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Behavioral and Social Approaches to Increase Physical Activity: Enhanced School-Based Physical Education

Task Force Finding

The Community Preventive Services Task Force recommends enhanced school-based physical education (PE) to increase physical activity based on strong evidence of effectiveness in increasing the amount of time students spend in moderate- or vigorous-intensity physical activity (MVPA) during PE classes.

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

Intervention Definition

Enhanced school-based physical education (PE) involves curricular and practice-based changes that increase the amount of time that K-12 students engage in moderate- or vigorous-intensity physical activity during PE classes. Strategies include the following:

  • Instructional strategies and lessons that increase physical activity (e.g., modifying rules of games, substituting more active games for less active ones)
  • Physical education lesson plans that incorporate fitness and circuit training activities

Program changes may include developing and implementing a well-designed PE curriculum and employing or providing teachers with appropriate training. Programs may be combined 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.

About the Systematic Review

This Task Force 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 effectiveness evidence is based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to promoting physical activity. This finding updates and replaces the 2000 Task Force recommendation on Enhanced School-Based Physical Education.


Most of the included studies evaluated enhanced PE programs that were implemented alone (and were not implemented with other interventions). Measured outcomes included the amount of time spent in 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 (95% CI: 6.33, 14.41; 13 studies)
  • The review identified two main types of enhanced PE intervention:
    1. 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).
    2. 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).
  • Students' total physical activity (weekdays and weekends) was reported in four studies. Two studies reported a statistically significant benefit of enhanced PE on MET-weighted minutes1 of vigorous physical activity and minutes of moderate physical activity, respectively. The remaining two studies found no significant differences in total physical activity between intervention and control groups.
  • Program effectiveness on cardiorespiratory fitness was mixed based on results from three studies that reported on this outcome.

1MET=metabolic equivalent. A metabolic equivalent, or MET, is a unit useful for describing the energy expenditure of a specific activity. A MET is the ratio of the rate of energy expended during an activity to the rate of energy expended at rest. For example, 1 MET is the rate of energy expenditure while at rest. A 4 MET activity expends 4 times the energy used by the body at rest. If a person does a 4 MET activity for 30 minutes, he or she has done 4 x 30 = 120 MET-minutes (or 2.0 MET-hours) of physical activity. A person could also achieve 120 MET-minutes by doing an 8 MET activity for 15 minutes (DHHS, 2008).

Study Characteristics

  • Studies were experimental (12 studies) or quasi-experimental (2 studies).
  • All of the studies compared the effectiveness of enhanced PE to standard PE and used objective or directly observed methods to measure the percent of PE class time students spent participating in MVPA.
  • Five of the included studies offered physical activity intervention components in addition to enhanced PE classes, 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 among elementary (50%), middle (36%), and high school (14%) PE classes.
  • In half of 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).


  • Based on the settings and populations from included studies, results are applicable to:
    • Males and females
    • Children and adolescents
    • U.S. schools in urban and rural settings
    • Programs of varying duration

Economic Evidence

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

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 duration 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).
  • Available resources for developing curriculum are offered through Let's Move! Active Schools External Web Site Icon, and CDC's Division of Adolescent School Health has developed a PE Curriculum Analysis Tool (PECAT) External Web Site Icon that can help schools align with national standards.

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Supporting Materials

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.

Promotional Materials

Community Guide News

More promotional materials for Community Guide reviews about increasing physical activity through behavioral and social approaches.


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.

Lonsdale 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: External Web Site Icon.


The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Behavioral and social approaches to increase physical activity: enhanced school-based physical education. Last updated: MM/DD/YYYY.

Review completed: December 2013