Physical Activity: Classroom-based Physical Activity Break Interventions

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to school-based physical activity interventions.

Masini A, Marini S, Gori D, Leoni E, Rochira A, Dallolio L. Evaluation of school-based interventions of activity breaks in primary schools: a systematic review and meta-analysis. Journal of Science and Medicine in Sport 2020;23:377-84.

The review included 22 studies overall (search period through April 2019). Six studies included in the review integrated physical activity within classroom lessons and were considered in a separate review. The team examined the remaining 16 intervention studies and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the subset of 16 studies, and expert input from team members and CPSTF.

The U.S. Department of Health and Human Services recommends that young people ages 6 17 years participate in at least 60 minutes of physical activity daily (HHS 2018). Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, improves cognitive function, reduces risk of depression, and may improve cardiovascular health (HHS 2018).

Schools have an important role in promoting and supporting daily and weekly physical activity among students. Classroom-based physical activity interventions can be used to supplement other school programs and policies to promote physical activity among students such as physical education programs, recess breaks, and active travel to school interventions (CDC 2018).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The published systematic review included 22 studies; 6 of these studies were included in meta-analyses for three outcomes.

• The amount of time children spent in moderate-to-vigorous intensity physical activity while at school increased by a median of 4.29 minutes (2 studies)
• The number of steps students took during a school day increased by a median of 960 steps (3 studies)
• There was a median increase of 26.15 minutes in the amount of time students were attentive to classroom lessons following activity breaks (2 studies).

A systematic review of economic evidence has not been conducted.

Based on the results from the review, findings should be applicable to primary school students in the United States.

The 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?)

• What are the effects of classroom-based physical activity breaks on the following outcomes?
  • Proportion of students that achieve 60 minutes of moderate-to-vigorous intensity physical activity per day (objectively measured), as recommended in the 2018 Physical Activity Guidelines for Americans, 2nd edition
  • Physical fitness, including aerobic fitness, muscle strength and endurance, flexibility, and body composition
  • Cognitive functions
  • Education outcomes (e.g., lesson uptake)
  • Academic achievement (e.g., test scores and year-end grades)
  • Other student health outcomes
• How do intervention effects vary by participant characteristics, including student age and grade, household income, parents’ education, and race/ethnicity in U.S. populations?
• How do intervention duration and frequency effect outcomes?
• What are barriers to teacher and school adoption and sustained implementation?
• What are solutions to address barriers to teacher and school adoption and sustained implementation?
• How might physical activity breaks be tailored so they are developmentally appropriate, culturally relevant, and inclusive of students with disabilities?

• Study designs included randomized trials (9 studies), controlled before-after designs (3 studies), single group before-after designs (3 studies), and a post implementation evaluation (1 study).
• Included studies were conducted in the United States (7 studies), Canada (2 studies), the United Kingdom (2 studies), Australia (1 study), the Netherlands (1 study), Poland (1 study), Macedonia (1 study), and Switzerland (1 study)
• U.S. studies included primary schools in which a high proportion of students qualified for the free or reduced lunch program (median 47%; 5 studies). Study participants included Black or African American students (median 19.8%; 5 studies) and Hispanic or Latino students (median 21.0%; 4 studies).

Effectiveness Review

• Logic Model
• Text Description

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

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Masini A, Marini S, Gori D, Leoni E, Rochira A, Dallolio L. Evaluation of school-based interventions of activity breaks in primary schools: a systematic review and meta-analysis. Journal of Science and Medicine in Sport 2020;23:377-84.

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

Buchele Harris H, Cortina KS, Templin T, Colabianchi N, Chen W. Impact of coordinated bilateral physical activities on attention and concentration in school-aged children. BioMed Research International 2018; 28(2018):2539748. http://dx.doi.org/10.1155/2018/2539748.eCollection 2018.

Carlson JA, Engelberg JK, Cain KL, Conway TL, Mignano AM, et al. Implementing classroom physical activity breaks: associations with student physical activity and classroom behavior. Preventive Medicine 2015; 81:67 72.

Drummy C, Murtagh EM, McKee DP, Breslin G, Davison GW, et al. The effect of a classroom activity break on physical activity levels and adiposity in primary school children. Journal of Paediatrics and Child Health 2016; 52(7):745 9.

Erwin HE, Beighle A, Morgan CF, Noland M. Effect of a low-cost, teacher-directed classroom intervention on elementary students’ physical activity. Journal of School Health 2011; 81(8):455 61.

Fedewa AL, Fettrow E, Erwin H, Ahn S, Farook M. Academic-based and aerobic-only movement breaks: are there differential effects on physical activity and achievement? Research Quarterly for Exercise and Sport 2018; 89(2):153 63.

Glapa A, Grzesiak J, Laudanska-Krzeminska I, Chin MK, Edginton CR, et al. The impact of brain brake classroom-based physical activities on attitudes toward physical activity in polish school children in third to fifth grade. International Journal of Environmental Research and Public Health 2018;15(2):E368.

Howie EK, Schatz J, Pate RR. Acute effects of classroom exercise breaks on executive function and math performance: a dose-response study. Research Quarterly for Exercise and Sport 2015; 86(3):217 24.

Katz DL, Cushman D, Reynolds J, Njkie V, Treu JA, et al. Putting physical activity where it fits in the school day: preliminary results of the ABC (Activity Bursts in the Classroom) for fitness program. Preventing Chronic Disease 2010; 7(4):A82.

Ma JK, Le Mare L, Gurd BJ. Classroom-based high-intensity interval activity improves off-task behavior in primary school students. Applied Physiology Nutrition and Metabolism 2014; 39(12):1332 7.

Ma JK, Le Mare L, Gurd BJ. Four minutes of in-class high-intensity interval activity improves selective attention in 9- to 11-year olds. Applied Physiology Nutrition and Metabolism 2015; 40(3):238 44.

Murtagh E, Mulvihill M, Markey O. Bizzy Break! The effect of a classroom-based activity break on in-school physical activity levels of primary school children. Pediatric Exercise Science 2013; 25:300 7.

Popeska B, Jovanova-Mitkovska S, Chin MK, Edginton CR, Mok MMC, et al. Implementation of Brain Breaks in the classroom and effects on attitudes toward physical activity in a Macedonian school setting. International Journal of Environmental Research and Public Health 2018; 15(6):E1127.

Schmidt M, Benzing V, Kamer M. Classroom-based physical activity breaks and children’s attention: cognitive engagement Works! Frontiers in Psychology 2016; 7:1474.

van den Berg V, Saliasi E, de Groot RHM, Chinapaw MJM, et al. Improving cognitive performance of 9-12 years old children: just dance? A randomize control trial. Frontiers in Psychology 2019; 10:174.

Watson AJL, Timperio A, Brown H, Hesketh KD. A pilot primary school active break program (ACTI-BREAK): Effects on academic and physical activity outcomes for students in Years 3 and 4. Journal of Science and Medicine in Sport 2019; 22(4):438 43.

Whitt-Glover MC, Ham SA, Yancey AK. Instant recess: a practical tool for increasing physical activity during school day. Progress in Community Health Partnerships 2011; 5(3):289 97.

Interventions evaluated in the following studies integrated physical activity with educational lessons and were considered by the CPSTF in a separate review of physically active lesson interventions.

Goh TL, Hannon J, Webster C et al. Effects of a TAKE 10! Classroom-based physical activity intervention on third- to fifth-grade children’s on-task behavior. Journal of Physical Activity and Health 2016; 13(7):712 8.

Graham DJ, Lucas-Thompson RG, O’Donnell MB. Jump In! An investigation of school physical activity climate, and a pilot study assessing the acceptability and feasibility of a novel tool to increase activity during learning. Frontiers in Public Health 2014; 28(2):58. http://dx.doi.org/10.3389/fpubh.2014.00058.eCollection 2014.

Grieco LA, Jowers EM, Bartholomew JB. Physically active academic lessons and time on task: the moderating effect of body mass index. Medicine & Science in Sports & Exercise 2009; 41(10):1921 6.

Grieco LA, Jowers EM, Errisuriz VL, Bartholomew JB. Physically active vs. sedentary academic lessons: a dose response study for elementary student time on task. Preventive Medicine 2016; 89:98 103.

Mahar MT, Murphy SK, Rowe DA, Golden J, Shields AT, et al. Effects of a classroom-based program on physical activity and on-task behavior. Medicine & Science in Sports & Exercise 2006; 38(12):2086 94.

Stewart JA, Dennison DA, Kohl HW, Doyle A. Exercise level and energy expenditure in the TAKE 10! in-class physical activity program. Journal of School Health 2004; 74(10):397 400.

Blog Post

Health.gov: Reaching Kids Where They Are Classroom-Based Interventions to Increase Physical Activity

Effectiveness Review

Refer to the existing systematic review for information about the search strategy:

Masini A, Marini S, Gori D, Leoni E, Rochira A, Dallolio L. Evaluation of school-based interventions of activity breaks in primary schools: a systematic review and meta-analysis. Journal of Science and Medicine in Sport 2020;23:377-84.

Centers for Disease Control and Prevention. Strategies for Classroom Physical Activity in Schools. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2018.

Masini A, Marini S, Gori D, Leoni E, Rochira A, Dallolio L. Evaluation of school-based interventions of activity breaks in primary schools: A systematic review and meta-analysis. Journal of Science and Medicine in Sport 2020; vol 23: 377-384.

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: US Department of Health and Human Services; 2018.

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.

• Classroom-based physical activity breaks may add minutes of moderate-to-vigorous intensity physical activity to the school day, which could help students achieve the recommended 60 minutes of daily physical activity.
• Interventions should be used in addition to, not instead of, other school programs and policies to promote physical activity among students. These may include recess breaks and the following CPSTF-recommended interventions:
  • Interventions to increase active travel to school (2016)
  • Enhanced school-based physical education (2013)
  • Combined nutrition and physical activity interventions in schools (2018)
• CPSTF recommendations support the priorities of CDC’s Healthy Schools Guidance and Comprehensive School Physical Activity Program Framework. CDC provides the following program and intervention guidance:
  • Increasing Physical Education and Physical Activity: A Framework for Schools (2017)
  • Strategies for Classroom Physical Activity in Schools (2018)
• Interventions provided training for classroom teachers, and most provided videos or web links to age- and classroom-appropriate exercises and dance routines.
• Advantages of classroom-based physical activity break interventions include the following:
  • Simplicity
  • Teacher flexibility to fit breaks into the classroom schedule
  • Low resource requirements
  • Scalability
• Factors related to the implementation and sustained use of classroom-based physical activity break interventions include:
  • Support teachers receive from school administrators
  • The school system’s level of comfort and buy-in
  • Resources, time, and spaces available
  • Goals of individual classes or courses
• Several publicly available resources provide implementation guidance:
  • Move for Thought is an integrated physical activity strategy for learning in primary school classrooms.
  • Active Academics offers classroom teachers practical physical activity ideas that can be integrated into regular classroom content areas.
  • Springboard to Active Schools provides professional development, technical assistance, and tools and resources for promoting physical activity in the classroom.
  • Active Schools provides information on implementing physical activity in the classroom, including links to activity ideas and webinars and trainings for classroom teachers.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Increase the proportion of adolescents who do enough aerobic physical activity — PA-06
• Increase the proportion of children who do enough aerobic physical activity — PA-09