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Instant Recess®: A Practical Tool for Increasing Physical Activity During the School Day

  • Gramercy Research Group
  • Sandra Ham Consulting

Abstract and Figures

An increased prevalence of overweight/obesity among children has led to school district level policies to increase physical activity (PA) among elementary school students. Interventions are needed that increase activity levels without sacrificing time spent in academics. We evaluated a policy implementation intervention for to increase in-school PA in elementary schools in Forsyth County, North Carolina, in a randomized study with a delayed intervention control group. The study included third- through fifth-grade classrooms in eight elementary schools. Instant Recess® was used to introduce 10-minute PA breaks in classrooms on schedules determined by teachers. Direct observation was used to measure activity levels, other student behaviors, and teacher behaviors related to PA in the classrooms. Twenty-eight visits to schools were made during the spring and fall semesters of 2009. At baseline 11% to 44% of intervention and control schools were engaged in classroom-based PA. PA increased from baseline to spring follow-up in intervention schools and was maintained the following fall. Control schools decreased PA from baseline to spring and increased PA once they began the intervention. Students in classrooms engaged in Instant Recess exhibited statistically significant increases in light (51%) and moderate-intensity (16%) PA and increases in time spent in on-task behavior (11%). Control schools experienced similar benefits after they began implementing Instant Recess. Instant Recess is useful for increasing PA and improving behavior among elementary school children. Additional research may be needed to understand how to create policies supporting classroom activity breaks and how to assess policy adherence.
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Work-In-Progress & Lessons Learned
Instant Recess®: A Practical Tool for Increasing Physical Activity During the School Day
Melicia C. Whitt-Glover, PhD
, Sandra A. Ham
, and Antronette K. Yancey, MD, MPH
(1) Gramercy Research Group; (2) Sandra Ham Consulting; (3) University of California, Los Angeles (UCLA) School of Public Health;
(4) UCLA Kaiser Permanente Center for Health Equity
Submitted 24 December 2010, revised 23 June 2011, accepted 12 July 2011.
espite the mental and physical health and devel-
opmental benets associated with physical activity
(PA), most youth engage in inadequate amounts.
ere is growing recognition that integrating brief bouts of PA
into daily routine both to deliver moderate to vigorous PA and
to interrupt prolonged periods of sedentariness, is an eective
strategy for improving PA adherence and health.
Schools are prime targets for interventions to increase PA
among children because 95% are enrolled, attendance enforce-
ment ensures high levels of exposure, and the organizational
infrastructure permits institutionalization, for example,
Background: An increased prevalence of overweight/obesity
among children has led to school district level policies to
increase physical activity (PA) among elementary school
students. Interventions are needed that increase activity levels
without sacricing time spent in academics.
Objectives: We evaluated a policy implementation interven-
tion for to increase in-school PA in elementary schools in
Forsyth County, North Carolina, in a randomized study with
a delayed intervention control group.
Methods: e study included third- through h-grade
classrooms in eight elementary schools. Instant Recess® was
used to introduce 10-minute PA breaks in classrooms on
schedules determined by teachers. Direct observation was
used to measure activity levels, other student behaviors, and
teacher behaviors related to PA in the classrooms.
Results: Twenty-eight visits to schools were made during the
spring and fall semesters of 2009. At baseline 11% to 44% of
intervention and control schools were engaged in classroom-
based PA. PA increased from baseline to spring follow-up in
intervention schools and was maintained the following fall.
Control schools decreased PA from baseline to spring and
increased PA once they began the intervention. Students in
classrooms engaged in Instant Recess exhibited statistically
signicant increases in light (51%) and moderate-intensity
(16%) PA and increases in time spent in on-task behavior
(11%). Control schools experienced similar benets aer
they began implementing Instant Recess.
Conclusions: Instant Recess is useful for increasing PA and
improving behavior among elementary school children.
Additional research may be needed to understand how to
create policies supporting classroom activity breaks and how
to assess policy adherence.
School, children, physical activity, policy, classroom,
teachers, anthropology, sociology and social phenomena,
childhood obesity, exercise, physical education
through regular teacher in-service training and modication
of curricula.
Active school environments, including activity-
focused physical education, have been strongly recommended
as an eective, evidence-based method of improving tness
and mitigating weight gain. School-based interventions to
increase PA among children are typically implemented in
physical education classes.
Unfortunately, overcrowded
classes in poorly equipped facilities, oen taught by untrained
teachers, also compromises the quality of physical education,
with little active participation of at least moderate intensity
(e.g., 5 to 7 minutes in a typical 30-minute physical educa-
Progress in Community Health Partnerships: Research, Education, and Action Fall 2011
vol 5.3
tion class).
ere is also recent evidence that the economic
downturn has further compromised current physical educa-
tion enhancement eorts.
Recently, some school systems have adopted ambitious
policies necessitating classroom approaches to augment the
modest increases in time spent in PA that have been achieved
through improved physical education classes and recess. Some
states have begun to mandate minimum amounts of PA to
augment physical education.
In North Carolina, a regulatory
policy adopted in 2006 by the State Department of Education
mandates that schools provide a minimum of 30 minutes of
daily PA for children in Kindergarten through eighth grades,
over and above physical education requirements (Healthy
Active Children Policy [HSP-S-000]). Unfortunately, for
teachers and students who experience pressures related to
and are evaluated on test scores and academic achievement,
unfunded mandates without additional resources or training
and guidance on how to adhere to the mandates can be frus-
trating. Providing school sta with tools to assist with policy
adherence may be useful. We conducted evaluation research
in a sample of elementary schools to assess the changes in
classroom PA in schools subject to HSP-S-000 aer a tool to
promote classroom PA was provided.
Defining the Target Community and Establishing
the Partnership
In September 2008, one of the authors (TY) visited Forsyth
County, North Carolina, to discuss possibilities for incorporat-
ing activity breaks into public school and aer school settings,
worksites, and sporting events. We (TY and MW) presented
the Instant Recess® concept to representatives from aer-
school programs and to the Forsyth County School Health
Alliance and the School Health Advisory Council (School
Health Advisory Council)
for Winston-Salem/Forsyth
County Schools (WS/FCS). Resistance to this concept was
anticipated and presenters expected that this would be the rst
of several visits to discuss the rationale for and the feasibility
of implementing activity breaks. Instead, the concept was
enthusiastically embraced, so much so that the organiza-
tions quickly began planning when to begin developing and
implementing policies incorporating Instant Recess into school
practice. e Active Living Research program, funded by e
Robert Wood Johnson Foundation, had a call for proposals to
support “opportunistic, time-sensitive studies on emerging or
anticipated changes in PA-related policies or environments.”
Given the pending changes to WS/FCS policies to enforce
HSP-S-000 and to provide teachers and sta with a tool for
doing so, we saw an opportunity to partner with WS/FCS to
evaluate a tool for implementing the policy change.
Partnership Activities
e project was a partnership between a local school sys-
tem (WS/FCS), a private research rm (Gramercy Research
Group [GRG]), a university (University of California, Los
Angeles [UCLA]), and a national organization (Professional
Athletes Council [PAC]). WS/FCS supports a full-time
position for a Program Specialist for Physical Education and
Health who is responsible for health and wellness activities
for all students in schools within the school district (~52,000
students in 42 elementary schools, 16 middle schools, 11 high
schools, and 11 special schools). e program specialist took
the lead on identifying schools that represented the diversity
of the district, and key school sta members to participate
in the project, recruiting eight elementary schools to par-
ticipate. To facilitate participation in teacher training, she
secured approval for the training as a continuing education
opportunity for teachers.
UCLA provided the training outline and existing Instant
Recess content on compact disc (CD), free of charge, for use
in the project ($54.75 per CD; total in-kind donation $21,900).
UCLA also provided additional funding for the project,
through a subcontract to its Centers for Disease Control
* e School Health Alliance is a collaborative eort of Wake Forest Baptist Medical Center, Forsyth Memorial Hospital, Winston-Salem /
Forsyth County Schools (WS/FCS), local health and human service agencies, parents, and educators. Its mission is to improve the ability
of students to learn by improving the health and safety of Forsyth County’s school-age children and adolescents and by coordinating and
targeting the eorts and resources of all types of community health care providers. As of January, 2004, the School Health Alliance also
serves as the School Health Advisory Council for WS/FCS, providing guidance on policy issues that aect students’ health, in accordance
with North Carolina statutes.
Whitt-Glover, Ham, & Yancey Instant Recess®
and Prevention (CDC) Racial and Ethnic Approaches to
Community Health across the U.S. (REACH US). PAC waived
its $1,000 Instant Recess licensing fee to reduce project costs.
At the end of the project, PAC co-founder, NFL player Allen
Rossum visited Winston-Salem to participate in a community-
wide childhood obesity awareness event.
GRG wrote both grants that provided funding to support
the implementation and evaluation for this project, Active
Living Research along with UCLA, and the UCLA REACH US
Legacy Project subcontract. GRG conducted the teacher train-
ing workshops and provided copies of Instant Recess materials
on CD for teachers and sta members at the eight elementary
schools involved in the application (~400 copies). Each school
sent eight representatives to participate in a 3-hour training
workshop, held on a Saturday at the YWCA of Winston-
Salem (space donated at no charge; school representatives
each received a $100 honorarium, made possible through
grant funds). GRG also conducted 20- to 60-minute trainings
at each elementary school with sta who did not attend the
o-site training to provide a brief overview of the project and
materials and to encourage school sta to participate.
Evaluation Design
During the Spring 2009 and Fall 2009 academic semesters,
we evaluated eight schools representative of the district in
demographic composition and socioeconomic status. Schools
were randomly assigned to immediate (N = 4) or delayed
intervention control (N = 4) groups. Teachers at intervention
schools began implementation in Spring 2009; controls began
implementation in Fall 2009. One control school dropped out
aer the Spring 2009 semester and was replaced by a school
that was a control only (no intervention). We conducted four
observational assessments of PA and behavior of teachers and
students in classrooms during the beginning and nal weeks
of academic instruction in both semesters.
An authorized Institutional Review Board (Copernicus
Group IRB) approved all research activities. Because no iden-
tifying data were collected for any students, informed consent
from parents and assent from students was not required.
However, per recommendations from the school system, we
obtained passive consent (children received “opt out” letters
that required parents to provide written notication if they
did not want their children included in the evaluation).
e intervention was to provide teachers with a tool and
technical assistance with using Instant Recess, designed by
one of the researchers (TY) in conjunction with the PAC,
to promote PA breaks in the classroom. e Instant Recess
break concept is to provide opportunities for individuals to
participate in 10-minute bouts of PA, in line with the recom-
mendation for U.S. youth and adults, anywhere, anytime, in
any type of attire. e breaks consist of a series of basic aerobic
dance, calisthenics, and sports movements. Moves are moder-
ate intensity, low-impact, and are performed in 10-minute
bouts set to music. e 10-minute time interval reects the
minimum duration of PA required to count toward the CDC’s
30-minute minimum daily recommendation.
Although these
exercises can be performed individually, social interaction in
groups is a necessary ingredient to maximize organizational
return on investment. Instant Recess materials are available
via CD or, for some routines, DVD format. e materials
are “plug and play” and only require users to have access to a
means for playing CDs or DVDs. e instructions for moves
are called out during the routine and participants are asked to
follow along. A guide is also available with pictures of how to
perform the moves for each routine. Additional information
about Instant Recess can be found elsewhere.
Instant Recess
materials can be accessed online (available from: http://www. or
Eight sta members from each school participated in a
half-day training workshop. Representatives included at least
one teacher from each grade, representing Kindergarten
through h grades, and at least one school administrator/
key decision maker. e workshop provided an overview of
childhood obesity, including national and local statistics, an
overview of Instant Recess with opportunities for teachers to
practice the routines, and a planning period during which
teachers and sta from each school developed a school-specic
strategy for incorporating Instant Recess, including identifying
at least one time during the school day when the entire school
would participate in Instant Recess. School administrators and
sta who attended the Instant Recess training were also encour-
aged to ask individual teachers to implement Instant Recess
throughout the school day as desired. Teachers trained at the
workshop were expected to serve as liaisons between the school
Progress in Community Health Partnerships: Research, Education, and Action Fall 2011
vol 5.3
and the evaluation team and as key resources for other sta and
teachers during the implementation and evaluation period. At
the end of the workshop, the program specialist and one of
the authors (MW) randomized schools and instructed school
sta on how to access Instant Recess content. All teachers and
sta in schools assigned to the immediate intervention received
copies of a CD with ve Instant Recess routines and a paper
copy of a guide demonstrating how to perform each move.
Each school also received a copy of the Instant Recess routines
available on DVD to be used in the centralized audiovisual
system at each school for school-wide Instant Recess breaks.
Pre-intervention and post-intervention data were col-
lected at the classroom level to determine the impact of the
PA policy and Instant Recess. Data were collected from a
representative sample of students in grades three through ve
to minimize disruptions within each school and to remain
within the constraints of funding provided for this project. For
each of the 4 assessments (beginning and end of Spring 2009
semester and beginning and end of Fall 2009 semester), we
randomly selected three classrooms from each grade at each
school (approximately nine classrooms per school); neither
teachers nor students were followed longitudinally.
Data were collected by trained observers using a modied
version of the System for Observing Instructional Fitness Time
which provided data on PA, lesson context, and stu-
dent and teacher behavior. Two data collectors were assigned
to each classroom, and each data collector randomly selected
four students to observe (approximately eight students per
classroom; 72 students per school). e students represented
the composition of the classroom in terms of gender, race/
ethnicity, and weight status. Direct observation occurred in
20-second intervals for 32 minutes in each classroom. Aer
each 20-second interval, the data collector recorded the stu-
dent’s activity level (unobservable; sitting/lying down; light
PA/standing; moderate PA/brisk walking; vigorous PA/run-
ning), whether the student was on-task or o-task (motor/
movement; noise; passive/other), and the lesson context
(classroom management; knowledge/lecture; tness drills/
skills; game play/free play). Each student was observed for an
interval lasting 2 minutes and 20 seconds. Aer every 2 min-
utes and 20 seconds, teachers were observed for one 20-second
interval. For teachers, data collectors recorded the teacher’s
activity level and the teacher’s level of engagement with the
class (unengaged; classroom management; knowledge lecture;
observation; actively engaged). Aer observing the teacher for
one 20-second interval, data collectors moved to the second
student selected for observation. is process continued, stu-
dent observation for an interval of 2 minutes and 20 seconds
followed by one 20-second interval teacher observation until all
four students had been observed once. e entire sequence was
then repeated twice more. Data collectors observed students
and the behavior of the teacher in 20-second increments for a
total of 96 observations per observer (21 observations/student
× 4 students and 12 observations of the teacher).
Data collectors also qualitatively recorded the Instant
Recess routine observed and their impressions of student
engagement, whether students followed instructions, and
perceived level of student and teacher enthusiasm. e goal
was to capture typical classroom behavior during pretest
Table 1. Characteristics of Sample of Elementary Schools
(N = 7) in the Winston-Salem, NC School District
School District
N % N %
Enrolled 24,983 100 4,599 100.0
Attendance (Jan–May) 95.5
Disciplinary Referrals 18.5
Male 51.2
Hispanic 5,457 21.8 1,460 29.5
Black 7,014 28.1 1,552 31.4
White 10,666 42.7 1,610 32.6
Mean SD Mean SD
Test Scores
Reading 54.7 25.6
Math 72.9 17.8
Science 46.0 29.6
Weight Status 4th Grade
Underweight 2.8 7.2 10.1
Healthy 53.2 49.4 18.4
Overweight 18.4 22.6 16.0
Obese 25.5 20.8 12.8
Whitt-Glover, Ham, & Yancey Instant Recess®
data collection and to observe behavior in classrooms that
performed Instant Recess during posttest evaluation. Schools
participated in their assigned activities (i.e., Instant Recess or
usual activities) for approximately 8 weeks in each semester.
Timing depended on school calendars and participation was
sometimes shortened to avoid interfering with end-of-grade
testing, eld trips, and end-of-year parties. Seven schools
completed pre–post evaluations (Table 1). At the end of each
8-week period, teachers from schools assigned to participate in
Instant Recess submitted a log to the study sta that indicated
the number of times each day the teacher used Instant Recess.
Teachers who submitted logs received a $5 gi card.
Using the SOFIT data, we ascertained the degree of policy
implementation by the proportions of classrooms per school
that had any time spent with a lesson context that included
“tness drills or skills” or “game and free play.” Instant Recess
was coded as tness drills or skills and other PA breaks were
coded as the best t among the categories. For student PA
levels, we computed the total minutes of activity per observa-
tion period for moderate and vigorous PA (MVPA) and light,
moderate, and vigorous PA (LMVPA). We also computed the
percent of time spent in on-task behavior and the percent of
teacher intervals spent in classroom management.
Statistical Analysis
We computed descriptive statistics for the percentages of
classrooms per school in which PA was observed during each
visit. We computed by intervention and time the median min-
utes that we observed students engaging in MVPA, LMVPA,
and on task behaviors, and minutes that teachers spent in
classroom management. We also computed percent change
from baseline to intervention visits. We tested the dierences
between group at baseline and between baseline and later visits
using Wilcoxon rank-sum exact tests. Finally, we computed
the mean minutes spent in LMVPA by intervention and time.
Because of the small sample sizes, we computed median min-
utes for the main results of the intervention and chose to use
means for the more descriptive graphical analyses for ease
of understanding by readers. e analyses were conducted
using Excel 2007 (Microso, Inc., Redmond, WA) and SAS
9.1 (SAS, Inc., Cary, NC).
Characteristics of schools participating in the evaluation
study and the school district are included in Table 1. e
evaluation sample had more Hispanic and Black students, a
smaller percentage of White students, a higher percentage of
Figure 1. Percent of Classrooms Per School That Were Observed Engaging in Physical Activity,
by Intervention Group and Time
Bar = standard error of total %.
Progress in Community Health Partnerships: Research, Education, and Action Fall 2011
vol 5.3
overweight students, and a lower percentage of obese students
compared with the entire school district. Twenty-eight visits
to schools were made during the spring and fall semesters of
2009, with observation of 8.8 classrooms per school per visit.
Teacher logs indicated a range of none to six PA breaks per
day implemented.
Between 11% and 44% of classrooms in intervention
schools and 11% to 22% of classrooms in control schools were
observed engaging in game/free play and tness skills/drills at
baseline (Figure 1). Although our goal was to conduct modi-
ed SOFIT observations in classrooms during times when
Instant Recess was scheduled, we were not always successful.
During follow-up visits in intervention schools, we observed
PA in two to seven classrooms per school, although not all
PA was Instant Recess. Slightly more than half of the activity
from tness skills and drills included Instant Recess. We also
observed classroom-based PA in control schools at follow-up
visits, which was coded as game/free play and tness skills/
drills, although these were not Instant Recess breaks. For
analysis purposes, we attempted to distinguish Instant Recess
breaks from other types of classroom PA.
Figure 1 shows signicant increases in PA between base-
line and spring follow-up in intervention schools, and suggests
that these increases were maintained through fall follow-up.
Interestingly, control schools also increased classroom PA
between baseline and spring follow-up, although the PA was
not attributed to Instant Recess. Control schools experienced
a signicant decrease between spring and fall follow-up, and
experienced only a slight and nonsignicant increase in PA
between the beginning and end of the fall semester. Control
schools were instructed to begin implementing Instant Recess
in the fall semester and received training from study sta on
implementation. ere was a noticeable increase in use of
Instant Recess between fall follow-up visits.
Although Instant Recess was designed as a moderate-
intensity activity, some students were active at lower (i.e.,
light) intensity levels during Instant Recess; consequently,
we computed changes in both MVPA and LMVPA for all
classrooms (Table 2). Median MVPA levels in intervention
schools increased by 16% and LMVPA levels increased 51%
per measurement period (p = .038). e time spent in on-task
behavior improved 11% (p = .038). Control schools did not
experience signicant increases in PA intensity until the nal
follow-up visit, aer they began implementing Instant Recess:
MVPA increased by 844% and LMVPA increased by 49%
above baseline levels. ere were no signicant dierences
between the intervention groups in the student or teacher
behavior measures at baseline.
To assist in explaining the results of the policy and Instant
Recess interventions, Figure 2 shows the mean minutes
observed in LMVPA for each group during each observa-
tion period. e intervention schools increased time spent
in LMVPA to approximately 6 minutes per session with the
Instant Recess intervention, with a slight decrease during the
nal follow-up. As expected, classrooms in which Instant
Recess was observed had approximately 8 to 10 minutes of
PA. e sole absolute control school had the lowest PA levels
and this did not change during the study.
Table 2. Minutes of Student and Teacher Behavior at the School Level Over a 32-Minute Observation Period
Intervention Schools (n = 4) Delay Schools (n = 3)
Baseline Visits 2–4 Baseline Visits 2–3 Visit 4
Median Range Median Range Median Range Median Range Median Range
MVPA 0.69 0.04–1.50 0.81 0.08–2.96 0.03 0.00–0.33 0.34 0.12–1.55 0.31 0.19–0.80
LMVPA 4.23
2.31–5.87 6.40
3.15–9.52 2.83
1.44–3.13 4.28
2.50–9.95 4.22 2.67–4.78
On Task 22.5
21.4–25.3 25.0
23.2–26.0 24.0 20.5–25.3 23.3 19.1–26.0 24.9 24.3–26.1
8.43 4.7–13.7 10.7 6.4–18.6 12.4
11.9–13.5 11.7 3.3–16.0 5.54
LMVPA = light-, moderate-, and vigorous-intensity physical activity; MVPA = moderate- to vigorous-intensity physical activity.
Behaviors were observed using the System for Observing Instructional Fitness Time (SOFIT).
Rank-sum differences within pairs (a,b), (c,d), (e,f), and (g,h), p.05. Other comparisons not indicated between groups at baseline and baseline versus later
visits show no significant differences.
Whitt-Glover, Ham, & Yancey Instant Recess®
is study showed that use of Instant Recess increased
classroom PA and improved on-task behavior in students.
ese ndings are consistent with previous studies of the
positive impact of classroom PA breaks on outcomes of
Instant Recess oers a simple tool that can be
used to increase PA in group settings. Instant Recess can be
adapted for use in any setting where a CD or DVD player/
screen are available. e breaks have been medically designed
for sedentary, overweight or less t youth and adults in ordi-
nary street wear. Unlike other similar models, Instant Recess
provides a continuous, rather than intermittent, 10-minute
bout of MVPA to count toward the minimum CDC rec-
ommendation for daily PA. Instant Recess is particularly
targeted to largely unmotivated captive audiences (rather
than willing volunteers) within environments with resource
and space constraints (e.g., classrooms). Studies suggest that
people experience immediate benets in terms of improved
meeting dynamics, productivity, feelings of well-being, self-
condence, skill development, and positive reinforcement
that motivates them to be more active on other occasions
and in other settings.
Although the rates of observed use of Instant Recess in
the current study were lower than expected, PA was fairly
common in the classrooms of both intervention and control
schools. ere are several factors that may account for this.
First, the reactivity of the teachers was a signicant factor in
this natural experiment. School administrators and teachers
became enthusiastic about the new Instant Recess policy for
increased PA. Although the importance of the randomized
design was explained during the training session, independent
actions by the teachers in the delayed intervention control
schools may have interfered with the evaluation. Teachers in
the delayed intervention control schools may have interpreted
the delayed condition to mean they could not use Instant
Recess and they may have perceived use of other opportunities
for PA in the classroom as still keeping in line with the study
design. In addition, much of the increase in PA was observed at
Figure 2. Mean Minutes of Light-, Moderate-, and Vigorous Physical Activity in Classrooms
by Group and Intervention
Intervention Schools = the 4 schools assigned to implement Instant Recess immediately (Spring)
Delay Schools = the 3 schools assigned to delay implementation of Instant Recess until Fall. Note: 4 schools were originally assigned to the delay group; however,
only 3 schools completed the pre-post intervention and were included in analyses
Control Schools = the 1 school added to the study during Fall data collection to replace the delay school that did not complete the program
Instant Recess Classrooms = classrooms in which Instant Recess was being performed during data collection
Progress in Community Health Partnerships: Research, Education, and Action Fall 2011
vol 5.3
the end of the spring semester, near the end of the school year.
Many teachers used games, free play, and picnics to reward
students for successfully completing the school year, which
involved increases in PA that were not attributed to Instant
Recess. Second, the observation period was only 32 minutes
out of the school day. It is possible that teachers used Instant
Recess more oen than observed. We were limited by study
resource constraints and in the amount of time during the day
schools were willing to allow observers in classrooms. is
meant that, during data collection, we sometimes observed
classrooms that did not do an Instant Recess break because we
were not observing the classroom during their planned Instant
Recess time. Teachers were encouraged to use Instant Recess
as a tool when they saw t, and most schools did not have a
designated, school-wide Instant Recess time. ird, students
in some classrooms were bored with frequent repetition of
the ve Instant Recess routines because they were used so
oen, so teachers may have used other sources for PA in the
classroom (e.g., playing popular music and having “dance
parties”). Teachers taking initiative in this way complied with
the policy and expressed their own enthusiasm and creativity,
while keep the children engaged in PA throughout the semes-
ter. A lesson learned was the need for a variety of content, as
well as possible contests encouraging schools to create their
own versions of Instant Recess breaks to address the demand
for new material. It would be worthwhile to explore ways
to vary the PA incorporated so that children could engage
in MVPA several times a day without becoming bored or
losing interest.
We did not measure MVPA throughout the school day,
although this was part of the initial plan, owing to funding
delays beyond our control. Accelerometers would be able to
measure the daily totals. is is of interest in the school district
to evaluate compliance with the HSP-S-000 policy of accrual of
at least 30 minutes per day of MVPA outside physical educa-
tion classes. Pre–post data during the spring semester showed
an increase in observed tness skills (Instant Recess), games,
or free play, with a greater increase in intervention schools
(Figure 1). Participation declined in the fall semester, but
remained higher in intervention schools. We observed only
a small increase in PA in intervention compared with control
schools, which was somewhat troubling. However, the fact
that our random sample did not always include observations
of classrooms during planned Instant Recess breaks may have
diluted the observed impact. Among classrooms where we
observed Instant Recess we noted a signicant increase in PA
compared with classrooms not doing Instant Recess (Figure 2).
is dierence was observed at all follow-up time points.
Although many teachers expressed enthusiasm for Instant
Recess, some were reluctant to participate themselves. Enthusi-
asm for participation was inuenced by teacher’s perceptions
of student willingness to participate and by the teacher’s own
willingness to participate (possibly inuenced by not wanting
to sacrice teaching time, being uncomfortable leading a break
because of their personal low tness levels, or, in one case,
not believing Instant Recess was vigorous enough to make a
dierence). We observed a direct correlation between minutes
of classroom time spent in Instant Recess and perceptions of
mixed enthusiasm (p = .0008) or high levels of enjoyment (p <
.0001). Continued encouragement from school administration
along with fun routines that appeal to students may inuence
teacher and student enthusiasm, thereby increasing participa-
tion. However, it is encouraging that Instant Recess materials
provided on CD and DVD allowed teachers to play the routine
for students without necessarily having to participate them-
selves, which is a benet over other models that only work if
the teacher is willing to participate.
is study has several limitations. First, the SOFIT instru-
ment was designed for use in physical education classes in
which the data are normally distributed. In contrast, we found
that MVPA and LMVPA were not normally distributed in
the classroom context. However, we could identify no more
appropriate validated instrument for directly observing PA in
elementary school classrooms. Second, the follow-up observa-
tions in each semester were conducted during the next-to-last
week of the semester. In the spring, several classrooms were
engaged in end-of-year activities rather than the main cur-
ricula. It may be better to make the follow-up observations
during weeks with typical schedules. ird, the student and
teacher feedback was unprompted and therefore subject to
selection bias of teachers who wanted to give feedback. e
inclusion of standard questions for feedback would improve
the reliability of these data. Fourth, the sample size was small
given the school level of analysis, so we could not adequately
explore the dierences between groups in the quantitative
measures or subgroup analyses by grade or school character-
Whitt-Glover, Ham, & Yancey Instant Recess®
istics. However, we presented a few overall statistics anyway
to tease out the main eects of the intervention and the two
sources of PA in classrooms.
Lessons learned from the eld suggest the usefulness of
PA breaks including Instant Recess for increasing PA par-
ticipation among elementary school children. Improvements
in data collection methods will likely solidify these ndings.
PA assessment methods created for physical education
classes require modication or redesign for use in academic
classrooms. ese pilot data suggest that activity breaks are
a promising method for increasing PA, a critical step toward
improving the nation’s health and longevity.
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... Physical activity is also good to the mental health of young individuals [11] . Physically active learners are more engaged in their school sessions, according to growing evidence [54] . Behavioral engagement refers to a set of behaviors that show participation in school activities, and it is most assessed through students' classroom conduct, time on task, and focus. ...
... on physical activity during PE classes (mean=3.54) ...
... During a lockdown when the schools are functioning by adopting online classes, the physical activity of the child is often overlooked. Emphasis on engaging in physical fitness sessions, yoga, meditation, and indoor games with a maximum expenditure of energy should be advocated by school education [15,16]. ...
... These were evident more among urban children when compared to rural children. Educational reforms not only advocated changes for remote learning but also designed strategies for promoting physical activity [15]. To curtail the complications that will promptly arise because of obesityrelated disorders, necessary measures and awareness of childhood obesity should be mandated for a healthy nation in the future [22]. ...
... immediate) effects of active breaks, children's behavior appears positively affected when the physical activity intensity was moderate-to-vigorous and sustained for more than 10 minutes or when the physical activity bouts were shorter (~5 minutes) and more intense. Unlike evidence for active lessons, there is agreement between previous studies that children's time on-task improves following non-curriculum-linked active breaks, compared to traditional class time activity (Carlson et al., 2015;Howie, Beets, & Pate, 2014;Ma, Le Mare, & Gurd, 2014;Whitt-Glover, Ham, & Yancey, 2011). ...
... Active Breaks can take various forms, and many curricula have been developed, tested, and disseminated (e.g., Bailey & DiPerna, 2015;Kibbe, Hackett, Hurley, et al, 2011;Whitt-Glover, Ham & Yancey, 2011). However, this setting has also witnessed numerous pseudoscientific, commercial products, such as the popular Brain Gym®, presumably seeking to capitalise on the current markets for so-called brain-based learning among policy makers and practitioners (Bailey, 2017a). ...
Full-text available
This report presents a series of reviews of the scientific literature to summarise the current evidence of the contributions of different school-based settings on the promotion of health-enhancing physical activity. The objectives of this report are: to review evidence from the last ten years of the contributions of school-based physical activity, physical education, and school sport on the promotion of health-enhancing physical activity; to consider the role of certain transversal factors in supporting the promotion of health-enhancing physical activity; to present a series of practical, evidence-based recommendations in support of the subsequent activities in the HEPAS project. The settings are: Physical activity (including Active Breaks; Active Learning; Active Recess; Active Transport; Active Homework); Physical Education (Curriculum physical education Lessons; Teacher Education / Workforce); and School Sport. The settings are supplemented by a set of ‘transversal categories’, which represent mediating factors for effective realisation of the promotion of health-enhancing physical activity are: Inclusion and Diversity; Continuous Professional Development; Facilities, Equipment and Resources; Community Partnerships; and School Events, Project Weeks, Camps.
... Several programs have been developed that combine MVPA with teaching and academic content, while others have used MVPA as a short break from seated instruction. Both of these types of programs have demonstrated success in increasing in-school physical activity, improving fitness, weight, on-task behavior, and academic achievement in healthy children (Bartholomew & Jowers, 2011;De Meij et al., 2010;Donnelly et al., 2009;Katz et al., 2010;Kibbe et al., 2011;Kriemler et al., 2010;Liu et al., 2008;Ma et al., 2014;Whitt-Glover et al., 2011). ...
Children with asthma often experience physical activity (PA) induced symptoms 5-15 min following the start of exercise. Classroom PA breaks provide short intermittent bouts of PA and may represent a novel strategy to safely promote PA participation in this clinical population. The purpose of this study was to determine the feasibility of a classroom-based PA intervention, Interrupting Prolonged Sitting with Activity (InPACT), where teachers implement 5 × 4-min moderate-to-vigorous physical activity (MVPA) breaks throughout the school day. Nine classrooms at one elementary-middle school in Detroit, MI (student demographics: 79% Hispanic; 80% on free/reduced lunch; 31% prevalence of asthma and asthma-like symptoms) participated in this 20-week intervention. Asthma status was self-reported via the International Study of Asthma and Allergies in Childhood (ISAAC) Video Questionnaire in conjunction with nurse documentation. PA participation, exercise intensity, and asthmatic symptom occurrence were assessed via direct observation. Students accumulated approximately 17 min of activity per day during PA breaks. Compared to students without asthma, a higher percentage of students with asthma participated in MVPA (asthma: 52.9% ± 1.2%; non-asthma: 46.2% ± 0.8%; p = 0.01), a lower percentage participated in light PA (asthma: 25.9% ± 1.0%; non-asthma: 30.1% ± 0.7%; p = 0.01), and sedentary time during activity breaks (asthma: 21.2% ± 0.9%; non-asthma: 23.8% ± 0.7%; p = 0.02). Out of 294 observations, six instances of asthmatic symptoms (coughing) were observed in students with asthma 5-15 min following the PA break. Symptoms self-resolved within 15-min of the PA break and did not result in sustained exercise-induced bronchoconstriction. Classroom-based interventions that incorporate short intermittent bouts of PA represent safe exercises for children with asthma and may help to reduce PA disparities in this clinical population.
... Classroom teachers play a significant role in LWP implementation through their interactions with students and their engagement in classroom practices related to healthy eating and PA. 31,32 As a result, LWPs provide specific guidance for health-promoting classroom practices. These practices include restricting the use of food as a reward for good behavior, eliminating food celebrations, encouraging PA breaks, and/or integrating PA into the curriculum, not withholding recess or PA as a punishment, and restricting the use as PA as punishment for poor behavior. ...
Background: School-level implementation of district-level local wellness policies (LWPs) is needed to create school environments that promote nutrition and physical activity (PA). Disparities in classroom-specific LWPs implementation were examined. Methods: An administrator survey (N = 756 schools; 24/24 districts) included 6 classrooms LWP best-practice items (fully/not fully implemented: restricting food celebrations or rewards, incorporating PA breaks or integrating PA in curricula, restricting withholding or using PA as punishment). A sum score (alpha = .71; elementary and middle/high examined separately) was used to examine associations with student body income (free-and-reduced priced meals (FARMS): ≤40%, 41-75%, ≥75%), race/ethnicity, and school location (rural/urban/suburban), accounting for district-level clustering, with moderation examined. Results: Classroom implementation scores were: elementary = 3.1 ± 1.8 (range: 0-6/6 items) and middle/high = 2.3 ± 1.6 (range:0-5/5 items). Among elementary and middle/high schools, 65% and 55% had >40% FARMS, 39% and 46% had ≥50% white student body, and 24% and 23% were urban, respectively. Elementary schools with >40% of FARMS-eligible students and middle/high schools with <25% white students reported implementing fewer items. Location was not associated with classroom practices nor was moderation observed. Conclusions: Disparities in classroom-specific LWP best practices implementation were observed by income and race/ethnicity. Tailored support may be needed to improve classroom LWP implementation in schools serving low-income students.
... The increases in children's PA levels made a valuable contribution to the daily 60 minutes of MVPA recommendation (Walter 2014). A few studies (Whitt-Glover et al. 2011;Erwin, Koufroudakis, and Beighle 2013;Carlson et al. 2015;Calvert et al. 2017;Calella et al. 2019), monitored children using accelerometers and implemented 10-to 15-minute active brain-breaks and concluded that children were less sedentary and that the intervention contributed to their daily MVPA. ...
The aim of the current study was to investigate the impact of classroom-based physically active brain-breaks on the in-school activity levels of Grade 1 (six- to eight-years-old) learners (N = 48) by comparing baseline results to the intervention PA patterns of the participants. Children wore Actigraphs accelerometers for five consecutive school days, and thereafter they participated in a six-week active brain-breaks (10-minute bouts of PA) intervention. On a typical school day, children spend an average of 106.2 ± 30.9 minutes in sedentary behaviour, 43.7 ± 13.7 minutes in moderate PA and 26.5 ± 13.6 minutes in vigorous PA. No differences were found between boys and girls. During the intervention, the children’s sedentary behaviour decreased (100.1 minutes) and their vigorous PA increased (34 minutes). The results emphasise the importance of participation in daily FMS and PA in order to increase Grade 1s’ in-school PA patterns and decrease sedentary behaviour.
Purpose: Physical inactivity is linked with several chronic diseases and poor academic outcomes. This study aimed to examine the effect an under-the-desk band would have on middle school students’ physical activity level, and academic engagement. Methods: Two local middle school classrooms (n = 42, M = 20, F = 22) participated in the study, which was conducted over 14 weeks. Physical activity was measured with accelerometry, and academic engagement was assessed using momentary time sampling. Enrolled participants were provided an accelerometer to wear upon entering the classroom. The baseline period lasted for 36 days. During the intervention period, which lasted for the next 30 days, an under-the-desk band was provided to students to freely fidget at their desks. After the study, 13 participants (M = 5, F = 8) in Class A were included in final physical activity analysis, and the 6 participants (M = 3, F = 3) in Class B were included in the academic engagement analysis. Results: Class A had significant increases in percentage of sedentary time (MD = –12.91%, ES = .88) in addition to significant decreases in the percentage of light (MD = 8.82%, ES = .67), moderate (MD = 3.08%, ES = .84), and vigorous (MD = –.04%, ES = .63) physical activity time during the intervention period compared to the baseline period. No significant or meaningful changes occurred in academic engagement with the use of the under-the-desk band. Conclusions: This study high- lights the importance of finding appropriate methods to increase physical activity for adolescents.
The aim of this meta-analysis was to evaluate the effects of movement strategies during academic time, on children's and adolescents' cognitive processing, memory, behavioral control, and academic skills. We used a 2 × 2 design to categorize studies, based on their level of integration with (low vs. high) and relevance to the learning content (low vs high). Meta-analyses were conducted per overarching outcome constructs. Age was explored as a potential moderator. A total of 83 studies involving 25,641 participants were included. The high integration-high relevance movement strategy applied in longer-term (i.e., chronic) physical activity interventions had positive effects with the largest effect (ES = 0.94) on memory. The low integration-low relevance movement strategy had large effects on behavioral control measures for longer-term physical activity (ES = 1.42) and single (i.e., acute) bouts of physical activity; ES = 1.15). A nuanced pattern of results emerged in the other categories (high-low and low-high). A theory-based mapping of studies was used to disentangle the effects of different types of movement strategies during academic time on selective outcomes. Consistencies were identified and explained referring to theories grounded in educational psychology and exercise and cognition research.
Background: Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. Objectives: The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. Selection criteria: Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. Main results: Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. Authors' conclusions: Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
Full-text available
Introduction: Despite well-documented evidence that physical activity is beneficial to children, average fitness levels of US children have declined. Lack of physical activity has been associated with childhood obesity. We evaluated the effects of a physical activity program in the elementary school classroom on health outcomes. Methods: Three schools in the Independence School District in Independence, Missouri, were assigned to receive the ABC (Activity Bursts in the Classroom) for Fitness program, and 2 comparable schools served as controls. The program, led by classroom teachers, provides multiple, brief, structured physical activity breaks throughout the day. Baseline data for the study were collected in September 2007, and follow-up data were collected in April 2008. Results: Physical fitness measures of upper-body strength, abdominal strength, and trunk extensor improved (P <.001). Medication use for asthma (P = .03), attention-deficit hyperactivity disorder (P = .07), or either medication combined (P = .005) decreased. Conclusion: The effects of the program on daily physical activity, fitness, and measures of health are beneficial.
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Educators are facing increased pressure to improve the academic performance of students. This increased emphasis on student accountability has led many school leaders to implement changes in the school day in order to maximize the time that students spend in academic pursuits. Frequently, this has resulted in the cutting or reducing of time spent in extra- and co-curricular activities, including recess and physical education. These changes have the potential to reduce the time children spend being physically active. Childhood health is also of great concern, and has recently received much attention in the popular media, including concern for obesity. Children are increasingly showing the development of lifestyle diseases such as Type-II diabetes and atherosclerosis, typically not seen until adulthood. These conditions can be brought about in part by low levels of physical activity and poor nutrition. The development and implementation of strategies to improve health and academic performance in school is important for ensuring the well-being and success of the children. In this article, the authors describe a program aimed at providing increased opportunities for physical activity and improved nutrition at school, along with the program's impact on several school performance and academic achievement variables. (Contains 2 tables and 1 figure.)
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Regular physical activity is important for health benefits among youth, but disparities exist. This paper describes disparities in physical activity participation and sedentary behaviors among youth in the United States, provides intervention implications, and offers recommendations for future research focused on reducing disparities related to levels of physical activity. Secondary analysis of national accelerometer data showed that achievement of recommended levels of physical activity ranged across subgroups from 2% to 61%. Mean hours per day spent in sedentary behavior ranged from 5.5 to 8.5. The largest disparities were by gender and age. An improved understanding of correlates may inform the design of interventions to increase physical activity in targeted subgroups. Additional theoretically based research is needed to elucidate which factors contributing to physical activity disparities are amenable to change via intervention. To eliminate health disparities, changes in policies that have an impact on physical activity may be necessary to promote physical activity among high-risk youth.
Full-text available
Despite well-documented evidence that physical activity is beneficial to children, average fitness levels of US children have declined. Lack of physical activity has been associated with childhood obesity. We evaluated the effects of a physical activity program in the elementary school classroom on health outcomes. Three schools in the Independence School District in Independence, Missouri, were assigned to receive the ABC (Activity Bursts in the Classroom) for Fitness program, and 2 comparable schools served as controls. The program, led by classroom teachers, provides multiple, brief, structured physical activity breaks throughout the day. Baseline data for the study were collected in September 2007, and follow-up data were collected in April 2008. Physical fitness measures of upper-body strength, abdominal strength, and trunk extensor improved (P <.001). Medication use for asthma (P = .03), attention-deficit hyperactivity disorder (P = .07), or either medication combined (P = .005) decreased. The effects of the program on daily physical activity, fitness, and measures of health are beneficial.
Full-text available
SHPPS was designed to measure policies and programs at the state, district, school, and classroom levels across multiple components of the school health program. Specifically, SHPPS was designed to answer the following questions: 1. What is the current status of five components of the school health program (health education, physical education, health services, food service, and health policies prohibiting tobacco use, alcohol and other drug use, and violence) at the state, district, school, and classroom levels nationwide? 2. Who is responsible for delivering each component of the school health program? What collaboration occurs among components? 3. What is the relationship between state and district polices and school programs and services? 4. What facilitates and prevents the delivery of quality school health programs? The success of SHPPS will be measured by the degree to which it stimulates positive changes in school health programs nationwide. It’s also hoped that SHPPS will foster research on how to foster the adoption and maintenance of school health programs.
This lively, inspiring, and informative book zeroes in on the state of American fitness-persistently sedentary, plagued by obesity-and issues a clarion call to action that reaches across economic, racial, and educational lines. Toni Yancey finds that despite our best intentions and repeated resolutions to exercise, as well as a 40-year investment in fitness education and counseling, physical activity in all levels of society continues to plummet. In a warm, reader-friendly narrative that draws on solid scientific research, personal experience, and her own poetry, Yancey calls for a radically different approach: one that respects diversity and is grounded in the cultures of those most at risk. Instant Recess proposes regular ten-minute exercise breaks that utilize music and dance and are easily incorporated into school, work, and community life. Rather than encouraging unhealthful habits like cigarette breaks or high fat snacks, these "instant recesses" make the active choice the natural one. Here is a new paradigm for fitness and public health that promises vitality, well being, and a greater sense of community-demonstrating, as Yancey argues, that what's good for the waistline is good for the bottom line.
Background: Physical Activity Across the Curriculum (PAAC) was a three-year cluster randomized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children. Methods: Twenty-four elementary schools were cluster randomized to the Physical Activity Across the Curriculum intervention or served as control. All children in grades two and three were followed to grades four and five. Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers. Body Mass Index was the primary outcome, daily Physical activity and academic achievement were secondary outcomes. Results: The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9, respectively (NS). However, change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum. Schools with > or =75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had <75 min of Physical Activity Across the Curriculum (1.8+/-1.8 vs. 2.4+/-2.0, p=0.02). Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores. Conclusions: The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children. Additionally, 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index.
Recommended daily physical activity accumulated in short intervals (e.g., <10 minutes) may be more feasible and appealing to the relatively sedentary populace than longer bouts. The purpose of this paper is to present a systematic review of the evidence for the effectiveness of short activity bouts incorporated into organizational routine as part of the regular "conduct of business." PubMed, MEDLINE, and Google Scholar databases were searched in August 2009 (updated search in February and July 2010) to identify relevant, peer-reviewed journal articles and abstracts on school-, worksite-, and faith-based interventions of short, structurally integrated physical activity breaks. The majority of interventions implemented daily physical activity bouts of 10-15 minutes in length. Schools were the most common settings among the 40 published articles included in this review. The rigor of the studies varied by setting, with more than 75% of worksite versus 25% of school studies utilizing RCT designs. Studies focused on a broad range of outcomes, including academic/work performance indicators, mental health outcomes, and clinical disease risk indicators, in addition to physical activity level. Physical activity was the most commonly assessed outcome in school-based studies, with more than half of studies assessing and observing improvements in physical activity outcomes following the intervention. About a quarter of worksite-based studies assessed physical activity, and the majority found a positive effect of the intervention on physical activity levels. About half of studies also observed improvements in other relevant outcomes such as academic and work performance indicators (e.g., academic achievement, cognitive performance, work productivity); psychosocial factors (e.g., stress, mood); and clinical disease risk indicators (e.g., blood pressure, BMI). The average study duration was more than 1 year, and several reported outcomes at 3-6 years. Interventions integrating physical activity into organizational routine during everyday life have demonstrated modest but consistent benefits, particularly for physical activity, and these are promising avenues of investigation. The proportionately longer-term outcomes available in these studies compared with individual-level studies suggest that physical activity promotion strategies at the organizational level may be more sustainable.
We conducted a midpoint review of The California Endowment's Healthy Eating, Active Communities (HEAC) program, which works in 6 low-income California communities to prevent childhood obesity by changing children's environments. The HEAC program conducts interventions in 5 key childhood environments: schools, after-school programs, neighborhoods, health care, and marketing and advertising. We measured changes in foods and beverages sold at schools and in neighborhoods in HEAC sites; changes in school and after-school physical activity programming and equipment; individual-level changes in children's attitudes and behaviors related to food and physical activity; and HEAC-related awareness and engagement on the part of community members, stakeholders, and policymakers. Children's environments changed to promote healthier lifestyles across a wide range of domains in all 5 key childhood environments for all 6 HEAC communities. Children in HEAC communities are also engaging in more healthy behaviors than they were before the program's implementation. HEAC sites successfully changed children's food and physical activity environments, making a healthy lifestyle a more viable option for low-income children and their families.
The World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity. Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease. The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents. The search strategy included searching several databases. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group. Standardized tools were used by two independent reviewers to rate each study's methodological quality and for data extraction. Where discrepancies existed discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured. 13,841 titles were identified and screened and 482 articles were retrieved. Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies). Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak. In total 26 studies were included in the review. There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally school-based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects. Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time.