Physical Activity: Enhanced School-Based Physical Education

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends enhanced school-based physical education (PE) to increase physical activity.


Enhanced school-based physical education (PE) involves changing the curriculum and course work for K-12 students to increase the amount of time they spend engaged in moderate- or vigorous-intensity physical activity during PE classes. Approaches include the following:
  • Teaching strategies (e.g., modifying games, substituting less active games with more active games)
  • Physical education lesson plans that incorporate fitness and circuit training activities

Schools may implement well-designed PE curricula taught by trained teachers. Programs may combine enhanced school-based PE with other school- and community-based interventions such as student health education about physical activity, activities that foster family involvement, and community partnerships to increase opportunities for physical activity.

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.

Promotional Materials

About The Systematic Review

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.

Summary of Results

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.

Summary of Economic Evidence

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

Evidence Gaps

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

Study Characteristics

  • 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).

Analytic Framework

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.

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.

Search Strategies

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.


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


  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”


  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


  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*))


((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

bike* OR
bicycl* OR
walking OR

“physical activity” OR
“physical inactivity” OR
“physical exercise” OR




Published/started date range:
2008 to 2013

Search for Evidence: Through July, 2008


  1. physical
  2. exp *exercise/
  3. exp *physical fitness/
  4. cardiorespiratory
  5. exp *exertion/
  6. aerobic
  7. exp *motor activity/
  8. sedentary$.mp.
  9. physical
  10. exp *leisure activities/
  11. exp *recreation/
  12. moderate
  13. vigorous
  14. exp *running/
  15. exp *jogging/
  16. exp *walking/
  17. climb$.mp.
  18. stair$.mp.
  19. occupational physical
  20. exp *housekeeping/
  21. household physical
  22. or/1-21
  23. exp *health promotion/
  24. exp *healthy people programs/
  25. 23 or 24
  26. 22 and 25
  27. exp *health behavior/
  28. exp *attitude to health/
  29. exp *Health Knowledge, Attitudes, Practice/
  30. (behavior and behavior mechanism).mp.
  31. (physical phenomena and processes).mp.
  32. 27 or 28 or 29 or 30 or 31
  33. 22 and 32
  34. exp *”Physical Education and Training”/
  35. exp *health education/
  36. school health
  37. classroom health
  38. 34 or 35 or 36 or 37
  39. 22 and 38
  40. TV
  41. video game
  42. 40 or 41
  43. 22 and 42
  44. college physical
  45. college health
  46. 44 or 45
  47. 22 and 46
  48. exp *social support/
  49. exp *family health/
  50. exp *social environment/
  51. 48 or 49 or 50
  52. 22 and 51
  54. point$ 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
  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
  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/
  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
  92. 22 and 91
  94. 22 and 93
  96. 22 and 95
  97. strength
  98. resistance
  99. weight
  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

Review References

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:

Considerations for Implementation

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

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.