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Physical Activity: Enhanced School-Based Physical Education


What the CPSTF Found

About The Systematic Review

This CPSTF 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 systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity. This finding updates and replaces the 2000 CPSTF recommendation on Enhanced School-Based Physical Education pdf icon [PDF - 254 KB].

Summary of Results

Information about data variability is available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 188 KB].

Most of the included studies evaluated enhanced PE programs implemented alone. Measured outcomes included the amount of time spent in moderate- or vigorous-intensity physical activity (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 (13 studies)
  • The review identified two main types of enhanced PE intervention:
    • 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).
    • 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).
  • Four studies reported students' total physical activity (weekdays and weekends). Two studies showed significant effects in the favorable direction; the other two found no significant differences between intervention and control groups.
  • Three studies reported mixed results on program effectiveness on cardiorespiratory fitness.

Summary of Economic Evidence

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


Based on the evidence, the Task Force finding should be applicable to the following:

  • Males and females
  • Children and adolescents
  • U.S. schools in urban and rural settings
  • Programs of varying duration

Evidence Gaps

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?)

  • The effectiveness of enhanced PE by sex, race and ethnicity, and socioeconomic and weight status
  • The effects of physical education programs in general, including programs that use written standards-based curricula; have adequate time, equipment, and facilities; and are led by licensed, certified, or other highly qualified teachers
  • Real world practices that account for potential confounding or mediating variables

Study Characteristics

  • Studies were experimental (12 studies) or quasi-experimental (2 studies).
  • All studies compared the effectiveness of enhanced PE to standard PE and measured outcomes using objective or directly observed methods.
  • Five of the included studies offered additional components 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 in PE classes for elementary (50%), middle (36%), and high school (14%) students.
  • In half 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).