School-based Programs to Increase Physical Activity

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What are school-based programs to increase physical activity?

School-based programs to increase physical activity can include programs to enhance physical education (PE) [1,2],  provide daily recess,[3], incorporate physical activity into regular classroom lessons[4]  and offer before and after school programs.[5] Physical education may be expanded by increasing the length of PE classes and increasing the number and types of fitness activities during PE classes.[1,2] Recess can help students get more physical activity to help them achieve the recommended 60 minutes of activity every day.  Physical activity also may be incorporated into classrooms through physically active academic lessons or activity breaks.[6] Coordination between school day and before/after school program staff and administrators can help provide students with consistent messaging and opportunities related to physical activity while they are on school grounds. Programs may be combined with other school- and community-based interventions such as health education about physical activity, activities that foster family involvement, and community partnerships to increase opportunities for physical activity.[1,7]

Changes to the school day to increase opportunities for physical activity can be adopted and implemented at the state-level or at the local school district level.[1,2,8] An example of a state moving towards this goal is Mississippi, where staff and administrators made improvements to school health environments across the state, including adding walking trails to school campuses, integrating five-minute movement breaks into the classroom, implementing fitness assessments, and adding an additional 15 minutes of physical activity at the beginning of each school day.

The purpose of these school-based programs is to increase students’ physical activity levels, and thereby help improve their fitness levels, help them maintain a healthy weight, and potentially improve their health outcomes over time.[1,2,4]

Georgia Shape: A Statewide, Multi-Faceted Childhood Obesity Initiative
Georgia Shape: A Statewide, Multi-Faceted Childhood Obesity Initiative
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Healthy Active Children: North Carolina School-Based Activity
Healthy Active Children: North Carolina School-Based Activity
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What’s the public health issue?

Physical activity is an important contributor to overall health, and engaging in regular physical activity can decrease the risk for numerous adverse health outcomes, including hypertension, diabetes, heart disease and some cancers.[9,10] Physical activity also is an important factor in achieving a healthy weight and maintaining it over time.[9] In 2008 the U.S. Department of Health and Human Services (HHS) recommended that young people aged 6–17 years participate in at least 60 minutes of physical activity daily.[9] In its 2012 report, HHS recommended that programs in school settings should be included as a key component of strategies to increase physical activity and address childhood obesity.[11] However, in 2017, only 26 percent of high school students surveyed had participated in at least 60 minutes of physical activity per day during the week before the survey, and only 30 percent attended physical education class daily while in school.[12]

What is the evidence of health impact and cost effectiveness?

Multiple systematic reviews of school-based programs to increase physical activity have found that these interventions are associated with increased physical activity among students. [1,13-15] Reviews also found evidence that these interventions are associated with positive effects on BMI [13] and obesity prevention.[16]

A 2017 benefit-cost analysis by the Washington State Institute for Public Policy (WSIPP) on school-based programs to increase physical activity found that they were associated with a positive benefit to cost ratio.[17] The WSIPP analysis estimated that elementary or middle school programs that added additional physical activity to the school day for students could result in a benefits to cost ratio of approximately $33.28 over a lifetime (in 2016 dollars, the base year for this analysis).[18] These benefits were calculated from decreased health care costs due to reductions in obesity and increased labor market earnings due to the positive impact of physical activity on academic achievement.

  1. The Guide to Community Preventive Services. Behavioral and social approaches to increase physical activity: Enhanced school-based physical education. The Community Guide: What Works to Promote Health 2013; Available at: http://www.thecommunityguide.org/pa/behavioral-social/schoolbased-pe.html.  Accessed September 6, 2018.
  2. Robert Wood Johnson Foundation, The University of Wisconsin Population Health Institute. County health rankings & roadmaps: School-based physical education. 2014; Available at: http://www.countyhealthrankings.org/policies/school-based-physical-education.  Accessed September 6, 2018.
  3. Institute of Medicine. Educating the student body: Taking physical activity and physical education to school. Washington, DC: The National Academies Press;2013. Available at: https://doi.org/10.17226/18314.
  4. Robert Wood Johnson Foundation, The University of Wisconsin Population Health Institute. County health rankings & roadmaps: Physically active classrooms. 2015; Available at: http://www.countyhealthrankings.org/policies/physically-active-classrooms.  Accessed September 6, 2018.
  5. McCombs J, Whitaker A, PY Yoo. The value of out-of-school time programs. Santa Monica, CA: RAND Corporation;2017. Available at: https://www.rand.org/pubs/perspectives/PE267.html.
  6. Donnelly JE, Lambourne K. Classroom-based physical activity, cognition, and academic achievement. Preventive medicine. 2011;52:S36-S42.
  7. Centers for Disease Control Prevention. School health guidelines to promote healthy eating and physical activity. MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports/Centers for Disease Control. 2011;60(RR-5):1.
  8. Slater SJ, Nicholson L, Chriqui J, Turner L, Chaloupka F. The impact of state laws and district policies on physical education and recess practices in a nationally representative sample of us public elementary schools. Arch Pediatr Adolesc Med. 2012;166(4):311-316.
  9. U.S. Department of Health and Human Services. Physical activity guidelines for americans. In: U.S. Department of Health and Human Services, ed2008.
  10. Centers for Disease Control Prevention. Barriers to children walking to or from school–united states, 2004. MMWR: Morbidity and mortality weekly report. 2005;54(38):949-952.
  11. Physical Activity Guidelines for Americans Midcourse Report Subcommittee of the President’s Council on Fitness SN. Physical activity guidelines for americans midcourse report: Strategies to increase physical activity among youth. In: Services USDoHaH, ed. Washington D.C.2012.
  12. Kann L, McManus T, Harris W, et al. Youth risk behavior surveillance — united states, 2017. MMWR Surveillance Summaries. 2018;67(No. SS-8):1–114.
  13. Demetriou Y, Höner O. Physical activity interventions in the school setting: A systematic review. Psychology of sport and exercise. 2012;13(2):186-196.
  14. Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013(2):CD007651.
  15. Norris E, Shelton N, Dunsmuir S, Duke-Williams O, Stamatakis E. Physically active lessons as physical activity and educational interventions: A systematic review of methods and results. Preventive medicine. 2015;72:116-125.
  16. Wang Y, Cai L, Wu Y, et al. What childhood obesity prevention programmes work? A systematic review and meta‐analysis. Obesity Reviews. 2015;16(7):547-565.
  17. Washington State Institute for Public Policy. Benefit-cost technical documentation: Washington state institute for public policy benefit-cost model. Washington State Dec 2017. Available at: http://wsipp.wa.gov/TechnicalDocumentation/WsippBenefitCostTechnicalDocumentation.pdf.
  18. Washington State Institute for Public Policy. Benefit-cost results Washington State Dec 2017. Available at: http://wsipp.wa.gov/BenefitCost/Program/574.
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