3
Education

As discussed in Chapter 2, the educational realm of comprehensive school health programs (CSHPs) includes two curricular components with a health focus: physical education and health education. These should be perceived as distinct courses or programs within the school curriculum. Although physical education and health education may have differences in their conceptual basis and approach, they share the common goal of enabling students to take personal control of factors that affect their health. Both fields are currently undergoing change, with new developments informed by research. This chapter will review the state of physical education and health education, and examine how these two curricular areas can contribute to a comprehensive school health program.

THE ROLE OF PHYSICAL EDUCATION IN COMPREHENSIVE SCHOOL HEALTH PROGRAMS

Introduction

The physical education instructional program is an integral part of a comprehensive school health program, because it teaches the knowledge and skills that lead to a physically active life-style and reinforces positive health behaviors (McGinnis et al., 1991). Research has confirmed a direct relationship between a physically active life-style and the long-term health status of individuals. A sedentary life-style as an adult leads to premature mortality and morbidity. The sedentary are more likely to experience



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School & Health: Our Nation's Investment 3 Education As discussed in Chapter 2, the educational realm of comprehensive school health programs (CSHPs) includes two curricular components with a health focus: physical education and health education. These should be perceived as distinct courses or programs within the school curriculum. Although physical education and health education may have differences in their conceptual basis and approach, they share the common goal of enabling students to take personal control of factors that affect their health. Both fields are currently undergoing change, with new developments informed by research. This chapter will review the state of physical education and health education, and examine how these two curricular areas can contribute to a comprehensive school health program. THE ROLE OF PHYSICAL EDUCATION IN COMPREHENSIVE SCHOOL HEALTH PROGRAMS Introduction The physical education instructional program is an integral part of a comprehensive school health program, because it teaches the knowledge and skills that lead to a physically active life-style and reinforces positive health behaviors (McGinnis et al., 1991). Research has confirmed a direct relationship between a physically active life-style and the long-term health status of individuals. A sedentary life-style as an adult leads to premature mortality and morbidity. The sedentary are more likely to experience

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School & Health: Our Nation's Investment coronary heart disease (Berlin and Colditz, 1990; Powell et al., 1987), hypertension (Paffenbarger et al., 1986; Blair et al., 1988), certain cancers (Kohl et al., 1988; Lee et al., 1992), osteoporosis (Cummings et al., 1985), and obesity (King and Tribble, 1991). The ultimate consequence of increased numbers of sedentary adults is an increase in the number of premature deaths. A study released in 1986 estimated that approximately 257,000 deaths in the nation could be attributed to a sedentary life-style, making this a risk factor equal to or greater than that attributed to obesity, elevated cholesterol, or hypertension (Hahn et al., 1986). Epidemiologic studies estimate that all-cause mortality rates are at least two to three times greater for sedentary persons than for those who are active (Centers for Disease Control and Prevention, 1997). Light to moderate physical activity for adults can have significant health benefits and reduce the chronic diseases associated with a sedentary life-style (Leon, 1989; Leon et al., 1987; Sallis et al., 1986). Since regular exercise increases functional capacity and reduces many risk factors for chronic disease (McGinnis, 1992; Pate et al., 1995; Powell et al., 1989), it is prudent to provide children with the information and skills necessary to maintain a physically active life-style. Physical education programs in schools should prepare children for a lifetime of physical activity (Sallis and McKenzie, 1991). Recognition of the link between physical education and public health is not a recent phenomenon. Lemuel Shattuck's pioneering 1850 Report to the Sanitary Commission of Massachusetts, described in Chapter 2, included physical training as part of the plan for improving public health (Means, 1975; Pate et al., 1995). Physical education has long been justified on the basis of broad physical, social, and moral developmental goals, although to date the major focus has often been on team and competitive sports. Even large-scale fitness testing programs in the recent past assessed sport-related skills rather than health-related fitness (Ross and Gilbert, 1985; Ross and Pate, 1987; Sallis and McKenzie, 1991). In a review of physical education's role in public health, Sallis and McKenzie noted: In a society in which adult sedentary behavior contributes substantially to the epidemic of cardiovascular and other chronic diseases, there is a rationale for shifting the orientation of physical education to a health focus. … Health-related physical education programs should focus on maximizing the participation of all children, whether they are athletically gifted, clumsy, disinterested, or obese. Physical education in schools is the only preparation most children will have in how to develop an active life-style. …

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School & Health: Our Nation's Investment Quality Physical Education The physical education instructional program makes a unique contribution to the health and education of students by promoting the development of a physically educated person who has skills necessary to perform a variety of physical activities, is physically fit, participates regularly in physical activity, knows the implications of and benefits from involvement in physical activities, and values physical activity and its contributions to a healthful life-style (National Association for Sport and Physical Education, 1992). The goals of the physical education program are the attainment of appropriate levels of physical fitness and the development and refinement of motor skills that support a physically active life-style and safe, efficient movement. Skillful movement is a fundamental part of everyday life. It is a prerequisite for health-related physical activities and supports safety and self-confidence in work-related performance and recreational pursuits. The recently released National Standards for Physical Education identify the psychomotor, cognitive, and affective aspects of physical education that all students should know and be able to do as a result of a quality physical education program (National Association for Sport and Physical Education, 1995). According to these standards, the physically educated person does the following: Demonstrates competency in many movement forms and proficiency in a few movement forms. Applies movement concepts and principles to the learning and development of motor skills. Exhibits a physically active life-style. Achieves and maintains a health-enhancing level of physical fitness. Demonstrates responsible personal and social behavior in physical activity settings. Demonstrates understanding and respect for differences among people in physical activity settings. Understands that physical activity provides opportunities for enjoyment, challenge, self-expression, and social interaction. The relationship between quality school physical education and health status was also recognized by the developers of Healthy People 2000 , the national decade-long public—private initiative to improve the health of the nation (U.S. Department of Health and Human Services, 1991). Two of the Healthy People 2000 national health objectives focused on physical activity in schools:

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School & Health: Our Nation's Investment Increase to at least 50 percent the proportion of children and adolescents in Grades 1 through 12 who participate daily in school physical education, Increase to at least 50 percent the proportion of school physical education class time that students spend being physically active, preferably engaged in lifetime physical activities. Quality physical education programs should be taught by qualified physical educators and include a planned, sequential curriculum that incorporates the seven national standards for physical education into a program of developmentally appropriate movement experiences for all students. Health-Related Physical Fitness Health-related physical fitness refers to performance levels in one or more of these fitness components: muscular strength and endurance, cardiovascular endurance, flexibility, and body composition. Health-related physical fitness is the aspect of a quality physical education program most readily identified as physical education's contribution to public health. However, the use of fitness scores to measure the impact of the physical education experience on public health is shortsighted. Physical fitness scores are a time-bound measure. They are important in describing current health status but not future health status. The importance of motor skill development must also be emphasized. A child who does not develop a level of confidence and competence as a skillful mover will probably choose not to pursue a lifetime of physical activity and may incur unnecessary injuries through poor, inefficient movement patterns. Research Participation in moderate to vigorous physical activity provides considerable health benefits for children and youth (Blair et al., 1989; Cale and Harris, 1993; McKenzie et al., 1992; Simons-Morton et al., 1988), as well as for adults. Relationships have been established between children's physical activity and obesity (Berkowitz et al., 1985; Saris et al., 1980; Sasaki et al., 1987), high-density lipoprotein (HDL) cholesterol (Durant et al., 1983), blood pressure (Hofman et al., 1987; Panico et al., 1987), and cardiovascular fitness (Duncan et al., 1983; Dwyer et al., 1983; Maynard et al., 1987; Siegel and Manfrede, 1984). Exercise training produces improved physical fitness in students (Mahon and Vaccaro, 1989; Pate and Ward, 1990; Pate et al., 1995). More than 100 large population-based studies on the relation of physical activity or fitness to health have been published in the peer-reviewed literature, most during the past 20 years; examples are

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School & Health: Our Nation's Investment summarized in Table 3-1. Youth physical activity has also been linked to improved mental health, cognitive functioning, and academic performance; and involvement in physical activity and sports has been associated with a decrease in smoking, alcohol consumption, and drug use and abuse (CDC, 1997; Shephard et al., 1984). It is well accepted that physical activity has significant health benefits, but the levels of activity required in childhood to achieve those benefits are not fully understood (Sallis and McKenzie, 1991). Furthermore, there is currently little research to directly link students' current or future physical fitness levels to the physical activity that occurs in physical education classes. Although the relationship between school physical education and active adult life-styles is not fully understood, many believe that increasing a person's ability to move competently and confidently may increase their willingness to become more physically active. Current Practice A nationwide assessment of physical education programs at the state, district, and school levels was recently completed by the Centers for Disease Control and Prevention (CDC) as part of the School Health Policies and Programs Study (SHPPS)1 (Pate et al., 1995). This assessment shows that current instructional practices in physical education do not meet the standards identified by the national health objectives Healthy People 2000 nor the National Standards for Physical Education. According to SHPPS data, most states (94 percent) and school districts (95 percent) require physical education. Yet 80 percent of states and 83 percent of all districts allow students to be excused from physical education classes for reasons such as parents' requests (65 percent of middle schools, 42 percent of secondary schools), physical disability (58 percent of middle schools, 59 percent of secondary schools), and participation in other activities such as band, chorus, or cheerleading (30 percent of middle schools, 23 percent of secondary schools). Even if no exemptions were approved, the number of students participating in daily physical education remains less than optimal. In middle school, less than one-half of the students (47 percent) are required to attend physical education each year (Table 3-2). Of those who 1    The School Health Policies and Programs Study was carried out in 1994 to examine policies and programs across multiple components of school health programs at the state, district, school, and classroom levels across the country. The October 1995 issue of The Journal of School Health is devoted to a summary report of SHPPS findings and includes separate analyses of school health education; school physical education; school health services; school foodservice; and school health policies prohibiting tobacco use, alcohol and other drug use, and violence.

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School & Health: Our Nation's Investment TABLE 3-1A Illustrative Studies Regarding Physical Activity and Physical Education Study Cohen, C.H. 1995. The effect of a three-year physical fitness program on the body composition and lifestyle behaviors of middle school students. RQES Supplement, March. Ignico, A.A. 1994. A longitudinal study of the fitness levels of children enrolled in daily versus twice weekly physical education. RQES Supplement, March. Sallis, J.F., Simons-Morton, B.G., Stone, E.J., Corbin, C.B., Epstein, L.H., Faucette, N., Ianotti, J.D., Killen, R.C., Klesges, Petray, C.K., Rowland, T.W., and Taylor, W. 1992. Determinants of physical activity and interventions in youth. Med. Sci. Sports Exerc. 24:S248–S257. Taylor, W., and Baranowski, T. 1991. Physical activity, cardiovascular fitness, and adiposity in children. RQES 62:157–163. Pate, R.R., Dowda, M., and Ross, J.G. 1990. Associations between physical activity and physical fitness in American children. AJDC 144:1123–1129. Dennison, B.A., Straus, E.D., Mellits, E.D., and Charney, E. 1987. Childhood physical fitness tests: Predictor of adult physical activity? Pediatrics 82:324–330. Gruber, J.J. 1986. Physical activity and self-esteem development in children, A meta-analysis. Pp. 30–48 in Effects of Physical Activity on Children (The American Academy of Physical Education Papers, No. 19), G.A. Stull an H.M. Eckert, eds. Champaign, Ill.: Human Kinetics. Iverson, D.C., Fielding, J.E., Crow, R.S., and Christenson, G.M. 1985. The promotion of physical activity in the United States population: The status of program in medical, worksite, community, and school settings. Public Health Reports 100:212–224. Caspersen, C.J., Powell, K.E., and Christenson, G.M. 1985. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports 100:126–131. Corbin, C.B., and Pangrazi, R.P. 1991. Are American children and youth fit? RQES 63(2):96–106.

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School & Health: Our Nation's Investment Principal Findings The study supports the position that life-style behaviors are established very early in life; therefore intervention programs must be implemented early on in elementary school in order to have a significant effect. The findings suggest that school physical education program can make a significant contribution to children's fitness levels, particularly in the area of cardiovascular endurance. This study reports that directed interventions increased physical activity in 4th-grade children. Interventions included teacher training, family support, incentives and focus on enjoyment. Obese children are less active than non-obese children. Results indicate that physical activity is positively related to cardiovascular fitness in more obese children. Physical activity and fitness are positively associated but directionally is not clear. Childhood fitness results did not predict levels of adult physical activity consistently. Positive fitness and regular physical activity participation are associated with positive self-concepts in children. The Statement on Exercise by the American Heart Association references this study under the area of implementation of exercise programs—schools as a study that demonstrates that organized school programs not only are feasible but can also be successful. This article provides working definitions of and distinctions among physical activity, exercise, and physical fitness. This article reviews several large-scale studies from perspective of accepted standards that have evolved since 1985. Most children meet some fitness criteria; many do not meet recommended standards in all fitness components (muscular strength and endurance, cardiovascular endurance, flexibility and body composition). Authors conclude that children have more health-related fitness than earlier studies indicated.

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School & Health: Our Nation's Investment Study Sallis, J.F., ed. 1994. Special Issue Pediatric Exercise Science 6(4), November. Kuntzleman, C.T., and Reiff, G.G. 1992. The decline in American children's fitness levels. RQES 63(2):107-111. Oded, B. 1990. Disease specific benefits of training in the child with a chronic disease: What is the evidence? Pediatric Exercise Science 2:384-394. Updyke, W.F., and Willet, M.S., eds. 1989. Physical Fitness Trends in American Youth. Washington, DC: Chrysler-AAU Physical Fitness Program. Ross, J.G., and Pate, R.R. 1987. The National Children and Youth Fitness Study II. A summary of findings. JOPERD 58:51-56. are required to take physical education each year, less than one-half (45 percent) are required to take physical education daily (Table 3-3). At the high school level, few schools require four years of physical education (Table 3-2). One-quarter of schools (26 percent) require three years; 25 percent require two years; 37 percent require one year; and 9 percent require less than one year. Only 67 percent of the classes at the secondary level are five days per week (Table 3-2) (Pate et al., 1995). Not only do most schools provide students with less daily exposure to physical education than the national health objectives have set as appropriate, but the instructional activities most commonly included in physical education classes are not the recommended lifetime physical activities or activities ensuring moderate aerobic exercise for all participants; but rather they are competitive sport activities (Table 3-4). Basketball, volleyball, baseball, and football were the top four activities presented in class (Pate et al., 1995). Another way to assess the quality of physical education classes is to identify the time that students are actively

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School & Health: Our Nation's Investment Principal Findings This issue devoted to review of literature relating to physical activity and adolescence and consensus statement on guidelines for adolescent activity. Includes two recommendations: (1) all adolescents should be physically active daily or nearly every day as part of play, games, sports and transportation, recreation, physical education, or planned exercise in context of family, school and community activities; (2) adolescents should engage in three or more sessions per week of activities that last 20 minutes or more at a time and that require moderate to vigorous levels of exertion. As fitness levels increase, positive changes in risk factors (HDL, triglycerides, body composition, blood pressure) also occur. There appear to be some benefits of physical activity and improved physical fitness for children with certain specific chronic diseases, but insufficient data and uncontrolled studies limit conclusive results. Results of this study indicate decline in some fitness measures for school-age youth. Children receive more of their physical education time from a specialist, are more likely to attend schools that conduct fitness tests, are less likely to take physical education outdoors, and spend less time at recess. School factors tend to be unrelated to body composition. Other factors related to student fitness include the child's activity level, as rated by the teacher, television watching time, receipt of physical activity through community organizations, and parental exercise habits. engaged in moderate to heavy physical activity. Parcel et al. (1987) and Faucette et al. (1990) observed and coded activity levels during physical education sessions in elementary classes. The average child was vigorously active for only two minutes (Parcel et al., 1987). Children were usually engaged in game play that required only a few to be active while the majority awaited their turn (Faucette et al., 1990). Recently, however, the Child and Adolescent Trial for Cardiovascular Health (CATCH) has shown that it is possible to increase significantly the intensity of physical activity in physical education classes; in CATCH intervention schools, students spent 40 percent of class time in moderate to vigorous physical activity (Luepker et al., 1996). Scheduling and environmental factors may make physical education less appealing for students. For example, students may not look forward to physical education class early in the day, especially in hot humid weather, if there is no opportunity to shower and change their clothes. The status of physical education in the curriculum may also be ques-

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School & Health: Our Nation's Investment TABLE 3-1B Studies Supporting the Contribution of Physical Activity to Academic Achievement Study Kirkendall, D.R. 1986. Effects of physical activity on intellectual development and academic performance. Pp. 49–63, in: Effects of Physical Activity on Children (The American Academy of Physical Education Papers, No. 19), G.A. Stull and H.M. Eckert eds. Champaign, Illinois: Human Kinetics. Shephard, R.J., Volel, M., Lavallee, H., LaBarre, R., Jequier, J.C., and Rajic, M. 1984. Required physical activity and academic grades: A controlled study. Pp. 58–63 in J. Ilmarinen and I. Vaelimaeki eds., Children and sport: Paediatric work physiology. Berlin, Germany: Springer-Verlag. Moore, J.B., Guy, L.M., and Reeve, T.G. 1984. Effects of the capon perceptual-motor program on motor ability, self-concept, and academic readiness. Perceptual and Motor Skills 58:71–74. Thomas, J.R., Chissom, B.S., Steward, C., and Shelly, F. 1975. Effects of perceptual motor training on preschool children: A multivariate approach. RQES 46:505–513. Lipton, E.D. 1970. A perceptual-motor development program's effect on visual perception and reading readiness of first grade children. RQES 41:402–405. Kuntzleman, C.T., and Reiff, G. 1992. American Children's Fitness Levels. RQES 63:107–111. Rowland, T.W. 1990. Exercise and Children's Health. Champaign, IL: Human Kinetics: Chapter 8. American Academy of Pediatrics. 1987. Physical Fitness and the Schools. Pediatrics 80(3). McKenzie, T.L., Faucette, F.N., Sallis, J.F., Roby, J.J. and Kilody, B. 1993. Effects of curriculum and inservice program on the quantity and quality of elementary physical education classes. RQES 64:178–187. tioned because physical education is not mentioned in the National Education Goals as one of the core subjects in which students should demonstrate competence (although one of the expanded objectives of Goal 3 states that ''all students will have access to physical education and health education to ensure they are healthy and fit") (National Education Goals Panel, 1994). Thus, in this era of increased emphasis on academic rigor and standards, students, parents, and other educators may perceive that

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School & Health: Our Nation's Investment Principal Findings This article reviews literature relating to cognitive development and physical activity. Indicates that while not conclusive, consistent and positive correlations are found between physical activity and academic achievement. The Trois Riveres study in Canada demonstrated significant gains in academic performance during a six-year elementary program as a result of increased time for physical education and concomitant 13% decrease in time for academic instruction. The results of this study supported increase in self-concept and reading readiness based on participation in perceptual-motor program. A perceptual motor training program appeared to facilitate limited, positive short term gains in academic ability. Physical education programs that focused on directionality of movement increased reading readiness in selected full class groups. Fitness levels of children are not increasing. Many children do not have fitness levels high enough to sustain good health. Suggests positive benefits of physical activity to various psychological factors which may influence success in academic settings (these include depression, anxiety, self-esteem). There is no evidence to suggest that physical activity reduces academic achievement. This is a position statement advocating daily physical education and physical activity in the schools. Targeted health-related objectives and teacher training increased student activity and lesson quality for 4th grade students when compared to control classes. Classes taught by specialist physical educators further improved lesson quality. physical education is less important than other "academic" subjects. The committee does not wish to engage in a debate over such artificial issues as whether physical education is an "academic" subject or its relative importance compared to other subjects. The point is that physical education and physical activity are very important to students' current and future health, and a choice should not have to be made between physical education and other "academic" subjects. Room should be made in the

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School & Health: Our Nation's Investment The committee recommends that all elementary teachers receive substantive preparation in health education content and methodology during their preservice college training. This preparation should give elementary generalist teachers strategies for infusing health instruction into the curriculum and prepare upper elementary teachers to lay the groundwork for the intensive middle or junior high health education program. REFERENCES Advertising Age. 1990. Special supplement: Marketing to Hispanics. Allensworth, D.D. 1994. The research base for innovative practices in school health education at the secondary level. Journal of School Health 64(5):80–186. Allensworth, D.D., and Wolford, C. 1989. A theoretical approach to HIV prevention. Journal of School Health 59(2):56-65. American Alliance for Health, Physical Education, Recreation, and Dance. 1995. AAHE/NCATE Guidelines Review Book. Reston, Va.: Association for the Advancement of Health Education. American Association for the Advancement of Science. 1989. Project 2061: Science for All Americans. Washington, D.C.: American Association for the Advancement of Science. American Association for the Advancement of Science. 1993. Benchmarks for Science Literacy. New York: Oxford University Press. American Cancer Society. 1993. National action plan for comprehensive school health education. Journal of School Health 63(1):46–66. American Cancer Society. 1994. Values and Opinions of Comprehensive School Health Education in U.S. Public Schools: Adolescents, Parents, and School District Administrators. Atlanta, Ga.: American Cancer Society. American Public Health Association. 1975. Resolutions and position papers: Education for health in the community setting. American Journal of Public Health 65(2):201–202. Bartlett, E. 1981. The contribution of school health education to community health promotion: What can we reasonably expect? American Journal of Public Health 71:1384–1391. Benard, B. 1986. Characteristics of effective prevention programs. Network 3:6–8. Bennett, B.B. 1987. The Effectiveness of Staff Development Training Practices: A Meta-Analysis. Ann Arbor, Mich.: Doctoral Dissertation No. 8721226. Berkowitz, R.I., Agras, W.S., Korner, A.F., Kraement, H.C., and Zeanah, C.H. 1985. Physical activity and adiposity: A longitudinal study from birth to childhood. Journal of Pediatrics 106:734–738. Berlin, J.A., and Colditz, G.A. 1990. A meta-analysis of physical activity in the prevention of coronary heart disease. American Journal of Epidemiology 132:253–287. Bertera, R.L., and Cuthie, J.C. 1984. Blood pressure self-monitoring in the workplace. Journal of Occupational Medicine 26:183–188. Blair, S.N., Kohl, H.W. III, Paffenbarger, R.S., Clark, D.G., Cooper, K.H., and Gibbons, L.W. 1989. Physical fitness and all-cause mortality. Journal of the American Medical Association 262:2395–2401. Botvin, G.J., and Eng, A. 1982. The efficacy of a multicomponent approach to the prevention of cigarette smoking. Preventive Medicine 11:199–211. Boyer, E.L. 1983. High School: A Report on Secondary Education in America. New York: Carnegie Foundation for the Advancement of Teaching.

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