Physical Activity: Classroom-based Physically Active Lesson Interventions

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends classroom-based physically active lesson interventions to increase physical activity and improve educational outcomes. Systematic review evidence shows these interventions, when delivered by classroom teachers, meaningfully increase the amount of time children spend engage in physical activity during the school day and improve educational outcomes in math and reading.

CPSTF also recommends classroom-based physical activity break interventions to increase physical activity.

Intervention

Classroom-based physically active lessons integrate bouts of physical activity within academic lessons. Teachers integrate activity into lessons held inside or outside of the classroom. Active lessons are scheduled every day or several times per week and typically last 10-30 minutes each. Activities aim to achieve moderate-to-vigorous intensity physical activity.

Interventions include training for teachers and may include access to integrated lesson plans or examples, and web or video resources designed to engage students in age- and classroom-appropriate exercises and dance routines.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

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.

Norris E, van Steen T, Direito A, Stamatakis E. Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54:826-38.

The review included 42 studies (search period through April 2019), of which 34 were included in meta-analyses of physical activity, health, cognition, and education-related outcomes. The team also examined the subset of 18 intervention studies conducted in the United States and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review and meta-analyses, additional information from the subset of 18 studies conducted in the United States, and expert input from team members and CPSTF.

Context

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).

Summary of Results

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

The published systematic review included 42 studies, of which 34 were included in meta-analyses providing summary effect estimates as standardized mean differences. Interventions lead to the following student outcomes:

  • Increased time spent in moderate-to-vigorous intensity physical activity over the school day
  • Improved lesson-related educational outcomes
  • Improved measurements of student attention to lesson content

The review did not find intervention effects on cognition or measures of physical fitness or body mass index.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from the review, findings should be applicable to students in preschool, kindergarten, and elementary schools in the United States.

Evidence Gaps

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?)

  • How do intervention effects vary by participant characteristics, including household income, parents’ level of education, and race/ethnicity in U.S. populations?
  • How do intervention effects vary based on duration and frequency of physically active lessons during the school day?
  • Do physically active lessons contribute to more students meeting recommendations for 60 minutes per day of moderate-to-vigorous intensity physical activity per day?
  • What is the impact of classroom-based physically active lesson interventions on the following outcomes:
    • Cognitive functions
    • Physical fitness, including aerobic fitness, muscle strength and endurance, flexibility, and body composition
    • Other student health outcomes
  • Are these interventions effective for older students in middle and high school settings?
  • 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 Characteristics

  • Study designs included group randomized controlled trials (27 studies), controlled before-after studies (14 studies), and prospective cohorts (1 study).
  • Studies were conducted in the United States (18 studies), Australia (7 studies), the United Kingdom (5 studies), the Netherlands (4 studies), and Denmark (2 studies), and one study each came from China, Croatia, Ireland, Israel, Portugal, and Sweden.
  • Most study interventions were implemented by teachers (32 studies). Many of them provided fully integrated active lesson plans (24 studies) or sample activities to be integrated into lessons (13 studies).
  • Included studies most often evaluated students in primary school settings (29 studies) or preschool settings (10 studies). One study evaluated interventions among students in grades K-8, and two studies included students in grades 6-9.
  • U.S. studies that reported information about race and ethnicity included students who self-identified as Black or African American (median of 10.9% from 9 studies), Hispanic or Latino (median of 13.1% from 7 studies), and Asian (median of 4.6% from 4 studies). Two studies were conducted in schools where a high proportions of students qualified for free (89%) or reduced-price (94%) lunch.

Analytic Framework

Effectiveness Review

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.

Summary Evidence Table

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:

Norris E, van Steen T, Direito A, Stamatakis E. Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54:826-38.

Included Studies

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

Bartholomew JB, Jowers EM. Physically active academic lessons in elementary children. Preventive Medicine 2011;52(Suppl 1):S51 S54.

Bartholomew JB, Jowers EM, Roberts G, Fall AM, Errisuriz V, et al. Active learning increases children’s physical activity across demographic subgroups. Translational Journal of the American College of Sports Medicine 2018;3:1 9.

Beck MM, Lind RR, Geertsen SS, Ritz C, Lundbye-Jensen J, et al. Motor-Enriched learning activities can improve mathematical performance in preadolescent children. Frontiers in Human Neuroscience 2016;10:645 45.

Callcott D, Hammond L, Hill S. The synergistic effect of teaching a combined explicit movement and phonological awareness program to preschool aged students. Early Childhood Education Journal 2015;43:201 11.

de Greeff JW, Hartman E, Mullender-Wijnsma MJ, Bosker RJ, Doolaard S, et al. Effect of physically active academic lessons on body mass index and physical fitness in primary school children. Journal of School Health 2016;86:346 52.

de Greeff JW, Hartman E, Mullender-Wijnsma MJ, Bosker RJ, Doolaard S, et al. Long-Term effects of physically active academic lessons on physical fitness and executive functions in primary school children. Health Education Research 2016;31:185 94.

Donnelly JE, Greene JL, Gibson CA, Smith BK, Washburn RA, et al. Physical activity across the curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventive Medicine 2009;49:336 41.

Donnelly JE, Hillman CH, Greene JL, Hansen DM, Gibson CA, et al. Physical activity and academic achievement across the curriculum: results from a 3-year cluster-randomized trial. Preventive Medicine 2017;99:140 5.

Duncan M, Cunningham A, Eyre E. A combined movement and story-telling intervention enhances motor competence and language ability in pre-schoolers to a greater extent than movement or story-telling alone. Eur Phys Educ Rev 2017;1356336X.

Elofsson J, Englund Bohm A, Jeppsson C, Samuelsson, J. Physical activity and music to support pre-school children’s mathematics learning. Education 3-13 2018;46:483 93.

Erwin H, Fedewa A, Ahn S. Student academic performance outcomes of a classroom physical activity intervention: a pilot study. International Electronic Journal of Elementary Education 2012;4:473 87.

Fedewa AL, Ahn S, Erwin H, Davis M. A randomized controlled design investigating the effects of classroom-based physical activity on children’s fluid intelligence and achievement. School Psychology International 2015;36:135 53.

Gammon C, Morton K, Atkin A, Corder K, Daly-Smith A, et al. Introducing physically active lessons in UK secondary schools: feasibility study and pilot cluster-randomised controlled trial. BMJ Open 2019;9:e025080.

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;2.

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;41:1921 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.

Have M, Nielsen JH, Ernst MT, Gejl AK, Fredens K, et al. Classroom-based physical activity improves children’s math achievement – A randomized controlled trial. PLoS One 2018;13:e0208787.

Helgeson JL. The impact of physical activity on academics in English classes at the junior high school level. Dissertation Abstracts International Section A: Humanities and Social Sciences 2013;74.

Hraste M, De Giorgio A, Jelaska PM, Padulo J, Granic I. When mathematics meets physical activity in the school-aged child: the effect of an integrated motor and cognitive approach to learning geometry. PLoS One 2018;13:e0196024.

Kirk SM, Vizcarra CR, Looney EC, Kirk EP. Using physical activity to teach academic content: a study of the effects on literacy in head start preschoolers. Early Childhood Education Journal 2014;42:181 9.

Kirk SM, Kirk EP. Sixty minutes of physical activity per day included within preschool academic lessons improves early literacy. Journal of School Health 2016;86:155 63.

Klinkenborg A. The effect of physical activity on science competence and attitude towards science content 2011.

Leandro CR, Monteiro E, Melo F. Interdisciplinary working practices: can creative dance improve math? Research in Dance Education 2018;19:74 90.

Liu A, Hu X, Ma G, Cui Z, Pan Y, et al. Evaluation of a classroom-based physical activity promoting programme. Obesity Reviews 2008;9(Suppl 1):130 4.

Mahar MT. Impact of short bouts of physical activity on attention-to-task in elementary school children. Preventive Medicine 2011;52(Suppl 1):S60 S64.

Martin R, Murtagh E. Active classrooms: a cluster randomized controlled trial evaluating the effects of a movement integration intervention on the physical activity levels of primary school children. Journal of Physical Activity and Health 2017;14:290 300.

Mavilidi M-F, Okely AD, Chandler P, Paas F. Infusing physical activities into the classroom: effects on preschool children’s geography learning. Mind, Brain, and Education 2016;10:256 63.

Mavilidi M-F, Okely AD, Chandler P, Paas F. Effects of integrating physical activities into a science lesson on preschool children’s learning and enjoyment. Applied Cognitive Psychology 2017;31:281 90.

Mavilidi M-F, Okely A, Chandler P, Domazet SL, Paas F. Immediate and delayed effects of integrating physical activity into preschool children’s learning of numeracy skills. Journal of Experimental Child Psychology 2018;166:502 19.

Miller S, Gildea A, Sloan S, Allen T. Physically active lessons: evaluation report and executive summary. London: Education Endowment Foundation, 2015.

Mullender-Wijnsma MJ, Hartman E, de Greeff JW, Bosker RJ, Doolaard S, et al. Improving academic performance of school-age children by physical activity in the classroom: 1-year program evaluation. Journal of School Health 2015;85:365 71.

Mullender-Wijnsma MJ, Hartman E, de Greeff JW, Doolaard S, Bosker RJ, et al. Physically active math and language lessons improve academic achievement: a cluster randomized controlled trial. Pediatrics 2016;137:e20152743 9.

Norris E, Shelton N, Dunsmuir S, Duke-Williams O, Stamatakis E. Virtual field trips as physically active lessons for children: a pilot study. BMC Public Health 2015;15:366.

Norris E, Dunsmuir S, Duke-Williams O, Stamatakis W, Shelton N. Physically Active Lessons Improve Lesson Activity and On-Task Behavior: A Cluster-Randomized Controlled Trial of the “Virtual Traveller” Intervention. Health Education & Behavior 2018;45:945 56.

Reed JA, Einstein G, Hahn E, Hooker SP, Gross VP, et al. Examining the impact of integrating physical activity on fluid intelligence and academic performance in an elementary school setting: a preliminary investigation. Journal of Physical Activity and Health 2010;7:343 51.

Reznik M, Wylie-Rosett J, Kim M, Ozuah PO. A classroom-based physical activity intervention for urban kindergarten and first-grade students: a feasibility study. Childhood Obesity 2015;11:314 24.

Riley N, Lubans DR, Morgan PJ, Young M. Outcomes and process evaluation of a programme integrating physical activity into the primary school mathematics curriculum: the easy minds pilot randomised controlled trial. Journal of Science and Medicine in Sport 2015;18:656 61.

Riley N, Lubans DR, Holmes K, Morgan PJ. Findings from the easy minds cluster randomized controlled trial: evaluation of a physical activity integration program for mathematics in primary schools. Journal of Physical Activity and Health 2016;13:198 206.

Shoval E, Sharir T, Arnon M, Tenebaum G. The effect of integrating movement into the learning environment of kindergarten children on their academic achievements. Early Childhood Education Journal 2018;46:355 64.

Szabo-Reed AN, Willis EA, Lee J, Hillman CH, Washburn RA, et al. Impact of three years of classroom physical activity bouts on Time-on-Task behavior. Medicine & Science in Sports & Exercise 2017;49:2343 50.

Trost SG, Fees B, Dzewaltowski D. Feasibility and efficacy of a “move and learn” physical activity curriculum in preschool children. Journal of Physical Activity and Health 2008;5:88 103.

Vazou S, Skrade MAB. Intervention integrating physical activity with math: math performance, perceived competence, and need satisfaction. International Journal of Sport and Exercise Psychology 2017;15:508 22.

Vetter M, O’Connor H, O’Dwyer N, Chou J, Orr R. Learning “Math on the Move”: Effectiveness of a Combined Numeracy and Physical Activity Program for Primary School Children. Journal of Physical Activity and Health 2018;15:492 8.

Search Strategies

Effectiveness Review

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

Norris E, van Steen T, Direito A, Stamatakis E. Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54:826-38.

Review References

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.

Norris E, van Steen T, Direito A, Stamatakis E. Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54:826-838

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

Considerations for Implementation

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

  • Classroom-based physically active lessons may provide additional 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:
  • 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:
  • Most of the included studies evaluated interventions implemented by teachers. The interventions provided training for teachers, and most also provided resources such as integrated lesson plans, and videos or web links to classroom appropriate exercises and dance routines.
  • Investigators in included studies noted several advantages of physically active lesson interventions including retention of classroom time for instruction, teacher flexibility to fit active lessons into the classroom schedule, and modest resource requirements. CPSTF notes that scalability may depend on development of, or access to, integrated lessons and activities that support daily or regular use.
  • Advantages of classroom-based physical activity break interventions include the following:
    • Retention of classroom time for educational instruction
    • Teacher flexibility to fit breaks into the classroom schedule
    • Low resource requirements
    • Scalability
  • Identified factors related to implementation and sustained use of physically activity lesson interventions include:
    • Teacher time required to integrate activity into lesson plans on a daily or regular basis in the absence of packaged active lessons
    • Support that teachers receive from school administrators
    • Level of buy-in and comfort level from the school system
    • Resources, time, and spaces available
    • Goals of individual classes or courses
  • Several publicly available resources provide implementation guidance:
    • Classroom Energizers (Eat Smart Move More) is a resource guide from North Carolina public schools that instructs on classroom-based physical activity integrated with academic concepts.
    • 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.

Crosswalks

Healthy People 2030

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