Elementary school physical activity opportunities and physical fitness of students: A statewide cross-sectional study of schools

A qualitative exploration of multi-stakeholder perspectives of before-school physical activity

BACKGROUND

Engagement in before-school physical activity can potentially enhance health and learning-related outcomes for children and adolescents. However, influencing factors and stakeholder perceptions of before-school physical activity remain under-researched. This qualitative study aimed to examine stakeholder perceptions of: a) the suitability of the before-school segment for physical activity, b) barriers and facilitators associated with before-school physical activity, and c) strategies for schools to support before-school physical activity.

METHODS

Twelve focus groups and one interview were conducted with 38 participants from a range of school stakeholder groups-students, parents, teachers, school leaders, external physical activity providers, and school health and physical activity experts. Focus groups were analysed using template analysis, guided by a social-ecological model.

RESULTS

Stakeholders perceived before-school physical activity as valuable, for reasons including perceptions of meaningful contributions to students' cognitive functioning, classroom behaviours, and wellbeing. Factors influencing before-school physical activity were identified across multiple social-ecological levels, including the critical role of school leadership support, availability of facilities, and provision of qualified supervision. Proposed strategies highlighted the need for sustainable design, contextual relevance, and community engagement in before-school initiatives. Additionally, communication of the manifold benefits identified by stakeholders was suggested as a means to drive support and engagement in before-school physical activity.

CONCLUSIONS

This study provides insight for schools seeking to enhance opportunities for physical activity in the before-school hours and may inform future intervention research on the subject, taking into account its multi-faceted influences and the need for context-specific strategies.

Before-school physical activity levels and sociodemographic correlates among Australian adolescents: A cross-sectional study

Understanding adolescents' physical activity levels and underpinning contextual factors is crucial for health promotion. This cross-sectional study, using 24-hour time use diaries and sociodemographic variables from the Longitudinal Study of Australian Children, addressed gaps in understanding of physical activity in the before-school segment (the time between waking up and commencing classes). The study examined a) adolescents' time spent in before-school physical activity, focusing on location and shared presence, and b) sociodemographic correlates of before-school physical activity. Completed diaries by 12-13 year-olds (n = 3,201) revealed that adolescents reported an average of 10.8 minutes of daily before-school physical activity (average segment length: 114 min), mostly classified as active transport (5.7 min). Most before-school physical activity occurred in a location other than home or school (6.1 min) and with peers (6.1 min). Notably, 51% of boys and 60% of girls did not report any before-school physical activity. Through two-part regression, we found that boys, adolescents from single-parent households, and those with longer before-school segments are more likely to report before-school physical activity compared to their counterparts. Before-school initiatives should promote active transport and diverse opportunities in other settings. Research into barriers and facilitators may inform more inclusive and effective promotion strategies, including school-based initiatives.

Educational outcomes of recess in elementary school children: A mixed-methods systematic review

BACKGROUND

Recess provides a key physical activity opportunity for students in school, yet a wide range of recess requirements exist. To design optimal recess policies, the effect of recess on students' educational outcomes must be better understood. Therefore, the purpose of this mixed-method systematic review is to identify and systematically evaluate research on the effects of recess on student educational outcomes, including behavior, cognitive performance and academic achievement.

METHODS

A systematic search of the literature in ERIC (EBSCO), ProQuest Central, PsycINFO, Teacher Reference Center, MEDLINE Complete (EBSCO), and CINAHL Complete was performed through September 2022. Data was extracted from quantitative studies, and reported themes with exemplar quotes were extracted from qualitative studies. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality.

RESULTS

The search identified 932 articles, of which 13 were included in the review, including 8 quantitative and 5 qualitative studies. Eleven studies were conducted in the United States, and reported sample size of studies ranged from 12 to 11,624. Studies found mixed effects on student behavior, discipline referrals and academic achievement. Qualitative studies reported multiple benefits of recess including increased focus, improved problem solving and academic achievement.

CONCLUSIONS

Overall, evidence suggests positive benefits for behavior and either positive or null benefits of recess on academic achievement. However, evidence is limited by non-controlled study designs and diversity in outcome assessments. Additional quantitative evidence is needed to convince policymakers of the specific evidence supporting recess, but also to advise on the optimal recess policies and practices to improve student learning.

Multiscale Impact of Environmental and Socio-Economic Factors on Low Physical Fitness among Chinese Adolescents and Regionalized Coping Strategies

As low physical fitness in adolescents increases their risk of all-cause mortality in future adulthood as well as regional public health budgets, many scholars have studied the factors influencing physical fitness in adolescents. However, the spatial non-stationarity and scale between physical fitness and influencing factors in adolescents are often neglected. To rectify this situation, this study constructed a multi-scale geographically weighted regression model based on data from the China National Student Fitness Survey and the China Statistical Yearbook in 2018 to investigate the spatial patterns of factors influencing low physical fitness among adolescents. The results showed that the influencing factors for measuring the physical fitness of Chinese adolescents had significant spatial heterogeneity and multi-scale effects. The local R² values were relatively low in the western region of China. Consideration should be given to increasing the lifestyle and ethnic and cultural characteristics of local residents when selecting influencing factors in the future. The physical fitness of men was mainly influenced by socio-economic factors, while that of women was influenced by natural environmental factors. According to the different spatial distribution patterns of MGWR, this study suggests that each region should develop regionalized strategies to cope with the low physical fitness of adolescents, including taking advantage of the natural environment to develop physical fitness promotion projects, accelerating the upgrading of industrial structures in the north-eastern and western regions, and the need to remain cautious of rapid urbanization in the east.

Validity and Reliability of a Site-Level Assessment Questionnaire to Assess Nutrition and Physical Activity Practices in Schools

Background: Schools are an ideal setting for policy, systems, and environmental approaches to obesity prevention. Although school health environment assessments exist for planning purposes, we developed and tested a comprehensive questionnaire that is suitable for both evaluation and planning. Methods: Reliability was measured by comparing data collected by school personnel from low-income elementary schools across California at two time points, an average of 2 months apart (n = 23). To assess convergent validity, school responses were compared with the responses completed by the research team (n = 28). A weighted kappa test statistic and percent agreement were calculated for each question and specific groups of questions (questionnaire section, item topic, and response type). Results: Test/retest reliability of the questionnaire yielded kappa statistics that ranged from -0.14 to 1.00 (interquartile range [IQR] 0.36). Percent agreement for reliability ranged from 34.78 to 100.00 (IQR 21.7). Kappa statistics for validity ranged from -0.14 to 1.00 (IQR 0.44). Percent agreement for validity ranged from 14.29 to 100.00 (IQR 39.2). Based on these findings, the tool was revised. Conclusions: Study findings indicate that the Site-Level Assessment Questionnaire as tested is a reliable and accurate instrument for use in low-income elementary schools. Revisions may have improved the validity and reliability. We therefore recommend either version for use to support low-income schools in their efforts to assess needs, evaluate progress, and create action plans; and to supply high-quality, aggregable data for large-scale analysis. Additional testing is recommended to validate the revised version, increase generalizability, and determine sensitivity to detect change over time.

Movement Difficulties at Age Five Among Extremely Preterm Infants

BACKGROUND AND OBJECTIVES

Children born extremely preterm (EPT), <28 weeks' gestational age, face higher risks of movement difficulties than their term-born peers. Studies report varying prevalence estimates and prognostic factors identifying children who could benefit from early intervention are inconsistent. This study investigated the prevalence of movement difficulties in children born EPT and associated risk factors.

METHODS

Data come from a population-based EPT birth cohort in 2011 and 2012 in 11 European countries. Children without cerebral palsy were assessed at 5 years of age (N = 772) with the Movement Assessment Battery for Children-Second Edition, which classifies movement difficulties as none (>15th percentile), at risk (6th-15th percentile) and significant (≤5th percentile). Associations with sociodemographic, perinatal, and neonatal characteristics collected from obstetric and neonatal medical records and parental questionnaires were estimated using multinomial logistic regression.

RESULTS

We found 23.2% (n = 179) of children were at risk for movement difficulties and 31.7% (n = 244) had significant movement difficulties. Lower gestational age, severe brain lesions, and receipt of postnatal corticosteroids were associated with significant movement difficulties, whereas male sex and bronchopulmonary dysplasia were associated with being at risk and having significant movement difficulties. Children with younger, primiparous, less educated, and non-European-born mothers were more likely to have significant movement difficulties. Differences in prevalence between countries remained after population case-mix adjustments.

CONCLUSIONS

This study confirms a high prevalence of movement difficulties among EPT children without cerebral palsy, which are associated with perinatal and neonatal risk factors as well as sociodemographic characteristics and country.

School-related sedentary behaviours and indicators of health and well-being among children and youth: a systematic review

BACKGROUND

The purpose of this systematic review was to examine the associations between school-related sedentary behaviours and indicators of health and well-being in children and youth (~ 5-18 years) attending school.

METHODS

This review was conducted to inform the development of School-Related Sedentary Behaviour Recommendations. Peer-reviewed, published, or in-press articles in English were included. Reviews, meta-analyses, and case studies were excluded; all other study designs were eligible. Further, articles had to meet the a priori study criteria for population, intervention, comparator (PROSPERO ID: CRD42021227600). Embase, MEDLINE® ALL, and PsycINFO were searched. Risk of bias was assessed for individual experimental studies using the Cochrane risk of bias assessment tool, and in observational studies based on the GRADE framework and in line with previous systematic reviews examining sedentary behaviours in children. Overall quality of evidence was assessed using the GRADE framework for each outcome category and study design. Results were synthesized narratively, grouped by study design and outcome category. Further, several high-level summaries were conducted to help interpret results.

RESULTS

Evidence was synthesized from 116 reports, including 1,385,038 participants and 1173 extracted associations. More school-related sedentary behaviour was favourably associated with nearly one-third of extracted associations for cognitive (33%) and social-emotional (32%) indicators (e.g., less anxiety), but unfavourably associated with other movement behaviours (e.g., less physical activity) (35%). Active lessons were favourable (72%), compared to more school-related sedentary behaviours, when examining associations for all health and well-being indicators. More homework was favourable across all health and well-being indicators in 4% of extracted associations for primary school children, and 25% of extracted associations for secondary school children. However, ≥2 h/day of homework appeared to be unfavourable for health and well-being. Limitations for synthesized studies included generally low quality of evidence and a lack of studies in South American, African, or low-middle income countries.

CONCLUSIONS

Findings can help inform policy makers, schools, and teachers, regarding the amount of homework assigned and the introduction of active lessons into the classroom to enhance health and well-being of children. More research is needed examining school-related sedentary behaviours and indicators of health and well-being in low- and middle-income countries.

US School-Based Physical Fitness Assessments and Data Dissemination

BACKGROUND

Low physical fitness (PF) levels during childhood affect healthy growth and development, and increase the risk of cardiovascular diseases. Physical education standards exist for nearly all states in the United States, but evaluation of PF in youth has yet to be systematic, reproducible, and harmonized. The purpose of this project was to describe publicly available data of school-based PF testing (SB-PFT).

METHODS

A list of state-mandated SB-PFT programs published by SHAPE 2016 was confirmed by contacting appropriate authorities. SB-PFT data were obtained through each state's department of education.

RESULTS

Sixteen states mandate SB-PFT, with 10 states providing publicly available data; 92% to 100% of states perform the pacer/mile, curl-up, and push-up; 54.2% to 78.5% of elementary and 44% to 66.5% of high-school youth are in the "healthy fitness zone" for aerobic capacity.

CONCLUSIONS

SB-PFT provided PF data in children across the United States. The variability and inconsistency in reporting and in the values, however, raises questions about the current status of SB-PFT data and its utility in assessing PF in children. The critical nature of PF assessments is highlighted in the current COVID-19 pandemic, during which physical education has been curtailed, and emerging data demonstrate worsening of the already low levels of PF in youth.

Does Education Close the Black-White Physical Activity and Obesity Gaps?

Objective: The purpose of the study was to investigate physical activity patterns and body mass index (BMI) among black and white women in college to determine if attending college acts as a catalyst for sustaining physical activity and for closing the black-white physical activity and obesity gaps. Participants/Methods: 111 undergraduate women (black N = 42; white N = 69) aged 18-25 volunteered to wear Fitbit Zip^TM activity trackers for 7 days. Height and weight measurements were used to compute BMI. Results: White women had higher levels of physical activity, lower weight status, and lower BMIs than black women. Conclusions: Racial disparities were evident; however, both groups had low to moderate levels of physical activity. Required physical education programing that targets women in college could lead to sustained physical activity.

Promoting Health-Related Cardiorespiratory Fitness in Physical Education: The Role of Class Intensity and Habitual Physical Activity

Physical education (PE) has the potential to promote health-related fitness, however, its contribution is still not clear. The aim of this study was to assess whether students’ health-related cardiorespiratory fitness (CRF) improved from the beginning to the end of the school year, and to examine the role of PE class intensity and habitual physical activity (PA) in promoting students’ CRF. This observational study employed a longitudinal design. Participants were 212 7th and 8th grade students (105 boys), mean age 12.9 years old, followed during one school year, from September 2017 to June 2018. The Progressive Aerobic Cardiovascular Endurance Run (PACER) was used to assess CRF at baseline and follow-up. PA was measured using accelerometers. PE class intensity was assessed using the System for Observing Fitness Instruction Time. Findings indicated that from the beginning to the end of the school year, a greater percentage of participants were in the CRF healthy fitness zone (73.1% to 79.7%, p = 0.022). Among boys, participating in organized sports (B = 4.61, 95% confidence interval [CI]: 0.33, 8.88) and the percentage of PE time being very active (B = 0.90, 95% CI: 0.44, 1.35) were positively associated with the change in PACER laps. Among girls, daily vigorous PA (B = 0.38, 95% CI: 0.15, 0.60) and participating in organized sports (B = 4.10, 95% CI: 0.93, 7.27) were also positively associated with PACER change, while being overweight or obese (B = −5.11, 95% CI: −8.28, −1.93) was negatively associated. In conclusion, PE was demonstrated to have a positive role in the promotion of CRF, especially among boys, while for girls, habitual PA seems to have a greater contribution. Nevertheless, results and conclusions should be considered carefully, taking into account study limitations, such as the non-direct measures of PE class intensity, CRF, and school setting.

Longitudinal evaluation of the impact of school characteristics on changes in physical activity opportunities

BACKGROUND

Even as many states adopt physical activity policies to promote physical activity and prevent childhood obesity, little is known about differences in policy implementation based on school characteristics. We studied association of school characteristics and changes in physical activity opportunities at the school level during the implementation of a statewide physical activity policy in the state of Georgia.

METHODS

A web-based school survey was administered to elementary schools at two time points (before and during policy execution). Matched respondents (289 classroom teachers, 234 administrators) reported the frequency and duration of recess and integrated physical activity time. We used paired t-test to assess changes in physical activity opportunities and chi-square tests to assess the association of change in physical activity opportunities with school characteristics. We then constructed a multiple linear regression model following a change score method to identify school-level factors that predict the magnitude of change in physical activity opportunities.

RESULTS

There was an overall significant increase in total physical activity opportunities across time; however, schools with higher poverty showed a decrease in physical activity time by 5.3 minutes per day (95% CI: -9.2, -1.3). Further, the changes in physical activity time for schools in suburban Georgia were smaller (-5.7, 95% CI: -9.5, -1.9) compared to schools located in towns.

CONCLUSIONS

The change in physical activity opportunities was not the same across schools and school characteristics predicted the magnitude of change. Additional efforts at the local level might be needed for equitable policy implementation based on schools' geographical location and poverty level of the student population.