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

Afterschool shared use of public school facilities for physical activity in North Carolina

OBJECTIVE

To determine the status and common characteristics of shared use in public schools in North Carolina.

METHOD

All public school principals (N=2,359) in North Carolina were invited to participate in an online survey (February - May, 2013) designed to provide baseline information about the extent and nature of shared use of school facilities.

RESULTS

Responses (n=1182, 50.1%) indicated that most schools share their facilities (88.9%). Formal agreements were more common when schools shared gyms and outdoor athletic fields. Informal agreements were most common with playgrounds and track facilities. Schools with more low income or Black students were less likely to share facilities. For schools that did not share use of their facilities the most frequent reason was no outside groups had ever asked.

CONCLUSION

Schools may be more accommodating to shared use partnerships. Community organizations seeking to use indoor school facilities or athletic fields should be prepared to complete a formal written agreement. Preconceived notions that schools are unwilling to share their facilities may be preventing community organizations from initiating shared use inquiries. Schools located in the middle tier of economic distress and schools with a greater concentration of Black students were less likely to share their facilities.

Correlates of state enactment of elementary school physical education laws

OBJECTIVE

To describe variation in U.S. state elementary school physical education (PE) policies and to assess associations between state PE policy enactment and education funding, academic achievement, sociodemographic disadvantage, and political characteristics.

METHODS

U.S. state laws regarding school PE time, staffing, curriculum, fitness assessment, and moderate-to-vigorous physical activity (MVPA) in 2012 were classified as strong/specific, weak/nonspecific, or none based on codified law ratings within the Classification of Laws Associated with School Students (C.L.A.S.S.). Laws were merged with state-level data from multiple sources. Logistic regression was used to determine associations between state characteristics and PE laws (N=51).

RESULTS

Laws with specific PE and MVPA time requirements and evidence-based curriculum standards were more likely in states with low academic performance and in states with sociodemographically disadvantaged populations. School day length was positively associated with enacting a PE curriculum that referenced evidence-based standards. School funding and political characteristics were not associated with PE laws.

CONCLUSIONS

Limited time and high-stake testing requirements force schools to prioritize academic programs, posing barriers to state passage of specific PE laws. To facilitate PE policy enactment, it may be necessary to provide evidence on how PE policies can be implemented within existing time and staffing structures.

Physical activity breaks and facilities in US secondary schools

BACKGROUND

Research on physical activity breaks and facilities (indoor and outdoor) in secondary schools is relatively limited.

METHODS

School administrators and students in nationally representative samples of 8th (middle school) and 10th/12th grade (high school) students were surveyed annually from 2008-2009 to 2011-2012. School administrators reported information about physical activity breaks and facilities. Students self-reported height, weight, and physical activity.

RESULTS

The prevalence of physical activity breaks and indoor and outdoor facilities (dichotomized by median split) differed significantly by region of the country, school size, student race/ethnicity, and school socioeconomic status (SES). Breaks were associated with lower odds of overweight (adjusted odds ratio [AOR] = 0.91, 95% confidence interval [CI]: 0.83-1.00) and obesity (AOR = 0.86, 95% CI: 0.75-0.99) among middle school students. Among low-SES middle school students and schools, higher indoor facilities were associated with lower rates of overweight and obesity. Among high school students, higher indoor and outdoor facilities were associated with 19-42% higher odds of moderate-to-vigorous physical activity.

CONCLUSIONS

Physical activity breaks and school facilities may help to address high rates of overweight/obesity and low physical activity levels among secondary students, especially lower-SES students. Students in all schools should have equal access to these resources.

Supporting public health priorities: recommendations for physical education and physical activity promotion in schools

Physical activity (PA) provides numerous physiological and psychosocial benefits. However, lifestyle changes, including reduced PA opportunities in multiple settings, have resulted in an escalation of overweight and obesity and related health problems. Poor physical and mental health, including metabolic and cardiovascular problems is seen in progressively younger ages, and the systematic decline in school PA has contributed to this trend. Of note, the crowded school curriculum with an intense focus on academic achievement, lack of school leadership support, funding and resources, plus poor quality teaching are barriers to PA promotion in schools. The school setting and physical educators in particular, must embrace their role in public health by adopting a comprehensive school PA program. We provide an overview of key issues and challenges in the area plus best bets and recommendations for physical education and PA promotion in the school system moving forward.

School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes

School-based interventions are essential to prevent pediatric obesity and type 2 diabetes. School environmental factors influence implementation of these interventions. This article examines how school factors acted as barriers to and facilitators of the HEALTHY intervention. The HEALTHY study was a cluster-randomized trial of a multicomponent intervention implemented in 21 schools. Interview data were analyzed to identify barriers and facilitators. Barriers included teacher frustration that intervention activities detracted from tested subjects, student resistance and misbehavior, classroom management problems, communication equipment problems, lack of teacher/staff engagement, high cost and limited availability of nutritious products, inadequate facility space, and large class sizes. Facilitators included teacher/staff engagement, effective classroom management, student engagement, schools with direct control over food service, support from school leaders, and adequate facilities and equipment. Contextual barriers and facilitators must be taken into account in the design and implementation of school-based health interventions.

The Correlation between Physical Activity and Grade Point Average for Health Science Graduate Students

Researchers have reported positive associations between physical activity and academic achievement. However, a common belief is that improving academic performance comes at the cost of reducing time for and resources spent on extracurricular activities that encourage physical activity. The purpose of this study was to examine the relationship between self-reported physical activity and grade point average (GPA) for health science graduate students. Graduate students in health science programs completed the International Physical Activity Questionnaire and reported their academic progress. Most participants (76%) reported moderate to vigorous physical activity levels that met or exceeded the recommended levels for adults. However, there was no significant correlation between G PA and level of physical activity. Negative findings for this study may be associated with the limited range of GPA scores for graduate students. Future studies need to consider more sensitive measures of cognitive function, as well as the impact of physical activity on occupational balance and health for graduate students in the health fields.

Shared use of school facilities with community organizations and afterschool physical activity program participation: a cost-benefit assessment

BACKGROUND

Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities.

METHODS

Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011.

RESULTS

Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses.

CONCLUSIONS

These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy.

School-based physical activity promotion: a conceptual framework for research and practice

Despite public health concerns and the many recognized benefits of physical activity (PA), levels of participation among youth remain below national recommendations. To this end, a variety of strategies for promoting physical activity for youth have been advocated, including multi-faceted, school-based approaches. One that continues to be identified as having great potential is a comprehensive school physical activity program (CSPAP). The aim of this article is to introduce a conceptual framework for school-based PA promotion that serves to stimulate, guide, and organize related research and practice. The CSPAP conceptual framework is a proposed framework, informed by existing science, recommendations, and a social ecological perspective with individual PA behavior as the epicenter. Discussed in turn are the four proposed interactive levels of influence (i.e., components, facilitators, leaders, and culture) and several integral elements proposed to operate at each level. The article concludes with a presentation of the utility of the framework for research and practice.

Evaluating the effects of the Lunchtime Enjoyment Activity and Play (LEAP) school playground intervention on children's quality of life, enjoyment and participation in physical activity

BACKGROUND

An emerging public health strategy is to enhance children's opportunities to be physically active during school break periods. The aim of this study was to evaluate the effects of the Lunchtime Enjoyment Activity and Play (LEAP) school playground intervention on primary school children's quality of life (QOL), enjoyment and participation in physical activity (PA).

METHODS

This study consisted of a movable/recycled materials intervention that included baseline, a 7-week post-test and an 8-month follow-up data collection phase. Children within an intervention school (n = 123) and a matched control school (n = 152) aged 5-to-12-years-old were recruited for the study. Children's PA was measured using a combination of pedometers and direct observation (SOPLAY). Quality of life, enjoyment of PA and enjoyment of lunchtime activities were assessed in the 8-12 year children. A multi-level mixed effect linear regression model was applied in STATA (version 12.0) using the xtmixed command to fit linear mixed models to each of the variables to examine whether there was a significant difference (p < 0.05) between the intervention and control school at the three time points (pre, post and follow-up).

RESULTS

Significant overall interaction effects (group × time) were identified for children's mean steps and distance (pedometers) in the intervention school compared to the control school. Intervention school children also spent significantly higher proportions within specified target areas engaged in higher PA intensities in comparison to the control school at both the 7-week post-test and 8-month follow-up. A short-term treatment effect was revealed after 7-weeks for children's physical health scale QOL, enjoyment of PA and enjoyment of intra-personal play activities.

CONCLUSIONS

Examining the effects of this school playground intervention over a school year suggested that the introduction of movable/recycled materials can have a significant, positive long-term intervention effect on children's PA. The implications from this simple, low-cost intervention provide impetus for schools to consider introducing the concept of a movable/recycled materials intervention on a wider scale within primary school settings.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registration Number: ACTRN12613001155785.

The contributing role of physical education in youth's daily physical activity and sedentary behavior

Background

School physical education (PE) is considered as an effective channel for youth to accumulate moderate-to-vigorous physical activity (MVPA) and reduce sedentary time. The purpose of this study was to determine the contributing role of PE in daily MVPA and sedentary time among youth.

Methods

The study recruited 67 sixth grade children (29 boys; Mean age = 11.75) from two suburban schools at a U.S. Midwest state, 48 of whom contributed ≥10 hours of physical activity (PA) data per day were included for analysis. An objective monitoring tool (i.e., Sensewear armband monitor) was used to capture the participants’ MVPA and sedentary time for 7–14 days. Pearson product–moment correlation analysis (r), multi-level regression analyses, and analysis of variance were conducted for data analysis.

Results

MVPA and sedentary time in PE showed significant positive associations with daily MVPA and sedentary time, respectively (r = 0.35, p < 0.01; r = 0.55, p < 0.01). Regression analyses revealed that one minute increase in MVPA and sedentary behavior in PE was associated with 2.04 minutes and 5.30 minutes increases in daily MVPA and sedentary behavior, respectively, after controlling for sex and BMI. The participants demonstrated a significantly higher level of MVPA (p = .05) but similar sedentary time (p = 0.61) on PE days than on non-PE days. Boys had significantly more daily MVPA (p < .01) and less sedentary time (p < .01) than girls; while higher BMI was associated with more sedentary time (p < .01).

Conclusions

PE displayed a positive contribution to increasing daily MVPA and decreasing daily sedentary time among youth. Active participation in PE classes increases the chance to be more active and less sedentary beyond PE among youth.

School sport participation under two school sport policies: comparisons by race/ethnicity, gender, and socioeconomic status

BACKGROUND

School-based extracurricular sport remains an effective strategy to increase physical activity. However, school sport is often limited to a small number of elite athletes. Few schools provide more inclusive sport programs that offer a wider array of activities regardless of ability.

PURPOSE

The aim of this study was to examine school sport participation in middle schools (ages 11-14) with contrasting school sport delivery strategies (intramural vs. interscholastic).

METHODS

Data were obtained through an online survey administered to students at four public middle schools (grades 6-8) in a southeastern US city (n = 2,582).

RESULTS

More students participated in school sports at intramural schools. Boys were more likely to participate in after-school sports at intramural schools. Low-income and Black children, two groups at greater risk of physical inactivity and other negative outcomes, had greater participation in intramural programs.

CONCLUSIONS

After-school intramural sports in middle school is a promising strategy for increasing sport participation.

Process evaluation for a school-based physical activity intervention for 6th- and 7th-grade boys: reach, dose, and fidelity

The purpose was to evaluate the reach, dose, and fidelity of Guys Only Activity for Life (G.O.A.L.), a 7-week pilot intervention conducted from February to March 2011 to increase 6th and 7th grade boys' moderate-to-vigorous physical activity (MVPA). One middle school was randomly assigned to the G.O.A.L. intervention and another from the same urban school district in the Midwestern U.S. to a comparison condition. Thirty boys, ages 10-14 years, participated in each school. The intervention, guided by the Health Promotion Model (HPM) and Self-Determination Theory (SDT), consisted of a 90-min after-school physical activity club 4 days/week and one motivational interviewing session with a registered (school) nurse. Data were gathered via attendance records, club observations, heart rate monitors, audio-taping of motivational interviewing sessions, and surveys. On average boys attended the club 2.11 days/week (SD=.86). A trained independent process evaluator reported that the physical activity club instructors provided the boys with the opportunity for a mean of 25.8 min/day of MVPA. Using a four-point Likert scale (1=disagree a lot; 4=agree a lot), the process evaluator perceived that the club was delivered with high fidelity and adherence to the underlying theories (M=3.48; SD=0.39). Sessions with the nurse lasted an average of 13 min, 29 s. All boys attended. Two trained independent coders indicated that the nurse demonstrated at least beginning proficiency for all tasks associated with motivational interviewing, with the exception of using sufficient open- as opposed to closed-ended questions and reflections compared to questions. Fidelity related to session delivery and adherence to the theories was high (M=3.83; SD=0.19). The process evaluation data indicated that strategies are needed to increase attendance and boys' MVPA during the club time.

Policy changes to implement intramural sports in North Carolina middle schools: simulated effects on sports participation rates and physical activity intensity, 2008-2009

Introduction

Extracurricular school sports programs can provide adolescents, including those who are economically disadvantaged, with opportunities to engage in physical activity. Although current models favor more exclusionary interscholastic sports, a better understanding is needed of the potential effects of providing alternative school sports options, such as more inclusive intramural sports. The purpose of this study was to simulate the potential effect of implementing intramural sports programs in North Carolina middle schools on both the rates of sports participation and on energy expenditure related to physical activity levels.

Methods

Simulations were conducted by using a school-level data set developed by integrating data from multiple sources. Baseline rates of sports participation were extrapolated from individual-level data that were based on school-level characteristics. A regression model was estimated by using the simulated baseline school-level sample. Participation rates and related energy expenditure for schools were calculated on the basis of 2 policy change scenarios.

Results

Currently, 37.2% of school sports participants are economically disadvantaged. Simulations suggested that policy changes to implement intramural sports along with interscholastic sports could result in more than 43,000 new sports participants statewide, of which 64.5% would be economically disadvantaged students. This estimate represents a 36.75% increase in economically disadvantaged participants. Adding intramural sports to existing interscholastic sports programs at all middle schools in North Carolina could have an annual effect of an additional 819,892.65 kilogram calories expended statewide.

Conclusion

Implementing intramural sports may provide economically disadvantaged students more access to sports, thus reducing disparities in access to school sports while increasing overall physical activity levels among all children.

Impact of Recess Interventions on Children's Physical Activity—A Meta-Analysis

Objective.

The purpose of this paper was to explore the effect of recess interventions on children's physical activity (PA) levels and to examine which specific interventions/characteristics have more influence on children's PA

Data Source.

Academic Search Premier, CINAHL, ERIC, MEDLINE, ProQuest, SPORT Discus

Study Inclusion and Exclusion Criteria.

Papers published between 1986 and 2012, published in the English language, and evaluating any recess intervention with PA as an outcome

Data Extraction.

Study outcomes were distilled into seven domains related to PA: age, gender, intervention type, intervention duration, duration of PA per intervention session, outcome measures, and study region

Data Synthesis.

Effect sizes were pooled within and across studies for each domain separately. Moderator analyses were performed using gender, age, and total length of intervention. Twenty-three independent samples were provided from 13 studies.

Results.

The estimated overall effect size for time in PA was 56 (SE .07), suggesting a positive and significant mean difference between pretest and posttest PA time after implementing a recess intervention. Differences in PA levels were moderated by age, duration and type of intervention, and type of outcome measures.

Conclusion.

The limited evidence suggests recess interventions can improve youth PA levels. Implications reinforce the importance of schools in advocating for recess during the school day. Strategies shown to increase student PA during recess should be implemented.

Association between state physical education (PE) requirements and PE participation, physical activity, and body mass index change

OBJECTIVE

To determine if state physical education (PE) laws are associated with student physical education attendance and physical activity (PA), and whether physical education and competitive food laws, in conjunction, are associated with lower BMI change.

METHOD

State laws regarding physical education time requirements and competitive foods in 2003 and 2006 were classified as strong, weak, or none, based on codified law ratings obtained from the Classification of Laws Associated with School Students. Laws were linked to student data on PE attendance and physical activity (8th grade, Spring 2007) and BMI change (5th-8th grade, 2004-2007), obtained from the Early Childhood Longitudinal Study (n=5510 students in 40 states).

RESULTS

Girls reported 0.31 more days of activity (95% CI: 0.02, 0.61) and were more likely to attend physical education ≥ 3 days/week (74.1% versus 52.1%, difference=22.0, 95% CI: 2.1, 42.0) if they resided in states with strong physical education laws compared to no physical education laws. Weak physical education laws had modest associations with PE and activity, and there was no evidence that weak laws reduce BMI gain regardless of competitive food laws.

CONCLUSION

Strong physical education laws with specific time requirements may increase physical education attendance and activity in girls. There is insufficient evidence that physical education laws reduce student weight gain.

Sports game play: a comparison of moderate to vigorous physical activities in adolescents

BACKGROUND

Research suggests participation in sports is an important contributor to overall adolescent physical activity (PA). Sports play has become increasingly important in physical education (PE) classes as a means for promoting healthful and enjoyable PA. Research is needed that investigates physiological and perceptual responses to sport play.

METHODS

We studied 101 (55 males; 46 females, age 11-14) students who participated in flag football (FF), basketball (BB), and flag rugby (FR). Activity counts were collected using accelerometers. Perceived competence and enjoyment were measured using the intrinsic motivation inventory.

RESULTS

Each sport activity produced acceptable levels of activity and positive perceptual responses, but differences among sports were noted. Accelerometry data indicated that FR and BB were more intense than FF (p < .001). Perceptual data indicated participation in FR elicited higher perceptions of competence and greater enjoyment when compared to FF and BB (p < .001).

CONCLUSIONS

Participation in sport activity within middle school PE classes provides excellent opportunities for energy expenditure and positive perceptual responses. Most importantly, FR provides an activity stimulus that has potential benefits both physiologically and psychologically.

Effects of a playground marking intervention on school recess physical activity in French children

OBJECTIVE

Playground interventions offer an opportunity to enhance school recess physical activity. We aimed to assess the effects of playground marking on objectively measured school recess physical activity in French children.

METHODS

Participants were four hundred and twenty children (6-11years old) from 4 primary schools in Nord-Pas de Calais, France. Children's physical activity (PA) was measured with a uniaxial accelerometer twice a day (morning and afternoon recess) during a 4-day school week in April and May 2009. Two experimental schools (EG) received a recess-based intervention (playground markings) and two others served as controls (CG). Percentage of time spent on the following intensities of physical activity during school recess was measured before and after intervention: sedentary (SED), light physical activity (LPA), moderate physical activity (MPA), vigorous physical activity (VPA), very high physical activity (VHPA) and moderate-to-vigorous physical activity (MVPA).

RESULTS

At baseline, school recess PA among children from CG was significantly (p<0.001) higher than that among EG children. No interaction was observed between the recess-based intervention and gender. After the intervention, the EG spent significantly (p<0.05) more time in MPA, VPA and MVPA with a concomitant significant decrease in SED (p<0.05) compared to baseline, while the PA in CG remained unchanged.

CONCLUSION

Painted playground markings had a positive short-term effect on school recess physical activity levels.

Elementary school practices and children's objectively measured physical activity during school

OBJECTIVE

To examine the relation of physical activity practices covering physical education (PE), recess, and classroom time in elementary schools to children's objectively measured physical activity during school.

METHODS

Participants were 172 children from 97 elementary schools in the San Diego, CA and Seattle, WA USA regions recruited in 2009-2010. Children's moderate-to-vigorous physical activity (MVPA) during school was assessed via accelerometry, and school practices were assessed via survey of school informants. Multivariate linear mixed models were adjusted for participant demographics and unstandardized regression coefficients are reported. The 5 practices with the strongest associations with physical activity were combined into an index to investigate additive effects of these practices on children's MVPA.

RESULTS

Providing ≥ 100 min/week of PE (B=6.7 more min/day; p=.049), having ≤ 75 students/supervisor in recess (B=6.4 fewer min/day; p=.031), and having a PE teacher (B=5.8 more min/day; p=.089) were related to children's MVPA during school. Children at schools with 4 of the 5 practices in the index had 20 more min/day of MVPA during school than children at schools with 0 or 1 of the 5 practices (p<.001).

CONCLUSIONS

The presence of multiple school physical activity practices doubled children's physical activity during school.

Children's school-related food and physical activity behaviors are associated with body mass index

Childhood obesity is a critical public health issue, with prevalence rates reaching nearly one in five children. Schools may be a promising public policy intervention point. The foods schools sell and the physical activity environments they foster can influence dietary behaviors and overall physical activity. Using secondary data from a nationally representative sample of children from the kindergarten class of 1998-1999 and nonexperimental methods, this study examines the associations between the food and physical activity environments in school and body mass index (BMI) for low-income boys and girls in the 8th grade during 2007. Results reveal that participating in school sports is associated with a 0.55 lower BMI score for boys. For low-income girls, eating the school breakfast is associated with a 0.70 higher BMI score and eating the school lunch is associated with a 0.65 higher BMI score. Each hour spent on homework is associated with a 0.02 higher BMI score for low-income girls. These findings suggest that schools may influence adolescent BMI and that there is room for improvement in school food and physical activity environments to promote healthier weights for low-income boys and girls.

Influence of school beverage environment on the association of beverage consumption with physical education participation among US adolescents

OBJECTIVES

We examined the association of adolescents' beverage consumption with physical activity and studied how their school beverage environment influences the association.

METHODS

We used nationally representative data from the 2007 Early Childhood Longitudinal Study-Kindergarten Cohort (n = 8850). We examined nonlinear associations of eighth graders' self-report of beverage consumption (milk, 100% juices, soft drinks) with moderate to vigorous physical activity and physical education (PE) participation using piecewise linear regression models.

RESULTS

We found a nonlinear association of participation in PE class with beverage consumption, especially in schools with vending machines and those selling soft drinks. For students participating in PE less than 3 days per week, beverage consumption was not significantly associated with participation in PE class frequency. For students participating in PE 3 to 5 days per week, 1 more day of participation in PE class was associated with 0.43 (SE = 0.14; P = .002) more times per week of soft drink consumption and 0.41 (SE = 0.17; P = .021) fewer glasses per week of milk consumption.

CONCLUSIONS

The more soft drink and less milk consumption related to high participation in PE class might be prevented by improving the beverage environment in schools. Systematic environmental interventions are needed to prevent such potential unintended consequences of promoting physical activity.

Withholding recess from elementary school students: policies matter

BACKGROUND

Recess is a key aspect of a healthy elementary school environment and helps to keep students physically active during the school day. Although national organizations recommend that students not be withheld from recess, this practice occurs in schools. This study examined whether district policies were associated with school practices regarding the withholding of recess for behavior management or academic reasons, as well as the use of physical activity (eg, running laps) for behavior management.

METHODS

Data were gathered from administrators at US public elementary schools by mail-back surveys conducted during the spring of the 2008-2009, 2009-2010, and 2010-2011 school years. Corresponding school district policies were gathered and coded. Each year's sample was nationally representative and data were analyzed as a stacked cross-sectional sample. A total of 1,919 surveys were received (61.2% response rate).

RESULTS

Averaged over the 3 years, students were not withheld from recess for poor behavior or academic reasons at 28.3% and 26.7% of elementary schools, respectively. Strong district policy was associated with an increased odds of not withholding students from recess for poor behavior (adjusted odds ratio [OR] = 2.27, p < .001) or completing schoolwork (adjusted OR = 1.99, p < .001). Withholding recess was less common in the South versus the West, Midwest, and Northeast. Use of physical activity for behavior management was rare and not associated with district policy.

CONCLUSIONS

Strengthening district policies may be an effective strategy for changing school practices pertaining to withholding of recess, and to ensure that all students have opportunities to be physically active during the school day.

School-day and overall physical activity among youth

BACKGROUND

Increasing school-day physical activity through policy and programs is commonly suggested to prevent obesity and improve overall child health. However, strategies that focus on school-day physical activity may not increase total physical activity if youth compensate by reducing physical activity outside of school.

PURPOSE

Objectively measured, nationally representative physical activity data were used to test the hypothesis that higher school-day physical activity is associated with higher overall daily physical activity in youth.

METHODS

Accelerometer data from 2003-2004/2005-2006 National Health and Nutrition Examination Surveys were analyzed in 2012 to estimate physical activity levels during the school day (8AM-3PM) among youth aged 6-19 years (n=2548). Fixed-effects regressions were used to estimate the impact of changes in school-day minutes of moderate-to-vigorous physical activity (MVPA) on changes in total daily MVPA.

RESULTS

Each additional minute of school-day MVPA was associated with an additional 1.14 minutes (95% CI=1.04, 1.24; p<0.001) of total daily MVPA, or 0.14 additional minutes (95% CI=0.04, 0.24; p=0.008) outside the school day, controlling for total daily accelerometer wear time and age, gender, race/ethnicity, and other non-time varying covariates. There were no differences in the effect of school-day MVPA on total MVPA by age group, gender, race/ethnicity, poverty status, or degree of change in MVPA.

CONCLUSIONS

Higher school-day MVPA was associated with higher daily MVPA among U.S. youth with no evidence for same-day "compensation." Increasing school-based physical activity is a promising approach that can improve total daily physical activity levels of youth.

Health knowledge among the millennial generation

The Millennial Generation, also known as Generation Y, is the demographic cohort following Generation X, and is generally regarded to be composed of those individuals born between 1980 and 2000. They are the first to grow up in an environment where health-related information is widely available by internet, TV and other electronic media, yet we know very little about the scope of their health knowledge. This study was undertaken to quantify two domains of clinically relevant health knowledge: factual content and ability to solve health related questions (application) in nine clinically related medical areas. Study subjects correctly answered, on average, 75% of health application questions but only 54% of health content questions. Since students were better able to correctly answer questions dealing with applications compared to those on factual content contemporary US high school students may not use traditional hierarchical learning models in acquisition of their health knowledge.

Preparing Educators to Promote and Provide Physical Activity in Schools

Today, children are at risk for disease stemming from the prevalence of sedentary behaviors. Schools are largely obesogenic environments but have the potential to promote and provide opportunities to meet the recommended daily minutes of physical activity. Yet educators must be prepared to do so. The objective of this review was to examine the strength of evidence from studies on professional development effectiveness in order to make recommendations on how to structure such experiences to prepare teachers to promote and provide physical activity in schools. Effective strategies for professional development that were confirmed in the literature focused on knowledge of subject matter, collective and collaborative participation, continual and long in duration, coherence with student learning, active learning, and the building of a community of practice. Further, research to examine the effectiveness of professional development on student physical activity participation within the school environment is warranted.

The impact of physical education on obesity among elementary school children

In response to the dramatic rise in childhood obesity, the Centers for Disease Control (CDC) and other organizations have advocated increasing the amount of time that elementary school children spend in physical education (PE) classes. However, little is known about the effect of PE on child weight. This paper measures that effect by instrumenting for child PE time with the state's mandated minimum number of minutes of PE, using data from the Early Childhood Longitudinal Study, Kindergarten Cohort (ECLS-K) for 1998-2004. Results from IV models indicate that PE lowers BMI z-score and reduces the probability of obesity among 5th graders. This effect is concentrated among boys; we find evidence that this gender difference is partly attributable to PE being a complement with other physical activity for boys, whereas they are substitutes for girls. This represents some of the first evidence of a causal effect of PE on youth obesity, and thus offers at least some support for the assumptions behind the CDC recommendations. We find no evidence that increased PE time crowds out time in academic courses or has spillovers to achievement test scores.

Identifying state-level policy and provision domains for physical education and physical activity in high school

BACKGROUND

It is important to quickly and efficiently identify policies that are effective at changing behavior; therefore, we must be able to quantify and evaluate the effect of those policies and of changes to those policies. The purpose of this study was to develop state-level physical education (PE) and physical activity (PA) policy domain scores at the high-school level. Policy domain scores were developed with a focus on measuring policy change.

METHODS

Exploratory factor analysis was used to group items from the state-level School Health Policies and Programs Study (SHPPS) into policy domains. Items that related to PA or PE at the High School level were identified from the 7 SHPPS health program surveys. Data from 2000 and 2006 were used in the factor analysis.

RESULTS

From the 98 items identified, 17 policy domains were extracted. Average policy domain change scores were positive for 12 policy domains, with the largest increases for "Discouraging PA as Punishment", "Collaboration", and "Staff Development Opportunities". On average, states increased scores in 4.94 ± 2.76 policy domains, decreased in 3.53 ± 2.03, and had no change in 7.69 ± 2.09 policy domains. Significant correlations were found between several policy domain scores.

CONCLUSIONS

Quantifying policy change and its impact is integral to the policy making and revision process. Our results build on previous research offering a way to examine changes in state-level policies related to PE and PA of high-school students and the faculty and staff who serve them. This work provides methods for combining state-level policies relevant to PE or PA in youth for studies of their impact.

Policy challenges in the fight against childhood obesity: low adherence in San Diego area schools to the California Education Code regulating physical education

OBJECTIVE

Assess the adherence to the Physical Education (PE) requirements per California Education Code in San Diego area schools.

METHODS

Surveys were administered anonymously to children and adolescents capable of physical activity, visiting a specialty clinic at Rady Children's Hospital San Diego. The main questions asked were their gender, grade, PE classes per week, and time spent doing PE.

RESULTS

324 surveys were filled, with 36 charter-school students not having to abide by state code excluded. We report on 288 students (59% females), mostly Hispanic (43%) or Caucasian (34%). In grades 1-6, 66.7% reported under the 200 min per 10 school days required by the PE code. Only 20.7% had daily PE. Average PE days/week was 2.6. In grades 7-12, 42.2% had reported under the 400 min per 10 school days required. Daily PE was noted in 47.8%. Average PE days/week was 3.4. Almost 17% had no PE, more so in the final two grades of high school (45.7%).

CONCLUSIONS

There is low adherence to the California Physical Education mandate in the San Diego area, contributing to poor fitness and obesity. Lack of adequate PE is most evident in grades 1-6 and grades 11-12. Better resources, awareness, and enforcement are crucial.

Physical activity during recess in low-income third-grade Texas students

OBJECTIVES

To estimate the prevalence of recess-based moderate and vigorous physical activity (MVPA) and vigorous physical activity (VPA) among third-grade students attending low-income, urban schools in Texas.

METHODS

Structured observations (N = 77 class and 616 student observations) using SOFIT were conducted over 3 months in 8 elementary schools with majority Hispanic students.

RESULTS

Students engaged in 66.4% and 19.2% of their ∼20-minute recess time in MVPA and VPA, respectively. Boys engaged in more MVPA and VPA (p < .007). Contextual differences in activity (setting and activity type) were identified.

CONCLUSIONS

Findings underscore the importance of scheduled recess time for children's physical activity.

Adapted intervention mapping: a strategic planning process for increasing physical activity and healthy eating opportunities in schools via environment and policy change

BACKGROUND

School environment and policy changes have increased healthy eating and physical activity; however, there has been modest success in translating research findings to practice. The School Environment Project tested whether an adapted version of Intervention Mapping (AIM) resulted in school change.

METHODS

Using a pair randomized design, 10 rural elementary schools were assigned to AIM or the School Health Index (SHI). Baseline measures were collected fall 2005, AIM was conducted 2005-2006, and follow-up measures were collected fall 2006 and 2007. Outcome measures included number and type of effective environment and policy changes implemented; process measures included the extent to which 11 implementation steps were used.

RESULTS

AIM schools made an average of 4.4 effective changes per school with 90% still in place a year later. SHI schools made an average of 0.6 effective changes with 66% in place a year later. Implementation steps distinguishing AIM from SHI included use of external, trained facilitators; principal involvement; explicitly stating the student behavior goals; identifying effective environment and policy changes; prioritizing potential changes based on importance and feasibility; and developing an action plan.

CONCLUSION

The AIM process led to environment and policy changes known to increase healthy eating and physical activity.

Estimated energy expenditures for school-based policies and active living

BACKGROUND

Despite overwhelming evidence of the health benefits of physical activity, most American youth are not meeting the 60 minutes per day recommendation for moderate- to vigorous-intensity physical activity (MVPA). Policy changes have the potential to bring about substantial increases in physical activity in youth, within school and community settings.

PURPOSE

The purpose of this study was to quantify the increase in energy expenditure for school-based policies and built environment changes.

METHODS

Scientific literature reviews were consulted, and more than 300 published studies (1995-2011) in English were identified based on titles and abstracts. After an initial screening, 85 articles were included. Study quality was assessed, and the impact of various strategies for increasing physical activity in youth was estimated from objective measurements/direct observation.

RESULTS

Within school settings, the average minutes of MVPA gained per school day for studies in each intervention category were as follows: mandatory physical education (23 minutes); classroom activity breaks (19 minutes); afterschool activity programs (10 minutes); standardized physical education curricula (6 minutes more than traditional physical education); modified playgrounds (6 minutes); and modified recess (5 minutes more than traditional recess). Within community settings, significant MVPA was associated with active commuting (16 minutes) and park renovations (12 minutes), but proximity to parks had a small effect (1 minute). No conclusions could be drawn regarding joint-use agreements, because of a lack of studies quantifying their impact on energy expenditure.

CONCLUSIONS

Of the various policies and built environment changes examined, the largest effects were seen with mandatory physical education, classroom activity breaks, and active commuting to school. Policymakers can use this information along with estimates of the cost, feasibility, and population reach, to identify the best options for increasing physical activity in youth.

An objective assessment of children's physical activity during the Keep It Moving! after-school program

BACKGROUND

After-school programs may provide valuable opportunities for children to accumulate healthful physical activity (PA). This study assessed the PA of third-, fourth-, and fifth-grade children in the Keep It Moving! (KIM) after-school PA program, which was implemented in an ethnically diverse and low socioeconomic status school district in Colorado Springs, Colorado.

METHODS

The PA of KIM participating children (N = 116) at 4 elementary schools was objectively assessed using ActiGraph accelerometers and the System for Observing Fitness Instruction Time (SOFIT). Linear mixed-effects models or generalized linear mixed-effects models were used to compare time spent in sedentary (SED) behaviors, light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) between genders and weight status classifications during KIM sessions.

RESULTS

Children accumulated 7.6 minutes of SED time, 26.9 minutes of LPA, and 22.2 minutes of MVPA during KIM sessions. Boys accumulated less SED time (p < .05) and LPA (p = .04) than girls, but accumulated more MPA (p = .04), VPA (p = .03), and MVPA (p = .03). Overweight/obese children accumulated more LPA (p = .04) and less VPA (p < .05) than nonoverweight children. SOFIT data indicated that children spent a considerable proportion of KIM sessions being very active (12.4%), walking (36.0%), or standing (40.3%).

CONCLUSION

The KIM program provides opportunities for disadvantaged children to accumulate substantial amounts of MVPA (>20 minutes per session) in an effort to meet current PA guidelines.

Preventing obesity through schools

This paper describes highlights from the Weight of the Nation 2012 Schools Track. Included is a summary of 16 presentations. Presenters shared key actions for obesity prevention through schools. The information provided at the Weight of the Nation can help school health practitioners access tools, apply evidence-based strategies, and model real-world examples to successfully start obesity prevention initiatives in their jurisdiction.

Physical activity during school in urban minority kindergarten and first-grade students

OBJECTIVES

To determine if physical activity (PA) during the school day varied by school, grade level, gender, weight status, and physical education (PE) and recess participation among urban kindergarten and first-grade students.

METHODS

Cross-sectional study at 4 Bronx, NY, schools. Student PA was measured by a Yamax Digi-Walker pedometer, an objective and validated measure of PA in children. Each student wore a sealed pedometer during school for 5 consecutive days. Hierarchical models were fit to identify variables predictive of PA.

RESULTS

A total of 916 had valid pedometer data (53% male, 70% Hispanic, mean age 5.98 years [SD 0.66], 45% overweight). PA varied by school (P < .0001). First-grade students took a significantly greater mean number of steps during school than kindergarten students. Overall, students took an average of 2479.7 (SD 961.8) steps/school day. PA did not differ by BMI status. Students took on average 724 more steps on PE days than on non-PE days and 490 more steps on days with outdoor recess than nonrecess days (P < .05 for both). Fewer than 1% of all students achieved lower cut points for previously published mean range of steps/school day for boys and girls. Multivariable analysis revealed higher grade level, participation in PE class, and outdoor recess as independent predictors of PA.

CONCLUSIONS

PA levels were low in kindergarten and first-grade students. Future interventions incorporating classroom-based PA and outdoor recess may increase PA in resource-poor urban schools with limited PE facilities.

The crucial role of recess in school

Recess is at the heart of a vigorous debate over the role of schools in promoting the optimal development of the whole child. A growing trend toward reallocating time in school to accentuate the more academic subjects has put this important facet of a child's school day at risk. Recess serves as a necessary break from the rigors of concentrated, academic challenges in the classroom. But equally important is the fact that safe and well-supervised recess offers cognitive, social, emotional, and physical benefits that may not be fully appreciated when a decision is made to diminish it. Recess is unique from, and a complement to, physical education--not a substitute for it. The American Academy of Pediatrics believes that recess is a crucial and necessary component of a child's development and, as such, it should not be withheld for punitive or academic reasons.

Obesity and other correlates of physical activity and sedentary behaviors among US high school students

Understanding correlates of physical activity (PA) can help inform and improve programs that promote PA among youth. We analyzed data from the 2010 National Youth Physical Activity and Nutrition Study, a representative sample of US students in grades 9-12. Logistic regression was used to examine associations between PA correlates (obesity, physical education classes, sports team participation, attitude toward PA, adult support for PA, and environmental support for PA) and participation in daily PA (DPA), vigorous PA (VPA), muscle-strengthening activity (MSA), viewing television (TV), and using computers or video games (C/VG). A positive attitude toward PA and adult support for PA were both associated with increased PA and decreased sedentary behavior. However, among students who lived in neighborhoods that were not safe for PA, a positive attitude toward PA was not associated with increased DPA or decreased sedentary behavior and was less strongly associated with VPA and MSA. Efforts to increase PA among youth should promote a positive attitude toward PA among youth and encourage adult family members to support their efforts to be active. Policies that promote safe neighborhoods may work synergistically with a positive attitude toward PA to increase participation in PA and decrease sedentary behaviors.

Sensation-seeking genes and physical activity in youth

Many studies examining genetic influences on physical activity (PA) have evaluated the impact of single nucleotide polymorphisms (SNPs) related to the development of lifestyle-related chronic diseases, under the hypothesis that they would be associated with PA. However, PA is a multidetermined behavior and associated with a multitude of health consequences. Thus, examining a broader range of candidate genes associated with a broader range of PA correlates may provide new insights into the genetic underpinnings of PA. In this study, we focus on one such correlate - sensation-seeking behavior. Participants (N = 1130 Mexican origin youth) provided a saliva sample and data on PA and sensation-seeking tendencies in 2008-2009. Participants were genotyped for 630 functional and tagging variants in the dopamine, serotonin and cannabinoid pathways. Overall 30% of participants (males - 37.6% and females - 22.0%) reported ≥60 min of PA on 5 of 7 days. After adjusting for gender, age and population stratification, and applying the Bayesian False Discovery Probability approach for assessing noteworthiness, four gene variants were significantly associated with PA. In a multivariable model, being male, having higher sensation-seeking tendencies and at least one copy of the minor allele for SNPs in angiotensin I-converting enzyme gene [ACE; rs8066276 odds ratio (OR) = 1.44; P = 0.012] and tryptophan hydroxylase 2 gene (TPH2; rs11615016 OR = 1.73; P = 0.021) were associated with increased likelihood of meeting PA recommendations. Participants with at least one copy of the minor allele for SNPs in synaptosomal-associated protein 25 gene (SNAP25; rs363035 OR = 0.53; P = 0.005) and cannabinoid receptor 1 gene (CNR1; rs6454672 OR = 0.62; P = 0.022) have decreased likelihood of meeting PA recommendations. Our findings extend current knowledge of the complex relationship between PA and possible genetic underpinnings.

An observational evaluation of move-to-improve, a classroom-based physical activity program, New York City schools, 2010

Introduction

Few children in the United States achieve the recommended 60 minutes of physical activity per day. Identifying successful interventions that increase physical activity for children is critical. This observational study evaluated the effects of Move-To-Improve (MTI), a classroom-based physical education program designed for kindergarten to third-grade teachers in New York City public schools. MTI organizes 3-hour trainings for teachers that demonstrate strategies for integrating activity into daily classroom schedules.

Methods

Randomly sampled elementary schools (N = 39) with classrooms trained in MTI in spring 2010 participated in the evaluation. In each school, we observed 2 classrooms trained in MTI and 2 untrained classrooms in the same school matched by grade level for 1 full school day. We analyzed data from 72 trained and 72 untrained classrooms.

Results

Ninety-nine percent of MTI-trained classroom teachers led their students in physical activity. MTI-trained classrooms spent an average of 9.5 minutes in physical activity per day, compared with 2.4 minutes in untrained classrooms (P < .001), an almost fourfold increase in activity. Levels of activity were higher in trained versus untrained classrooms regardless of grade level or class size.

Conclusion

Teachers trained in MTI led their classrooms in significantly more physical activity compared with teachers who were not trained. The MTI program is an effective strategy for increasing physical activity during the school day. A curriculum that empowers classroom teachers to incorporate activity into their regular day is a practical approach to promoting healthier living for children.

Statewide evaluation of local wellness policies in Georgia: an examination of policy compliance, policy strength, and associated factors

OBJECTIVE

To analyze relationships between demographic characteristics of Georgia school systems and: (1) compliance with the Child Nutrition and WIC Reauthorization Act (CNRA); and (2) strength of wellness policy goals in nutrition, physical activity, and other school-based activities.

DESIGN

Each local school district submitted their school-board-approved wellness policy to researchers. Each policy was reviewed and coded for compliance with CNRA and evaluated on the strength of its goals.

SETTING

Public school districts.

PARTICIPANTS

One hundred seventy-six of 180 Georgia public school systems participated.

MAIN OUTCOME MEASURES

Independent variables were demographic characteristics of Georgia school systems. Dependent variables were ratings from the policy evaluation instrument, grouped into composite indices to compare the strength (ie, ratings) of wellness policy goals.

ANALYSIS

Pearson correlation, cross-tabulation.

RESULTS

Significant positive associations were found between academic performance and: strength of overall wellness policy goals (P < .05), goals in nutrition education (P < .01), and other school-based activities (P < .01). Economic status of the student population was found to be positively associated with strength of nutrition education goals (P < .05).

CONCLUSIONS AND IMPLICATIONS

Districts with stronger academic performance had more comprehensive overall wellness policy goals and stronger goals in nutrition education and other school-based activities.