Physical education and physical activity: results from the School Health Policies and Programs Study 2006

Impact of New York City's 4-year multi-component natural experiment to improve elementary school physical education on student cardiorespiratory fitness

BACKGROUND

School physical education is an important population-level health intervention for improving youth fitness. This study estimated the impact of New York City's PE Works program - which included providing PE teachers, training for classroom teachers, and administrative/ teacher support for PE - on student cardiorespiratory fitness as measured by the FitnessGram's 15-meter PACER test for aerobic capacity.

METHODS

This longitudinal study (2014/15-2018/19) includes 581 elementary schools (n = 315,999 4th /5th -grade students; 84% non-white; 74% who qualify for free or reduced-price meals, a proxy for socioeconomic status). We apply the parametric g-formula to address schools' time-varying exposure to intervention components and time-varying confounding.

RESULTS

After four years of staggered PE Works implementation, 49.7% of students/school (95% CI: 42.6%, 54.2%) met age/sex-specific Healthy Fitness Zone (HFZ) aerobic capacity standards set by the FitnessGram. Had PE Works not been implemented, we estimate 45.7% (95% CI: 36.9%, 52.1%) would have met aerobic capacity HFZ standards. Had PE Works been fully implemented in all schools from the program's inception, we estimate 57.4% (95% CI: 49.1%, 63.3%) would have met aerobic capacity HFZ standards. Adding a PE teacher, alone, had the largest impact (6.4% (95% CI: 1.0, 12.0) increase).

CONCLUSION

PE Works positively impacted student cardiorespiratory fitness. Mandating and funding multicomponent PE programs is an important public health intervention to increase children's cardiorespiratory fitness.

Determinants of Change in Physical Activity in Children during the Transition from Elementary to High School

INTRODUCTION

Effective public health interventions targeting factors that influence physical activity are urgently needed to reduce the age-related decline in physical activity in youth. The purpose of this study was to identify associations between physical activity and a set of potential influences on physical activity in children as they transition from elementary to high school.

METHODS

Participants were 951 children from South Carolina school districts who completed outcome and independent variable measures on at least two time points from the 5th to 11th grades in 2010-2017. The primary outcome variable was physical activity, measured by accelerometry. Independent variables included a comprehensive set of variables in the child, parent/home, school, and community domains. Children, parents and school administrators, and staff completed questionnaires to assess psychosocial and home, school, and neighborhood environmental influences. Growth curve analyses identified independent variables associated with physical activity over time, either as a main effect or as an interaction with age.

RESULTS

As main effects, self-efficacy, self-schema, sport participation, weekday outdoor hours, importance of child participating in sports and physical activity, safe to play outside, and Physical Activity Resource Assessment weighted score were positively associated with physical activity. The associations between physical activity and enjoyment motivation, appearance motivation, weekend outdoor time, and home equipment exhibited significant interactions with age. Enjoyment motivation influenced physical activity during the earlier years, whereas the remaining three variables influenced physical activity in the later years.

CONCLUSIONS

Interventions should target multiple domains of influences that may vary by age.

Impact of a multi-level, multi-component intervention to improve elementary school physical education on student cardiorespiratory fitness: an application of the parametric g-formula

Background

School physical education is an important population-level health intervention for improving youth fitness. The purpose of this study is to determine the causal impact of New York City's PE Works program on student cardiorespiratory fitness.

Methods

This longitudinal study (2014-2019) includes 581 elementary schools (n=315,999 4th/5th-grade students; 84% non-white; 74% who qualify for free or reduced-price meals). We apply the parametric g-formula to address schools' time-varying exposure to intervention components and time-varying confounding.

Results

After four years of staggered PE Works implementation, 49.7% of students per school (95% CI: 42.6%, 54.2%) met age/sex-specific cardiorespiratory fitness standards. Had PE Works not been implemented, we estimate 45.7% (95% CI: 36.9%, 52.1%) would have met fitness standards. Had PE Works been fully implemented in all schools from the program's inception, we estimate 57.4% (95% CI: 49.1%, 63.3%) would have met fitness standards. Adding a PE teacher, alone, had the largest impact (6.4% (95% CI: 1.0, 12.0) increase).

Conclusion

PE Works, which included providing PE teachers, training for classroom teachers, and administrative/teacher support for PE, positively impacted student cardiorespiratory health. Mandating and funding multilevel, multicomponent PE programs is an important public health intervention to increase children's cardiorespiratory fitness.

A natural experiment to assess recess frequency on children's physical activity in Arizona (U.S.) elementary schools

BACKGROUND

In the United States, the number of state policies mandating recess in schools has rapidly increased over the past decade; however, few policies specify recess frequency. Informed by an ecological model of physical activity (PA) policy, this study examined and compared total amounts and intensity of PA expended during recess among children attending schools in compliance with Arizona recess policy ARS§ 15-118 mandating 2 + daily recess periods versus not.

METHODS

PA during recess was measured among grade three children (ages 8-10) in four randomly selected elementary schools (two complying averaging 30 daily recess minutes; two non-complying averaging 15 daily recess minutes) in Maricopa County, Arizona. Group-level PA was assessed by direct observation using the System for Observing Play and Leisure (137 observations). A subset of students (N = 134) from all schools wore ActiGraph GT3X + devices during recess to measure individual PA. General linear mixed effects models were used to analyze the impact of recess frequency on group and individual PA during recess.

RESULTS

Students attending complying schools spent significantly greater proportions of time in moderate-to-vigorous PA (MVPA) based on direct observation (5%) and accelerometry (15%) and less time being sedentary based on accelerometry (14%) during recess. Across the school day, this would equate to 5.1 more MVPA minutes based on systematic direct observation and 9.5 more MVPA minutes based on accelerometry, and 4.1 less minutes being sedentary based on accelerometry if students received two daily 15-minute recess periods compared to one.

CONCLUSIONS

Students attending elementary schools implementing 2 + recesses, in accordance with state policy, demonstrated greater MVPA and less sedentary time, providing preliminary evidence that recess frequency is associated with greater PA intensity among children during recess. Schools that adhere to state-level PA policies may provide a more supportive environment for PA, resulting in increased movement among students. Specifying recess frequency should be considered in statewide recess policy.

Promoting children's health and well-being through structured recreation during online recess

Recess is a critical source of physical, social and emotional health and well-being for children, but generally not prioritized during online learning. A 13-week structured recreation intervention was delivered virtually during recess to students in the fifth and sixth grades (age 10-12 years; N = 71) at one elementary school (Phoenix, AZ, USA). We used embedded mixed method with a prospective pre-/post-design to measure change in student-reported emotion and qualities of engagement in an online setting. Students completed an online pre-/post-survey to measure emotion and motivational responses (enjoyment, competence and relatedness). We used narrative notes to qualitatively assess student engagement during programming. Differences in student-reported emotion were analyzed using paired t-tests. The effect of motivational responses on emotion was analyzed using multiple regression analyses. In vivo coding and concept coding were used to analyze qualitative data. We found no statistically significant differences in student-reported emotion; however, student relationships with peers predicted increased positive and decreased negative emotions after the intervention. Seven categories promoted student engagement: challenging, enjoyable, experiential, practical, purposeful, relatable and relevant. School-based health practitioners can offer structured activities virtually during recess, when in-person learning is interrupted and in all-online settings, to promote emotional well-being.

Factors associated with provision of physical activity in primary schools in Makindye Division in Kampala, Uganda: a cross-sectional study

BACKGROUND

Globally, school-going children spend most of their days at school, sitting in lessons and unable to achieve the daily WHO recommendations for Physical Activity (PA) of at least 60 minutes per day. Limited studies have assessed the opportunities schools provide for PA to help the children achieve their daily recommended PA. We determined the level of and the factors associated with PA offered in primary schools in Makindye Division in Kampala during the school term.

METHODS

This cross-sectional study was conducted in 36 selected government and private primary schools in Makindye Division, Kampala. PA was defined as the amount of time in minutes available for PA as per WHO recommendations - sufficient (60 minutes or more of PA) or insufficient (less than 60 minutes of PA) and assessed for any factors associated with provision of time for PA in schools. Data were collected by interview administered questionnaires and analysed descriptively. Factors associated with PA were assessed using a logistic regression model.

RESULTS

Of the 36 schools, 3 were government and 33 were private schools. The proportion of schools offering sufficient time for PA among Primary schools in the Makindye Division was (8/36) 22%. The average time for PA for all schools per week was 197 minutes (SD 70.7). Sufficient PA was associated with the provision of PE lessons after a break or after lunch (p-value 0.038). Sufficient PA was more likely in schools that offered volleyball (OR 8.69), had space in the school for PA (OR 13.27), provided athletics (OR 2.26) and whose fees were Ushs 700,000 (USD 187) or more (OR 1.30).

CONCLUSIONS

Only 22% of sampled schools offered sufficient time for PA among Primary schools in Kampala per WHO guidelines. Provision of sufficient time for PA was associated with PE scheduled either after break or lunch. Sufficient PA was more likely with schools that had space for PA, schools which offered volleyball and athletics, and whose fees were 700,000/= or more. Schools should consider scheduling PE lessons after break or after lunch to increase the likelihood of meeting the targeted time for PA. Primary schools need to be supported to establish facilities and to increase diversity in available activities to ensure children achieve their recommended PA.

Effects of Sports, Exercise Training, and Physical Activity in Children with Congenital Heart Disease-A Review of the Published Evidence

Children and adolescents with congenital heart disease (CHD) should be encouraged to adopt a physically active lifestyle, ideally by participating in sports activities at school and sports clubs. Children with complex CHD or other risk factors (for example, pacemakers, cardioverter-defibrillators, channelopathies) may, however, need specific individualized training programs. This review article summarizes the current knowledge regarding the clinical effects of sports and exercise training on CHD and its pathophysiologic mechanisms. An evidence-based approach based on a literature search, using PubMed, Medline, CINHAL, Embase, and the Cochrane Library was conducted, last completed on 30 December 2021. In studies with 3256 CHD patients in total, including 10 randomized controlled trials, 14 prospective interventional trials, 9 observational trials, and 2 surveys, exercise training has been shown to improve exercise capacity and physical activity, motoric skills, muscular function, and quality of life. Sports and exercise training appears to be effective and safe in CHD patients. Despite being cost-efficient, training programs are currently scarcely reimbursed; therefore, support from healthcare institutions, commissioners of healthcare, and research-funding institutions is desirable. There is a strong need to establish specialized rehabilitation programs for complex CHD patients to enhance these patients' access to this treatment intervention. Further studies may be desirable to confirm these data to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.

Classroom teachers' "off-the-shelf" use of movement integration products and its impact on children's sedentary behavior and physical activity

Movement integration (MI) products are one of many MI strategies that aim to reduce students' sedentary behavior (SB) and increase physical activity (PA) during classroom time. This study examined elementary classroom teachers' off-the-shelf (i.e., no researcher support) use of MI products (GoNoodle Plus [GN], ABC for Fitness [ABC], Take10) and their impact on students' SB and PA. Teachers (N = 57) at five schools received one MI product and reported MI strategy uses/day while student (n = 1,098, 52% female, 66% Black) accelerometer-determined SB and PA was assessed. Mixed regression models estimated changes in MI uses/day and SB and PA during the school day prior to and after teachers received the MI product. GoNoodle was the only MI product where overall MI strategy uses/day increased (∆ = 0.8, 95% CI = 0.1, 1.4). Across products, students' SB increased (∆ = 2.2, 95% CI = 1.2, 3.1) while light (∆ = -1.7, 95% CI = 1.2, 3.1) and MVPA (∆ = -0.5, 95% CI = -0.8, -0.2) decreased. For GN SB (∆ = -3.3, 95% CI = -7.8, 1.3), light (∆ = 2.5, 95% CI = -0.7, 5.7), and MVPA (∆ = 0.8, 95% CI = -0.9, 2.5), did not show statistically significant change. For Take10 SB (∆ = 1.0, 95% CI = -0.2, 2.2) and MVPA (∆ = 0.1, 95% CI = -0.3, 0.6) did not change while light PA decreased (∆ = -1.1, 95% CI = -2.0, -0.3). For ABC SB increased (∆ = 11.1, 95% CI = 8.4, 13.9) while light (∆ = -7.0, 95% CI = -8.9, -5.0) and MVPA (∆ = -4.2, 95% CI = -5.2, -3.1) decreased. GN shows promise for classroom teacher use. However, given limited uptake of the other products and the lack of change in children's SB and PA, this study suggests that off-the-shelf MI products cannot be integrated into classroom routines without additional support.

FAST Heroes: Results of Cross-Country Implementation of a Global School-Based Stroke Education Campaign

Background

Educating the at-risk population about stroke symptoms and requirement of calling an ambulance when stroke strikes is challenging. This exploratory cross-country study provides insights to the FAST Heroes educational campaign and outcomes hitherto achieved.

Aims

The primary aim of the study was to measure the transfer of stroke-related knowledge to parents after a global school-based FAST Heroes educational campaign for 5- to 9-year-old children in 14 different countries. The secondary aim was to evaluate parents and teachers' acceptability toward the program.

Methods

The duration of the program was 5 h; 1 h per week, joining face-to-face educational sessions with workbooks, cartoons, web-based learning, and other fun activities. Outcomes were measured before implementation (t1), after implementation (t2), and at 6-month follow-up (t3). Program acceptability and stroke knowledge were evaluated by feedback surveys for teachers and parents.

Results

Worldwide, 4,202 parents completed the program with their children and answered surveys at t1 and t2. They increased their knowledge of three stroke symptoms from 48 to 83% (p < 0.001). All three surveys were completed by 86 parents, who improved their knowledge of stroke symptoms, 55% (t1), 79% (t2), and 94% (t3) (p < 0.001). Overall, the educational messages were successfully passed onward.

Conclusions

Findings confirm the primary aim of the study that is knowledge about stroke transfer well from children to their families through the FAST Heroes program. Second, parents and teachers globally consider the program feasible and worthwhile. The results will inform further rollout of the campaign.

Physical Educators' Qualifications and Instructional Practices Toward Students With Disabilities

The purposes of this study were (a) to investigate the prevalence of physical educators who report delivering high-quality instructional practices to students with disabilities and (b) to examine the relationships between teachers' qualifications and the delivery of high-quality instructional practices. A secondary analysis using data from the School Health Policy and Practice Study 2014 data set was employed. The analytic sample included 256 physical educators who taught students with disabilities. Prevalence estimates of physical educators who reported using high-quality instructional practices were calculated. Two separate binary logistic regressions using weighted data were conducted to evaluate the relative contribution of (a) teacher qualifications and (b) educational degrees in accounting for differences in the use of high-quality instructional practices. Less than half of the sample reported using high-quality instructional practices. Considering the increasing prevalence of students with disabilities in general education classrooms, teacher education programs should prioritize providing teacher candidates with coursework that aligns with the expectations of physical educators who teach students with disabilities.

Designing an adolescent physical activity and nutrition intervention before and after COVID-19: A formative research study

BACKGROUND

With rates of childhood obesity continually increasing, effective physical activity (PA) and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can also be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19).

OBJECTIVE

We conducted formative research via in-person and online focus groups among middle schoolers and parents to better understand barriers and facilitators to PA and fruit and vegetable (FV) consumption and inform the design of a large intervention for a low-income, urban setting in the U.S. Midwest.

METHODS

We conducted two phases of qualitative focus groups with parents (n=20) and 6-9 grade middle schoolers (n=22). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using Dedoose software.

RESULTS

Main facilitators to PA prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while main barriers to PA were time constraints and social discomfort. Main facilitators to eating FV included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators to PA remained the same, while additional barriers to PA such as lack of motivation and limited time spent outside of the home were reported during the pandemic. For FV consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more FV to middle schoolers throughout the day.

CONCLUSIONS

Some themes identified were common to those reported in previous studies, such as peer influence on PA and parental influence on FV consumption. Novel themes, such as lack of motivation to be active and limited time outside the home, helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major, unexpected change in intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted.

CLINICALTRIAL

Temporal Trends in Children's School Day Moderate to Vigorous Physical Activity: A Systematic Review and Meta-Regression Analysis

BACKGROUND

Evidence from a limited sample of countries indicates that time for physical education and recess during school have declined. Schools are called to provide children with 30 minutes of moderate to vigorous physical activity (MVPA). This systematic review and meta-analysis estimated temporal trends in children's school day MVPA.

METHODS

Three online databases were searched to identify studies with objectively measured MVPA, during school hours, in school aged children (5-18 y). Multilevel random-effects meta-analyses estimated MVPA by year, and meta-regression analyses estimated temporal trends in school day MVPA.

RESULTS

Studies (N = 65) providing 171 MVPA estimates, representing 60,779 unique children, from 32 countries, and spanning 2003-2019 were identified. Most studies were conducted in North America (n = 33) or Europe (n = 21). School day MVPA ranged from 18.1 (95% confidence interval, 15.1-21.1) to 47.1 (95% confidence interval, 39.4-54.8) minutes per day in any given year. Meta-regression analyses indicated that MVPA declined from 2003 to 2010 (approximately 15 min decline), plateaued from 2010 to 2015 (approximately 1 min decrease), and increased from 2015 to 2019 (approximately 5 min increase).

CONCLUSIONS

School day MVPA decreased from 2003 to 2010 and has recently begun to increase. However, the majority of the evidence is from North America and Europe with some evidence from Oceania and very little evidence from Asia to South America.

Disparities in Youth Sports and Barriers to Participation

Purpose of Review

Youth sports participation has shifted from a school-based, seasonal activity to club-based, year-round activity over the past 10–15 years. Single sport specialization has become increasingly common with a concurrent increase in injury and burnout. Paralleling trends seen in other aspects of health care, disparities in regard to participation in youth sports, and subsequent injury treatment exist as well. Recognition of these disparities amongst coaches, parents, and athletes involved in youth sports are essential to promote the short- and long-term health of pediatric and adolescent athletes.

Recent Findings

Multiple barriers exist for youth in regard to sports participation. Youth who come from families without extensive financial means are increasingly finding it difficult to play organized sports, with this trend holding when broken down by insurance status (public versus private). This problem is further exacerbated by the lack of community-based programming in locations where organized (albeit expensive) options do not exist. The lack of athletic trainers increases the divide, as well as the care that injured athletes receive (particularly in public schools within communities of color) is not equivalent to schools with extensive financial resources. Thus, ability to quickly return to play after injury and/or access the health care system is limited. This is further exemplified by inferior outcomes in regard to care for anterior cruciate ligament, meniscus, shoulder instability, and concussions in this population.

Summary

Youth sports participation is laden with multiple disparities. This is unfortunately reflective of historical barriers to opportunities/advancements in multiple other areas of society. These disparities place certain groups of children at an uphill battle not only for participation when healthy, but also returning to participation when injured. Larger structural changes in youth sports are necessary to promote life-long, healthy physical activities for individuals most at risk.

Daily Physical Education Linked to Higher Youth Aerobic Fitness Levels: A 4-Year Longitudinal Study

PURPOSE

Physical education (PE) provides opportunities for youth physical activity during the school day, yet daily PE policies remain low. This study investigated whether daily PE was linked to youth aerobic capacity across a 4-year period in Greenville (South Carolina).

METHODS

Youth in grade levels second to eighth at 2 schools providing daily PE and 2 schools that did not provide daily PE participated in the study (N = 466). The 2 schools used as comparisons provided standard PE outlined by South Carolina, which included one 50-minute session per week (elementary) and daily PE for one semester (middle school). Aerobic fitness was measured using the FITNESSGRAM® Progressive Aerobic Cardiovascular Endurance Run test (May 2011-2015). Number of Progressive Aerobic Cardiovascular Endurance Run laps completed, age, gender, ethnicity, body composition, and school attended were included in multilevel linear regression analyses.

RESULTS

Across the sample, aerobic fitness increased with age. Throughout the study, males demonstrated growth in aerobic fitness compared with a slight decline for females (P < .001). Youth participation in daily PE was linked to increases in aerobic fitness compared with youth who did not receive daily PE (P < .001).

CONCLUSIONS

Findings suggest that exposure to daily PE may contribute to increased aerobic fitness in youth.

Objective Assessment of Physical Activity and Associated Contexts During High School Sport Practices

Background: Organized sports provide children and adolescents with opportunities to achieve recommended amounts of moderate to vigorous physical activity (MVPA), and schools are a primary setting for sports programs. The main aims of this study were to examine participant physical activity (PA) levels during the most popular high school sports in the United States and to assess the influences of practice contextual factors on PA levels. Methods: Participant PA and its contexts were assessed during practices for the 10 most popular girls' and boys' high school sports in the United States. Data were obtained during 598 practice sessions in 12 schools in North Carolina using a validated direct observation instrument (System for Observing Fitness Instruction Time (SOFIT). A regression model was applied to understand the association between sport context and athletes' PA. Results: Overall, athletes were observed engaging in MVPA 60% of practice time. MVPA varied among sports and levels were highly influenced by practice contexts. Among girls' sports, cross country and soccer practices provided the highest proportion of MVPA and MVPA percent during boys' practice sessions was highest during cross country and track and field. Practice contexts were associated with MVPA accrual with time allocated for gameplay and fitness activities associated with the highest levels of PA. Conclusions: The results contribute to an understanding of which sports and how their practices are conducted facilitate increased PA. Findings indicate athletes accrue substantial amounts of PA during high school practices, but that it varies from sport to sport. As well, the context that characterizes sport practices is a significant determinant in how much PA occurs. Most sports that emphasized game simulation, fitness, and skill development drills had higher levels of MVPA. Given the length and frequency of practices and how the content is delivered, we can accurately predict how much PA athletes are likely to achieve during a given sport season. The findings from this study demonstrate that sport can make a useful, if not sufficient role in helping high school athletes reach recommended PA levels. PA engagement can be optimized by attending to the management of contexts surrounding the sports.

State laws governing school physical education in relation to attendance and physical activity among students in the USA: A systematic review and meta-analysis

BACKGROUND

This study systematically synthesized and quantified the relationship linking state laws governing school physical education (PE) to PE attendance and physical activity (PA) in class and throughout the day and week among students in the USA.

METHODS

A keyword search was performed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and EconLit. Meta-analyses were performed to estimate the effects of state PE laws.

RESULTS

A total of 17 studies were included in the review, and five contributed to the meta-analyses. A total of 8 studies used nationally representative school- or student-level data, three focused on multiple states, and the remaining six examined the PE laws of a single state. The presence and strength of state PE laws were positively associated with PE attendance and the frequency and duration of PA during PE classes and throughout the school day. Compared to those residing in states with weak or no PE laws, students in states with strong PE laws had an additional 0.2 days (95% confidence interval (95%CI): 0.1-0.4) of PE attendance per week and spent an additional 33.9 min (95%CI: 22.7-45.0) participating PE classes per week. State PE laws affected girls' PA more than boys'. Different aspects of state PE laws tended to affect students' PE attendance differently. Disparities in the implementation of state PE laws existed across schools.

CONCLUSION

Future studies should adopt objective measures on PE and PA participation and examine the roles schools and districts play in mediating the effect of state PE laws on students' PE attendance and PA.

Standards-based physical education in schools: The role of state laws

Purpose

Examine the association of state physical education (PE) laws (https://class.cancer.gov) with school policies addressing motor skill development, physical activity (PA) participation, and health-enhancing physical fitness (https://www.cdc.gov/healthyyouth/data/shpps/data.htm).

Methods

National school-level data on PE standards were obtained from the 2014 School Health Policies and Practices Study (SHPPS) of US schools for analytical samples of 408-410 schools in 43 states. These data were linked to Classification of Laws Associated with School Students (CLASS) data, which reflect the strength of state-PE curriculum laws and the associated state PE curriculum standards. Logistic regressions and generalized linear models with a complementary log-log link examined associations between state law and school-level standards.

Results

Compared to having no state law, weak law (OR: 5.07, 95% CI: 1.02-25.27) or strong law (OR: 2.96, 95% CI: 1.04-8.37) was associated with higher odds of school PE standards addressing motor skill development, while only strong state law was associated with higher prevalence of addressing achievement and maintenance of physical fitness (coefficient: 0.63, 95% CI: 0.12, 1.14). State laws were not associated with addressing PA participation.

Conclusions

Schools were more likely to address motor skills and physical fitness development when states had strong PE laws.

Operationalizing and Testing the Concept of a Physical Activity Desert

BACKGROUND

The prevalence of childhood obesity is higher in economically and socially deprived areas. Higher levels of physical activity reduce the risk of excessive weight gain in youth, and research has focused on environmental factors associated with children's physical activity, though the term "physical activity desert" has not come into wide use.

METHODS

This exploratory study operationalized the term "physical activity desert" and tested the hypothesis that children living in physical activity deserts would be less physically active than children who do not. A cross-sectional study design was applied with 992 fifth-grade students who had provided objectively measured physical activity data. Five of 12 possible elements of the built environment were selected as descriptors of physical activity deserts, including no commercial facilities, no parks, low play spaces, no cohesion, and the presence of incivilities.

RESULTS

Univariate and multivariate analyses showed that only the absence of parks was associated with less physical activity in children.

CONCLUSION

Children living in a "no park" zone were less active than their counterparts who lived near a park. This study contributes preliminary conceptual and operational definitions of "physical activity desert." Future studies of physical activity deserts should be undertaken in larger and more diverse samples.

Y-PATHS: A Conceptual Framework for Classifying the Timing, How, and Setting of Youth Physical Activity

BACKGROUND

Multiple models and frameworks exist for the measurement and classification of physical activity in adults that are applied broadly across populations but have limitations when applied to youth. The authors propose a conceptual framework specifically designed for classifying youth physical activity.

METHODS

The Youth Physical Activity Timing, How, and Setting (Y-PATHS) framework is a conceptualization of the when (timing), how, and where (setting) of children's and adolescents' physical activity patterns. The authors developed Y-PATHS using the design thinking process, which includes 3 stages: inspiration, ideation, and implementation.

RESULTS

The Y-PATHS includes 3 major components (timing, how, and setting) and 13 subcomponents. Timing subcomponents include (1) school days: in-school, (2) school days: out-of-school, and (3) nonschool days. How subcomponents include: (1) functional, (2) transportation, (3) organized, and (4) free play. Setting subcomponents include: (1) natural areas, (2) schools, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure.

CONCLUSIONS

The Y-PATHS is a comprehensive classification framework that can help researchers, practitioners, and policymakers to better understand youth physical activity. Specifically, Y-PATHS can help to identify the domains of youth physical activity for surveillance and research and to inform the planning/evaluation of more comprehensive physical activity programming.

Objective Measurement of Physical Activity Attributed to a Park-Based Afterschool Program

BACKGROUND

Only 24% of US youth meet physical activity recommendations set by the Centers for Disease Control and Prevention. Research demonstrates that community-based programs provide underresourced minority youth with opportunities for routine physical activity, although limited work draws from accelerometry data. This study objectively assessed youth physical activity attributable to participation (vs nonparticipation) days in a park-based afterschool program in Miami-Dade County, Miami, FL.

METHODS

Participants' (n = 66; 60% male; 57% white Hispanic, 25% non-Hispanic black, 14% Black Hispanic, mean age = 10.2 y) physical activity was assessed April to May 2019 over 10 days across 7 park sites using Fitbit (Charge 2) devices. Separate repeated-measures multilevel models were developed to assess the relationship between program daily attendance and total (1) moderate to vigorous physical activity minutes and (2) step counts per day.

RESULTS

Models adjusted for individual-level age, sex, race/ethnicity, poverty, and clustering by park showed significantly higher moderate to vigorous physical activity minutes (β = 25.33 more minutes per day; 95% confidence interval, 7.0 to 43.7, P < .01) and step counts (β = 4067.8 more steps per day; 95% confidence interval, 3171.8 to 4963.8, P < .001) on days when youth did versus did not attend the program.

CONCLUSIONS

Study findings suggest that park-based programs may support underserved youth in achieving daily physical activity recommendations.

Moving more and sitting less in schools: What's the next step?

Schools serve as the ideal location for implementing interventions to increase physical activity (PA) as children spend most of their day in the school setting. As adolescents become more and more sedentary and obesity statistics become more dire, efforts to increase physical literacy and PA should be heightened. Physical literacy is the ability for a child to understand the movement of their body and how it can be manipulated to increase activity for recreation or sports movement. When physical literacy is paired with school-based multi-component programs, children are more likely to make a behavior change. As educators know, children are more likely to make a behavior change when mastery of content is achieved, and the lesson is tailored to their needs. Even small changes, like moving a little more or adding an additional serving of vegetables to the diet, can make a profound impact. In the current review we discuss: 1) the state of PA within school systems; 2) provide a rationale for why school systems fail to meet said guidelines; and 3) suggest how guidelines can eventually be achieved through the promotion of physical literacy and effective school-based multi component programs.

The Positive Impact and Associated Mechanisms of Physical Activity on Mental Health in Underprivileged Children and Adolescents: An Integrative Review

(1) Background: Review-based studies are required to consider the different designs and data that describe the association between physical activity and mental health for underprivileged children and adolescents. There is a particular need to identify mechanisms which could explain the association, and factors which influence the association in this population group. (2) Methods: An integrative review with a systematic search was conducted in three stages: (i) a systematic literature search on four databases from inception until May 2020. Studies were eligible if they examined underprivileged children, involved moderate to vigorous physical activity (MVPA) and had a focus on at least one outcome measure related to mental health. (ii) Two critical appraisal tools were used to assess quality across different study designs. (iii) Synthesis was undertaken in four stages, examining social, internal and physical outcomes and mechanisms. (3) Results: A total of 16 studies were included (2 qualitative; 12 quantitative and 2 mixed methods). Fifteen (15/16; 93.8%) showed an association between MVPA and a significant improvement in at least one mental health outcome. The most studied outcomes included: internal aspects (n = 14), significant effects were identified in 12/14 studies; social aspects (n = 6), significant effects were identified across all studies and finally physical aspects (n = 5), significant effects were found in 3/5 studies. Autonomy support was identified as a mechanism to explain the change, whilst age and gender influenced the strength of the association. (4) Conclusions: The findings provide confirmation of the link between MVPA and the improved mental health and wellbeing of disadvantaged children and adolescents. Future research must consider the long-term effect through longitudinal studies, along with determining whether any specific types of PA are more impactful than others.

Physical Activity Opportunities of Low-Income Elementary School-Aged Children During the Segmented School Day

BACKGROUND

In this study, we examined moderate-to-vigorous physical activity (MVPA) of children in a school district serving children from low-income and minority households.

METHODS

This observational study was conducted in 8 rural elementary schools in South Carolina. Children (N = 719, age = 7.7 years, 48.0% girls, 88.0% African American) wore accelerometers during school hours. Physical activity was distilled into time engaged in MVPA during 4 distinct opportunities. These 4 opportunities were non-activity time (eg, class-time), extended lunch (lunch recess after eating), physical education (PE), and recess. Mixed effects linear regressions estimated MVPA on days that had no activity opportunities, extended lunch, recess, PE, and multiple activity opportunities (eg, PE and recess).

RESULTS

On days with multiple activity opportunities, girls and boys accumulated 8.0 (95% CI = 4.9, 11.1) and 7.1 (95% CI = 3.6, 10.7) additional minutes of MVPA compared to a no activity day. On PE days boys accumulated 5.2 (95% CI = 0.3, 10.2) additional minutes of MVPA, whereas recess days provided girls with 3.0 (95% CI = 0.1, 6.0) additional MVPA minutes. No other activity opportunities provided statistically significant increases in school-day MVPA.

CONCLUSIONS

In low-income schools it may be necessary to provide multiple physical activity opportunities during the school day to increase boys' and girls' MVPA.

Elementary Classroom Teachers' Self-Reported Use of Movement Integration Products and Perceived Facilitators and Barriers Related to Product Use

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers' self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators and barriers. MI product use lasted for 11.2 (Standard Deviation (SD) = 7.5) min/occasion and MI products were used 4.1 (SD = 3.5) times/week on average. Activity Bursts in the Classroom for Fitness, GoNoodle, and Physical Activity Across the Curriculum were most frequently used. Facilitators of and barriers to MI product use were identified within three central areas-logistics, alignment with teaching goals, and student needs and interests. Teachers were receptive to MI products and used them frequently throughout the week. When considering the adoption of MI products, teachers, administrators, and policy makers should consider products that are readily usable, align with teaching goals, and are consistent with student needs and interests.

Effect of Gender, Physical Activity and Stress-Related Hormones on Adolescent's Academic Achievements

BACKGROUND

Physical activity (PA) has been shown to develop better fitness and body function in children. Various studies have shown that as the age of students increases, its correlation with school achievement decreases. Different hormonal changes during adolescence make it difficult to adjust in his/her environment, causing stress. To the best of our knowledge, no study has studied the correlation between stress-related hormones and school performance among adolescents. This study was conducted to evaluate physical activity and stress-related hormones, cortisol and serotonin, among school adolescents aged 12-18 years old and find their association with academic achievements.

METHODS

A total of 300 students were invited to participate in this study. Physical activity of the participants was assessed in relation to the time spent performing various physical activities. End of the academic year grades were obtained from the school as a collective measure of academic achievement and executive function. The levels of cortisol and serotonin were measured using the competitive immunoassay techniques.

RESULTS

There was a significant correlation between age, gender, BMI, cortisol, serotonin, physical activity score; and academic achievement, and executive functioning among participants. Academic achievement and executive functioning scores correlated positively with gender, serotonin, physical activity score, but negatively with age, BMI and salivary cortisol. Stepwise regression analysis showed that physical activity and demographic parameters and stress-related hormones, cortisol and serotonin, explained around 61.9-77.9% of academic performance and executive functioning variation in school adolescents, especially females.

CONCLUSIONS

Optimal physical activity and release of stress-related hormones could be the determining factor for performance in school and other activities. These results should be taken into consideration while planning the school curriculum.

Pay to Play? State Laws Related to High School Sports Participation Fees

CONTEXT

Participation in high school sports can impact the physical and mental health of students and influence other positive social and economic outcomes. To maintain sports programs amidst school budget deficits, many districts are implementing sports participation fee policies. Although locally implemented, these district policies can be guided by state law.

OBJECTIVE

The main objective of this study was to assess state laws and regulations related to high school sports participation fees.

DESIGN

Codified statutes and administrative regulations were compiled for all 50 states and the District of Columbia using subscription-based services from LexisNexis and WestlawNext. A content assessment tool was developed to identify key components of school sports participation fee laws and used for summarization. Key components identified included legislation summarization, years in effect, whether it allows fees, whether there is any fee waiver, qualifications needed for fee waiver, whether there is a tax credit, and whether there is disclosure of implementation. State information was aggregated and doubled-coded to ensure reliability.

RESULTS

As of December 31, 2016, 18 states had laws governing sports participation fees; 17 of these states' laws allowed for such fees, whereas 1 state prohibited them. Most laws give authority to local school boards to set and collect fees. The laws in 9 states have provisions for a waiver program for students who cannot pay the fees, although they do not all mandate the existence of these waivers. Other content within laws included tax credits and disclosure.

CONCLUSION

This analysis shows that states with laws related to school sports participation fees varied in scope and content. Little is known about the implementation or impact of these laws at the local level and the effect of fees on different student population groups. This warrants future investigation.

State Lawmaker's Views on Childhood Obesity and Related School Wellness Legislation

BACKGROUND

School wellness legislation has potential to impact the health of children and alter the obesity crisis in the United Sates. Little is known about how state lawmakers perceive child wellness legislation effectiveness relative to obesity prevention. Our purpose was to understand state lawmakers' perceptions of childhood obesity and school wellness policies relative to the Social Ecological Model (SEM).

METHODS

Twenty-one state representatives and nine state senators from one US state completed in-depth interviews. Member checks and peer debriefing occurred throughout data collection and analysis. Transcripts were coded and triangulated. A conventional content analysis generated consistent themes.

RESULTS

Five main themes developed: (1) child overweight and obesity is problematic; (2) current legislation is ineffective; (3) funding and enforcing child wellness legislation is difficult; (4) it is difficult to legislate personal behavior; and (5) efforts from other levels of the SEM are more effective at promoting wellness.

CONCLUSIONS

Lawmakers understand negative impacts of child obesity, but perceive immediate legislative issues like budgetary concerns inhibit robust policy-oriented action. Participants believe parents, guardians, and individuals should ultimately be responsible for child wellness. Community, school, and family efforts to address childhood obesity and support wellness may be more effective in achieving positive outcomes than state and federal policy.

Temporal Trends in the Association between Participation in Physical Education and Physical Activity among U.S. High School Students, 2011-2017

The purpose of this study was to assess trends in physical education and physical activity among U.S. high school students from 2011 to 2017, respectively, and to evaluate temporal trends in the relationship between physical education class participation and physical activity levels. Data from a total of 51,616 high school students who participated in the Youth Risk Behavior Surveillance System (YRBSS) from 2011 to 2017 were analyzed for this study. Physical education was measured as follows: In an average week when you are in school, on how many days do you go to physical education classes? Physical activity was measured as follows: During the past 7 days, on how many days were you physically active for a total of at least 60 min per day? Meeting physical activity guideline was defined as engaging in 7 days per week of at least 60 min per day. Across the 2011-2017 YRBSS, there were no linear (p = 0.44)/quadratic trends (p = 0.37) in physical education and linear (p = 0.27)/quadratic trends (p = 0.25) in physical activity, respectively. Regarding the trends in the association between physical education and physical activity, there were no statistically significant linear (unstandardized regression coefficient (b) = 0.013, p = 0.43) or quadratic (p = 0.75) trends; however, at the sample level, there was a slight increase in the odds ratio effect sizes from 2011 to 2017 (ES = 1.80-1.98). The pooled association between physical education participation and physical activity was statistically significant, OR = 1.88, 95% CI = 1.75-2.03, p < 0.001. That is, on average across the four YRBSS cycles, students who participated in physical education had 1.88 times higher odds of meeting physical activity guideline when compared to students who did not participate in physical education. The trends of physical education and physical activity did not change between 2011 and 2017. Overall, we observed a significant relationship between participation in physical education and physical activity. There was a non-significant yet stable trend of association between participation in physical education and physical activity over time.

The Public Health Consequences of Sport Specialization

Sport specialization was thought to affect a relatively small number of elite athletes, but it is now a common practice in youth sport culture. Recent research in the field of sport specialization has led to a better understanding of the influence this issue is having on youth (ie, younger than 19 years of age) today. This review focuses on sport specialization from a public health perspective to elucidate the effect that this practice is having within the United States. The specific goals of this review are to describe (1) the prevalence of sport specialization and the factors that may affect the decision to specialize, (2) the costs of youth sport-related injuries in the context of sport specialization, (3) the financial costs that sport specialization has for families, and (4) how sport specialization may be affecting physical literacy.

Impact of Physical Education Litigation on Fifth Graders' Cardio-Respiratory Fitness, California, 2007-2018

Objectives. To examine the impact of physical education (PE) litigation on changes in cardio-respiratory fitness among racially/ethnically and socioeconomically diverse students.Methods. We used annual school-level data for all California schools with measures of fifth graders' cardio-respiratory fitness spanning 2007-2008 through 2017-2018. A difference-in-difference design assessed changes before and after lawsuits in the proportion of students meeting fitness standards in schools in districts that were parties to PE lawsuits (n = 2715) versus in schools in districts not involved (n = 3152). We ran separate models with the proportion of students meeting fitness standards by sex, race/ethnicity, and low-income status as outcomes.Results. PE litigation led to a 1-percentage-point increase in the proportion of fifth-grade students meeting cardio-respiratory fitness standards (95% confidence interval [CI] = 0.03%, 2.0%). Effects were especially pronounced for female (1.3-percentage-point increase; 95% CI = 0.1%, 2.5%), African American (3.4-percentage-point increase; 95% CI = 0.5%, 6.2%), and low-income (2.8-percentage-point increase; 95% CI = 0.5%, 6.0%) students.Conclusions. Schools in districts subject to PE litigation showed greater improvements in student fitness, particularly among students typically at higher risk for inactivity and low fitness. Litigation may be an impactful tool for enforcing PE provision in accordance with the law.

Evaluation of an Intervention to Increase Physical Activity in Low-Income, Urban Middle Schools

BACKGROUND

Physical education (PE) can provide opportunities to engage in daily moderate-to-vigorous physical activity (MVPA), but MVPA levels in many classes are low. This study examines MVPA during middle school PE lessons before and after receiving the SPARK (Sports, Play, and Active Recreation for Kids) program.

METHODS

Sixteen schools were enrolled in the study. PE teachers at eight schools received the intervention. PE lessons at all schools (N = 561) were observed over 2 years. Hierarchical linear regression models examined the effect of the intervention on the amount and consistency of MVPA and sedentary behavior.

RESULTS

An average of 13.7% of observed class time was spent in MVPA (approximately 5 minutes of a 60-minute class), compared to 27.5% of time spent sedentary. There was no evidence that the curriculum resulted in increased MVPA or consistent MVPA, or that it decreased sedentary behavior. Findings also suggested that contextual factors may contribute to physical activity levels in PE.

CONCLUSIONS

Mixed evaluation findings of the SPARK middle school curriculum demonstrate that an out-of-the-box curriculum does not have the same results in all contexts. Implications for school health are described based upon findings. Further research is needed to identify effective strategies to increase MVPA for adolescents both in and outside of PE.

Asthma symptoms, interactive physical play and behavioral and academic outcomes in urban children with persistent asthma

OBJECTIVES

Asthma may lead to reduced participation in interactive physical play (IPP). Urban youth with asthma are also at risk for behavioral and academic difficulties. Exploring associations between asthma, IPP and socio-emotional and academic outcomes in children with asthma is important. Study objectives are to: (1) describe IPP participation among school children with persistent asthma; (2) determine if IPP varies with asthma severity (3) determine independent associations of both asthma severity and IPP with socio-emotional and academic outcomes.

METHODS

We analyzed data from children with persistent asthma enrolled in the SB-TEAM trial (Rochester, NY). Caregiver surveys assessed asthma severity, IPP participation (gym ≥3 days/week, running at recess, sports team participation), socio-emotional and academic outcomes. Bivariate and regression analyses assessed relationships between variables.

RESULTS

Of 324 children in the study (59% Black, 31% Hispanic, mean age 7.9), 53% participated in any IPP at school. Compared to those with mild persistent asthma, fewer children with moderate-severe asthma had no limitation in gym (44% vs. 58%, p < .01), and fewer ran at recess (29% vs. 42%, p < .01) or engaged in any IPP (48% vs. 58%, p = .046). Asthma severity was not associated with socio-emotional or academic outcomes. However, children participating in IPP had better positive peer social and task orientation skills, were less shy/anxious, and more likely to meet academic standards (all p < .05). Results were consistent in multivariable analyses.

CONCLUSIONS

Urban children with moderate-severe asthma partake in less IPP, which is associated with socio-emotional and academic outcomes. Further efforts are needed to optimize asthmatic children's participation in IPP.

Systematically Observed Movement Integration in a Low Socioeconomic School District: A Cross-Sectional, Observational Study

PURPOSE

To describe teacher's integration of activity into general education classroom time (ie, movement integration-MI).

DESIGN

Cross-sectional, observational.

SETTING

Eight elementary schools in a rural, low-income school district.

PARTICIPANTS

Elementary classroom teachers (N = 48).

MEASURE

Classroom teachers were observed using the System for Observing Student Movement in Academic Routines and Transitions (SOSMART) on random, unannounced days during the 2015-16 academic year.

ANALYSIS

Descriptive statistics were calculated for the frequency and types of MI being used.

RESULTS

Of the 9398 SOSMART scans completed, students engaged in movement in 41.3% of the scans. Student movement was observed to be teacher directed in 14.4% and nonteacher directed in 26.9% of scans. Nonteacher-directed movement consisted mostly of transitions ( M = 99.5%) in which movement occurred as a result of preestablished classroom rules, protocols, and organization.

CONCLUSION

This is one of the first studies to provide objective information about MI. These descriptive data lay the groundwork for future correlational and experimental research that can lead to the development of effective intervention design to increase MI use in schools.

Organized Sports for Children, Preadolescents, and Adolescents

Interest and participation in organized sports for children, preadolescents, and adolescents continue to grow. Because of increased participation, and younger entry age, in organized sports, appropriate practice, game schedules, and content become more important, taking into account athlete developmental stage and skills. Parental support for organized sports in general, with focus on development and fun instead of winning, has emerged as a key factor in the athlete's enjoyment of sports. Schools and community sports organizations who support multiple levels of sport (eg, recreational, competitive, elite) can include more youth who want to play sports and combat sport dropout. This report reviews the benefits and risks of organized sports as well as the roles of schools, community organizations, parents, and coaches in organized sports. It is designed to complement the American Academy of Pediatrics clinical reports "Physical Activity Assessment and Counseling in Pediatric Clinical Settings" and "Sports Specialization and Intensive Training in Young Athletes" by reviewing relevant literature on healthy organized sports for youth and providing guidance on organized sport readiness and entry. The report also provides guidance for pediatricians on counseling parents and advocating for healthy organized sports participation.

Evaluation of a classroom movement integration training delivered in a low socioeconomic school district

Movement integration (MI), which involves infusing physical activity (PA) into general education classrooms, is an evidence-based strategy within whole-of-school approaches for helping children meet the national PA guideline of at least 60 min per day. This study evaluated an MI training delivered in a low socioeconomic elementary school that had recently invested in three movement facilitative classrooms (a kinesthetic classroom and two activity labs). We investigated (a) the training's fidelity in meeting recommended best practices for professional development and (b) school professionals' perspectives of the training. Eight school professionals participated in the study, including five classroom teachers, two activity lab supervisors, and the principal. The researchers used a video of the training to rate the fidelity of the training to best practice recommendations. Interviews, field notes, and informal conversations with participants were qualitatively analyzed for themes. The training received a total fidelity score of 42%. Qualitative findings highlighted participants' varied perspectives of the training's purpose, challenges associated with the training and future recommendations for MI trainings. For MI trainings to be a valuable asset in increasing teachers' value and effective implementation of MI, trainings need to be designed to be in line with best practice recommendations and teachers' perceived needs.

A Case Study of a New State Model for Assessing Local Wellness Policies

BACKGROUND

In 2016, the United States Department of Agriculture issued a final rule to strengthen local wellness policies (LWPs). As school districts pursue compliance, states can provide critical guidance by leveraging support from intermediary programs such as the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). After Arizona SNAP-Ed piloted a statewide model for assessing LWPs, we evaluated that model by exploring local SNAP-Ed agency experiences with the pilot. Our case study objectives were to determine the model's feasibility and utility from the perspective of local agencies supporting school districts during LWP review and revision.

METHODS

We used open-ended semistructured interviews with the 13 local SNAP-Ed agencies who engaged in each LWP assessment phase and analyzed data using constant comparative analysis.

RESULTS

Participants found the model feasible and useful. Five themes emerged, 3 of which tracked strongly with successful LWP review and revision: local agency staff comprehension, the openness of local agency staff and district/school personnel to the process, and the local agency's engagement of the district/school throughout the process.

CONCLUSIONS

Leveraging local agency support can be an effective strategy to improving LWPs, given understanding, buy-in, and staff engagement. Findings can inform agencies seeking to engage intermediaries in LWP assessment and revision.

Change in Children's Physical Activity: Predictors in the Transition From Elementary to Middle School

INTRODUCTION

Interventions to promote physical activity in children should be informed by knowledge of the factors that influence physical activity behavior during critical developmental transitions. The purpose of this study is to identify, from a comprehensive, multidomain set of factors, those that are associated with change in objectively measured physical activity in children as they transition from elementary to middle school.

METHODS

The study used a prospective cohort design, with children observed in fifth, sixth, and seventh grades. Growth curve analyses were used to examine associations between exposure variables measured at baseline and children's physical activity across three observations. A total of 828 children, aged 10.6 (SD=0.5) years at baseline provided physical activity data in fifth grade and at one or both follow-ups. Exposure variables assessed child characteristics, parent characteristics, home characteristics, social factors, school environment, and community characteristics. Physical activity was measured via accelerometry. Data were collected in two school districts in South Carolina in 2010-2013 and analyzed in 2017.

RESULTS

Variables measured within the child, parent/home, and community domains were positively associated with children's physical activity as they transitioned from fifth to seventh grade. These included parent encouragement of physical activity, parental support for physical activity, child sports participation, parent's report of the child's physical activity level, the child's time spent outdoors, social spaces for physical activity in the community, and the number of physical activity facilities that were proximal to the child's home.

CONCLUSIONS

Interventions designed to increase children's physical activity should include strategies that target multiple domains of influence.

Comparing Physical Activity Behavior of Children During School Between Balanced and Traditional School Day Schedules

BACKGROUND

Some Canadian schools have modified their daily schedules from the traditional school day (TSD) schedule (two 15-minute breaks and one 60-minute break) to a balanced school day (BSD) schedule (two 40-minute breaks). While this change increases daily planning and instructional time, it also changes the amount of time available for moderate-vigorous physical activity (MVPA).

METHODS

This study uses a case-control design to examine differences in objectively measured MVPA between children in 3 schools using a BSD schedule and 3 schools using a TSD schedule. Study participants (aged 10-12 years) were recruited from schools in Ontario, Canada.

RESULTS

Regardless of schedule type, girls had lower MVPA than boys, and as both boys and girls got older their MVPA significantly decreased. The findings indicate there was no statistically significant difference in the total minutes of in-school MVPA between children from BSD schools and children from TSD schools. MVPA was significantly higher for older girls attending BSD schools than older girls attending TSD schools, suggesting that implementing a BSD may help curb declining MVPA as girls enter adolescence.

CONCLUSION

Despite encouraging findings, more rigorous studies (ie, pre-post experiments with control) are needed to better understand how changing schedules impacts children's health.

Perspectives on High School "Pay to Play" Sports Fee Policies: A Qualitative Study

BACKGROUND

Participation in high school athletics is associated with many physical and psychosocial benefits. School budget cuts and increased program costs have resulted in policies requiring student athletes to pay fees for sports participation. The purpose of this study was to explore the implementation and perception of these policies among state and district key informants.

METHODS

We conducted an Internet search to compile a list of state and district athletic directors for study recruitment to participate in qualitative interviews. Twelve key informants were interviewed via telephone, digitally audio-recorded, and the conversations transcribed verbatim. Two team members coded transcripts and themes were identified and summarized.

RESULTS

The main reasons for implementing fee policies were increasing program costs, revenue loss or decreased school budget, and unsuccessful levy passage. The policies varied in fee structure, and were reported by sport, by athlete, by year, or by family. Participants discussed fee waivers as a strategy to assist athletes unable to pay the sports participation fees. Waivers were most likely linked with federal poverty qualifications.

CONCLUSION

The results from these interviews provided insight into sports participation policies in US high schools. More information is needed to explore the consequences of these policies on high school sports participation as well as longer-term outcomes.

The Effect of Organized Versus Supervised Recess on Elementary School Children’s Participation, Physical Activity, Play, and Social Behavior: A Cluster Randomized Controlled Trial

Background: Recess strategies that increase children’s physical activity and contribute to the daily 60 minutes of moderate to vigorous physical activity (MVPA) are recommended. Methods: A cluster randomized trial was conducted to examine the effect of supervised versus organized recess on children’s participation, physical activity, play, and social behavior. In supervised recess, children were free to play, and physical education (PE) teachers ensured safety. In organized recess, PE teachers provided challenging tasks. Data were collected using systematic observation. Children (N = 281; 8–10 y) from 14 schools received a 6-day parkour unit in PE and three opportunities to participate in a 20-minute parkour recess. Schools were randomized over a supervised and organized parkour recess condition. Results: The majority of children participated in parkour recess (range = 56%–85%), with more boys participating in all 3 organized versus supervised recess sessions (57% vs 35%, P = .01). Boys spent more time in MVPA during organized recess (79% vs 71%, P = .02). Boys and girls spent more time in activity games during organized recess (59% vs 46%, P = .01; 59% vs 47%, P = .001). Conclusion: Organized recess attracted more children and made the largest contribution to daily MVPA.

Impact of Litigation on Compliance With California Physical Education Laws in Elementary Schools

BACKGROUND

School physical education (PE) is one of the most effective public health tools to increase youth physical activity, yet compliance with PE mandates is low. In an effort to ensure adherence to state PE law, a 2013 lawsuit was filed against 37 California school districts that were found to be noncompliant. This study sought to assess school personnel's perceptions of the lawsuit's impact on PE mandate compliance, understand barriers and facilitators to lawsuit compliance, and identify potential unintended consequences of the lawsuit.

METHODS

Phone interviews (n = 97) were conducted with personnel in districts/schools that were parties to the lawsuit and in matched control districts/schools that were not parties to the lawsuit.

RESULTS

Interviewees reported that PE minutes increased in schools that were parties to the lawsuit, primarily due to settlement requirements mandating PE tracking and reporting, thereby increasing accountability for PE. Time lost on paperwork was the most often cited barrier to compliance. Unwillingness to participate in PE-related research for fear of incrimination was the primary unintended consequence.

CONCLUSIONS

When existing PE minute laws are not implemented or enforced, greater accountability is needed. In this case, litigation appears to be an effective accountability mechanism to increase compliance with law.

Active Commuting to School, Physical Activity, and Behavior Problems Among Third-Grade Children

BACKGROUND

We examined factors associated with active commuting to school and the relationships of active commuting and physical activity to child- and teacher-reported internalizing and externalizing behavior problems in a sample of third graders.

METHODS

The study sample consisted of 13,166 third graders enrolled in the Early Childhood Longitudinal Study Kindergarten Class of 1998-1999. "Active" commuters were children who walked to school and "passive" commuters were those who took the bus or were driven. Linear analyses evaluated differences in behavior problems by school commute, physical activity, and sports team participation after adjusting for sociodemographic, regional, and neighborhood factors.

RESULTS

Overall, 11% of children actively commuted. Type of commute differed by sociodemographics, region, urbanicity, school type, and neighborhood safety. Active commuters had less general physical activity participation and sports team participation. Commuting type and general physical activity were not associated with behavior problems, but sports team participation was associated with fewer child-reported internalizing and externalizing behaviors as well as fewer teacher-reported internalizing behaviors.

CONCLUSIONS

Our findings demonstrate the ongoing need for creating and maintaining physical activity programs (such as sports teams) among school-aged children to optimize children's overall health and well-being.

"You Only Teach PE and It Doesn't Really Matter": Middle School PE Teachers' Perspectives on Intervention Efforts to Increase Physical Activity

Physical education (PE) is a frequent site of public health intervention to promote physical activity (PA); however, intervention research frequently overlooks the perspective of PE teachers. The purpose of this qualitative study was to explore teachers' experiences with and perceptions of a PA curriculum intervention. Six findings within three categories were identified and described in detail. In-depth one-on-one semistructured interviews were conducted with nine PE teachers from eight middle schools in Los Angeles. Feeling underappreciated and having a "muddled mission" within PE were driving factors in teacher morale and practice. Teachers had positive experiences with the curriculum, but significant barriers remained and limited the potential for PA during PE classes. PE teachers are pulled in multiple directions and perceive a lack of necessary support systems to achieve student health goals. Interventions aimed at leveraging PE as a site of PA promotion must incorporate the perspectives of PE teachers.

Investigating best practices of district-wide physical activity programmatic efforts in US schools- a mixed-methods approach

Background

The majority of US children do not meet physical activity recommendations. Schools are an important environment for promoting physical activity in children, yet most school districts do not offer enough physical activity opportunities to meet recommendations. This study aimed to identify school districts across the country that demonstrated exemplary efforts to provide students with many physical activity opportunities and to understand the factors that facilitated their programmatic success.

Methods

A total of 59 districts were identified as model districts by members of the Physical Activity and Health Innovation Collaborative, an ad hoc activity associated with the Roundtable on Obesity Solutions at the National Academies of Sciences, Engineering, and Medicine. Semi-structured interviews were conducted with consenting stakeholders from 23 school districts to understand physical education and activity efforts and elucidate factors that led to the success of these districts’ physical activity programming. Districts were geographically and socioeconomically diverse and varied in their administrative and funding structure.

Results

Most districts did not offer the recommended 150 or 225 min of physical activity a week through physical education alone; yet all districts offered a range of programs outside of physical education that provided additional opportunities for students to be physically active. The average number of school-based physical activity programs offered was 5.5, 3.5 and 2.1 for elementary, middle and high schools, respectively. Three overarching and broadly relevant themes were identified that were associated with successfully enhancing physical activity opportunities for students: soliciting and maintaining the support of champions, securing funding and/or tangible support, and fostering bi-directional partnerships between the district and community organizations and programs. Not only were these three themes critical for the development of physical activity opportunities, but they also remained important for the implementation, evaluation and sustainability of programs. These themes also did not differ substantially by the socioeconomic status of districts.

Conclusions

These findings demonstrate the success of school districts across the nation in providing ample opportunities for physical activity despite considerable variability in socioeconomic status and resources. These results can inform future research and provide actionable evidence for school districts to enhance physical activity opportunities to students.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5889-4) contains supplementary material, which is available to authorized users.

An Intervention to Increase Students' Physical Activity: A 2-Year Pilot Study

INTRODUCTION

Schools are called upon to provide children with 30 minutes/day of moderate to vigorous physical activity (MVPA). Most school-based physical activity interventions have not targeted schools that serve children from low-income families. This study evaluated the effects of a pilot, competency-building professional development program on the school day MVPA and total activity (light- to vigorous-intensity activity) of students from schools that serve low-income families.

STUDY DESIGN

Single group intervention with multiple follow-up repeated cross-sectional measures.

SETTING/PARTICIPANTS

Students attending eight elementary schools in one low-income school district serving 3,719 students.

INTERVENTION

Participatory-based, experiential, competency-building professional development workshop for physical education and classroom teachers. Baseline was fall 2015, and the intervention was delivered during spring 2016 through spring 2017.

MAIN OUTCOME MEASURES

Hip-placed accelerometers were used to derive the percentage of children accumulating 30 minutes of MVPA during the school day, minutes of MVPA, and time spent sedentary. Analyses were conducted during July 2017.

RESULTS

A total of 1,570 first- and fourth-grade students (49.8% girls, 87.0% African American, 88% free and reduced-price lunch) were measured across the project. Primary analyses indicated that the percentage of girls and boys meeting the 30-minutes/day guideline increased by 9.3% (95% CI=4.7%, 13.9%) and 10.4% (95% CI=5.5%, 15.3%), respectively. A corresponding increase of 1.7 (95% CI=0.5, 2.8) and 2.5 (95% CI=1.1, 3.8) MVPA minutes accumulated during the school day were observed for both girls and boys, respectively. Primary analyses indicated that statistically significant increases in MVPA and total activity for boys and girls were observed across the school day, during classroom time, and during physical education.

CONCLUSIONS

Participatory-based, experiential, competency-building professional development is an effective strategy for increasing students' MVPA and total activity in low-income schools. However, data from this study indicate that targeting settings outside of the school day may be more appropriate given that schools were providing more than two thirds of the recommended 30 minutes/day of MVPA prior to intervention.

What's Physical Activity Got to Do With It? Social Trends in Less Active Students at Recess

BACKGROUND

Public health concerns regarding childhood obesity and sedentary behavior make investigations of children's physical activity (PA) promotion crucial. School recess, a highly discretional time, plays a central role in shaping children's activity preferences.

METHODS

Participants included 40 children (30 girls, 10 boys) from fourth and fifth grades, categorized as low active during recess (<26% moderate-to-vigorous PA [MVPA]). PA was measured via accelerometer (Actigraph wGT3X+) and activity choice gauged through a self-report measure over a 3-day period. To assess attitudes and perceptions of recess, individual interviews were conducted. Accelerometer data were analyzed into minutes and percentage of MVPA; interviews were transcribed verbatim and analyzed utilizing open and axial coding.

RESULTS

Participants were active for 18% of recess, choosing activities that were primarily individual-based. Interview data showed low active children attribute recess enjoyment to social interaction and time away from schoolwork as well as an intention to avoid other children who were unkind and/or caused social conflict.

CONCLUSIONS

This study supports the importance of gaining a child's perspective of their own behavior, particularly those children classified as less active. Findings add a unique contribution to school health research through an innovative, child-centered approach to explore perceptions of PA.