Physical Activity: Enhanced School-Based Physical Education

This CPSTF finding is based on evidence from a systematic review published in 2013 (Lonsdale et al., 14 studies, search period through March 2012). An updated search for evidence (search period January 2012-December 2012) did not identify any additional studies.

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. This finding updates and replaces the 2000 CPSTF recommendation on Enhanced School-Based Physical Education.

Information about data variability is available in the CPSTF Finding and Rationale Statement.

Most of the included studies evaluated enhanced PE programs implemented alone. Measured outcomes included the amount of time spent in moderate- or vigorous-intensity physical activity (MVPA) during PE lessons, total amount of time engaged in physical activity, and cardiorespiratory fitness.

• Proportion of PE class time students spent participating in MVPA: difference of 10.37 percentage points in favor of the intervention groups (13 studies)
• The review identified two main types of enhanced PE intervention:
  • Teaching strategies: teachers encouraged MVPA through activity selection, class organization and management, and instruction (9 studies).
    • Students whose teachers used this strategy spent a higher percentage of their class time participating in MVPA when compared with controls (absolute difference of 6 percentage points).
  • Fitness infusion: teachers supplemented students’ participation in sport activities (e.g., basketball) with vigorous fitness activities, such as running or jumping (4 studies).
    • Students whose teachers used fitness infusion spent a higher percentage of their class time participating in MVPA when compared with controls (absolute difference of 16 percentage points).
• Four studies reported students’ total physical activity (weekdays and weekends). Two studies showed significant effects in the favorable direction; the other two found no significant differences between intervention and control groups.
• Three studies reported mixed results on program effectiveness on cardiorespiratory fitness.

An economic review of this intervention did not find any relevant studies.

Based on the evidence, the Task Force finding should be applicable to the following:

• Males and females
• Children and adolescents
• U.S. schools in urban and rural settings
• Programs of varying duration

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?)

• The effectiveness of enhanced PE by sex, race and ethnicity, and socioeconomic and weight status
• The effects of physical education programs in general, including programs that use written standards-based curricula; have adequate time, equipment, and facilities; and are led by licensed, certified, or other highly qualified teachers
• Real world practices that account for potential confounding or mediating variables

• Studies were experimental (12 studies) or quasi-experimental (2 studies).
• All studies compared the effectiveness of enhanced PE to standard PE and measured outcomes using objective or directly observed methods.
• Five of the included studies offered additional components including: homework assignments and family workshops aimed at increasing family involvement (4 studies), health education sessions outside of PE classes intended to improve knowledge about physical activity and develop behavioral self-management skills (4 studies) and partnerships with community agencies to increase opportunities for physical activity in the community (1 study).
• Studies were conducted in PE classes for elementary (50%), middle (36%), and high school (14%) students.
• In half the studies, a PE teacher led the enhanced PE curriculum. Other studies evaluated programs led by a classroom teacher (1 study), a combination of PE and classroom teachers (2 studies), or a hired teacher or coach (2 studies).

Effectiveness Review

Analytic Framework

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

• Study Design and Sample Characteristics
• Intervention and Control Description
• Intervention Results: Lesson Time and Proportion of Lesson Time Spent in MVPA
• Intervention Results: Effects on Total Physical Activity
• Intervention Results: Effects on Aerobic Capacity
• Risk of Bias for 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

Studies from the Existing Systematic Review

Fairclough S, Stratton G. Improving health-enhancing physical activity in girls’ physical education. Health Educ Res 2005;(4):448-57.

Ignico A, Corson A, Vidoni C. The effects of an intervention strategy on children’s heart rates and skill performance. Early Child Dev Care 2006;176(7):753-61.

McKenzie TL, Nader PR, Strikmiller PK, et al. School physical education: effect of the child and adolescent trial for cardiovascular health. Prev Med 1996;25(4):423-31.

McKenzie TL, Sallis JF, Prochaska JJ, et al. Evaluation of a two-year middle-school physical education intervention: M-SPAN. Med Sci Sports Exerc 2004;36(8):1382-8.

McKenzie TL, Stone EJ, Feldman HA, et al. Effects of the CATCH physical education intervention: teacher type and lesson location. Am J Prev Med 2001;21(2):101-9.

Quinn PB, Strand B. A comparison of two instructional formats on heart rate intensity and skill development. Physical Educator 1995;52(2):62-9.

Rowlands AV, Esliger DW, Pilgrim EL, et al. Physical activity content of Motive8 PE compared to primary school PE lessons in the context of children’s overall daily activity levels. J Exerc Sci Fit 2008;6(1):26-33.

Sallis JF, McKenzie TL, Alcaraz JE, et al. The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids. Am J Public Health 1997; 87(8):1328-34.

Scantling E, Dugdale H, Bishop P, et al. The effects of two instructional formats on the heart rate intensity and skill development of physical education students. Physical Educator 1998; 55(3):138.

Simons-Morton BG, Parcel GS, Baranowski T, et al. Promoting physical activity and a healthful diet among children: results of a school-based intervention study. Am J Public Health 1991;81(8):986-91.

Strand B, Anderson C. A comparison of two instructional formats on heart rate intensity, skill achievement and student attitude. Neb J Health Phys Educ Recreat Dance1996;27:21-4.

van Beurden E, Barnett LM, Zask A, et al. Can we skill and activate children through primary school physical education lessons? “Move it Groove it”–a collaborative health promotion intervention. Prev Med2003;36(4):493-501.

Verstraete S, Cardon G, De Clercq D, et al. Effectiveness of a two-year health-related physical education intervention in elementary schools. J Teach Phys Educ 2007;26(1):20-34.

Webber LS, Catellier DJ, Lytle LA, et al. Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls. Am J Prev Med 2008;34(3):173-84.

Young DR, Phillips JA, Yu T, et al. Effects of a life skills intervention for increasing physical activity in adolescent girls. Arch Pediatr Adolesc Med 2008;160(12):1255-61.

This literature search was performed to provide a systematic review of the evidence to the Guide to Community Preventive Services and update previous reviews of the literature on approaches to increase physical activity (Khan et al., 2002, Heath et al., 2006).

The updated search for evidence was done in two parts and included the following intervention approaches: 1) Campaigns and Information, 2) Behavioral and Social, and 3) Environmental and Policy.

In July 2008, the following databases were searched for evidence: CSA Sociological Abstracts, Allied & Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PsycINFO, Sportdiscus, and Transportation Research Information Services (TRIS).

In 2014, an additional search was conducted to bridge the evidence from 2008 2013. The following databases were searched: MEDLINE, PubMed, CINAHL, PsycINFO, CENTRAL, Sociological Abstracts, Environment Abstracts, and Transport Research International Documentation (TRID).

The databases searched covered publications in biomedical, behavioral, environmental, and transportation sciences. The types of documents searched in the databases included journal articles, books, book chapters, reports, conference papers, and dissertations.

Search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software. In addition, the bibliographies of all reviewed articles were used to identify any further literature.

References

Kahn EB, Ramsey LT, Brownson R, et al. The effectiveness of interventions to increase physical activity: a systematic review.. Am J Prev Med 2002;22(4S):73-107.

Heath GW, Brownson RC, Kruger J, et al. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. J Phys Act Health 2006;3(Suppl 1):S55-76.

Search for Evidence: January, 2008 December, 2013

Ovid MEDLINE

1. physical activit$.ti,ab.
2. Exercise/
3. exercise$.ti.
4. Physical Fitness/
5. physical inactivity.ti,ab.
6. Leisure Activities/
7. Recreation/
8. moderate activity.ti,ab.
9. vigorous activity.ti,ab.
10. Walking/
11. walking.ti.
12. Running/
13. running.ti.
14. Jogging/
15. jogging.ti.
16. Bicycling/
17. bicycl$.ti.
18. Resistance Training/
19. Motor Activity/
20. or/1-19
21. health promotion/
22. health promotion.ti,ab.
23. healthy people programs/
24. Health Behavior/
25. motivational interview$.ti,ab.
26. ((lifestyle or life style) adj (chang$ or intervention$)).ti,ab.
27. (behavio$ chang$ or behavio$ modification$).ti,ab.
28. behavio$ intervention$.ti,ab.
29. Attitude to Health/
30. Health Knowledge, Attitudes, Practice/
31. “Physical Education and Training”/
32. physical education.ti,ab.
33. Health Education/
34. health education.ti,ab.
35. school based.ti,ab.
36. recess.ti.
37. recess.ti,ab. and school$.ti,ab,hw.
38. (after school or afterschool).ti,ab.
39. child care/ or child day care centers/
40. (childcare or child care).ti.
41. (worksite$ or work site$ or workplace$ or work place$).ti,ab.
42. (community or communities).ti,ab.
43. neighborhood$.ti,ab.
44. fitness centers/
45. Social Support/
46. social environment/
47. community networks/
48. Environment Design/
49. City Planning/
50. physical environment.ti,ab.
51. built environment.ti,ab.
52. Transportation/
53. active commut$.ti,ab.
54. Telephone/
55. (web based or website$ or computer based).ti,ab.
56. social media.ti,ab.
57. blog$.ti,ab.
58. text messaging/ or text message$.ti,ab.
59. video games/
60. ((active or motion) adj3 (game$ or gaming)).ti,ab.
61. Social Marketing/
62. campaign$.ti,ab.
63. (intervention$ or program).ti.
64. or/21-63
65. 20 and 64
66. limit 65 to english language
67. limit 66 to humans
68. limit 66 to animals
69. 68 not 67
70. 66 not 69
71. limit 70 to yr=”2008 -Current”

PubMed

1. Search “physical activity”[tiab]
2. Search “physical activities”[tiab]
3. Search exercise*[ti]
4. Search “physical inactivity”[tiab]
5. Search moderate activity[tiab]
6. Search vigorous activity[tiab]
7. Search walking[ti]
8. Search running[ti]
9. Search jogging[ti]
10. Search bicycl*[ti]
11. Search #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10
12. Search motivational interview*[tiab]
13. Search (lifestyle[tiab] OR “life style”[tiab]) AND (chang*[tiab] OR intervention*[tiab])
14. Search behavio* chang*[tiab] OR behavio* modification*[tiab]
15. Search behavio* intervention*[tiab]
16. Search “health promotion”[tiab]
17. Search “Physical Education”[tiab]
18. Search “health Education”[tiab]
19. Search school based[tiab]
20. Search recess[ti]
21. Search recess[tiab] AND school*[tiab]
22. Search after school[tiab] OR afterschool[tiab]
23. Search childcare[ti] OR “child care”[ti]
24. Search worksite*[tiab] OR work site*[tiab] OR workplace*[tiab] OR work place*[tiab]
25. Search community[tiab] OR communities[tiab]
26. Search neighborhood*[tiab]
27. Search “physical environment”[tiab]
28. Search “built environment”[tiab]
29. Search active commut*[tiab]
30. Search web based[tiab] OR website*[tiab] OR computer based[tiab]
31. Search social media[tiab]
32. Search blog*[tiab]
33. Search text message*[tiab]
34. Search (active[tiab] OR motion[tiab]) AND (game*[tiab] OR gaming[tiab])
35. Search campaign*[tiab]
36. Search intervention*[ti] OR program[ti]
37. Search #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36
38. Search #11 AND #37
39. Search #11 AND #37 AND publisher[sb]
40. Search #11 AND #37 AND publisher[sb] Filters: English
41. Search #11 AND #37 AND publisher[sb] Filters: Publication date from 2008/01/01; English Sort by: PublicationDate

Cumulative Index to Nursing and Allied Health Literature

1. (MH “Exercise”) OR (MH “Walking”) OR (MH “Physical Activity”) OR (MH “Cycling”) OR (MH “Physical Fitness”)
2. (MH “Leisure Activities”) OR (MH “Recreation”)
3. (MH “Running”) OR (MH “Jogging”)
4. 1 OR 2 OR 3
5. (MH “Health Promotion”)
6. (MH “Health Education”)
7. (MH “Health Behavior”)
8. (MH “Motivational Interviewing”)
9. (MH “Life Style Changes”)
10. (MH “Behavior Modification”)
11. (MH “Attitude to Health”)
12. (MH “Health Knowledge”)
13. (MH “Physical Education and Training”)
14. school and recess
15. “after school” OR afterschool
16. (MH “Child Care”) OR (MH “Child Day Care”)
17. worksite OR workplace OR “work site” OR “work place”
18. (MH “Communities”) OR (MH “Poverty Areas”) OR (MH “Rural Areas”) OR (MH “Suburban Areas”) OR (MH “Urban Areas”)
19. neighborhood*
20. (MH “Fitness Centers”)
21. (MH “Support, Psychosocial”)
22. (MH “Social Environment”)
23. (MH “Community Networks”)
24. (MH “Transportation”) OR (MH “Bicycles”)
25. (MH “Telephone”)
26. (MH “Blogs”)
27. (MH “World Wide Web”) OR (MH “World Wide Web Applications”)
28. (MH “Instant Messaging”)
29. (MH “Video Games”)
30. (MH “Social Marketing”)
31. “campaigns”
32. TI intervention* OR TI program
33. (TI intervention* OR TI program OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21 OR 22 OR 23 OR 24 OR 25 OR 26 OR 27 OR 28 OR 29 OR 30 OR 31 OR 32) AND 4
34. (ZR “2008”) or (ZR “2009”) or (ZR “2010”) or (ZR “2011”) or (ZR “2012”) or (ZR “2013”)
35. 33 AND 34
36. (33 AND 34 ) AND LA english

PsycINFO

1. Physical Activity/
2. Exercise/
3. Physical Fitness/
4. Recreation/
5. Walking/
6. Running/
7. bicycl$.ti.
8. or/1-7
9. Health Promotion/
10. Health Behavior/
11. Active Living/
12. Motivational Interviewing/
13. Behavior Change/
14. Lifestyle Changes/
15. behavio$ intervention$.ti,ab.
16. Health Knowledge/
17. Health Education/
18. Physical Education/
19. School Based Intervention/
20. recess.ti.
21. recess.ti,ab. and school$.ti,ab,hw.
22. After School Programs/
23. Child Care/
24. Child Day Care/
25. Working Conditions/
26. (worksite$ or work site$ or workplace$ or work place$).ti.
27. Communities/
28. Neighborhoods/
29. Social Support/
30. Social Networks/
31. Social Environments/
32. Environmental Planning/
33. Urban Planning/
34. Built Environment/
35. Urban Environments/
36. Suburban Environments/
37. Transportation/
38. Public Transportation/
39. “Commuting (Travel)”/
40. active commut$.ti,ab.
41. Websites/
42. (web based or computer based).ti,ab.
43. Computer Mediated Communication/
44. Social Media/
45. blog$.ti,ab.
46. text messag$.ti,ab.
47. Computer Games/
48. ((active or motion) adj3 (game$ or gaming)).ti,ab.
49. Social Marketing/
50. campaign$.ti,ab.
51. (intervention$ or program).ti.
52. or/9-51
53. 8 and 52
54. limit 53 to english language
55. limit 54 to yr=”2008 -Current”

Cochrane Central Register of Controlled Trials

1. physical next activity:ti,ab,kw from 2008 to 2013, in Trials
2. exercise*:ti,kw from 2008 to 2013, in Trials
3. physical next fitness:ti,kw from 2008 to 2013, in Trials
4. physical next inactivity:ti,ab from 2008 to 2013, in Trials
5. leisure next activities:ti,kw from 2008 to 2013, in Trials
6. recreation:ti,kw from 2008 to 2013, in Trials
7. moderate next activity:ti,ab,kw from 2008 to 2013, in Trials
8. vigorous next activity:ti,ab,kw from 2008 to 2013, in Trials
9. walking:ti,kw from 2008 to 2013, in Trials
10. running:ti,kw from 2008 to 2013, in Trials
11. jogging:ti,kw from 2008 to 2013, in Trials
12. bicycl*:ti,kw from 2008 to 2013, in Trials
13. resistance next training:ti,kw from 2008 to 2013, in Trials
14. motor next activity:ti,kw from 2008 to 2013, in Trials
15. {or 1-14} from 2008 to 2013, in Trials
16. health next promotion:ti,ab,kw from 2008 to 2013, in Trials
17. health next behavior:ti,kw from 2008 to 2013, in Trials (Word variations have been searched)
18. motivational next interview*:ti,ab,kw from 2008 to 2013, in Trials
19. (lifestyle:ti,ab,kw or life next style:ti,ab,kw) and (chang*:ti,ab,kw or intervention*:ti,ab,kw) from 2008 to 2013, in Trials
20. behavio* next chang*:ti,ab,kw from 2008 to 2013, in Trials
21. behavio* next modification*:ti,ab,kw from 2008 to 2013, in Trials
22. behavio* next intervention*:ti,ab,kw from 2008 to 2013, in Trials
23. “attitude to health”:ti,ab,kw from 2008 to 2013, in Trials
24. “health knowledge”:ti,ab,kw from 2008 to 2013
25. physical next education:ti,ab,kw from 2008 to 2013, in Trials
26. school next based:ti,ab,kw from 2008 to 2013, in Trials
27. recess:ti,ab,kw and school*:ti,ab,kw from 2008 to 2013, in Trials
28. after next school:ti,ab,kw or afterschool:ti,ab,kw from 2008 to 2013, in Trials
29. child next care:ti,ab,kw or childcare:ti,ab,kw from 2008 to 2013, in Trials
30. child:ti,ab,kw and (day next care:ti,ab,kw or daycare:ti,ab,kw) from 2008 to 2013, in Trials
31. worksite:ti,ab,kw or work next site:ti,ab,kw from 2008 to 2013, in Trials
32. workplace:ti,ab,kw or work next place:ti,ab,kw from 2008 to 2013, in Trials
33. community:ti,ab,kw or communities:ti,ab,kw from 2008 to 2013, in Trials
34. neighborhood*:ti,ab,kw from 2008 to 2013, in Trials
35. fitness next center*:ti,ab,kw from 2008 to 2013, in Trials
36. social next support:ti,ab,kw from 2008 to 2013, in Trials
37. social next environment:ti,ab,kw from 2008 to 2013, in Trials
38. environment* next design:ti,ab,kw from 2008 to 2013, in Trials
39. city next planning:ti,ab,kw from 2008 to 2013, in Trials
40. physical next environment:ti,ab,kw from 2008 to 2013, in Trials
41. built environment:ti,ab,kw from 2008 to 2013, in Trials
42. transportation:ti,ab,kw from 2008 to 2013, in Trials
43. active next commut*:ti,ab,kw from 2008 to 2013, in Trials
44. telephone:ti,kw or phone:ti,kw from 2008 to 2013, in Trials
45. web next based:ti,ab,kw or website:ti,ab,kw from 2008 to 2013, in Trials
46. social next media:ti,ab,kw from 2008 to 2013, in Trials
47. blog*:ti,ab,kw from 2008 to 2013, in Trials
48. text next messag*:ti,ab,kw from 2008 to 2013, in Trials
49. video next game*:ti,ab,kw from 2008 to 2013, in Trials
50. active near gam*:ti,ab,kw from 2008 to 2013, in Trials
51. motion near gam*:ti,ab,kw from 2008 to 2013, in Trials
52. social next marketing:ti,ab,kw from 2008 to 2013, in Trials
53. campaign*:ti,ab,kw from 2008 to 2013, in Trials
54. intervention*:ti or program:ti from 2008 to 2013, in Trials
55. {or 16-54} from 2008 to 2013, in Trials
56. 15 and 55 from 2008 to 2013, in Trials

Sociological Abstracts and Environment Abstracts

((TI(“physical activity”) OR TI((exercise* OR “physical fitness”)) OR TI((“physical inactivity” OR “leisure activities”)) OR TI((recreation OR “moderate activity”)) OR TI((“vigorous activity” OR walking)) OR TI((running OR jogging)) OR TI((bicycl* OR “resistance training”)) OR TI(“motor activity”)) OR all(recess AND school*))

AND

((all(“health promotion”) OR all((“health behavior” OR “health behaviour”)) OR all((“motivational interview*” OR lifestyle NEAR/2 chang*)) OR all((lifestyle NEAR/2 intervention* OR “life style” NEAR/2 chang*)) OR all((“life style” NEAR/2 intervention* OR behavio* NEAR/2 chang*)) OR all((behavio* NEAR/2 intervention* OR behavio* NEAR/2 modification*)) OR all((“attitude to health” OR “health knowledge”)) OR all((“physical education” OR “school based”)) OR all((recess AND school* OR “after school”)) OR all(afterschool)) OR (all(“child care”) OR all((childcare OR child AND “day care”)) OR all((child AND daycare OR worksite*)) OR all((“work site*” OR workplace*)) OR all((“work place*” OR community)) OR all((communities OR neighborhood*)) OR all((“fitness center*” OR “social support”)) OR all((“social environment” OR “environment* design”)) OR all((“city planning” OR “physical environment”)) OR all((“built environment” OR transportation))) OR (all(“active commut*”) OR all((telephone OR phone)) OR all((“web based” OR website)) OR all((“social media” OR blog*)) OR all((“test messag*” OR “video game*”)) OR all((active NEAR/3 gam* OR motion NEAR/3 gam*)) OR all((“social marketing” OR campaign*)) OR ti((intervention* OR program)))) = 894

Transport Research International Documentation

Index Terms:
Bicycle commuting OR
Bicycling OR
Cyclists OR
Bicycle travel OR
Physical fitness OR
Walking OR

Title:
bike* OR
bicycl* OR
walking OR

Keywords:
“physical activity” OR
“physical inactivity” OR
“physical exercise” OR
jogging

AND

Languages:
English

AND

Published/started date range:
2008 to 2013

Search for Evidence: Through July, 2008

MEDLINE

1. physical activity.mp
2. exp *exercise/
3. exp *physical fitness/
4. cardiorespiratory fitness.mp.
5. exp *exertion/
6. aerobic capacity.mp.
7. exp *motor activity/
8. sedentary$.mp.
9. physical inactivity.mp.
10. exp *leisure activities/
11. exp *recreation/
12. moderate activity.mp.
13. vigorous activity.mp.
14. exp *running/
15. exp *jogging/
16. exp *walking/
17. climb$.mp.
18. stair$.mp.
19. occupational physical activity.mp.
20. exp *housekeeping/
21. household physical activity.mp.
22. or/1-21
23. exp *health promotion/
24. exp *healthy people programs/
25. 23 or 24
26. 22 and 25
27. exp *health behavior/
28. exp *attitude to health/
29. exp *Health Knowledge, Attitudes, Practice/
30. (behavior and behavior mechanism).mp.
31. (physical phenomena and processes).mp.
32. 27 or 28 or 29 or 30 or 31
33. 22 and 32
34. exp *”Physical Education and Training”/
35. exp *health education/
36. school health education.mp.
37. classroom health education.mp.
38. 34 or 35 or 36 or 37
39. 22 and 38
40. TV viewing.mp.
41. video game playing.mp.
42. 40 or 41
43. 22 and 42
44. college physical education.mp.
45. college health education.mp.
46. 44 or 45
47. 22 and 46
48. exp *social support/
49. exp *family health/
50. exp *social environment/
51. 48 or 49 or 50
52. 22 and 51
53. decision.mp.
54. point$ of decision$.mp.
55. 53 or 54
56. 22 and 55
57. exp *environment/
58. exp *environment design/
59. exp *urban population/
60. pedestrian*.mp.
61. exp *urban health/
62. environmental change$.mp.
63. environmental interventionS.mp.
64. 57 or 58 or 59 or 60 or 61 or 62 or 63
65. 22 and 64
66. exp *fitness centers/
67. 22 and 66
68. exp *occupational health/
69. 22 and 68
70. exp *transportation/
71. 22 and 70
72. exp *mass media/
73. mass media.mp.
74. exp *communications media/
75. exp *communication/
76. exp *information dissemination/
77. exp *diffusion of innovation/
78. exp *telecommunications/
79. exp *radio/
80. exp *telephone/
81. exp *television/
82. exp *computer-assisted instruction/
83. exp *internet/
84. exp *marketing/
85. exp *marketing of health services/
86. exp *social marketing/
87. campaign.mp.
88. advertising.mp.
89. 72 or 73 or 74 or 75 or 76 or 77 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88
90. 22 and 89
91. community.mp.
92. 22 and 91
93. college.mp.
94. 22 and 93
95. classroom.mp.
96. 22 and 95
97. strength training.mp.
98. resistance training.mp.
99. weight lifting.mp.
100. 97 or 98 or 99
101. 22 and 100
102. exp *Bicycling/
103. 22 and 102
104. 39 or 43 or 47 or 52 or 56 or 65 or 67 or 69 or 71 or 90 or 92 or 94 or 96 or 101 or 103

Chriqui JF, Eyler A, Carnoske C, Slater S. State and district policy influences on district-wide elementary and middle school physical education practices. J Public Health Manag Pract 2013; 19(3 Suppl 1):S41-8.

Institute of Medicine. Educating the student body: taking physical activity and physical education to school. Washington (DC):The National Academies Press; 2013.

Lnsdale C, Rosenkranz RR, Peralta LR, Bennie A, Fahey P, Lubans DR. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons. Prev Med 2013; 56 (2):152-61.

National Association for Sport and Physical Education. 2010 Shape of the nation report: Status of physical education in the USA. Reston (VA): American Alliance for Health, Physical Education, Recreation and Dance; 2010.

National Association for Sport and Physical Education. Physical education is critical to educating the whole child [Position statement]. Reston (VA): American Alliance for Health, Physical Education, Recreation and Dance; 2011.

Pate RR, Davis MG, Robinson TN et al. Promoting physical activity in children and youth: A leadership role for schools: A scientific statement from the American Heart Association council on nutrition, physical activity, and metabolism (physical activity committee) in collaboration with the councils on cardiovascular disease in the young and cardiovascular nursing. Dallas (TX): American Heart Association; 2006.

U.S.Department of Health and Human Services. 2008 physical activity guidelines for Americans. ODPHP Publication No. U0036. 2008. Washington (DC): 2008. Available from URL: http://www.health.gov/paguidelines.

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

• In the United States, the National Association for Sport and Physical Education (NASPE 2011), the Institute of Medicine (IOM 2013), and the American Heart Association (Pate et al. 2006) recommend a minimum of 150 minutes of PE class per week for elementary school students, and 225 minutes per week for secondary school students. (NASPE 2011; IOM 2013; Pate et al. 2006)
• High-quality PE classes, as defined by the NASPE (2011) and IOM (2013), need to balance physical activity with high levels of active learning and opportunities for instruction, feedback, and reflection. NASPE, CDC, the IOM, the AHA, the U.S. Department of Health and Human Services (DHHS), the U. S. Department of Education, and the President’s Council on Physical Fitness and Sport all support the need for high-quality physical education in schools (NASPE 2010).
• Increasing the frequency or length of PE classes is another way to increase students’ total MVPA. Emerging evidence suggests students in states or school districts with laws governing PE have more PE class time (Chriqui et al. 2013). Few studies, however, have evaluated the effects of these policies on students’ MVPA time or fitness.
• Schools should consider offering enhanced PE as part of a comprehensive school-based physical activity program that includes recess, activity breaks, intramural sports, interscholastic sports, walk- and bike-to-school programs, staff wellness and involvement, or family and community participation (IOM 2013; US DHHS 2008).
• Let’s Move! Active Schools offers resources for developing curricula.
• CDC’s Division of Adolescent School Health has developed a PE Curriculum Analysis Tool (PECAT) that can help schools align with national standards.

Evidence-Based Cancer Control Programs (EBCCP)

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

Healthy People 2030

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

• Increase the proportion of adolescents who participate in daily school physical education — ECBP‑01

Health Impact in 5 Years (HI-5)

HI-5 highlights community-wide approaches that have demonstrated 1) positive health impacts, 2) results within five years, and 3) cost effectiveness and/or cost savings over the lifetime of the population or earlier.

• School-Based Programs to Increase Physical Activity