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

Faculty and staff development strategies to prevent childhood obesity

Childhood obesity prevention and management is currently a priority health focus in the United States. Graduates of nursing programs and practicing registered nurses must be competent to implement interventions and programs to assess, prevent, and manage childhood obesity in acute care and community settings. This article provides an overview of the scope of the problem and recommendations from relevant health organizations. Nurse and staff educators are provided with specific content and teaching strategies for the prevention and management of childhood obesity for developing the knowledge and skills of nursing students, staff nurses, and advanced practice nurses.

Physical activity during school recess: a systematic review

CONTEXT

Interest has increased in examining the physical activity levels of young people during school recess. Identifying correlates of their recess physical activity behaviors is timely, and would inform school-based physical activity programming and intervention development. The review examined the correlates of children's and adolescent's physical activity during school recess periods.

EVIDENCE ACQUISITION

A systematic search of six electronic databases, reference lists, and personal archives identified 53 studies (47 focused on children) published between January 1990 and April 2011 that met the inclusion criteria. Data were analyzed in 2011. Correlates were categorized using the social-ecological framework.

EVIDENCE SYNTHESIS

Forty-four variables were identified across the four levels of the social-ecological framework, although few correlates were studied repeatedly at each level. Positive associations were found of overall facility provision, unfixed equipment, and perceived encouragement with recess physical activity. Results revealed that boys were more active than girls.

CONCLUSIONS

Providing access to school facilities, providing unfixed equipment, and identifying ways to promote encouragement for physical activity have the potential to inform strategies to increase physical activity levels during recess periods.

Population-level intervention strategies and examples for obesity prevention in children

With obesity affecting approximately 12.5 million American youth, population-level interventions are indicated to help support healthy behaviors. The purpose of this review is to provide a summary of population-level intervention strategies and specific intervention examples that illustrate ways to help prevent and control obesity in children through improving nutrition and physical activity behaviors. Information is summarized within the settings where children live, learn, and play (early care and education, school, community, health care, home). Intervention strategies are activities or changes intended to promote healthful behaviors in children. They were identified from (a) systematic reviews; (b) evidence- and expert consensus-based recommendations, guidelines, or standards from nongovernmental or federal agencies; and finally (c) peer-reviewed synthesis reviews. Intervention examples illustrate how at least one of the strategies was used in a particular setting. To identify interventions examples, we considered (a) peer-reviewed literature as well as (b) additional sources with research-tested and practice-based initiatives. Researchers and practitioners may use this review as they set priorities and promote integration across settings and to find research- and practice-tested intervention examples that can be replicated in their communities for childhood obesity prevention.

Geographic variations in elementary school-based physical activity practices

BACKGROUND

Physical activity (PA) is associated with health and academic benefits among children, but many schools do not meet national recommendations. This study examined school-based PA practices in nationally representative samples of public elementary schools, and geographic variations in those practices.

METHODS

Mail-back surveys were used to gather data from 578 public elementary schools during the 2006-2007 school year and 680 public elementary schools during the 2009-2010 school year.

RESULTS

Nationwide, only 1 in 5 schools met the national recommendation of at least 150 minutes of physical education (PE) per week, although PE was more prevalent in the South. Nearly three-fourths of schools nationwide met recommendations for 20 or more minutes of recess daily, and this was more prevalent in the Midwest but less so in the South. Approximately 40% of schools offered sports and approximately 40% offered other opportunities for PA during the school day. The only practice that increased over time was formal classroom instruction on PA.

CONCLUSIONS

There has been little change in elementary school-based PA practices nationwide in recent years. With the upcoming renewal of the Elementary and Secondary Education Act, policymakers have an important opportunity to promote increased PA in schools.

Physical activity promotion in schools: which strategies do schools (not) implement and which socioecological factors are associated with implementation?

We studied the implementation and associated factors of strategies (e.g. sports after school and during lunch break, active schoolyards, active school commuting) and organizational principles (e.g. safe bike racks, pupil involvement) that facilitate the physical activity (PA)-promoting role of schools. Key representatives of 111 elementary and 125 secondary schools filled out an online survey. Less than half of the elementary schools organized sports during lunch-break or after school. In secondary schools the least implemented strategies were the promotion of active school commuting and after-school sports. In general pupil, parental and community involvement scored low. Better knowledge of community schools and having attended in-service training were associated with higher implementation scores in elementary and secondary schools. Better implementation of the strategies was found in larger schools. Participation in activities from the School Sports Association and more perceived interest from parents and the school board were also associated with higher implementation scores. In conclusion, knowledge of community schools and in-service training next to sufficient human resources are potential key factors to promote PA. Efforts are needed to convince and help schools to increase parental and pupil involvement and to build a policy on school-community partnerships.

Physical education's role in public health: steps forward and backward over 20 years and HOPE for the future

The 1991 paper, "Physical education's role in public health" described the importance of physical education in addressing public health problems. On its 20th anniversary, this article reviews accomplishments in improving the health impact of physical education and identifies areas lacking progress. Major accomplishments include development of evidence-based programs, documentation of health and academic benefits of physical education, and acceptance of physical education as a public health resource. Additional work is needed to evaluate the uptake of evidence-based programs, improve national surveillance of physical education quantity and quality, establish stronger policies supporting active physical education, and achieve wide acceptance of public health goals within the physical education field. These opportunities constitute an agenda for actualizing the promise of health-optimizing physical education before the next 20 year anniversary.

The association of state law to physical education time allocation in US public schools

OBJECTIVES

We examined whether public schools in states with specific and stringent physical education (PE) laws, as assessed by the Physical Education-Related State Policy Classification System (PERSPCS), available on the Classification of Laws Associated with School Students (C.L.A.S.S.) Web site, reported more weekly PE time in the most recent School Health Policies and Programs Survey (SHPPS).

METHODS

Schools (n=410) were grouped by their state's PERSPCS time requirement scores (none, nonspecific requirement, or specific requirement). Average weekly school-level PE was calculated using the SHPPS-reported PE minutes. Weighted analyses determined if PE minutes/week differed by PERSPCS group.

RESULTS

Schools in states with specific requirement laws averaged over 27 and 60 more PE minutes/week at the elementary and middle school levels, respectively, compared with schools within states with nonspecific laws and over 40 and 60 more PE minutes per week, respectively, compared with elementary and middle schools in states with no laws. High school results were nonsignificant.

CONCLUSIONS

Public health guidelines recommend at least 60 minutes of daily physical activity for children, and PE may further this goal. Strong codified law with specific time requirements for PE may be an important tool contributing toward adequate PE time and daily physical activity recommendations.

Experimenting with cigarettes and physical activity among Mexican origin youth: a cross sectional analysis of the interdependent associations among sensation seeking, acculturation, and gender

BACKGROUND

Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation.

METHODS

In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson's χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student's t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation.

RESULTS

Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active.

CONCLUSIONS

Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.

Association and diffusion of nutrition and physical activity policies on the state and district level

BACKGROUND

School district wellness policies designed to reduce obesity and promote student health and well-being often lack specific requirements or any mandate that schools comply with the policy. Researchers, educators, and policymakers have called for states to take an active role in shaping district policies. The objective of this study was to determine if states with strong school-based nutrition and physical activity (PA)-related policies have stronger district wellness policies, and explore the direction of policy diffusion between states and districts.

METHODS

State policies and nationally representative samples of district policies for the 2006-2007 and 2008-2009 school years were obtained across 5 domains-competitive foods, school meals, nutrition education, physical education (PE), and PA-and were classified as "strong" or "weak," based on policy language, in each grade level (elementary, middle, high). Linear models estimated the cross-sectional and longitudinal associations between state and district policies.

RESULTS

In 2006-2007 and 2008-2009, district elementary school competitive food policies were stronger in states with strong policies. For policies governing competitive foods in high schools and school meals at all grade levels, mean district policy strength increased from 2006-2007 to 2008-2009 in states with strong 2006-2007 policies. States that strengthened their PE policies from 2006-2007 to 2008-2009 saw an increase in mean district PE policy strength. Across all domains, states that had weak 2006-2007 policies and made no changes saw little increase in district policy strength.

CONCLUSION

District competitive food, school meal, and PE policies are stronger in states that have developed strong policies in these domains.

Cardiorespiratory fitness and proximity to commercial physical activity facilities among 12th grade girls

PURPOSE

To investigate the relationship between proximity to commercial physical activity (PA) facilities and cardiorespiratory fitness of 12th grade girls.

METHODS

Adolescent girls (n = 786, 60% African American, mean age = 17.6 ± .6 years) performed a submaximal fitness test (Physical Work Capacity 170 test). Commercial PA facilities were mapped and counted within a .75-mile street-network buffer around girls' homes using Geographic Information Systems. Sedentary activities and vigorous physical activity (≥6 metabolic equivalents) were determined by the average number of 30-minute blocks reported per day on the 3-Day Physical Activity Recall. Mixed model regressions were calculated using school as a random variable.

RESULTS

Girls had higher weight-relative Physical Work Capacity 170 test scores if there was a commercial PA facility (n = 186, 12.4 ± 4.2 kg m/min/kg) within a .75-mile street-network buffer of home as compared with girls without a nearby facility (n = 600, 11.2 ± 3.6 kg m/min/kg). After adjusting for demographic variables, sports participation, sedentary behaviors, and vigorous physical activity, having one or more commercial PA facilities within a .75-mile street-network buffer of homes was significantly related to cardiorespiratory fitness.

CONCLUSIONS

Both with and without adjustment for covariates, the presence of a commercial PA facility within a .75-mile street-network buffer of a girl's home was associated with higher cardiorespiratory fitness.

Process evaluation results from the HEALTHY physical education intervention

Process evaluation is an assessment of the implementation of an intervention. A process evaluation component was embedded in the HEALTHY study, a primary prevention trial for Type 2 diabetes implemented over 3 years in 21 middle schools across the United States. The HEALTHY physical education (PE) intervention aimed at maximizing student engagement in moderate-to-vigorous physical activity through delivery of structured lesson plans by PE teachers. Process evaluation data collected via class observations and interventionist interviews assessed fidelity, dose delivered, implementor participation, dose received and barriers. Process evaluation results indicate a high level of fidelity in implementing HEALTHY PE activities and offering 225 min of PE every 10 school days. Concerning dose delivered, students were active for approximately 33 min of class, representing an average of 61% of the class time. Results also indicate that PE teachers were generally engaged in implementing the HEALTHY PE curriculum. Data on dose received showed that students were highly engaged with the PE intervention; however, student misbehavior was the most common barrier observed during classes. Other barriers included teacher disengagement, large classes, limited gym space and poor classroom management. Findings suggest that the PE intervention was generally implemented and received as intended despite several barriers.

An analysis of community use policies in Missouri school districts

BACKGROUND

Joint use or community use policies are state-, district-, or school-level policies that allow for shared use of space or facilities between a school and a city or private organization. For this study, we (1) created an inventory of community use policies within Missouri school districts; (2) analyzed the policies for content, and (3) identified district characteristics that predict the presence of a community use policy.

METHODS

A coding tool was developed to assess the content of collected policies. Descriptors of 515 districts was gathered from the Missouri Department of Elementary and Secondary Education website. The policies were collected via district website or phone/e-mail contact and coded. Frequency of variables and a logistic regression to predict district presence of policy were computed.

RESULTS

Of the 515 districts in Missouri, 375 had a community use policy. Most (216) came from a policy template from the Missouri School Boards' Association or Missouri Consultants for Education (115). Only 42 districts had unique community use policies. Large or medium-sized districts were more likely to have a policy than small districts. Districts with higher percentage of students qualifying for free/reduced lunch were less likely to have a policy.

CONCLUSION

Making changes to the 2 main resource templates have the potential to improve many district community use policies. Future efforts should focus on increasing policies and implementation in low resource and small districts. More research is needed on implementation and evaluation of community use policies.

Implementing childhood obesity policy in a new educational environment: the cases of Mississippi and Tennessee

OBJECTIVES

Our purpose was to investigate the processes involved in, and outcomes of, implementing 3 new state-level, school-oriented childhood obesity policies enacted between 2004 and 2007.

METHODS

We followed policy implementation in 8 high schools in Mississippi and Tennessee. We collected data between 2006 and 2009 from interviews with policymakers, administrators, teachers, and students; observations of school-based activities; and documents.

RESULTS

Significant barriers to the effective implementation of obesity-related policies emerged. These most notably include a value system that prioritizes performances in standardized tests over physical education (PE) and a varsity sport system that negatively influences opportunities for PE. These and other factors, such as resource constraints and the overloading of school administrators with new policies, mitigate against the implementation of policies designed to promote improvements in student health through PE.

CONCLUSIONS

Policies designed to address health and social problems in high-school settings face significant barriers to effective implementation. To have a broad impact, obesity-related policies must be tied to mainstream educational initiatives that both incentivize, and hold accountable, the school-level actors responsible for their implementation.

A recess intervention to promote moderate-to-vigorous physical activity

BACKGROUND

Schools provide a prime environment for interventions that attempt to increase physical activity and prevent obesity.

OBJECTIVE

This study examined the effect of a 30-min, structured recess using 22 games of known energy expenditure on moderate-to-vigorous physical activity when compared to free play implemented with third graders from two elementary schools over 9 weeks.

METHODS

Moderate-to-vigorous physical activity and other cardiovascular risk factors were assessed pre- and post-intervention in 27 children.

RESULTS

Moderate-to-vigorous physical activity during recess increased significantly in intervention school children from 6.9 ± 0.8 to 14.9 ± 0.9 min pre- and post-intervention, respectively (adjusted mean change 8.0 ± 1.1; P < 0.0001), with no differences by gender or body mass index (BMI). In-school, moderate-to-vigorous physical activity also increased significantly more for intervention compared to control children (adjusted mean change 14 ± 4 min vs. 3 ± 3 min; P = 0.014, respectively).

CONCLUSION

There was no significant difference in BMI and cardiovascular risk factors. A structured recess is feasible to implement and can significantly increase moderate-to-vigorous physical activity.

Benefits and environmental determinants of physical activity in children and adolescents

In this review, we identify the health benefits associated with physical activity (PA); address the physical activity and sedentary guidelines issued by public health scientists as well as children's compliance to these guidelines; discuss the importance of motor skill acquisition during early childhood; and identify different settings that contribute to physical activity participation and strategies for improving PA in these settings. Results show that regular participation in PA during childhood has numerous immediate benefits, including positive changes in adiposity, skeletal health, psychological health, and cardiorespiratory fitness. Additionally, motor skill development during early childhood may have immediate health benefits as well as long-lasting effects in adulthood. Furthermore, the benefits of PA during childhood also appear to positively influence adult health outcomes, such as increased bone mineral density. Key environmental settings that have been shown to influence children's PA behavior include child care, active commuting to and from school, school recess, school physical education, after-school programs, churches, medical settings, and the home environment. Recommendations for practitioners and researchers are discussed.

Has the Alberta daily physical activity initiative been successfully implemented in Calgary schools?

INTRODUCTION

In September 2005, the Alberta government introduced the daily physical activity (DPA) initiative, which requires that students from grades 1 to 9 be physically active in school for a minimum of 30 min per day.

OBJECTIVE

To obtain information on whether and how the DPA initiative has been implemented in Calgary schools.

METHODS

Information was obtained through a descriptive survey. Principals and vice-principals from elementary schools participated in an interview, in which they were asked questions about the DPA initiative, their definition of physical activity, the types of activities that fulfilled the DPA requirement, and barriers to increasing physical activity and physical education.

RESULTS

98.2% of respondents reported being aware of the DPA initiative; 100% of respondents reported it being successfully implemented. The leading responses to the question, "How do you define physical activity?" were "moving/movement" (43.5%), "increasing the heart rate" (32.7%) and "being active" (29%). 78.2% of participants responded that physical education was the only type of activity that fulfilled the DPA requirement; the other participants reported that recess, intramurals and DPA periods organized by the teacher also counted. 69.1% and 61.1% of respondents, respectively, stated that there were barriers to increasing physical education and physical activity. A lack of time in the curriculum, a lack of space and a lack of funding were the most frequently reported barriers.

CONCLUSION

According to principal and vice-principal reports, the DPA initiative has been successfully implemented in elementary schools in Calgary. This suggests that government initiatives directed at increasing physical activity at school could result in increasing the actual amount of physical activity that children participate in. However, prospective longitudinal research directly measuring the amount of physical activity that children engage in is needed to directly assess the impact of such initiatives.

Geographic disparities in state and district policies targeting youth obesity

BACKGROUND

States and school districts nationwide have enacted policies targeting youth obesity, but many policies lack specific requirements or enforcement language. Geographic disparities in youth obesity could worsen if policies are weaker in areas with higher obesity prevalence.

PURPOSE

To determine if state or district policy strength varies with youth obesity prevalence across Census divisions.

METHODS

Policies in five domains related to nutrition and physical activity in schools were obtained from all states and nationally representative samples of 578 and 592 public school districts in the 2006-2007 and 2008-2009 school years, respectively. Policy language strength was rated on a 0-100 scale on both the state and district level. Regression models were used to determine if mean 2006-2007 strength scores, and changes in mean scores from 2006-2007 to 2008-2009, were associated with youth obesity prevalence across Census divisions. Analyses were conducted in 2010.

RESULTS

State and district policies governing foods sold outside of school meal programs ("competitive foods") were stronger in 2006-2007 in the two divisions with the highest youth obesity prevalence (East South Central, West South Central). Furthermore, mean competitive food policy strength increased the most from 2006-2007 to 2008-2009 in these divisions. The West South Central had the weakest district physical education policies in 2006-2007, however, and was the only division in which average strength of district school meal policies decreased.

CONCLUSIONS

State and districts in Census divisions with the highest youth obesity prevalence are taking steps to restrict competitive foods in schools, but many have not targeted other policy domains as aggressively.

Differences in physical activity during school recess

BACKGROUND

School recess provides a daily opportunity for physical activity engagement. The purpose of this study was to examine physical activity levels during recess by gender, ethnicity, and grade, and establish the contribution of recess to daily school physical activity levels.

METHODS

Two hundred and ten children (45% boys) from grades 3 to 6 in 4 elementary schools had their physical activity during school quantified using uni-axial accelerometry every 5 seconds for 5 consecutive school days. Data were collected in fall 2009. The proportion of time spent engaged in physical activity during daily school recess was determined using existing age-appropriate cutpoints. The relative contribution of recess to school day physical activity was also determined.

RESULTS

Boys were more active than girls during recess. Girls engaged in more sedentary activity than boys. No main effects for ethnicity were observed. Children in grades 3 and 5 were more active than children in grades 4 and 6. Recess contributed 17.9% and 15.5% toward boys' and girls' school day moderate-to-vigorous physical activity, respectively.

CONCLUSION

Children engaged in physical activity during recess, though interventions may be needed to increase the intensity of activity in this context.

School sport policy and school-based physical activity environments and their association with observed physical activity in middle school children

Empirical research on the effects of school sport policies on children's physical activity is limited. This study examined sport policies (intramural vs. varsity), physical settings within schools, and supervision in relation to physical activity using the System for Observing Play and Leisure in Youth (SOPLAY). Data were collected on physical activity levels of children in four middle schools. Regression analyses assessed the main effects of sport policy, type of physical activity setting, and supervision as well as interactions. Regression models were stratified by gender. Children in intramural schools were more likely to use indoor spaces and be boys. Regression models indicated that varsity sport programs were associated with lower physical activity levels among boys but not girls. Significant associations between type of physical activity settings and physical activity levels were observed only for boys. Adult supervision was not associated with children's physical activity levels. Finally, descriptive results showed athletic facilities were under-utilized in all schools.

Reducing childhood obesity through policy change: acting now to prevent obesity

Childhood obesity is epidemic in the United States, and is expected to increase the rates of many chronic diseases. Increasing physical activity and improving nutrition are keys to obesity prevention and control. But changing individual behavior is difficult. A comprehensive, coordinated strategy is needed. Policy interventions that make healthy dietary and activity choices easier are likely to achieve the greatest benefits. There is emerging evidence on how to address childhood obesity, but we must take action now to begin to reverse the epidemic.

School sports opportunities influence physical activity in secondary school and beyond

BACKGROUND

The purpose of the present study was to examine whether the availability of intramural or extramural sports in secondary schools is associated with physical activity levels in youth throughout secondary school and at age 20.

METHODS

Eight hundred and eight adolescents from 10 secondary schools in Montreal, Canada, provided physical activity data every 3 months during the school year from ages 13 to 17, and again at age 20. School administrators completed questionnaires on the availability of intramural and extramural sports. Three-level general linear models were used to examine associations among the number of intramural and extramural sports, moderate and vigorous physical activity controlling for age, sex, body mass index, mother's education, and school-level socioeconomic status.

RESULTS

Regardless of whether or not they reported participating in intramural sports, adolescents in schools with more intramural sports engaged in 3.6 (p = .03) more total, and 1.3 (p = 0.03) more vigorous activities per week than those attending schools with fewer intramural sports. Number of extramural sports was not statistically significantly associated with physical activity, regardless of whether or not individual students participated.

CONCLUSION

Providing more opportunities for intramural sports in secondary schools may be an effective strategy to help adolescents attain physical activity recommendations.

Impact of short bouts of physical activity on attention-to-task in elementary school children

OBJECTIVE

The study's objective was to describe the measurement of on-task behavior and review the research on the effects of short physical activity breaks on attention-to-task in elementary school students, with a particular focus on a promising approach to improving on-task behavior with short bouts of physical activity in the classroom setting.

METHODS

Procedures to directly observe attention-to-task were detailed. Published studies that measured attention-to-task in elementary school students following physical activity breaks were reviewed.

RESULTS

Direct measurement of attention-to-task is intensive and demanding on observers. Previous research on attention-to-task following physical activity breaks is sparse. The limited evidence suggests a small to moderate improvement on attention-to-task following physical activity breaks (Effect Sizes typically ranged from 0.13 to 0.60). Teachers can be trained in a relatively short time to effectively lead classroom-based physical activities. Students who participated in classroom-based physical activities that incorporate academic concepts demonstrated significantly better improvements (+8.3%) in attention-to-task than control group participants (-3.1%).

CONCLUSIONS

Attention-to-task is a variable that directly relates to concerns of classroom teachers. The limited available research has demonstrated moderate to good evidence that physical activity during the school day improves attention-to-task in elementary school students. Because of the positive effects of physical activity on attention-to-task, it is recommended that elementary school teachers consider implementing physical activity sessions throughout the school day in the form of recess and classroom-based physical activities.

Physically active academic lessons in elementary children

BACKGROUND

Although schools are an ideal location to conduct interventions that target children, the emphasis on standardized testing makes it difficult to implement interventions that do not directly support academic instruction. In response, physically active academic lessons have been developed as a strategy to increase physical activity while also addressing core educational goals. Texas I-CAN! is one incarnation of this approach.

METHODS

We will review the on-going research on the impact of these active lessons on: teacher implementation, child step count, child attention control, and academic performance.

RESULTS

The collected studies support the impact of physically active academic lessons on each area of interest.

CONCLUSIONS

If these data can be replicated, it suggests that teachers might find these lessons of benefit to their primary role as educators, which should ease dissemination of these and other physically active lessons in elementary schools.

When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth?

Regular participation in organized youth sports does not ensure adequate exposure to skill- and health-related fitness activities, and sport training without preparatory conditioning does not appear to reduce risk of injury in young athletes. Current trends indicate that widespread participation in organized youth sports is occurring at a younger age, especially in girls. Current public health recommendations developed to promote muscle strengthening and bone building activities for youth aged 6 yr and older, along with increased involvement in competitive sport activities at younger ages, has increased interest and concern from parents, clinicians, coaches, and teachers regarding the optimal age to encourage and integrate more specialized physical training into youth development programs. This review synthesizes the latest literature and expert opinion regarding when to initiate neuromuscular conditioning in youth and presents a how-to integrative training conceptual model that could maximize the potential health-related benefits for children by reducing sports-related injury risk and encouraging lifelong, regular physical activity.

Monitoring and evaluating school nutrition and physical activity policies

Given the increase in the number of Canadian jurisdictions with school nutrition and/or physical activity policies, there is a need to assess the effectiveness of such policies. The objectives of this paper are to 1) provide an overview of key issues in monitoring and evaluating school nutrition and physical activity policies in Canada and 2) identify areas for further research needed to strengthen the evidence base and inform the development of effective approaches to monitoring and evaluation. Evaluation indicators, data sources and existing tools for evaluating nutrition and physical activity are reviewed. This paper has underscored the importance of identifying common indicators and approaches, using a comprehensive approach based on the WHO framework and ensuring that research capacity and funding is in place to facilitate high-quality evaluation efforts in the future.

The physical activity climate in Minnesota middle and high schools

BACKGROUND

This article describes policies, practices, and facilities that form the physical activity climate in Minneapolis/St. Paul, Minnesota metro area middle and high schools and examines how the physical activity climate varies by school characteristics, including public/private, school location and grade level.

METHODS

Surveys examining school physical activity practices, policies and environment were administered to principals and physical education department heads from 115 middle and high schools participating in the Transdisciplinary Research on Energetics and Cancer-Identifying Determinants of Eating and Activity (TREC-IDEA) study.

RESULTS

While some supportive practices were highly prevalent in the schools studied (such as prohibiting substitution of other classes for physical education); other practices were less common (such as providing opportunity for intramural (noncompetitive) sports). Public schools vs. private schools and schools with a larger school enrollment were more likely to have a school climate supportive of physical activity.

CONCLUSIONS

Although schools reported elements of positive physical activity climates, discrepancies exist by school characteristics. Of note, public schools were more than twice as likely as private schools to have supportive physical activity environments. Establishing more consistent physical activity expectations and funding at the state and national level is necessary to increase regular school physical activity.

Physical education resources, class management, and student physical activity levels: a structure-process-outcome approach to evaluating physical education effectiveness

BACKGROUND

This study was conducted to empirically evaluate specific human, curricular, and material resources that maximize student opportunities for physical activity during physical education (PE) class time. A structure-process-outcome model was proposed to identify the resources that influence the frequency of PE and intensity of physical activity during PE. The proportion of class time devoted to management was evaluated as a potential mediator of the relations between resource availability and student activity levels.

METHODS

Data for this cross-sectional study were collected from interviews conducted with 46 physical educators and the systematic observation of 184 PE sessions in 34 schools. Regression analyses were conducted to test for the main effects of resource availability and the mediating role of class management.

RESULTS

Students who attended schools with a low student-to-physical educator ratio had more PE time and engaged in higher levels of physical activity during class time. Access to adequate PE equipment and facilities was positively associated with student activity levels. The availability of a greater number of physical educators per student was found to impact student activity levels by reducing the amount of session time devoted to class management.

CONCLUSION

The identification of structure and process predictors of student activity levels in PE will support the allocation of resources and encourage instructional practices that best support increased student activity levels in the most cost-effective way possible. Implications for PE policies and programs are discussed.

Daily participation in sports and students' sexual activity

CONTEXT

Previous studies suggest that student athletes may be less likely than nonathletes to engage in sexual behavior. However, few have explored sexual risk behavior among athletes in early adolescence.

METHODS

In 2005, a sample of 10,487 students in 26 Los Angeles public middle and high schools completed a self-administered survey that asked about their demographic characteristics, sports participation, sexual behaviors and expectations, and parental relationships. Chi-square analyses compared reported levels of daily participation in sports, experience with intercourse, experience with oral sex and condom use at last intercourse by selected characteristics. Predictors of sexual experience and condom use were assessed in multivariate logistic regression analyses.

RESULTS

One-third of students reported daily participation in sports. This group had higher odds of ever having had intercourse and ever having had oral sex than their peers who did not play a sport daily (odds ratios, 1.2 and 1.1, respectively). The increases in risk were greater for middle school sports participants than for their high school counterparts (1.5 and 1.6, respectively). Among sexually experienced students, daily sports participants also had elevated odds of reporting condom use at last intercourse (1.4).

CONCLUSIONS

Students as young as middle school age who participate in sports daily may have an elevated risk for STDs and pregnancy. Health professionals should counsel middle school athletes about sexual risk reduction, given that young students may find it particularly difficult to obtain contraceptives, STD testing and prevention counseling.

The identification of children with adverse risk factor levels by body mass index cutoffs from 2 classification systems: the Bogalusa Heart Study

BACKGROUND

The cutoffs from the Centers for Disease Control and Prevention (CDC) growth charts and from the Cooper Institute (FitnessGram) are widely used to identify children who have a high body mass index (BMI).

OBJECTIVE

We compared the abilities of these 2 systems to identify children who have adverse lipid concentrations and blood pressure measurements and the reliability (consistency) of each classification system over time (mean follow-up: 7 y).

DESIGN

A cross-sectional analysis based on data from 22,896 examinations of 5- to 17-y-olds was conducted. Principal components analyses were used to summarize levels of the 5 risk factors, and likelihood ratios and the κ statistic were used to compare the screening abilities of the 2 systems. Of these children, 3972 were included in longitudinal analyses.

RESULTS

There were marked differences in the prevalence of a high FitnessGram BMI by age, with the prevalence among boys increasing from 2.5% to 21% between the ages of 5 and 11 y. The identification of adverse risk factors by the 2 systems was only fair (κ = 0.25), but there was little difference in the abilities of the CDC and FitnessGram cutoffs to identify high-risk children. Longitudinal analyses, however, indicated that the agreement between initial and follow-up FitnessGram classifications was substantially lower than that based on CDC cutoffs (κ = 0.28 compared with 0.49).

CONCLUSIONS

The FitnessGram and CDC cutoffs have similar abilities to identify high-risk children. However, a high FitnessGram BMI is difficult to interpret because the reliability over time is low, and the prevalence increases markedly with age.

The crucial role of recess in schools

BACKGROUND

Recess is at the heart of a vigorous debate over the role of schools in promoting optimal child development and well-being. Reallocating time to accentuate academic concerns is a growing trend and has put recess at risk. Conversely, pressure to increase activity in school has come from efforts to combat childhood obesity. The purpose of this review was to examine the value of recess as an integral component of the school day.

METHODS

A comprehensive review of recess-specific literature was conducted, beginning with a Google Scholar search, to cull definitions, position statements, and policy recommendations from national/international associations and organizations. A multi-database search followed. Additional articles were selected from reference lists.

RESULTS

The search yielded a range of articles, from those focused on specific aspects of recess to those that examined multiple factors, including how to structure and conduct recess. Several themes emerged supporting recess as beneficial for children's cognitive, social, emotional, and physical functioning. Optimal recess was well-supervised and safe. Crucial components were well-maintained playground equipment and well-trained supervisors.

CONCLUSION

Recess serves a critical role in school as a necessary break from the rigors of academic challenges. Recess is a complement to, not a replacement for, physical education. Both promote activity and a healthy lifestyle; however, recess--particularly unstructured recess and free play--provides a unique contribution to a child's creative, social, and emotional development. From the perspective of children's health and well-being, recess time should be considered a child's personal time and should not be withheld for academic or punitive reasons.

The association between the availability of sugar-sweetened beverage in school vending machines and its consumption among adolescents in California: a propensity score matching approach

There is controversy over to what degree banning sugar-sweetened beverage (SSB) sales at schools could decrease the SSB intake. This paper uses the adolescent sample of 2005 California Health Interview Survey to estimate the association between the availability of SSB from school vending machines and the amount of SSB consumption. Propensity score stratification and kernel-based propensity score matching are used to address the selection bias issue in cross-sectional data. Propensity score stratification shows that adolescents who had access to SSB through their school vending machines consumed 0.170 more drinks of SSB than those who did not (P < .05). Kernel-based propensity score matching shows the SSB consumption difference to be 0.158 on the prior day (P < .05). This paper strengthens the evidence for the association between SSB availability via school vending machines and the actual SSB consumption, while future studies are needed to explore changes in other beverages after SSB becomes less available.

Leisure-time physical activity in elementary schools: analysis of contextual conditions

BACKGROUND

Little is known about children's leisure-time physical activity (PA) at school and how it is associated with contextual variables. The purpose of this study was to objectively assess children's voluntary PA during 3 daily periods and examine modifiable contextual factors.

METHODS

We conducted SOPLAY (System for Observing Play and Leisure Activity in Youth) observations before school, during recess, and at lunchtime in 137 targeted activity areas in 13 elementary schools over 18 months. During observations, each child was coded as Sedentary, Walking, or Vigorous, and simultaneous entries were made for area characteristics (accessibility, usability, presence of supervision, loose equipment, and organized activities). Logistic regression analysis was used to test associations between PA and area characteristics.

RESULTS

Assessors made 2349 area visits and observed 36,995 children. Boys had more moderate-to-vigorous physical activity (MVPA; 66.2 vs 60.0%, p < .001) and more vigorous PA (29.8 vs 24.6%; p < .001) than girls. Areas were typically accessible and usable, but provided organized activities infrequently (16.5%). Odds of engaging in MVPA were greater during lunch and recess than before school and in areas with play equipment (p < .05).

CONCLUSIONS

Children accrued a substantial amount of voluntary PA during leisure time at school. Their PA would likely be increased if school playground equipment was more readily available and if supervisors were taught to provide active games and promote PA rather than suppress it.

A survey of physical education programs and policies in Texas schools

To better understand key physical education program factors and policies that may affect Texas students' physical fitness, a 39-question survey, administered as part of the Texas Youth Fitness Study (TYFS), was sent to 5651 Texas schools via e-mail. The survey consisted of five sections: (a) demographics, (b) physical education/recess frequency and duration, (c) resources/environment, (d) school physical education polices, and (e) experience/perception of fitness testing. A total of 2576 responses were received, of which 1505 responses (elementary = 58.1%, middle school = 21.2%, high school = 19.4%, and "mixed" school = 1.3%) were used for the report. Most of the findings are consistent with those reported in recent national studies. In addition, there were four distinct aspects: (a) broad support among teachers for the Senate Bill 530 mandate, (b) strong evidence of adherence to the mandated testing protocols, (c) teachers' negative experiences related to the testing, and (d) lack of recess in some Texas elementary schools. The survey provided rich updated information on physical education programs and policies in Texas schools.

A multilevel examination of school and student characteristics associated with physical education class enrollment among high school students

BACKGROUND

Schools can be an efficient venue for promoting physical activity (PA) among adolescents. Physical education (PE) requires investigation because it is a variable associated with adolescent PA levels and its existence in schools represents a significant opportunity for strategies to combat declining PA levels among this population. This article examines the between-school variability in student rates of PE enrollment among a large sample of high schools in Ontario, Canada, and identifies the school- and student-level characteristics associated with PE enrollment.

METHODS

This cross-sectional study utilized self-reported school- and student-level data from administrators and students at 73 high schools. Students' enrollment in PE, demographic, behavioral, and psychosocial variables was linked to school environment data comprising of school demographics and administrator assessed quality of policies, facilities, and programs related to PA. Analysis involved multilevel modeling.

RESULTS

The mean rate of PE enrollment among the 73 high schools was 62.4%, with rates by school ranging from 28.9% to 81.1%. When student demographics, behavioral, and psychosocial factors were controlled for, there was still a school effect for student PE enrollment. The school effect was explained by the provision of daily PE and school median household income.

CONCLUSIONS

This is the first study to examine the extent to which PE enrollment varies between schools and to identify school factors associated with school variability in rates of PE enrollment. Although most variation in PE enrollment lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy makers.

Distribution of health-related physical fitness in Texas youth: a demographic and geographic analysis

This study examined demographic and geographic variability in aggregated school-level data on the percentage of students achieving the FITNESSGRAM Healthy Fitness Zones (HFZ). Three-way analyses of variance were used to examine differences in fitness achievement rates among schools that had distinct diversity and socioeconomic status profiles. The results revealed age-related declines in the percentage of youth who achieved the HFZ standard for cardiovascular fitness (elementary school: 70%; middle school: 46%; high school: 34%). Interestingly, there was little evidence of age-related declines in other fitness dimensions. School-level attainment of fitness was consistently higher in schools categorized as low diversity and high socioeconomic status. Clear spatial patterns in fitness achievement were also evident when data were analyzed at the region and county level using geodemographic information system software.

Relationships between youth sport participation and selected health risk behaviors from 1999 to 2007

BACKGROUND

How adolescents spend their out-of-school time represents one of the most important factors for predicting positive youth development. Sport participation relates to many beneficial outcomes. However, current economic conditions threaten high school sport programs around the United States. This investigation examined relationships by year between sport participation and numerous health risk behaviors among high school students.

METHODS

Data were derived from the Centers for Disease Control and Prevention's Youth Risk Behavior Surveys administered every 2 years from 1999 through 2007. Items assessed were sport participation, vigorous physical activity, dietary habits, weight loss, sexual activity, interpersonal violence and suicidality, and substance use. Multiple logistic regression analyses were used to examine relationships between sport participation and each health behavior. Interaction effects tested whether relationships varied by year, sex, age, and/or race/ethnicity.

RESULTS

Analyses revealed some consistencies across years in relationships between sport participation and health risk behaviors for both sexes. However, most relationships varied by race/ethnicity. Among White students, sport participation related to multiple positive health behaviors. Conversely, African American, Hispanic, and Other athletes showed fewer positive health behaviors and some negative behaviors.

CONCLUSIONS

Findings suggest that participation in organized sports affords many health benefits to most adolescents, but relates to some negative health behaviors in certain subgroups. Information regarding sport participation and health risk behaviors among subgroups across years can inform school policy, practice, and future research.

Defining standards and policies for promoting physical activity in afterschool programs

BACKGROUND

National guidelines exist that define "quality" afterschool programs (3-6 pm, ASP). No widely adopted national standards/policies exist, however, for ASP providers for the promotion of physical activity (PA). To address this gap, state-level ASP organizations have developed or adopted standards/policies related to PA. The extent to which standards and policies are uniform and disseminated is unclear. The purpose of this study was to review state-level ASP documentation to identify standards/policies for promoting PA within the ASP setting.

METHODS

A systematic review of state-level ASP organizations' standards/policies was conducted to identify documentation that included language explicitly defining or related to the promotion of physical activity within ASP. State-level ASP organizations were identified from registries available from national ASP organizations. Documentation was retrieved from online sources and reviewed using a standardized content analysis protocol.

RESULTS

Quality ASP definitions were retrieved from 47 states. Of these, 14 incorporated language related to the promotion of PA. This included the provision of adequate outdoor space for attendees to be active, provision of frequent PA opportunities, and promoting physical development. A total of 5 states had standards/policies that explicitly identified the amount of time for attendees to be physically active during ASP attendance, while 3 states outlined standards/policies regarding core competencies for ASP providers to promote PA.

CONCLUSIONS

Overall, standards/polices related to promoting PA within ASP were largely absent. Those that do exist, however, can provide a foundation for future empirical tests. The testing of these standards/policies will assist in the development of national guidelines to promote PA within the ASP setting.

Examination of trends and evidence-based elements in state physical education legislation: a content analysis

OBJECTIVES

To develop a comprehensive inventory of state physical education (PE) legislation, examine trends in bill introduction, and compare bill factors.

METHODS

State PE legislation from January 2001 to July 2007 was identified using a legislative database. Analysis included components of evidence-based school PE from the Community Guide and other authoritative sources: minutes in PE, PE activity, teacher certification, and an environmental element, including facilities and equipment. Researchers abstracted information from each bill and a composite list was developed.

RESULTS

In total, 781 bills were analyzed with 162 enacted. Of the 272 bills that contained at least 1 evidence-based element, 43 were enacted. Only 4 bills included all 4 evidence-based elements. Of these 4, 1 was enacted. Funding was mentioned in 175 of the bills introduced (37 enacted) and an evaluation component was present in 172 of the bills (49 enacted).

CONCLUSIONS

Based on this analysis, we showed that PE is frequently introduced, yet the proportion of bills with evidence-based elements is low. Future research is needed to provide the types of evidence required for development of quality PE legislation.

Policies to promote the community use of schools: a review of state recreational user statutes

CONTEXT

Concern over liability is a barrier to allowing community use of school property for the purpose of engaging in active sport and recreational activities. Recreational user statutes have the potential to limit liability for public schools when use occurs outside of regular school hours, reduce the fear of liability among school administrators, and increase opportunities for access to school facilities for recreation and physical activity by community members. The purpose of this study was to examine the applicability of recreational user statutes to public schools when the use of school facilities for recreational purposes would occur outside of regular school hours.

EVIDENCE ACQUISITION

A review of recreational user statutes from all 50 states was conducted in 2007 and 2009. Characteristics of those statutes from states with laws potentially applicable to public school recreation and sport facilities were described in detail.

EVIDENCE SYNTHESIS

Forty-two states had recreational user statutes that would potentially offer protection from liability for public schools. Protected activities listed in state statutes were summer sports (n=2); winter sports (n=22); athletic competition (n=1); sporting events and activities (n=1); exercise (n=4); and any other outdoor sport, game, or recreational activity (n=2). Specific protected physical activities listed were playing on playground equipment (n=1); running/jogging (n=2); roller-skating and rollerblading (n=4); skateboarding (n=2); disc golf (n=1); and bicycling (n=16).

CONCLUSIONS

This study suggests the need for further statutory liability protections for public schools, and immunity provisions that target activities conducive to physical activity, common on school grounds, and popular among community residents. It further suggests that empirical studies be conducted to examine school administrator's perceptions relevant to liability as a potential barrier to opening school sport and recreational facilities to members of the community outside of regular school hours.

Participation in activities outside of school hours in relation to problem behavior and social skills in middle childhood

BACKGROUND

Research has shown that participating in activities outside of school hours is associated with lower dropout rates, enhanced school performance, improved social skills, and reduced problem behaviors. However, most prior studies have been limited to small populations of older children (>12 years). This analysis focuses on children aged 6 to 11 to assess the potential association between participation in activities outside of school hours and behavior in middle childhood in a nationally representative survey.

METHODS

Estimates were based on 25,797 children from the 2003-2004 National Survey of Children's Health. Outside of school activity was defined as participating in sports teams/lessons, clubs/organizations, or both at least once in the past year. Analysis of variance was used to evaluate the differences in behavior problems and social skills adjusting for sociodemographic factors, among children classified by participation in outside of school activities.

RESULTS

Seventy-five percent of children participated in outside of school activities: 23% in sports, 16% in clubs, and 36% in both clubs and sports. Activity participation differed by gender, race/ethnicity, type of school, poverty status, family structure, household education, and school and community safety. Children participating in both sports and clubs had higher social skills index scores, but no significant difference in problem behavior scores compared with children who did not participate in any outside of school activity.

CONCLUSION

Children participating in both sports and clubs had greater social competence during middle childhood compared with children who did not participate in any outside of school activities.

Enrollment in physical education is associated with health-related behavior among high school students

BACKGROUND

Physical education (PE) plays a critical role in the healthy development of youth; however, the influence of PE classes in helping to provide students with health-related behavior patterns is not clear. This study aims to analyze whether participation in PE classes is associated with health-related behavior among high school students.

METHODS

A total of 4210 students attending public high schools in Pernambuco (northeast of Brazil) were selected using random 2-stage cluster sampling. Data were collected by using the Global School-based Student Health Survey. The independent variable was the frequency of participation in PE classes, whereas physical activity, television viewing, smoking, and alcohol, fruit, vegetables and soda consumption were dependent variables. Logistic regressions were carried out to perform crude and adjusted analysis of the association between enrollment in PE classes and health-related behaviors.

RESULTS

Sixty-five percent of students do not take part in PE classes, with a significantly higher proportion among females (67.8%). It was observed that enrollment in PE classes was positively associated with physical activity, TV viewing, and fruit consumption, but was negatively associated with soda drinking. The likelihood of reporting being active and eating fruit on a daily basis was 27% and 45% higher, respectively, among those who participate in at least 2 classes per week in comparison with those who do not. Students who participate in PE classes had 28-30% higher likelihood of reporting lower TV viewing during week days.

CONCLUSIONS

Findings suggest that higher levels of enrollment in PE classes could play a role in the promotion of health-related behaviors among high school students.

Facility provision in elementary schools: correlates with physical education, recess, and obesity

OBJECTIVES

The objectives were to: (1) document correlations among facility provision (availability and adequacy) in elementary schools, child sociodemographic factors, and school characteristics nationwide; and (2) investigate whether facility provision is associated with physical education (PE) time, recess time, and obesity trajectory.

METHODS

The analytic sample included 8935 fifth graders from the Early Childhood Longitudinal Survey Kindergarten Cohort. School teachers and administrators were surveyed about facility provision, PE, and recess time in April 2004. Multivariate linear and logistic regressions that accounted for the nesting of children within schools were used.

RESULTS

Children from disadvantaged backgrounds were more likely to attend a school with worse gymnasium and playground provision. Gymnasium availability was associated with an additional 8.3 min overall and at least an additional 25 min of PE per week for schools in humid climate zones. These figures represent 10.8 and 32.5%, respectively, of the average time spent in PE. No significant findings were obtained for gymnasium and playground adequacy in relation to PE and recess time, and facility provision in relation to obesity trajectory.

CONCLUSIONS

Poor facility provision is a potential barrier for school physical activity programs and facility provision is lower in schools that most need them: urban, high minority, and high enrollment schools.

Resistance training among young athletes: safety, efficacy and injury prevention effects

A literature review was employed to evaluate the current epidemiology of injury related to the safety and efficacy of youth resistance training. Several case study reports and retrospective questionnaires regarding resistance exercise and the competitive sports of weightlifting and powerlifting reveal that injuries have occurred in young lifters, although a majority can be classified as accidental. Lack of qualified instruction that underlies poor exercise technique and inappropriate training loads could explain, at least partly, some of the reported injuries. Current research indicates that resistance training can be a safe, effective and worthwhile activity for children and adolescents provided that qualified professionals supervise all training sessions and provide age-appropriate instruction on proper lifting procedures and safe training guidelines. Regular participation in a multifaceted resistance training programme that begins during the preseason and includes instruction on movement biomechanics may reduce the risk of sports-related injuries in young athletes. Strategies for enhancing the safety of youth resistance training are discussed.

Implementation of Texas Senate Bill 19 to increase physical activity in elementary schools

In 2001, the 77th Texas legislature passed Senate Bill 19 requiring students in publicly funded elementary schools to participate in physical activity and schools to implement a coordinated school health program by September 1, 2007. We report on awareness of and adherence to Senate Bill 19 in a statewide sample of elementary schools and a subsample in two public health regions located along the Texas-Mexico border. Statewide, structured interviews with principals indicated high awareness of Senate Bill 19's requirements, but lower awareness of the need for parental involvement. Only 43% of Texas schools had adopted their coordinated program 1 year or less before the implementation deadline. Principals reported an average of 179 min of physical education per week, higher than the 135-min mandate. Among the subsample border schools, principals' physical activity reports were consistent with teacher records and student reports. Further, direct observation of physical education indicated that 50% of class time was spent in moderate and vigorous physical activity, meeting the level of physical activity intensity recommended by Healthy People 2010. The differences observed by public health regions included: more physical activity minutes in Region 10 (231 min compared to 217 min in Region 11); higher adoption of coordinated school health programs (92% compared to 75%); more district-level school health advisory committees (58% compared to 38%) and school-level school health advisory committees (83% compared to 25%); and a lower prevalence of obesity in 4th grade students (21% compared to 32%). Differences by region suggest that Senate Bill 19 is not being adhered to equally across the state, and some regions may require further support to increase implementation. Results underscore the importance of continued monitoring of enacted legislation, and that legislation for child health that focuses on school programs and policies requires funding and refinement to produce the intended effect.