8

Recommendations

This chapter presents the committee’s recommendations for strengthening and improving programs and policies for physical activity and physical education in the school environment, including before, during, and after school. These recommendations were developed in accordance with the guiding principles outlined in Chapter 1, which included recognizing the benefits of instilling lifelong physical activity habits in children, the value of applying systems thinking in efforts to improve physical activity and physical education in the school environment, current disparities in opportunities and the need to achieve equity in physical activity and physical education, the importance of considering all types of school environments, the need to consider the diversity of students in developing recommendations, the importance of taking into account the practicality of implementation and the challenges and barriers faced by stakeholders, and the need for recommendations to be based on the best-available scientific evidence and promising approaches. The consensus recommendations presented in this chapter are a result of the committee’s deliberations on the existing evidence and on the need for additional evidence.

In making its recommendations, the committee also recognized that, although schools can play a major role in improving physical activity among the nation’s children, schools alone cannot implement the changes across systems that will be required to foster a healthy and educated future generation. The involvement of many more institutional players and supports will be necessary to make and sustain the needed changes. The committee applied systems thinking to delineate the elements of the overall system of policies and regulations at multiple levels that can influ-



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8 Recommendations T his chapter presents the committee’s recommendations for strength- ening and improving programs and policies for physical activity and physical education in the school environment, including before, during, and after school. These recommendations were developed in accordance with the guiding principles outlined in Chapter 1, which included recog- nizing the benefits of instilling lifelong physical activity habits in children, the value of applying systems thinking in efforts to improve physical activ- ity and physical education in the school environment, current disparities in opportunities and the need to achieve equity in physical activity and physical education, the importance of considering all types of school environments, the need to consider the diversity of students in developing recommendations, the importance of taking into account the practicality of implementation and the challenges and barriers faced by stakeholders, and the need for recommendations to be based on the best-available scientific evidence and promising approaches. The consensus recommendations pre- sented in this chapter are a result of the committee’s deliberations on the existing evidence and on the need for additional evidence. In making its recommendations, the committee also recognized that, although schools can play a major role in improving physical activity among the nation’s children, schools alone cannot implement the changes across systems that will be required to foster a healthy and educated future generation. The involvement of many more institutional players and supports will be necessary to make and sustain the needed changes. The ­ommittee applied systems thinking to delineate the elements of the c overall system of policies and regulations at multiple levels that can influ- 365

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366 Educating the Student Body ence physical activity and physical education in the school environment. To frame its deliberations, the committee drew on its conceptual framework (see Figure 1-4 in Chapter 1) and closely examined the evidence base (see Appendix B for additional detail on the study methods). recommendations The committee formulated recommendations in six areas: taking a whole-of-school approach, considering physical activity in all school-­ related policy decisions, designating physical education as a core subject, monitoring physical education and opportunities for physical activity in schools, providing preservice training and professional development for teachers, and ensuring equity in access to physical activity and physical education. Taking a Whole-of-School Approach Recommendation 1: District and school administrators, teachers, and parents should advocate for and create a whole-of-school approach to physical activity that fosters and provides access in the school environ- ment to at least 60 minutes per day of vigorous- or moderate-intensity physical activity more than half (>50 percent) of which should be accom- plished during regular school hours. • School districts should provide high-quality curricular physical education during which students should spend at least half (≥50 percent) of the class time engaged in vigorous- or moderate- intensity physical activity. All elementary school students should spend an average of 30 minutes per day and all middle and high school students an average of 45 minutes per day in physical education class. To allow for flexibility in curriculum scheduling, this recommendation is equivalent to 150 minutes per week for elementary school students and 225 minutes per week for middle and high school students. • Students should engage in additional vigorous- or moderate- intensity physical activity throughout the school day through recess, dedicated classroom physical activity time, and other opportunities. • Additional opportunities for physical activity before and after school hours, including but not limited to active transport, before- and after-school programming, and intramural and extramural sports, should be made accessible to all students.

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Recommendations 367 Rationale Because the vast majority of youth are in school for many hours, because schools have important infrastructure for physical activity and are critical to the education and health of children and adolescents, and because physical activity promotes health and learning, it follows that physical activity should be a priority for all schools, particularly if there is an opportunity to improve academic achievement. As discussed in Chapter 1, schools have for years been the center for other key health-related program- ming, including screenings, immunizations, and nutrition and substance abuse programs. Unfortunately, school-related physical activity has been fragmented and varies greatly across the United States, within states, within districts, and even within schools. Physical education typically has been relied on to provide physical activity as well as curricular instruction for youth; however, even the best-quality physical education curriculum will not allow children to meet the guideline of at least 60 minutes per day of vigorous- or moderate-intensity physical activity. Interscholastic and intra- mural sports are another traditional opportunity for physical activity, but they are unavailable to a sizable proportion of youth. Schools are being underutilized in the ways in which they provide opportunities for physi- cal activity for children and adolescents. A whole-of-school approach that makes the school a resource to enable each child to attain the recommended 60 minutes or more per day of vigorous- or moderate-intensity physical activity can change this situation. The committee therefore recommends a whole-of-school approach to increasing physical activity for children and adolescents. Under such an approach, all of a school’s components and resources operate in a coor- dinated and dynamic manner to provide access, encouragement, and pro- grams that enable all students to engage in vigorous- or moderate-intensity physical activity 60 minutes or more each day. A whole-of-school approach encompasses all segments of the school day, including travel to and from school, school-sponsored before- and after-school activities, recess and lunchtime breaks, physical education, and classroom instructional time. Beyond the resources devoted to quality daily physical education for all students, other school resources, such as classroom teachers, staff, admin- istrators, and aspects of the physical environment, are oriented toward physical activity. Intramural and extramural sports programs are available to all who wish to participate, active transport is used by substantial num- bers of children to move from home to school and back again, recess and other types of breaks offer additional opportunities for physical activity, and lesson plans integrate physical activity as an experiential approach to instruction. A whole-of-school approach encompasses all people involved in the day-to-day functioning of the school, including students, faculty, staff,

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368 Educating the Student Body and parents. It creates an atmosphere in which physical activity is appreci- ated, encouraged, and rewarded by all these groups. Similarly, inactivity is discouraged and minimized. School buildings, outdoor grounds and play- grounds, indoor and outdoor equipment, and streets and pathways leading to the school from the surrounding neighborhood encourage and enable all persons to be more physically active. Moreover, the school is part of a larger system that encompasses community partnerships to help these goals be realized. Potential Actions For state legislatures and state departments of education, potential actions to implement this recommendation include • adopting and/or strengthening physical education and recess poli- cies so they align with existing national recommendations for total number of weekly minutes of physical education, as well as requiring students to spend at least half (≥50 percent) of the class time engaged in vigorous- or moderate-intensity physical activity while maintain- ing an appropriate emphasis on skills development; • adopting and/or strengthening policies on before- and after-school programs so they align with national recommendations for physical activity; • adopting school siting policies that encourage locating schools within residential neighborhoods; and • working with national- and state-level parent-teacher organizations to mobilize and create engagement in this effort. For school districts and schools, potential actions include • continuing to strengthen policies by requiring time for physical edu- cation and recess that aligns with national recommendations; • increasing the amount of time youth spend in physical activity by providing brief classroom breaks or incorporating physical activity directly into academic sessions; • offering intramural sports and physical activity clubs before or after school and helping make such programs accessible to all students; • adopting joint- or shared-use agreements allowing school facilities to be used for physical activity programs during nonschool hours; • identifying key champions in schools to lead efforts to increase physical activity; and • working with parent groups and parent-teacher associations to cre- ate a demand for and mobilize efforts to increase physical activity.

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Recommendations 369 For municipalities, local governments, and urban planners, potential actions include • considering renovating schools already located in existing neighbor- hoods rather than building new schools away from where students live; • incorporating strategies for traffic calming (e.g., lower speed limits, speed humps or tables, sidewalks with buffers, medians) and traffic control (e.g., marked crosswalks, traffic lights with pedestrian sig- nals) into community planning to ensure safe active travel routes for students; and • adopting school policies that encourage locating schools within resi- dential neighborhoods. Considering Physical Activity in All School-Related Policy Decisions Recommendation 2: Federal and state governments, school systems at all levels (state, district, and local), city governments and city planners, and parent-teacher organizations should systematically consider access to and provision of physical activity in all policy decisions related to the school environment as a contributing factor to improving academic per- formance, health, and development for all children. Rationale Many examples exist of effective and promising strategies for increas- ing vigorous- and moderate-intensity physical activity in schools. The most thorough yet often most difficult to implement are multicomponent interventions based on a systems approach that encompasses both school and community strategies. For strategies with a singular focus, the evidence is most robust for interventions involving physical education. Quality physical education curricula increase overall physical activity, increase the intensity of physical activity, and potentially influence body mass index (BMI)/weight status in youth. However, the lack of consistent monitoring of physical activity levels during physical education classes in schools (espe- cially elementary and middle schools) impedes monitoring and evaluation of progress toward increasing physical activity during physical education in schools across the nation (see Recommendation 4). Beyond physical education, opportunities for increasing physical activ- ity are present in the classroom and, for elementary and middle schools, during recess. Classroom physical activity and strategies to reduce seden-

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370 Educating the Student Body tary time in the school setting hold promise for increasing overall physical activity among children and adolescents, yet isolating the impact of these strategies is complex, and they are often met with resistance from key stakeholders. With respect to recess, its use to increase physical activity is a nationally recommended strategy, and there is evidence that participating in recess can increase physical activity and improve classroom behavior. However, implementation of recess across school districts and states is not currently at a sufficient level to increase physical activity. Effective and promising strategies beyond the school day include after-school programming and sports, as well as active transport to and from school. After-school programming and participation in sports are important physical activity opportunities in the school setting, but imple- mentation of and access to these opportunities vary greatly. Moreover, for- mal policies adopting physical activity standards for after-school programs are needed. Finally, evidence shows that children who walk or bike to school are more physically active than those who do not. Successful active transport interventions address policy and infrastructure barriers. Also associated with the school environment are agreements between schools and communities to share facilities as places to be physically active. Although this is a relatively new research topic, these joint-use agreements can be a way to give youth additional opportunities for physical activity outside of school. Further research is needed on the utilization of facilities due to these agreements and their impact on physical activity. Potential Actions For states, school districts, schools, and school wellness committees, potential actions to implement this recommendation include • designating individuals or committees specifically responsible for physical activity–related opportunities and programs (an emphasis on physical activity is important and new enough that these indi- viduals should not also be responsible for programs directed at worthy but already well-established health-related behaviors such as nutrition or drug abuse); • specifying objectives for vigorous- and moderate-intensity physical activity during all segments of the school day (e.g., physical educa- tion, recess, classroom, transport to and from school, before- and after-school programs); and • working with leading professional organizations across disciplines to emphasize the importance of physical activity and encourage them to embed this priority into their national recommendations or posi- tion statements.

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Recommendations 371 Designating Physical Education as a Core Subject Recommendation 3: Because physical education is foundational for lifelong health and learning, the U.S. Department of Education should designate physical education as a core subject. Rationale Physical education in school is the only sure opportunity for all school- aged children to access health-enhancing physical activity and the only school subject area that provides education to ensure that students develop the knowledge, skills, and motivation to engage in health-enhancing physi- cal activity for life. Yet states vary greatly in their mandates with respect to time allocated for and access to physical education. Nearly half (44 percent) of school administrators report having cut significant time from physical education and recess to increase time devoted to reading and mathematics since the No Child Left Behind Act became law, which made federal funding dependent on schools’ making adequate progress in the latter subject areas. Moreover, disparities have been documented in access to physical education for students of Hispanic ethnicity and lower socioeconomic status. Currently, despite growing concern about the negative consequences of physical inactivity, physical education is not considered or treated as a core subject. Several national studies and reports have pointed to the importance of implementing state laws and regulations mandating both time requirements for physical education and monitoring of compliance with those requirements. Although a number of national governmental, non­overnmental, private industry, and public health organizations and g agencies have offered specific recommendations for the number of days and minutes per day of physical education, no standardized state policy has emerged. As a core academic subject, physical education would receive much-needed policy attention that would enhance its overall quality in terms of content offerings, instruction, and accountability. The enactment of this recommendation also would likely result in downstream account- ability that would assist in policy implementation. Potential Actions For the U.S. Department of Education and federal and state public health agencies, potential actions to implement this recommendation include • finding innovative applications of physical education as a core sub- ject in sample states or districts to highlight and measure outcomes.

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372 Educating the Student Body For nongovernmental organizations, potential actions include • developing advocacy materials and planning dissemination of these materials to key stakeholders. Monitoring Physical Education and Opportunities for Physical Activity in Schools Recommendation 4: Education and public health agencies at all govern- ment levels (federal, state, and local) should develop and systemati- cally deploy data systems to monitor policies and behaviors pertaining to physical activity and physical education in the school setting so as to provide a foundation for policy and program planning, development, implementation, and assessment. Rationale The intent of this recommendation is to give citizens and officials concerned with the education of children in the United States—including parents and teachers as well as education and public health officials at the local, state, and federal levels—the information they need to make decisions about future actions. Principals, teachers, and parents who know that regu- lar vigorous- and moderate-intensity physical activity is an essential part of the health and potentially the academic performance of students and who have adopted a whole-of-school approach to physical activity will want and need this information. This information also is important to support the development of strategies for accountability for strengthening physical activity and physical education in schools. Aside from a few good one-time surveys of physical activity during physical education classes, remarkably little information is available on the physical activity behaviors of students during school hours or school-related activities. Even the best public health monitoring systems do not obtain this information. This dearth of information is surprising given that school-­ related physical activity accounts for such a large portion of the overall volume of physical activity among youth and that vigorous- and moderate- intensity physical activity is vital to students’ healthy growth and develop- ment and may also influence academic performance and classroom behavior. Evidence is emerging that laws and policies at the state and district ­evels can have important influence on the physical activity behaviors of l large numbers of children and adolescents. Also emerging is evidence of a gap between the intent and implementation of school physical activity– related policies, so that their final impact is commonly less, sometimes

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Recommendations 373 appreciably so, than expected. While the factors that create an effective policy are still being elucidated, policies that entail required reporting of outcomes, provision of adequate funding, and easing of competing priori- ties appear to be more likely to be implemented and effective. Further evalu- ation of physical activity and physical education policies is needed to fully understand their impact in changing health behavior. Monitoring of state and district laws and policies has improved over the past decade. In general, the number of states and districts with laws and policies pertaining to physical education has increased, although many such policies remain weak. For example, most states and districts have policies regarding physical education, but few require that it be provided daily or for a minimum number of minutes per week. Those that do have such requirements rarely have an accountability system in place. Although some comprehensive national guidelines exist, more are needed to define quality standards for policies on school-based physical activity and create more uniform programs and practices across states, school districts, and ultimately schools. The few existing monitoring systems for school-related physical activ- ity behaviors need to be augmented. Information is needed not only on the amount of vigorous- or moderate-intensity physical activity in which youth are engaged but also on its distribution across segments of the school day (i.e., physical education, recess, classroom, travel to and from school, school- related before- and after-school activities). Existing national surveys are not designed to provide local or even state estimates of these student behaviors. State departments of education, local school districts, and state and local health departments will need to collaborate to provide adequate monitoring. Also needed is augmented monitoring of physical activity–related guidelines, policies, and practices at the federal, state, and local levels. Potential Actions For the U.S. Departments of Education and Health and Human Services, potential actions to implement this recommendation include • collaborating to ensure the availability and publication of informa- tion about school physical activity– and physical education–related policies and students’ physical activity behaviors and • facilitating collaboration among state and district departments of education and state and local health departments to obtain and publicize such information. For federal agencies, specifically the Centers for Disease Control and Prevention (CDC), potential actions include

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374 Educating the Student Body • continuing to improve the Youth Risk Factor Behavior Surveillance System (YRBSS) and the National Health and Nutrition Examination Survey (NHANES) to capture more completely students’ school- related physical activity behaviors; • developing tools suitable for use by schools and school districts for monitoring students’ physical activity behaviors throughout the school day; and • providing training for state and local health departments and state and district school systems as they endeavor to improve the monitoring of school-related physical activity behaviors and student achievement. For local school districts and schools, in coordination with local health departments, state departments of education, and state departments of p ­ ublic health, potential actions include • regularly assessing student achievement of physical education stan- dards and the physical activity behaviors of students during all seg- ments of the school day; • developing systems to collect and publicize the information collected by local schools; • augmenting existing monitoring systems for students’ physical fit- ness to include school-related physical activity behaviors and student achievement; • utilizing current systems for collecting educational information w ­ ithin schools and districts to monitor the quality of physical edu- cation and the usual dose of physical activity for students during school hours, while going to and from school, and at school-related functions, and involving teachers in developing the most efficient ways to collect and provide the data needed for monitoring; and • involving wellness committee members and parents in the monitor- ing of opportunities for students to be physically active during physi- cal education, recess, classroom activities, travel to and from school, and at school-related events before and after school. Providing Preservice Training and Professional Development for Teachers Recommendation 5: Colleges and universities and continuing education programs should provide preservice training and ongoing professional development opportunities for K-12 classroom and physical education teachers to enable them to embrace and promote physical activity across the curriculum.

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Recommendations 375 Rationale Teaching physical education effectively and safely requires spe- cific knowledge about physical/mental development, body composition (­ orphology) and functions (physiology and biomechanics), and motor m skills development and acquisition. Teaching physical education also requires substantial knowledge and skill in pedagogy, the science and art of teaching, which is required for any subject. In addition, because health is associated with academic performance, priority should be given to educat- ing both classroom and physical education teachers regarding the impor- tance of physical activity for the present and future physical and mental health of children. The current wave of effort to curb childhood physical inactivity has begun to influence teacher education programs. Data appear to suggest that training programs for physical education teachers are beginning to evolve from a traditionally sport- and skills-centered model to a more comprehen- sive physical activity– and health-centered model. However, education pro- grams for physical education teachers are facing a dramatic decrease in the number of kinesiology doctoral programs offering training to future teacher educators, in the number of doctoral students receiving this training, and in the number of professors (including part-time) offering the training. Additional data suggest a shortage of educators in higher education institu- tions equipped to train future physical education teachers. With unfilled positions, these teacher education programs are subject to assuming a mar- ginal status in higher education and even to being eliminated. Professional development—including credit and noncredit courses, classroom and online venues, workshops, seminars, teleconferences, and webinars—improves classroom instruction and student achieve- ment, and data suggest a strong link among professional development, teacher learning and practice, and student achievement. The most impact- ful statement of government policy on the preparation and professional development of teachers was the 2002 reauthorization of the Elementary and Secondary Education Act. Although Title I of the act places highly qualified teachers in the classroom, Title II addresses the same goal by funding professional development for teachers. According to the No Child Left Behind Act, professional development should be offered to improve teachers’ knowledge of the subject matter they teach, strengthen their class- room management skills, advance their understanding and implementation of effective teaching strategies, and build their capabilities to address dis- parities in education. This professional development should be extended to include physical education instructors as well.

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376 Educating the Student Body Potential Actions For the U.S. Department of Education and local school districts, poten- tial actions to implement this recommendation include • identifying exemplary training programs and highlighting best prac- tices and • establishing requirements for competencies in physical education and physical activity for preservice and continuing education for all teachers and school administrators. Ensuring Equity in Access to Physical Activity and Physical Education Recommendation 6: Federal, state, district, and local education admin- istrators should ensure that programs and policies at all levels address existing disparities in physical activity and that all students at all schools have equal access to appropriate facilities and opportunities for physical activity and quality physical education. Rationale All children should engage in physical education and meet the recom- mendation of at least 60 minutes per day of vigorous- or moderate-intensity physical activity regardless of their region, school attended, grade level, or individual characteristics. However, a number of studies have documented social disparities in access to physical education and other opportunities for physical activity by race/ethnicity, socioeconomic status, gender, and immigrant generation. Moreover, because not every child has the means or opportunity to participate in before- and after-school activities and intramural/extramural sports, curriculum-based physical education pro- ­ grams often provide the only opportunity for all school-aged children to access health-enhancing physical activity. Potential Actions For the U.S. Department of Education, state departments of education, and school boards, potential actions to implement this recommendation include • conducting an inventory of facilities for physical activity, including type, condition, safety, and availability and opportunities for physi- cal activity across schools and districts to provide insight on where improvements can be made to address disparities.

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Recommendations 377 For local school districts, school wellness committees, and other rel- evant local entities, potential actions include • thoroughly reviewing existing physical activity opportunities and reducing barriers to access for all students, including but not lim- ited to creation and maintenance of physical facilities and safety of their use. future research NEEDS AND AREAS for ADDITIONAL INVESTIGATION Even though much is known about physical activity in youth, more knowledge is needed. In addition to developing recommendations for action to strengthen and improve programs and policies for physical activ- ity and physical education in the school environment, the committee was asked to identify major gaps in knowledge and recommend key topic areas in need of research. These gaps are acknowledged in the discussion of the evidence in each chapter of this report. They are also highlighted here to emphasize the importance of continuing to refine the research base on which future recommendations can be made for advancing the health and academic achievement of children and youth through physical education and physical activity in schools. The committee identified a number of broad future research needs and areas for additional investigation: • What are the effects of various doses of physical activity and the settings in which those doses occur on measures of academic achievement? • How can the whole-of-school approach be expanded to include opportunities for community-based promotion of physical activity? • What are the short- and long-term health, developmental, and aca- demic impacts of physical education on children and adolescents? • What are the acute and long-term health, developmental, and aca- demic effects of daily sedentary behavior in school? • What specific features of the built environment in schools influence participation in physical activity? • What is the effect of increasing school-based physical activity on physical activity outside of school? • What are the specific behavioral, environmental, and policy-related barriers to increasing physical activity in schools? • What innovations can improve the effectiveness of physical educa- tion for children and adolescents?

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378 Educating the Student Body More specifically: • In the area of the brain, cognition, and academic achievement, future research is needed on —  he effects of physical activity and increases in aerobic fitness on t basic measures of brain health, cognition, and learning; —  dose-response relationship between physical activity and the academic performance; —  he daily school schedule and how best to integrate physical edu- t cation classes as well as recess and classroom physical activity breaks, given that little is known about the effects of time of day and the timing of delivery of physical activity bouts in relation to the demands of cognitive tasks; —  effects of different physical activity types, such as aero- the bic, motor skills oriented, or perceptual-motor, on academic performance; —  relative effects of different settings within the school in the increasing physical activity; and —  multifaceted nature of the relationship between physical the activity and cognitive and brain health, including the degree to which these effects can be attributed to a break from academic time and what portion is a direct result of engagement in physi- cal activity. • In the area of physical health and development, future research is needed on —  limitations of previous research, to address and facilitate the a deeper level of understanding of the relationship between motor competence and physical activity—more specifically, longitudinal data to permit a full understanding of the relation- ship between motor skills and participation in physical activity across the life span, as well as experimental studies in which skill levels can be manipulated (positively or negatively) to determine how participation in physical activity changes; —  motor skills and participation in physical activity; and — he effects of intermittent versus sustained physical activity on t disease risk factors. • In the area of monitoring, future research is needed on —  hysical activity and physical fitness in youth and their effects p on academic performance; —  effective strategies for developing and employing systems to track the quality and frequency of physical education and physi- cal activity opportunities across the curriculum;

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Recommendations 379 —  effective implementation of systems with which to monitor school-related laws, policies, and practices that may enable or impede physical activity and physical education; —  aseline estimates of the physical activity behaviors of children b and adolescents at school across all age groups and grade levels; racial/ethnic, socioeconomic, and geographic groups; and all segments of the school day (including transport to and from school, physical education, recess, classroom time, and before- and after-school activities); and —  standardized, national-level data on the offering of and par- ticipation in physical education, as well as student performance of and engagement in vigorous- or moderate-intensity physical activity during physical education. • In the area of policy and programming, future research is needed to examine systematically the personal, curricular, and policy barri- ers to successful physical education in schools. • In the area of equity, future research is needed on —  reexamination of opportunities for physical activity in school- a based intramural and extramural sports and active transport to school to address disparities based on race/ethnicity, socio- economic status, school location and resources, and students’ disabilities or cultural/religious barriers; — he effectiveness of physical education, recess, classroom physi- t cal activity, and strategies for reducing sedentary time in increas- ing physical activity across subgroups based on race/ethnicity and immigrant and socioeconomic status, including the differ- ential effects of these approaches among those subgroups; —  benefits of tailoring school-based physical education and the physical activity interventions to the wide social and physical variations among schools; and —  isparities in the built environment among schools and whether d they contribute to disparities in physical activity across racial/ ethnic and socioeconomic subgroups.

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