Physical Activity: Classroom-based Physical Activity Break Interventions

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends classroom-based physical activity break interventions to increase physical activity among primary school students. Systematic review evidence shows that when trained classroom teachers deliver these interventions, children meaningfully increase the amount of time they spend engaged in physical activity during the school day.

CPSTF also recommends classroom-based physically active lesson interventions to increase physical activity and improve educational outcomes.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Classroom-based Physical Activity Break Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

Classroom-based physical activity breaks regularly engage students in short bouts of physical activity. Teachers implement breaks between classroom lessons. Sessions are scheduled one to three times each school day and last four to ten minutes each. Activities aim to achieve moderate-to-vigorous intensity physical activity.

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

About The Systematic Review

CPSTF uses recently published systematic reviews to conduct accelerated assessments. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to school-based physical activity interventions.

Masini A, Marini S, Gori D, Leoni E, Rochira A, Dallolio L. Evaluation of school-based interventions of activity breaks in primary schools: a systematic review and meta-analysis. Journal of Science and Medicine in Sport 2020;23:377-84.

The review included 22 studies overall (search period through April 2019). Six studies integrated physical activity within classroom lessons and were considered in a separate review. The team examined the remaining 16 intervention studies.

The CPSTF finding is based on results from the published review, additional information from the subset of 16 studies, and expert input from team members and CPSTF.

Study Characteristics

Study designs included randomized trials (9 studies), controlled before-after designs (3 studies), single group before-after designs (3 studies), and a post implementation evaluation (1 study)
Studies were conducted in the United States (7 studies), Canada (2 studies), the United Kingdom (2 studies), Australia (1 study), the Netherlands (1 study), Poland (1 study), Macedonia (1 study), and Switzerland (1 study)
U.S. studies included primary schools with a high proportion of students qualifying for free or reduced lunch (median 47%; 5 studies)
- Study participants included Black or African American students (median 19.8%; 5 studies) and Hispanic or Latino students (median 21.0%; 4 studies)

Summary of Results

The published systematic review included 22 studies; 6 of these studies were included in meta-analyses for three outcomes:

Time children spent in moderate-to-vigorous intensity physical activity while at school increased by a median of 4.29 minutes (2 studies)
Number of steps students took during a school day increased by a median of 960 steps (3 studies)
Median increase of 26.15 minutes in the amount of time students were attentive to classroom lessons following activity breaks (2 studies)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from the review, findings should be applicable to primary school students in the United States.

Evidence Gaps

What are the effects of classroom-based physical activity breaks on the following outcomes?
- Proportion of students that achieve 60 minutes of moderate-to-vigorous intensity physical activity per day (objectively measured), as recommended in the 2018 Physical Activity Guidelines for Americans, 2nd edition
- Physical fitness, including aerobic fitness, muscle strength and endurance, flexibility, and body composition
- Cognitive functions
- Education outcomes (e.g., lesson uptake)
- Academic achievement (e.g., test scores and year-end grades)
- Other student health outcomes
How do intervention effects vary by participant characteristics, including student age and grade, household income, parents’ education, and race/ethnicity in U.S. populations?
How do intervention duration and frequency effect outcomes?
What are barriers to teacher and school adoption and sustained implementation?
What are solutions to address barriers to teacher and school adoption and sustained implementation?
How might physical activity breaks be tailored so they are developmentally appropriate, culturally relevant, and inclusive of students with disabilities?

Implementation Considerations and Resources

Classroom-based physical activity breaks may add minutes of moderate-to-vigorous intensity physical activity to the school day, which could help students achieve the recommended 60 minutes of daily physical activity.

Interventions should be used in addition to, not instead of, other school programs and policies to promote physical activity including:

CPSTF recommendations support CDC’s Healthy Schools Guidance and Comprehensive School Physical Activity Program Framework.

Interventions provided training for classroom teachers, and most provided videos or web links to age- and classroom-appropriate exercises and dance routines.

Advantages include simplicity, teacher flexibility, low resource requirements, and scalability.

Implementation resources:

Move for Thought – integrated physical activity strategy for primary school classrooms
Active Academics – practical physical activity ideas for regular classroom content areas
Springboard to Active Schools – professional development, technical assistance, tools and resources
Active Schools – information on implementing physical activity in classrooms, including activity ideas and webinars

Crosswalks

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