physical education articles 2021

Articles on Physical education

Displaying 1 - 20 of 35 articles.

Is exercise really good for the brain? Here’s what the science says

Matthieu P. Boisgontier , L’Université d’Ottawa/University of Ottawa and Boris Cheval , Université de Genève

Girls should get the chance to play football at school – but PE needs a major rehaul for all students

Shrehan Lynch , University of East London

School playgrounds are getting squeezed: here are 8 ways to keep students active in small spaces

Brendon Hyndman , Charles Sturt University ; Jessica Amy Sears , Charles Sturt University , and Vaughan Cruickshank , University of Tasmania

Outdoor education has psychological, cognitive and physical health benefits for children

Jean-Philippe Ayotte-Beaudet , Université de Sherbrooke and Felix Berrigan , Université de Sherbrooke

London’s Olympic legacy: research reveals why £2.2 billion investment in primary school PE has failed teachers

Vicky Randall , University of Winchester and Gerald Griggs

How sport can help young people to become better citizens

Vaughan Cruickshank , University of Tasmania and Casey Peter Mainsbridge , University of Tasmania

Missing out on PE during lockdowns means students will be playing  catch-up

Jora Broerse , Victoria University ; Cameron Van der Smee , Federation University Australia , and Jaimie-Lee Maple , Victoria University

Disabled children still face exclusion in PE – here’s what needs to change

Tom Gibbons , Teesside University and Kevin Dixon , Northumbria University, Newcastle

Taking the circus to school: How kids benefit from learning trapeze, juggling and unicycle in gym class

Marion Cossin , Université de Montréal

Thinking of choosing a health or PE subject in years 11 and 12? Here’s what you need to know

Brendon Hyndman , Charles Sturt University and Vaughan Cruickshank , University of Tasmania

Aussie kids are some of the least active in the world. We developed a cheap school program that gets results

Taren Sanders , Australian Catholic University ; Chris Lonsdale , Australian Catholic University ; David Lubans , University of Newcastle ; Michael Noetel , Australian Catholic University , and Philip D Parker , Australian Catholic University

When men started to obsess over  six-packs

Conor Heffernan , The University of Texas at Austin

PE can do much more than keep children fit – but its many benefits are often overlooked

David Grecic , University of Central Lancashire ; Andrew Sprake , University of Central Lancashire , and Robin Taylor , University of Central Lancashire

Distance learning makes it harder for kids to exercise, especially in low-income communities

Katelyn Esmonde , Johns Hopkins University and Keshia Pollack Porter , Johns Hopkins University

Kids need physical education – even when they can’t get it at school

Collin A. Webster , University of South Carolina

Learning through adventure: the many skills that can be taught outside the classroom

Gary Stidder , University of Brighton

Kids aren’t getting enough exercise, even in sporty Seattle

Julie McCleery , University of Washington

Bushwalking and bowls in schools: we need to teach kids activities they’ll go on to enjoy

Vaughan Cruickshank , University of Tasmania ; Brendon Hyndman , Charles Sturt University , and Shane Pill , Flinders University

How children who dread PE lessons at school can be given a sporting chance

Kiara Lewis , University of Huddersfield

Look up north. Here’s how Aussie kids can move more at school, Nordic style

Katja Siefken , University of South Australia ; Carol Maher , University of South Australia , and Charlotte Pawlowski , University of Southern Denmark

Related Topics

• Child health
• Physical activity

Top contributors

Program Director – Health and Physical Education, Maths/Science, Faculty of Education, University of Tasmania

Senior Manager, Brisbane Catholic Education & Associate Professor of Education (Adj.), Charles Sturt University

Reader in Sports Science (Clinical Physiology), University of Essex

Lecturer in Physical Education, University of Central Lancashire

Lecturer in Developmental Psychology, The University of Edinburgh

Senior Lecturer in Psychology, The University of Queensland

Assistant Professor of Psychological and Behavioural Science, London School of Economics and Political Science

Associate Professor in Physiology, Exercise and Nutrition, University of Stirling

Senior Research Fellow, Australian Catholic University

Senior Lecturer, Department for Health, Humanities and Social Sciences, University of Bath

Senior Lecturer, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham

Senior Lecturer in Physiology, Exercise and Nutrition, University of Stirling

Professor, Medical Research Future Fund Emerging Leader, University of South Australia

Senior Lecturer, Sport, Exercise and Health Sciences, Loughborough University

Lecturer in Sport and Fitness, The Open University

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Why Physical Education Can’t Be a Casualty of the Pandemic

Physical education provides a range of benefits to children; the fact that it’s been sidelined during school phase-back plans is a tragedy.

Commentary: PE Shouldn’t Be a Casualty of the Pandemic

Katherine Frey | The Washington Post | Getty Images

Students are social distancing during physical education class at Nitschmann Middle School, Oct. 14, 2020, in Bethlehem, PA.

A hard and fast warning was just issued from the United Kingdom and it affects our children. U.S. policymakers, educators and administrators, take note. The warning: the COVID-19 pandemic has exacerbated declines in children's physical fitness, excessive weight and mental health. Action is needed.

Sadly, in the U.S., two epidemics pre-dated COVID-19: an obesity epidemic and a mental health crisis. In fact, these two epidemics have been intensified by the global health pandemic, particularly for children. Suspected childhood obesity rates are on the rise with evidence suggesting long-term negative impacts and mental health-related pediatric emergency room visits were up by 31% by the end of 2020.

In the U.S., the prevalence of childhood obesity is 18.9% ; almost a fifth of our children are overweight, with disproportionately higher rates identified in vulnerable children, like those from a lower socioeconomic status and children with disabilities. Children who are obese are more likely to have poorer social emotional health, and physical activity is a known behavior to combat obesity and aid in improving mental health .

Photos: America's Pandemic Toll

For many children, it's been a year of schooling from home. This means substantial screen time and limited physical activity. Like most teachers, physical educators pivoted in March 2020, and creatively managed to teach physical education via virtual learning environments. Their role has been critical in ensuring students are active and maintaining the learning that would have occurred in physical education for the past year. Their efforts have been nothing but exceptional and, as they know, it was always a temporary substitute for in-person learning.

Physical educators teach a range of skills including but not limited to hand-eye coordination, balance, sport-specific skills, and how to transfer learned skills to community participation, which is known to uplift social-emotional health and possibly academics . The American Academy of Pediatrics agrees that schools play a critical role in providing opportunities for childhood physical activity. Physical educators are experts at combating the childhood physical inactivity epidemic and childhood mental health crisis – both epidemics silently but surely reaching a boiling point.

Yet, trends indicate that physical education is being left out of many phase-back plans for students as the pandemic lifts. I've heard stories of limited physical education, such as only 15 minutes per week and stories like gymnasiums, the primary physical education classrooms, being repurposed in phase-back plans, often retrofitted with dividers to act as traditional classrooms. Some schools, using hybrid-style phase-back plans, have left physical education online , neglecting to consider it for in-person learning .

This practice does not align with education laws.

Equitable access to physical education is vital to embracing physical activity as a lifelong behavior. In the United States, physical education is clearly identified as a part of a well-rounded education in the Every Student Succeeds Act (ESSA). And in fact, the overarching special education law in the U.S., the Individuals with Disabilities in Education Act ( IDEA ), indicates that physical education is a direct service for children with disabilities. This means physical education can and should be included in every individual education plan (IEP) for children with disabilities.

I don't want to be facile about the difficult decisions teachers, administrators and districts consider as their schools return to a new normal. But undervaluing the role of physical education is inappropriate – it is a part of a well-rounded education by law and a part of a student with a disability's IEP, a legal document. To sideline trained experts in our children's physical and mental health is a problem. Furthermore, physical educators are being asked to aid the school in ways that depreciate their training . I've heard stories, for example, of PE teachers being asked to monitor hallways.

The benefits of physical activity are well-known and well-documented. They have profound lifelong health benefits, such as better cardiovascular health, stronger muscles and bones, improved mental health, and lower risk for cardiovascular disease, diabetes, metabolic syndrome, and other diseases. The American College of Sports Medicine has an initiative called Exercise is Medicine; if a dose of physical activity came in the form of a pill, everyone would take it. But physical activity is not a pill. It is a behavior that is learned, taught, practiced and reinforced. It is a behavior that is powerful for our health, education and life.

If we get it right, we can ensure a healthier future for our children that includes education about physical activity and knowledge about how it positively impacts mental health.

Our collective need for movement has never been clearer. And we don't have time to miss out on opportunities to improve the mental and physical health of our children.

Physical education needs to take priority in school phase-back plans.

In fact, the law requires it.

Megan MacDonald is an associate professor of kinesiology in the College of Public Health & Human Sciences at Oregon State University and the IMPACT for Life Faculty Scholar. She is also the director of the early childhood research core at the university's Hallie E. Ford Center for Children & Families and a public voices fellow through the OpEd Project.

Tags: children's health , children , public health , Coronavirus , pandemic , public schools , K-12 education , United States

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Teaching Physical Education During COVID-19: Lessons Learned

How do I do this?

If you’re a health and physical educator, chances are you muttered that question — in some form — when the pandemic forced schools to shift to a mostly distance learning format.

At that time, it quickly became apparent that typical lessons and practices would not transition easily to remote learning. Teaching physical education during COVID-19 would be no simple task.

Even those of us who consider ourselves tech savvy, with experience teaching online or using online instructional tools, had to reimagine our face-to-face courses as we shifted to pandemic pedagogies. In response to the uncertainty, the physical education community banded together to share online content resources, instructional strategies, and engaging activities for distance learning.

My coauthors and I have been working extensively with K-12 physical educators and pre-service teachers over the past year to support them as they address the question of “How do I do this?”

It has been amazing to work with resilient and creative physical educators at all stages of career progression as we have unpacked and found creative solutions to a significant pedagogical challenge.

Common Questions About Teaching PE During COVID

In Part 1 and Part 2 of a three-part series published in the April 2021 issue of JOPERD , we address the 10 most common questions we received when providing professional development to PK-12 physical educators throughout the pandemic and in our teacher education courses.

These questions reflect health and physical educators’ need to:

• Meet the needs of low-income/disadvantaged students
• Teach with limited or no equipment
• Develop and maintain relationships online
• Teach elementary PE online
• Engage parents/families/guardians
• Determine an amount of work to assign in class
• Develop meaningful content for at-home learning
• Design engaging distance learning lessons
• Assess purposefully
• Accommodate all students online

We encourage readers to look at the articles not just through the lens of applying these concepts to the online environment but as solutions to common problems that may also support quality teaching and learning during face-to-face instruction.

Providing Choice in Physical Education

A common theme across all articles in the three-part series is the concept of offering choice. Integrating student-centered teaching approaches, including the concept of “voice and choice” is relevant to at least eight of the 10 questions covered in these articles.

“Voice and choice” means giving students opportunities to provide feedback (a voice) and allowing them to select from a range of options that meet their needs and interests (choice).

There is established and emerging evidence that suggests offering students choices helps develop autonomy, increase engagement, and increase motivation. There are many ways for educators to include choice, such as:

• Make physical activity meaningful. Let students choose activities that are meaningful to them. For example, if you are in a fitness unit allow students to choose the component of health or relevant skill they want to focus on and then guide them toward activities that will help them achieve their goals.
• Use community asset mapping . Give students options and resources for activities in their community (e.g., trails, parks, frisbee golf courses, safe bike routes). It is amazing how many people (of all ages!) are not aware of the wellness-focused resources, clubs, meet-up groups, etc. that are in their neighborhood.
• Remember Universal Design for Learning (UDL). UDL guides educators in the decisions they make to help provide flexible learning environments to accommodate individual learning differences. Here are some great definitions and examples of UDL in action . Physical educators should consider how they can utilize UDL principles to design their courses, assessments, and learning experiences to optimize the assets of their students.
• Provide options for equipment and other modifications. It is important to remember all the ways we can modify the learning environment. This might include allowing students to choose the equipment they will be most successful with (playground ball vs. basketball) and giving them options for modifying game rules. Or you may want to use child-designed game teaching approaches and give students the option of choosing the level of defense (cold, warm, hot) that will allow them to be challenged but successful.

When providing students choices, it is important to remember to use invitational language and to avoid prescriptive language. This means providing a range of options for students to choose from, not requiring them to select a specific exercise or task. When using these teaching strategies, the primary job of the educator is to promote student reflection about their choices and guide them toward alternate opportunities if necessary.

Looking to the Future

In Part 3 of the JOPERD series, we address the “So now what?” question. Now that most of us have had to teach in a distance learning format during the last year — and likely learned some new technology skills — how can we use these new skills when returning to in-person instruction?

It would be a shame for health and physical educators to revert to pre-pandemic pedagogies that are devoid of 21 st century skills and lack the student-centered approaches that many used during the pandemic.

A great way to leverage your online content is to think about ways you can integrate it into your face-to-face classes using a blended learning approach. Literature related to flipped and blended learning offer guidance not only of why we should be integrating technology into our face-to-face classes but how .

There are many benefits for blended and flipped learning including:

• Promoting student autonomy including improved students’ preparation for class;
• Increased knowledge and skill development opportunities and maximizing time in-class;
• Promoting positive social interactions and student engagement through purposeful reflection and collaboration;
• Shifting the teacher’s role to more of a “facilitator” and a dispenser of knowledge.

Although there have been many struggles over the past year, the silver lining from the COVID-19 pandemic is that health and physical educators have learned many lessons that can have positive impact on student learning as we return to the classroom, gymnasium, and other learning spaces.

What Can I Do?

Great question! First and foremost, educators need to practice self-care and ensure they are meeting the social and emotional needs of their students before learning can happen. Be kind to yourself as you transition back to in-person teaching!

As the profession looks forward to the 2021-2022 academic year (and beyond) do not hesitate to have hard conversations with your colleagues about the purpose of physical education and how you can rethink how you are meeting the needs of all learners.

Knowing that lasting change takes time, be sure to experiment with new teaching practices and take small steps. As was reinforced during the pandemic, we have a supportive health and physical education community with amazing resources to help you accomplish your goals.

Featured image by Giovanni Gagliardi on Unsplash .

Additional Resources

• How Do We Do This? Distance Learning in Physical Education During COVID-19 (April 2021 issue of JOPERD )
• SHAPE America COVID-19 Resource Library
• Best Practices for Delivering Online and Hybrid Learning (SHAPE America On-Demand Webinar)

David Daum, Ph.D., is an assistant professor of kinesiology at San Jose State University in California. He teaches undergraduate courses in physical education and supervises physical education credential candidates during their student teaching. His scholarship focuses on technology in physical education including K-12 online physical education.

Tyler Goad, Ph.D., is an assistant professor in the Department of Health, Physical Education, and Recreation at Emporia State University. He recently completed his doctorate at West Virginia University with an emphasis in physical education teacher education. His research interest include online physical education, technology in physical education, and professional issues in teacher education/higher education.

Chad Killian is an assistant professor of kinesiology at Georgia State University in Atlanta where he teaches undergraduate and graduate courses in physical education and advises doctoral students. His primary research interests involve studying the use and efficacy of digital instruction in the K-12 physical education environment.

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Article sections.

• Situating the Review Theoretically
• Search Strategy and Parameters
• Inclusion and Exclusion Criteria
• Technological Enhancement in Teaching: Using Technology as a Substitute of Teachers but not as Transforming Teaching and Learning Practices
• Technological Enhancement in Learning: Using Technology to Improve Motor Skills, Health, and Motivation
• Technological Enhancement in Curriculum: Using Technology to Facilitate the Enactment of New Curriculum
• Appendix: Details of Included Literature

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Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs

• Andjelka Pavlovic   ORCID: orcid.org/0000-0002-4400-5466 1 ,
• Laura F. DeFina 1 ,
• Breanna L. Natale 1 ,
• Shelby E. Thiele 1 ,
• Timothy J. Walker 2 ,
• Derek W. Craig 2 ,
• Georgina R. Vint 1 ,
• David Leonard 1 ,
• William L. Haskell 3 &
• Harold W. Kohl 2 , 4  

BMC Public Health volume  21 , Article number:  485 ( 2021 ) Cite this article

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The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning.

A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers ( n  = 1789), school ( n  = 62) and district administrators ( n  = 64), nurses ( n  = 3), and “other” ( n  = 522).

Of 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For closed schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For open schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”.

The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.

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In December 2019, a cluster of pneumonia like cases began to appear in China caused by a previously unknown virus, SARS-CoV-2 . The known cases of disease caused by this virus (COVID-19) grew at an exponential rate causing the World Health Organization (WHO) to declare COVID-19 a pandemic in March 2020. By early September, approximately 25.6 million confirmed cases were diagnosed worldwide with over 850,000 deaths across more than 200 countries [ 10 ]. The pandemic nature of COVID-19 led to extraordinary societal measures aimed at containing the virus including closure of schools, social distancing, and sheltering in place at home across the United States (US) [ 6 ].

The impact of prolonged school closures on students undergoing “distance learning” for a pandemic is unknown. During extended breaks from school, such as summertime, there are significant challenges including “summer learning loss” which reflects not only stagnation of learned information but also regression. From an academic perspective, the loss is greater in spelling skills and math computation than reading [ 13 ]. These losses are more pronounced among children with low socioeconomic status, learning disabilities, and those who are English language learners [ 8 ].

In addition to academics, children’s health suffers during these breaks as body mass index (BMI) is known to increase during the summer as much as 5.2 percentile points in one study evaluating 3588 ethnically diverse children [ 7 ]. A smaller study evaluating the impact of break duration on weight showed that shorter breaks (3 and 7 weeks) mitigated increases in BMI versus 12-week breaks. Finally, children who participated in organized summer sports had significant improvement in their cardiovascular fitness compared to non-participants [ 1 ]. The current norm of distance learning, born out of necessity for social distancing, will likely have parallel effects. Given the known, negative impact of extended school breaks on youth health, it is critical to understand how current remote schooling affects physical activity levels of children.

Many schools and school districts are faced with the challenge of finding the best approaches to deliver distance education including Physical Education (PE). While instruction for basic subjects can be adapted for distance learning, less is known about PE given the space requirements for traditional lessons. Additionally, social distancing and sheltering at home may decrease opportunities for physical activity. Experts continue to emphasize the importance of a physically active lifestyle for health and stress management, assuming appropriate precautions [ 9 ]. The purpose of the current study was to: 1) examine the maintenance of PE and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curriculum, and 3) understand the challenges experienced by physical educators during distance learning.

The “Meeting Children’s Physical Activity Needs during the COVID-19 Pandemic” questionnaire was developed to focus on three domains: 1) descriptive characteristics (job title of survey respondent, school location, school/district type and classification, and Title 1 status), 2) access to PE and physical activity, and 3) challenges associated with delivering PE and physical activity during the pandemic. To address these aims, the authors developed a new questionnaire as part of the present study and the list of all questions is included in the Supplement . In general, closed-ended response format was used to allow for efficient data aggregation and analysis. Further, emphasis was placed on limiting the number of questions for ease of administration while still capturing adequate information. The face validity was assessed by experts in the field. The questionnaire was then entered into Qualtrics XM® (SAP America Inc., Philadelphia, PA) and appropriate survey logic was inserted (i.e. PE questions were only displayed to PE teachers, etc.). The technical aspects of the survey tool were assessed by three experienced subject matter experts. Upon completion of the aforementioned assessment, the questionnaire was administered to potential participants.

The target population was selected from individuals with available email addresses within a single fitness assessment software (FitnessGram®), a tool to collect school-based fitness assessment data on children grades 3 to 12. This tool is widely used in the US and allowed for a diverse sample of respondents in terms of socioeconomics, regions, and states. Each survey participant answered a maximum of 15 questions based on their institution’s educational environment. FitnessGram users consist predominantly of PE teachers and school/district administrators including current or previous participants in The Cooper Institute Youth Programs (NFL Play 60 FitnessGram Project and the Healthy Zone™ School Program).

On April 23rd, 2020, the questionnaire was distributed to a convenience sample of 60,198 email contacts in the fitness assessment software contact database representing 29,786 active users and 30,412 prior users. Within the active contacts, 6839 schools were represented. The prevalence of viable and current email addresses in this database is unknown, making a definitive response rate unclear. In order to enhance response, four reminder emails were sent at approximately 2 day intervals and a giftcard raffle incentive was offered to participants. The deadline for completing the survey was May 4th, 2020 at 11:59 PM. A one-week response time was chosen at the guidance of school administration and to ensure availability of results well before fall planning. Ultimately, 3159 individuals responded to the survey. Of those, 594 individuals provided no answers and 125 provided partial demographic information, but answered no study-related questions. This resulted in a final analytic sample of 2440.

An introductory e-mail was sent to potential participants with study information, including the voluntary nature, and informed consent was implied when the respondent actively initiated the questionnaire. No identifying information was utilized in the study analysis. The research project and methodology were approved by The Cooper Institute Scientific and Institutional Review Boards.

Responses were exported from the Qualtrics XM® online survey platform and analyzed in SAS/STAT®, version 9.4 (SAS Institute, Inc. Cary NC USA). Descriptive statistics on respondent locations, job titles and school classification and status were tabulated along with selected responses on PE requirements and delivery before and during the pandemic. Changes in hours of PE required before and during the pandemic were tested using rank-sum statistics. The trend in responses across a Likert scale of accumulated physical activity changes among respondents whose school was closed was based on a model of log-linear counts. We considered each respondent as an independent observation, taking the view that respondents answered according to their own experiences, not as agents of a particular school or district.

Descriptive characteristics of respondents are presented in Table  1 . The majority of respondents were PE teachers ( n  = 1789), followed by district ( n  = 64) and school ( n  = 62) administrators, and nurses ( n  = 3). An additional 522 survey respondents chose the “other” category, which consisted of classroom teachers, coaches, PE department chairs, athletic directors, and information technology personnel. The final sample of respondents had representation from each of the 50 US states, the District of Columbia and Puerto Rico. Additionally, 41 participants reported residing outside of the US. Overall, we saw little regional variation in the results. The greatest number of participants were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status, an indicator of low socioeconomic status, (60.4%). The vast majority of respondents reported their campus being closed during the COVID-19 pandemic (97.8%) with 97.4% of school closures occurring during the month of March 2020.

Survey participants were asked if their school had access to distance learning prior to the COVID-19 pandemic. The largest percentage of respondents reported either “no access” (19.7%) or “I don’t know” (18.9%) to the availability of distance learning. For those schools with a distance learning infrastructure, math and science were most commonly available at 19.5 and 17.4%, respectively. Health and PE lagged behind with 12.3 and 12.1% identifying these subjects as part of distance learning prior to the COVID-19 pandemic. For those schools that closed their campuses, 86.1% were reportedly able to deliver PE remotely. The preferred methods of delivering such PE curricula were via distance learning (47.7%), at-home resources (26.6%), and parent collaboration (15.3%).

Prior to the COVID-19 pandemic, only 2.8 and 7.7% of pandemic closed and open schools, respectively, had no PE requirements (Fig.  1 ). The most common mandatory PE time was 1–2 h/week. During the pandemic, the percentage of schools with no PE requirement increased for both closed (21%) and open schools (60.5%). Furthermore, the total closed schools requiring at least 1 h of PE/week increased and the percentage of 3 and ≥ 4 required hours/week decreased. Overall, the survey results show that mandatory PE was maintained in the closed schools to a larger degree than open schools.

Physical Education requirements (hours/week) prior to versus during the COVID-19 pandemic based on school closure status (closed schools, left panel; open schools, right panel)

In addition to the PE related questions, we sought to determine the amount of physical activity and exercise obtained by students following the onset of the pandemic compared to the amount in a typical school day. Nearly 79% of survey respondents reported that students were accumulating either “significantly less” or “somewhat less” activity during the closure (Fig.  2 ). Respondents from Title 1 schools reported less physical activity for students during the shut-down than respondents from non-Title 1 schools or respondents unaware of their school’s Title 1 standing ( p  < 0.001). No significant differences in physical activity were observed across school level (i.e. elementary, middle, or high schools) or US regions. When able to deliver physical activity, the most commonly cited methods included at-home resources such as GoNoodle, OPEN, or YouTube (29%), e-learning platforms (27.9%), or virtual fitness/workouts by PE teachers (25.6%).

Survey respondent’s impression of the amount of physical activity accumulated during the school closure compared to the amount obtained in the typical school setting.

Finally, the survey addressed the challenges experienced by teachers delivering PE in both closed (Fig.  3 a) and open (Fig. 3 b) schools. For schools closed during the pandemic, the three most frequently cited challenges included “student access to online learning” (23.3%), “teacher/student communication” (14.3%), and “teacher remote work arrangements” (11.6%). For school and district administrators, “availability of teacher resources to address social-emotional needs of a student” and “telecommunication and IT difficulty” were identified as substantial challenges. For schools remaining open throughout the COVID-19 pandemic, the most commonly reported challenges include “social distancing” (26.4%), “access to gymnasium/equipment” (23.1%), and “concern for personal health and wellbeing” (23.1%). In addition, the district administrators were concerned with “addressing parent/students concerns regarding the COVID-19 pandemic” (33.3%) (data not shown).

The survey respondents were asked to select the top three most significant challenges to teaching during the COVID-19 pandemic. a Challenges experienced by closed schools. b Challenges experiences by schools that remained open

To date, this is the first study to examine the impact of the COVID-19 pandemic on PE and physical activity in youth as reported by a national convenience sample of physical educators, school/district administrators, and others. We showed that during the pandemic, respondents reported that youth across the US spent less time in both PE and physical activity. This finding, coupled with the dramatic relaxation of PE requirements, suggests a substantial reduction in opportunities for physical activity in youth during the pandemic. Although no other research regarding PE during a pandemic exists, previous literature has clearly demonstrated the negative impact of extended breaks from school on the health of youth [ 1 , 2 , 7 ]. For example, Carrel et al. [ 2 ] showed that in obese, middle-school children, a nine-month fitness-based PE intervention improved cardiorespiratory fitness, BMI, and insulin levels. Unfortunately, when the intervention was stopped during a 3-month summer break, all improvements were lost. This highlights the importance of ensuring continuation of PE and exercise during prolonged school breaks. Our survey discovered that a sizable percentage of respondents reported a reduction in or having no PE requirements during the pandemic. This “PE dumping” is likely multifaceted arising from acute health-related precautions, economic concerns, and the necessity to maintain academic programming.

The pandemic did not only impact PE, but also played a role in the amount of physical activity and exercise undertaken by youth across the nation. The results showed that 78.8% of survey participants believed their students were obtaining either “significantly less” or “somewhat less” physical activity compared to their typical school day. These findings demonstrate the need for at-home resources and solutions, so that youth can continue engaging in physical activity despite stay-at-home orders. Our findings were consistent with that of Pietrobelli et al. [ 11 ] who showed that children and adolescents, enrolled in a longitudinal observational study in Verona, Italy, decreased their time spent in sports by an average of 2.3 h/week and increased their screen time by approximately 4.9 h/week during the COVID-19 pandemic. Similar trends were observed in Shanghai, China among 2426 youth who participated in the Global Physical Activity Questionnaire developed by the WHO [ 15 ]. The authors found that the median time spent in physical activity decreased from 540 min/week to 105 min/week during the pandemic. Additionally, the prevalence of physically inactive youth increased from 21.3 to 65.6% during the same time period. Based on these findings, it is clear that opportunities for physical activity have decreased around the globe, and it is imperative that all youth are provided with safe, simple and easily implemented physical activity programs during the various phases of this pandemic [ 3 ].

The ramifications of decreased physical activity, school closures, and social isolation extend beyond declines in physical health. Mental health, specifically anxiety, stress, and depression, are negatively impacted when school-based resources are removed, leading to a worsening of these conditions [ 5 ]. As such, it is of utmost importance to support youth facing bereavement, parental unemployment, and drastic losses of household income. A possible method of improving mental health during the pandemic is to implement a structured exercise program that the child or adolescent finds enjoyable. Previous literature has shown that depressed adolescents treated with exercise were able to significantly reduce symptoms, improve psychosocial functioning, and maintain improvements at one-year follow up [ 4 ].

Finally, the findings of the present study identified and confirmed the substantial challenges experienced by teachers in both open and closed schools. While the concerns vary greatly between the two settings, this work provides great insight to educators and administrators for the upcoming school year. First, for schools that remained open, the PE curricular requirement was largely zero. This is not surprising as most of the US has been under social distancing orders, and as such, it is likely that schools removed activities where a student could break the “6 feet of separation” guideline and have to share exercise and/or sports equipment. For the schools that remained open, the biggest challenges were social distancing, access to a gymnasium, and concern for personal health and wellbeing. These challenges are especially important, as they should be utilized to inform educators and administrators returning to campus in the future. It will be critical to identify curriculum, activities, and equipment that allow youth to be physically active while avoiding close contact or use of uncleaned equipment.

In the closed schools, the most frequent challenge experienced by teachers as well as school/district administrators during the pandemic was “student access to online learning.” Considering that 60.4% of the respondents were from Title 1 schools, it is possible that the resources to carry out virtual learning were not immediately available to a large percentage of students. It was reassuring to see that an emphasis was put on having at least 1 h/week of PE in the at-home environment, which supports expert guidelines that everyone should remain physically active with appropriate precautions. Nonetheless, the general impression from the respondents was that there was a moderate to significant decrease in physical activity. This may be driven by economic, social, and environmental factors that prevent children from engaging in physical activity. If the pandemic continues, it will be critical to ensure that all children have access to physical activity motivating materials.

A strength of this study is the inclusion of a national convenience sample of survey respondents across each of the 50 US states, including the District of Columbia and Puerto Rico. An important benefit of this study was that 60.4% of the respondents were from Title 1 schools, which is comparable to the reported 2015–2016 national average [ 12 ]. Another strength of the study was the ability to gather information from various sources within the educational hierarchy including but not limited to physical educators, district and school administrators, athletic directors, grade teachers, coaches and nurses. The individually reported data reflect the unique respondent’s personal experience of their school environment and curriculum. Additionally, data were collected in a limited time frame after most schools have been working remotely for at least a month, and in general, were unaware of plans for returning to school. Hence, the accuracy of the perceived experiences was likely high. A limitation of the study is the lack of a scientifically validated questionnaire for school-level information that would answer the proposed aims. However, face validity was considered. Another limitation of the study is that a single survey respondent answered the questions based on their perception of the school environment, which could lead to biased responses. However, most participants who completed the survey were physical educators and thus the local expert on the topic. While the findings for open schools provide valuable insight, these results should be interpreted with caution as only a small number of schools in our study cohort remained open during the early phase of the COVID-19 pandemic. Lastly, data collected on students’ physical activity levels during the pandemic were based on subjective responses by the teacher rather than an objective tool such as an accelerometer.

In conclusion, the study showed the impact of COVID-19 on PE and physical activity across the nation. Significant reductions were observed in requirements for PE as well as the amount of time engaged in physical activity. Both of these factors could lead to higher obesity and lower cardiorespiratory fitness among children, predisposing them to cardiometabolic disease and other health consequences. Additionally, the most significant challenges experienced by teachers during the pandemic were identified for both closed and open schools. These results clearly support that different measures must be taken to keep children active and fit based on their educational environment. Schools should continue to maintain a PE requirement as a critical educational component during the pandemic. For those schooling remotely, it is critical to prioritize online learning options in the school curriculum and provide access to physical activity promoting materials. A potential obstacle, particularly in Title 1 schools, is the availability of adults to assist in the remote education as parents may need to work. It will likely require a combination of school- and community-based leadership support to ensure that children have adult supervision for both academic and physical education. For those attending school, the issues are more complicated as activity must be integrated with the need for social distancing. Optimally, PE curriculum with outdoor activities and without shareable equipment would provide opportunity for PE and exercise. Future research should examine the optimal methods to teach in both environments considering current acute health issues, or Coronavirus, and long-term obesity and inactivity related concerns such as diabetes. Additionally, future work should focus on developing carefully crafted questionnaires that will provide optimal insight for longitudinal and post-COVID-19 studies. It must be emphasized that maintenance of physical education and activity needs to be highly prioritized in the school or district planning as a healthy child is known to be a better learner with less behavioral issues [ 14 ].

Availability of data and materials

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

Body Mass Index

Physical Education

United States

World Health Organization

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Acknowledgements

The research team would like to thank Georgi Roberts, MS, Director of Health and Physical Education at Ft. Worth, TX Independent School District, for providing valuable feedback on the study and the survey. We are very grateful to Dr. Kenneth H. Cooper for his zealous efforts to ensure all youth have an opportunity to live a healthy and active life. Finally, we would like to thank Dr. Carolyn Barlow for her support in survey development and Ms. Julie Reed for providing administrative support.

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Andjelka Pavlovic, Laura F. DeFina, Breanna L. Natale, Shelby E. Thiele, Georgina R. Vint & David Leonard

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Conceived and designed the experiments: AP, LD, BN, ST, TW, DC, HK, WH. Performed the experiments: AP, LD, BN, ST, TW, DC. Analyzed and interpreted the data: AP, LD, BN, ST, TW, DC, GV, DL, HK, WH. Wrote the paper: AP, LD, BN, ST, TW, DC, GV, DL, HK, WH. All authors have read and approved the manuscript.

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Pavlovic, A., DeFina, L.F., Natale, B.L. et al. Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs. BMC Public Health 21 , 485 (2021). https://doi.org/10.1186/s12889-021-10545-x

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Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students — Youth Risk Behavior Survey, United States, 2021

Supplements / April 28, 2023 / 72(1);75–83

Shannon L. Michael, PhD 1 ; Sherry Everett Jones, PhD, JD 2 ; Caitlin L. Merlo, MPH 1 ; Sarah A. Sliwa, PhD 1 ; Sarah M. Lee, PhD 1 ; Kelly Cornett, MS 1 ; Nancy D. Brener, PhD 2 ; Tiffany J. Chen, MSPH 3 ,4 ; Carmen L. Ashley, MPH 2 ; Sohyun Park, PhD 3 ( View author affiliations )

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Introduction, limitations, future directions.

• Full Issue PDF

The fall of 2021 was the first school semester to begin with widespread in-person learning since the COVID-19 pandemic began. Understanding dietary and physical activity behaviors of adolescents during this time can provide insight into potential health equity gaps and programmatic needs in schools and communities. This report uses data from the 2021 national Youth Risk Behavior Survey conducted among a nationally representative sample of U.S. public and private school students in grades 9–12 to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race and ethnicity. In addition, 2-year comparisons (2019 versus 2021) of these behaviors were examined. In 2021, daily consumption of fruits, vegetables, and breakfast during the past 7 days remained low and decreased overall with specific disparities by sex and race and ethnicity from 2019 to 2021. The overall prevalence of students attending physical education classes daily, exercising to strengthen muscles on ≥3 days/week (i.e., met the guideline for muscle-strengthening activity), and playing on at least one sports team decreased from 2019 to 2021; whereas being physically active for ≥60 minutes/day on all 7 days (i.e., met the guideline for aerobic activity) and meeting both aerobic and muscle-strengthening guidelines remained low but did not change. These findings underscore the need for strategies to increase healthy dietary and physical activity behaviors both in the recovery phase of COVID-19 and longer term.

Healthy dietary and physical activity behaviors provide adolescents with various benefits and are important public health strategies for chronic disease prevention ( 1 , 2 ). These benefits include supporting healthy growth and development, maintaining a healthy body weight, reducing anxiety, and reducing the risk for developing health conditions (e.g., heart disease or type 2 diabetes) ( 1 , 2 ). Not having consistent opportunities to practice these health behaviors could negatively affect students’ physical and mental health, which have long-term health implications ( 1 – 3 ).

From the start of the COVID-19 pandemic in 2020, school and community practices changed to comply with COVID-19 guidance. Such changes included modified meal services and sport schedules, which likely affected opportunities for students to consistently engage in healthy dietary and physical activity behaviors ( 4 , 5 ). For example, recent studies illustrated that breakfast regularity declined during the pandemic, whereas afternoon and evening snack consumption increased among adolescents ( 6 ), and homes had more high-calorie snack foods, unhealthy foods (e.g., desserts or sweets), and nonperishable processed foods during the pandemic ( 7 ). Likewise, adolescent physical activity levels decreased at the beginning of the pandemic because of changes in school- and sports-based programs ( 4 , 8 ). These pandemic-related effects are concerning because students might not meet key recommendations in the Dietary Guidelines for Americans 2020–2025 for following a healthy eating pattern ( 1 ) and not reach the duration and frequency of physical activity recommended by the Physical Activity Guidelines for Americans, second edition ( 2 ).

Despite studies examining dietary and physical activity behaviors of students between March 2020 and July 2021 ( 4 – 8 ), little is known about these behaviors among U.S. high school students during the fall of 2021 when most of them returned to school in person. This report provides 2021 national estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race and ethnicity. This report also compares 2019 with 2021 data overall and by sex and race and ethnicity to identify health disparities magnified during the pandemic. Health professionals, state and local health officials, policymakers, and school leaders can use the findings in this report to highlight the need for school health policies, practices, and programs that promote students’ healthy dietary and physical activity behaviors and their overall physical and mental health during immediate and longer-term pandemic recovery efforts.

Data Source

This report includes data from the 2019 (N = 13,677) and 2021 (N = 17,232) YRBS, a cross-sectional, school-based survey conducted biennially since 1991. Each survey year, CDC collects data from a nationally representative sample of public and private school students in grades 9–12 in the 50 U.S. states and the District of Columbia. Additional information about YRBS sampling, data collection, response rates, and processing is available in the overview report of this supplement ( 9 ). The prevalence estimates for dietary and physical activity behaviors for the overall study population and by sex, race and ethnicity, grade, and sexual identity are available at https://nccd.cdc.gov/youthonline/App/Default.aspx . The full YRBS questionnaire, data sets, and documentation are available at https://www.cdc.gov/healthyyouth/data/yrbs/index.htm . This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.*

Six dietary variables and five physical activity variables were examined for this report ( Table 1 ). The dietary variables included the following: during the 7 days before the survey, had eaten fruit or drunk 100% fruit juices <1 time/day, had eaten vegetables <1 time/day, had not eaten breakfast on all 7 days (i.e., did not eat breakfast daily), had drunk soda or pop ≥1 time/day (not counting diet soda or diet pop), had drunk a sports drink ≥1 time/day, and had drunk <3 glasses/day of plain water. The physical activity variables included the following: during the 7 days before the survey, had been physically active for a total of ≥60 minutes/day on all 7 days (i.e., met the federal guideline for aerobic activity) ( 2 ), had exercised to strengthen or tone muscles on ≥3 days (i.e., met the federal guideline for muscle-strengthening activity), had met both aerobic and muscle-strengthening guidelines, had attended physical education classes on all 5 days during an average school week, and had played on ≥1 sports team during the 12 months before the survey.

Student demographic characteristics examined included sex (female or male) and race and ethnicity. Students were classified into seven racial and ethnic categories including American Indian or Alaska Native (AI/AN), Asian, Black or African American (Black), Hispanic or Latino (Hispanic), Native Hawaiian or other Pacific Islander (NH/OPI), White, and students who were two or more races (multiracial). (Persons of Hispanic origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic.) Grade was also included in the regression model.

For each behavior, the 2021 prevalence and 95% CIs were calculated overall and for each sex and race and ethnicity group. Statistically significant pairwise differences by sex and race and ethnicity were determined by t -tests with Taylor series linearization, as were comparisons between 2019 and 2021. Differences between prevalence estimates were considered statistically significant if the t -test p value was <0.05. Only statistically significant findings are described.

Using national YRBS data from 2021, four logistic regression models examined the association between: 1) having played on ≥1 sports team and being physically active for ≥60 minutes/day on all 7 days, 2) having played on ≥1 sports team and having met both aerobic and muscle-strengthening guidelines, 3) having attended physical education classes on all 5 days and being physically active for ≥60 minutes/day on all 7 days, and 4) having attended physical education classes on all 5 days and having met both aerobic and muscle-strengthening guidelines. These models controlled for sex, race and ethnicity, and grade. Results from the analyses are reported as adjusted prevalence ratios (APRs) with 95% CIs. APRs were considered statistically significant if the 95% CI did not include 1.0. Prevalence estimates with a denominator <30 were considered statistically unreliable and therefore were suppressed ( 9 ).

Dietary Behaviors

In 2021, 47.1% of students had eaten fruit or drunk 100% fruit juices <1 time/day, 45.3% had eaten vegetables <1 time/day, 75.0% had not eaten breakfast daily, 14.7% had drunk sugar-sweetened soda or pop ≥1 time/day, 11.2% had drunk a sports drink ≥1 time/day, and 44.2% had drunk <3 glasses/day of plain water ( Table 2 ).

Dietary behaviors varied by demographic characteristics. A higher percentage of female than male students had eaten fruit or drunk 100% fruit juices <1 time/day (50.5% versus 43.6%), had not eaten breakfast daily (80.1% versus 69.9%), and had drunk <3 glasses/day of plain water (46.1% versus 42.2%). In contrast, a higher percentage of male than female students had drunk sugar-sweetened soda or pop ≥1 time/day (16.5% versus 12.7%) and had drunk a sports drink ≥1 time/day (13.6% versus 8.4%). Although certain exceptions were observed, the prevalence of these poor dietary behaviors was lower among Asian students, but higher among Black students, than among students from other racial and ethnic groups.

During 2019–2021, increases occurred for three of the poor dietary behaviors examined ( Table 3 ). The percentage of students who had eaten fruit or drunk 100% fruit juices <1 time/day increased overall and among female, male, Hispanic, and White students. The percentage of students who had eaten vegetables <1 time/day also increased overall and among female and White students. In addition, the percentage of students who had not eaten breakfast daily increased overall and among female, male, Black, Hispanic, and White students.

Physical Activity Behaviors

In 2021, 23.9% of students had been physically active for ≥60 minutes/day on all 7 days, 44.9% had exercised to strengthen or tone their muscles ≥3 days/week, 16.0% had met both aerobic and muscle-strengthening guidelines, 19.0% had attended physical education classes on all 5 days, and 49.1% had played on ≥1 sports team ( Table 4 ).

Physical activity behaviors varied by demographic characteristics. A higher percentage of male than female students had been physically active for ≥60 minutes/day on all 7 days (31.7% versus 15.7%), had exercised to strengthen or tone their muscles on ≥3 days/week (56.6% versus 32.3%), had met both aerobic and muscle-strengthening guidelines (22.9% versus 8.8%), had attended physical education classes on all 5 days (21.1% versus 16.7%), and had played on ≥1 sports team (52.0% versus 46.4%).

Differences by race and ethnicity illustrated no clear pattern across all the physical activity behaviors. For example, the prevalence of being physically active for a total of ≥60 minutes/day on all 7 days was higher among AI/AN students than among Asian, Black, and Hispanic students. Whereas, the prevalence of meeting both aerobic and muscle-strengthening guidelines, and playing on ≥1 sports team was higher among White students than among Black, Hispanic, and multiracial students.

During 2019–2021, decreases occurred overall for three of the five physical activity behaviors examined ( Table 5 ). The percentage of students who had exercised to strengthen or tone their muscles on ≥3 days/week decreased overall and among female, Black, NH/OPI, and multiracial students. The percentage of students who had attended physical education classes on all 5 days decreased overall and among male, Asian, Hispanic, and NH/OPI students. The percentage of students who had played on ≥1 sports team decreased overall and among female, male, Black, Hispanic, White, and multiracial students. In addition, although the percentage of students who had met the aerobic and muscle-strengthening guidelines did not change overall, the percentage decreased among NH/OPI students.

Associations Between Physical Activity Behaviors

The findings in this report illustrated decreases from 2019 to 2021 in both the prevalence of students who had attended physical education classes on all 5 days and students who had played on ≥1 sports team but no changes in the prevalence estimates of having been physically active for ≥60 minutes/day on all 7 days or having met both aerobic and muscle-strengthening guidelines. These observations warranted an examination of the potential effect of physical education and sports participation on being physically active and meeting both guidelines.

In 2021, after adjusting for sex, race and ethnicity, and grade, students who played on ≥1 sports team compared with those who did not were 2.6 times more likely to be physically active for ≥60 minutes/day on all 7 days (APR = 2.6; CI = 2.4–2.8) and 3.6 times more likely to have met both aerobic and muscle-strengthening guidelines (APR = 3.6; CI = 3.3–4.0). Similarly, students who attended physical education classes on all 5 days compared with those who did not were 1.8 times more likely to be physically active for ≥60 minutes/day on all 7 days (APR = 1.8; CI = 1.5–2.0) and 2.1 times more likely to have met both aerobic and muscle-strengthening guidelines (APR = 2.1; CI = 1.7–2.5).

Although healthy dietary and physical activity behaviors are important for adolescents’ overall physical health, this study found that none of the 11 behaviors examined in this report have improved since 2019. Certain dietary and physical activity behaviors have worsened overall and for certain sex and racial and ethnic groups. These findings are particularly concerning because of the association between poor dietary behaviors and insufficient physical activity and numerous chronic health conditions and poor mental health ( 1 – 3 ). Understanding current dietary and physical activity behaviors among students and comparing them to prepandemic data can identify areas of high need and be used to influence longer-term physical and mental health outcomes through primary chronic disease prevention strategies.

Overall, these findings illustrate that certain students are not engaging in healthy dietary behaviors. Specifically, in 2021, consumption of fruits, vegetables, and daily breakfast remained low with certain disparities by sex and race and ethnicity, and these behaviors worsened overall from 2019 to 2021. Multiple factors could have contributed to these changes. For example, during the pandemic, certain students might have shifted away from healthy foods in favor of unhealthy alternatives to alleviate stress ( 10 ).

Although no differences were observed from 2019 to 2021 in consuming sports drinks ≥1 time/day, consuming soda ≥1 time/day, or consuming water <3 times/day, consumption of sugary drinks remained elevated in 2021. This poor dietary behavior is concerning because of its association with chronic diseases ( 1 ).

In 2021, with the exception of low fruit consumption, all poor dietary behaviors were lower among Asian students compared with students from other racial and ethnic groups. A previous study illustrated similar results for Asian students for sugar-sweetened beverage consumption but no significant findings for fruit and vegetable intake; breakfast consumption was not examined in that study ( 11 ). This study also found that three of the poor dietary behaviors (i.e., ate vegetables <1 time/day, had not eaten breakfast on any of the past 7 days, and drank a sports drink ≥1 time/day) were higher among Black students compared with Hispanic, White, and multiracial students. This observation is consistent with findings from 2019 ( 12 ).

The prevalence of all five physical activity behaviors was below 50%, and three of these behaviors decreased from 2019 to 2021. This observation was not surprising because of changes in adolescents’ school and extracurricular schedules as a result of the COVID-19 pandemic. Being physically active for ≥60 minutes/day on all 7 days (i.e., meeting guideline for aerobic activity) and meeting both aerobic and muscle-strengthening guidelines did not change from 2019 to 2021, which is inconsistent with findings from the beginning of the pandemic illustrating that physical activity decreased ( 4 ). However, the prevalence estimates for 2021 are still troubling, with less than one fourth (23.9%) of students getting the recommended ≥60 minutes of physical activity daily and only 16.0% meeting both aerobic and muscle-strengthening guidelines. Not meeting national physical activity guidelines means that students are not receiving the multiple physical and mental health benefits of physical activity (e.g., reducing stress, anxiety, and depression) and preventing various chronic disease risk factors ( 2 ).

The results in this report indicate decreases from 2019 to 2021 in physical education class attendance and sports team participation overall for certain sex and racial and ethnic groups. Both of these physical activity behaviors were affected by school closures during the COVID-19 pandemic. It is unclear why these two physical activity opportunities declined although meeting guidelines did not; however, the results of the logistic regression in this study illustrated that students who attend physical education classes daily or participate on a sports team are more likely to get ≥60 minutes of daily physical activity and meet the guidelines, indicating that opportunities for physical activity in and out of school are both important for meeting guidelines. Physical education classes and sports opportunities are also critical for developing social and emotional learning competencies (e.g., social interaction skills, communication skills, teamwork, and goal setting) as well as fostering school connectedness ( https://www.shapeamerica.org/standards/guidelines/sel-crosswalk.aspx ). School and other types of COVID-19 closures also might have maintained or exacerbated inequities related to accessing physical activity because students might have stayed at or close to their home and neighborhood with varying levels of safety and access to physical activity supports ( 13 ).

Similar to dietary behaviors, differences across racial and ethnic groups were inconsistent for the physical activity behaviors. However, this study illustrates that being physically active for ≥60 minutes/day on all 7 days, meeting both aerobic and muscle-strengthening guidelines, and playing on a sports team were higher among White students compared with Black, Hispanic, and multiracial students. A recent study had similar findings, indicating that White female adolescents had higher physical activity participation compared with Black, Hispanic, and other minority female students ( 14 ). Other differences across race and ethnicity found in this study warrant further investigation to determine what factors supported higher prevalence of physical activity behaviors among certain groups.

General limitations for the 2021 YRBS are available in the overview report of this supplement ( 9 ). The findings in this report are subject to at least four additional limitations. First, the national YRBS collects data on frequency of consumption rather than amount; therefore, these data cannot directly determine whether students are meeting specific dietary recommendations. Second, individual measures of socioeconomic status are not accounted for and are known to be associated with dietary consumption and physical activity opportunities ( 8 , 15 ). Third, this study did not investigate how these behaviors differed by sex within race and ethnicity to further examine health disparities. Finally, specific student experiences during COVID-19 are unknown (e.g., the extent of remote learning, school closure, and community burden of COVID-19). Therefore, quantifying the effect of COVID-19 is limited.

Schools face multiple priorities, including addressing mental health issues, mitigating learning loss among students, and offering opportunities for students to learn about and practice health behaviors. These priorities do not need to compete. Ensuring regular access to school-based physical activity and school meals that meet U.S. Department of Agriculture nutrition standards support students’ health and readiness to learn ( 2 , 16 ). For example, schools can address poor dietary behaviors among high school students by encouraging participation in the National School Lunch and School Breakfast Programs and providing multiple opportunities for students to access breakfast, including Grab and Go and Second Chance models ( https://frac.org/wp-content/uploads/how_it_works_bic_fact_sheet.pdf ; https://fns-prod.azureedge.us/sites/default/files/resource-files/SBPfactsheet.pdf ) that do not require students to arrive early to eat in the cafeteria. In addition, the Community Preventive Services Task Force recommends school-based gardening programs combined with nutrition education as a strategy to increase vegetable consumption ( https://www.thecommunityguide.org/sites/default/files/assets/Nutrition-Gardening-Fruit-Vegetable-Consumption-Children-508.pdf#:~:text=The Community Preventive Services Task Force recommends school-based,increase children%E2%80%99s vegetable consumption. Rationale Basis of Finding ).

Schools are also uniquely suited to provide students with multiple opportunities for physical activity participation. The actions of schools can be supported by other community strategies to increase physical activity promoted by Active People, Healthy Nation, an initiative led by CDC ( https://www.cdc.gov/physicalactivity/activepeoplehealthynation/index.html ). Further, implementing a Comprehensive School Physical Activity Program (CSPAP) increases opportunities for students to be physically active before, during, and after school, and can be tailored based on available resources, interests, time allotments, and community support ( https://www.cdc.gov/healthyschools/physicalactivity/index.htm ). A CSPAP approach enables schools to engage community partners, staff members, families, and before- and after-school leaders to increase the total amount of physical activity access for adolescents throughout the day.

Certain poor dietary behaviors (e.g., skipping breakfast and infrequent consumption of fruits and vegetables) appear to have worsened during the pandemic, and certain students continue to fall short of recommended levels of physical activity. Understanding current dietary and physical activity behaviors among high school students nationwide can support schools, communities, and families to make decisions about strategies needed to improve these behaviors during the pandemic recovery phase and beyond.

Corresponding author : Shannon L. Michael, PhD, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Telephone: 770-488-6125; Email: [email protected] .

1 Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2 Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC; 3 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC; 4 McKing Consulting Corporation, Atlanta, Georgia

Conflicts of Interest

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.

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Abbreviation: NA = not applicable. * This variable comprised more than one question. The responses of the questions were summed and then dichotomized to reflect <1 time/day versus ≥1 time/day.

* N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction, students in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering each question varied. Percentages in each category are calculated on the known data. † Refer to Table 1 for variable definitions. § On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. No significant differences by race and ethnicity. ¶ On the basis of t -test analysis with Taylor series linearization (p<0.05). No significant differences by sex. American Indian or Alaska Native (AI/AN) students significantly different from Black or African American (Black) students; Asian students significantly different from Black, Hispanic or Latino (Hispanic), Native Hawaiian and other Pacific Islander (NH/OPI), White, and multiracial students; Black students significantly different from Hispanic, White, and multiracial students; Hispanic students significantly different from White and multiracial students; and NH/OPI significantly different from White students. ** On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. Asian students significantly different from AI/AN, Black, Hispanic, NH/OPI, White, and multiracial students; Black students significantly different from Hispanic, White, and multiracial students; and Hispanic students significantly different from White students. †† On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. AI/AN significantly different from Asian students; Asian students significantly different from Black, Hispanic, White, and multiracial students; and White students significantly different from multiracial students. §§ On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. AI/AN students significantly different from Asian, Hispanic, White, and multiracial students; Asian students significantly different from Black, Hispanic, White, and multiracial students; and Black students significantly different from Hispanic, White, and multiracial students. ¶¶ On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. Asian students significantly different from Black, Hispanic, White, and multiracial students; and Black students significantly different from Hispanic and multiracial students. *** Persons of Hispanic origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic. ††† Prevalence estimates with a denominator <30 were considered statistically unreliable and therefore were suppressed.

* 2019: N = 13,677 respondents; 2021: N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction, students in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering each question varied. Percentages in each category are calculated on the known data. † Refer to Table 1 for variable definitions. § On the basis of t -test analysis with Taylor series linearization (p<0.05). An increase indicates a worsening of dietary behavior. ¶ Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic. ** Prevalence estimates with a denominator <30 were considered statistically unreliable and therefore were suppressed.

* N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction, students in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering each question varied. Percentages in each category are calculated on the known data. † Refer to Table 1 for variable definitions. § On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. American Indian or Alaska Native (AI/AN) students significantly different from Asian, Black or African American (Black), and Hispanic or Latino (Hispanic) students; and Asian, Black, Hispanic, and multiracial students significantly different from White students. ¶ On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. White students significantly different from multiracial students. ** On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. AI/AN students significantly different from Asian and Black students; Black students significantly different from Hispanic and White students; and Hispanic and multiracial students significantly different from White students. †† On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. Asian students significantly different from AI/AN, Black, Hispanic, White, and multiracial students. §§ On the basis of t -test analysis with Taylor series linearization (p<0.05). Female students significantly different from male students. AI/AN students significantly different from Hispanic students; Black students significantly different from Hispanic and White students; Hispanic students significantly different from White and multiracial students; and White students significantly different from multiracial students. ¶¶ Persons of Hispanic origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic.

* 2019: N = 13,677 respondents; 2021: N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction, students in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering each question varied. Percentages in each category are calculated on the known data. † Refer to Table 1 for variable definitions. § On the basis of t -test analysis with Taylor series linearization (p<0.05). A decrease indicates a worsening of the physical activity behavior. ¶ Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic.

Suggested citation for this article: Michael SL, Jones SE, Merlo CL, et al. Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students — Youth Risk Behavior Survey, United States, 2021. MMWR Suppl 2023;72(Suppl-1):75–83. DOI: http://dx.doi.org/10.15585/mmwr.su7201a9 .

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Highlights in Physical Education and Pedagogy: 2021/22

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Physical Education and Its Importance to Physical Activity, Vegetable Consumption and Thriving in High School Students in Norway

Associated data.

Data supporting reported results can be found on the following link: https://teams.microsoft.com/_#/school/files/General?threadId=19%3A00faa60f3ab64020b836a1c964c56962%40thread.skype&ctx=channel&context=PYD%2520Database&rootfolder=%252Fsites%252FTEAM_PYDCrossNational_Project%252FShared%2520Documents%252FGeneral%252FPYD%2520Database (accessed on 18 August 2021).

Earlier research indicates that physical education (PE) in school is associated with positive outcomes (e.g., healthy lifestyle, psychological well-being, and academic performance). Research assessing associations with resilience and thriving indicators, such as the 5Cs of Positive Youth Development (PYD; competence , confidence , character , caring , and connection ) is limited and more so in the Norwegian context. The aim of the present study was to investigate associations between PE grade (reflecting students’ effort in theoretical and practical aspects of the subject) and the 5Cs as well as healthy behaviors (physical activity (PA), fruit and vegetable consumption), using cross-sectional data collected from 220 high school students in Norway ( M age = 17.30 years old, SD = 1.12; 52% males). Results from structural equation modelling indicated positive associations between PE grade and four of the 5Cs ( competence , confidence , caring , and connection ; standardized coefficient: 0.22–0.60, p < 0.05) while in logistic regressions, a unit increase in PE grade was associated with higher likelihood of engaging in PA and vegetable consumption (OR = 1.94; 95% CI = 1.18–3.18 and OR = 1.68; 95% CI = 1.08–2.63, respectively). These significant findings suggest the need for policies and programs that can support effective planning and implementation of PE curriculum. However, further research is needed to probe into the role of PE on youth health and development with representative samples and longitudinal designs.

1. Introduction

The positive and protective effects of physical activity (PA), such as enhanced physical health, psychological well-being, increased concentration, academic performance, and reduced feelings of depression and anxiety, have been well documented in earlier studies [ 1 , 2 , 3 ]. Physical education (PE) is taught as a subject in many countries around the world, but it also incorporates aspects of PA within the school context, because of the different indoor and outdoor activities students engage in during PE sessions. Indeed, Mooses and colleagues [ 4 ] found PE to significantly increase daily moderate to vigorous PA alongside reducing sedentary time among schoolchildren. In addition, Tassitano and colleagues [ 5 ] observed a positive association between enrollment in PE sessions and several health-related behaviors including physical activity and fruit consumption.

In many schools, students’ efforts in PE are captured in the grade they receive on the subject. Thus, higher grades in PE would indicate greater efforts and achievement in the physical activities engaged in, which in turn can lead to the promotion of outcomes related to health and development as indicated in earlier studies [ 1 , 2 , 3 ]. The present study seeks to determine whether this is the case in high school students in Norway.

1.1. Physical Education in the Global and Norwegian Contexts

In basic terms, physical education has been described as “education through the physical”. Consistent with United Nations Educational, Scientific and Cultural Organization, PE embraces terms, such as “physical culture”, “movement”, “human motricity”, and “school sport”, and refers to a structured period of directed physical activity in school contexts [ 6 ]. A PE curriculum usually features activities such as team and individual games and sports, gymnastics, dance, swimming, outdoor adventure, and track and field athletics [ 6 ]. By engaging in a variety of physical activities, students are taught physical, social, mental, and emotional skills to empower them to live an active and healthy lifestyle. PE is also an arena where students can develop and practice skills related to collaboration, communication, creativity, and critical thinking [ 7 ].

In a world-wide survey of physical education that involved 232 countries (and autonomous regions), 97% of the countries were found to have either legal requirements for PE within their general education systems or PE was a general practice at some ages of the schoolchildren or phases of compulsory schooling [ 6 ]. The number of PE lessons that were taught in schools across the countries varied from 0.5 to 6.0 per week and from 16 to 46 weeks per year during compulsory education. Country variation depended greatly on the mindset held about the importance and relevance of the subject in the school curricula.

A European Commission report on physical education and sport at school in Europe indicates that while about 50% of the educational systems have national strategies to support the development of PE and PA, two-thirds have large-scale schemes assigned to these activities [ 8 ]. With activities that include athletics, dance, health and fitness, gymnastics, games, outdoor and adventure, swimming, winter sports, and others, the goals of European countries have been to promote the development of pupils and students in the physical, personal, and social domains [ 8 ].

As in many European countries, PE is one of several subjects taught to pupils and students in compulsory education in Norway (i.e., 6–16-year-olds in primary and lower secondary education). The PE curriculum has both practical and theoretical components. In both components of the curriculum, students are introduced to organized physical activities and spontaneous play in varied environments, in a wide range of sports, dance and other movement activities, and in outdoor life, which allows them to orient and spend time in nature in different seasons as well as being an aspect of exercise and lifestyle that deals with the effect of physical activity on health. In high schools, students receive a total of 168 h of PE lessons during their 3-year education, where in addition to sports activities, outdoor life, and lessons on exercise and lifestyle, they receive education in physical motor activities that go beyond traditional sports activities. Moreover, students at this level of education have the possibility to combine PE with active participation in competitive sports [ 9 ].

PE lessons in Norway focus on providing students with challenges and courage to enable them to stretch their own boundaries, in both spontaneous and organized activities. In addition, it is anticipated that students will experience joy, mastery and inspiration by participating in a variety of physical activities, which will eventually help them to develop self-esteem, self-understanding, positive perception of the body and positive identity. Furthermore, the social aspects of the physical activities are intended to create an arena where students can exercise fair play and respect for each other [ 9 , 10 ]. All these effects are positive outcomes that tend to signify several components of what has been referred to as the 5Cs of PYD ( competence , confidence , character , caring, and connection ) [ 11 ] and the ability to develop healthy behaviors, thus supporting health as defined by the World Health Organization. In 1948, the World Health Organization [ 12 ] defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (p. 100). PE’s role in facilitating health and development will thus touch on WHO’s three dimensions of health.

The current focus of the Norwegian PE curriculum is a result of changes made to the curriculum in 2012, due among others to students and teachers’ dissatisfaction with the stress emanating from the expectations attached to sports achievements and physical performance abilities as well as the observation and measurement the teachers had to undertake to grade students’ abilities. With the present curriculum, it is the effort made by students (i.e., the attempts made to use the acquired knowledge and capabilities to reach developmental goals and not necessarily the attained progress) that is considered as relevant [ 13 ]. Thus, a high grade in PE subject will not only indicate a form of academic achievement, but it will also signify students’ efforts and experience in a variety of physical activities and their knowledge on how these activities can promote positive developmental outcomes, such as health, self-development, and identity [ 14 ].

1.2. Positive Youth Development and the 5Cs

Positive Youth Development is a line of research and a developmental framework that focuses on the identification and promotion of youth strengths [ 15 , 16 ], and the equipping of youth toward becoming productive members of their society [ 16 ]. PYD suggests that all young people have strengths and as such are potential resources to their own development and that of the society they are a part of. In addition, PYD proposes that all youth contexts, such as home, school and the local community, have human and material resources that youth can have access to in their interactions with significant others in these contexts [ 17 ]. In PE sessions, these contextual resources will be the support from peers and teachers, the opportunities created for students to develop resilience, competences and mastery, the boundaries students will have to respect as well as the expectations to be met. Youth strengths will be the personal interest, skills, and abilities that students bring to the PE sessions.

Within PYD, the 5Cs are viewed as a product of the alignment between youth strengths and contextual resources [ 15 ]. Accordingly, the dynamic interaction that ensues between an active, engaged, and competent person and their receptive, supportive, and nurturing ecologies in the context of varying degrees of risk and adversity will lead to a process referred to as adaptive developmental regulations [ 11 , 15 , 18 ], where youth can be resilient, thrive and develop to their full potential. Thriving means youth are scoring high on the 5Cs. The 5Cs include competence (which reflects the positive views of an individual’s action in domains, such as academic, social, cognitive and vocational); confidence (which relates to the individual’s sense of mastery and purpose for the future, a positive identity and self-efficacy); character (which denotes one’s integrity, moral commitment, and respect for societal and cultural rules); caring (which indicates one’s sense of empathy and sympathy for others); and connection (which reflects the bidirectional exchanges and healthy relations between the individual and friends, family, school, and community). Within the PYD framework, the 5Cs typically reflect thriving and positive development, but also resilience (in contexts where there are high levels of risk and adversity) among young people [ 15 , 18 ]. PYD proposes that youth who are thriving are put on a life trajectory towards an “idealized adulthood” [ 19 ]. In addition, youth who are resilient and thriving are more likely to contribute to their own development as well as to the development of their society [ 15 ].

1.3. Earlier Research on Positive Youth Development, Healthy Behaviors and Physical Education

Research on the relationship between grade in PE (which reflects students’ participation in PE sessions) and the 5Cs of PYD is limited, although earlier studies have recounted several positive outcomes of PE in schools. In one study that investigated PYD-related outcomes in the contexts of PE, Holt et al. [ 20 ] found in a qualitative study of 8 teachers and 59 children at an inner-city school in Canada that PE activities engaged in tended to promote developmental outcomes, such as empathy and healthy relationships between students. In addition, PE activities became an arena where teachers considered students’ input to the PE activities and created boundaries and procedures for expected behaviors.

Furthermore, Bailey [ 1 ], in a review article, summarized several positive and profound benefits of PE that included physical health, healthy lifestyle, psychological well-being, social skills and improved academic performance. These benefits were more probable in contexts where there were positive experiences of the PE activities, enjoyment, efforts made to engage all students as well as when teachers and coaches were committed and were equipped with the necessary skills. In another literature review on the impact of PE and sport on educational outcomes, Stead and Nevill [ 21 ] found that increased physical education, physical activity or sport tended to maintain or enhance academic achievement. The authors also found a positive association between physical activity and aspects of mental health, such as self-esteem, emotive well-being, spirituality, and future expectations. Moreover, Stead and Nevill [ 21 ] observed that the implementation of extra organized physical activity, as little as 10 min into the school day, tended to improve classroom behavior. These earlier studies support the important role of PE on health (including the physical, mental, and social dimensions) and positive development in youth.

As for healthy behaviors and their associations with PE, Mayorga-Vega and colleagues [ 22 ] conducted a study among 158 students in a Spanish high school and found that students had greater physical activity levels and lower levels of sedentary behaviors during PE days compared to non-PE days and weekends. In a much larger sample of 4210 high school students in Brazil, Tassitano et al.’s [ 5 ] assessment of the role of PE enrollment on several health behaviors revealed, among others, positive associations of enrollment in PE classes with physical activity and fruit consumption, as well as a negative association with drinking of sugar-sweetened beverages. In a longitudinal study of Canadian adolescents, Wiseman and Weir [ 23 ] investigated PE rating among other subjects alongside the importance of PE for PA levels and several health variables over a two-year period. Their results indicated that most of the participants (78%) preferred PE over other subjects, and that preferring PE was associated with higher PA levels, lower BMI, and higher self-esteem. Thus, while earlier research supports the predictive role of PE on youth development and healthy behaviors, the evidence regarding the importance of PE to the 5Cs of PYD is unclear because of limited research.

1.4. Aims of the Present Study

Research on the 5Cs of PYD has usually involved American youth [ 11 , 24 ] although research featuring non-American samples is growing [ 25 , 26 ]. Moreover, while the effects of PE on youth health and development have been widely studied, a literature search did not return any study that had assessed the relation between PE and the 5Cs in the Norwegian context. Several studies have hinted how activities engaged in during PE can be used to foster positive development. For example, Mandigo et al. [ 27 ] described how quality PE activities can be used to promote positive development and peace education among schoolchildren in a developing country. More specifically, the authors outlined various behaviors in the physical, intellectual, psychological, and social domains that physical educators can instill in schoolchildren to foster the 5Cs of PYD and peaceful interactions. Holt and colleagues [ 20 ] also described how strategies, such as setting of clear boundaries and allowing inputs from schoolchildren, and the teacher being a PE specialist, could facilitate positive youth development. Thus, in line with these earlier PYD studies, PE can be an arena where youth development as well as health (as proposed by WHO) are promoted.

In the present study, the aim is to examine the link between grade in PE and positive outcomes reflected in the 5Cs of PYD. A second aim is to study the association between PE grade and healthy behaviors, such as PA during leisure time and the consumption of fruit and vegetables. With the goal of the Norwegian PE curriculum to promote health, self-development and identity among others, grade in PE reflecting attained knowledge, participation and efforts invested in various physical activities should be associated with the 5Cs. Thus, as a hypothesis, students with higher PE grades are also expected to report higher scores on the 5Cs. Like the 5Cs, positive associations are hypothesized between PE grade and healthy behaviors. If positive associations are found between PE, the 5Cs and healthy behaviors, PE can be considered as an avenue to instill competencies that can have implications for students’ health, thriving, and resilience. Earlier studies suggest that boys engage in PA more often than girls, and PA tends to decrease with age [ 28 ]. Parents’ educational level has also been found to be positively related to the 5Cs [ 26 ]. Hence, gender, age, and parents’ education were accounted for in the assessment of the influence of PE grade on the 5Cs and healthy behaviors.

2. Materials and Methods

2.1. sample.

The current study forms part of a larger international project on positive development among youth and emerging adults, where the general goal is to assess how youth strengths and contextual resources align to foster thriving and youth contribution to societal development [ 29 ]. For the present study, cross-sectional data were collected from 220 students in four high schools located in Eastern and Western Norway. About 52% of the participants were boys and the age range was between 16 and 20 years ( M = 17.30, SD = 1.12). Almost 83% reported that the highest level of education of their father was postsecondary, while 87% did the same for their mother’s education.

2.2. Measures

2.2.1. physical education grade.

Participants self-reported their current academic grade (1 to 6) on physical education. A grade of 1 represents minimum knowledge and effort invested during PE sessions while a grade of 6 represents great knowledge and maximum invested effort in PE sessions.

2.2.2. The 5Cs of PYD

To assess the 5Cs, Geldhof and colleagues’ [ 11 ] short version of the PYD questionnaire, consisting of 34 items, was used. Samples of the items used in measuring the 5Cs include: “I am just as smart as others my age” ( competence , 6 items); “I really like the way I look” ( confidence , 6 items); “I usually act the way I am supposed to” ( character , 8 items); “When I see someone being exploited I want to help them” ( caring , 6 items); and “I am a helpful and important family member” ( connection , 8 items). Responses were measured on a 5-point Likert scale, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree), for example, where a higher score indicated a higher experience of the C-item in question. The psychometric properties of the 5Cs scale have been mostly assessed in U.S. samples [ 11 , 24 ] but also in some non-U.S. samples [ 25 , 26 ].

2.2.3. Healthy Behaviors

Items measuring healthy behaviors (physical activity, fruit and vegetable consumption) were adopted from the Search Institute’s [ 30 ] survey on attitudes and behaviors. Participants indicated 0 (No) or 1 (Yes) to the following items: “I engage in physical activity (for at least 30 min) twice or more per week”, “I eat at least one serving of fruit every day” and “I eat at least one serving of vegetables every day”. Spearman correlation among the three healthy behaviors ranged from 0.25 to 0.37.

2.2.4. Demographic Variables

Data were also collected on gender (boy or girl), age and mother and father’s educational level (five levels of education: 1 (no education), 2 (primary school), 3 (high school), 4 (technical or vocational school), and 5 (university)). The demographics were treated as control variables in the data analysis.

2.3. Procedure

Data collection took place in May–August 2019. Convenience sampling was used to select four schools located in the Eastern and Western parts of Norway. The heads of the conveniently selected schools were contacted via e-mail, with a request to participate in the study and an information letter about the purpose of the study. After agreeing to participate, the heads of schools were sent informed consent forms, developed in accordance with the NSD (Norwegian Centre for Research Data) guidelines, which they were asked to sign and send back. Once that was done, teachers from the four schools who agreed to conduct the survey with their students were sent the questionnaire via email. Informed consent was sought from students prior to the data collection, which took place during school hours over the schools’ internal web system. NSD (Norwegian Centre for Research Data) approved the study (51708/3/IJJ), while Semantix Translations Norway AS, Oslo, Norway, a company that specializes in interpretation services, translated the questionnaire from English to Norwegian using double-checking methods and translation experts in the relevant field of research to ensure preservation of meaning.

2.4. Data Analysis

G*Power 3 [ 31 ] was used to conduct a power analysis to determine the sample size that will allow for the assessment of meaningful associations and the detection of effect sizes (small, medium, or large). Using a two-tailed test with the 5 independent variables (PE grade and the four demographic variables (gender, age, father’s education and mother’s education)), and an alpha value of 0.05, the results indicated that with a power of 0.80, sample sizes of 395, 55, and 25 were needed to detect effect sizes of 0.02 (small), 0.15 (medium), and 0.35 (large), respectively. Reaching the study’s sample size of 220 meant that medium to large effect sizes can be detected in the statistical analyses.

Descriptive and correlation analyses were performed using IBM SPSS Statistics for Windows, version 25, while all other analyses were carried out using Mplus version 8 [ 32 ]. Most participants (80%) were missing only 3 cases or less, while 59% had full data. The analyses in Mplus were conducted with the Maximum likelihood estimation, an estimation method used to handle missing cases. The method works by estimating a likelihood function for each case based on the variables present in the dataset such that all the available data are used.

Descriptive analyses were conducted to assess the pattern of study variables: the demographics, PE grade, the 5Cs of PYD and the three healthy behaviors. Confirmatory factor analysis (CFA) was performed on the items measuring the 5Cs to verify the factorial structure of the scale. Chi-square tests and indices, such as the Tucker Lewis Index (TLI; acceptable above 0.90), the Root Mean Square Error of Approximation (RMSEA; acceptable below 0.08), and Comparative Fit Index (CFI; acceptable above 0.90) [ 33 , 34 ]) were used to evaluate model fit. To test the hypothesis that higher scores in PE will be associated with higher scores in the 5Cs, structural equation modelling (SEM) analysis was carried out. In preliminary analyses, the linearity and normal distribution of the 5Cs as dependent variables were determined, with skewness and kurtosis falling within the acceptable range of −2 to +2 and −7 to +7, respectively for SEM analysis [ 35 ]. Finally, the hypothesis that higher scores in PE will be associated with higher odds of the healthy behaviors was tested using logistic regressions due to the binary response categories of the healthy behavior variables. In both SEM and logistic regression, the demographic variables: gender, age, and father’s and mother’s educational background were controlled for.

3.1. Descriptive Analysis

In Table 1 , a frequency analysis of PE grade showed that about 96% of the participants reported grades between 4 and 6. In the Norwegian high school system, a grade of 1 is the lowest, while 6 is the highest a student can earn in a subject. For the 5Cs of PYD, high Cronbach’s alphas, indicating high internal consistencies (ranging from 0.85–0.93) were estimated for all the Cs. The frequency distribution of the three healthy behaviors revealed that most of the participants (about 82%) engaged in PA for at least 30 min twice or more per week, while 57% and 70% consumed at least one serving of fruit and vegetable per day, respectively ( Table 1 ).

Descriptive statistics and reliability coefficients for study variables among Norwegian youth.

Furthermore, descriptive analysis of the 5Cs showed that the highest mean score was registered for caring ( M = 4.29, SD = 0.78), followed by character and then connection . Competence had the lowest mean score ( M = 3.65, SD = 0.86). Thus, on average, participants’ responses on the 5Cs suggested moderate to relatively high levels of the PYD outcomes. The statistically significant correlations between PE grade and the 5Cs (mean scores) were weak to moderate, ranging from 0.17 to 0.55. In addition, the correlation between PE grade and the healthy behaviors were weak but statistically significant (0.19–0.25). Finally, several significant but weak correlations were observed between the 5Cs and the healthy behavior variables as well as between the demographic variables, the 5Cs and the healthy behavior variables ( Table 2 ).

Correlation analyses of demographic variables, physical education grade, the 5Cs of PYD, and healthy behaviors.

Note. * p < 0.05; ** p < 0.01.

3.2. CFA of the 5Cs of PYD and Structural Equation Modelling of PE Grade and the 5Cs

Prior to the assessment of the associations between PE grade and the 5Cs, confirmatory factor analysis (CFA) was conducted on the 34 items of the 5Cs to determine the factorial structure of the scale. An initial CFA of the items, where 14 pairs of same-facet items (in competence , confidence , character and connection ) were allowed to correlate, yielded a poor model fit: χ 2 (500, N = 194) = 998.075, p < 0.001, RMSEA = 0.072, CFI = 0.872, TFI = 0.857. An examination of the modification indices revealed cross-loadings of four items, two items regarding social competence for competence , one item on social conscience for character and another on caring . In addition, the modification indices indicated correlations among one pair of same-construct items (i.e., confidence ) and two pairs of different-construct items, one between competence and connection , and the other between confidence and character . After eliminating cross-loading items and including the correlations, an adequate model fit was attained in a second CFA: χ 2 (378, N = 194) = 646.879, p < 0.001, RMSEA = 0.061, CFI = 0.917, TFI = 0.905. The factor loadings for all 5Cs in this new CFA were adequate, ranging from 0.54 to 0.91. Correlations among the latent factors of the 5Cs were between 0.32 and 0.88.

In Table 3 , having controlled for demographic factors (i.e., gender, age, and parents’ educational background), findings from the structural equation modelling revealed significant associations between PE grade and all the 5Cs of PYD except for character . Not surprisingly, the strongest association was between PE grade and competence (standardized coefficient of 0.60), both largely reflecting students’ competence. The standardized coefficients for confidence and connection were 0.36, and 0.37, respectively, while for caring the coefficient was 0.22. Thus, higher scores in PE were significantly associated with higher scores in the 5Cs besides character . As for the demographic variables, only gender was significantly related to caring in the SEM analysis (standardized coefficient of 0.36), where girls scored higher than boys.

Structural equation model of physical education grade and the 5Cs of PYD.

Note. PE—Physical education; a Controlled for gender, age, father’s education and mother’s education; * Standardized coefficient. Italics and bold show significant levels less than 0.05.

3.3. Logistic Regression Analyses of Physical Education and Healthy Behaviors

For the associations between PE grade and healthy behaviors, logistic regression models were analyzed because of the binary response categories of the behaviors ( Table 4 ). After controlling for the demographic variables, a unit increase in PE grade was associated with a 94% higher likelihood of engaging in PA (OR = 1.94; 95% CI = 1.18–3.18), and a 68% higher likelihood of vegetable consumption (OR = 1.68; 95% CI = 1.08–2.63), that is, when all other variables in the models were held at a constant. Thus, PE grade was significantly related to higher odds of PA and vegetable consumption, while the association with fruit consumption was not significant. None of the demographic variables were significantly related to the healthy behavior variables in the logistic regression analyses.

Associations between physical education (PE) and healthy behaviours: logistic regression analysis.

Note. PE—Physical education; B—Unstandardized coefficient; S.E.—Standard Error; Sig—Significance level; OR—Odds Ratio; CI—Confidence Interval.

4. Discussion

The aim of the present study was to investigate the associations of PE grade with the 5Cs of PYD and healthy behaviors. As hypothesized, positive associations were observed between PE grade and four of the 5Cs ( competence , confidence , caring , and connection ) after adjusting for gender, age, and father’s and mother’s educational background. In contrast, although there was an indication that character was associated with PE grade, this association was not statistically significant in the SEM analysis. For the associations between PE grade and healthy behaviors, while logistic regression analyses showed higher odds of engagement in PA and vegetable consumption with every unit increase in PE grade, no such association was found for fruit consumption. Thus, the hypotheses were confirmed, although not for the association of PE grade with character and fruit consumption. That PE was found to be largely associated with the 5Cs and healthy behaviors is consistent with earlier findings that have supported the significant role of PE sessions on positive outcomes reflecting WHO’s different dimensions of health (physical, mental, and social) [ 1 , 21 ].

The current finding that PE grade was strongly related to competence was no surprise, as both connote a form of academic competence. In the present study, competence as one of the 5Cs was measured as competence in the academic and physical domains. Thus, PE grade was not only related to academic competence or cognitive abilities, but also to physical competence in sports and athletic activities. Earlier research among German students that supports the current findings reported a positive association between PE and cognitive skills measured by grades in German and mathematics [ 36 ], while findings of a review article also indicated that increasing the amount of time dedicated to PE and sports was in many instances associated with academic performance [ 1 ]. The goal of the Norwegian PE curriculum to enable students to develop mastery in the skills needed to undertake a variety of physical activities [ 9 ] can therefore be important not just for the grade in PE but for the general academic competence of students as well.

In addition to being associated with competence , PE grade was associated with confidence , caring and connection. Accordingly, students who scored high in PE were also more likely to report indicators of thriving and positive development, associations that have been confirmed in a related study on the link between participation in sport camps and the 5Cs of PYD that were captured as two factors (pro-social values and confidence/competence) [ 37 ]. Moreover, Bailey [ 1 ] in a review, reported on how PE and sports in schools can provide a favorable environment for social development, a finding that largely corroborates the current results on the significant link between PE and connection (signifying healthy social relations at home, school, and local community). Indeed, an important aim of the Norwegian PE curriculum among others is to create a social arena for fair play and respect between students [ 9 , 10 ]. However, character (reflecting the integrity and moral compass of youth) was the only thriving indicator that was not associated with PE grade, neither in zero-order correlation nor in multivariate analysis. It is possible that the alignment between youth strengths and contextual resources that facilitate the 5Cs of PYD in PE sessions predicts some of the Cs better than others. This assertion will need to be probed into in future research.

Furthermore, PE grade was related to healthy behaviors, such as PA and vegetable consumption, but not fruit consumption. Earlier research among students attending a Spanish high school associated participation in PE with greater PA levels and lower levels of sedentary behaviors during PE days compared to non-PE days and weekends [ 22 ]. Enrollment in PE activities among high school students in Brazil has been found to be positively related to healthy behaviors, such as PA and fruit consumption, as well as negatively related to drinking of sugar-sweetened beverages [ 5 ]. Wiseman and Weir [ 23 ] also found among Canadian high school students that preferring PE over other school subjects was associated with higher PA levels, lower BMI, and higher self-esteem. Although it was PE grade that was assessed in the current study, the grade reflects students’ participation in both theoretical and practical components of the Norwegian PE sessions. Thus, the current finding on the positive association between PE grade and healthy behaviors is largely in line with earlier findings. In summary, PE sessions reflected in the grade of students were associated with positive youth developmental outcomes, such as thriving (the 5Cs) and healthy behaviors, outcomes that tend to reflect all three dimensions of health (physical, mental, and social) as defined by the World Health Organization.

In SEM and logistic regression, the demographics did not appear to play an important role on the 5Cs and healthy behaviors, as a significant association was only observed between gender and caring , with girls reporting higher scores than boys. This finding is in line with earlier research that found similar associations in upper secondary and university students in Spain [ 38 ] and is often attributed to gender socialization, where boys are taught to be tough and girls caring. In future studies, the role of gender and other demographics are worth investigating to ascertain their effects and place in intervention programs.

4.1. Limitations

The present study has some limitations that need to be considered in the interpretation of the findings. First, the relationships between PE grade and the positive youth developmental outcomes may not indicate causation due to the cross-sectional design of the current study. While the present and earlier findings suggest a positive influence of PE on youth development and healthy behaviors, it is also possible that high levels of the thriving indicators ( competence , confidence , caring and connection ) led to more effort in PE sessions, and consequently, high grade in the subject. In addition, it is likely that students who participate in healthy behaviors such as PA and vegetable consumption will also perform better in PE sessions. Looking at these relationships within a longitudinal design will shed more light on both the developmental trajectories and relations between PE participation and positive youth outcomes.

Second, while there is no reason to believe that youth will be deceptive in the report of their grade and competencies, it is still likely that their self-report responses were affected by social desirability bias, where they tended to over-report their PE grades, for example. In future studies, students’ actual grades provided by teachers can be one method to address the limitation associated with self-report responses and the associated social desirability bias. Third, the binary response categories (Yes/No) of the healthy behaviors did not allow much variation among the behaviors to be assessed. Moreover, although the measures represented general assessment of PA and fruit and vegetable consumption, they did not adequately reflect the global recommendations of the healthy behaviors. This is a limitation that can be addressed in future studies with better instruments that allow for more variations as well as assessment of the recommended amounts and levels of the healthy behaviors. Fourth, the items measuring the 5Cs of PYD were created with US samples, and although the scale was largely validated with the Norwegian sample, there were some items that cross-loaded onto different factors. In addition, relatively high correlations were found among some of the measures, for example between competence and confidence . Thus, it is possible that some items of the 5Cs did not adequately capture or make a distinction between the thriving indicators in Norwegian students. These shortcomings can be a topic of investigation in future studies using qualitative methods.

Finally, although the power analysis indicated that the sample size of 220 was enough to detect medium to large effect sizes in the relationships being studied, a larger sample could provide more robust findings. Besides, the participating schools and thus the students involved in the current study were selected through convenience sampling, thus limiting the extent to which the present findings can be generalized to the whole youth population in Norway. Future studies that use a more representative and inclusive sample reflecting youth from different geographic locations, diverse ethnicities and other backgrounds will be more effective in generating findings that are representative of the Norwegian youth population.

4.2. Implications for Research, Policy, and Practice

Despite the limitations, the current study has implications for research, policy, and practice. In terms of research, the validation of the 5Cs of PYD scale among high school students in Norway adds to the limited research of the 5Cs in Norway and paves the way for further research of the thriving indicators among youth in the Norwegian and other similar Scandinavian and European contexts. Additional research on the 5Cs can also eventually lead to a more refined scale that includes items unique to the Norwegian, Scandinavian or European context. In addition, future studies on PE and the 5Cs can assess the level of risk and adversity in the contexts in which youth are interacting. This will enable the assessment of not only thriving, but resilience as well.

As for policy, the fact that PE grade is related to thriving and healthy behaviors suggests that the Norwegian PE curriculum is important to the promotion of the positive development of the youth, and, possibly, resilience. These results should make the effective implementation of PE curriculum in all schools a priority on the Norwegian political agenda at both the national and community or school level. This way, young people across gender, socio-economic statuses, ethnicities, and other backgrounds can be reached and empowered with the necessary physical, cognitive, and psychosocial skills and competences that are associated with the array of activities taught in PE sessions. Moreover, the current findings of the significant role of PE can inform strategies used in PE curricula in other Scandinavian and European countries. In line with a European Commission report [ 8 ], although all European countries acknowledge the importance of PE at school, only two-thirds of the educational systems had large-scale national initiatives to support the promotion of PE and PA. Indeed, as implied in the current findings, the goal of European countries to facilitate the physical, personal and social development of pupils and students can only be realized when PE curricula are planned and implemented effectively.

There are some practical implications of the current findings as well. With the significant associations between PE grade, the 5Cs of PYD (indicating thriving indicators), and healthy behaviors, it is important that during PE sessions, efforts are made to engage all students in activities that can create positive experiences, enjoyment and mastery as outlined in the PE curriculum. In the curriculum, there is also a focus to provide students with challenges that can enable them to participate actively in both spontaneous and organized activities as well as arenas where students can exercise fair play and respect for each other. Efforts made to implement all these aims in the PE sessions will not only produce healthy, thriving, and resilient youth but, as proposed by PYD, the efforts would also mean a healthy transition into adulthood for the youth.

5. Conclusions

Positive effects of PE participation have been well documented in earlier studies. The current study adds to these benefits with findings that suggest that PE grade reflecting participation in PE is significantly related to thriving indicators, such as competence , confidence , caring and connection (4 out of the 5Cs of PYD), as well as healthy behaviors such as PA and vegetable consumption. These findings support the importance of PE sessions to the healthy development of youth and suggest that policies and programs at the national and local levels that ensure the effective implementation of a PE curriculum in school would be promoting developmental outcomes that align with the dimensions of health outlined by the World Health Organization. However, more research needs to be carried out with adequate measurement of healthy behaviors and representative samples to ascertain the facilitating role of PE sessions on youth health, thriving, and positive development, but also resilience in risk and adverse contexts of youth, as this can secure a life trajectory towards an idealized adulthood for all youth.

Acknowledgments

I would like to acknowledge Maria Bøhlerengen for coordinating the data collection and the youth participants for their engagement in the present study.

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of NSD—Norwegian Centre for Research Data, Norway (protocol code 51708/3/IJJ and 18 July 2017).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The author declares no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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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.

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Large Scientific Review Confirms the Benefits of Physical Touch

Premature babies especially benefited from skin-to-skin contact, and women tended to respond more strongly than men did.

By Joanne Silberner

A hug, a handshake, a therapeutic massage. A newborn lying on a mother’s bare chest.

Physical touch can buoy well-being and lessen pain, depression and anxiety, according to a large new analysis of published research released on Monday in the journal Nature Human Behaviour.

Researchers from Germany and the Netherlands systematically reviewed years of research on touch, strokes, hugs and rubs. They also combined data from 137 studies, which included nearly 13,000 adults, children and infants. Each study compared individuals who had been physically touched in some way over the course of an experiment — or had touched an object like a fuzzy stuffed toy — to similar individuals who had not.

For example, one study showed that daily 20-minute gentle massages for six weeks in older people with dementia decreased aggressiveness and reduced the levels of a stress marker in the blood. Another found that massages boosted the mood of breast cancer patients. One study even showed that healthy young adults who caressed a robotic baby seal were happier, and felt less pain from a mild heat stimulus, than those who read an article about an astronomer.

Positive effects were particularly noticeable in premature babies, who “massively improve” with skin-to-skin contact, said Frédéric Michon, a researcher at the Netherlands Institute for Neuroscience and one of the study’s authors.

“There have been a lot of claims that touch is good, touch is healthy, touch is something that we all need,” said Rebecca Boehme, a neuroscientist at Linkoping University in Sweden, who reviewed the study for the journal. “But actually, nobody had looked at it from this broad, bird’s eye perspective.”

The analysis revealed some interesting and sometimes mysterious patterns. Among adults, sick people showed greater mental health benefits from touch than healthy people did. Who was doing the touching — a familiar person or a health care worker — didn’t matter. But the source of the touch did matter to newborns.

“One very intriguing finding that needs further support is that newborn babies benefit more from their parents’ touch than from a stranger’s touch,” said Ville Harjunen, a researcher at the University of Helsinki in Finland, who also reviewed the study for the journal. Babies’ preference for their parents could be related to smell, he speculated, or to the differences in the way parents hold them.

Women seem to benefit more from touch than men, which may be a cultural effect, Dr. Michon said. The frequency of the touch also mattered: A massage once every two years isn’t going to do much.

Several studies included in the review looked at what happened during the height of the Covid pandemic, when people were isolated and had less physical contact with others. “They found correlations during Covid times between touch deprivation and health aspects like depression and anxiety,” Dr. Michon said.

Touching the head appears to have more of a beneficial effect than touching the torso, some studies found. Dr. Michon couldn’t explain that finding, but thought it could have to do with the greater number of nerve endings on the face and scalp.

Another mystery: Studies of people in South America tended to show stronger health benefits of touch than did those studies that looked at people in North America or Europe. Dr. Michon said that culture may somehow play a role. But Dr. Boehme said the studies showing the differences between countries were too small to be definitive. “I think the mechanism behind this is biological,” she said. “I think that’s hard-wired and will be the same for all of us.”

In 2023, Jeeva Sankar, a pediatrics researcher at All India Institute of Medical Sciences, and a colleague published a rigorous review of skin-to-skin care for newborns. The analysis concluded that touch therapy for preterm or low-birth-weight infants should start as soon as possible and last eight hours or more, a recommendation that the World Health Organization adopted. Dr. Sankar said the new review was important because touch is often neglected in modern medical care, but it was too broad. He would have liked it to focus more on how various forms of touch could be integrated in medical care.

Dr. Michon stressed that the types of touch considered in these studies were positive experiences to which the volunteers agreed. “If someone doesn’t feel a touch as being pleasant, it’s likely going to stress them out,” he said.