This is an excerpt from Comprehensive School Physical Activity Programs by Russell Carson & Collin Webster.
Review of Research
The following sections will review literature pertaining to school-based interventions. The first section will examine key school-based interventions that preceded the term “CSPAP,” and the second section will specify evaluation studies performed on CSPAP interventions.
Pre-CSPAP Evaluation Studies
When thinking of seminal work regarding multicomponent school PA interventions, the Sports, Play, and Active Recreation for Kids (SPARK) project (Sallis et al., 1997) is at the top of the list. SPARK was a PA intervention designed to increase PA of elementary aged youth both in physical education class and at home. The intervention was based primarily in physical education. However, a self-management program that focused on increasing PA outside of school included newsletters and homework for youth and families. Results showed a significant increase in PA for those youth who participated in the SPARK intervention, with youth who were taught by a certified physical education teacher experiencing the most gains. Girls also experienced significant gains in abdominal strength and cardiovascular endurance.
The Coordinated Approach to Child Health (CATCH) program has shown numerous benefits to youth over the past decade with early results focusing on significant changes in cardiovascular risk factors (Luepker et al., 1996). A total of 56 intervention schools (40 control schools; N = 5,106) participated in the CATCH program, which included food service modifications, enhanced physical education, and classroom health curricula, and half received additional family education components. The randomized controlled trial that took place across four states showed increases in moderate-to-vigorous PA (MVPA) and a decrease in fat content served at lunch (Luepker et al., 1996). A follow-up to the original CATCH study showed behavioral changes were still present after a three-year period following the intervention (Nader et al., 1999).
In 2003, Caballero and colleagues examined a three-year healthy eating and PA intervention among American Indian youth. The purpose of their study was to examine a multicomponent intervention that included both nutrition and PA components. The PA components included classroom PA breaks; increased energy expenditure during physical education; guided play during recess; and family and community engagement in the form of family fun nights, workshops, and family packs linked to the classroom curriculum. A total of 1,704 youth across 41 schools participated in the study. A decrease in total fat intake but not a reduction in body mass index (BMI) were found.
The Lifestyle Education for Activity Program (LEAP) was designed to increase the PA levels of high school girls through a comprehensive school-based intervention (Pate et al., 2005). The LEAP program was designed after the CATCH program and focused on physical education, health education, school environment, school health services, faculty and staff health promotion, and family and community involvement. This program was unique because it targeted high school girls and increasing behaviors and attitudes toward PA. After one year of intervention, girls in the intervention schools significantly increased vigorous PA compared to those in comparison schools. It is important to note that this program was based on self-reported, three-day PA recall and PA was not objectively measured.
Lubans and colleagues (2011) designed a comprehensive intervention for adolescent boys, which took place in secondary schools in Australia. The primary outcome of the intervention was decreased BMI; secondary outcomes included decreased percent body fat and waist circumference and increased muscular fitness and PA. The duration of the program was six months; the program consisted of school sport sessions, interactive seminars, lunchtime activities, PA and nutrition handbooks, leadership sessions, and pedometers for self-monitoring. Significant reductions were found for BMI and percent body fat, but no change was found for waist circumference, muscular fitness, and PA.
Also, in 2011, Puder and colleagues worked with preschool children to determine if a multicomponent preschool intervention that was culturally relevant for migrant children would decrease BMI and body fat while increasing aerobic fitness. The intervention consisted of structured PA lessons during the week, nutrition lessons, family communication about PA, sleep and screen time, and built environment changes within the preschool classroom. Although BMI did not significantly decrease, there were positive effects on aerobic fitness, waist circumference, percent body fat, PA, media use, and eating habits.
Finally, the Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools (HEROES) program (Seo et al., 2013) included 1,091 students who participated in a comprehensive intervention with a goal to increase PA of students. Schools made changes in their environment based on individual situations, but all intervention activities were led by a school wellness coordinator. Students significantly increased vigorous PA over the 18-month period but did not significantly improve moderate PA. School-level implementation, however, was a significant predictor of vigorous PA, and small school size predicted moderate PA.
CSPAP Evaluation Studies
Given that the term CSPAP is new, there are fewer studies that identify themselves as evaluating a CSPAP, although some would argue that many studies mentioned previously would qualify as CSPAP interventions. Literature detailing specific CSPAP interventions most often refers to outcomes in metrics, such as increased PA and aerobic capacity, decreased sedentary time, and the prevalence of obesity. Some literature apply more of a whole-of-school approach, which also include nutrition, to study more distal outcomes, such as classroom behavior and academic achievement.
In 2014, the Journal of Teaching in Physical Education released a monograph that included the first set of published research articles that were identified as CSPAPs. In this issue, Centeio and colleagues (2014) described a CSPAP that was implemented with urban students that affected PA levels of both students and parents. Specifically, an intervention that included quality physical education, classroom PA, and after-school PA clubs was implemented across one school year. The primary outcome measure was PA, which was objectively measured with students and subjectively measured with adults. After eight months, Centeio and colleagues (2014) reported that students had increased their MVPA by 4.5 minutes a day, and parents also reported an increase of PA.
Also in 2014, Carson, Castelli, and colleagues trained teachers to become PA leaders. Teachers were then expected to implement CSPAPs in their respective districts in the upcoming school year. Carson, Castelli, and colleagues measured the number of PA opportunities offered by teachers as well as students' PA levels and sedentary behavior using a wearable device. They found that teachers implemented significantly more opportunities for students to be physically active but the effect on students' actual behaviors over eight months was small. All students decreased their time spent in MVPA and increased time spent in sedentary behaviors, with students of trained teachers recording slightly better levels at postintervention (e.g., spent more time in MVPA and less time being sedentary than comparison students).
Step counts were targeted for a CSPAP intervention that was conducted by Burns and colleagues (2015), which focused on quality physical education and having students spend 50 percent or more of physical education classes in MVPA. Additionally, schools promoted active recess and integrated classroom PA breaks. Results showed that intervention students increased their steps from pre- to postintervention by approximately 1,126 steps per day (Burns et al., 2015).
In a related CSPAP study conducted by similar authors with at-risk elementary aged youth (N = 1,460), Brusseau et al. (2016) reported that the three-month CSPAP intervention significantly increased students' steps (an increase of ~603 steps per day) and time spent in MVPA (~5 minutes per day) as well as health-related fitness measures (Progressive Aerobic Cardiovascular Endurance Run [PACER] laps, push-ups, and curl-ups; Brusseau et al., 2016). A significant decrease in BMI (small effect size) was also found at the end of 12 weeks. This intervention consisted of three CSPAP components: quality physical education, PA during the school day (classroom and recess), and PA before and after school. These results are consistent with the results found by Centeio and colleagues (2014), who reported an increase of MVPA of approximately 4.5 minutes a day.
In 2016, Burns and colleagues (2016) examined change in elementary children's (N = 1,460) classroom behavior while a CSPAP was being implemented. Although there was no control group, they saw a significant increase in on-task behavior after CSPAP implementation in 70 classrooms over 6- and 12-week periods.
In 2017, Centeio and colleagues reported the impact of an eight-month CSPAP program on youth rate of improvement in reading and math achievement. They found that levels of PA (measured in steps) had a direct impact on youth rate of improvement in math and the level of school implementation of the CSPAP had a direct impact on rate of improvement in reading (Centeio, Somers, et al., 2018). Although there was no control group, this study is one of a few studies that examined a full CSPAP in relation to academic achievement of youth.
Also in 2017, Burns and colleagues used cardiometabolic health markers as an outcome measure of a nine-month CSPAP performed in five low-income schools. In this study, the schools hired a physical activity leader to assist in implementing PA experiences throughout the school day. The physical activity leader was responsible for helping the physical education teacher implement quality curriculum, provide semistructured recess for students, instruct classroom teachers on how to implement activity breaks, and provide opportunities for drop-in PA events. Improvements were made amongthird- through sixth-graders in high-density lipoprotein cholesterol, triglycerides, and mean arterial pressure, and sixth-graders also showed improvements in low-density lipoprotein cholesterol (Burns et al., 2017). Although this study did not employ a control group, it is the first of its kind to measure the effects of a CSPAP on the cardiometabolic health markers of youth.
Centeio, McCaughtry, and colleagues (2018) found that the Building Healthy Communities (BHC) program led to a decrease in obesity and central adiposity offifth-grade students. The program was a whole-of-school approach (including a CSPAP) that targeted both PA and healthy eating, with a central focus on PA. The program consisted of six components: quality physical education, principal engagement, classroom education and activity, active recess, student leadership teams, and an after-school PA club. The program was evaluated using a quasi-experimental design with four treatment and two comparison schools. Students in the treatment schools significantly decreased their central adiposity (measured by waist-to-height ratio) and BMI compared to students in the comparison schools, who slightly increased their central adiposity (Centeio, McCaughtry, et al., 2018).
The previously discussed examples measure CSPAPs with different outcome measures. However, the most common measure used has been the PA behavior of students. Few articles examine the impact outside of student outcomes. The study conducted by Centeio and colleagues (2014) assessed the impact of CSPAPs on teachers' and parents' PA levels, and Pulling Kuhn and colleagues (2015) found that the work engagement of CSPAP-trained teachers significantly increased when compared to a control group.
Given the information previously provided, following are the knowledge claims that we know about CSPAPs.
- Many multicomponent school intervention programs have been successful at increasing PA behaviors of youth, irrespective of gender. Most programs measure physical activity or MVPA, but some of them have shown success in decreasing BMI.
- Most outcome measures of the evaluations conducted focus on youth PA levels and overweight and obesity. Although not a focus of this chapter, many of the successful interventions also include nutrition programming in addition to the PA programming.
- Few studies saw a decrease in BMI or obesity-related measures.
- Among the few studies that have examined the extended impact of multicomponent school programming in adults (parents and teachers), the effects are promising.
- Common components include classroom PA breaks and quality physical education as the two components mostly present in the current CSPAP interventions.
Knowledge Gaps and Directions for Future Research
Understanding where the field has been and where it should be headed regarding the evaluation of CSPAPs is important. After reviewing the evaluation literature in relation to CSPAPs, the authors have outlined where they believe knowledge gaps exist and some suggestions for future research. To begin, little if any CSPAP research has been conducted with randomized controlled groups or using a randomized controlled trial (Centeio, McCaughtry, et al., 2018). Future research should include randomized controlled groups in order to fully understand the impact of such interventions. Additionally, little research has examined the effect that CSPAPs have on the collective school environment (e.g., policies) and longitudinally how these cultural shifts might affect youth health and behaviors post-CSPAP intervention. Furthermore, few CSPAP studies have focused on outcome measures beyond physical health indicators (e.g., academic achievement and on-task behavior). Understanding the collective effects of CSPAPs on academic achievement could be one way to advocate for CSPAPs among principals and school personnel who value academic classroom time.
In addition to the previous suggestions, among the literature that was reviewed, most programs are designed for elementary aged students, and few of the interventions previously mentioned are specifically designed for preschool or secondary education settings. Although there have been successful interventions at the elementary level, future research should be conducted to better examine preschool- and secondary level interventions to evaluate the effectiveness of these programs. In addition, few if any publications discuss process evaluation of CSPAP programming. Carson, Pulling, and colleagues (2014) presented a mixed-methods evaluation of the delivery of national CSPAP trainings, but published manuscripts have yet to examine the process that it takes to implement the resultant comprehensive programs. Additionally, there is no known literature that discusses the cost effectiveness of implementing CSPAPs into the school setting and the amount of money they are saving long term. Finally, to date, there is no longitudinal data about the impact that participation in CSPAPs during youth has on adult PA and beyond the K-12 environment. Given the amount of time and money that it takes to implement CSPAPs into the school setting, understanding beyond the short-term effects is important because it influences the health benefits tracking into adulthood.