Evidence-Based Overview of Accelerometer-Measured Physical Activity during School Recess: An Updated Systematic Review

The associations of different recess types on physical activity and sedentary behaviour in Estonian primary school students

Students' physical activity (PA) levels tend to decrease with increasing age; however, the school day structure can potentially influence students' PA levels. This study aimed to measure and compare objective levels of PA during recess and school time between schools with different recess types. 15 different schools were selected, and accelerometry-based PA levels of 9-13-year-old students were measured. Schools were selected based on the recess types: (i) 'daily outdoor recess'; (ii) 'irregular outdoor recess'; (iii) 'indoor recess'. The 'daily outdoor recess' group reached the highest moderate-to-vigorous PA (MVPA) during recess compared to other groups. 'Indoor recess' group had more sedentary time during recess compared to 'irregular outdoor recess' and 'daily outdoor recess' groups (43.6 ± 1.0%, 34.0 ± 1.0%, 30.8 ± 0.8%, respectively; P < .05). Time in MVPA was unchanged during recess across all grades in the 'daily outdoor recess' group (from 22.8% to 25.6%), while decreased MVPA from 27% to 17% and from 21% to 10% was found in 'irregular outdoor recess' and 'indoor recess' group, respectively; P < .05. Sedentary time increased from 34% to 52% in the 'indoor recess' group and from 26% to 43% in the 'irregular outdoor recess' group (P < .05). There was a positive association between the recess length and MVPA minutes acquired during recess; however, during a 15-25 min outdoor recess, students spent more time in MVPA compared to a 30-50 min outdoor recess (28%-30.5%, 21%-23%, respectively). The findings emphasize that unstructured outdoor recess has a high potential to maintain the MVPA levels with increasing age.

Effectiveness of a multicomponent intervention to promote physical activity during the school day: rationale and methods of the MOVESCHOOL study

Background

Increasing levels of physical activity (PA) and reducing sedentary time among adolescents during the school day is a pressing need. Emerging methodologies and strategies been shown to be effective in increasing PA levels and providing additional benefits for students, such us physically active lessons (PAL), active breaks (AB) and active recesses (AR). However, evidence concerning adolescents remains limited. This manuscript presents the methods and rationale of the MOVESCHOOL study, which aims was to examine the effects of a multicomponent school-based intervention during the school day on indicators of PA, sedentary time, health, executive functions and education in adolescents.

Methods

A quasi-experimental study was conducted with the aim to involve a total of 800 students aged 12-14 years old from 11 schools (7th and 8th grade) in south-western Spain, five schools forming the intervention group and six schools forming the control group. The evaluation included two independent measurements: pre-intervention and post-intervention. The intervention lasted 29 weeks and consisted of a multi-component programme including a weekly PAL, two 5 min daily AB, and a daily AR. Primary outcomes included accelerometer-based PA and sedentary time, health-related physical fitness, academic indicators, and executive functions. For statistical analyses, descriptive, correlational, regression, and repeated measures ANOVA analyses will be applied. Additionally, qualitative data were gathered through semi-structured individual interviews and focus groups, and information will be evaluated with thematic analysis.

Discussion

The MOVESCHOOL study represents a pioneering effort in Spain, being the first of its kind to evaluate the effectiveness of a multicomponent programme in secondary schools. Furthermore, this project provides valuable insights into the effects of a multicomponent school-based PA intervention on PA levels, sedentary time, health-related, cognitive, academic indicators and psychological health markers in secondary school students. The results of this study will make a significant contribution to the educational community, providing them with innovative teaching methods and strategies that have the potential to increase PA levels during the school day. In addition, this research promises to provide a transformative experience for educators, equipping them with tools to promote the holistic development of their students, enriching their academic performance and enhancing their well-being.

Clinical trial registration

ClinicalTrials.gov, identifier NCT06254638.

The Effects of the LiiNK Intervention on Physical Activity and Obesity Rates among Children

BACKGROUND

Obesity and inactivity among children are at an all-time high and have been steadily increasing in prevalence over the last thirty years. The school environment provides the ideal setting for reaching a large number of children across diverse populations in order to reverse these trends. However, there are many inconsistent results yielded by school-based physical activity interventions due to implementation length, time for activities, and the use of structured physical activities. The LiiNK Project® is a whole-child intervention addressing these gaps by providing children 45-60 min of recess (unstructured, outdoor play) in their schools daily, while the control children are allowed to engage in recess for 30 min daily. The purpose of this study was to compare the physical activity intensity and obesity rates of third- and fourth-grade children participating in the LiiNK intervention, which provides 60 min of recess for third graders and 45 min for fourth graders, to those in a control group allowed 30 min of daily recess.

METHODS

The children were 8-10 years old (M = 9.2; 52% females and 48% males). The intervention children comprised 90 third graders and 100 fourth graders, and the control children comprised 101 third graders and 92 fourth graders. Physical activity levels were monitored using accelerometers to assess sedentary, light, and moderate-to-vigorous physical activity (MVPA). Obesity rates were evaluated using bio-electrical impedance analysis (BIA), in which body fat percentage is calculated based on normative values using age and sex in the equation.

RESULTS

The third-grade intervention children engaged in 13 more MVPA minutes and took 900 more steps daily than their control counterparts, and also presented a greater proportion of overweight children transitioning to a healthy weight status from the fall to the spring semester. Conversely, the fourth-grade control children increased their activity by 500 steps and 15 more MVPA minutes daily. Despite this, the intervention children overall demonstrated a reduction in body fat percentage, while the control children demonstrated an increase in body fat percentage.

CONCLUSIONS

Ultimately, 60 min of unstructured, outdoor play in schools provides children the best opportunity to engage in MVPA, which may positively impact body fat percentages, offering a potential strategy for combatting childhood obesity in school settings.

Outdoor recess is associated with more positive attitudes toward physical activity among pre-adolescent students and their parents

Introduction

School day structure has the potential to increase students' physical activity (PA) levels and form positive attitudes about PA. Including various PA opportunities and free play possibilities in the school schedule, especially outdoor recess, can improve students' moderate-to-vigorous PA (MVPA) levels during school time. Therefore, the main aim of the study was to investigate students' and their parents' attitudes about outdoor recess and PA opportunities in schools with different recess opportunities.

Methods

Students from grades three to six (9-13-year-olds) and their parents responded to a questionnaire about the effect of outdoor recess and opportunities for PA during the school day. Schools were divided into three groups based on the recess opportunities during the school day: (1) "outdoor recess", (2) "outdoor recess on some days", (3) "indoor recess".

Results

Students and parents of the "outdoor recess" group had significantly more positive attitudes about outdoor recess and PA opportunities in school. Students of the "outdoor recess" group stated being significantly more active during their leisure-time compared to other groups. Parents of the "outdoor recess" group stated that the school has asked their opinion regarding PA opportunities during the school day significantly more compared to the other two groups.

Discussion

These findings emphasize the positive effect outdoor recess can have on students' PA beliefs and habits. Parents of the "outdoor recess" group also had more positive attitudes toward PA which is important as parents most likely convey their attitudes and beliefs to their children. In addition, involving and informing parents is critical when changing the school schedule and introducing new school culture, to make the changes last.

Association of Recess Provision With Accelerometer-Measured Physical Activity and Sedentary Time in a Representative Sample of 6- to 11-Year-Old Children in the United States

PURPOSE

To assess the association between the amount of recess provision and children's accelerometer-measured physical activity (PA) levels.

METHODS

Parents/guardians of 6- to 11-year-olds (n = 451) in the 2012 National Youth Fitness Survey reported recess provision, categorized as low (10-15 min; 31.9%), medium (16-30 min; 48.0%), or high (>30 min; 20.1%). Children wore a wrist-worn accelerometer for 7 days to estimate time spent sedentary, in light PA, and in moderate to vigorous PA using 2 different cut points for either activity counts or raw acceleration. Outcomes were compared between levels of recess provision while adjusting for covariates and the survey's multistage, probability sampling design.

RESULTS

Children with high recess provision spent less time sedentary, irrespective of type of day (week vs weekend) and engaged in more light or moderate to vigorous PA on weekdays than those with low recess provision. The magnitude and statistical significance of effects differed based on the cut points used to classify PA (eg, 4.7 vs 11.9 additional min·d-1 of moderate to vigorous PA).

CONCLUSIONS

Providing children with >30 minutes of daily recess, which exceeds current recommendations of ≥20 minutes, is associated with more favorable PA levels and not just on school days. Identifying the optimal method for analyzing wrist-worn accelerometer data could clarify the magnitude of this effect.

Physical Activity Levels During School Recess in a Nationally Representative Sample of 10- to 11-Year-Olds

PURPOSE

School recess provides a valuable opportunity for children's daily moderate- to vigorous-intensity physical activity (MVPA). This study aimed to quantify MVPA during school recess in a representative sample of Scottish children and examine whether recess MVPA varied by gender, socioeconomic status, season, urban/rural residency, and recess length.

METHOD

Five-day accelerometry MVPA data were analyzed from 773 children (53.9% girls, 46.1% boys, 10- to 11-y-olds) from 471 schools. Binary logistic regression explored associations between meeting/not meeting the recommendation to spend 40% of recess time in MVPA and the aforementioned risk factors. Descriptive recess data were also analyzed.

RESULTS

Participants spent an average of 3.2 minutes (SD 2.1) in MVPA during recess. Girls engaged in 2.5 minutes (SD 1.7) of MVPA compared with 4.0 minutes (SD 2.2) for boys. Only 6% of children met the recess MVPA recommendation. The odds of girls (odds ratio 0.09; 95% confidence interval, 0.04-0.25) meeting the recommendation was lower (P < .001) compared with boys. No statistically significant differences were observed in meeting the recommendation for the other risk factors.

CONCLUSION

Levels of MVPA during school recess are very low in Scottish children, and interventions aimed at increasing MVPA during recess are needed.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Adherence to Recess Guidelines in the United States Using Nationally Representative Data: Implications for Future Surveillance Efforts

BACKGROUND

National adherence to the recess recommendations of the Centers for Disease Control and Prevention (CDC) has not been comprehensively studied in the United States.

METHODS

Data from 6 nationally representative data sets over the last decade (Classification of Laws Associated with School Students, Early Childhood Longitudinal Study, National Health and Nutrition Examination Survey, National Youth Fitness Survey, School Health Policies and Practices Survey, and the School Nutrition and Meal Cost Study) provided estimates for adherence to CDC recess guidelines.

RESULTS

While approximately 65-80% of elementary school-children receive the recommended 20+ minutes of daily recess according to parent-, principal-, and school-report, adherence declines by sixth grade, and little information is available for middle/high school students. Adherence to playground safety was high (90%), but adherence to recommendations about recess before lunch (<50%), withholding recess as punishment (∼50%), and training recess staff (<50%) were lower.

CONCLUSIONS

School policy and practice should align with CDC recommendations, with the aim of providing sufficient quality recess to all youth, K-12th grade. Comprehensive, on-going national surveillance of multiple recess domains is needed to inform policy and ensure equitable provision of recess.

School Children's Physical Activity and Preferred Activities during Outdoor Recess in Estonia: Using Accelerometers, Recess Observation, and Schoolyard Mapping

Studies about recess have found that children have higher physical activity (PA) during outdoor recess compared to indoor recess, and well-constructed schoolyards play an important role in stimulating PA in children. This study aimed at investigating the affordances of schoolyards and outdoor recess PA in two urban and two rural primary schools in Estonia. Schoolyards were described with the geographical mapping method, children's activities during outdoor recess were registered by using observations, and PA levels were measured with accelerometers. Students from grades two to six (8-13-year-olds) were included in the study. All observed schoolyards had different spaces including various ball game areas, climbing facilities, and slacklines. The natural environment dominated in the rural schools, and artificial surfaces dominated in the urban schools. Boys in the study tended to enjoy more sport-related activities, whereas girls preferred more social and less active activities. Students participating in outdoor recess spent about twice as much time (20.4%) on moderate-to-vigorous PA (MVPA) compared to indoor recess (9.5%), although boys were more active than girls (22.9% vs. 17.3%). All schoolyards afforded more MVPA during outdoor recess compared to indoor recess, whereas schoolyards with more space per child and natural environment elements generated more varied PA and higher MVPA. These findings confirm the importance of schoolyard design and quality for the variety and intensity of students' PA during outdoor recess.

Models of school recess for combatting overweight in the United States

Objectives

The aim of the study was to quantify and compare potential energy expenditure associated with school recess in the U.S. based on four scenarios: professional recommendations and state policies for the conduct of recess, previous studies that measured physical activity intensity during recess (i.e., reality), and no daily recess.

Methods

Estimated energy expenditure (kcal) was modeled using secondary data over six years of elementary school for boys and girls using a standard formula: Intensity × duration × frequency × mass .

Results

Boys and girls would expend similar energy under the professional recommendation (boys, 69,146 kcal; girls, 63,993 kcal) and state policy (boys, 69,532 kcal; girls, 64,351 kcal) scenarios. These values are significantly greater than a no recess scenario (boys, 26,974 kcal; girls, 24,821 kcal). The greatest energy expenditure was found for the reality scenario, based on actual studies that measured physical activity intensity (boys, 82,208 kcal; girls, 75,628 kcal).

Conclusions

Professional recommendations and state policies for recess duration may be overly conservative and recommendations for percentage of MVPA may be overly liberal compared to the reality of energy expended during recess. Both potential and real estimates dwarf a scenario of withholding recess (i.e., no recess), which is discouraged in only six state policies. Mandated reporting with "groundtruthing" is needed to determine true recess frequency/duration and state policy compliance.

Physical Activity at School Recess: A Key Element in Balancing Social Disparities

BACKGROUND

Since children are generally not achieving desirable levels of physical activity (PA), schools can provide an opportunity to increase their active time. This study aimed to describe individual- and social-level variables associated with PA at school recess in a culturally diverse primary school.

METHODS

This observational cross-sectional study included 131 children attending primary school. PA data were measured via accelerometry during school recess and analyzed in relation to data on sociodemographics, anthropometrics, and PA outside school. Data were analyzed using generalized linear modeling and logistic regression.

FINDINGS

Girls were more sedentary and engaged in less moderate to vigorous physical activity (MVPA) than boys (p < .001), while older girls were less active than younger girls (p < .001). Also, non-Caucasian children were less sedentary (p < .001) and engaged in more MVPA (p = .007). Belonging to ethnic minorities was also associated with lower socioeconomic status, higher body mass index, and less PA outside of school and on weekends.

CONCLUSIONS

Girls (especially older girls) and children from lower socioeconomic contexts should be prioritized when promoting PA.

IMPLICATIONS FOR SCHOOL HEALTH POLICY

School recess can be used as an effective strategy aimed at increasing PA and reducing social inequalities.

Individual- and Environmental- Level Predictors of Recess Activity and Sedentary Behavior: Findings from the I-CAN! study

Introduction/Purpose

Recess represents a prime opportunity for physical activity during the school day. However, evidence is mixed with regard to factors associated with activity during recess.

Methods

Data were collected as a part of the Texas Initiative for Children's Activity and Nutrition (I-CAN!) program from 14 elementary schools and 1,049 4th-grade students. Percent of time in moderate-to-vigorous physical activity (MVPA) and sedentary behavior during recess was measured using GT3X+ accelerometers. Students' demographics, aerobic fitness, and body mass index (BMI) were collected from school records and FITNESSGRAM® data. Aspects of the playground environment supporting activity (e.g. soccer goals) or sedentary behavior (e.g. benches) were calculated following the procedures of the System for Observing Play and Leisure Activity in Youth (SOPLAY), with recess spatial area calculated via the polygon measurement tool in Google™ Earth Pro software. Recess time was collected from school data. Weather during recess was determined using time-stamped archived weather data from Weather Underground. Two-level, linear mixed model regression examined associations between individual- and school-level characteristics and percent time in MVPA.

Results

At the student-level, boys were more active than girls (effect size (ES)=0.50) and percent time in MVPA was directly associated with aerobic fitness (ES=0.35). At the school-level, recess infrastructure was associated with percent time in MVPA (ES=1.45), except for factors related to sedentary behavior, which were indirectly associated with percent time in MVPA (ES=-1.98). Patterns for sedentary behavior mirrored these effects.

Conclusions

This is one of the few studies to test the associations of fitness and sedentary upgrades to play areas with MVPA and sedentary behavior. The results suggest that recess is most likely to support MVPA in boys and those who are already most fit (i.e., those who would not be the target of intervention). This is not surprising because the focus of recess is on free choice of play, and thus recess might be supported more for social and emotional benefits than the impact on physical activity.

Health Impact Assessment (HIA) of a Daily Physical Activity Unit in Schools: Focus on Children and Adolescents in Austria Up to the 8th Grade

Physical activity has a variety of health benefits for young people. The World Health Organization (WHO) recommends that children and adolescents aged 5-17 years should be physically active for at least 60 min a day. This Health Impact Assessment (HIA) examined the potential impact of a daily physical activity unit in Austrian schools, with a focus on children and adolescents up to eighth grade. The HIA methodology systematically followed several stages: screening and scoping, appraisal, and formulation of recommendations. A literature review, an online survey (n = 712), focus group discussions (n = 4), and appraisal workshops (n = 2) have been carried out. The analyzed results indicate a primarily positive impact on the individual health of children and adolescents, on social and community-related networks, on living and working conditions, and on the system level. Recommendations for the implementation include ensuring equal opportunities and support for disadvantaged children and schools. Furthermore, the comprehensible selection of pilot regions and the nationwide resource planning should be considered. Additional important factors include the education and further training of pedagogical staff and coaches, and the availability of sufficient infrastructure. In the long term, the fixed integration of five additional teaching units of physical activity per week, and an increased focus on the elementary/nursery school sector were identified as significant.

Physical Activity Time and Intensity in Physical Education During the COVID-19 Pandemic

With the COVID-19 outbreak, schools have experienced difficulty providing moderate-to-vigorous physical activity (MVPA) to their students, which should normally account for at least 50% of children’s physical education (PE) class time. We aimed to determine the intensity of physical activity (PA) within PE classes at various grade levels to compare children’s in-class PA with the World Health Organization’s (WHO) recommended guidelines. Thus, 301 students (1st to 12th grade) participated in the investigation. Children were evaluated during the PE classes with different typologies and durations. We assessed PA intensity using accelerometry and grouped data into either sedentary-to-light PA (SEDLI) or MVPA. Each child was assessed using both the time spent in PA (hours:minutes:seconds) and the percentage of time spent in PA versus other class activities. We found that, in the second-grade level group (fifth and sixth grades), girls spent more time in MVPA intensity than boys. Additionally, two-hour PE classes doubled the SEDLI for students in the third-grade group, and polythematic classes (those with more than one sport) promoted more MVPA level time than monothematic classes (only one sport). Concerning PA intensity during PE classes, 31–43% of the PE class total time was spent in MVPA but presented short duration and did not usually persist for 10 consecutive minutes (59% of the time). Children spent a large amount of time at the SEDLI intensity, considered insufficient for PA health benefits. Finally, to meet WHO guidelines for PA intensity, PE classes will need to increase MVPA time and reduce non-active periods between activities.