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Physical Activity: Classroom-based Physical Activity Break Interventions


What the CPSTF Found

About The Systematic Review

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. 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 included in the review integrated physical activity within classroom lessons and were considered in a separate review. The team examined the remaining 16 intervention studies and abstracted supplemental information about study, intervention, and population characteristics.

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.


The U.S. Department of Health and Human Services recommends that young people ages 6–17 years participate in at least 60 minutes of physical activity daily (HHS 2018). Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, improves cognitive function, reduces risk of depression, and may improve cardiovascular health (HHS 2018).

Schools have an important role in promoting and supporting daily and weekly physical activity among students. Classroom-based physical activity interventions can be used to supplement other school programs and policies to promote physical activity among students such as physical education programs, recess breaks, and active travel to school interventions (CDC 2018).

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

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

  • The amount of time children spent in moderate-to-vigorous intensity physical activity while at school increased by a median of 4.29 minutes (2 studies)
  • The number of steps students took during a school day increased by a median of 960 steps (3 studies)
  • There was a 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.


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

Evidence Gaps

The 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?)

  • 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?

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).
  • Included 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 in which a high proportion of students qualified for the free or reduced lunch program (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).