INTRODUCTION: PHYSICAL ENVIRONMENT AND HEALTH
Understanding the effects of the physical environment on children’s health is important to make better policy, guidelines for design, and decisions on capital investments. This is critical because medical researchers have found that children’s less mature systems are more susceptible to environmental hazards and that they have many more years of life to develop problems (1). In turn, the opportunity for early life interventions can potentially influence healthy habits and behaviors that can positively shape their adult lives. Notably, the increasing rate and earlier onset of childhood obesity, which can have long-term effects on health, coincides with children spending increasingly longer portions of their most formative years in child care or school environments, places often considered an untapped opportunity to intervene early and effectively to learn healthier habits (2,3).
Ecological models in public health suggest that the physical and sociocultural surroundings affect the health and wellness of people and that effective interventions operate at multiple levels, from physical environments to policies and educational programs, which promote physical activity (4). While recognizing the need for multilevel strategies, this article is focused more narrowly on the physical environment: the physical space outside the person’s body, both its natural and constructed characteristics, which may be modified to influence health positively or negatively. Evaluating the available evidence of the physical environment’s effects on health generally, and through physical activity more specifically, suggests that the way the built environment affects children is not always similar to the way it influences adults. A goal of this research is to understand the current state of research on the physical environment for all age-groups, identify the similarities and differences specific to children, and find potential for new evidence in the school environment that may guide future transdisciplinary research directions.
Studies have found the child care center or preschool that a child attends to be one of the strongest predictors of physical activity (5,6), which in turn affects obesity, and yet studies on the influence of specific attributes of the environment are considered lacking (2)—especially ones that isolate or comprehensively examine many attributes of the school’s physical environment. A recent review of the literature on the effect of the built environment on people’s physical activity concluded that future studies should examine context-specific physical activity and develop context-specific models and frameworks (7). Although context-specific studies of schools are beginning to guide policy and program interventions, there is an opportunity to develop transdisciplinary research that could also guide better evidence-based design, regulations, and investments in a physical environment that supports the success of other efforts to ensure better outcomes.
This article summarizes the most important findings in the literature that provide evidence of the effects that the physical environment of the school has on children’s health and resilience generally, and on their physical activity more specifically; presents field observations from research on the design of schools in Finland—one of the best school systems in the world in one of the most challenging climates with a strong tradition of outdoor learning and frequent time outside; and identifies potential gaps in knowledge and future directions for research specifically focused on the design of the physical environment of active schools, which can support physical activity, social competence, and better learning in children.
THE STATE OF RESEARCH ON PHYSICAL ENVIRONMENT AND PHYSICAL ACTIVITY OF ALL AGE-GROUPS
Increased urbanization, growing population, digital technology, food systems, pollution, climate change, and other factors transforming the natural and built environment—which may hinder or support healthy habits and outcomes including physical activity—are areas of increasing interest to researchers, policy makers, and designers, thanks to several important studies in recent decades, which were reviewed for this article and will be mentioned in this and the following sections. A broad review of the literature indicates that these studies generally take on two forms: (a) determination of correlates, where researchers make observations of attributes of the social or physical environment and measure health outcomes to find if there is strong correlation, and (b) designing interventions in environments that are suspected to have a certain deficiency or barrier and measuring the effect of those interventions in a particular health outcome or behavior. In both types of studies, it is important to be able to make effective observations and accurate measurements of, and creative interventions in, the physical environment. However, often research teams do not include physical–spatial design expertise. A recent study explicitly mentioned architectural coherence as a potentially important contributor to physical activity, but self-admittedly had to leave this characteristic unexplored because of the lack of expertise of researchers in design considerations (8). Better studies may be more comprehensive and better supported by expertise in spatial–environmental design combined with research experience designing valid and appropriate methods to measure effects and outcomes.
Studies examining correlates of the physical environment and physical activity, and its related health outcomes, cover a broad range of ages and characteristics of the physical environment. For example, historical changes in clothing, the closest component of the physical environment to our bodies, are hypothesized to have decreased our energy expenditures (caring for them) and increased our ability to withstand various environments (making exercise more comfortable) (9). Buildings, as extensions of our clothing to provide shelter, are where people spend a significant portion of their lives to be protected from the weather. Attention to the interior configuration of space, especially building circulation systems where people move from one place to another, is theorized to have effects on people’s desire and motivation for physical activity. For example, building elements like stairs, which are often hard to find or unattractive, can be designed to encourage people to choose them over elevators, from simple signage strategies to improvements that make them more open, accessible, and attractive (10). The design of the office environment, specifically the amount of natural light, shows correlations with a person’s sleep and vitality, which show a tendency toward more physical activity when compared with artificial light—albeit it remains unclear if it is the cause or the effect (11). The design of the urban context also affects health, and especially on physical activity. Whether it is improved accessibility (8), the convenience of accessing building and park facilities (12,13), their physical location, and the time of year (14), these factors appear to influence whether a person is more likely to engage in physical activity. Transportation, land use planners, and community designers have an especially strong record of research on correlates, specifically between physical activity and land use; what has been called the triple D of “density, diversity, and design” (8); and other qualities of community and landscape design (often called greenery) (15,16).
It is important to note that design quality matters, so this is not a case of simply “build it and they will come.” Studies suggest that aesthetic considerations, defined as pleasurability (8), and design elements that affect perceived park safety and landscape experience (e.g., tree-lined paths) (17) affect physical activity. Similarly, perceived traffic safety, neighborhood safety, and lack of sidewalks (8,10,18) are important factors. For these and other reasons, the second type of study, interventions, is more challenging. Some interventions can be simple, and the measurements can be measured with relative ease, e.g., add signage in building lobbies and corridors to increase the use of stairs (9,10). However, other interventions can be more complex to design and measure, and even when following evidence from previously identified correlates, the results of these interventions can be surprising or unexpectedly ineffective. Some literature reviews speculate that methodological flaws or the potentially unduly effect of methods of measurement on results are challenges to the design of these studies (10,19). Nonetheless, this is a relatively new and important area of research that deserves more attention and resources to support refinement of methods toward potentially transformative findings.
EVIDENCE OF EFFECTS OF THE SCHOOL’S PHYSICAL ENVIRONMENT ON CHILDREN
Many attributes of the physical environment are known to affect the health and performance of school children, including, among many, the access to natural light inside and outside (20,21); toxins in air, water, and materials of building, furnishings, and toys (1,22–26); and access to views of greenery from the inside and the qualities of the landscape or outdoor space they have access to (27–29). The mechanisms by which some of these physical environment attributes improve academic performance or cognitive function are not all known, but some areas of research theorize or test what these might be. For example, one study suggests that access to views of nature from the interior of a building can improve cognitive functioning through involuntary attention, which allows the neural inhibitory mechanism to rest, and similarly, that walks and activities in nature can better improve proofreading or attentional capacity than other “urban” activities (28). Physical activity has also been found to improve brain function, cognitive function, and academic achievement (30). Multiple studies long established that physical activity is correlated with time outside (14,31), but more recent studies found that the intentional design of the outdoor spaces to include features like greenery and topography combined with the more structured elements can result in more participation of different groups (gender and age) and higher physical activity (16,32). With more children living in urban areas, it becomes more urgent to understand this correlation, to guide the design of better urban school buildings and their associated landscapes to support the multiple ways in which the attributes of and frequent access to high design quality of outdoor spaces can improve the health and cognitive function of children even when they are inside.
The physical activity of young children has a strong correlation with the childcare centers they attend, explaining as much as half of the variability (5,33), and although studies sometimes examine limited attributes of the physical environment as part of larger lists of environmental conditions—as mentioned before—often these teams do not seem to have sufficient expertise to comprehensively assess the physical environment and, thus, do not sufficiently examine the effect of physical attributes separate from social or programming aspects. Some studies have defined instruments and methods of study to systematically assess the environmental characteristics of the school or childcare center, most often focused on a few limited variables. For example, the Environment and Policy Assessment and Observation identifies physical characteristics including, among many, portable and fixed equipment and items in rooms that may suggest a sedentary environment, although the effect of the latter was considered moderate (2). It also includes many other nonphysical environmental criteria that are not the focus of this paper, e.g., policies and practices such as curricular or schedule opportunities, and training of staff and children training. Similarly, the Early Childhood Environment Rating Scale—Revised model identifies, among other things, whether there is more portable and less fixed equipment and also measures playground size (34). Neighborhood-scale systems like the Neighborhood Environment for Children Rating Scale attempt to systematically document and assess perceived safety, e.g., loitering, presence of gangs, etc., which are factors identified as affecting children’s physical activity (18). These instruments seldom measure permanent infrastructural or design attributes of the space (spatial configurations, adjacencies, etc.), and often focus on the more changeable, e.g., equipment. A more flexible approach called behavior mapping, based on concepts of behavior setting (ecological units) and affordance (perceived properties of the physical environment), is an objective method to make direct observations of behavior and associated built environment characteristics that are coded in space (mapped) and has been suggested to generate visual evidence that is more likely to gain support from designers like landscape architects in need of more evidence-based guidelines (35) to work on the design of school playgrounds and other places where children may be more physically active.
The literature found on the effects of the environment on children’s physical activity can be categorized by scale and type of space and range from the established and replicated correlate studies to early examinations of new or more fine-grained evidence on design attributes (see Table, Supplemental Content 1, which provides a more detailed list of studies examining the association between physical environment attributes and children’s health, including physical activity, indicating whether it is positive, negative, inconclusive or indirect, http://links.lww.com/TJACSM/A46). These studies include the following: (a) correlate studies of attributes at an urban scale, whether perceived, objective, or both (18,36), including food environment (9,37), distance from home to school (38), and availability and quality of transportation infrastructure (8,19,38–40); (b) comparisons of location, e.g., inside versus outside, paved versus natural, rural versus urban, forest versus playground, etc. (41–43), based on measures such as physical activity and time spent outside (14,31,44); (c) availability studies, such as available indoor play space, available outdoor play space, and available equipment (2,34,44,45), including comparisons of size or type and/or quantity of equipment, e.g., portable versus fixed or number of balls (19,34,46); (d) access studies, also both perceived and objective, e.g., perceived convenient access to play spaces (10,19), proximity to green spaces (13), and access to facilities before and after school time (47); (e) barrier studies, for example, climate barriers or constructed barriers to getting outside or being physically active (5,10,14,48,49); (f) design quality studies, e.g., the formal, spatial, or experiential qualities of playgrounds or outdoor settings (topography, landscape type, more portable versus more fixed equipment, amount of greenery, adjacencies, centrality and clustering of play settings, and aesthetics) (8,15,16,32,34,50,51), including human factors like the perception of importance of the physical environment; and (g) physical intervention studies, e.g., testing simple improvements to school yards to create games or courts, and measured physical activity before and after the intervention (52).
Although there are multiple sociocultural factors that explain differences in student performance and health outcomes, including political, socioeconomic status, and demographic (47), it is a reasonable assumption that—based on the evidence referenced before—the physical environment can support good health outcomes as well as exacerbate bad outcomes and conditions of inequality. For example, high income and less crime are associated with more physical activity and lower inactivity (12,49,53). As mentioned earlier, the perceived safety and pleasurability of the physical environment may be one of many reasons for this disparity, but also the access to and convenience of certain types of facilities. This is not to say that every barrier to physical activity can be solved with design of the physical environment or design alone. Efforts to improve physical activity in children often focus on policy and training, as presented in many of the studies cited before. However, some of the studies cited here tested interventions in the physical environment and demonstrated that physical design attributes are worth exploring on their own. The central questions to this research, which seem fairly unexplored, are, does the physical environment of school buildings and grounds contribute to better outcomes in children’s health and learning, in particular through promotion of physical activity, and how can we measure that? As far as could be gleaned from previous studies in this literature review, the focus is usually on specific areas of the school designed for physical activity, or more recently in activity-permissive classrooms through, for example, the use of stand-biased furniture (54,55). Although many studies assess general quality of the schools or child care centers (often including nonphysical environmental qualities), none comprehensively looked at other potential ways, especially indirect ways, in which the physical environment may support physical activity.
Considering that an important contributor to physical activity is the amount of time spent outside, much attention is paid to the design of the outdoor spaces and their effect on physical activity. However, it is important to identify what are the barriers to going outside in the first place, in what ways the physical interior environment could be hindering or supporting going outside, and whether there are qualities of interior environments that can support more physical activity. This literature review did not find studies on children’s physical activity examining several physical environment attributes that may be worth exploring, especially the permanent building characteristics (as opposed to impermanent or frequently changed characteristics of furniture or equipment), such as access to natural light and ventilation, or window area; spatial dimensions like ceiling height or interior open activity area per child; type and quality of interior circulation spaces, e.g., use of ramps instead of stairs, or corridor width; proximity of classrooms to outdoor play spaces or sports facilities; variety of interior space types and adjacencies, e.g., shared spaces that require moving throughout the day from one place to another; transition spaces from inside to outside; or other qualities of school playgrounds, e.g., amount of sitting areas, shade, cover, etc. To begin to understand the potential effects of some of these design attributes, it may be helpful to examine schools where outdoor learning and active play is a priority of high-quality education. Expert observations in site visits can generate hypothesis on potential contributing attributes in the physical environment. These observations can inform future studies of correlates or comparative interventions to test the hypothesis. An example of that type of observation was performed in Finland schools, in this case focused on the quality of access from indoor to outdoor spaces that may facilitate more time outside, as explained in the following section.
CASE STUDY: DESIGNING FINLAND’S SCHOOLS TO GO OUTSIDE
Finland is a great case study to examine because of its success in high-quality education and consistently high academic performance, its culture of high-quality design of schools, the curricular emphasis on frequent access to outdoor play despite harsh winters, the fact that these high-quality schools are almost universally available to all students at no cost, and the recent implementation of a national level program to promote physical activity. This was not always the case. In the last 30 yr, the school system in Finland moved from being a mediocre system of education to be one of the best in the world, according to many international standards (56). The impressive results of school reform were achieved by a philosophy of equality of opportunities and support, including free access to play-based early childhood care, nutritious meals, and health services in school; learning through diversity, based on choice and incentives, as well as early support for special needs; and the strong and continuous professional development of the teachers (57). Another important aspect of the Finnish school system and Finnish culture, in general, is their commitment to high-quality design, including the built environment and, in particular, the strong and internationally recognized culture of school design (58). This often-overlooked aspect of the educational system in discussions about Finland’s educational success, i.e., the reform of school architecture, follows the pedagogical and philosophical principles and guidelines of the National Curriculum Framework (56). Kaisa Nuikkinen, the Chief Architect of the Helsinki City Education Department, spent 25 yr writing guidelines, leading the process of programming, planning, site, and designer selection for the design of schools in Helsinki. She believes that “if the building is consciously viewed as an instrument of learning, the architecture itself can serve an inspirational, tangible teaching tool” (59). The design of schools in Finland is usually selected through design competitions, incentivizing constant innovation and experimentation with spatial expressions of curricula and new programming priorities. These competitions often result in stunning architecture with ample daylight, high-quality interiors using healthy materials, thoughtfully designed spaces of learning, and generous community spaces connected with beautiful and dynamic landscapes and playgrounds.
Finland’s education system emphasizes frequent and plentiful time outside during the day as part of the learning experience, even in their extreme winters. This was not about physical activity specifically but about the many other benefits of having a break between classes and learning outside, which are documented on studies about outdoor learning (60), and even place-based learning, more critically named learning in “the commons” or outside of traditional boundaries (61). The typical Finnish curriculum has a recess between each class, as often as 15 min every 45 min (62). Recess breaks, whether inside or outside, have been shown in a study to improve cognitive performance and adjustment to school, even without physical activity (63). However, the same study found playful unstructured breaks better facilitate learning, social skills, and competence necessary to better adjustment to school, and that is more likely to happen, especially in boys, during the type of game that involves more vigorous physical activity.
Since 2012, Finland has been promoting physical activity in schools at a national level through the Finnish Schools on the Move (FSOM) program (64,65), which is implemented flexibly in each municipality but includes some basic recommendations to improve the school physical and social environment. A recent report said that 42% of schools recently extended one of the many recess periods to 30 min to promote physical activity (62). This report card indicates that 98% of schools have gymnasiums and that 63% of schools made improvements to the schoolyards in the last decade to make them more appealing and engaging for the neighborhood (62), an attribute (after-hours access) that is correlated with more physical activity in studies mentioned earlier (47). Although they are still in the initial implementation phase of the program, acknowledging that they started with very low grades on PA and that results show they still have challenges achieving 60 min of PA per day, the reports from 2016 to 2018 show some marginal improvements in active play, but significant improvements in various other grades, especially the grade related to schools, and with overall better grades than the United States (see Table 1). These report cards are looking at national statistics (62,64,66) and did not measure differences in outcomes in schools that implemented specific improvements versus others.
Many factors influence the better performance of Finnish schools, but one factor makes the achievements of the physical environment more remarkable: the continental subarctic or boreal climate, which means long winters with very cold temperatures, short days, and significant snow. Weather has been found to be a barrier to physical activity (44,49,68), and during informal interviews performed by the author in preschools in the northeastern United States, the time and complication of getting children ready to go outside and then cleaning them up to go inside were cited often as a reasons why children do not go outside to play while in school. Considering the more extreme climate of Finland, the fact that 87% of students spend recess outside (65), and the frequency in which children go outside, is impressive. This does not guarantee vigorous physical activity, but given the connection between outside play and higher PA mentioned earlier, it is an important first step in the right direction. In Finland, 65% of schools use the yard as part of active learning other than physical education (65), and 68% have playing fields, but since the implementation of FSOM, 46% of schools have refurbished yards to improve PA. Many of the schools that made these changes as part of the FSOM program implemented these changes in the last 2 to 4 yr, and so far no study has compared specific interventions to control groups where measures were not implemented yet. However, the results may be reflected in the incremental improvement in scores in report cards from 2014 to 2018 (see Table 1).
Two more specific questions are raised by this research. In the short term, are there aspects of the physical environments of the Finnish schools that facilitate such frequent exits to recess and the high percentage of time spent outside? And in the long term, how are the improvements to the physical environment being made since 2012 FSOM influencing PA and academic performance? While doing field research in schools in Finland and interviewing their leadership, two examples in Espoo, a suburb of Helsinki, stand out as good examples of simple and innovative design strategies for spaces within buildings that support a culture of going outside: the Kirkkojärvi School by Verstas Architecure, which accommodates 770 students from preschool to grades 1–9 (6–16 yr old), and the Saunalahti Lastentalo by JKMM Architects, which is a preschool and health center for expecting and new mothers (a hybrid typology that has evolved from a Finnish social welfare system invented in the early part of the 20th century). These and all other school buildings visited in this research had generous gymnasiums and/or multipurpose rooms that can support physical activity inside when conditions are too harsh. Kirkkojärvi is a great example of how gymnasiums and cafeterias are made integral to the daily learning experiences of children, spatially and formally integrated into the volume of the building (see Fig. 1A–B and Fig. 2). However, outside play is just as important or more to the school culture. The student’s daily schedules are organized to purposefully allow a 15-min recess between each 45-min class period—even and especially in winter—something that the principal of the school described with particular pride as part of their commitment to high-quality education and student success.
An interview with the principal revealed that there is one attribute of the physical design of the school that is seen as critical to supporting these frequent breaks for outside play. The buildings facilitate quick transitions from inside to outside and back inside during regular classroom lessons, by providing multiple and generously sized wet spaces or mudrooms near classrooms where children can put on and take off winter gear quickly (Figs. 2 and 3). In the case of Kirkkojärvi, each age-group has a home area with ample natural light and sitting areas that connect to a large mudroom leading outside. These ample and intentionally designed transition spaces are equipped with floor grates that capture wet snow and allow cleaning of boots, as well as sinks, benches, clothes dryers, and shelves for student gear. Students take their shoes off inside, walking to their classrooms in their socks and leaving their shoes in these mudrooms ready to go back outside the next time. At the Saunalahti Lastentalo, each preschool classroom has a direct view of the playground and access from the large mudrooms immediately adjacent to and shared between each pair of classrooms (Fig. 3). These types of transition spaces were observed at many of schools visited throughout Finland, some ubiquitous throughout the school (shared by fewer students), whereas others are more centralized and shared by many, with varying levels of service (sitting, storage, washing, etc.). These functional spaces make transitions from inside to outside to back inside easier but may also influence the students perception of the outdoor space as one to be active and messy—not unlike Gibson’s theory of affordance (69), which would posit that the mudroom affords the student the opportunity to go burn energy, sweat, and come back inside clean. These rooms also have the potential to influence the willingness of the teachers or staff to allow and encourage students to go outside often and play freely. Although these observations were qualitative, the effects of design strategies like these could be assessed through objective measurements, systematic observations, and behavior mapping to determine whether measurable differences in design attributes affect frequency of use and levels of physical activity.
Examining Finnish schools also sheds some light into opportunities for future design research. Design research is traditionally defined as research into design methods and processes, but it also is used to describe research into the object of design itself. For the purposes of this article, design research refers to the systematic scrutinizing of designed environments and, in response, developing new proposals for design interventions that can be assessed qualitatively or quantitatively to measure effects. In this case, we first examined the culture of school design in Finland and observed in field the ways in which spaces are used to support learning and health outcomes, including food (eating as well as cooking), recess, and physical activity. On the basis of these observations, a new program of research can be proposed, based on design interventions in other contexts, which can be quantified or qualified through transdisciplinary methods.
FUTURE DIRECTIONS AND RESEARCH NEEDS
A review of recent research explained how theoretical frameworks on physical activity have long been dominated by psychological and social factors of individuals or groups, and that research focused almost exclusively on recreational or leisure-time physical activity, arguing for more research on environmental factors and a broader definition of active living (10). The increase in interest in ecological models in public health (4) or contextualist theories in developmental psychology (14) highlights the influence of physical and sociocultural surroundings on behaviors, including physical activity, and a focus on the benefits of physical activity of different intensity that can happen naturally and continuously throughout people’s lives. This is evident in recent literature and interventions designed to improve physical activity in children, as summarized earlier. Because studies show that there is a wide range of influential factors to physical activity at multiple levels—the physical (built/natural) environment being an increasingly evident one—a goal of future research should be to provide safe, attractive, and convenient places for physical activity (4), especially schools and their broader environments where children spend the majority of their time, combined with other multilevel interventions focused on training or education of children themselves and their educators and caretakers. Researchers identified the need for studies that examine context-specific physical activity and behavior-specific environmental attributes (7), and the built environment of the school is a physical environment that must be examined more closely.
Context-specific research of physical environments can be strengthened by expert assessments that are in-depth and comprehensive, including systematic but flexible qualitative observations of the built environment and structured interviews of users by experts that specifically try to identify potential environmental attributes that may not be hypothesized before being observed in context. Transdisciplinary teams and approaches are needed to do multilevel observations and interventions (4,19). Because design disciplines have been explicitly excluded before, and because of the need for design interventions that can be tested (8,9), designers with experience in the built environment of children should be an integral part of these transdisciplinary teams. These teams should include various experts on children development, physical activity, school users and administrators, and designers, to not only make observations and recommendations but also work together on designing interventions in the physical environment that can be evaluated. These evaluations can compare behaviors before and after interventions, or compare places of intervention to controls without it. Qualitative observations of attributes like the transition spaces observed in Finland schools may help identify specific attributes of the physical environment of schools that may act as infrastructures to afford (51) physical activity, for further study. Researchers can start by identifying high-performing or active schools and assessing what aspects of their physical environment are supportive of more physical activity, or what barriers hinder it, and how students have had to overcome them. Strategies like behavior mapping can be useful because they provide “a flexible method for understanding the dynamic impact of the built environment on behavior” (51) and also because experts on environmental design can partner with experts on measures of physical activity to identify the boundaries of space based on observed activities in real time, which may not be explicitly physical boundaries (e.g., illumination level or temperature as opposed to physical boundaries like walls). Similarly, transdisciplinary teams can assess the physical environment of schools with low physical activity, and identify what aspects of the physical environment may be contributing to this, to then test this hypothesis through larger studies.
Cross-sectional studies can generate inventories of physical attributes of school facilities to examine correlation with physical activity in children, with the purpose of identifying future directions for research that may clarify causation. The assessment of the physical environment will include quantitative measurements of buildings (e.g., physical dimensions, area per child, distance to and number of access points to outdoor spaces, solar exposure, and area of natural ventilation), as well as field surveys of programmatic components (e.g., type and quality of transition zones to outdoor spaces, gross motor and outdoor classrooms, covered outdoor areas, etc.) and spatial qualities (variety of spaces, adjacencies, relative sizes, and distribution). Building and playground solar orientation, topography, shade, wind protection, visible free sky, and ground cover can be evaluated with field observations, fisheye photography, aerial photographs, and shadow studies. On days when physical activity data are collected, environmental data for daylight levels, temperature, humidity, air velocity, and pressure can be collected with environmental meters.
In addition to objectively measured physical attributes, perceptions of the importance of the physical environment have been found to be positively associated with energy expenditure, and researchers suggest that the influence of the school settings on these perceptions should be examined (70). How the environment influences perceptions may be measured through surveys or interviews of users. Future studies may also include expert field observations of perceived design or environmental attributes of various school facilities for which physical activity data are available or can be measured and interviews of schoolchildren, staff, and administrators to identify self-reported facilitators and/or barriers to physical activity specifically found in the physical environment, which can be analyzed through coding of interviews and comparisons of design to look for patterns. Comparisons of objectively measured physical activity (e.g., wearable technology) in different schools in the same school system, design expert observations, and qualitative data on perceptions and self-reported barriers can provide pilot data to hypothesize the influence of physical environment attributes. Because there are usually multiple factors at play, these studies should control for other factors like climate, age-group, curriculum, and funding, as many of these can be confounding variables.
Longitudinal studies are considered more appropriate than cross-sectional studies when trying to understand whether patterns of results reflect the ability of the environment to constrain or facilitate certain behaviors (19). The cross-sectional study may be able to suggest specific interventions in several facilities that can then be evaluated over a long period. A longitudinal study can then follow the same group for a period and observe the patterns of physical activity when the physical environment changes, whether it is a natural variation or the implementation of a program of improvements. Designing specific interventions in the physical environment (design of buildings, landscapes, urban context, and equipment in schools) and measuring their effect is a complex and long-term research problem to solve but one that, if done by teams from multiple disciplines including designers, can provide invaluable insight into and a more comprehensive look at the effect of the environment in schoolchildren’s physical activity and academic performance. These context-specific studies may not be entirely generalizable to all populations, climates, age-groups, and academic systems. However, as individual case studies can shed light on the effect of the physical environment, these studies illustrate novel methods of analysis and evidence-based design approaches and broaden the effect of other programs of intervention to promote healthier habits and improved learning outcomes.
The fieldwork in Finland was possible thanks to funding from a faculty research incentive grant from the College of Arts, Media, and Design at Northeastern University. The author thanks Minna Welin, Vice Principal of Saunalahden Koulu, and Kari Louhivuori, Principal of Kirkkojärvi School, for providing information on specific case studies and general Finnish school system as well as helping with identifying projects and contacts and arrangement of site visits. Some of the base drawings (before annotations) were produced by the author’s students in a master’s research course at Northeastern University focused on the design of children spaces.
The author has no conflicts of interest to disclose. The observations of this case study and review of results in the literature do not constitute endorsement by the American College of Sports Medicine.
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