Coordinated Approach: Comprehensive Policy and Action Planning.

BACKGROUND: Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K-12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K-12 student PA and nutrition in the United States. METHODS: A 2-phase literature review search included a search of systematic reviews for individual qualifying studies (2010-2018), followed by a search for individual articles (2010-2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition. RESULTS: We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors. IMPLICATIONS: Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes. CONCLUSIONS: Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors.

Predicting the Presence of Active Schools: A National Survey of School Principals in the United States.

BACKGROUND: Principals are key to the promotion of physical activity (PA) in schools. The purpose of this study was to understand how school principals' PA values, behaviors, and individual and school characteristics were associated with the presence of an active school. METHODS: A representative sample of 1019 school principals in the United States was surveyed. Survey items addressed principals' values and behaviors associated with PA, individual and school demographic factors, such as years of experience and school level, and a single item asking whether principals perceived their school to be an active school (ie, provides students with opportunities to be physically active before, during, and after the school day). Significant variables from a cross-tabulation and chi-square analysis were added to a hierarchical logistic regression model to assess the predictive properties of principal values and behaviors as they relate to the presence of an active school. RESULTS: Approximately half of principals (47%) reported having an active school. The model significantly predicted the presence of an active school but accounted for only 6.6% of the total variance. Although values toward PA and more frequent personal PA behaviors were associated with the presence of an active school within the cross-tabulation and chi-square analysis, neither variable emerged as a significant predictor in the regression model. CONCLUSIONS: Principals' personal PA values and behaviors contribute to the presence of an active school, but other variables, including years of experience and school contextual factors, are more powerful predictors.

The Walking Classroom: Measuring the Impact of Physical Activity on Student Cognitive Performance and Mood.

BACKGROUND: The Walking Classroom is an education program that provides students with an opportunity to accumulate physical activity without losing instructional time. METHOD: This research tests Kuczala's application of kinesthetic learning theory through measuring knowledge retention, postactivity information processing, and mood in students who engage in a short bout of physical activity while listening to Walking Classroom podcasts about language arts, science, and history, and those who remain seated during a podcast, compared with baseline levels. Students from 9 high-poverty fourth- and fifth-grade classrooms (n = 319) in a North Carolina county comprised the sample. RESULTS: Utilizing multivariate analysis of covariance, the results demonstrate significantly higher levels of learning while walking compared with learning while sitting. Measures of mood utilizing the 10-item version of the Positive and Negative Affect Scale also demonstrated a significant effect in predicted directions. CONCLUSION: The results support that coupling physical activity with instruction leads to increased performance and mood for elementary school students.

Parents' Perceptions and Engagement Regarding School-Based Physical Activity Promotion.

PURPOSE: This study examined parents' perceived importance of, and engagement in, school-based physical activity (PA) promotion. DESIGN: A cross-sectional, quantitative survey design was employed. SETTING: The survey was conducted in the United States. SUBJECTS: Using a probability-based panel (AmeriSpeak®), a national sample of 3599 parents was randomly recruited to participate in the survey and 1015 participants (28.2%) completed it. Parents or legal guardians of children enrolled in K-12 during the 2017-2018 school year were eligible to participate. MEASURES: The survey was developed and distributed by a national collaborative for active schools with the support of a national research center. ANALYSIS: Data were analyzed using structural equation modeling and path analysis. RESULTS: The data supported a 6-factor solution encompassing perceived importance of PA before, during, and after school, communication with administrators, and volunteering and participating in school-based PA (CFI = .974, RMSEA = .034, SRMR = .056). Path coefficients from perceived importance of PA before/after school to current (ß = .43; 95%CI[.25, .61]) and future communication with administrators (ß = .40; 95%CI[.23, .55]) were statistically significant, as were coefficients from perceived importance of PA before/after school to past (ß = .60; 95%CI[.35, .83]) and current volunteering/participating in school-based PA (ß = .63; 95%CI[.42, .85]). CONCLUSION: Parents' perceived importance of school-based PA opportunities before and after school warrants emphasis in future research and advocacy.

"Happy, Healthy, and Smart": Student Responses to the Walking Classroom Education Program Aimed to Enhance Physical Activity.

BACKGROUND: Over 1 in 3 children in US schools is overweight or obese; thus, most teachers believe physical education and activity are necessary K-12 components. One potential avenue to infuse physical activity (PA) in educational settings is integrating in classrooms based on learning objectives and academic outcomes. In this study, we examined student emotion through the use of the Walking Classroom (WC) learning platform. METHODS: Students from 9 fourth- and fifth-grade classrooms (N = 100) in 1 North Carolina county participated in 10 separate focus groups related to their engagement in an active education program. Discussions centered on how engaging in a short bout of PA during a WC podcast impacted students' overall educational experience. Data analysis included open in vivo manual coding methods resulting in major themes and visual word-clouds. RESULTS: Students reported feeling happy, healthy, educated, smart, and excited while walking and learning. Afterwards, students discussed feeling strong, relaxed, energized, happy, and alert. On days students were not able to do a walk, they reported feeling mad, bored, sad, sleepy, and tired. CONCLUSION: Offering active learning appears to result in students feeling happier, healthier, and smarter.

SHAPE America's 50 Million StrongTM: Critical Research Questions Related to Youth Physical Activity.

SHAPE America - Society of Health and Physical Educators has targeted youth physical activity (PA) as 1 of its 4 goals within the 50 Million StrongTM campaign. Only 27.1% of youth met the target of all students (preK-12) participating in at least 60 min of PA that increases their heart rate enough to breathe hard at least some of the time for 7 days/week. Thus, improvements for child and adolescent engagement in PA need to be made now through 2029 and beyond. The need for these improvements warrants research related to PA and youth. We present a plethora of research questions within 3 general areas: PA and school PA programs, PA and sedentary behavior measurement, and PA and social justice imperatives. Each question is framed within the social-ecological framework levels of learning, opportunity, policy, and population health.

Identifying and Quantifying the Unintended Variability in Common Systematic Observation Instruments to Measure Youth Physical Activity.

BACKGROUND: Direct observation protocols may introduce variability in physical activity estimates. METHODS: Thirty-five physical education lessons were video recorded and coded using the System for Observing Fitness Instruction Time (SOFIT). A multistep process examined variability in moderate to vigorous physical activity (MVPA%; walking + vigorous/total scans). Initially, per-SOFIT protocol MVPA% (MVPA%SOFIT) estimates were produced for each lesson. Second, true MVPA% (mean MVPA% of all students using all observations, MVPA%true) estimates were calculated. Third, MVPA% (MVPA%perm) was calculated based on all permutations of students and observation order. Fourth, physical education lessons were divided into 2 groups with 5 lessons from each group randomly selected 10,000 times. Group MVPA%perm differences between the 10 selected lessons were compared with the MVPA%true difference between group 1 and group 2. RESULTS: Across all lessons, 10,212,600 permutations were possible (average 291,789 combinations per lesson; range = 73,440-570,024). Across lessons, the average absolute difference between MVPA%true and MVPA%SOFIT estimates was ±4.8% (range = 0.1%-17.5%). Permutations, based on students selected and observation order, indicated that the mean range of MVPA%perm estimates was 41.6% within a lesson (range = 29.8%-55.9%). Differences in MVPA% estimates between the randomly selected groups of lessons varied by 32.0%. CONCLUSION: MVPA% estimates from focal child observation should be interpreted with caution.

Academic-Based and Aerobic-Only Movement Breaks: Are There Differential Effects on Physical Activity and Achievement?

PURPOSE: This study investigated the academic achievement and physical activity differences between types of activity breaks implemented in elementary school classrooms. This study evaluated whether there was a difference between the impact of purely aerobic-based movement breaks and the impact of academic-based breaks on children's academic achievement outcomes. METHOD: Participants included 460 children in 3rd grade through 5th grade at 4 elementary schools. There were 176 children in the schools that engaged in academic-based breaks and 284 in the schools that engaged in aerobic-only breaks. Schools were randomly assigned at the school level to implement either aerobic movement breaks with academic content infused within the breaks ("academic-based breaks") or aerobic-only movement breaks without the addition of academic material ("aerobic-only breaks") for approximately 10 min of activity per day. Math and reading achievement as well as children's step counts were measured before and after the intervention. A mixed-effects (multilevel-growth) model, in which the repeated measures of individuals nested within a classroom are analyzed, was used to answer all posited research questions. RESULTS: Small to moderate effect sizes (ES) indicating gains in reading achievement (ES = .13) and steps (ES = .33) were found for classrooms that used aerobic-only movement breaks compared with those that used academic-based breaks. CONCLUSIONS: The type of movement breaks that are implemented in classrooms may have differential outcomes for children's achievement and activity levels. Results from the present study indicate that children who were given aerobic-only movement breaks had slightly larger gains in reading achievement and physical activity levels than children who were given academic-based breaks.

Perceptions of Using Sit-to-Stand Desks in a Middle School Classroom.

The purpose of this study was to explore the feasibility of sit-to-stand desks in a middle school classroom. Participants used sit-to-stand desks during health class. Momentary time sampling was used for physical activity and behavioral observations. Results indicate students sat 37%, stood 59%, and walked 4% of the time. Misbehaviors occurred 4% of the observed period. The following themes emerged: focus, freedom, distractions, and design. Sit-to-stand desks appear to encourage standing during instruction while simultaneously limiting misbehaviors. Students indicated some distractions but were generally positive toward desk implementation and suggested they supported learning behaviors. The teacher echoed most of the student themes.

Elementary Students' Physical Activity Levels and Behavior When Using Stability Balls.

OBJECTIVE: Physical activity is positively related to improved student behaviors. Stability balls have been used as interventions to affect student behavior. The objective of this study was to determine whether the use of stability balls elicits more physical activity than the use of regular chairs and whether stability balls positively influence behavior. METHOD: Participants (n = 43 fourth graders) sat on stability balls during class and wore accelerometers. Eight were randomly selected for behavioral observations using momentary time sampling. RESULTS: Significant decreases in accelerometer counts were found. No obvious difference for on-task behaviors was found between students using stability balls and those using chairs. CONCLUSION: Stability balls do not necessarily elicit more physical activity than do chairs; however, students accumulate light-intensity physical activity when using them. Classroom behavior was not detrimentally affected by stability ball use; thus, stability balls do not appear to detract from the classroom instructional atmosphere.

School-based physical activity promotion: a conceptual framework for research and practice.

Despite public health concerns and the many recognized benefits of physical activity (PA), levels of participation among youth remain below national recommendations. To this end, a variety of strategies for promoting physical activity for youth have been advocated, including multi-faceted, school-based approaches. One that continues to be identified as having great potential is a comprehensive school physical activity program (CSPAP). The aim of this article is to introduce a conceptual framework for school-based PA promotion that serves to stimulate, guide, and organize related research and practice. The CSPAP conceptual framework is a proposed framework, informed by existing science, recommendations, and a social ecological perspective with individual PA behavior as the epicenter. Discussed in turn are the four proposed interactive levels of influence (i.e., components, facilitators, leaders, and culture) and several integral elements proposed to operate at each level. The article concludes with a presentation of the utility of the framework for research and practice.

Impact of recess interventions on children's physical activity--a meta-analysis.

OBJECTIVE: The purpose of this paper was to explore the effect of recess interventions on children's physical activity (PA) levels and to examine which specific interventions/characteristics have more influence on children's PA. DATA SOURCE: Academic Search Premier, CINAHL, ERIC, MEDLINE, ProQuest, SPORT Discus. STUDY INCLUSION AND EXCLUSION CRITERIA: Papers published between 1986 and 2012, published in the English language, and evaluating any recess intervention with PA as an outcome. DATA EXTRACTION: Study outcomes were distilled into seven domains related to PA: age, gender, intervention type, intervention duration, duration of PA per intervention session, outcome measures, and study region. DATA SYNTHESIS: Effect sizes were pooled within and across studies for each domain separately. Moderator analyses were performed using gender, age, and total length of intervention. Twenty-three independent samples were provided from 13 studies. RESULTS: The estimated overall effect size for time in PA was .56 (SE .07), suggesting a positive and significant mean difference between pretest and posttest PA time after implementing a recess intervention. Differences in PA levels were moderated by age, duration and type of intervention, and type of outcome measures. CONCLUSION. The limited evidence suggests recess interventions can improve youth PA levels. Implications reinforce the importance of schools in advocating for recess during the school day. Strategies shown to increase student PA during recess should be implemented.

Children's physical activity levels during indoor recess dance videos.

BACKGROUND: Children's physical activity (PA) levels remain low, and schools are being asked to assume a leadership role in PA promotion. Research suggests outdoor recess contributes to children's overall PA levels. However, similar research is not available for indoor recess, which occurs frequently due to a variety of factors. The purpose of this study was to describe PA levels and intensity during indoor recess using PA dance videos. METHODS: Fifty-four children (27 girls) wore accelerometers for 5 days during indoor recess. Factorial analyses of variance were conducted to examine the differences in PA between sexes and across grades. RESULTS: Participants averaged 17.66 (SD = 2.82) minutes in indoor recess. On average, 22.22% (SD = 12.72) was spent in moderate-to-vigorous physical activity (MVPA), and 45.70% (SD = 11.29) of time was spent in low-intensity physical activity (LPA) totaling 67.92% (SD = 16.54) of total recess time. Boys accumulated a higher percentage of MVPA and total PA compared to girls. CONCLUSIONS: Students engaged in PA 68% of indoor recess time, equaling almost 12 minutes of PA during recess. Results suggest PA dance videos are 1 effective method for increasing elementary children's PA during indoor recess as an alternative to sedentary activities.

Incorporating physical activity into the schools using a 3-tiered approach.

BACKGROUND: Public health models have been used to address a number of school-based concerns, notably in the identification and treatment of students at-risk for academic or behavioral deficits. Significant benefits are associated with this model as, compared to a traditional approach, the focus is shifted from remediation to prevention, and from student pathology to student strengths. METHODS: Although this model has been applied to multiple populations and used across a variety of settings, it has yet to be conceptualized as a framework for the integration of school-based physical activity (PA). RESULTS: This article first reviews the public health service delivery model as well as the benefits of PA on children's physical health, mental health, and cognitive outcomes. Second, suggestions for incorporating PA into the schools using a 3-tiered system and as barriers to success are discussed. CONCLUSION: School-based PA is a promising tool-and yet an overlooked and undervalued intervention-for a number of concerns applicable to children's academic achievement and overall mental health.

Perspectives on physical activity and exercise among Appalachian youth.

BACKGROUND: Most children in the United States receive far less physical activity (PA) than is optimal. In rural, under resourced areas of Appalachian Kentucky, physical inactivity rates are significantly higher than national levels. We sought to understand children's perceptions of PA, with the goal of developing culturally appropriate programming to increase PA. METHODS: During 11 focus groups, we explored perspectives on PA among 63 Appalachian children, ages 8-17. Sessions were tape recorded, transcribed, content analyzed, and subjected to verification procedures. RESULTS: Several perspectives on PA emerged among these rural Appalachian youth, including the clear distinction between PA (viewed as positive) and exercise (viewed as negative) and an emphasis on time and resource factors as barriers to adequate PA. Additional PA determinants expressed in the focus groups are similar to those of other populations. We include children's recommendations for appealing PA programs. CONCLUSIONS: Appalachian and other rural residents contend with the loss of rural health advantages (due to declines in farming/other occupational and avocational transitions). At the same time, Appalachian residents have not benefitted from urban PA facilitators (sidewalks, recreational facilities, clubs and organized leisure activities). Addressing low PA levels requires extensive community input and creative programming.

Systematic review of recess interventions to increase physical activity.

BACKGROUND: With the rapid increase in obesity rates among youth, efforts to increase physical activity (PA) have become a priority. School-based strategies for PA promotion must be cost-effective, unobtrusive, and linked to improved academic performance. Efforts to maximize recess PA are advocated because of both health and academic benefits. The purpose of this manuscript was to review recess interventions aimed to improve PA among youth, and make recommendations to develop related best practices. METHODS: An extensive literature search was conducted to include all primary research articles evaluating any recess intervention with PA as an outcome. RESULTS: The included 13 interventions represented both settings within the U.S and internationally, among preschools and elementary/primary schools. A variety of strategies were used within the design and implementation of each of the interventions including: added equipment/materials, markings, zones, teacher involvement, active video games, activity of the week, and activity cards. Of the included studies, 95% demonstrated positive outcomes as a result of the recess intervention. CONCLUSIONS: A number of simple, low-cost strategies can be implemented to maximize the amount of recess time students are allotted. Long-term follow-up studies are warranted for each of the recess strategies identified to be effective.

Physical education's contribution to daily physical activity among middle school youth.

Little is known about the exact contribution of physical education (PE) to total daily physical activity (PA) among children and adolescents. Therefore, the purpose of this study was to describe the PA of middle school students during PE and non-PE days and determine if children would compensate for a lack of PE by increasing their PA later in the day. Two hundred seventy nine students (159 boys, 120 girls) wore pedometers (Walk4Life LS252, Plainfield, IL) during 5 school days, with at least two of the days including scheduled PE. The least (~1,575; 31% increase), moderately (~2,650; 20% increase), and most highly active students (~5,950; 34% increase) accumulated significantly more daily step counts on days when they participated in PE. Nearly three times the percent of boys (37%) and more than two times the percent of girls (61%) met the recommended steps/day guidelines on days when PE was offered. Rather than a compensatory effect, the most highly active students were more active on school days with PE, even after accounting for the steps they accrued in PE. The evidence is consistent with other studies that have found that PE contributes meaningfully to daily PA, that youth do not compensate when they are not provided opportunities to be physically active in school-based programs, and some youth are stimulated to be more active when they participate in school-based PA programs.

Physical education's role in public health: steps forward and backward over 20 years and HOPE for the future.

The 1991 paper, "Physical education's role in public health" described the importance of physical education in addressing public health problems. On its 20th anniversary, this article reviews accomplishments in improving the health impact of physical education and identifies areas lacking progress. Major accomplishments include development of evidence-based programs, documentation of health and academic benefits of physical education, and acceptance of physical education as a public health resource. Additional work is needed to evaluate the uptake of evidence-based programs, improve national surveillance of physical education quantity and quality, establish stronger policies supporting active physical education, and achieve wide acceptance of public health goals within the physical education field. These opportunities constitute an agenda for actualizing the promise of health-optimizing physical education before the next 20 year anniversary.

School day segmented physical activity patterns of high and low active children.

BACKGROUND: Variability exists in children's activity patterns due to the association with environmental, social, demographic, and inter-individual factors. This study described accelerometer assessed physical activity patterns of high and low active children during segmented school week days whilst controlling for potential correlates. METHODS: Two hundred and twenty-three children (mean age: 10.7 ± 0.3 yrs, 55.6% girls, 18.9% overweight/obese) from 8 north-west England primary schools wore ActiGraph GT1M accelerometers for 7 consecutive days during autumn of 2009. ActiGraph counts were converted to minutes of moderate (MPA), vigorous (VPA) and moderate-to-vigorous (MVPA) physical activity. Children were classified as high active (HIGH) or low active (LOW) depending on the percentage of week days they accumulated at least 60 minutes of MVPA. Minutes spent in MPA and VPA were calculated for school time and non-school time and for five discrete school day segments (before-school, class time, recess, lunchtime, and after-school). Data were analysed using multi-level modelling. RESULTS: The HIGH group spent significantly longer in MPA and/or VPA before-school, during class time, lunchtime, and after-school (P < .05), independent of child and school level factors. The greatest differences occurred after-school (MPA = 5.5 minutes, VPA = 3.8 minutes, P < 0.001). MPA and VPA were also associated with gender, BMI z-score, number of enrolled children, playground area per student, and temperature, depending on the segment analysed.The additive effect of the segment differences was that the HIGH group accumulated 12.5 minutes per day more MVPA than the LOW group. CONCLUSIONS: HIGH active children achieved significantly more MPA and VPA than LOW active during four of the five segments of the school day when analyses were adjusted for potential correlates. Physical activity promotion strategies targeting low active children during discretionary physical activity segments of the day, and particularly via structured afterschool physical activity programs may be beneficial.