Physical Activity: Classroom-based Physically Active Lesson Interventions
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends classroom-based physically active lesson interventions to increase physical activity and improve educational outcomes. Systematic review evidence shows these interventions, when delivered by classroom teachers, meaningfully increase the amount of time children spend engage in physical activity during the school day and improve educational outcomes in math and reading.
CPSTF also recommends classroom-based physical activity break interventions to increase physical activity.
The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Classroom-based Physically Active Lesson Interventions are available in The Community Guide Collection on CDC Stacks.
Intervention
Classroom-based physically active lessons integrate bouts of physical activity within academic lessons. Teachers integrate activity into lessons held inside or outside of the classroom. Active lessons are scheduled every day or several times per week and typically last 10-30 minutes each. Activities aim to achieve moderate-to-vigorous intensity physical activity.
Interventions include training for teachers and may include access to integrated lesson plans or examples, and 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 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.
Norris E, van Steen T, Direito A, Stamatakis E. Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54:826-38.
The review included 42 studies (search period through April 2019), of which 34 were included in meta-analyses of physical activity, health, cognition, and education-related outcomes. The team also examined the subset of 18 intervention studies conducted in the United States and abstracted supplemental information about study, intervention, and population characteristics.
The CPSTF finding is based on results from the published review and meta-analyses, additional information from the subset of 18 studies conducted in the United States, and expert input from team members and CPSTF.
Study Characteristics
- Study designs included group randomized controlled trials (27 studies), controlled before-after studies (14 studies), and prospective cohorts (1 study).
- Studies were conducted in the United States (18 studies), Australia (7 studies), the United Kingdom (5 studies), the Netherlands (4 studies), and Denmark (2 studies), and one study each came from China, Croatia, Ireland, Israel, Portugal, and Sweden.
- Most study interventions were implemented by teachers (32 studies). Many of them provided fully integrated active lesson plans (24 studies) or sample activities to be integrated into lessons (13 studies).
- Included studies most often evaluated students in primary school settings (29 studies) or preschool settings (10 studies). One study evaluated interventions among students in grades K-8, and two studies included students in grades 6-9.
- U.S. studies that reported information about race and ethnicity included students who self-identified as Black or African American (median of 10.9% from 9 studies), Hispanic or Latino (median of 13.1% from 7 studies), and Asian (median of 4.6% from 4 studies). Two studies were conducted in schools where a high proportions of students qualified for free (89%) or reduced-price (94%) lunch.
Summary of Results
The published systematic review included 42 studies, 34 of which were included in meta-analyses providing summary effect estimates as standardized mean differences. Interventions lead to the following student outcomes:
- Increased time spent in moderate-to-vigorous intensity physical activity over the school day
- Improved lesson-related educational outcomes
- Improved measurements of student attention to lesson content
The review did not find intervention effects on cognition or measures of physical fitness or body mass index.
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 students in preschool, kindergarten, and elementary schools in the United States.
Evidence Gaps
- How do intervention effects vary by participant characteristics, including household income, parents’ level of education, and race/ethnicity in U.S. populations?
- How do intervention effects vary based on duration and frequency of physically active lessons during the school day?
- Do physically active lessons contribute to more students meeting recommendations for 60 minutes per day of moderate-to-vigorous intensity physical activity per day?
- What is the impact of classroom-based physically active lesson interventions on the following outcomes:
- Cognitive functions
- Physical fitness, including aerobic fitness, muscle strength and endurance, flexibility, and body composition
- Other student health outcomes
- Are these interventions effective for older students in middle and high school settings?
- 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 among students. These may include recess breaks and the following CPSTF-recommended interventions:
- CPSTF recommendations support the priorities of 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 of classroom-based physical activity break interventions include the following:
- Simplicity
- Teacher flexibility to fit breaks into the classroom schedule
- Low resource requirements
- Scalability
- Factors related to the implementation and sustained use of classroom-based physical activity break interventions include:
- Support teachers receive from school administrators
- The school system’s level of comfort and buy-in
- Resources, time, and spaces available
- Goals of individual classes or courses
- Several publicly available resources provide implementation guidance:
- Move for Thought is an integrated physical activity strategy for learning in primary school classrooms.
- Active Academics offers classroom teachers practical physical activity ideas that can be integrated into regular classroom content areas.
- Springboard to Active Schools provides professional development, technical assistance, and tools and resources for promoting physical activity in the classroom.
- Active Schools provides information on implementing physical activity in the classroom, including links to activity ideas and webinars and trainings for classroom teachers.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.