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

The Link Between Nutrition and Physical Activity in Increasing Academic Achievement

BACKGROUND

Research demonstrates a link between decreased cognitive function in overweight school-aged children and improved cognitive function among students with high fitness levels and children engaging in regular physical activity (PA). The purpose of this study was to examine whether regular PA and proper nutrition together had a significant effect on academic achievement.

METHODS

Using the seventh wave of the Early Childhood Longitudinal Study, Kindergarten Class 1998-99 (ECLS-K) dataset, linear regression analysis with a Jackknife resampling correction was conducted to analyze the relationship among nutrition, PA, and academic achievement, while controlling for socioeconomic status, age, and sex. A nonactive, unhealthy nutrition group and a physically active, healthy nutrition group were compared on standardized tests of academic achievement.

RESULTS

Findings indicated that PA levels and proper nutrition significantly predicted achievement scores. Thus, the active, healthy nutrition group scored higher on reading, math, and science standardized achievement tests scores.

CONCLUSIONS

There is a strong connection between healthy nutrition and adequate PA, and the average performance within the population. Thus, results from this study suggest a supporting relationship between students' health and academic achievement. Findings also provide implications for school and district policy changes.

Accelerometer-Assessed Physical Activity and School Absenteeism Due to Illness or Injury Among Children and Adolescents: NHANES 2003 to 2006

INTRODUCTION

To examine the association between objectively measured moderate to vigorous physical activity (MVPA) and total physical activity with school absenteeism due to illness or injury among children and adolescents.

DESIGN

Cross-sectional study.

SETTING

National Health and Nutrition Examination Survey 2003 to 2006.

PARTICIPANTS

A total of 1249 children (aged 6-11 years) and 1747 adolescents (aged 12-17 years).

MEASURES

School absenteeism was categorized as no/minimal school absenteeism (0-8 missed school days in the past 12 months), moderate absenteeism (9-17 missed days), or severe absenteeism (18+ missed days). Physical activity was objectively measured via accelerometry.

ANALYSIS

Multinomial logistic regression.

RESULTS

Children in the most active quartile had 89% reduced odds of severe absenteeism relative to the least active quartile (odds ratio [OR]: 0.11; 0.95% confidence interval [CI]: 0.02-0.48); results were similar for MVPA. For adolescents, those in the most active quartile for MVPA had a 41% reduced odds of having moderate (vs no/minimal) absenteeism (OR = 0.59; 95% CI: 0.35-0.99). For children, a multiplicative interaction effect of MVPA and poverty level on severe absenteeism was observed (OR = 0.98, P = .02).

CONCLUSION

Higher levels of physical activity were associated with lower odds of severe school absenteeism. Such an observation is important, as school absenteeism strongly contributes to academic performance. Particular attention for promoting physical activity and closely monitoring school absenteeism among youth below the poverty level may be warranted.

Anthropometric Characteristics and Physical Fitness in Rural and Urban 11- to 16-Year-Old Melanesian Adolescents: A Cross-sectional Study in New Caledonian Schools

We evaluated anthropometric characteristics and physical fitness in 556 Melanesian adolescents from rural and urban New Caledonia to build health education programs focused on physical activity. In 2013, body weight, height, skinfold thickness, lean body mass (LBM), percentage fat body mass (%FBM), physical fitness (power, agility, speed, maximal aerobic speed [MAS], estimated VO_2max), and self-reported physical activity were assessed. Rural adolescents were significantly shorter and faster, had lower weight, %FBM, LBM, and power output and similar MAS and VO_2max, and were more active than urban adolescents. Rural girls were significantly shorter, had higher MAS and VO_2max, and were faster and significantly more active than urban girls while similar %BFM was observed in both groups of girls. Rural boys showed significantly lower height, weight, %FBM, and power and were significantly faster and more active than urban boys. In conclusion, rural Melanesian adolescents are more active, with good physical fitness (especially boys), although high %FBM was noted (especially in girls).

Impact of NFL PLAY 60 Programming on Elementary School Children's Body Mass Index and Aerobic Capacity: The NFL PLAY 60 FitnessGram Partnership Project

BACKGROUND

We examined the impact of the Fuel Up to Play 60 (FUTP60) program on children's body mass index (BMI) and aerobic capacity (AC).

METHODS

Participation in the FUTP60 and both BMI and AC profiles were collected through the NFL PLAY 60 FitnessGram Partnership Project involving over 100 schools from 22 US states. We specifically examined the distributions of BMI and AC among participating versus nonparticipating schools in the 2012-2013 school year. Hierarchical linear models tested the impact of participation and availability of additional funding for program implementation on the proportions of youth meeting FitnessGram health-related fitness standards (ie, Needs Improvement-Health Risk [NIHR] and Healthy Fitness Zone [HFZ] categories).

RESULTS

After 1 year implementing the program, participating schools had lower proportions of boys (-4.1 ± 2.0%, p = .04) and girls (-4.5 ± 2.0%, p = .03) in the NIHR for BMI, and lower proportion of girls (-9.7 ± 4.0%, p = .02) in the NIHR for AC. There were no differences in the distributions for the HFZ and the availability of additional funding did not alter the relationships (p > .05).

CONCLUSIONS

This study provides preliminary evidence that participation in the FUTP60 is associated with improved profiles of health-related fitness.

A school-based physical activity promotion intervention in children: rationale and study protocol for the PREVIENE Project

Background

The lack of physical activity and increasing time spent in sedentary behaviours during childhood place importance on developing low cost, easy-toimplement school-based interventions to increase physical activity among children. The PREVIENE Project will evaluate the effectiveness of five innovative, simple, and feasible interventions (active commuting to/from school, active Physical Education lessons, active school recess, sleep health promotion, and an integrated program incorporating all 4 interventions) to improve physical activity, fitness, anthropometry, sleep health, academic achievement, and health-related quality of life in primary school children.

Methods

A total of 300 children (grade 3; 8-9 years of age) from six schools in Granada (Spain) will be enrolled in one of the 8-week interventions (one intervention per school; 50 children per school) or a control group (no intervention school; 50 children). Outcomes will include physical activity (measured by accelerometry), physical fitness (assessed using the ALPHA fitness battery), and anthropometry (height, weight and waist circumference). Furthermore, they will include sleep health (measured by accelerometers, a sleep diary, and sleep health questionnaires), academic achievement (grades from the official school’s records), and health-related quality of life (child and parental questionnaires). To assess the effectiveness of the different interventions on objectively measured PA and the other outcomes, the generalized linear model will be used.

Discussion

The PREVIENE Project will provide the information about the effectiveness and implementation of different school-based interventions for physical activity promotion in primary school children.

Self-efficacy of physical education teachers in including students with cerebral palsy in their classes

Children with cerebral palsy (CP) are often mainstreamed into the general education system, but are likely to be excluded from physical education (PE) classes. A questionnaire was constructed and utilized to measure PE teachers' self-efficacy (SE) toward inclusion of students with CP in each of three mobility categories (independent, using assistive devices, using wheelchair mobility) and the impact of experience and training on teachers' SE. Participants in the study were 121 PE teachers from different parts of Israel (mean age: 41.02±9.33 years; range: 25.00-59.00 years). Exploratory factor analysis was used to determine the structure of the sub-scales' factors' structure and Cronbach's Alpha reliability was satisfactory (range 0.872-0.941). Independent t-tests were calculated in order to compare the SE of teachers with and without adapted PE experience. Repeated Analysis of Variance was performed to measure within-group differences in SE. Results revealed that the PE teachers' SE in teaching students who use mobility assistive devices or wheelchairs was significantly lower compared to teaching those who walk and run unaided (F=19.11; p<0.001). The teachers' SE towards including CP children who independently ambulate was influenced (p<0.05; d=0.94) by the teacher's experience (elementary school practicum). SE in the mobility with assistive device group was also significantly influenced (p<0.05; d=0.1) by teaching experience (previous experience and having a specialization in adapted PE). Finally, SE when teaching the wheelchair mobility group was influenced by having an adapted PE specialization (p<0.05; d=0.82). Specialized training in this particular area should be enhanced to increase teachers' SE and enable greater participation of children with CP in general physical education classes.

A Review of Implementation Outcome Measures of School-Based Physical Activity Interventions

BACKGROUND

Measuring the implementation of school-based physical activity (PA) interventions is an important prerequisite in assessing their impact. Prior to conducting a study to assess the implementation of the daily physical activity (DPA) policy in Ontario, Canada, a literature review was conducted to identify existing survey instruments to measure 5 implementation outcomes: adoption, fidelity, implementation cost, reach, and sustainability.

METHODS

A search for survey instruments to assess these implementation outcomes at the teacher and school administrator levels was conducted in 7 bibliographic databases, as well as the gray literature. Each survey instrument was coded as assessing 1 of the 5 implementation outcomes if it included at least 1 item measuring the construct.

RESULTS

Twenty-three survey instruments were identified. None of the instruments were specifically developed to measure the implementation outcomes. Fidelity was the most common implementation outcome measured, followed by adoption. The least common implementation outcome measured was sustainability. Thirty-five percent of survey instruments assessed were previously tested for validity and 26% were previously tested for reliability.

CONCLUSIONS

Based on this review, a gap in available instruments to measure implementation outcomes of school-based PA programs was identified. An adapted theoretical framework, presented here, has potential application in future implementation studies.

Predictors of Segmented School Day Physical Activity and Sedentary Time in Children from a Northwest England Low-Income Community

Background: Schools have been identified as important settings for health promotion through physical activity participation, particularly as children are insufficiently active for health. The aim of this study was to investigate the child and school-level influences on children′s physical activity levels and sedentary time during school hours in a sample of children from a low-income community; Methods: One hundred and eighty-six children (110 boys) aged 9–10 years wore accelerometers for 7 days, with 169 meeting the inclusion criteria of 16 h∙day⁻¹ for a minimum of three week days. Multilevel prediction models were constructed to identify significant predictors of sedentary time, light, and moderate to vigorous physical activity during school hour segments. Child-level predictors (sex, weight status, maturity offset, cardiorespiratory fitness, physical activity self-efficacy, physical activity enjoyment) and school-level predictors (number on roll, playground area, provision score) were entered into the models; Results: Maturity offset, fitness, weight status, waist circumference-to-height ratio, sedentary time, moderate to vigorous physical activity, number of children on roll and playground area significantly predicted physical activity and sedentary time; Conclusions: Research should move towards considering context-specific physical activity and its correlates to better inform intervention strategies.

Partnerships for Active Children in Elementary Schools: Outcomes of a 2-Year Pilot Study to Increase Physical Activity During the School Day

Purpose:

To evaluate the impact of the pilot study Partnerships for Active Children in Elementary Schools on the percentage of children achieving the Institute of Medicine guideline of 30 minutes of moderate-to-vigorous physical activity (MVPA) during the school day.

Design:

Pre/multiple post-quasi-experimental.

Setting:

Four elementary schools.

Participants:

Physical education (n = 3) and classroom teachers (n = 12) and students (n = 229).

Intervention:

Partnerships for Active Children in Elementary Schools was a multicomponent, theory-driven intervention facilitated through school–university partnerships. Intervention approaches included communities of practice, community-based participatory research, and service learning.

Measures:

Accelerometer-derived percentage of children accumulating 30 minutes of MVPA during the school day.

Analysis:

Multilevel mixed-effects regression estimated MVPA differences over time.

Results:

Compared to control, a 2.4% (95% confidence interval [CI]: −0.0% to 4.8%) and 8.8% (95% CI: −0.3% to 15.4%) increase in the percentage of time girls and boys engaged in MVPA during the school day was observed. The percentage of boys and girls in the intervention group achieving 30 minutes of MVPA/day increased from 57.5% to 70.7% and 35.4% to 56.9%, respectively. Boys and girls in the control group decreased from 61.5% to 56.4% and 52.6% to 41.9%, respectively. However, these changes did not reach statistical significance.

Conclusion:

Partnerships for Active Children in Elementary Schools demonstrated meaningful impact on children’s MVPA during the school day by increasing boys’ and girls’ MVPA. However, additional strategies may be required to help schools achieve the Institute of Medicine guideline.

A Wellness Mobile Application for Smart Health: Pilot Study Design and Results

Wellness is one of the main factors crucial in the avoidance of illness or disease. Experience has shown that healthy lifestyle programs are an important strategy to prevent the major shared risk factors for many diseases including cardiovascular diseases, strokes, diabetes, obesity, and hypertension. Within the ambit of the Smart Health 2.0 project, a Wellness App has been developed which has the aim of providing people with something similar to a personal trainer. This Wellness App is able to gather information about the subject, to classify her/him by evaluating some of her/his specific characteristics (physical parameters and lifestyle) and to make personal recommendations to enhance her/his well-being. The application can also give feedback on the effectiveness of the specified characteristics by monitoring their evolution over time, and can provide a positive incentive to stimulate the subject to achieve her/his wellness goals. In this paper, we present a pilot study conducted in Calabria, a region of Italy, aimed at an evaluation of the validity, usability, and navigability of the app, and of people’s level of satisfaction with it. The preliminary results show an average score of 77.16 for usability and of 76.87 for navigability, with an improvement of the Wellness Index with a significance average of 95% and of the Mediterranean Adequacy Index with a significance average of as high as 99%.

Shared Use of Physical Activity Facilities Among North Carolina Faith Communities, 2013

Introduction

Shared use of recreational facilities is a promising strategy for increasing access to places for physical activity. Little is known about shared use in faith-based settings. This study examined shared use practices and barriers in faith communities in North Carolina.

Methods

Faith communities in North Carolina (n = 234) completed an online survey (October–December 2013) designed to provide information about the extent and nature of shared use of recreational facilities. We used binary logistic regression to examine differences between congregations that shared use and those that did not share use.

Results

Most of the faith communities (82.9%) that completed the survey indicated that they share their facilities with outside individuals and organizations. Formal agreements were more common when faith communities shared indoor spaces such as gymnasiums and classroom meeting spaces than when they shared outdoor spaces such as playgrounds or athletic fields. Faith communities in the wealthiest counties were more likely to share their spaces than were faith communities in poorer counties. Faith communities in counties with the best health rankings were more likely to share facilities than faith communities in counties that had lower health rankings. The most frequently cited reasons faith communities did not share their facilities were that they did not know how to initiate the process of sharing their facilities or that no outside groups had ever asked.

Conclusion

Most faith communities shared their facilities for physical activity. Research is needed on the relationship between shared use and physical activity levels, including the effect of formalizing shared-use policies.

Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood

Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.

Shared use agreements and leisure time physical activity in North Carolina public schools

Although increasing community access to public schools through shared use agreements (SUAs) has been a recommended strategy for promoting physical activity (PA) among national, state and local organizations, empirical evidence examining the efficacy of SUAs is limited. This study examined the degree of usage and production of PA among schools with shared use, and how variation in PA output is related to characteristics of the school, type of activity, facility type, and when activity occurs. Data were collected in 20 schools across North Carolina using System for Observing Play and Recreation in Communities (SOPARC) and Structured Physical Activity Surveys (SPAS) to assess PA in school athletic facilities during out of school time. Findings indicated that although schools had a policy of shared or open use, most facilities were empty during non-school hours. Hierarchal linear regression models also showed that formal programming was positively associated with both use and PA levels. Given the abundance of empty facilities, community groups in need of space to facilitate structured PA programs should pursue avenues of sharing facilities with public schools. Furthermore, to increase the efficacy of shared use, structured physical activity programs may be needed. Future studies are encouraged to further explore the effects of the specific types of shared use programs on PA production as well other aspects of the built environment surrounding schools.

Research Opportunities and Challenges in the Era of Healthy Living Medicine: Unlocking the Potential

Non-communicable diseases, such as cardiovascular disease (CVD), obesity, cancer, pulmonary disease, and diabetes are a very high global health concern. The health costs of risk factors for CVD, such as hypertension (HTN), is mounting and are unrelenting. As an example, it is estimated that direct and indirect costs due to HTN amounted to $46.4 billion in 2011 and projections of six-fold increases by 2030; the importance of low-cost nonpharmacological interventions involving collaborative teams of health care professionals is at a critical junction. Certainly, the data supported by research including some clinical trials for healthy living interventions support deploying health education, nutrition, smoking cessation, and physical activity(PA) in preventing CVD risk, such as HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of BP management. However, less is known about what optimization of PA/ET modalities with nutrition and lifestyle tracking with modern era technologies will bring to this equation. New research methods may need to consider how to collaborate to collect data in using teams of researchers while interacting with community centers, school systems, and in traditional health care practices. This review will discuss and present what is known about the research that support modern era healthy living medicine and how this data may be integrated in venues that support health lifestyle in the community (i.e. schools and the work place).

Accelerometry-Derived Physical Activity of First Through Third Grade Children During the Segmented School Day

BACKGROUND

Schools should provide children 30 minutes/day of moderate-to-vigorous-physical-activity (MVPA). Determining school day segments that contribute to children's MVPA can inform school-based activity promotion. The purpose of this paper was to identify the proportion of children accumulating 30 minutes/day of school-based MVPA, and to identify school day segments' contribution to children's MVPA.

METHODS

First-third graders (N = 323 [173 girls and 150 boys]) accelerometer-derived sedentary behaviors, light activity, and MVPA were measured for 1 to 5 school days. Children's activity was estimated during class time, lunch, physical education (PE), and recess. To explore disparities in MVPA, children were stratified into high/low-active groups.

RESULTS

Girls and boys accumulated 30.4 and 34.4 minutes/day of MVPA on PE days and 23.5 and 27.3 minutes/day of MVPA on non-PE days. This translated to 36.5 and 44.1% of girls and boys accumulating 30 minutes of MVPA on PE days and 16.3 and 36.5% on non-PE days. On PE days, PE contributed the most MVPA for girls and boys (11.8 and 13.0 minutes/day), followed by class time (11.4 and 12.5 minutes/day), recess (5.2 and 6.5 minutes/day), and lunch (2.0 and 2.4 minutes/day). Disparities between high/low children were greatest during PE and class time.

CONCLUSIONS

Most children were not accumulating 30 minutes/day of MVPA. PE and class time are promising school day segments for promoting MVPA.

A Structured Peer-Mentoring Method for Physical Activity Behavior Change Among Adolescents

Despite national guidelines for regular physical activity, most adolescents are not physically active. Schools serve an estimated 60 million youth and provide an educational environment to meet the current physical activity guidelines. The obesity epidemic and chronic disease comorbidities associated with physical inactivity are not likely to be reversed without a strong contribution from local schools. This article describes how a structured peer-mentoring method provides a feasible, flexible, and tailored means to meet the current guidelines for best practice in a school setting. Structured peer mentoring using trained high school mentors to support behavior change in younger peers is an innovative method to meeting the School Health Guidelines to Promote Healthy Eating and Physical Activity Through structured peer mentoring, adolescents are provided consistent social support in a caring and personalized manner. This support builds skills and competencies enhancing self-efficacy to sustain a lifetime of physical activity behavior.

Is physical education an effective way to increase physical activity in children with lower cardiorespiratory fitness?

Several findings revealed the importance of accruing moderate and vigorous physical activity (MVPA) to improve health. Physical education (PE) may play an important role on promoting children's MVPA. However, it remains unknown whether PE might be effective when increasing physical activity (PA) levels in children with lower cardiorespiratory fitness (CRF). Therefore, the aim of this study was to assess children's PA during PE and during days with and without PE with a special focus on CRF status. One hundred and fifty Spanish children and adolescents from 3rd to 12th grade were recruited. PA levels were assessed with GT3X accelerometers. Peak oxygen uptake (VO_2peak ) was estimated using a portable breath by breath Metamax 3B. Participants were classified as healthy aerobic fitness (HAF) and unhealthy aerobic fitness (UHAF) according to standardized cut-off point criteria. During PE, students with HAF accrued more MVPA than those with UHAF (8.7 vs 5.7 min/session; P ≤ 0.001). MVPA was higher on PE days than days without for both UHAF (50.0 vs 42.7 min/day; P ≤ 0.05) and HAF students (56.9 vs 49.4 min/day; P ≤ 0.05). Although less active during PE, students with lower CRF accumulated more MVPA and total PA on PE days than days without PE. An increase in PE days might be a smart policy to raise the recommended PA levels, regardless of CRF status.

Promoting Fitness and Safety in Elementary Students: A Randomized Control Study of the Michigan Model for Health

BACKGROUND

In elementary grades, comprehensive health education curricula have demonstrated effectiveness in addressing singular health issues. The Michigan Model for Health (MMH) was implemented and evaluated to determine its impact on nutrition, physical fitness, and safety knowledge and skills.

METHODS

Schools (N = 52) were randomly assigned to intervention and control conditions. Participants received MMH with 24 lessons in grade 4 and 28 more lessons in grade 5 including material focusing on nutrition, physical fitness, and safety attitudes and skills. The 40-minute lessons were taught by the classroom teacher who received curriculum training and provided feedback on implementation fidelity. Self-report survey data were collected from the fourth-grade students (N = 1983) prior to the intervention, immediately after the intervention, and 6 weeks after the intervention, with the same data collection schedule repeated in fifth grade. Analysis of the scales was conducted using a mixed-model approach.

RESULTS

Students who received the curriculum had better nutrition, physical activity, and safety skills than the control-group students. Intervention students also reported higher consumption of fruits; however, no difference was reported for other types of food consumption.

CONCLUSION

The effectiveness of the MMH in promoting fitness and safety supports the call for integrated strategies that begin in elementary grades, target multiple risk behaviors, and result in practical and financial benefits to schools.

Design and Evaluation of the NFL PLAY 60 FITNESSGRAM Partnership Project

This article describes the conceptual design and evaluation strategies used in the NFL PLAY 60 FITNESSGRAM Partnership Project, a large participatory research network focused on building effective school physical education programming. The article summarizes the unique participatory design, recruitment methods, programming strategies, and analytical plans used to evaluate this large project. The study provides unique insight into how to effectively deliver large-scale school-based physical fitness and physical activity programming to support and enhance physical education programming in schools.

Contextual factors related to physical activity during daily middle school physical education

OBJECTIVES

Given the importance of optimizing physical activity in adolescents, the purpose of this study was to examine the effect of activity mode, environment, and semester on step counts/minute and MVPA during daily middle-school physical education (PE).

DESIGN

A prospective and observational research design.

METHODS

Participants included 232 students (Mean age=13.3±0.4 years) recruited from the seventh and eighth grades from one public middle-school in the U.S. Activity modes were employed across the school year including motor skills, games, and fitness activities located in indoor and outdoor environments. Step counts/minute and MVPA were monitored across 132 PE lessons during Fall and Spring semesters using NL-1000 piezoelectric pedometers. A three-way Multivariate Analysis of Covariance (MANCOVA) was employed to examine the effect of activity mode (skill games vs. fitness), environment (indoors vs. outdoors), and semester (Fall vs. Spring) on student step counts/minute and MVPA. MANCOVA was followed by separate ANCOVA tests.

RESULTS

MANCOVA yielded a statistically significant three-way interaction (Wilks' Λ=0.98 F(2, 1153)=8.9, P<0.001). Follow-up tests supported that physical activity was higher during outdoor fitness activities in the Fall compared to indoor motor skills in the Spring for step counts/minute (Mean difference=27.0 steps/minute, P<0.001, Cohen's d=1.6) and MVPA (Mean difference=7.8min, P<0.001, Cohen's d=2.0).

CONCLUSIONS

Daily middle-school physical activity was the highest during outdoor fitness activities in the Fall and the lowest during indoor motor skill games in the Spring.

Early motor skill competence as a mediator of child and adult physical activity

OBJECTIVE

In order to effectively promote physical activity (PA) during childhood, and across the lifespan, a better understanding of the role of early motor skill development on child and adult PA is needed.

METHODS

Here, we propose a conceptual model delineating the hypothesized influence of motor skill development on child and adult PA, while providing an overview of the current empirical research related to this model.

RESULTS

There is consistent and emerging evidence showing that adequate motor skill competence, particularly locomotor and gross motor skills, is associated with increased PA levels during the preschool, child, and adolescent years, with early motor skill development also influencing enjoyment of PA as well as long-term PA and motor skill performance. The physical education setting appears to be a well-suited environment for motor skill development.

CONCLUSION

Employing appropriate strategies to target motor skill development across the childhood years is of paramount interest in helping shape children's PA behavior, their experiences related to PA, as well as maintain their PA.

Adolescent Physical Education Class Participation as a Predictor for Adult Physical Activity

BACKGROUND

The aim of this study was to determine whether engagement in more physical education (PE) classes during one high school year is associated with change in physical activity (PA) from adolescence to young adulthood.

METHODS

Data were from 1774 participants in Waves 2 (high school, 1996) and 4 (young adulthood, 2008) of the National Longitudinal Study of Adolescent to Adult Health. The predictor was number of PE classes/week in high school (daily, some, or none). The outcome was change in moderate-to-vigorous physical activity (ΔMVPA) over the 12-year period. ΔMVPA was based on differences in MVPA scores derived at each wave from responses to a physical activity behavior recall (range, -9 to 9 scale score or -15 to 15 MVPA episodes/week). Multivariable generalized linear models examined the association between PE participation and ΔMVPA, adjusting for sociodemographics, weight status, and school clustering.

RESULTS

In high school, 34.7% participated in daily PE, whereas 50.1% participated in none. Participation in more PE classes was associated with greater MVPA in high school (mean MVPAW2none = 3.11, standard deviation [SD] = 1.99; mean MVPAW2some = 3.70, SD = 2.00; mean MVPAW2daily = 4.31, SD = 1.95; p < 0.0001). Overall, MVPA decreased over the 12 years (median ΔMVPA = -1.0, or 1-2 MVPA episodes/week). MVPA decreased more for males (median ΔMVPAmale = -1.0, interquartile range [IQR] = -3.0 ± 1.0; median ΔMVPAfemale = 0.0, IQR = -2.0 ± 2.0; p < 0.0001) and those who had participated in some/daily PE (median ΔMVPAsome = -1.0, IQR = -3.0 ± 1.0; median ΔMVPAdaily = -1.0, IQR = -3.0 ± 1.0) than those not in PE (median ΔMVPAnone = 0.0, IQR = -2.0 ± 2.0; p < 0.0001). The relationship between PE and ΔMVPA was maintained in multivariable analyses (βsome = -0.58, standard error [SE] = 0.18; p = 0.002; βdaily = -0.93, SE = 0.16; p < 0.001).

CONCLUSIONS

High school PE participation did not prevent declining PA from adolescence to young adulthood.

Public Disclosure to Improve Physical Education in an Urban School District: Results From a 2-Year Quasi-Experimental Study

BACKGROUND

Many elementary schools have policies requiring a minimum amount of physical education (PE). However, few schools comply with local/state PE policy and little is known about how to improve adherence. We evaluated changes in PE among fifth-grade classes, following participatory action research efforts to improve PE quantity and policy compliance that focused on publically disclosing PE data.

METHODS

Data were collected in 20 San Francisco public elementary schools in spring 2011 and 2013. PE schedules were collected and PE classes were directly observed (2011, N = 30 teachers; 2013, N = 33 teachers). Data on the proportion of schools meeting state PE mandates in 2011 were shared within the school district and disclosed to the general public in 2012.

RESULTS

From 2011 to 2013, PE increased by 11 minutes/week based on teachers' schedules (95% CI: 3.0, 19.6) and by 14 minutes/week (95% CI: 1.9, 26.0) based on observations. The proportion of schools meeting the state PE mandate increased from 20% to 30% (p = .27).

CONCLUSIONS

Positive changes in PE were seen over a 2-year period following the public disclosure of data that highlighted poor PE policy compliance. Public disclosure could be a method for ensuring greater PE policy adherence.

Healthy Lifestyle Interventions to Combat Noncommunicable Disease—A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine

Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.

Integrating movement in academic classrooms: understanding, applying and advancing the knowledge base

In the context of comprehensive and coordinated approaches to school health, academic classrooms have gained attention as a promising setting for increasing physical activity and reducing sedentary time among children. The aims of this paper are to review the rationale and knowledge base related to movement integration in academic classrooms, consider the practical applications of current knowledge to interventions and teacher education, and suggest directions for future research. Specifically, this paper (i) situates movement integration amid policy and research related to children's health and the school as a health-promoting environment; (ii) highlights the benefits of movement integration; (iii) summarizes movement integration programs and interventions; (iv) examines factors associated with classroom teachers' movement integration; (v) offers strategies for translating research to practice and (vi) forwards recommendations for future inquiry related to the effectiveness and sustainability of efforts to integrate movement into classroom routines. This paper provides a comprehensive resource for developing state-of-the-art initiatives to maximize children's movement in academic classrooms as a key strategy for important goals in both education and public health.

Cost Effectiveness of an Elementary School Active Physical Education Policy

INTRODUCTION

Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state "active PE" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA.

METHODS

A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014.

RESULTS

An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million).

CONCLUSIONS

Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.

Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine

Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.

Increasing Children's Physical Activity During the School Day

Insufficient levels of daily physical activity (PA) among children in the USA and worldwide have profound implications for pediatric obesity and children's health and well-being more generally. Public health recommendations highlight the central role that schools play in providing equitable opportunities for PA for all children. This review identifies evidence-based approaches for increasing children's PA throughout the school day and discusses multilevel factors that support implementation of such approaches. Opportunities to increase school-day PA span not only in-school time (e.g., quality recess and physical education, classroom activity breaks) but also time before school (e.g., active commuting initiatives) and after school (e.g., intramural and interscholastic sports programs). For such approaches to impact children's PA, dimensions of implementation such as adoption, fidelity, penetration, implementation costs, and sustainability are critical. Multilevel factors that influence implementation include policies, school environment and organizational factors, teacher and classroom factors, child and family characteristics, and attributes of the PA approach itself. Research and field observations reinforce the importance of understanding challenges specific to working with schools, including multiple stakeholders, competing priorities, limited facilities and staff capacity, and heterogeneity of students. Thus, while schools hold promise as promoters and equalizers of PA engagement for all children, more research is needed on the levers that influence implementation of effective school-based PA policies and programs.

Associations Between Home Environment and After-School Physical Activity and Sedentary Time Among 6th Grade Children

This study examined associations of various elements of the home environment with after-school physical activity and sedentary time in 671 6th-grade children (Mage = 11.49 ± 0.5 years). Children's after-school total physical activity, moderate-to-vigorous physical activity, and sedentary time were measured by accelerometry. Parents completed surveys assessing elements of the home social and physical environment. Mixed-model regression analyses were used to examine the associations between each element of the home environment and children's after-school physical activity and sedentary time. Availability of home physical activity resources was associated positively with after-school total physical activity and negatively with after-school sedentary time in boys. Parental support was associated positively with after-school total physical activity and MVPA and negatively with after-school sedentary time in girls. The home physical environment was associated with boys' after-school physical activity and sedentary time, whereas the home social environment was associated with girls' after-school physical activity and sedentary time.

Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children

This study aims to evaluate the effectiveness of two school-based physical education (PE) programmes (exercise-based and games-based) compared with traditional PE, on health- and skill-related physical fitness components in children in Tirana, Albania. Participants were 378 first-grade (6.8 years) and 389 fourth-grade (9.8 years) children attending four randomly selected schools in Tirana. Twenty-four school classes within these schools were randomly selected (stratified by school and school grade) to participate as exercise group (EG), games group (GG) and control group (CG). Both EG and GG intervention programmes were taught by professional PE teachers using station/circuit teaching framework while CG referred to traditional PE school lessons by a general teacher. All programmes ran in parallel and lasted 5 months, having the same frequency (twice weekly) and duration (45 min). Heart rate (HR) monitoring showed that intensity during PE lessons was significantly higher in the intervention groups compared with control (P < 0.001). Both PE exercise- and games programmes significantly improved several health- and skill-related fitness indicators compared with traditional PE lessons (e.g. gross motor skill summary score: 9.4 (95% CI 7.9; 10.9) for exercise vs. control and 6.5 (95% CI 5.1; 8.1) for games vs. control, cardiorespiratory fitness: 2.0 ml O2 · min(-1) · kg(-1) (95% CI 1.5; 2.4) for exercise vs. control and 1.4 ml O2 · min(-1) · kg(-1) (95% CI 1.0; 1.8) for games vs. control). Furthermore, compared to games-based PE, exercise-based PE showed more positive changes in some gross motor coordination skills outcomes, coordination skills outcomes and cardiorespiratory fitness. The results from this study show that exercise- and games-based PE represents a useful strategy for improving health- and skill-related physical fitness in Albanian elementary school children. In addition, the study shows that exercise-based PE was more effective than games-based PE in improving gross motor function and cardiorespiratory fitness.

Prioritizing school intramural and interscholastic programs based on observed physical activity

PURPOSE

To examine which school sports engage children in more physical activity.

DESIGN

Observational, cross-sectional study examining differences between intramural (IM) and interscholastic (IS) sports.

SETTING

Athletic facilities at two schools with IM sports and two schools with IS sports in Wake County, North Carolina.

SUBJECTS

Middle-school children (N = 6735).

MEASURES

Percentage of children observed in sedentary, moderate, and vigorous activity assessed by the System for Observation Play and Leisure Among Youth (SOPLAY). Energy expenditure and physical activity intensity were also estimated by using MET values.

ANALYSIS

T-tests; generalized linear model using cumulative logit link function.

RESULTS

IM sports had higher MET values than IS sports (t = -3.69, p < .001), and IM sports ranked in four of the top five sports in terms of average MET values. Regression models found a significant interaction between school sport delivery model and gender, with boys significantly less physically active in IS programs than boys in IM programs (B = -.447, p < .001) but more physically active (B = .359, p <.001) than girls in IM sports.

CONCLUSION

Regardless of sport type, IM sports generated more physical activity than IS sports among boys but not girls. Soccer, basketball, and track, regardless of school delivery approach, provide the highest physical activity levels. Results suggest that school administrators consider reassessing their programs to more efficiently use diminishing resources to increase students' physical activity levels.

The potential and reality of physical education in controlling overweight and obesity

Although preventing youth overweight and obesity is a public health priority, quality physical education (PE) is marginalized in practice. In May 2014, we estimated energy expenditure (EE; derived from PE frequency, duration, and intensity; mean student mass; and class size) from national recommendations and data from the 19 US states with PE duration guidelines, under 3 scenarios: potential (quality PE, defined as 50% moderate-to-vigorous physical activity [MVPA]), reality (MVPA = 35%), and classroom instruction only. Students in schools following nationally recommended PE standards from grades 1 through 10 could expend from 35 000 to 90 000 more kilocalories than students who received classroom instruction instead. PE's potential for increasing student EE will only be realized with stronger school policies and increased accountability.

Motivators of and Barriers to Eating Foods and Snacks Among Adolescents

Adolescents from low-income households and minority groups are disproportionately affected by obesity compared with their non-Hispanic white counterparts. Engaging in health promoting behaviors such as routinely eating healthy foods and snacks and engaging in physical activity are ways of preventing and reducing obesity and obesity disparities. The major purposes of the present study are (a) to identify the motivators of and barriers to eating healthy foods and snacks among culturally diverse adolescents and (b) to determine if the strengths of endorsement of these motivators and barriers differ by race, gender, and age. In the present study, a series of factor analyses was used to identify the motivators of and barriers to eating healthy foods and snacks among the culturally diverse adolescent participants (N = 172) in the national study. Specifically, an adolescent motivator of eating healthy foods and snacks scale, adolescent barrier to eating healthy foods and snacks scale, and subscales for each of these 2 scales were identified. The adolescent motivator subscales found were Knowledge and Commitment (α = .86) and Routine (α = .87). The adolescent barrier subscales found were Lack of Exposure (α = .72), Pessimistic Attitude (α = .80), and Temptation (α = .59). MANOVAs were used to determine if the mean scores for these scales and subscales differ by race, age, and gender. Nonsignificant differences were found among the mean scores for these scales and subscales. Results have implications for customizing adolescent health promotion interventions, including those to reduce and prevent obesity.

The role of family and community involvement in the development and implementation of school nutrition and physical activity policy

BACKGROUND

Although there are several evidence-based recommendations directed at improving nutrition and physical activity standards in schools, these guidelines have not been uniformly adopted throughout the United States. Consequently, research is needed to identify facilitators promoting schools to implement these recommendations. Therefore, this study analyzed the 2008 School Health Profiles Principal Survey (Profiles) to explore the role of family and community involvement in school nutrition and physical activity standards.

METHODS

Survey data on nutrition and physical activity policies, as well as family and community involvement, were available for 28 states, representing 6732 secondary schools. One-factor analysis of variance (ANOVA), 2-sample t-tests, Pearson's chi-square tests, and multiple logistic and linear regression models were employed in this analysis.

RESULTS

Family and community involvement were associated with schools more frequently utilizing healthy eating strategies and offering students healthier food options. Further, involvement was associated with greater support for physical education staff and more intramural sports opportunities for students.

CONCLUSIONS

Though family and community involvement have the potential to have a positive influence on school nutrition and physical activity policies and practices, involvement remains low in schools. Increased efforts are needed to encourage collaboration among schools, families, and communities to ensure the highest health standards for all students.

Society of Behavioral Medicine position statement: elementary school-based physical activity supports academic achievement

The Society of Behavioral Medicine (SBM) urges elementary schools to provide children with ample opportunities to engage in physical activity during school hours. In addition to promoting overall child health, physical activity also supports academic achievement. In addition to improving their aerobic fitness, regular physical activity improves cognitive function, influences the brain, and improves mood in children. Better aerobic fitness and physical activity are associated with increased grade point averages and standardized test scores. Despite the documented relationship between physical activity, fitness, and academic achievement, few schools have implemented physical activity as a tool to improve academic performance. SBM recommends that elementary schools provide children with the recommended 60 min of moderate-to-vigorous physical activity during school hours. Further, SBM urges schools to work with the local school districts and state education departments to mandate minimum physical activity time for elementary school physical education.

Prediction of Optimal Daily Step Count Achievement from Segmented School Physical Activity

Optimizing physical activity in childhood is needed for prevention of disease and for healthy social and psychological development. There is limited research examining how segmented school physical activity patterns relate to a child achieving optimal physical activity levels. The purpose of this study was to examine the predictive relationship between step counts during specific school segments and achieving optimal school (6,000 steps/day) and daily (12,000 steps/day) step counts in children. Participants included 1,714 school-aged children (mean age =9.7±1.0years) recruited across six elementary schools. Physical activity was monitored for one week using pedometers. Generalized linear mixed effects models were used to determine the adjusted odds ratios (ORs) of achieving both school and daily step count standards for every 1,000 steps taken during each school segment. The school segment that related in strongest way to a student achieving 6,000 steps during school hours was afternoon recess (OR = 40.03;P<0.001) and for achieving 12,000 steps for the entire day was lunch recess (OR = 5.03;P<0.001). School segments including lunch and afternoon recess play an important role for optimizing daily physical activity in children.

Lessons Learned: A Strategic Alliance to Improve Elementary Physical Education in an Urban School District

BACKGROUND

Physical education (PE) can help to achieve important public health goals, but is often under-prioritized and lacking in schools.

OBJECTIVES

To detail the actions, impact, and successes of a strategic alliance formed by three collaborating organizations to improve PE in a large California school district.

METHODS

Semistructured interviews with alliance members, principals, and teachers in 20 elementary schools, 3 years after the alliance formation.

LESSONS LEARNED

Interviewees reported district-level increases in priority and funding for PE and attributed improvements to the alliance's collection and dissemination of local data on the status of PE. Common goals, trust, and open communication within the alliance were seen as critical to the alliance's success. However, changes in district- or school-level accountability measures for PE were not reported.

CONCLUSIONS

This strategic alliance succeeded in promoting district-level priority and funding for PE. Ongoing alliance work will focus on increasing accountability measures for PE, which may take longer to implement.

Effects of daily physical education on physical fitness and weight status in middle school adolescents

BACKGROUND

In 2009, the Pennsylvania Department of Health developed the Active Schools Program (ASP) which required 30 minutes of daily physical education (PE) in middle schools to reduce childhood obesity. This investigation evaluated the ASP effects on physical fitness and weight status in middle school adolescents throughout 1 academic year.

METHODS

A quasi-experimental design was used to recruit middle schools into an intervention group (N = 30) or control group (N = 9).

RESULTS

Physical fitness outcomes had larger intervention effects than weight status outcomes. These effects were most profound among at-risk students. Multiple linear regression analysis provided a best-guess effect of daily PE on body mass index (BMI) percentile of -1.2, 95% confidence interval (CI) (-1.9, -0.5) for at-risk females and -0.8, 95% CI (-1.5, -0.1) for at-risk males. Much of this benefit is attributable to the differential increase in physical fitness achieved by students with the benefit of having daily PE.

CONCLUSIONS

Thirty minutes of daily PE can be considered a scientific approach to ameliorate health outcomes in at-risk middle school adolescents, particularly among females. Improvements on BMI percentile among at-risk youth are presaged by greater improvements in physical fitness. This investigation supports a school-based approach aimed to improve behavioral risk factors as a means to reduce childhood obesity.

A tangled web: the challenges of implementing an evidence-based social engagement intervention for children with autism in urban public school settings

There is growing evidence that efficacious autism-related interventions rarely are adopted or successfully implemented in public schools, in part because of the lack of fit between the intervention and the needs and capacities of the school setting. There is little systematic information available regarding the barriers to implementation of complex interventions such as those addressing social engagement for children with autism.The present study used fieldnotes from an implementation trial to explore barriers that emerged during the training of school personnel and subsequent implementation of a social engagement intervention. A number of barriers at the individual (training) and school levels (policies surrounding recess, staffing, prioritization of competing demands, level of respect and support, and availability of resources) interfered with the continued use and sustainment of the intervention. We offer potential strategies to overcome these barriers and provide directions for future research in this critical area.

How can schools help youth increase physical activity? An economic analysis comparing school-based programs

OBJECTIVE

For optimal health, physical activity should be an integral and routine part of daily life. Youth spend a significant amount of time at school yet rarely achieve the recommended 60 min of moderate and vigorous physical activity in physical education (PE) classes or recess. This study assessed the following types of school-based opportunities to improve physical activity for youth: after-school programs, before-school programs, PE classes, extended-day PE, and short physical activity breaks during the school day.

METHOD

An economic analysis conducted in 2013 compared school-based approaches to increasing physical activity. Analysis factors included costs, reach, effects on physical activity gains, cost-effectiveness, and other potentially augmenting benefits.

RESULTS

Two programs were significantly superior in terms of reach and cost per student: (1) extending the school day with mandatory PE participation and (2) offering short (10-minute) physical activity breaks during regular classroom hours. After-school program costs per student are high and the programs have a smaller reach, but they offer benefits (such as childcare) that may justify their higher costs. Before-school programs did not appear feasible.

CONCLUSION

Incorporating short physical activity breaks into the existing school day would be a cost-effective way to increase school-based activity. This type of program is inexpensive and has broad reach. Inserting activity breaks throughout the day is appropriate, especially when youth are otherwise largely sedentary.

Joint use policies: are they related to adolescent behavior?

OBJECTIVE

Joint use policies (JUP) encourage shared facility use, usually between schools and a city or private organization, for both physical activity-related and non-physical activity-related programs. Little is known about JUP's impact on physical activity (PA). This study examined whether more specific JUPs were associated with increased PA and decreased sedentary behavior (SB) in adolescents.

METHODS

Data on PA, sports participation, and SB were taken from annual cross-sectional nationally representative samples of 51,269 8th, 10th and 12th grade public school students nested in 461 school districts in the US from 2009-2011. JUP measures were constructed using information obtained from corresponding school district JU policies. Multivariable analyses were conducted, controlling for individual demographic and socioeconomic characteristics and clustering at the district level.

RESULTS

Results showed small associations between more specific JUPs and increased PA (IRR 1.01, 95% CI: 1.00, 1.02). Closer examination of specific JUP provisions indicates that specifying what times facilities are available for use was associated with vigorous exercise and prioritizing school or affiliated organizations' use and which spaces were available for use were associated with vigorous exercise and more frequent PA participation, which includes participation in sports or athletics. No associations were found between more specific JUPs and SB.

CONCLUSIONS

JUPS may have small influences on adolescent physical activity behavior. Future longitudinal studies should be conducted to examine the impact of JUPs in conjunction with other physical activity-related policies and environmental changes to determine what impact they have on overall adolescent physical activity and sedentary behavior.

Physical activity practices in elementary schools and associations with physical education staffing and training

PURPOSE

Authorities recommend that schools provide a variety of opportunities for students to obtain physical activity (PA) before, during, and after school. This study assessed the prevalence of several school PA practices-including measures of quantity and quality of physical education (PE)-in elementary schools and examined the associations of PA practices with school resources (PE staffing, training, and facilities).

METHOD

Surveys were obtained from respondents in nationally representative samples of elementary schools from 2009-2010 to 2011-2012 (1,831 schools).

RESULTS

Few schools (20.8%) provided students with PE class every day, but most (76.3%) had an appropriate PE student-to-teacher ratio ( ≤ 25:1). Many schools (74.0%) offered 20 min of recess daily, but fewer than half offered organized opportunities for PA before or after school (e.g., sports). After controlling for demographics and school size, having a full-time PE teacher and requiring PE teachers to obtain PE-related continuing education (CE) were associated with PE practices such as offering ≥ 150 min of PE per week (for 3rd-grade students) and testing PE knowledge, skills, and fitness. Required CE was also associated with a higher likelihood of offering PA during the school day (i.e., activity breaks and PA outside of PE class) and before or after the school day (i.e., afterschool PA programs).

CONCLUSION

Few schools offer a broad array of PA programming. However, PE staffing and CE are positively associated with many PA practices including those outside of PE, possibly indicating that PE staff serve a crucial role in promoting a whole-school PA-supportive environment.