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The contribution of regular physical activity to health

This is an excerpt from Implementing Physical Activity Strategies by Russell Pate & David Buchner.

Research has established the contribution of regular physical activity to key health outcomes, such as obesity prevention and musculoskeletal development, and to educational outcomes, such as attentiveness, cognitive processing, discipline, and academic performance (USDHHS 2008). However, American children's physical activity levels have been declining during the past several decades (Knuth and Hallal 2009; Sturm 2005; Sturm 2008) and many children and youth are not active at recommended levels. Young people spend approximately half of their waking hours in school settings, and recent studies have demonstrated a positive contribution of school-based physical activity to children's overall physical activity levels and to weight management (Fernandes and Sturm 2011; Jackson et al. 2010; Wu et al. 2011). Hence, schools are prime targets for interventions that increase children's physical activity levels (Gonzalez-Suarez et al. 2009; Naylor and McKay 2009). A Cochrane review of school-based physical activity programs showed that such interventions have resulted in increased physical activity, decreased television viewing time, and improved aerobic capacity and blood cholesterol levels (Dobbins et al. 2009).

Physical activity during the school day has traditionally come in the form of recess, a supervised but unstructured time for free play, imagination, movement, stress relief, enjoyment, rest, and socialization, with demonstrated physical, social, emotional, cognitive, and organizational benefits (Beighle 2012; Ramstetter et al. 2010). However, because of an increased emphasis on standardized testing, time allotted to recess during the elementary school day is decreasing (Lee et al. 2007; Pressler 2006; UCLA and Samuels and Associates 2007). (Time devoted to physical education is decreasing too, for the same reason; Henley et al. 2007; McKenzie and Kahan 2008). Some schools have banned traditional vigorous recess activities such as playing tag, climbing monkey bars, and running, because of fear of liability for injury (e.g., Bazar 2006), despite case law that makes this unlikely (Spengler et al. 2010).

Schwinn© is used by permission from Pacific Cycle Inc.

Ridgers and colleagues (2011) observed significant decreases in recess and lunchtime moderate and vigorous physical activity, with commensurate increases in sedentary time, during the periods 2001-2006 and 2003-2008; these changes were magnified in older children. Similarly, data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) demonstrated that although approximately half (40-50 percent) of 6- to 11-year-old youth were active at levels that met current Centers for Disease Control and Prevention (CDC) recommendations (i.e., more than 60 minutes of at least moderate-intensity physical activity on five or more days per week), only 6 to 11 percent of 12- to 15-year-old youth achieved this level of activity (Whitt-Glover et al. 2009). In addition, 6- to 11-year-olds spend an average of 5.9 hours per day in sedentary behaviors, whereas 12- to 15-year-olds spend 7.8 hours per day in sedentary behaviors (Whitt-Glover et al. 2009).

In fact, studies in the emerging field of inactivity physiology have demonstrated the adverse consequences of prolonged sitting, independent of failure to achieve recommended levels of moderate to vigorous intensity physical activity (MVPA) (Dunstan et al. 2011; Owen et al. 2010). The sharp decline in physical activity and increase in sedentary behaviors during the ages of transition to adolescence suggest that the period between childhood and adolescence may be a critical time for intervening regarding physical activity. This may be an especially important period for children from racial and ethnic minority backgrounds, given data showing that teachers whose students were predominantly black or from low-income households reported less time allocated for recess than did teachers of white and more affluent students (Barros et al. 2009).

A number of strategies can be used to increase children's physical activity levels during recess. These strategies, which are particularly effective in combination, include providing inexpensive playground equipment (e.g., plastic hoops, jump ropes, and bean bags), training recess supervisors to organize or teach games and interact with students, painting playground surfaces with lines for games or murals, and designating playground "activity zones" (Beighle 2012; Stratton and Leonard 2002; Taylor et al. 2011; Verstraete et al. 2006).

The private sector is responding to the recess deficit. One notable example is PlayWorks, a nonprofit group that serves 129,000 students in 320 schools across the United States by structuring recess using trained adult coaches and student coach assistants (Robert Wood Johnson Foundation 2007). Another is the Dannon company's Danimals Rally for Recess campaign, an online contest to encourage schools to resurrect recess, offering prizes for meeting certain benchmarks and lottery drawings to win construction of a playground. Many corporations and foundations provide play equipment to schools.

Reprinted, by permission, from Playworks. Photo: Anukul Gurung.

Despite the role of recess as a venerable and cherished school institution and recent efforts to increase the amount of energy children expend during recess (e.g., Morabia and Costanza 2009), little rigorous research has evaluated efforts to stem the erosion of recess. Considerable debate exists about the benefits of free play versus structured play, duration and timing of breaks, optimal supervision and monitoring arrangements, and changing needs as children age (Ramstetter et al. 2010; Robert Wood Johnson Foundation 2007). For example, a recent study found that permanent school playground facilities were associated with children's physical activity levels, but school physical activity policies were not. Two clear messages emerging from the sparse literature, and from practice-based evidence, are that recess should be considered children's personal time and should not be withheld for academic or punitive reasons and that physical activity (e.g., running, calisthenics) should not be used as a punishment (Ramstetter et al. 2010)

NPAP Tactics and Strategies Used in This Program

Education Sector

  • Strategy 1: Provide access to and opportunities for high-quality, comprehensive physical activity programs, anchored by physical education, in Pre-kindergarten through grade 12 educational settings. Ensure that the programs are physically active, inclusive, safe, and developmentally and culturally appropriate.
  • Strategy 2: Develop and implement state and school district policies requiring school accountability for the quality and quantity of physical education and physical activity programs.
  • Strategy 3: Develop partnerships with other sectors for the purpose of linking youth with physical activity opportunities in schools and communities.

Program Description

Physical activity breaks, opportunities to incorporate physical activity into the school day, can supplement the levels of activity obtained through recess and physical education classes (Barr-Anderson et al. 2011; Katz et al. 2010; Trost 2007; Trost, Fees, and Dzewaltowski 2008; Weeks et al. 2008). Unlike recess, a topic on which research has been scarce, physical activity breaks have been the subject of a number of recent studies. These breaks, which incorporate short, structured, group physical activities into the school routine, are an environmental intervention that requires minimal upfront or ongoing costs and offers ready exportability and cultural adaptability. The White House Childhood Obesity Task Force Report identified activity breaks as a key secondary school strategy, because recess is seldom an option for older students (United States White House Task Force on Childhood Obesity 2010). Research has demonstrated improvements in individual behaviors and health outcomes (e.g., increased MVPA, attenuated excess weight gain, lowered blood pressure, increased bone density) as well as organizational benefits (improved academic performance, longer attention spans, fewer disciplinary problems) among students participating in classroom physical activity breaks (Barr-Anderson et al. 2011; Murray et al. 2008). Furthermore, classroom physical activity breaks have been shown to improve students' attention and behavior, whereas breaks without physical activity do not (CDC 2010). An additional benefit of classroom-based physical activity interventions is that teachers and other school personnel may be engaged as active role models for students (Alexander et al. 2012; Donnelly et al. 2009; Erwin et al. 2011; Institute of Medicine 2006, 2009; Kibbe et al. 2011; Sibley et al. 2008; Woods 2011).

Take 10! (T10) and Instant Recess(IR) are examples of school-based physical activity break interventions with demonstrated success in increasing students' physical activity levels and improving academic engagement. In contrast to recess or physical education class, in which students are required to exit the classroom to engage in physical activity, these interventions bring physical activity into the classroom in order to increase children's physical activity during the school day. The two programs take different approaches: T10 incorporates brief bouts of physical activity into students' academic lessons, whereas IR is intended as a mental respite for students and teachers. The programs are similar in that both align with a number of the Education Sector strategies endorsed by the National Physical Activity Plan (NPAP). This chapter provides a review of T10 and IR, including an overview of how they relate to those NPAP strategies.

Take 10! (T10)

Introduced in 1999, T10 isa school-basedprogram that has demonstrated the feasibility and utility of using 10-minute physical activity breaks in the elementary school classroom setting.Studies have shown that these breaks engage students in exercise of sufficient intensity and duration to count toward CDC-recommended levels: for example, average MET levels of 5 to 7 for first, third, and fifth graders, with commensurate caloric expenditures of 27 to 36 calories and step counts of 600 to 1,400 per 10-minute session (Kibbe et al. 2011; Lloyd et al. 2005; Stewart et al. 2004). (One MET is the metabolic equivalent equal to 3.5 milliliters of oxygen consumed per kilogram and per minute.)The breaks also improve on-task time, particularly in students who are easily distracted (Mahar et al. 2006; Mahar 2011). With its grade-level targeted curriculum, T10 provides an example of Strategy 1 of the Education Sector of the NPAP: Provide access to and opportunities for high-quality, comprehensive physical activity programs, anchored by physical education, in prekindergarten through grade 12 educational settings. Ensure that the programs are physically active, inclusive, safe, and developmentally and culturally appropriate.

Whereas T10 emphasizes being active while learning (Kibbe et al. 2011), Physical Activity Across the Curriculum (PAAC), a federally funded study of a variation of T10 that is being conducted at the University of Kansas, focuses on making physical activity integral to the lesson (DuBose et al. 2008). Research findings demonstrate that PAAC engaged 60 to 80 percent of elementary school non - physical education teachers in conducting T10 breaks in 24 low- to moderate-resource public schools in three eastern Kansas cities (Donnelly et al. 2009; Honas et al. 2008). Study staff provided teacher training in a six-hour, off-site in-service session at the beginning of each school year. The gradual increase in the number of teachers engaged each year and the number of minutes provided reflected a progressive cultural norm change (an average of 70 minutes a week of activity was offered, and nearly 50 percent of teachers achieved the goal of 90-100 minutes a week after two years).

PAAC increased children's physical activity levels, in school and outside of school and on both weekdays and weekend days, suggesting that children do not offset increases in school-based physical activity with decreases in out-of-school physical activity. PAAC also improved reading, math, spelling, and composition scores. In the intervention schools that averaged more than 75 minutes of active lessons weekly, students gained less weight than those in control schools.

Instant Recess (IR)

IR, previously known as Lift Off!,consists of 10-minute themed physical activity breaks, usually performed to music, with simple movements based on sports or ethnic dance traditions. IR is scientifically designed to engage major muscle groups, maximizing energy expenditure, enjoyment, and engagement of individuals of varying ability levels while minimizing perceived exertion and injury risk. IR began as a worksite wellness project of the Chronic Disease Prevention division of the Los Angeles County Department of Health Services in 1999 and expanded as a partnership between state and local health agencies, universities, foundations, corporations, and nonprofit groups (Yancey 2010; Yancey et al. 2004a, 2004b, 2006). Involvement with professional sports teams in 2006 led to the adaptation of IR for the school setting. In contrast to T10, in which the onus generally is on teachers to determine how best to incorporate activity into their lesson plans and to lead the physical activities themselves, IR is an extracurricular turnkey or "plug and play" intervention that is usually technology mediated (Yancey et al. 2009). IR breaks may be distributed as DVDs or CDs, streamed from the Internet, or uploaded as electronic files to district servers accessed by teachers through intranet "smart boards" or closed-circuit TV.

Learn more about Implementing Physical Activity Strategies.

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