Physical Activity: Enhanced School-Based Physical Education

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends enhanced school-based physical education (PE) to increase physical activity.

The full CPSTF Finding and Rationale Statement and supporting documents for Behavioral and Social Approaches to Increase Physical Activity: Enhanced School-Based Physical Education are available in The Community Guide Collection on CDC Stacks.

Intervention

Enhanced school-based physical education (PE) involves changing the curriculum and course work for K-12 students to increase the amount of time they spend engaged in moderate- or vigorous-intensity physical activity during PE classes. Approaches include the following:

  • Teaching strategies (e.g., modifying games, substituting less active games with more active games)
  • Physical education lesson plans that incorporate fitness and circuit training activities

Schools may implement well-designed PE curricula taught by trained teachers. Programs may combine enhanced school-based PE 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 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.

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)

Summary of Results

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 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 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.

Applicability

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

  • 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

Implementation Considerations and Resources

  • 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
  • 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
  • Increasing the frequency or length 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. 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
  • Let’s Move! Active Schools offers resources for developing curricula
  • CDC’s Division of Adolescent School Health has developed a PE Curriculum Analysis Tool (PECAT) that can help schools align with national standards

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