-setting regulatory interventions on multiple types of sedentary behaviour, which makes comparative discussions challenging. In general, results of health behaviour research over the past decades have shown that interventions that address structural and environmental determinants of multiple behaviours to be more effective in comparison with individual-focussed interventions [ 31 ]. Furthermore, the continuous and universal elements of regulatory interventions may be particularly important explanations for the observed reductions in sedentary behaviour. Standalone school and other institution-led interventions may struggle with financial and logistic costs which threaten long-term implementation [ 13 ]. In contrast, the universality element of regulatory intervention can reduce or remove peer pressures and potential stigmatisation among children and teachers that are often associated with more selective/targeted interventions [ 24 ]. Our findings support WHO guidelines for physical activity and sedentary behaviour that encourage sustainable and scalable approaches for limiting sedentary behaviour and call for more system-wide policies to improve this global challenge[ 8 ].

Implications for future policy and research

Our study has important implications for future research and practice both nationally and internationally. Within China, future research should focus on optimising the implementation of the regulatory intervention through implementation research and assess long-term effects of the regulation on both behavioral and health outcomes. Internationally, our findings also provide a promising policy avenue for other countries and communities outside of China to explore the opportunities and barriers to implement such programmes on sedentary behaviour. This exploratory process could start with assessing how key stakeholders (including school-aged children, parents/carers, schoolteachers, health professionals, and policy makers) within different country contexts perceive regulatory actions as an intervention approach for improving health and wellbeing in young people, and how they can be tailored to fit their own contexts. Within public health domains, including healthy eating promotion, tobacco and alcohol control, regulatory intervention approaches (e.g., smoking bans and sugar taxation) have been adopted. However, regulatory actions for sedentary behaviour are scarce [ 19 ]. Within the education sector, some countries recently banned mobile phone use in schools for academic purpose [ 25 ]. While this implies potential feasibility and desirability of such interventions internationally, there is little research on the demand for, and acceptability of, multi-faceted sedentary behaviour regulatory interventions for the purpose of improving health and wellbeing. It will be particularly important to identify and understand any differences in perceptions and feasibility both within (e.g., public versus policy makers) and across countries of differing socio-cultural-political environments.

This natural experiment evaluation indicates that a multi-setting, regulatory intervention on sedentary behaviour has been effective in reducing total sedentary behaviour, and multiple types of sedentary behaviour among Chinese school-aged children and adolescents. Contextually appropriate, regulatory interventions on sedentary behaviour could be explored and considered by researchers and policy makers in other countries.

Data availability

Access to anonymised data used in this study can be requested through the corresponding author BL, subject to approval by the Guangxi CDC. WZ and SVP have full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Abbreviations

Centre for disease control and prevention

Directed acyclic graph

Gross domestic product

Metabolic equivalents

Organisation for Economic Co-operation and Development

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Acknowledgements

We would like to acknowledge Dr Peter Green and Dr Ruth Salway for providing feedback on the initial data analysis plan, and Dr Hugo Pedder and Lauren Scott who provided feedback on the statistical analyses.

This work was funded by the Wellcome Trust through the Global Public Health Research Strand, Elizabeth Blackwell Institute for Health Research. The funder of our study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Bai Li, Remco Peters & Charlie Foster

Public Health Wales, Cardiff, UK

Selene Valerino-Perea

Department of Nutrition and School Health, Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China

Weiwen Zhou

School of Public Health, Guangxi Medical University, Nanning, Guangxi, China

Yihong Xie, Zouyan He & Yunfeng Zou

Centre for Health, Law, and Society, School of Law, University of Bristol, Bristol, UK

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Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

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BL conceived the study idea and obtained the funding with support from WZ, CF, KS, YX, YZ, ZH and RP. BL, CF, FdV and KS designed the study. WZ led data collection and provided access to the data. YX, SVP and ZH cleaned the data. SVP analysed the data with guidance from BL, FdV and CF. BL, SVP and RP drafted the paper which was revised by other authors. All authors read and approved the final manuscript for submission.

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Correspondence to Bai Li .

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Li, B., Valerino-Perea, S., Zhou, W. et al. The impact of the world’s first regulatory, multi-setting intervention on sedentary behaviour among children and adolescents (ENERGISE): a natural experiment evaluation. Int J Behav Nutr Phys Act 21 , 53 (2024). https://doi.org/10.1186/s12966-024-01591-w

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School district preparing for new summer reading intervention programs

A s students across the borough prepare to head home for the summer, the Kenai Peninsula Borough School District is preparing a reading intervention program that many of its third grade students will need to complete before returning for fourth grade.

The program is the latest piece of the Alaska Reads Act the district has had to bring itself into compliance with this school year. That legislation, signed into law by Gov. Mike Dunleavy in 2022, created four new programs all designed to ensure all Alaska students can read at grade level by the time they finish third grade.

The legislation says third graders who test well below benchmark on their end-of-year literacy assessment may either be held back, or retained, one school year, or must receive additional intervention services before starting fourth grade.

As KPBSD worked last fall to roll out a new curriculum as part of the bill’s implementation, some staff weren’t clear how that additional summer instruction would be delivered or paid for. KPBSD Assistant Superintendent Kari Dendurent said last week the district as recently as March was still trying to find funding.

As of early April, 152 third-grade students — roughly one in four third graders — were testing well below benchmark on their literacy assessments and would need to undergo supplemental instruction over the summer or be held back a year. Dendurent said school staff have been meeting since early May with those students’ parents to present them with options.

Those options include having their student:

Held back one school year;

Attend 20 hours of in-person instruction during the first week of August;

Complete monitored online literacy exercises and activities; or

Complete two physical workbooks of literacy exercises and activities.

“If a student is scoring well below on this benchmark, they are going to be recommended for retention as well as summer instruction,” Dendurent said. “Then, based on that recommendation, the parents can make a decision.”

The online instruction option would be an extension of the literacy acceleration and remediation program that students already use during the school year — Amplify’s Boost. Amplify is the company behind KPBSD’s new Core Knowledge Language Arts, or CKLA, curriculum.

KPBSD envisions the in-person instruction being delivered for four hours per day, five days per week, for one week at the end of the summer. Instruction would be offered at 12 school sites, with one certified staff member working with a maximum of 10 students each. In-person instruction would be available only for students attending brick-and-mortar schools.

To pay for that instruction, the district applied in late April for $50,000 in grant funding from the Alaska Department of Education and Early Development. If awarded, the grant would pay for staff salaries and benefits, as well as student transportation and snacks, among other things.

For most KPBSD third graders, in-person instruction will be delivered for four hours per day from Aug. 5-9 at their community school. Instruction for students attending Voznesenka and Kachemak-Selo schools will take place from May 30 to June 4. Students at Razdolna School will be instructed from July 22-26.

Dendurent said Thursday that scheduling instruction at the end of summer for most students was intentional.

“We don’t want to have the regression happen over the summer,” she said.

Per the district’s grant application, it is KPBSD’s goal that students who attend the in-person program increase both their reading fluency score by five words per minute and increase their overall literacy assessment scores by 25%. That’s in addition to completing a minimum of four Amplify Boost programs per week.

The DEED grant, if awarded, would also pay for a certified staff member that would help families complete Amplify Boost programs. KPBSD’s grant application says that coordinator would help students and families access and use the programs, send weekly communications to families and supply accountability strategies, among other things.

“The teacher coordinator will monitor Boost usage, set goals with students and parents, review data, assist with reporting to school intervention teams at the start of school about student progress and learning, and assist during in person instruction reading program as needed,” the application says.

The application also points to the most recent round of statewide assessment results in explaining why money for an in-person instruction program is needed. Those results, published in April, show that most KPBSD third graders — about 71% — were below proficient on the English Language Arts assessment.

Dendurent said the literacy support provided for in the Alaska Read Act is exactly the type of intervention needed to address those scores in a meaningful way.

“The State of Alaska is doing the right thing to push that every single student should be reading at proficiency levels by the end of the third grade,” she said. “If we if we looked at these (scores) and chose to do nothing, then I think that would be a problem.”

The district expects to hear by May 26 whether its grant application has been approved.

Reach reporter Ashlyn O’Hara at [email protected].

40 Facts About Elektrostal

Written by Lanette Mayes

Modified & Updated: 10 May 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

Elektrostal's fascinating history, vibrant culture, and promising future make it a city worth exploring. For more captivating facts about cities around the world, discover the unique characteristics that define each city . Uncover the hidden gems of Moscow Oblast through our in-depth look at Kolomna. Lastly, dive into the rich industrial heritage of Teesside, a thriving industrial center with its own story to tell.

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Weather forecast for the next coming days and current time of Elektrostal.

Elektrostal Sunrise and sunset

Find below the times of sunrise and sunset calculated 7 days to Elektrostal.

Elektrostal Hotel

Our team has selected for you a list of hotel in Elektrostal classified by value for money. Book your hotel room at the best price.

Elektrostal Nearby

Below is a list of activities and point of interest in Elektrostal and its surroundings.

Elektrostal Page

• Information /Russian-Federation--Moscow-Oblast--Elektrostal#info
• Demography /Russian-Federation--Moscow-Oblast--Elektrostal#demo
• Geography /Russian-Federation--Moscow-Oblast--Elektrostal#geo
• Distance /Russian-Federation--Moscow-Oblast--Elektrostal#dist1
• Map /Russian-Federation--Moscow-Oblast--Elektrostal#map
• Nearby cities and villages /Russian-Federation--Moscow-Oblast--Elektrostal#dist2
• Weather /Russian-Federation--Moscow-Oblast--Elektrostal#weather
• Sunrise and sunset /Russian-Federation--Moscow-Oblast--Elektrostal#sun
• Hotel /Russian-Federation--Moscow-Oblast--Elektrostal#hotel
• Nearby /Russian-Federation--Moscow-Oblast--Elektrostal#around
• Page /Russian-Federation--Moscow-Oblast--Elektrostal#page
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Geographic coordinates of Elektrostal, Moscow Oblast, Russia

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Coordinates of Elektrostal in decimal degrees

Coordinates of elektrostal in degrees and decimal minutes, utm coordinates of elektrostal, geographic coordinate systems.

WGS 84 coordinate reference system is the latest revision of the World Geodetic System, which is used in mapping and navigation, including GPS satellite navigation system (the Global Positioning System).

Geographic coordinates (latitude and longitude) define a position on the Earth’s surface. Coordinates are angular units. The canonical form of latitude and longitude representation uses degrees (°), minutes (′), and seconds (″). GPS systems widely use coordinates in degrees and decimal minutes, or in decimal degrees.

Latitude varies from −90° to 90°. The latitude of the Equator is 0°; the latitude of the South Pole is −90°; the latitude of the North Pole is 90°. Positive latitude values correspond to the geographic locations north of the Equator (abbrev. N). Negative latitude values correspond to the geographic locations south of the Equator (abbrev. S).

Longitude is counted from the prime meridian ( IERS Reference Meridian for WGS 84) and varies from −180° to 180°. Positive longitude values correspond to the geographic locations east of the prime meridian (abbrev. E). Negative longitude values correspond to the geographic locations west of the prime meridian (abbrev. W).

UTM or Universal Transverse Mercator coordinate system divides the Earth’s surface into 60 longitudinal zones. The coordinates of a location within each zone are defined as a planar coordinate pair related to the intersection of the equator and the zone’s central meridian, and measured in meters.

Elevation above sea level is a measure of a geographic location’s height. We are using the global digital elevation model GTOPO30 .

Elektrostal , Moscow Oblast, Russia