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Lessons Learned from a Physically Active Learning Intervention

Texas I-CAN!

Bartholomew, John B.1; Jowers, Esbelle M.1; Golaszewski, Natalie M.2

Translational Journal of the American College of Sports Medicine: September 1, 2019 - Volume 4 - Issue 17 - p 137–140
doi: 10.1249/TJX.0000000000000095
Original Investigation

ABSTRACT The Texas Initiatives for Children’s Activity and Nutrition (Texas I-CAN!) has focused on the development of interventions to provide physically active learning (PAL) to regular education, elementary classroom. This article provides an overview of our approach and the iterations through which we have progressed in the intervention. We adopt a framework that considers PAL along continuums of relatedness to and integration with the academic goals of the lessons. This provides a lens through which to view our iterations of I-CAN!, as we sought a version of PAL that is both acceptable to teachers and effective for physical activity and academic outcomes. As such, this provides an overview of the choices that must be made to translate theory to practice.

1The University of Texas at Austin, Austin, TX

2University of California at San Diego, San Diego, CA

Address for correspondence: John B. Bartholomew, Ph.D., FACSM, Teresa Lozano Long Endowed Chair in Kinesiology and Health Education, Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., Mail Stop D3700, Austin, TX 78712-1204 (E-mail:

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Early deficiencies in academic performance pose a significant challenge as the gap between low- and high-performing students widens as children age, especially for lower socioeconomic status (SES) and minority students (1). It is therefore critical that we support elementary teachers in their efforts to create lessons that engage students. Students who are engaged and focused will consistently respond with better academic achievement than their less focused counterparts (2). Physically active learning (PAL) is designed to incorporate bodily movement and physical activity into instruction. PAL has consistently been shown to increase physical activity (3), enhance academic achievement (4,5), and, in the time after PAL, improve elementary students’ attention and impulse control as assessed by observations in time on task (6,7). The consistent change in time on task suggests that learning may be affected not only by the content of the physically active lessons but also by the increased engagement with material taught after PAL. A discussion of time on task is more fully presented elsewhere in this collection of articles. Moreover, PAL is a low-cost and highly flexible strategy that requires little teacher training (8,9). As such, it may be an ideal intervention for the elementary classroom. Unfortunately, the study of PAL has been limited by a lack of systematic and coherent definitions and implementation of PAL within the school setting.

Research into PAL has emerged from the fields of kinesiology and public health with little understanding of the school setting (10). As a result, the primary emphasis has been to increase opportunities for physical activity with a secondary emphasis on educational outcomes. Given this context, it is not surprising that many of these efforts have been limited to physical activity breaks in the regular education classroom (11). These have met resistance from teachers as time spent in physical activity is not an outcome that is in alignment with their primary role as educators (10). In response, interventions have evolved to include an academic component—i.e., PAL. Unfortunately, these consistently exhibit poor- to medium-quality designs (4,5). For example, most occur in a single classroom or school. When they do use multiple classrooms and schools, most trials are insufficiently powered to analyze these nested data at the level of assignment. As a result, there is a need for more randomized control trials that assess the effect of PAL on student behavior and academic outcomes.

In an effort to provide structure to this research, Mavilidi and colleagues (12) have established a framework for categorizing PAL. Their framework revolves around two dimensions: 1) relevance with the academic goals of the lesson and 2) integration of the physical activity with that lesson. Physical activity breaks, where students perform sets of star jumps or running in place would be considered low relevance and low integration. Where this movement includes a simple, academic component, e.g., performing jumps as a means of acting out mathematics equations, it is moderately relevant and integration. Relevance and integration can be increased when movement is more strongly integrated with the learning task and the movements are relevant to the concepts being taught. We have developed a lesson on the solar system in which students walk around an object to illustrate orbits while spinning to illustrate rotation on an axis. In this case, the activity is both highly relevant and highly integrated into the lesson aims. Where these precede the lesson, e.g., as a warm-up activity, they would be considered highly relevant but not integrated. This level of complexity illustrates why we prefer the term physically active learning, or PAL, in lieu of other common terms—e.g., embodied learning, movement integration, or brain breaks—that only capture a segment of the approach. In addition, we prefer to consider integration and relevance as continuums and not categories to, again, better reflect the complexity and possible permutations of lesson designs. Despite this, the framework is a significant step forward, and it provides a more systematic way to consider PAL research. For example, integrated PAL resulted in improved learning relative to nonintegrated or traditional, sedentary lessons for preschool students (13). Moreover, the framework provides a lens through which to interpret the existing research. To this end, we will review our efforts to develop successful PAL interventions.

The Texas Initiatives for Children’s Activity and Nutrition (Texas I-CAN!) was designed as a school-based intervention to improve student health and academic performance. To avoid asking teachers to choose between activity and academics, the treatment incorporates bodily movement/physical activity with academic material. Our model is based on the premise that long-duration, sedentary lessons—of the type that are common in elementary classrooms—lead to attention fatigue and reduced impulse control. This behavioral outcome has generally been assessed by teacher ratings of student performance (14). However, independent observers are preferable to teacher ratings as they are less likely to reflect racial and ethnic (15,16) or gender bias (17). Moreover, it has long been recognized that children with early behavioral problems (18) and attention deficit/hyperactivity disorder (19) are likely to have their attention judged more harshly by teachers than independent observers. As a result, it is recommended that independent researchers, trained to be objective and nonjudgmental, conduct systematic and direct observations of student behavior to avoid bias (20,21). We have pursued this through an application of direct observations of time on task. These procedures have consistently been used with physical activity trials (7,22) to capture change in attention and impulse control. Again, a fuller description of time on task is provided elsewhere in this collection.

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We spent the last 15 yr developing and evaluating the I-CAN! intervention through four main iterations before we found a mode of PAL that was both palatable to teachers and practical for academic material. From the outset, we focused on an in-class intervention so that we might leverage the effect of time on task on subsequent academic instruction and academic performance. In addition, the authoritarian role of the teacher was expected to ensure treatment compliance at the student level when I-CAN! was offered within class lessons (8). The original iteration was based on training teachers to incorporate physical activity into their lesson plans. We provided sample lessons (e.g., graphing distance run or time on a jump rope) and trained teachers to use this model to develop similar lessons across their core curriculum. Thus, the resulting lessons ranged in the degree of relevance and integration. The training was highly regarded by teachers, receiving an average rating of 4.7 on a 5-point scale. Unfortunately, few teachers (<25%) fully implemented the training. Focus groups indicated that teachers strongly supported the concept, but lack of planning time and available resources (model lessons/materials) were significant barriers to implementation. In response, our second iteration sought to minimize the barriers to implementation through an existing, active learning intervention: Take 10 (23). Take 10 provides a series of 10-min active lessons, using repetitive movement to conduct common academic content. This would be considered low in both relevance (general vs specific content) and integration with the goals of the lesson. Given this, teachers felt that the lessons were overly simple and became monotonous during the school year. Our third iteration used a committee of teachers with specializations in English as a Second Language, Physical Education, and Special Education. They were asked to develop a novel intervention for active learning. The resulting lessons were high in relevance and integration. For example, cardiovascular relay sets students in relay teams on a spot marked “muscle.” The first student takes a blue poly sport that represents an unoxygenated blood cell. They run to an area marked “heart” then to an area marked “lungs.” They exchange the blue poly spot for red—representing the oxygenation of the blood cell. They then race back to the muscle to deliver the oxygen. This is a pedagogically complex lesson that is linked to a single concept/unit—in this case, the cardiovascular system. Although the lesson was highly rated by teachers, emphasizing this level of complexity requires a new lesson each week or every few days to match a change in academic content. This made it difficult to incorporate into planning, especially as the complexity of each lesson required several repetitions to train students.

Our fourth and final iteration focused on physically active and enjoyable games (e.g., running relays or freeze tag) that could be used as a foundation to review course material. For example, students could perform relays, running to a point, in turn, to solve math problems as the rest of their team members performed physical activities in place (such as squats or marching in place). These would be considered integrated with but not relevant to the lesson goals. This structure brought with it several advantages. It achieves a high dose of physical activity within each lesson. Reducing the number of games for teachers to choose from significantly eased the initial training burden for teachers and reduced the repetitions needed to train students in the class. In fact, while we offer multiple foundational games, most teachers choose three to four favorites. Once the basic game has been taught, various concepts can be added (e.g., math relay can be completed with math facts, definitions, or two-stage addition). This provides a high degree of flexibility that allows the intervention to evolve with the curriculum and be applied across elementary grades. In addition, the use of few foundational lessons reduces the training burden for students and simplifies teacher planning. As these lessons are designed to be highly flexible, they can be completed in the classroom, gymnasium, or outdoors and can be adapted for children with limited physical ability, as we have had children in wheelchairs participate. Finally, this is a low-cost intervention, where the primary expense is limited to the initial teacher training and a few basic materials and supplies.

Thus, we have worked across the range of physically active lessons: low integration and low relevance, high integration and low relevance, and high integration and high relevance. This experience illustrated the tension between teacher and student engagement and the practical challenge of implementing these lessons over a 9-month curriculum. Teacher and student engagement is increased with greater integration and relevance. However, these are much more challenging to implement, which undermines fidelity for all but the most motivated teachers. Given the different levels of readiness to implement these lessons, we choose to focus on high integration but low relevant lessons. Future work might consider improved systems of delivery, e.g., Internet-based video and search engines, that would serve to ease implementation of the more complex lessons. This is an area ripe for future research.

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We have recently completed a cluster randomized control trial (RCT, NIH: 1R01HD070741) in which 28 schools were assigned to physically active math lessons, active spelling lessons, or business-as-usual control. Data were collected across 149 teachers (n = 99 intervention, n = 50 control) and 2716 fourth-grade students. Teachers in intervention schools implemented I-CAN! lessons for 10–15 min on at least 4 d·wk−1. Data were analyzed via a three-level (students, teachers, and condition) hierarchical model. The full trial is described elsewhere (24). Students who participated in a physically active I-CAN! lesson experienced an increase in both steps (ES = 0.44) and time in moderate to vigorous physical activity (ES = 0.38), with no change in sedentary time (ES = 0.04) (3). Students in intervention schools also experienced significant improvement in time on task during subsequent academic instruction, whereas those who were exposed to the sedentary academic lesson experienced a decrease in time on task (ES = 0.32) that was positively correlated with the average dose of objectively measured (accelerometer) physical activity during the I-CAN! lessons (7).

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There is a clear need to find opportunities to increase physical activity in elementary schools and to enhance student academic engagement. PAL has proven to be successful at both. There is a significant increase in the time spent active and in observed time on task in the academic period immediately after the physically active lesson. It is important to note that the data shared from our large RCT are based on the full inclusion of all teachers in the analysis—including both those classes where implementation was at a high level and those with lower levels of compliance. In fact, our process evaluation revealed that only half of all teachers implemented at the prescribed levels. This is a common challenge in the PAL literature (25), which indicates the need to find a version of PAL that teachers will, in fact, implement at a high level while still affecting physical activity and academic outcomes. This remains the central challenge of this research—a challenge that is complicated to the extent that these outcomes may be in tension. Although recent findings suggest that highly relevant and integrated PAL are more impactful for academic outcomes (13), our experience suggests that the more relevant and integrated the activity, the more difficult it is for teachers to plan and implement these lessons. How, then, do we create an intervention that is effective and implemented with high fidelity? This is a question well worth asking, as the existing positive results indicate that PAL has great potential as a means to create a more active and engaged classroom.

The project described was supported by award number 1R01HD070741 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health.

The authors declare that they have no conflicts of interest to disclose. In addition, the results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors also declare that results are presented clearly and honestly without fabrications, falsification, or inappropriate data manipulation.

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