Participation in physical activity (PA) is an important determinant of health and is associated with a wide range of physical and psychosocial benefits. The Centers for Disease Control and Prevention (CDC) recommends that children obtain at least 60 min or more of moderate to vigorous PA (MVPA) daily; however, only 21.6% of children and adolescents 6 to 19 yr of age attain 60 or more minutes of MVPA on five or more days of the week. Children spend up to half of their waking hours in school; therefore, from a population-based approach, schools provide the best opportunity to increase PA among the nation’s youth (1).
Comprehensive School Physical Activity Programs (CSPAP) have been recommended by the CDC/Society for Health and Physical Educators and endorsed by the Institute of Medicine (1) for increasing MVPA in children (2). These programs supplement physical education (PE) with PA throughout the day and emphasize involvement of school staff, the participants’ immediate family, and the wider community. However, evidence regarding the effectiveness of CSPAP for increasing PA in children is limited and conflicting (2–8). The National Association for Sport and Physical Education recommends that elementary schools provide 150 min and secondary schools provide 225 min of PE each week (9). However, very few schools require daily PE or provide the amount of PA recommended by the CDC (10) and the Institute of Medicine (11). To develop successful strategies to engage elementary-aged children in PA, it is necessary to understand the current challenges associated with the delivery of PA in the school and the positive outcomes associated with PA practice or delivery. This special issue of the Translational Journal of the American College of Sports Medicine will provide perspectives on both the positive outcomes (cognition, academic achievement, and on-task behavior) and challenges (built environment, school PA policy, teacher implementation/compliance, and teacher reflections) of implementing CSPAP interventions in elementary schools.
SUCCESSFUL IMPLEMENTATION AND OUTCOMES
Cognition and Academic Achievement
The primary responsibility of schools is the education of its students, and because of the limited time available for meeting the state required education minutes, activities that may be ancillary, such as PA, will not be well received unless it can be demonstrated that they do not hamper the learning of students. Ideally, ancillary activities will have the potential to enhance learning and will then be seen favorably by teachers and administration. Improvements in cognitive function and/or academic achievement would be examples of favorable outcomes in response to PA that would provide sound evidence for increased PA during the school day. For example, in 2010, the CDC developed a comprehensive review of PA delivered throughout the school day and concluded that most attempts to increase PA in the school had positive outcomes for eight of the nine classroom PA studies cited. In addition, only positive associations were found between classroom-based PA (CBPA) and indicators of cognitive skills and attitudes, academic behavior, and academic achievement; none of the studies found negative associations (10). Moreover, Donnelly et al. (12,13) have provided meta-analysis and literature reviews that support positive effects for PA on cognitive function and academic achievement in elementary schoolchildren. In this special issue, Grieco et al. (14) provides additional support for PA role in enhancing academic achievement in the form of physically active learning, which is designed to incorporate bodily movement and PA into instruction. The authors provide details regarding how physically active learning was used in the Texas I-CAN study.
In addition to classroom PA, Hillman and colleagues provide this special issue with support for single bouts of PA and their influence on cognition. Importantly, the authors review event-related potentials and other physiologic mechanisms to provide mechanistic support for the influence of acute PA on childhood brain and cognition outcomes.
Student On-task Behavior/Attention to Task
PA lessons within the classroom have been shown as a viable means of aiding in the accumulation of the daily PA for children (15). Physical activity across the curriculum (13,16,17), “brain break,” energizers (18,19), and FUNervals (14,20) have resulted in up to 100 min of PA each week. However, among teachers, there are concerns that PA may result in a diminished focus for subsequent lessons if students do not “settle down” quickly after a PA session (21). Conversely, PA may provide a needed break from academic instruction and a means of venting energy, thus allowing students to focus better and potentially aid in learning (18,19). This is called “attention to task” and is considered essential for learning. In this special issue, Mahar (19) presents measurement issues associated with directly observed on-task behavior in schools and a summary of the key studies that have made a substantial contribution to the literature in this field. In addition, the author provides suggestions to enhance the implementation of CBPA and to further develop the research base.
It is well established that the built environment influences PA (22). For example, it is difficult for children to walk to school if the neighborhood is not safe and sidewalks are nonexistent. Likewise, the school environment influences children’s PA. School playgrounds without proper layout and equipment discourage increased levels of PA, whereas playgrounds with adequate well-maintained equipment encourage PA (23).
Data on built environments and PA are primarily observational, and the effect of changing environments is not fully known. However, it is believed that a school’s built environment uniquely affects the overall PA levels and health of the students, and this environment is often a product of a variety of issues such as budget, education policies, the surrounding community, etc. If a school environment encourages PA, such as offering a variety of areas to participate in PA, the PA levels of the students are often greater than those schools without these types of environments (23,24). However, there is not an abundance of research designed to infer causality between the built environment of the schools and the PA levels of the students. Further examination is required to delineate the breadth and magnitude of influence that the built environment can have on PA.
In this special issue, Laboy describes how current PA guidelines and research often overlook the importance of the physical environment and culture around movement. Access to natural light, building materials, furnishings, and landscape quality may affect schoolchildren’s level of PA and in turn their health, behavior, and performance. To help move forward the investigation of environment and PA, Laboy identifies gaps in knowledge and suggests directions to help guide future research.
School PA Policy
Factors that have a significant effect on the accessibility of PA in schools, such as mandated time for recess and PE, and requirements for outdoor space or exercise furnishings are directed by policy; thus, school policy has been suggested to have the greatest potential effect on student health and wellness (25). As previously noted, the National Association for Sport and Physical Education recommends elementary and secondary schools provide 150 and 225 min of PE each week, respectively (9); however, the crowded school curriculum with an intense focus on academic achievement, lack of school leadership for PA, less than adequate funding, and lack of resources (26) has led to fewer than 3% of elementary schoolchildren receiving PE during each school day (27,28).
School PA policies have the ability to change aspects of the prevalence and delivery of school PA programs and practices. Policy includes not only the frequency and the duration of programs (e.g., PE; recess; before, during, and after school programs; and classroom PA breaks) but also the aspects of the program content, how it is delivered, and by whom. Policy may also relate to more indirect aspects of programs such as staff training, program funding, as well as school facilities design, use, and maintenance. Schoolwide policies are instrumental in promoting sustainable increases in student PA by ensuring that the school environment supports healthy behaviors. For example, Slater et al. (29) reported that the odds of schools having 150 min/wk of PE increased if they were located in states or school districts having a law or policy requiring 150 min·wk−1 of PE compared with states without these laws. Likewise, schools located in states with laws encouraging daily recess were significantly more likely to have 20 min of recess daily compared with states without these laws.
In this special issue, a review of PA policies by Lounsbery and colleagues provides both a historical perspective and sheds light on modern-day challenges to emphasizing movement throughout the school day. Lounsbery et al. highlight the immense pressure schools are under to help children meet academic standards, such that time dedicated to play and movement has been reallocated to increase academic instruction. Lounsbery et al. also has an interesting discussion regarding the importance of wording, advocacy, and implementation for these policies to increase the likelihood that they will achieve their intended effects.
Regardless of research information, intent, or policy, little will change for PA in elementary schools if teacher’s compliance to activity recommendations is poor. Many teachers do not feel they are adequately prepared to provide PA opportunities, and some do not feel it is their responsibility (30). Teachers have the paramount role in the implementation and sustainability of classroom PA interventions. Understanding their perspectives on the PA throughout the school day can provide researchers with the information needed to develop successful, sustainable interventions for both the students to participate in and the teachers to deliver. In particular, the ease of implementation is crucial for implementation and sustainability (31,32). In this special issue, Turner and colleagues explore factors related to teacher’s implementation of CBPA. Their manuscript highlights the varying methods to which teachers used to maintain and deliver CBPA, as well as that in order for CBPA to be sustainable organizational-level/district and school administrator support is necessary.
In similar fashion with Turner et al., Lerum and colleagues discuss their findings from the Active Smarter Kids (ASK) study in which they explored continued implementation of the CBPA intervention in 22 schools. Of interest was the maintenance of PA breaks postintervention and the identification of themes the teachers identified for the purpose and utility of PA in school for students. Most importantly, their findings help provide support for the importance of involving teachers in the design and implementation of CBPA programs.
The research surrounding cognitive function, academic achievement, and classroom behavior suggest that PA participation produces positive outcomes for elementary-aged schoolchildren. Such positive outcomes, unfortunately, are often overshadowed by the challenges associated with the delivery of PA within the school. The lack of optimal environmental circumstances or policies that encourage PA within the school prevents state health advisors, school administrators, teachers, and researchers alike from taking advantage of a captive audience to deliver PA programs to improve the health and wellness of our youth. Critical evaluations and research needs to be conducted where interventions are designed to overcome the barriers of delivering PA within the school. Fortunately, PA can be provided in many before, during, and after school activities that do not compete for time spent on academic instruction, which is often a concern for many policymakers. Therefore, increasing PA using methods that are congruent with school health mandates and public policy initiatives can contribute to higher levels of PA and fitness to improve learning and academic achievement. Public policy initiatives are ultimately needed to support programs to increase PA that will foster healthier children and improve the school learning environment. The journal editors and manuscript authors hope that this special issue related to the outcomes and challenges of successful CBPA interventions in elementary-aged children will provide others with the necessary next steps to expand this much needed scientific field of study.
Preparation of this manuscript was supported by the National Institutes of Health (grant no. KL2TR002367, Szabo-Reed). The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine.
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