6

Approaches to Physical Activity in Schools

Key Messages

•  Data are insufficient to permit assessment of opportunities for and participation in sedentary activities in schools.

•  Schools need to strive to reduce unnecessary opportunities for sedentary behavior.

•  When embracing the advantages of technology for learning, schools need to be aware of its negative impact on students’ physical activity behavior.

•  Recess has been shown to be beneficial for academic achievement. It is counterproductive to withhold recess or replace it with classroom activities as a punishment.

•  Several models and examples demonstrate that scheduling multiple daily recess periods during the school day is feasible.

•  School-based sports and active transport provide opportunities for physical activity but may not be accessible or attractive for all youth.



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6 Approaches to Physical Activity in Schools Key Messages • Data are insufficient to permit assessment of opportunities for and participation in sedentary activities in schools. • Schools need to strive to reduce unnecessary opportunities for seden- tary behavior. • When embracing the advantages of technology for learning, schools need to be aware of its negative impact on students’ physical activity behavior. • Recess has been shown to be beneficial for academic achievement. It is counterproductive to withhold recess or replace it with classroom activities as a punishment. • Several models and examples demonstrate that scheduling multiple daily recess periods during the school day is feasible. • School-based sports and active transport provide opportunities for physical activity but may not be accessible or attractive for all youth. 259

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260 Educating the Student Body These opportunities need to be reexamined to address disparities based on socioeconomic status, school location and resources, stu- dents’ disabilities, or cultural/religious barriers. • Participation in intra- and extramural sports has flourished over the past 40 years; however, school systems need to ensure that equitable sports opportunities are available for youth in all types of school set- tings and at all levels of socioeconomic status. • Nonsport after-school programs should include physical activity. • Active transport to and from school can be a safe and effective way to increase students’ daily physical activity, especially where a large proportion of students live close to their school. • Each community needs to examine systematically opportunities for community-based promotion of physical activity. • Inviting students’ families and other community members to par- ticipate in developing before- and after-school programs, including sports and active transport, will increase program sustainability. I t has been argued that, while reversing the obesity epidemic is not solely the responsibility of schools, the trend is unlikely to change without schools’ assistance (Siedentop, 2009). Schools are an ideal venue for the implementation of healthy behaviors because they serve more than 56 mil- lion youth in the United States; because youth spend such a large amount of time in school; and because schools already have the access, personnel, equipment, and space to implement physical activity programming. Physical activity opportunities in schools take the form primarily of formal instruction in physical education for all students and sport-based athletics for the talented and interested. Although physical education is a required school subject, the classes may occur infrequently, and children taking them often accrue only low levels of physical activity (Simons- Morton et al., 1994). According to Tudor-Locke and colleagues (2006), physical education programs typically provide only 8-11 percent of a stu- dent’s daily recommended physical activity. However, a meta-analysis of the literature revealed that physical education can help children achieve up to 40 percent of the recommended 60 or more minutes of daily vigorous- or

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Approaches to Physical Activity in Schools 261 moderate-intensity physical activity per day (Bassett et al., 2013; see also Chapter 5). Mahar (2011) states that children’s physical activity levels are directly related to the opportunities they have to be active. Schools have the poten- tial to influence the physical activity behaviors of their students through various opportunities in addition to physical education (e.g., recess periods, classroom physical activity breaks, active transport to and from school; van Landeghem, 2003). Furthermore, children are sedentary for much of the school day, and emerging evidence suggests that long periods of inactiv- ity should be avoided. Thus it is essential for the school setting to provide opportunities outside of physical education for school-age children to be physically activity throughout the school day. This chapter reviews the status and trends of sedentary behavior in schools and describes opportunities for physical activity in the school envi- ronment other than physical education, including classroom activity breaks, recess, intra- and extramural sports, active transport, and after-school pro- grams. Also reviewed are policies that may affect these opportunities, as well as barriers to and enablers of the opportunities. Chapter 7 examines the evidence on the effectiveness of these physical activity opportunities. Sedentarism in schools The committee did not identify a widely recognized definition of sed- entarism, a new word in the English language, but one that exists in other languages to describe sedentary behaviors, sedentary activities, a sedentary lifestyle, or physical inactivity. Bernstein and colleagues (1999) describe sed- entarism in terms of energy expenditure, while Ricciardi (2005) defines it in terms of what it is not, that is, not engaging in physical activity. Probably the most commonly accepted definition is time spent other than in sleep, or time spent in vigorous-, moderate-, or light-intensity physical activity. The word also is used to describe the status of a person or a population with high levels of sedentary behaviors or a sedentary lifestyle. Sedentarism can be categorized as (1) recreational sedentarism, which refers mainly to media use or “screen time” but can also include more traditional sedentary activities such as recreational reading or having a con- versation while sitting, and (2) nonrecreational sedentarism, which refers to schoolwork or other types of work that occur while sitting and also to other sedentary activities that are necessary to perform daily tasks, such as motor- ized transportation or eating a meal. Most of the public health interest in sedentarism has focused on decreasing recreational sedentarism, especially screen time, but there is increasing interest in ways to alter sedentary work so it can be performed while engaging in light physical activity or even while standing. Standing desks and treadmill desks are becoming popular

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262 Educating the Student Body for adults in the workplace, for example, and many schools are seeking creative ways to integrate light physical activity into traditionally sedentary schoolwork. Such efforts are important given the amount of sedentary time entailed in schoolwork. In Australia, for example, 42 percent of nonscreen sedentary time is school related (Olds et al., 2010). Such efforts to address nonrecreational sedentarism are just emerging, and much research and innovation are needed to move these efforts for- ward. On the other hand, significant research already exists on decreasing recreational sedentarism, especially among children, to treat or prevent obesity. Today, 46 percent of U.S. children aged 6-11 fail to meet the recom- mendation of less than 2 hours of recreational sedentarism (screen time) per day (Fakhouri et al., 2013). In addition to the nonrecreational sedentarism that occurs while children sit to perform schoolwork, significant recre- ational sedentarism takes place on the way to school and in school during breaks, recess, lunch, and after-school programs. Data are not available on the extent to which recreational sedentarism occurs on school grounds and on whether recreational sedentarism in school should be an important pub- lic health target as it already is outside of school. What is known, however, is that “eight- to eighteen-year-olds spend more time with media than in any other activity besides (maybe) sleeping—an average of more than 7½ hours a day, seven days a week” (Rideout et al., 2010, p. 1). One of the lessons of pediatric obesity research is that behavioral approaches designed to increase physical activity are different from those designed to decrease recreational sedentarism and have different effects on behavior and health. Using behavioral economic theory, Epstein and colleagues (1995) demonstrated that monitoring children and encouraging them to decrease recreational sedentarism was more successful in treating obesity than either promoting physical activity or targeting both physi- cal activity and sedentarism at the same time. Furthermore, the children randomized to the intervention targeting only sedentarism increased their enjoyment of vigorous- or moderate-intensity physical activity, while enjoy- ment of moderate-intensity physical activity decreased among those ran- domized to physical activity promotion; changes in enjoyment among those in the combined intervention group were between those in the other two groups. The importance of targeting a decrease in sedentarism was further highlighted when Robinson (1999) published the first successful school- based obesity prevention intervention that targeted only sedentarism, with no behavioral intervention focused on physical activity promotion or dietary changes. Since then, several randomized trials have confirmed the causal link between recreational sedentarism and childhood obesity (Tremblay et al., 2011). Despite this evidence, however, the approach of specifically targeting sedentarism has received only limited attention. While academic research has focused on using school as a setting in which to teach

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Approaches to Physical Activity in Schools 263 students how to decrease sedentarism outside of school, this approach has not translated into widespread policies or curricula. Such efforts may be particularly important as sedentarism appears to track among individuals from childhood to adulthood (Gordon-Larsen et al., 2004; Nelson et al., 2006). Of interest, a large nationally representative survey found that, “con- trary to the public perception that media use displaces physical activity, those young people who are the heaviest media users report spending similar amounts of time exercising or being physically active as other young people their age who are not heavy media users” (Rideout et al., 2010, p. 12). The question was, “Thinking just about yesterday, how much time did you spend being physically active or exercising, such as playing sports, working out, dancing, running, or another activity?” This finding suggests that media use does not displace vigorous- or moderate- intensity physical activity but more likely displaces light-intensity physical activity, schoolwork, and sleep. Light-intensity physical activity, including playing or even just standing, is more difficult to measure than vigorous- or ­ oderate-intensity physical activity, but its positive health impact is m increasingly being recognized (see Box 2-4 in Chapter 2). The finding of this survey also suggests that promotion of vigorous- or moderate-intensity physical activity may not decrease sedentarism but rather might replace light-intensity physical activity. Therefore, the optimal way to promote an overall increase in physical activity (including light-intensity physical activ- ity) may be to use behavioral approaches to decrease sedentarism, as has been shown in behavioral research (Epstein et al., 1995; Robinson, 1999). One of the challenges to monitoring sedentarism is the fact that children and adolescents frequently multitask. As noted earlier, Rideout and col- leagues (2010) found that U.S. youth aged 8-18 spent more than 7.5 hours per day using recreational media; 29 percent of this time was spent multi- tasking, resulting in a total media exposure of almost 10.5 hours per day. This figure represents an overall increase in sedentarism since 1999, when the corresponding figures were 6.2 hours and 7.3 hours per day, respectively. Television content still dominated sedentary time, accounting for 4.3 hours per day. Computer use for schoolwork (not included in these totals) aver- aged 16 minutes, while computer use for recreational purposes totaled 1.3 hours per day. On a typical day, 70 percent of youth went online for any purpose, including 57 percent at home, 20 percent at school, and 14 percent elsewhere. It is unknown whether all online activities at school were related to schoolwork. In addition to displacing physical activity and schoolwork, recreational media use exposes youth to “a constant stream of messages” that shape their perception of what is normative, including food choices, physical appearance, physical activity, and even sedentarism itself (Rideout et al.,

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264 Educating the Student Body 2010). Usually, these perceived norms are not in line with healthy or aca- demically productive behaviors, and cannot be countered by the best efforts of parents and teachers. As a consequence, compared with those who used recreational media the least, “heavy users” tended to have lower school grades and to report that they were getting in trouble “a lot,” unhappy, sad, or bored (Rideout et al., 2010). Furthermore, in the face of rapidly advanc- ing technology, parents and teachers are not always fully aware of the many ways in which media and marketing are part of youth’s lives. In addition to television and desktop computers, laptops, tablets, and cell phones often follow children and adolescents into the school bus, class, recess, and after- school activities unless such access is limited by policy, providing increasing opportunities to be sedentary on school grounds. In 2009 an average of 20 percent of media consumption, more than 2 hours per day, occurred with mobile devices, some of this media use likely occurring on school grounds. This figure probably has increased since then. Rideout and colleagues also note that children whose parents make an effort to limit media use spend less time consuming media, but whether this holds true for limits on recre- ational sedentarism in the school setting is unknown. Both recreational and nonrecreational sedentarism in schools need to be monitored separately from physical activity. Specific school policies, based on updated knowledge of media use, need to focus on decreasing rec- reational sedentarism in school and integrating prevention of recreational sedentarism outside of school into the education curriculum. Because media use among youth already is significantly higher than recommended, schools should not provide students with increased opportunities for sedentarism, such as television sets in classrooms, the cafeteria, or after-school programs; access to social networks and recreational media on school computers; or the ability to use cell phones anywhere and at any time on school grounds or school transportation. Research is needed to explore sedentarism and media use in schools more systematically so that evidence-based school policies to decrease these behaviors can be implemented to increase overall, including light-intensity, physical activity. In particular, surveys of media use are needed to document the amount of recreational sedentarism taking place in the school setting, where, in contrast with the home setting, public health policy can poten- tially be implemented. Opportunities to increase physical activity in the School Environment School physical activity programs are needed so that schools can ensure they are providing students with 60 minutes or more of vigorous-

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Approaches to Physical Activity in Schools 265 or moderate-intensity physical activity per day. Physical activity programs are neither equivalent to nor a substitute for physical education, and both can contribute meaningfully to the development of healthy, active children (NASPE and AHA, 2012). The former are behavioral programs, whereas the latter are instructional programs. Box 6-1 presents the Healthy People 2020 objectives for non–physical education physical activity opportunities in school settings. The following sections describe various non–physical education oppor- tunities for physical activity in the school environment. The discussion includes relevant policies, barriers, and enablers. BOX 6-1 Healthy People 2020 Objectives for Non– Physical Education Physical Activity Opportunities in School Settings • Increase the number of States that require regularly scheduled elementary school recess. • Increase the proportion of school districts that require regularly scheduled elementary school recess. • Increase the proportion of school districts that require or recommend elementary school recess for an appropriate period of time. • Increase the proportion of the Nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours (that is, before and after the school day, on weekends, and during summer and other vacations). • Increase the proportion of trips of 1 mile or less made to school by walking by children and adolescents aged 5 to 15 years. • Increase the proportion of trips of 2 miles or less made to school by bicycling by children and adolescents aged 5 to 15 years. SOURCE: HHS, 2012.

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266 Educating the Student Body Classroom Activity Breaks An emerging strategy for increasing daily participation in physical activity in schools is the implementation of structured, classroom-based physical activity breaks. Classroom physical activity includes all activity regardless of intensity performed in the classroom during normal classroom time. It includes activity during academic classroom instruction as well as breaks from instruction specifically designed for physical activity. It also includes time spent learning special topics (e.g., art, music) even if not taught by the usual classroom teacher. It excludes physical education and recess even if conducted in the classroom by the usual classroom teacher. It also excludes physical activity breaks during lunchtime. Although some discussions of schooltime activity breaks include such breaks during lunchtime (Turner and Chaloupka, 2012), the committee views lunchtime physical activity as more akin to activity during recess and before and after school than to physical activity during normal academic classroom time. While a number of programs specifically designed to increase the volume of students’ physical activity during usual classroom time exist, the com- mittee found no information about changes in such programs over time at the population level. A typical break consists of 10-15 minutes focused on vigorous- or m ­ oderate-intensity physical activity. This strategy has been found to be effective in significantly increasing physical activity levels of school-age children (Ernst and Pangrazi, 1999; Scruggs et al., 2003; Mahar et al., 2006). Bassett and colleagues (2013) found that classroom activity breaks provide school-age children with up to 19 minutes of vigorous- or mod- erate-intensity physical activity, and the sustained use of such breaks was shown to decrease body mass index (BMI) in students over a period of 2 years (Donnelly et al., 2009). The effectiveness of classroom physical activ- ity breaks is discussed further in Chapter 7. An example of an effective school-based physical activity program is Take 10! Kibbe and colleagues (2011) provide consistent evidence that the Take 10! program has been effective in increasing physical activity levels among a variety of samples of children enrolled in kindergarten through 5th grade in various countries. Likewise, Mahar and colleagues (2006) found that, with the implementation of 10-minute physical activity breaks called “Energizers,” students increased their time on task while averaging approximately 782 more steps in a day. Another example, supported by the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity (2012), is Jammin’ Minute, a realistic and effective “bridge” tool for increasing children’s physical activity until schools have sufficient resources to develop more comprehensive physical education programs. Jammin’ Minute has important implications for advocates and policy makers, as well

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Approaches to Physical Activity in Schools 267 as administrators and teachers, seeking ways to make school environments healthier for children. At the same time, it should be emphasized that, while the benefits of small increases in physical activity during the school day need to be recognized, the ultimate goal of policy makers and advocates should be to ensure that all schools have comprehensive physical education programs (see Chapter 5). Another program, Texas I-CAN!, helped teachers incorporate physical activity by modifying lesson plans to include more active activities, thereby increasing vigorous- or moderate-intensity physical activity by 1,000 steps per day (Bartholomew and Jowers, 2011). It was found that these curriculum-based activities improved time on task immediately following the breaks, especially in children who were overweight; these students went from being on task 58 percent of the time on typical instruction days to 93 percent of the time after the breaks (Grieco et al., 2009). These findings emphasize the effectiveness and feasibility of provid- ing classroom-based structured opportunities for physical activity. Breaks in the classroom provide an additional opportunity for physical activity throughout the school day with minimal planning, no equipment, and a short amount of time required; they can also incorporate learning opportu- nities for students. It should be noted that the literature tends to focus on the effect of classroom physical activity breaks on elementary school rather than secondary school students. For classroom-based physical activity breaks to become a priority, it will be important to provide evidence that such breaks do not detract from academic achievement. Chapter 4 provides an extensive review of the evidence showing that physical activity in general has positive effects on academic performance. With respect to classroom-based physical activity, the Centers for Disease Control and Prevention (CDC) (2010) reviewed studies examining the association between such activity and academic performance in elementary school–age children. Eight of nine published studies found positive effects on such outcomes as academic achievement and classroom behavior; only one study found no relationship (Ahamed et al., 2007), but that study also found that the breaks did increase physical activity levels and did not adversely affect academic achievement. Donnelly and Lambourne (2011) provide further support for the link between physi- cal activity and positive cognitive and academic outcomes in elementary school–age children. In addition, studies in elementary school–age children have found an increase in on-task behavior in the classroom after partici- pation in a physical activity break (Jarrett et al., 1998; Mahar et al., 2006; Mahar, 2011; see also Chapter 4). For example, Mahar and colleagues (2006) found that time on task increased by 8 percent (p < .017) with the implementation of a 10-minute break. They also found that the 20 percent of students who were off task improved the most in time on task. Similar

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268 Educating the Student Body results were found in Georgia, where 4th graders exhibited significantly less fidgeting behaviors and significantly better on-task behaviors on days when activity breaks were conducted (Jarrett et al., 1998). Finally, a meta- analysis by Erwin and colleagues (2012) found that breaks increase the frequency of physical activity behaviors and have positive learning out- comes. It should be noted that the effect and benefits of classroom-based physical activity breaks in preschool populations have not been thoroughly investigated. Policies That Affect Classroom Physical Activity Breaks Classroom physical activity breaks are a relatively new approach to promoting physical activity during the school day. Consequently, research on policies that support or hinder the use of this approach is sparse. For this approach to become more prevalent, supportive policies will be neces- sary, an observation supported by the fact that just one in four U.S. public elementary schools offered children and youth physical activity breaks apart from physical education and recess during the 2009-2011 school years (Turner and Chaloupka, 2012). Research clearly demonstrates the important role of state laws and school district policies in promoting physi- cal activity opportunities in schools. For example, schools are more likely to meet physical education recommendations when state laws and school district policies mandate a specific amount of time for physical education classes (Slater et al., 2012; see also Chapter 5). Currently, few if any school districts require that physical activity opportunities be provided throughout the school day or within the classroom (Chriqui et al., 2010). Therefore, research is needed to identify strategies for implementing classroom-based physical activity breaks and providing teachers with the skills and confi- dence necessary to engage students in these activities. In addition, questions remain about the optimal duration, timing, and programming (e.g., types of activities) for physical activity breaks (Turner and Chaloupka, 2012). Barriers to Classroom Physical Activity Breaks One factor that influences classroom physical activity breaks is com- petition for time during the school day, arising from the need for schools to meet the academic requirements of the No Child Left Behind Act (see Chapter 5). As discussed above and in Chapter 4, however, the literature clearly supports that classroom physical activity breaks are not only benefi- cial in promoting physical activity in children and youth but also can occur in the classroom without compromising learning and in fact improve aca- demic performance and related classroom behaviors. In addition, research has shown that using innovative curriculum change, such as Physical Activity Across the Curriculum (Donnelly et al., 2009), can increase daily

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Approaches to Physical Activity in Schools 269 physical activity and improve academic performance. Additionally, schools often have a scarcity of resources related to staffing, teacher training, funding, champions, and/or facilities for physical activity. Dwyer and col- leagues (2003), for example, document the lack of facilities and equipment for physical activity breaks. As a result of these barriers, it has been found that, although teachers see the importance of physical activity breaks for children’s health and development, they infrequently integrate movement into the classroom (Parks et al., 2007). From the literature, classroom physical activity breaks appear to be heavily implemented in early childhood and elementary classrooms (CDC, 2010). Few if any classroom physical activity breaks appear to occur in mid- dle and high school settings. The lack of physical activity breaks for this age group may be due to the increased academic demands of testing, along with difficulty of implementing breaks that target these older students. However, classroom-based physical activity curricula are emerging at a rapid rate. Programs available for purchase include Active and Healthy Schools activity break cards, Promoting Physical Activity and Health in the Classroom activ- ity cards, Energizers, and Take 10! Other resources for classroom physical activity breaks are available at no cost to schools, such as Jammin’ Minute, ABS for Fitness, Activity Bursts in the Classroom, Game On! The Ultimate Wellness Challenge, and approximately 50 others. These resources can be ­ found through the Alliance for a Healthier Generation at www.healthier generation.org. They provide an excellent starting point for teachers and are flexible enough to be modified to meet the needs of specific classrooms. Space is another concern for classroom teachers, who must consider the safety of students. The classroom (e.g., desks and tables) needs to be arranged to provide adequate open space for students to move during physical activity breaks. Figure 6-1 shows the activity area/space available in a traditionally organized classroom. Figures 6-2 and 6-3 show how the classroom can be arranged to optimize the space for movement and physi- cal activity. Recess One of the most common forms of physical activity break during the school day is recess. Children can accumulate up to 40 percent of their daily physical activity time during recess (Ridgers et al., 2006). Recess, according to Pellegrini and colleagues (1995), is the time of day set aside for students to take a break from their class work; engage in play with their peers; and take part in independent, unstructured activities. Recess is most common in elementary schools and is rare during the secondary years. While separate and distinct from physical education, recess is an essen- tial component of the total educational experience for elementary-age chil-

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300 Educating the Student Body room cleaning. For parents the average cost for after-school programs is $67.00 per week, a $20.00 increase over the past 5 years (Afterschool Alliance, 2009). Thus, public funds are needed to defray some of these costs to schools and families. In addition, the inability of an after-school program to provide trans- portation home is a major barrier to participation for a large number of students. Programs have an advantage in recruiting participants when operating in schools where a majority of the students live within safe walk- ing distance (in particular, urban city schools) (Grossman et al., 2001). For children not living within walking distance of school, busing is an alterna- tive, but the limited supply of buses and drivers, as well as their cost, is a major barrier. There are substantial negative consequences of inadequate transportation. Youth who live beyond walking distance from their school and who cannot be picked up by a parent or adult at the designated time are unable to participate in programs. For schools that can provide busing for after-school programs, the number of seats available on those buses limits the number of children who can participate. Even when children live within walking distance of their school, many parents feel uncomfortable about their child walking home alone in the dark at 5:00 or 6:00 PM. School districts have struggled with easing this transportation problem. Money has been unavailable in schools’ budgets, or there have been restrictions on how transit money can be spent. For example, some school districts give trans- portation funding only to academic programs, and after-school programs are considered nonacademic. Staff training is another concern for after-school programs. If training does occur, it is often in house. Existing training programs tend to focus on games and to use prepackaged materials, and they fail to address promotion of physical activity (Ajja et al., 2012; Weaver et al., 2012). Differences in Opportunities in After-School Programs In addition to providing children with enrichment opportunities, a key factor behind the policy interest in after-school programs is the increasing need for child care. Almost all adults agree that elementary school children need adult supervision. Young people aged 10-14 are often seen as old enough to stay on their own for short periods of time, but they are also old enough to get into serious trouble. Unfortunately, these older children are much less likely to participate in supervised after-school pro- grams, whether the programs take place at youth-serving organizations or at school. It is easier to recruit elementary school children to these programs than middle and high school students, who tend to have busier schedules, increased responsibilities, and greater freedom (Grossman et al., 2001). Grossman and colleagues also found that 30 percent of enrollees in after-

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Approaches to Physical Activity in Schools 301 school programs were in 3rd grade or lower, 45 percent were in 4th through 6th grades, 23 percent were in 7th and 8th grades, and only 2 percent were in 9th grade or higher. Additionally, elementary-age children who enrolled attended more frequently than older youth. Summary In addition to physical education, schools can offer students non­ instructional opportunities to engage in beneficial physical activity before, during, or after the school day. These opportunities take various forms, such as interscholastic sports teams, intramural sport clubs, recess, and in- class physical activity breaks. Interscholastic sports provide opportunities for students with athletic talent. But budgetary constraints, team-cut poli- cies, transportation, lack of facilities, and pay-to-play policies and practices in many high schools may limit participation. Intramural sports clubs in middle and high schools are a viable way for the majority of children to engage in in-school or after-school physical activities. Research data con- sistently show, however, that although these programs can serve a large number of children, not every child will opt to participate or be able to find transportation home after an activity. Recess and classroom physical activity breaks have become valuable opportunities for elementary school students to be active during the school day. Their value in middle and high schools is questionable when they are combined with lunch, and at the secondary level classroom activity breaks are lost to valuable and limited academic time. Evidence supporting the integration of physical activity into academic lessons does exist but only for elementary schools. Given the nature of institutionalized education and its emphasis on academic achieve- ment, it is unclear that the approach will be embraced by school officials and most classroom teachers. One consensus from the literature is that, to take advantage of and enhance the many opportunities for physical activity outside of physical education, policy makers and practitioners must acknowledge the anchor function of physical education (National Physical Activity Plan, 2010). Curriculum time is insufficient for all of the recommended 60 minutes or more of vigorous- or moderate-intensity physical activity to take place dur- ing physical education, so the activity in which children engage throughout the school day is important. Therefore, a holistic, comprehensive approach is increasingly being advocated to promote physical activity in schools. School environments encourage more physical activity, both before and after school, if they include well-designed playgrounds; open spaces; and facilities and equipment that are available, accessible, and inviting to children. AAHPERD’s CSPAP program can serve as an example. It provides opportunities anchored in the knowledge and skills learned in physical

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302 Educating the Student Body education and uses a flexible programming method that allows local deci- sion makers and teachers to integrate physical activity opportunities into relevant school activities before, during, and after the school day. It must be emphasized that, while school-based physical activity should be used to support physical activity in the school environment, it should not be used as a replacement for physical education, whose importance is explained in Chapter 5. References AAP (American Academy of Pediatrics). 2013. The crucial role of recess in school. Pediatrics 131(1):183-188. AAHPERD (American Alliance for Health, Physical Education, Recreation and Dance). 2011. 2011 Comprehensive School Physical Activity Program (CSPAP) survey report. Reston, VA: AAHPERD. Active Policy Solutions. 2013. Active policy solutions: Analysis and history of the Department of Education’s January 2013 guidance. Washington, DC: Active Policy Solutions. Afterschool Alliance. 1999. A report of findings from the December 1999 Mott foun- dation/JCPenney nationwide survey on afterschool programs. Washington, DC: Afterschool Alliance. Afterschool Alliance. 2009. America after 3pm: The most in-depth study of how America’s children spend their afternoons. Washington, DC: Afterschool Alliance. Ahamed, Y., H. Macdonald, K. Reed, P. J. Naylor, T. Liu-Ambrose, and H. McKay. 2007. School-based physical activity does not compromise children’s academic performance. Medicine and Science in Sports and Exercise 39(2):371-376. Ajja, R., M. W. Beets, J. Huberty, A. T. Kaczynski, and D. S. Ward. 2012. The healthy afterschool activity and nutrition documentation instrument. American Journal of Preventive Medicine 43(3):263-271. Amis, J. M., P. M. Wright, B. Dyson, J. M. Vardaman, and H. Ferry. 2012. Implementing childhood obesity policy in a new educational environment: The cases of Mississippi and Tennessee. American Journal of Public Health 102(7):1406-1413. Bartholomew, J. B., and E. M. Jowers. 2011. Physically active academic lessons in elemen- tary children. Preventive Medicine 52(Suppl):S51-S54. Bassett, D. R. 2012. Encouraging physical activity and health through active transporta- tion. Kinesiology Reviews 1(1):91-99. Bassett, D. R., Jr., J. Pucher, R. Buehler, D. L. Thompson, and S. E. Crouter. 2008. Walking, cycling, and obesity rates in Europe, North America, and Australia. Journal of Physical Activity and Health 5(6):795-814. Bassett, D. R., E. C. Fitzhugh, G. W. Heath, P. C. Erwin, G. M. Frederick, D. L. Wolff, W. A. Welch, and A. B. Stout. 2013. Estimated energy expenditures for school-based policies and active living. American Journal of Preventive Medicine 44(2):108-113. Beets, M. W., M. Wallner, and A. Beighle. 2010. Defining standards and policies for promoting physical activity in afterschool programs. Journal of School Health 80(8):411-417. Beighle, A., M. W. Beets, H. Erwin, J. L. Huberty, J. B. Moore, and M. B. Stellino. 2010. Physical activity promotion in after-school programs. After-School Matters 11:24-32. Belansky, E. S., N. Cutforth, E. Delong, C. Ross, S. Scarbro, L. Gilbert, B. Beatty, and J. A. Marshall. 2009. Early impact of the federally mandated local wellness policy

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