Physical Activity: Classroom-Based Health Education Focused on Providing Information

The CPSTF finding is based on evidence from a systematic review of 10 studies (search period 1980 – 2000).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity.

Information about data variability is available in the published evidence review.

Ten studies were included in the systematic review.

• Interventions reported different effects on time spent in physical activity outside the school setting.
  • Three study arms from two studies showed increases in activity.
  • Five study arms from two studies showed decreases in self-reported activity.
  • Five study arms from one study found positive changes in self-reported behavior.
  • Eleven study arms from two studies found no change or negative changes in self-reported behavior.
• Although findings did not show changes in activity, four of five study arms from three studies showed increases in the following:
  • General health knowledge
  • Exercise-related knowledge
  • Self-efficacy about exercise
• Effects on body fat measures were mixed, showing decreases in BMI (body mass index) among both boys and girls, but decreases in skinfold measurement among boys only.

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How do interventions affect various population subgroups, such as age, gender, race, or ethnicity?
• Do informational approaches to increasing physical activity help to increase health knowledge? Is it necessary to increase knowledge or improve attitudes toward physical activity to increase physical activity levels?
• Do these interventions increase awareness of opportunities for, and benefits of, physical activity?
• Are there any key harms?
• Is anything known about whether or how approaches to physical activity could reduce potential harms (e.g., injuries or other problems associated with doing too much too fast)?
• What resource (time and money) constraints prevent or hinder the implementation of these interventions?
• Can reliable and valid measures be developed to address the entire spectrum of physical activity, including light or moderate activity?
• What is the cost-effectiveness of each of these interventions? What combinations of components are most cost-effective?
• How can effectiveness in terms of health outcomes or quality-adjusted health outcomes be better measured, estimated, or modeled?
• How can the cost benefit of these programs be estimated?
• How do specific characteristics of each of these approaches contribute to economic efficiency?

• Many of the evaluated classes had a behavioral skills component (e.g., role-play, goal-setting, contingency planning) but did not add time for physical activity to the curriculum.
• Most of the interventions were designed to reduce the risk of developing chronic disease.
• In most studies, comparison groups received the standard health education curriculum.
• The duration of intervention activities ranged from 3 months to 5 years.

Effectiveness Review

Analytic Framework see Figure 1 on page 76

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table — Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Bush PJ, Zuckerman AE, Theiss PK, et al. Cardiovascular risk factor prevention in black schoolchildren: two-year results of the “Know Your Body” program. Am J Epidemiol 1989;129:466 82.

Dale D, Corbin CB. Physical activity participation of high school graduates following exposure to conceptual or traditional physical education. Res Q Exerc Sport 2000;71:61 8.

Davis SM, Lambert LC, Gomez Y, Skipper B. Southwest cardiovascular curriculum project: study findings for American Indian elementary students. J Health Educ 1995;26(suppl):S72 S81.

Holcomb JD, Lira J, Kingery PM, Smith DW, Lane D, Goodway J. Evaluation of Jump Into Action: a program to reduce the risk of non-insulin dependent diabetes mellitus in school children on the Texas-Mexico border. J Sch Health 1998;68:282 8.

Killen JD, Robinson TN, Telch MJ, et al. The Stanford Adolescent Heart Health Program. Health Educ Q 1989;16:263 83.

Marcus AC, Wheeler RC, Cullen JW, Crane LA. Quasi-experimental evaluation of the Los Angeles Know Your Body Program: knowledge, beliefs, and self-reported behaviors. Prev Med 1987;16:803 15.

Perry CL, Klepp KI, Dudovitz B, Golden D, Griffin, Smyth M. Promoting healthy eating and physical activity patterns among adolescents: a pilot study of “Slice of Life.” Health Educ Q 1987;2:93 103.

Petchers MK, Hirsch EZ, Bloch BA. A longitudinal study of the impact of a school heart health curriculum. J Community Health 1988;13:85 94.

Walter HJ, Hofman A, Connelly PA, Barrett LT, Kost KL. Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention. Am J Epidemiol 1985;122:772 81.

Walter HJ, Hofman A, Connelly PA, Barrett LT, Kost KL. Coronary heart disease prevention in childhood: one-year results of a randomized intervention study. Am J Prev Med 1986;2:239 45.

The search for evidence started with seven computerized databases (MEDLINE, Sportdiscus, Psychlnfo, Transportation Research Information Services [TRIS], Enviroline, Sociological Abstracts, and Social SciSearch) and included reviews of reference lists and consultations with experts in the field. Studies were eligible for inclusion if they:

• Were published in English during 1980-2000
• Were conducted in an Established Market Economy*
• Assessed a behavioral intervention primarily focused on physical activity
• Were primary investigations of interventions selected for evaluation rather than, for example, guidelines or reviews
• Evaluated outcomes selected for review; and
• Compared outcomes among groups of persons exposed to the intervention with outcomes among groups of persons not exposed or less exposed to the intervention (whether the study design included a concurrent or before-and-after comparison)

* Established Market Economies as defined by the World Bank are Andorra, Australia, Austria, Belgium, Bermuda, Canada, Channel Islands, Denmark, Faeroe Islands, Finland, France, Germany, Gibraltar, Greece, Greenland, Holy See, Iceland, Ireland, Isle of Man, Italy, Japan, Liechtenstein, Luxembourg, Monaco, the Netherlands, New Zealand, Norway, Portugal, San Marino, Spain, St. Pierre and Miquelon, Sweden, Switzerland, the United Kingdom, and the United States.

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.

Evidence-Based Cancer Control Programs (EBCCP)

Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)