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What Students Lose When Recess Is Squeezed Out of the Schedule

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What Students Lose When Recess Is Squeezed Out of the Schedule

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What Students Lose When Recess Is Squeezed Out of the Schedule

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Two professors discuss why recess is not a priority in the education system and equity issues amongst students.

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How to Balance Academics with Physical Exercise

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How to Balance Academics with Physical Exercise

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How to Balance Academics with Physical Exercise - AccuTrain

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New research from the University of North Carolina, Greensboro, shows that when students engage in high-intensity interval exercises, they score significantly

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Of the many subjects children study in school, there may be none more important than physical education. However it must be of high quality and aligned with state/national standards and guidelines. A high quality physical education program offers children opportunities to develop the skills, concepts, and dispositions needed to be physically active for life. Sufficient, regular physical activity not only helps prevent major diseases but it also: promotes learning; reduces stress, anxiety, and depression; and improves overall student wellness. It doesn't matter if the child excels in every other subject in school and grows up to become a successful professional, with poor health any professional achievement becomes secondary.

There are many factors that contribute to the ease of implementing and sustaining a quality program, including the involvement of the administration, parents, and community. However it ultimately comes down to the willingness of the physical education teacher(s) to do their best no matter the situation.

​That being said, REAL teachers still need our support and appreciation. This can be in the form of equipment (every jump-rope, pedometer, heart-rate monitor, and home-made scoop catcher counts), classroom assistance, time and funding for professional development, and by advocating for quality physical education at the local, state, and national level.

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Information and resources on the importance of quality physical education (research, articles, position statements, etc).

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Physical Activity Promotes Brain Development

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Physical Activity Promotes Brain Development

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Brain Breaks

After sitting for long periods of time, it is important that children get up and move! Take a short walk, or do some dancing and then freeze when the music stops. These are often called Brain Breaks! They are short bouts of physical activity that help reset the brain and get blood and oxygen flowing more rapidly to the brain and body. Children should never be sedentary for longer than 60 minutes at a time. In fact many researchers suggest doing Brain Brakes after 30 minutes of being sedentary. Brain Breaks can be done with minimal to no equipment or preparation and should be fun and engaging. They should include cardio activities as well as motor skill development such as crossing the midline of the body and challenging the brain to utilize both sides. Examples include Follow the Leader, Red Light Green Light, Count My Moves or Treasure Hunt!

References

1. Active Living Research. Active Education: Growing Evidence on Physical Activity and Academic Performance.

2. Koutsandréou, F., Wegner, M., Niemann, C., & Budde, H. (2016). Effects of Motor versus Cardiovascular Exercise Training on Children's Working Memory. Medicine & Science in Sports & Exercise, 48(6), 1144-1152. doi:10.1249/mss.0000000000000869

3. BrainandSpinalCord.org (2017). Brain Function. Retrieved September 25, 2017.

4. Hillman, C., Pontifex, M., Raine, L., Castelli, D., Hall, E., & Kramer, A. (2009). The effect of acute treadmill walking on cognitive control and academic achievement in preadolescent children. Neuroscience, 159(3), 1044-1054. doi:10.1016/j.neuroscience.2009.01.057

5. Budde H, Voelcker-Rehage C, Pietraßyk-Kendziorra S, Ribeiro P, Tidow G. Acute coordinative exercise improves attentional performance in adolescents. Neurosci Lett 2008;441:219-223. [PubMed: 18602754]

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Physical Activity Promotes Brain Development | Extension | University of Nevada, Reno

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Children who are more physically active perform better academically and have better memory and attention.

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Are the Kids Alright? What New Federal Data Say About Child Well-Being

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Are the Kids Alright? What New Federal Data Say About Child Well-Being

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Rates of children's physical inactivity, misbehavior, and unmet health needs shot up during the first year of the COVID-19 pandemic alongside concerns about parental stress, according to a new analysis of federal data on child well-being.

Meanwhile, the numbers of children diagnosed with depression and anxiety stayed on pre-pandemic trendlines, growing steadily between 2016 and 2020.

In findings with significant implications for the work of schools, researchers at the U.S. Health Resources and Services Administration examined a trove of parent-reported data collected between 2016 and 2020. They analyzed five-year trends and looked for statistically significant increases between 2019 and 2020 in an effort to identify problems that may have been worsened by the pandemic and the continuation of troubling patterns that predate the national crisis.

Examining 36 different indicators of child well-being, researchers also saw increasing rates of parental job transitions during the first year of the pandemic.

"Today's study confirms what all too many of us know and feel in our daily lives: COVID-19 was an exceptional burden on the mental well-being of our nation's families, including kids," U.S. Health and Human Services Secretary Xavier Becerra said in a statement in response to the study, which was published Monday in JAMA Pediatrics, a journal of the American Medical Association.

But it's premature to draw a definite causal link between the changes in data and the pandemic, the authors wrote. The survey questions are fielded between June and January each year, researchers cautioned. And some questions, about issues like health care, asked parents to look back 12 months, which means their 2020 responses may reflect pre-pandemic experiences.

Challenges in meeting student needs

The data come as school districts grapple with growing student needs by creating new mental health programs, connecting families to community resources like food pantries, and improving methods of identifying and supporting students experiencing homelessness. Schools are aided by an unprecedented infusion of federal relief aid, but district administrators say they still face significant hurdles, like staffing challenges.

In his March 1 State of the Union Address, President Joe Biden pledged to ease some of those concerns by working with Congress to allow schools to bill Medicaid for mental health services and by cutting red tape on telehealth programs, which are used in an increasing number of schools.

The study's authors used five years of data from the National Survey of Children's Health, a nationally representative survey completed by parents and guardians of about 175,000 randomly selected children from birth to 17 years old in all 50 states and the District of Columbia.

"This analysis provides an opportunity to evaluate the nation's progress (or lack thereof) in improving the health and well-being of U.S. children and their families, including the first opportunity to use the [survey data] to investigate potential effects of the COVID-19 pandemic," the study's authors wrote.

Among the key findings:

Children's diagnoses of depression and anxiety continued to climb in 2020, keeping pace with a trend that emerged in the years prior to the pandemic. Between 2016 and 2020, the number of children diagnosed with anxiety grew by 29 percent, and the number diagnosed with depression grew by 27 percent.

Despite those growing needs, the analysis detected no statistically significant uptick in the portion of children who received mental health treatment over the last five years. In 2020, 80 percent of children who needed mental health care received services, the survey found.

The analysis found a 21 percent increase in children with behavior or conduct problems reported by their parents or caregivers between 2019 and 2020, echoing anecdotal concerns educators have shared with Education Week about students' social skills, self-control, and emotional maturity.

The proportion of children who received preventive care visits dropped by 9 percent between 2019 and 2020 after remaining relatively stable the previous four years. Reports of unmet health-care needs also grew; 3 percent of respondents reported unmet needs in 2016, a number that stayed relatively stable until it spiked to 4 percent in the 2020 surveys, the analysis found.

Children's physical activity continued a decline that started in the years prior to the pandemic. The number of respondents who say their children got an hour a day of physical activity decreased by 18 percent between 2016 and 2020.

The number of parents who reported "coping very well with the demands of raising children" decreased in the years prior to the pandemic, but it dropped more significantly from 2019 to 2020. About 60 percent of respondents agreed with that statement on the 2020 survey, compared to about 67 percent in 2016. The most-recent survey was fielded as parents juggled remote work, employment disruptions, and closures of schools and child-care providers.

The proportion of children whose parents "quit a job, declined a job, or changed jobs because of child-care problems" increased by 34 percent between 2019 and 2020.

Caution on drawing a firm connection to COVID

But the study's authors raised some caveats in looking at the data.

"Cautious interpretation of the 2020 estimates is warranted, and additional years of data are needed to determine whether 2020 was truly a turning point for certain trends and how long the indirect effects of the pandemic may last," they wrote.

Still, the findings echo other data points and conversations among educators.

For example, on a national survey of educators administered by the EdWeek Research Center in January, 39 percent of respondents said that "compared to prior to the pandemic in 2019, the social skills and emotional maturity levels" of their current students are "much less advanced." Forty-one percent said their students' were "somewhat less advanced" in those areas, and 16 percent said they were "about the same" as their pre-pandemic peers.

Educators attributed those concerns to interruptions in in-person learning time, a divisive political climate among adults, and family stressors, like parental employment issues.

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Are the Kids All Right? What New Federal Data Say About Child Well-Being

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A five-year trove of federal data shows troubling trends in children's health continued or even increased as COVID swept the country.

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"Our lives are not beauty pageants."

-Renee Engeln

Author of Beauty Sick: How the Cultural Obsession with Appearance Hurts Girls and Women

Our social media focused culture has put so much pressure on young people's appearance.

77% of adolescents experience body image distress (Milton, 2021).

These are the mental health problems that can happen when a person doesn't like their body:

Eating disorders, almost all eating disorders come with body dissatisfaction (Stice & Shaw, 2002) - The number of eating disorders doubled during pandemic (Radhakrishnan et al., 2022).

These are the effects of our culture on our young girls:

34% of 5-year-old girls restrain their food intake (Damiano et al., 2015)

40% of girls between 5 and 9 years old wish they were thinner (Damiano et al., 2015)

33% of third grade girls report that they are afraid of becoming fat (Dohnt & Tiggemann, 2006)

28% of 5-year-old girls want their bodies to look like the women they see in movies and on TV (Shapiro et al., 1997)

The stories below represent some of the human costs behind the statistics:

Our culture's body size preferences for "thin" and "buff" bodies have caused people harm. People spend too much time trying to manage their bodies with dieting and exercise leading to disordered eating, eating disorders and low self-esteem issues.

Our culture's preferences for other appearance ideals-in addition thin or buff preferences-have caused harm to people of different races, ethnicities, sexual preferences, gender identities, and physical and cognitive abilities.

Our culture's disparagement of larger bodies has caused people harm:

We can push back against the way bodies and appearance are thought about and discussed in our culture. Research has studied body image and appearance pressure for decades. We know what causes these problems. And, we have good ideas about what we can do to help. BE REAL has taken research findings and created presentations that teach the adults in children's lives about 3 Shifts (directly below) to create body confident environments at school and at home. Our Body Confident Schools workshop is for educators-teachers, school wellness professionals, counselors and administrators-and Body Confident Kids for parents. This way educators and parents can be on the same page about what is helpful for students. BE REAL Ambassadors give these presentations in their local areas.

Cultural Belief:

"Focusing on our Body as an Ornament"

BE REAL Shift:

"Focusing on our Body as an Instrument for our Own Use"

Less focus on how we appear to others and more focus on what our bodies do for us.

Cultural Belief:

"Focusing on Body Measurements (BMI, Weight, Clothing Size)"

BE REAL Shift:

"Focusing on Healthy, Self-Care Behaviors"

It's about the process of self-care, not the results.

Cultural Belief:

"Judging People

by their Appearance"

BE REAL Shift:

"Recognizing People Come in All Shapes and Sizes"

It's about compassion, not comparison.

BE REAL's research-based BodyKind high school, body image curriculum teaches students to use self-compassion when their self-critical thoughts about appearance come up in their thoughts. The skills we teach help adolescents develop emotional regulation, cognitive reframing and critical thinking skills to promote body confidence and positive mental health.

BodyKind meets the U.S. Health Education Curriculum (HECAT) Standard 2: Analyzing Influences.

BodyKind was developed by body image academics, psychologists, teachers and parents. We've tested BodyKind with hundreds of students. Students and teachers really love it! Please read about our pilot test in Brooklyn Center Community High School in Minneapolis published in Body Image academic research journal.

At BE REAL we join forces with organizations that promote anti-fat legistation and anti-bullying laws. We can all make sure that bullying for body size or appearance-which is the #1 reason students are bullied- is called out and enforced just like bullying for race, sexuality, or religion. All students deserve dignity and respect.

"Our beliefs about bodies disproportionately impact those whose race, gender, sexual orientation, ability, and age deviate from our default notions. The further from the default, the greater the impact. We are all affected - but not equally."
― Sonya Renee Taylor, The Body Is Not an Apology: The Power of Radical Self-Love

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Author of Beauty Sick: How the Cultural Obsession with Appearance Hurts Girls and Women These are the mental health problems that can happen when a person doesn't like their body: Eating disorders, almost all eating disorders come with body dissatisfaction (Stice & Shaw, 2002) - The number of eating disorders doubled during pandemic (Radhakrishnan et al., 2022).

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The National Survey of Children's Health (NSCH) provides rich data on multiple, intersecting aspects of children's lives-including physical and mental health, access to and quality of health care, and the child's family, neighborhood, school, and social context. The National Survey of Children's Health is funded and directed by the In 2003, 2007, and 2011/12, the NSCH was conducted using telephone methodology, and was conducted by the Health Resources and Services Administration (HRSA) National Center for Health Statistics at the Centers for Disease Control under the direction and sponsorship of the federal Maternal and Child Health Bureau (MCHB). Maternal and Child Health Bureau (MCHB). A revised version of the survey was conducted as a mail and web-based survey by the Census Bureau in 2016, 2017, 2018, 2019, 2020, 2021 and 2022. Among other changes, the 2016 National Survey of Children's Health started integrating two surveys: the previous NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). See the MCHB website for more information on the 2016, 2017, 2018, 2019, 2020, 2021 and 2022 National Survey of Children's Health administration, methodology, survey content, and data availability.

The previous version of the NSCH was conducted three times between 2003 and 2012.

The 2016, 2017, 2018, 2019, 2020, 2021 and 2022 NSCH public-use files (PUF) are available on the Census Bureau's NSCH page. Additionally, national and state estimates for over 300 Child and Family Health Measures and Title V National Performance Measures (NPMs) and National Outcome Measures (NOMs) from the 2016, 2017, 2018, 2019, 2020, 2021, 2022, combined 2016-2017, 2017-2018, 2018-2019, 2019-2020, 2020-2021 and 2021-2022 NSCH are available on the interactive data query. All NSCH survey data shown on the DRC website, including constructed National Performance and Outcome Measures, child and family health measures, and demographic variables are available as SAS, SPSS, and Stata datasets on the DRC Dataset Request Page.

The Data Resource Center takes the results from the NSCH and makes them easily accessible to parents, researchers, community health providers and anyone interested in maternal and child health. Data on this site are for the nation and each of the 50 states plus the District of Columbia. State and national data can be further refined to assess differences by race/ethnicity, income, type of health insurance, and a variety of other important demographic and health status characteristics. Additional resources on the survey can be found on the following pages:

Survey Design and Sponsorship

Maternal and Child Health Bureau at the Health Resources and Services Administration in partnership with Census Bureau, National Center for Health Statistics at the Centers for Disease Control, Child and Adolescent Health Measurement Initiative, and a National Technical Expert Panel

Data Collection
2016, 2017, 2018, 2019, 2020, 2021, 2022: Census Bureau
2003, 2007, 2011/12: National Center for Health Statistics at the Centers for Disease Control and Prevention

Geographic areas
Nationwide, all 50 states and the District of Columbia

Periodicity
Yearly survey beginning in 2016
Previous surveys conducted in 2003, 2007, 2011/12

Population sampled
Non-institutionalized children in the US ages 0-17 years

Sample size range
2022: Nationally: 54,103; State: between 688 - 4,724
2021: Nationally: 50,892; State: between 788 - 2,956
2020: Nationally: 42,777; State: between 644 - 3,039
2019: Nationally: 29,433; State: between 474 - 651
2018: Nationally: 30,530; State: between 520 - 769
2017: Nationally: 21,599; State: between 343 - 470
2016: Nationally: 50,212; State: between 638 - 1,351
2003, 2007, 2011/12: Nationally: between 91,000 and 102,000; State: between 1,800-2,200

Representative
Weighted to be representative of the US population of non-institutionalized children ages 0-17

Topics
Physical and emotional health; factors that may relate to well-being of children, including medical home, family interactions, parental health, school experiences, and safe neighborhoods

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national survey of children with special health care needs

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National Survey of Children's Health - Data Resource Center for Child and Adolescent Health

# data[].attributes.attachment_link.description
The National Survey of Children's Health (NSCH) provides rich data on multiple, intersecting aspects of children's lives-including physical and mental health, access to quality health care, and the child's family, neighborhood, school, and social context.

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CDC - Association Between Physical Activity and Academic Performance

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CDC - Association Between Physical Activity and Academic Performance

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CDC - How much physical activity do children need?

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CDC - How much physical activity do children need?

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Centers for Disease Control and Prevention

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The amount of physical activity children need depends on their age. Children ages 3 through 5 years need to be active throughout the day. Children and adolescents ages 6 through 17 need to be active for 60 minutes every day.

This may sound like a lot, but don't worry! Children may already be meeting the recommended physical activity levels. You can also see ways to encourage children to participate in activities that are age-appropriate, enjoyable, and offer variety.
Recommendations for Children Ages 3 Through 5 Years

Be physically active throughout the day for growth and development.

Adult caregivers should encourage children to be active when they play.

Recommendations for Children and Adolescents Ages 6 Through 17 Years

60 minutes or more of moderate-to-vigorous intensity physical activity each day.

Aerobic activity: Most of the daily 60 minutes should include activities like walking, running, or anything that makes their hearts beat faster. At least 3 days a week should include vigorous-intensity activities.

Muscle-strengthening: Includes activities like climbing or doing push-ups, at least 3 days per week.

Bone-strengthening: Includes activities such as jumping or running, at least 3 days per week.

Want examples of what counts? Check out the aerobic, muscle-strengthening, and bone-strengthening activity for children and adolescents.

Also, school-based physical activity can help children meet the recommended 60 minutes of daily physical activity.

On a scale of 0 to 10, where sitting is a 0 and the highest level of activity is a 10, moderate-intensity activity is a 5 or 6. When children do moderate-intensity activity, their heart beats faster, and they breathe much harder than when they are at rest or sitting. Vigorous-intensity activity is a level 7 or 8. When children do vigorous-intensity activity, their heart beats much faster than normal, and they breathe much harder than normal.

Another example is when children walk to school with friends each morning, they're probably doing moderate-intensity aerobic activity. But when children run, or chase others while playing tag during recess, they're probably doing vigorous-intensity activity.

Some physical activity is better-suited for children than adolescents. For example, younger children usually strengthen their muscles when they do gymnastics, play on a jungle gym, or climb trees. Children do not usually need formal muscle-strengthening programs, such as lifting weights. As children grow older and become adolescents, they may start structured weight lifting programs. They may do these types of programs along with their sports team practices.

How can you help children get the recommended amount of physical activity? Find out here.

Connect with Nutrition, Physical Activity, and Obesity

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How much physical activity do children need?

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The amount of physical activity children need depends on their age. See recommendations for ages 3 through 17.

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Centers for Disease Control and Prevention

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Academic Performance
- Improves attention and memory

Brain Health
- Reduces risk of depression

Muscular Fitness
- Builds strong muscles and endurance

Heart and Lung Health
- Improves blood pressure and aerobic fitness

Cardiometabolic Health
- Helps maintain normal blood sugar levels

Long-term Health
- Reduces risk of several chronic diseases, including type 2 diabetes and obesity

Bone Strength
- Strengthens bones

Healthy Weight
- Helps regulate body weight and reduce body fat

Immediate Benefits for Adults

A single bout of moderate-to vigorous physical activity provides immediate benefits for your health.

Sleep
- Improves sleep quality

Less Anxiety
- Reduces feelings of anxiety

Blood Pressure
- Reduces blood pressure

Long-term Benefits for Adults

Regular physical activity provides important health benefits for chronic disease prevention.

Brain Health
- Reduces risks of developing dementia (including Alzheimer's disease) and reduces risk of depression

Heart Health
- Lowers risk of heart disease, stroke, and type 2 diabetes

Cancer Prevention
-Lowers risk of eight cancers: bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach

Healthy Weight
- Reduces risk of weight gain

Bone Strength
- Improves bone health

Balance and Coordination
- Reduces risks of falls

Emerging research suggests physical activity may also help boost immune function. 1,2

Immediate Benefits for Adults 65 and Older

A single bout of moderate-to vigorous physical activity provides immediate benefits for your health.

Sleep
- Improves sleep quality

Less Anxiety
- Reduces feelings of anxiety

Blood Pressure
- Reduces blood pressure

Long-term Benefits for Adults 65 and Older

Regular physical activity provides important health benefits for chronic disease prevention.

Brain Health
- Reduces risks of developing dementia (including Alzheimer's disease) and reduces risk of depression

Heart Health
- Lowers risk of heart disease, stroke, and type 2 diabetes

Cancer Prevention
-Lowers risk of eight cancers: bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach

Healthy Weight
- Reduces risk of weight gain

Independent Living
- Helps people live independently longer

Bone Strength
- Improves bone health

Balance and Coordination
- Reduces risks of falls

Emerging research suggests physical activity may also help boost immune function. 1,2

Source: Physical Activity Guidelines for Americans, 2nd edition (Chapter 2, page 32)

1. Nieman, D. C., & Wentz, L. M. (2019). The compelling link between physical activity and the body's defense system. Journal of sport and health science, 8(3), 201-217.

2. Jones, A. W., & Davison, G. (2019). Exercise, Immunity, and Illness. In Muscle and Exercise Physiology (pp. 317-344). Academic Press.

Connect with Nutrition, Physical Activity, and Obesity

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Benefits of physical activity for children, adults, and adults 65 and

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Learn how being active provides many benefits to children, adults, and adults 65 and older.

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Keep Your Teen Moving to Reduce Risk of Depression

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Keep Your Teen Moving to Reduce Risk of Depression

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Science shows moderate to vigorous aerobic exercise is good for us -- it improves sleep; lowers blood pressure; protects against heart disease, diabetes and cancer; reduces stress; boosts mood; and fights anxiety and depression.

It's especially important in adolescence, where the first signs of depression often begin, studies show. But unless your child is an athlete, it can be tough to wean them away from social media and the ever-present screento swim laps or go for a blood-pumping jog.

A new study has some good news: even light exercise may help protect children against developing depression.

The study, published Tuesday in the journal Lancet Psychiatry,found that 60 minutes of simple movement each day at age 12 was linked to an average 10% reduction in depression at age 18. The types of movement ranged from running and biking to walking, doing chores, painting or playing an instrument.

"It's not just more intense forms of activity that are good for our mental health," Aaron Kandola, a PhD student in psychiatry at University College London and lead author of the study, said in a statement.

"A lot of initiatives promote exercise in young people, but our findings suggest that light activity should be given more attention as well," senior author Dr. Joseph Hayes, a psychiatrist and clinical research consultant at University College London, said in a statement.

"Schools could integrate light activity into their pupils' days, such as with standing or active lessons," Hayes said. "It doesn't require much effort and it's easy to fit into the daily routines of most young people."

Long-term results

The study used information from the University of Bristol's Children of the '90s study, which has been following 14,500 women and their children for 30 years, from pregnancy onward.

As part of this, 4,257 adolescents wore instruments to track their movements at ages 12, 14 and 16 over a three-day period. For at least 10 hours each day, accelerometers recorded whether the child moved or was sedentary. The machines provided a better method of tracking than prior studies, which relied on self-reporting, researchers said.

"Worryingly, the amount of time that young people spend inactive has been steadily rising for years, but there has been a surprising lack of high quality research into how this could affect mental health," Kandola said.

Sedentary behavior increased as the children grew older, the study found, with depression scores highest among the least active. Each additional hour of sitting at age 12 was linked to an 11% increase in depression scores at age 18, based on a clinical questionnaire which measures depressive symptoms and their severity on a spectrum.

At age 14, each additional hour of being inactive raised depressive scores by 8%, while 16-year-olds had an increased score of 10.5%, the study found. The study only looked at depression, not anxiety disorders.

Researchers adjusted their analysis to account for those with depression at the beginning of the study as well as socioeconomic status, parental history and the like, which are all linked to mental health. While the study is only an association and can't prove a relationship between movement and depression, "our study suggests that these two trends may be linked," Kandola said.

In fact, the data "suggested that a 2 [hour] reduction in daily sedentary behavior between the ages of 12 and 16 years old was associated with a 16 [to] 22% reduction in depression scores by age 18," the study said.

Rates of adolescent mental disorders on rise

According to the World Health Organization, depression is one of the leading causes of illness and disability among adolescents around the world, accounting for "16% of the global burden of disease and injury in people aged 10 to 19 years."

In the United States, rates of teen depression are on the rise. A new study to be published in March found rates of major depressive episodes in the last year among teens increased 52% between 2005 and 2017. The study analyzed data from the U.S. National Survey on Drug Use and Health and found rates rose from 8.7% to 13.2% over that time span.

A depressive episode is defined by a list of symptoms that include feeling sad, hopeless, frustrated, anxious or worthless for at least two weeks.

That number fits with a 2017 analysis by the US National Institute of Mental Health, which found 13.3% of American teens aged 12 to 17 have suffered at least one major depressive episode over the last 12 months. That's more than three million children, mostly girls. Girls are almost three times as likely to suffer depressive episodes, the report said.

The trend is worrisome, experts say, especially since only 50% of depressed teens are diagnosed before adulthood and suicide is on the rise. A study last year found that the numbers of children and teenswith suicidal thoughts who went to emergency rooms in the U.S. doubled between 2007 and 2015.

The National Institute of Mental Health is currently funding three separate research projects to study the depressed teenage brain and evaluate treatments.

What to look for

For parents, it might be hard to distinguish between normal teen angst and depression. Symptoms include fatigue, irritability, odd sleeping patterns, a wish to be left alone and a lack of interest in school and daily activities, among others.

In 2016, the U.S. Preventive Services Task Force said that all primary care doctors, such as pediatricians and family physicians, should routinely screen teens over age 12 for signs of depression. One of the most used tests is called the PHQ, or patient health questionnaire.

The questions cover mood, sleep, energy, concentration and suicidal thoughts, and asks the teen to rate the severity of their symptoms from "not at all" to "nearly every day."

Parents should be able to access the test via their pediatrician, as the American Academy of Pediatrics updated their guidelines in 2018, encouraging all pediatricians to screen teens for depression, and depending on the severity of the results, refer teens for treatment.

Parents, say experts, can help their depressed child by being supportive and validating their feelings. Rather than being critical, says the U.S. nonprofit Child Mind Institute, try to notice positive behaviors.

For example, "Instead of saying, 'Honey, you should really get up and do something. How about calling an old friend?' you might say, 'I'm going to the mall to do an errand. Let me know if you want to come with me, and maybe we can get lunch together,'" the institute suggests.

And if you can't break through the first time you try to connect to your teen, says YoungMinds, keep trying on another day. But don't ignore your teen's feelings hoping they will go away.

The National Alliance on Mental Illness in the U.S. has these tips as well:

1. Watch for warning signs: low self-esteem, withdrawal, lack of energy and interest, lower test scores at school, fatigue and suicidal thoughts. If seen, get your child professional help.

2. Spend quality time with your child and encourage "open and honest" conversations in which you actively listen to your child.

3. Encourage regular exercise, healthy eating habits and regular, quality sleep.

4. Encourage connections to others through family gatherings, social events, sleepovers and clubs and activities at school.

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Keep your teen moving to reduce risk of depression, study says

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A new study has found that even light exercise may help protect children against developing depression.

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Staying Active May Lower Adolescents' Risk of Depression 

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Staying Active May Lower Adolescents' Risk of Depression 

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The more time an adolescent spends sitting, the more likely he or she is to experience depressive symptoms, according to a new University College London-led study. These findings ( Kandola et al., 2020) were published on February 11 in The Lancet Psychiatry.

To the best of my knowledge, this is the first accelerometer-based longitudinal study with a large sample size (n = 4,257) to investigate the association between daily physical activity, sedentary behaviors, and the prevalence of depressive symptoms among adolescents age 12-18.

Accelerometers (i.e., fitness trackers) provide more objective and reliable data than studies that rely on self-reporting of daily physical activity. Depressive symptoms were measured using Clinical Interview Schedule-Revised (CIS-R) depression scores.

The researchers found that adolescents whose daily routine consistently included light physical activity (e.g., walking) were less likely to be depressed. They also identified a dose-response that linked the amount of time sitting vs. the amount of time moving with higher or lower depression scores. Across the board, adolescents who sat less and moved more tended to have fewer depressive symptoms.

In addition to walking, light physical activity can include things like playing a musical instrument in the marching band, dancing in a TikTok video, doing household chores, or making art while standing.

"Light activity could be particularly useful because it doesn't require much effort and it's easy to fit into the daily routines of most young people. Schools could integrate light activity into their pupils' days with standing or active lessons," the study's lead author, Aaron Kandola of UCL said in a news release. "Small changes to our environments could make it easier for all of us to be a little bit less sedentary." (See " Why Prolonged Classroom Sitting Isn't Ideal for Student Health")

On a day-to-day basis, the researchers found that every additional hour of sedentary behavior at age 12, 14, and 16 was associated with an uptick in depression scores of 11.1%, 8%, and 10.5%, respectively, by age 18.

Conversely, every additional 60 minutes of light physical activity per day at age 12, 14, and 16 was associated with depressive symptom scores that were 9.6%, 7.8% and 11.1% lower, respectively, by age 18.

Adolescents who were consistently sedentary at the ages of 12, 14, and 16 had depression scores that were 28.2% higher than their more active peers by age 18.

"Our findings show that young people who are inactive for large proportions of the day throughout adolescence face a greater risk of depression by age 18," Kandola said. "We found that it's not just more intense forms of activity that are good for our mental health, but any degree of physical activity that can reduce the time we spend sitting down is likely to be beneficial."

This is great news. Even if you're a teen who doesn't like to get sweaty and hates vigorous exercise, this research suggests that incorporating some very light and easy physical activity into your daily routine could make you less likely to get depressed. You don't have to subject yourself to a grueling session of HIIT or become an exercise fanatic to reap the mental health benefits of light physical activity. Making a small effort to sit a bit less and move a little more could make a big difference in your risk of depression.

Please note: These findings are correlative. The researchers cannot prove that higher levels of physical activity cause a reduction of adolescents' depressive symptoms; they can only identify a correlation. For example, adolescents suffering from major depressive disorder (MDD)-for reasons that have nothing to do with how much time they spend sitting-may tend to be less active than "happy-go-lucky" peers without any depressive symptoms.

That said, the researchers made a concerted effort to avoid reverse causation by adjusting their data analysis to account for pre-existing depressive symptoms at the outset of the study. They also adjusted for confounding factors such as a parental history of clinical depression and socioeconomic status.

Previous research ( Choi et al., 2019) has shown that moderate-to-vigorous physical activity (MVPA) can lower the risk of depression in adults. The latest research (2020) by Kandola et al. suggests that light physical activity, that doesn't require huffing and puffing or breaking a sweat, may also help keep depression at bay for adolescents and adults.

Depression Essential Reads

"Worryingly, the amount of time that young people spend inactive has been steadily rising for years, but there has been a surprising lack of high-quality research into how this could affect mental health. The number of young people with depression also appears to be growing and our study suggests that these two trends may be linked," Kandola concluded. "We should be encouraging people of all ages to move more and to sit less, as it's good for both our physical and mental health."

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Staying Active May Lower Adolescents' Risk of Depression

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Any degree of physical activity may reduce teens' risk of depressive symptoms.

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When high school junior Nora Huynh got her report card, she was devastated to see that she didn't get a perfect 4.0.

Nora "had a total meltdown, cried for hours," her mother, Jennie Huynh of Alameda, Calif., says. "I couldn't believe her reaction."

Nora is doing college-level work, her mother says, but many of her friends are taking enough advanced classes to boost their grade-point averages above 4.0. "It breaks my heart to see her upset when she's doing so awesome and going above and beyond."

And the pressure is taking a physical toll, too. At age 16, Nora is tired, is increasingly irritated with her siblings and often suffers headaches, her mother says.

Teens Talk Stress

When NPR asked on Facebook if stress is an issue for teenagers, they spoke loud and clear:

"Academic stress has been a part of my life ever since I can remember," wrote Bretta McCall, 16, of Seattle. "This year I spend about 12 hours a day on schoolwork. I'm home right now because I was feeling so sick from stress I couldn't be at school. So as you can tell, it's a big part of my life!"

"At the time of writing this, my weekend assignments include two papers, a PowerPoint to go with a 10-minute presentation, studying for a test and two quizzes, and an entire chapter (approximately 40 pages) of notes in a college textbook," wrote Connor West of New Jersey.

"It's a problem that's basically brushed off by most people," wrote Kelly Farrell in Delaware. "There's this mentality of, 'You're doing well, so why are you complaining?' " She says she started experiencing symptoms of stress in middle school, and was diagnosed with panic disorder and generalized anxiety disorder in high school.

"Parents are the worst about all of this," writes Colin Hughes of Illinois. "All I hear is, 'Work harder, you're a smart kid, I know you have it in you, and if you want to go to college you need to work harder.' It's a pain."

Parents are right to be worried about stress and their children's health, says Mary Alvord, a clinical psychologist in Maryland and public education coordinator for the American Psychological Association.

"A little stress is a good thing," Alvord says. "It can motivate students to be organized. But too much stress can backfire."

Almost 40 percent of parents say their high-schooler is experiencing a lot of stress from school, according to a new NPR poll conducted with the Robert Wood Johnson Foundation and the Harvard School of Public Health. In most cases, that stress is from academics, not social issues or bullying, the poll found. (See the full results here.)

Homework was a leading cause of stress, with 24 percent of parents saying it's an issue.

Teenagers say they're suffering, too. A survey by the American Psychological Association found that nearly half of all teens - 45 percent - said they were stressed by school pressures.

Chronic stress can cause a sense of panic and paralysis, Alvord says. The child feels stuck, which only adds to the feeling of stress.

Parents can help put the child's distress in perspective, particularly when they get into what Alvord calls catastrophic "what if" thinking: "What if I get a bad grade, then what if that means I fail the course, then I'll never get into college."

Then move beyond talking and do something about it.

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MentalFlow: School Stress Takes A Toll On Health, Teens And Parents Say

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When high school junior Nora Huynh got her report card, she was devastated to see that she didn't get a perfect 4.0. Nora "had a total meltdown, cried for hours," her mother, Jennie Huynh of Alameda, Calif., says. "I couldn't believe her reaction." Nora is doing college-level w

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National Institute of Diabetes and Digestive and Kidney Diseases

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Defining Overweight and Obesity

A person whose weight is higher than what is considered to be a normal weight for a given height is described as being overweight or having obesity. ¹

Fast Facts

According to 2017-2018 data from the National Health and Nutrition Examination Survey (NHANES)

Nearly 1 in 3 adults (30.7%) are overweight.²

More than 2 in 5 adults (42.4%) have obesity.²

About 1 in 11 adults (9.2%) have severe obesity.²

According to 2017-2018 NHANES data

About 1 in 6 children and adolescents ages 2 to 19 (16.1%) are overweight.³

Almost 1 in 5 children and adolescents ages 2 to 19 (19.3%) have obesity.³

About 1 in 16 children and adolescents ages 2 to 19 (6.1%) have severe obesity.³

Using Body Mass Index (BMI) to Estimate Overweight and Obesity

BMI is a tool to estimate and screen for overweight and obesity in adults and children. BMI is defined as weight in kilograms divided by height in meters squared. BMI is related to the amount of fat in the body. A high amount of fat can raise the risk of many health problems. A health care professional can determine if a person's health may be at risk because of his or her weight.

Adults

The table below shows BMI ranges for overweight and obesity in adults 20 and older.

BMI of Adults Ages 20 and Older

Use this online tool from the Centers for Disease Control and Prevention (CDC) to gauge BMI for adults.

Children and Teens

A child's body composition changes during growth from infancy into adulthood, and it differs by sex. Therefore, a young person's weight status is calculated based on a comparison with other same-age and same-sex children or teens using CDC's age- and sex-specific growth charts. The comparison results in a percentile placement. For example, a boy whose weight in relation to his height is greater than 75% of other same-aged boys places in the 75th percentile for BMI and is considered to be of normal or healthy weight.

Children grow at different rates at different times, so it is not always easy to tell if a child is overweight. A child's health care professional should evaluate the child's BMI, growth, and potential health risks due to excess body weight.

BMI for Children and Teens

Weight Status Category

Percentile Range

Underweight

Less than 5th percentile

Normal or healthy weight

5th percentile to less than 85th percentile

Overweight

85th to less than 95th percentile

Obesity

95th percentile or greater

Severe obesity

120% of the 95th percentile

Use this online tool from the CDC to calculate BMI and the corresponding BMI-for-age percentile based on CDC growth charts, for children and teens.

Causes and Health Consequences of Overweight and Obesity

Factors that may contribute to excess weight gain among adults and youth include genetics; types and amounts of food and drinks consumed; level of physical activity; degree of time spent on sedentary behaviors, such as watching TV, engaging with a computer, or talking and texting on the phone; sleep habits; medical conditions or medicines; and where and how people live, including their access to and ability to afford healthy foods and safe places to be active. 4,5

Overweight and obesity increase the risk for many health problems, such as type 2 diabetes, high blood pressure, heart disease, stroke, joint problems, liver disease, gallstones, some types of cancer, and sleep and breathing problems, among other conditions. 5,6 Learn more about the causes and health consequences of overweight and obesity.

Prevalence of Overweight and Obesity

Adults
Age-adjusted percentage of US adults with overweight, obesity, and severe obesity by sex, 2017-2018 NHANES Data ²
As shown in the above table
Age-adjusted prevalence of obesity among adults ages 20 and over, by sex and age: United States, 2017-2018 ⁷

Nearly 1 in 3 adults (30.7%) are overweight.

More than 1 in 3 men (34.1%) and more than 1 in 4 women (27.5%) are overweight.

More than 2 in 5 adults (42.4%) have obesity (including severe obesity).

About 1 in 11 adults (9.2%) have severe obesity.

The percentage of men who are overweight (34.1%) is higher than the percentage of women who are overweight (27.5%).

The percentage of women who have severe obesity (11.5%) is higher than the percentage of men who have severe obesity (6.9%).

Age-adjusted prevalence of obesity among adults ages 20 and over, by sex, race, and Hispanic origin: United States, 2017-2018 ⁷
As shown in the above bar graph

Among adults ages 20 and over, there are no significant differences in prevalence of obesity by sex or age group
Age-adjusted prevalence of severe obesity among adults ages 20 and over, by sex, age, and race and Hispanic origin: United States, 2017-2018 ⁷

Prevalence of overweight, obesity, and severe obesity among children and adolescents ages 2 to 19 years: United States, 2017-2018 NHANES data ³ Prevalence of obesity among children and adolescents ages 2 to 19 years: United States, 2017-2018 NHANES data ³ Prevalence of obesity among children and adolescents ages 2 to 19 years, by sex and race and Hispanic origin: United States, 2017-2018 NHANES data ³
As shown in the above bar graph

More than 2 in 5 non-Hispanic white adults (42.2%) have obesity.

Nearly 1 in 2 non-Hispanic Black adults (49.6%) have obesity.

More than 1 in 6 non-Hispanic Asian adults (17.4%) have obesity.

Nearly 1 in 2 Hispanic adults (44.8%) have obesity.

Obesity affects more than 2 in 5 non-Hispanic white men (44.7%), more than 2 in 5 non-Hispanic Black men (41.1%), more than 1 in 6 non-Hispanic Asian men (17.5%), and more than 2 in 5 Hispanic men (45.7%).

Nearly 2 in 5 non-Hispanic white women (39.8%), more than half of non-Hispanic Black women (56.9%), more than 1 in 6 non-Hispanic Asian women (17.2%), and more than 2 in 5 Hispanic women (43.7%), have obesity.

As shown in the above bar graph, men and women differ in their rates of obesity and severe obesity.

More women (11.5%) than men (6.9%) have severe obesity.

Severe obesity was highest among people ages 40 to 59 (11.5%), followed by people ages 20 to 39 (9.1%) and people ages 60 and older (5.8%).

About 1 in 11 non-Hispanic white adults (9.3%) have severe obesity.

More than 1 in 8 non-Hispanic Black adults (13.8%) have severe obesity.

About 1 in 50 non-Hispanic Asian adults (2.0%) have severe obesity.

About 1 in 13 Hispanic adults (7.9%) have severe obesity.

Severe obesity was highest among non-Hispanic Black adults (13.8%), followed by non-Hispanic white adults (9.3%), Hispanic adults (7.9%), and non-Hispanic Asian adults (2.0%).

Trends in age-adjusted (PDF, 97.2 KB) obesity and severe obesity prevalence among adults ages 20 and over: United States, 1999-2000 through 2017-2018 ⁷
Youth
Trends in obesity among children and adolescents ages 2-19 years, by age: United States, 1963-1965 through 2017-2018 ³
According to the 2017-2018 NHANES data

Among children and adolescents ages 2 to 19, about 1 in 6 (16.1%) are overweight, more than 1 in 6 (19.3%) have obesity, and about 1 in 18 (6.1%) have severe obesity.

According to the 2017-2018 NHANES data

Among children ages 2 to 5, more than 1 in 8 (13.4%) have obesity.

Among children and youth ages 6 to 11, more than 1 in 5 (20.3%) have obesity.

Among adolescents ages 12 to 19, more than 1 in 5 (21.2%) have obesity.

According to the 2017-2018 NHANES data

More than 1 in 6 non-Hispanic white boys (17.4%) have obesity and more than 1 in 7 non-Hispanic white girls (14.8%) have obesity.

Nearly 1 in 5 non-Hispanic Black boys (19.4%) and more than 2 in 7 non-Hispanic Black girls (29.1%) have obesity.

About 1 in 8 non-Hispanic Asian boys (12.4%) and about 1 in 20 non-Hispanic Asian girls (5.1%*) have obesity.

About 2 in 7 Hispanic boys (28.1%) and nearly 1 in 4 Hispanic girls (23.0%) have obesity.

More than 2 in 7 Mexican American boys (29.2%) and 1 in 4 of Mexican American girls (24.9%) have obesity.

* See asterisked note in the figure above.

Trends in Obesity among Adults and Youth in the United States

Adults

As shown in the figure above

The prevalence of obesity and severe obesity increased significantly among adult men and women between 1999-2000 and 2017-2018.

Youth

As shown in the above line graph

The prevalence of obesity among children and adolescents ages 2 to 19 years roughly doubled between 1988-1994 and 2017-2018.

Among children ages 2 to 5, the prevalence of obesity increased between 1988-1994 and 2003-2004, decreased between 2003-2004 and 2011-2012, and then increased again.

Among children ages 6 to 11, the prevalence of obesity increased between 1988-1994 and 2003-2004, fluctuated over the next several years, and most recently (2013-2014 to 2017-2018) increased.

Among adolescents, ages 12 to 19, the prevalence of obesity has increased between 1988-1994 and 2017-2018.

References

[1] Defining adult obesity. Centers for Disease Control and Prevention. Updated June 7, 2021. Accessed January 29, 2021. www.cdc.gov/obesity/basics/adult-defining.html

[2] Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960-1962 through 2017-2018. NCHS Health E-Stats, Centers for Disease Control and Prevention. 2020. Updated February 8, 2021. Accessed January 29, 2021. www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obesity-adult.htm

[3] Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2-19 years: United States, 1963-1965 through 2017-2018. NCHS Health E-Stats, Centers for Disease Control and Prevention. Updated January 29, 2021. Accessed April 22, 2021. www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf (PDF, 352 KB)

[4] What causes obesity and overweight? National Institute of Child Health and Human Development, National Institutes of Health. Updated July 28, 2021. Accessed January 29, 2021. www.nichd.nih.gov/health/topics/obesity/conditioninfo/cause

[5] Adult overweight causes and consequences. Centers for Disease Control and Prevention. Updated March 22, 2021. Accessed January 29, 2021. www.cdc.gov/obesity/basics/causes.html

[6] Cotter TG, Rinella M. Nonalcoholic fatty liver disease 2020: the state of the disease. Gastroenterology. 2020;158(7):1851-1864. doi:10.1053/j.gastro.2020.01.052

[7] Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. National Center for Health Statistics Data Brief 360. Centers for Disease Control and Prevention. Updated February 27, 2020. Accessed January 29, 2021. www.cdc.gov/nchs/products/databriefs/db360.htm

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Trends in overweight, obesity, and severe obesity for children, adolescents, and adults.

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National Library of Medicine - The Effect of Movement on Cognitive Performance

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National Library of Medicine - The Effect of Movement on Cognitive Performance

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Raed Mualem, 1, 2, ³ Gerry Leisman, 3, 4,* Yusra Zbedat, ¹ Sherif Ganem, ⁵ Ola Mualem, ³ Monjed Amaria, ¹ Aiman Kozle, ¹ Safa Khayat-Moughrabi, ³ and Alon Ornai ²

Abstract

The study examines the relationship between walking, cognitive, and academic skills. Students from elementary, middle, high school, and college were required to walk for 10 min prior to completing feature detection, Simon-type memory, and mathematical problem-solving tasks. Participants were counterbalanced to remove a time bias. Ten minutes of walking had a significant positive effect on Simon-type memory and critical feature-detection tasks among all age groups. Separately, with mathematical problem-solving ability, higher performing high-school students demonstrated significant positive effects on mathematical reasoning tasks based on the Bloom Taxonomy. However, poorly achieving high-school students performed significantly better than those with higher grades in mathematics on tests of mathematical problem-solving ability based on the Bloom's Taxonomy. The study indicates that there is justification to employ relatively simple means to effect lifestyle, academic, and cognitive performance.

Keywords: sequential memory, attention, cognition, movement, walking, Bloom's taxonomy, mathematics achievement

Introduction

Brain plasticity and cognitive function are significantly improved by physical activity ( 1). The importance of this association is more important than ever given the significantly increased sedentary behavior and obesity worldwide in childhood and adulthood and the upsurge in aging populations of diminishing fitness and cognitive functions ( 2). Kramer and Erickson ( 3, 4) assessed the hypothesis that exercise and physical activity might protect and even augment brain and cognitive function throughout one's lifespan. They critically reviewed the literature on the relationship between physical activity on brain and cognition function. The authors included prospective observational or epidemiological studies; non-human animal studies; and randomized human clinical trials. They reported that the literature supports the assertion that cognitive and brain function is enhanced by physical activity.

McDonnell et al. ( 5) found that a single 30-min period of physical activity is related to increases in neuroplasticity with discernible positive effects in motor-skill coordination and in declarative memory. Hillman et al. ( 6) studied the relationship between electrophysiological variables associated with attention and treadmill walking on academic performance. Hillman and colleagues observed the cognitive function and cardiopulmonary fitness at rest of each of their participants to determine baseline aerobic and cognitive capability. An exercise period was provided that involved 20 min of walking on a treadmill at 60% of the estimated maximum heart rate followed by the assessment of cognitive function once heart rate resumed to within 10% of pre-exercise levels. The participants exhibited a significant increase in response accuracy; greater P3 event related potential amplitude, and significantly improved performance on academic achievement tests after aerobic exercise when compared with rest. The results of Hillman and colleague's study revealed that exercise is associated with increases in cognitive function as measured by tests of academic performance and attention. These data suggest that even single sessions of light exercise can influence essential processes related to cognitive skills.

Smith et al. ( 7) required adults in their late 1920s and early 1930s to ride exercise bicycles for a period of 30 min. Brain-state changes immediately after the session were examined and again after 15 min. Short-interval intra-cortical inhibition before and at 0 and 15 min following 30 min of ergometer cycling at low-moderate or moderate-high intensity was examined as well as cortical stimulus-response curves (90-150% resting motor threshold). Neuroplasticity, it was concluded, could be improved by a single 30-min session of physical activity with noticeable changes after only 15 min of exercising.

Neuroplasticity is associated with the both the actual number as well as the connection strength between neurons as well as in regional connectivities within the brain ( 8). It is on this basis that we can explain why it is that exercise and physical activity positively increase cognitive-motor function. Kamijo et al. ( 9) had studied the relationship between academic achievement and physical exercise, as did Hillman et al. ( 10). Of interest is the fact that Cotman and Berchtold ( 11) noted that with physical activity, brain-derived neurotrophic factor (BDNF), that supports synaptogenesis in the basal forebrain and hippocampus, functions in areas fundamental to memory, learning, and thinking and is significantly elevated in rodents. Similar findings have been found in humans ( 12). Interestingly, although BDNF increases in mouse hippocampus after 7 days of wheel running compared with sedentary mice ( 11), termination of the exercise according to Ref. ( 13) reverses, in rodents, the increased cell number, and cognitive gains. Chaddock-Heyman et al. ( 14) found advantage from regular exercise for the brain's white matter and noted that connectivities between diverse cortical gray matter brain regions were facilitated. The relationship between brain state and an individual's physical fitness was observed in 24 9- and 10-year-old children. Researchers observed thicker and denser white matter among those children exhibiting greater degrees of physical fitness in turn linked with significantly superior attention span, memory, and cognitive facilities.

In the present, we examined the relationship between 10 min of walking to determine its effects on cognitive and academic performance in various age groups.

Materials and Methods

Feature Detection and Simon-Type Memory

Participants

Seventy-five elementary school children all in grade 5 consisting of 35 females and 40 males and 75 middle school children all in grade 7 (36 females and 39 males), 75 high school all in grade 9 consisting of 38 females and 37 males and 58 college students (35 females and 23 males) between the ages of 22 and 27 years participated in the study. All participants came from middle class backgrounds as determined by the methodology of Hollingshead and Redlich ( 15) IRB approval was obtained from the Research Committee of Oranim Academic College.

In the mathematic problem-solving study 75 high-school students in grade 9 consisting of 38 females and 37 males participated in the study. IRB approval was obtained from the Research Committee of Oranim Academic College.

Procedure

Participants were divided into two groups. Both groups were given a sequential memory task consisting of a Simon-type multisensory memory game ( 16) and a feature-detection task consisting of presentations of famous paintings twice, once with the complete painting and later with a minor feature of the painting missing. The task of each participant was to find the missing feature. Group A was given the tasks immediately after 10 min of outdoor walking in the school yard at a normal pace at 10 a.m. each session and Group B was given the tasks without 10 min of walking. A period of 10 min of walking was chosen rather than 15 min as longer periods would likely covert aerobic into anaerobic metabolism ( 17). After a period of a full week, Group B performed 10 min of walking prior to the task and Group A did not. Therefore, the groups were counterbalanced. This design attempted to avoid time as a confounding variable. In all cases, both the Simon-type and feature-detection tasks, all participants in both pre- and post-walking sessions were counterbalanced in that in the pre-testing situation Group A was examined prior to walking, and B after walking, with different but statistically equivalent tasks.

In the mathematical problem-solving task, participants were divided into two groups. Both groups were given a mathematical problem-solving task based on PISA, a multinational test of mathematical problem-solving ability ( 18). The tasks were based on Bloom's Taxonomy (remember, understanding, apply, and analyze) ( 18, 19).

We did not use the PISA test itself but rather employed "PISA-type" questions that were not part of current PISA tests but rather examples of questions typically found on PISA. We were not testing academic achievement but rather changes in mathematical problem-solving ability as measured by these question examplars-after aerobic walking.

As all groups received equivalent questions, PISA standardization became irrelevant in the context of the present study as the entire test was not used but only samples. The focus was not the PISA test results but rather changes in how the participants answered the same type of questions reflecting mathematical problem-solving ability.

Group A performed the PISA tasks immediately after 10 min of walking and Group B was given the tasks without 10 min of walking. After a period a full week, Group B had 10 min of walking prior to the task and Group A did not. Therefore, the groups were counterbalanced. This design attempted to avoid time confounded the results. This design attempted to avoid time as a confounding variable. All participants in both pre- and post-walking sessions were counterbalanced in that in the pre-testing situation Group A was examined prior to walking, and B after walking, with different but statistically equivalent tasks.

Each level of the taxonomic hierarchy contained two questions and was taken from the last edition of PISA. The questions provided the participants both before and after the walking intervention were different but statistically equivalent in difficulty. During the week between pre- and post-testing, participants had no opportunity to practice the material contained in PISA, as it was not part of their curriculum for their grades. Participants, therefore, had no practice effect. Questions were taken from the Israel Arabic edition of PISA from the ministry of education with questions exemplified in the materials provided by the OECD ( 20).

Statistical Analysis

Paired t-test comparisons were performed between pre- and post-walking tasks as each participant served as his own control. Non-parametric Spearman's rho correlations were also performed in order to examine the impact of attention on memory in the Simon-type and feature-detection tasks.

Results

Simon-Type Memory and Feature Detection

The analysis created forced dichotomies between poor and high-performing students in mathematical problem solving. Weak students had a grade average of less than 60% and those defined as having a grade point average of greater than 60%.

The results demonstrated significant improvement in the final PISA scores with walking of 10.6% ( t = 5.01; df, 31; p < 0.0001) and sequential memory tasks with an 11% increase in performance ( t = 5.727; df, 74; p < 0.0001) after 10 min of walking. Among middle school participants, significant improvement was recorded on feature detection with a 26% increase in performance ( t = 2.39; df, 74; p < 0.05) and sequential memory tasks with a 15.4% increase in performance ( t = 2.905; df, 74; p < 0.001) after 10 min of walking. Among high-school participants, significant improvement was recorded on feature detection with a 25% increase in performance ( t = 3.48; df, 69; p < 0.001) and on sequential memory tasks with an 8% increase in performance ( t = 3.48; df, 69; p < 0.001) after 10 min of walking. Among college-aged participants, significant improvement was recorded on feature detection with a 34% increase in performance ( t = 5.05; df, 57; p < 0.001) and on sequential memory tasks with a 20% increase in performance ( t = 11.98; df, 57; p < 0.001) after 10 min of walking. The tabular representation of the results may be found in Tables ​Tables1 1 and ​and2 2 .

Table 1

Age

Before

After

% Change of the mean

t

p-Value

N

Table 2

Age

Before

After

% Change of the mean

t

p-Value

N

Table ​Table3 3 reports Spearman's rho correlational data for memory and feature-detection tasks. For all age groups, no significant relationships were noted, indicating the independence of the experimental tasks and the collective effects of walking on performance.

Table 3

NS

Correlation Coefficient

0.070

Elementary school

NS

Correlation coefficient

0.028

Middle school

NS

Correlation coefficient

0.154

High School

NS

Correlation coefficient

0.206

College

Mathematical Skill

The present study additionally aimed to determine the effects of 10 min of walking on the effectiveness of mathematical learning performance in high-school male and female students. Participant performance was based on the Bloom's Taxonomy hierarchy that is represented in Figure ​Figure1 1 .

Participants

Seventy high-school students all in grade 9 (M = 17 years), consisting of 38 females and 37 males, participated in the study. Each participant served as his/her own control. A mathematical test based on the Bloom Taxonomy was employed ( 19). Students were examined prior to and after a 10-min period of walking. The following week each participant, at the same time, repeated a comparable task after a 10-min walk, and performance was re-examined. This then eliminated a temporal bias in the results and the groups were counterbalanced. The high-school level participants were divided into two groups, one consisting of low achievers, defined as those participants with a grade average of less than 60%, and a second group consisting of high achievers, whose grade point average was greater than 60%.

Results

The academically lower group obtained a significant increase of 6.29% in remember and 11.1% in understanding on the PISA tasks that evaluated performance within the Bloom's Taxonomy. Applying demonstrated an 8.4% increase and 19.6% in analyze domains. The final grades for all participants increased by 10.6%. The results for the low-achieving group are represented in Table ​Table4 4 .

The academically higher achieving group obtained a significant increase of 4.4% in remember and 3% in understanding on PISA tasks that evaluated performance within the Bloom's Taxonomy. Applying demonstrated an 8.0% increase and 6.9% in analyze domains. The final grades for all participants increased by 5.5%. The results for the low-achieving group are represented in Table ​Table5 5 .

Discussion

Movement in the form of aerobic walking significantly enhances performance of children on tests of sequential memory requiring cognitive-motor interaction and on tests of feature detection associated with attentional focus. Older children demonstrated significantly greater improvement in sequencing tasks than did younger children and these children, in turn, performed significantly better on tasks requiring attentional focus. The results should generate both future research and impact on the nature of classroom instruction in the context of the relationship between movement and cognition.

Postural muscles, we have claimed elsewhere ( 21), were the chief channels for the evolution of motor and cognitive binding. For a more comprehensive review of the nature of evolutionary brain development, posture, brain size, and the implications for limitations of the pelvis as well as the genetic implications, the reader is referred to Melillo and Leisman ( 22) and Falk et al. ( 23).

Reduced postural activity in childhood harms natural exploration of the surrounding environment, thereby reducing the ability to learn from experiences. Deviations from normal postural development or from normal levels of postural activity can disrupt or delay cerebellar and cortical maturation and may disrupt the underlying oscillatory timing mec ( 24); hanisms on which motor and cognitive binding is based ( 25- 29). As a result, cognition, more likely, evolved secondarily and in parallel to the evolution of human upright bipedalism. Although viewed as separate functions historically, it can be argued that complex motricity and cognition are functionally connected. The effect of this is that motricity is inextricably involved in cognitive skill acquisition ( 21, 24, 30).

Motor and cognitive functions are both controlled by cerebellum, basal ganglia, and frontal lobe regions of the brain that cooperatively network to exercise control over the intentionality of movement and on executive functions that require the individual to anticipate and predict the requisite movements. Dysfunction associated with developmental delays all involve conditions of reduced optimization of brain integration that in turn disrupt executive function, frontal lobe-based behaviors, and articulation with motor components of the nervous system ( 22, 28, 31).

Not uncommonly seen in children with developmental delays, is motor incoordination or "clumsiness," relating to posture and gait that supports the concept of "weak central coherence" that in turn relates to a processing bias for local and featural information and difficulty in extracting the essence of meaning, detecting missing or hidden figures or "seeing the big picture" in daily life experiences ( 22, 28, 32).

Among the limitations of this study included the fact that missing was information about the ethnicity of the participants. Among the elementary school participants, the students were of mixed ethnic background, but in the high-school population, all were Arabic speaking. Cultural effects are important issues to examine in future research. Additionally, mathematical skills as measured by PISA questions were only examined among high-school students and not among elementary school participants. In addition, a broad range of academic and cognitive skills were not examined in detail such as reading comprehension, reaction time, sensory-motor abilities, and the like. These are also the subjects of future research.

The tasks in this study simply examined the gross relation between walking as a form of motricity and feature detection and attention, cognitive, and academic performance. The results demonstrated the relationship and benefit between movement, in the form of walking, a postural function, and cognitive skills, such as critical feature detection.

Conclusion

The public health implications of the relationship between children's lifestyle and cognitive-motor interaction are significant. There exists a pandemic of physical inactivity among all age groups. We have predictions that sedentariness will continue to grow throughout the world in the near and long-term future ( 33). We can conclude that at least 10 min of walking has significant effect on mathematical problem-solving abilities in higher performing high school, but more so in lower performing students according to the results of testing mathematical problem-solving ability according to the Bloom's Taxonomy. Additionally, in all age groups 10 min of walking is a minimum that can affect performance in Simon-type memory and feature-detection tasks independent of children's age.

Ethics Statement

This study was carried out in accordance with the recommendations of the Research Committee of Oranim Academic College with written informed consent from all participant's parents or guardians. All subjects' parents or guardians gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Research Committee of Oranim Academic College.

Author Contributions

GL and RM wrote the paper. YZ, OM, SG, OM, SK-M, MA, and AK collected data and participated in the experimental design. RM, GL, and AO performed the statistical analyses.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

8. Leisman G. Brain networks, plasticity, and functional connectivities inform current directions in functional neurology and rehabilitation. Funct Neurol Rehab Ergon (2011) 2:315-56. [ Google Scholar]

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23. Falk D, Zollikofer CP, Morimoto N, Ponce de León MS. Metopic suture of Taung ([[ Australopithecus africanus) and its implications for hominin brain evolution. Proc Nat Acad Sci U S A (2012) 109:8467-70. 10.1073/pnas.1119752109 PubMed] [ PMC free article] [ CrossRef] Google Scholar]

25. Vercruyssen M, Simonton K. Effects of posture on mental performance: we think faster on our feet than on our seat. In: Lueder R, Noro K, editors. Hard Facts about Soft Machines: The Ergonomics of Seating. Bristol, PA: Taylor & Francis; (1994). p. 119-32. [ Google Scholar]

30. Voelcker-Rehage C, Niemann C, Hübner L, Godde B, Winneke AH. Benefits of physical activity and fitness for lifelong cognitive and motor development-brain and behavior. Sport Exer Psychol Res (2016) 18:43-73. 10.1016/B978-0-12-803634-1.00003-0 [[ CrossRef] Google Scholar]

Articles from Frontiers in Public Health are provided here courtesy of Frontiers Media SA

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The Effect of Movement on Cognitive Performance

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The study examines the relationship between walking, cognitive, and academic skills. Students from elementary, middle, high school, and college were required to walk for 10 min prior to completing feature detection, Simon-type memory, and mathematical ...

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Prevalence of Childhood Obesity in the United States

Childhood obesity is a serious problem in the United States, putting children and adolescents at risk for poor health. Obesity prevalence among children and adolescents is still too high.

For children and adolescents aged 2-19 years in 2017-2020 ¹:

The prevalence of obesity was 19.7% and affected about 14.7 million children and adolescents.

Obesity prevalence was 12.7% among 2- to 5-year-olds, 20.7% among 6- to 11-year-olds, and 22.2% among 12- to 19-year-olds. Childhood obesity is also more common among certain populations.

Obesity prevalence was 26.2% among Hispanic children, 24.8% among non-Hispanic Black children, 16.6% among non-Hispanic White children, and 9.0% among non-Hispanic Asian children.

Obesity-related conditions include high blood pressure, high cholesterol, type 2 diabetes, breathing problems such as asthma and sleep apnea, and joint problems.

¹Read CDC National Center for Health Statistics (NCHS) data brief

Note: Obesity is defined as a body mass index (BMI) at or above the 95th percentile of the CDC sex-specific BMI-for-age growth charts.

Obesity and Socioeconomic Status

[ Read the Morbidity and Mortality Weekly Report (MMWR)]

In 2011-2014, among children and adolescents aged 2-19 years, the prevalence of obesity decreased as the head of household's level of education increased.

Obesity prevalence was 18.9% among children and adolescents aged 2-19 years in the lowest income group, 19.9% among those in the middle-income group, and 10.9% among those in the highest income group.

Obesity prevalence was lower in the highest income group among non-Hispanic Asian boys and Hispanic boys.

Obesity prevalence was lower in the highest income group among non-Hispanic White girls, non-Hispanic Asian girls, and Hispanic girls. Obesity prevalence did not differ by income among non-Hispanic Black girls.

Women, Infant, Children (WIC) Data

Data and Statistics
Interactive database, surveillance systems, state reports, and maps related to obesity.

Connect with Nutrition, Physical Activity, and Obesity

Page last reviewed:

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Childhood obesity is a serious problem in the United States. Learn more...

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CDC - Adolescent Obesity Prevalence Trends Over Time (2003-2019)

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CDC - Adolescent Obesity Prevalence Trends Over Time (2003-2019)

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The Youth Risk Behavior Surveillance System (YRBSS) monitors six types of health risk behaviors as well as the prevalence of select health conditions and diseases, including obesity, among youths. As part of the YRBS survey, high school students report on their own behaviors as well as their height and weight, which are used to calculate Body Mass Index (BMI) percentile. These self-reported data are useful for tracking the proportion of high school students with obesity (BMI >95 th percentile) over time.

For a closer look at High School YRBS data about obesity prevalence, view the interactive source data tables. Users can filter data by state, race/ethnicity, sex, and grade level.

Click on the tabs to see maps from 2003-2019.

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Adolescent Obesity Prevalence: Trends Over Time (2003-2019)

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The Youth Risk Behavior Surveillance System (YRBSS) monitors six types of health risk behaviors as well as the prevalence of select health conditions and diseases, including obesity, among youths. As part of the YRBS survey, high school students report on their own behaviors as well as their height and weight, which are used to calculate Body Mass Index (BMI) percentile.

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Girls and Beauty Confidence - The Global Report

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Girls and Beauty Confidence - The Global Report

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Physical Activity and Cognition: Inseparable in the Classroom

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Physical Activity and Cognition: Inseparable in the Classroom

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Facultat d'Educació, Universitat de Barcelona, Barcelona, Spain

Traditional education has tended to compartmentalize abstract thought, emotion, and physical activity. However, neuroscientific evidence suggests that these are completely interlinked in the learning process. The traditional lecture-style lesson relegates students to a passive and sedentary role, precluding physical movement. In addition, the current trend of schools reducing recess hours, dropping physical education classes, or subjects that involve the whole body-theater, music, outdoor activity-further limits the scope for physical movement within the learning milieu. Neuroscientific evidence suggests that sedentarism impacts negatively on brain health, and not only physical well-being. Humans are designed to be on the move, to interact with their environment through movement: physical activity is a key contributing factor to healthy brain function. This mini review presents and analyzes evidence from diverse studies and meta-analyses showing the strong link between movement and cognition in primary and secondary school students. There is a growing body of neuroscientific evidence of the benefits that movement and physical activity have for cognition. In the research examined, the authors identify diverse types and degrees of physical activity and their impact on the brain. The neurological impact of movement on the brain can be understood at three levels: increased vascularization-oxygen and glucose to the brain-augmenting brain activity; the release of neurotransmitters and Brain Derived Neurotrophic Factor (BDNF) which favor neurogenesis, memory, attention and motivation; and the development of complex movement-related neural circuits and their interconnection with the executive brain functions. This article proposes a set of concrete applications for educators to bring movement into their classrooms and/or learning contexts, thus favoring cognition. Based on this evidence and given the current educational reality which generally approaches learning as an abstract activity divorced from our corporality, the authors argue for the need to incorporate physical activity and movement into the learning context.

Introduction

Neuroscientists, such as Immordino-Yang and Damasio, in their paper "We feel therefore we learn" ( Immordino-Yang and Damasio, 2007) allude to the need in education for a shift in paradigm from that of Descartes "I think therefore I am"-an aggrandization of rational, abstract thought-toward a paradigm that recognizes the social and emotional components of human cognition. In classrooms around the world there is a growing recognition of the need to incorporate socioemotional learning into pedagogical practice, based on a broader conception of the learner as a "whole person"-a social being with emotions. If classroom practice is beginning to recognize the place of emotion in learning, possibly the next challenge to educators is the recognition of the body as a key element in cognitive development and processing. Teaching and learning cannot focus purely on the brain, to the exclusion of the body. The traditional lecture-style lesson relegates students to a passive and sedentary role, precluding physical movement. The current trend of schools toward reducing time allocated for physical activity, prioritizing instead the focus on academic subjects that feature in standardized tests, exacerbates sedentarism in schoolchildren ( Chaddock-Heyman et al., 2018). A 2018 World Health Organization (WHO) report established that "in 2016 almost 340 million children and adolescents (aged 5-19 years) or almost one in every five (18.4%) were overweight or obese globally"-a more than 10-fold increase in the past 4 decades. Moreover, WHO statistics for 2010 revealed that 80% of school-going adolescents were insufficiently physically active. Evidently, this has major health implications, as well as an impact on cognition and academic achievement. Neuroscientific evidence suggests that sedentarism not only hinders learning, but that it flies in the face of how the human anatomy and brain have evolved: from the perspective of evolutionary neurobiology, authors, such as Bramble and Lieberman (2004); Lieberman (2010), and Raichlen and Polk (2013) propose that long distance running and walking molded the human anatomy and brain size. Vorkapic-Ferreira et al. posit that "The evolutionary hypothesis of endurance running states that movement played a crucial role in the emergence of typically human anatomical features, as well as in the shaping and structure of the human brain (...). Effectively, the human body, including the brain, has evolved to withstand extended periods of cardiovascular stress. Movement is so essential to the brain that regular physical activity is imperative for it to function properly. Studies have shown that aerobic exercise increases neuron proliferation, neurotrophic factors synthesis, gliogenesis, synaptogenesis, regulates neurotransmission and neuromodulation systems, and reduce systemic inflammation. All of these effects have a significant impact on improving mental health, reducing age-related gray matter decline, and improving cognitive functions" ( Vorkapic-Ferreira et al., 2017). We are designed to be on the move, we interact with our environment through movement: physical activity is the foundation of brain functioning, as asserted by Llinás (2001); Ratey and Hagerman (2008), and Wolpert (2011). Diamond observes that "The same or substantially overlapping brain systems are important for both cognitive and motor functions ( Diamond, 2000; Rosenbaum et al., 2001). The brain does not recognize the same sharp division between cognitive and motor function (or cognitive and emotional functioning, or social and emotional functioning, and so on) that we impose in our thinking" ( Diamond, 2010).

Neuroscience research over the past 10 years has produced significant evidence that movement and cognition are favorably linked ( Diamond, 2000; Cotman and Berchtold, 2002; Hillman et al., 2005, 2009a; Chaddock et al., 2010a; Castelli et al., 2014; Erickson et al., 2015; Mandolesi et al., 2018). Today, a growing body of studies points to the wide-ranging benefits of physical activity for cognition: neurophysiological and neurochemical changes improve brain function, alter brain structure, lead to greater well-being and improve learning. However, some studies produce mixed results-of a neutral, insignificant or negative relationship-and researchers urge the refining of research parameters and greater methodological rigor in order to identify contextual variable/s involved (age-range, intensity, duration or type of exercise, etc.) ( Marques et al., 2017). Overall, however, it would appear a relevant challenge for educators to explore how to implement this knowledge of a favorable association between physical activity and cognition, in order to improve the teaching-learning process.

Physical activity triggers the release of neurochemicals that favor learning and memory. These neurotransmitters include dopamine, associated with motivation, focus and learning; serotonin which enhances mood, norepinephrine which improves attention, perception and motivation ( Basso and Suzuki, 2017). Emotional well-being is vital for learning. When the amygdala in the "emotional brain" or limbic system detects emotional states, such as stress, fear or anger, it is overwhelmed by excessive levels of norepinephrine and dopamine, and "freezes" in an "amygdala hijack" ( Goleman, 2005; Willis, 2009), impeding the processing of new information in the hippocampus, i.e., learning is impeded ( Willis, 2009). The prefrontal cortex, where higher-order cognitive functions (the executive functions, EF) are concentrated, is also highly vulnerable to stress-related norepinephrine and cortisol release, which lead to prefrontal dysfunction ( Birnbaum et al., 1999; Liston et al., 2009). As Lavados (2012) and Mora (2017) observe: we learn what we love, positive emotion smooths the way for learning. Or, to paraphrase Amanda Céspedes-more effective learning requires more affective learning ( Céspedes, 2008). Negative emotional states in students effectively hamper learning-and the opposite is true: when teachers are aware of the affective state of their students, and work to cultivate a positive, safe socioemotional classroom environment, learning and memory are enhanced ( Diamond, 2010). Thus, when teachers incorporate physical activity into the learning process-with the subsequent release of the abovementioned neurotransmitters they are potentially fostering positive mood states, lowering stress and favoring learning and memory ( Willis, 2009; Lavados, 2012).

Furthermore, because movement activities usually include interaction and eye-contact, this stimulates the "social brain," causing the activation of mirror neurons which favor empathy; the release of feel-good endorphins; the social-bonding neurotransmitter oxytocin; and motivational neurotransmitters like dopamine ( Rilling et al., 2002; Willis, 2008). Diamond and Ling emphasize that our emotional, social and physical well-being impact heavily on cognition. They explain how EFs are the first to suffer if a subject feels stressed, sad, lonely, not in good physical health and lacks sleep ( Diamond and Ling, 2015). Physical exercise combats these damaging states, enabling higher-order cognitive functions ( Carmack et al., 1999; Williamson et al., 2001; Haslacher et al., 2015) and improves sleep ( Yang et al., 2012; Chen et al., 2015; Wachob and Lorenzi, 2015). Gould points out the 2-fold impact of physical exercise: it reduces stress along with the negative consequences stress has for brain function while it also favors neurogenesis and brain performance ( Gould, 2015). Given that students are habitually exposed to stress (the demands of tests, time limits, etc.), physical activity may be playing the role of stress-reducer that consequently improves the brain's capacity for cognitive processing ( Mora, 2017). Studies also point to the importance of movement activities being voluntary or joyful (the attitude of the student toward the activity matters): when exercise is collaborative, unthreatening and fun (vs. a boring obligation), brain-function is enhanced ( Diamond and Ling, 2015). Ratey and Hagerman present the case study of a high school which integrated motivational, fun, non-competitive physical education sessions into the school day. When the school took the international standards test, Trends in International Mathematics and Science Study (TIMSS) it came out in first place in science and sixth in math in the world-the US average is at eighteenth and nineteenth place ( Llinás, 2001). Nevertheless, although this data appears encouraging, it warrants mention that this was a school-wide change in policy on physical activity, not an experiment conducted by a research team. Hence, this evidence, though potentially positive, should be taken with caution, and rigorous follow-up studies would be warranted in order to narrow down variables involved and to clarify the interpretation of results.

The favorable impact of voluntary aerobic exercise on the size and function of the hippocampus (region associated with learning) in rodents has been much studied ( Van Praag et al., 2005; Vivar et al., 2013). Voluntary aerobic exercise is an excellent trigger of Brain Derived Neurotrophic Factor (BDNF) which stimulates the growth of new neurons (neurogenesis), new connections between neurons (synaptogenesis) and the protection of existing neural circuits in the hippocampus ( Voss et al., 2013; Jeon and Ha, 2015; Basso and Suzuki, 2017) (in older adults it counteracts hippocampal shrinkage Voss et al., 2013-a burgeoning research field, but beyond the scope of this mini review). It is remarkable that PA should cause these structural changes particularly in the part of the brain where learning occurs-and not in the sensorial or motor regions. Ratey explains that it makes evolutionary sense: "... the reason we need an ability to learn is to help us find and obtain and store food. We need fuel to learn, and we need learning to find a source of fuel ..." ( Ratey and Hagerman, 2008). As posited by Gómez-Pinilla et al., "these findings suggest that BDNF is part of a central mechanism through which physical activity integrates with elements of energy metabolism to impact aspects of hippocampal function. These findings support the evolutionary contention that learning ability is intimately related to energy balance, an attribute that may have developed to maximize motor operations that increased the chances of obtaining food and the probability of survival" ( Gómez-Pinilla et al., 2008). Physical activity is effectively "growing the brain" through BDNF release and increased hippocampal size.

A longitudinal study by López-Vicente (the first of this nature) followed 1,400 children from the age of 6 through to their teens. Their conclusions indicated that children with a lower level of physical activity at age 6 showed significantly poorer results in memory tests as adolescents than their fitter peers ( López-Vicente et al., 2017). This would appear to imply that greater levels of PA in developing years has long-term cognitive benefits. Research studies by Hillman et al. show how children with higher aerobic-fitness levels showed better neurocognitive function, evidenced in greater attention and working memory levels as well as brain response speed to cognitive tasks ( Hillman et al., 2005). Their research also showed that fitter children show better cognitive performance in tasks, demonstrating greater executive control and attentional resources ( Hillman et al., 2009a). Sibley and Etnier's metanalysis compiles evidence that PA improves perceptual skills, IQ, achievement, verbal tests, mathematic tests, among others ( Sibley and Etnier, 2003). In the abovementioned studies, as in others cited, is important to highlight that causality should not be assumed between the variables, such as fitness level and the different brain functions measured. These results point to a favorable relationship, but the nuances of that relationship, and the other variables involved warrants further exploration.

This said, the overall conclusions emerging from research on PA and cognition indicate a favorable association. Within the current context where schools promote sedentary habits ( Donnelly and Lambourne, 2011), the emerging evidence on the favorable interconnection between PA and cognition should encourage teachers to integrate PA into their lessons, and educational institutions to foster PA through curricular, infrastructural and cultural changes. Around the world different establishments are implementing change-from primary schools to Harvard University. Today, the Internet abounds with practical suggestions and programs, such as those used in many of the abovementioned research studies. By encouraging students to bike or walk to school, safeguarding recess-time and fostering active, fun recess and PE activities, and raising awareness among parents and teachers, schools can move toward a more wholesome and holistic learning experience, where the whole child (socioemotional, cognitive and physical) is engaged. Teachers can integrate movement-based activities at different moments of the day-when lethargy sets in after lunch, when concentration spans are waning, to break the ice, pique curiosity, build group trust, to diminish stress. Apart from the resources suggested in the bibliography, when teachers are convinced about not excluding corporality from cognitive processes, they become more attuned to the opportunities that arise for including PA to the benefit of learning. They can start lessons with a stretching activity, organize group work so students need to move, to different stations in the classroom, do rotating poster-work on different walls, organize team activities that involve running up to write/stick the answer on the board, throwing a ball or other object to each other while recalling information, Simon Says, mime, drama, short choreographies, etc. Children (and adults) need to move, and when teachers recognize and honor that need in the classroom, learners become better positioned to enjoy and succeed at learning.

Conclusion

In conclusion, this mini review has attempted to provide a limited overview of a growing body of research supporting the interconnectedness of PA and cognition. Though much research points to a positive association between PA, fitness and cognition, a critical and cautious approach is required, as discussed above. As John Bruer cautioned in 1997, "Brain and education: A Bridge too Far" ( Bruer, 1997), educators need to be wary of making sweeping generalizations based on initial research findings or superficial information. Today, educators are witnessing and participating in an important shift in paradigm toward one which conceives of the indivisibility of the social, the emotional and the physical in cognitive processing. This holistic conception of the human being is not novel-the Greeks had a clear idea of the interconnectedness of brain, emotion and body. Current neuroscience research appears to affirm the ideas of major educational thinkers like Vygotsky, Piaget, Freire, Montessori. Their intuition that learning is a social, emotional, interactive, meaningful, physical, co-constructive process is being validated today by neuroscience research. This mini review has examined some key contributions of neuroscience research on the inter-connectedness of PA and cognition, with a view to supporting practical classroom application by educators.

Author Contributions

AD designed and researched the article and wrote the manuscript. AF reviewed the final document.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

References

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Physical Activity and Cognition: Inseparable in the Classroom

# data[].attributes.attachment_link.description
Traditional education has tended to compartmentalize abstract thought, emotion, and physical activity. However, neuroscientific evidence suggests that these are completely interlinked in the learning process. The traditional lecture-style lesson relegates students to a passive and sedentary role, precluding physical movement.

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2017 Dove Global Girls Beauty and Confidence Report

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2017 Dove Global Girls Beauty and Confidence Report

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Impact of Physical Exercise on Symptoms of Depression and Anxiety in Pre-adolescents

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Impact of Physical Exercise on Symptoms of Depression and Anxiety in Pre-adolescents

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Front Psychol. 2019; 10: 1820.

Abstract

Aim

The intensity of the most appropriate exercise to use in depressed youth is unclear due to differences in methodology and the lack of evidence documenting the effect of physical activity in children. Therefore, the authors of this study attempted to document the effectiveness of different training intensities to reduce symptoms of depression and anxiety in pre-teens.

Methods

The study included twenty-seven, randomly selected pre-adolescents (aged between 9-11 years of age) all of whom had Primary education. The participants were enrolled and, over a 5-week period, were subject to either intensive or low-to-moderate exercise programs four times a week. Psychological self-reports, as well as physical examinations, were conducted before and after such programs in blinded assessments. Psychological effects were considered the primary outcome, whilst physical condition was secondary.

Results

Four subjects were lost and twenty-three were analyzed. General linear model with 2 criteria revealed significant changes ( p = 0.05) in trait anxiety symptoms over time in the low-to-moderate intensity group (LMIG). Within group changes followed a significant decrease in levels of anxiety (38.82 ± 2.20 to 33.36 ± 2.83, p = 0.004) and depression (10.36 ± 2.83 to 6.73 ± 1.88, p = 0.006) related symptoms amongst those in the LMIG.

Interpretation

This study indicated that depression and anxiety symptoms were reduced amongst a non-clinical sample of Primary educated pre-adolescents when they were subject to a low-to-moderate exercise program. The program focused on associating movement with pleasure, encouraged positive and non-competitive interactions between participants.

Keywords: exercise medicine, depression, anxiety, youth, students, move and feel good clinical trial

Introduction

Although often clinically undiagnosed, symptoms of depression and anxiety can be seen in pre-adolescent children aged 9 to 12. These signs often go unrecognized, despite their prevalence: 8-9% of children and adolescents show depressive symptoms ( Mehler-Wex and Kolch, 2008) and levels of anxiety disorders range from 2.5-30% due to the heterogeneity of diagnostic methods ( Salum et al., 2013). Detecting these symptoms at an early stage is important in the treatment of present and future mental-health issues; children and pre-adolescents with early signs of depression are more likely to have severe depression later in life ( Korczak et al., 2017b). Nonetheless, the optimal treatment for those symptoms in this age bracket should focus on non-pharmaceutical options, as anti-depressant medication is shown to increase the risk of suicidal thoughts amongst children ( Hammad et al., 2006).

There are many cohort studies or Randomized Controlled Trials (RCT) indicating that physical activity (PA) or adapted physical exercise programs are associated with decreased depressive symptoms in adulthood. There is also evidence that indicates that physical exercise reduces levels of depression in adolescents and pre-adolescents. However, additional studies with higher methodological quality are needed to corroborate these findings ( Carter et al., 2016; Korczak et al., 2017a; Radovic et al., 2017).

An important question is "what is the most appropriate exercise intensity in children and adolescents?" The few studies in this issue have yielded contradictory results. The first study showed no therapeutic difference as per the intensity of the exercise for children and young people up to the age of 20 ( Larun et al., 2006). A program of varying intensity, based on individual preferences, reduced symptoms of depression in a sample of 87 adolescents ( Carter et al., 2015). According to a meta-analysis, a low or moderate intensity exercise program (three times a week for 6 to 12 weeks) is most effective in reducing depression scores in this age group ( Carter et al., 2016). Another systematic review found that more frequent and intense sessions were associated with fewer depressive symptoms ( Korczak et al., 2017a). The limited amount of meta-analyses available incurs a high level of inter-study heterogeneity, in terms of intervention methods and outcome measures. This is especially apparent in children and adolescents in non-clinical settings ( Larun et al., 2006; Carter et al., 2016). To date, there is no evidence that indicates PA or adapted exercise programs have a negative effect on psychological status.

Researchers have attempted to evaluate the link between fit physical condition and depression. One meta-analysis clearly indicated that there is a negative correlation between fit behavior in young people and depressive behavior ( Korczak et al., 2017a). A previous cohort found a possible buffering effect of vigorous exercise on the relationship between stressful life events and depression in a sample of adolescents (12-15 years), whereby a low level of PA and high levels of sedentary lifestyle predicted a high score of depressive symptoms ( Sund et al., 2011). In addition, a RCT with a high methodological quality [confirmed 6/10 score according to the Physiotherapist Evidence Database (PEDro scale)] showed that adolescents meeting the DSM-IV MDD criteria reduced their score of depression from 6 weeks of intervention (3 sessions per week) with vigorous intensity [>12 Kilocalories/Kilogram/Week (KKW)] compared to low intensity (<4 KKW) exercise ( Hughes et al., 2013). Another point of view is that these behaviors seemed to be closely linked with the cognitive functions. At present, they found some evidence that hippocampal volume could be bigger in more fit compared to less fit pre-adolescents. A bigger hippocampal volume would be related to better memory tasks ( Chaddock et al., 2010). Then cognitive function scored lower in children and adolescents with depressive disorder ( Wagner et al., 2015). The cingulate cortex and prefrontal areas seem to exhibit altered functioning in depressive patients and this appeared to explain the poor performance in cognitive processes ( Belzung et al., 2015). Eventually, considering that better cardiovasuclar fitness may enable improving the cognitive function and seems to protect from depressive symptoms and we provide a short time period of intervention (5 weeks), we could support the notion that a high-intensity program may be effective in reducing depressive symptoms in children. In fact, the purpose of this intensity would be to improve the participants' physical condition by giving a protect effect on the mental health compared to a lower intensity that could change the physical condition to a lesser extent in a 5 weeks duration of experiment.

The main objective of this study was to investigate the impact of structured PA on the prevention of depressive and anxiety symptoms in a non-clinical sample of schoolchildren. A low- to moderate-intensity PA was compared to a high-intensity PA. We also sought to evaluate whether such physical activities, implemented in the form of games, could affect the above-mentioned symptoms. We hypothesized that high-intensity PA would lead to greater psychological improvement than low- to moderate-intensity activity, assuming that physical condition was closely linked to individual psychology.

Anxiety and depressive symptoms have common risk factors, indicating that a similar prevention for both disorders may be useful in many cases. Therefore, we studied the common effect of PA on these symptoms ( Belhadj Kouider and Petermann, 2015).

Methods

Participants

Participants were recruited from a primary school on a voluntary basis and the study was presented in classrooms. The inclusion criteria were as follows: (1) Be involved in an official education program; (2) aged between 9 and 12 years; (3) acceptance of the randomization principle; (4) absence of neurological or psychiatric history; (5) absence of uncorrected sensory disorder preventing the understanding of instructions; and (6) absence of conduct disorders. The exclusion criteria were as follows: (1) refusal to participate; (2) Body Mass Index above P95; (3) unstable diabetes; (4) coagulation disorders (apart from specific exceptions and medical authorization); (5) severe and unstable asthma; (6) history of heart malformation or cardiovascular disease; and (7) medical conditions prohibiting sport or PA. All parents completed a medical questionnaire before starting the research. Accordingly, only the children who met the inclusion and exclusion criteria were included. The others (who were treated by medications or therapy) were kindly excluded.

The study was undertaken at the "elementary school Parmentier - Jean XXIII" in Brussels and its facilities (a classroom, gymnasium, and park). Participants were informed that they would not be allowed to choose the group to which they would be assigned and could leave the study at any time if they wished. Their parents provided their written informed consent before the start of the experiment. The ethical Committee of the School of Medicine of the Université catholique de Louvain approved the study.

Design

We conducted a low- to moderate-intensity intervention and a high-intensity intervention in parallel, focusing on pleasure, interaction and non-competition. Each intervention took place for 5 weeks at a rate of four sessions per week (Monday, Tuesday, Thursday, and Friday) during the lunch hour. Thus, the study followed children from two groups for a total of 20 sessions that lasted 50 min. There was an assessment period in the week before and the week after the program, where tests of the participants were gathered. Quantifiers for the randomization included individual scores for the CDI, BMI, duration of the Léger shuttle test, age, sex, and school year. Thereafter, the principal investigator assorted the participants into two equivalent groups. Randomization at the group level was done by an external blind researcher who provided the intervention allowance by e-mail. Eventually the participants who met the inclusion criteria were assigned randomly to either the HIG ( n = 14) or the LMIG ( n = 13) based on the pre-evaluation. During the intervention sessions, therapists and participants were not aware of individual scores used for randomization. The two pairs of therapists (two physical educators and two physiotherapists) managed the same number of sessions in each group alternately. The principal investigator provided medical security as well as the components of each program.

The Metabolic Equivalent of Task (MET) was used to define the intensity of interventions ( Ainsworth et al., 2000). The World Health Organization (WHO) saw that an activity included between 1.6 and 3 MET was low intensity, 3 and 6 MET was moderate intensity and more than 6 MET was high intensity.

An HIG intervention session combined jogging and interactive games [Children Games (5 MET), teach physical education (6.5 MET), run at 5 to 7 miles per hour (mph) (8 at 11.5 MET)], which included muscle building (6 MET). Each session began with a warm-up and ended with muscle stretching. This program aimed to improve Leger's VO2max score, muscle building, and overall physical fitness. For instance, sessions included a treasure hunt across a large perimeter jog/walk combination (6-6.5 MET), wheelbarrow racing, spider walking and reinforcement exercises through gym weights. For each participant, 75 to 80% of the theoretical maximum heart rate for their age was recommended with verification of their heart rate during the sessions.

Each LMIG intervention combined games that highlighted the sensation of (gentle and slow) movements (proprioception) with seated play [sitting with children plays (2.8 MET)], postural control [stretching, yoga (2.5 MET)] and interactive games [walking children's games (MET 5), walk/run -playing with children, with moderate period (MET 4)]. Each session started with a warm-up and aimed not to focus on performance or exertion to the point of breathlessness. The sessions included, for example, a slow relay race with variations of movement, interactive games in teams (walking or running slowly whilst perpetuating equilibration), a treasure hunt in a small area, mime games, riddles and optical illusions.

In both interventions, the experimenters recorded the duration of all exercises and the participants' feelings and heart rates. Positive remarks were regularly written in an individual file to motivate each participant. The exercises were explained, customized and set up by the therapists. Every effort has been made to create a non-competitive atmosphere (mockery was forbidden). At the end of each session, a similar gift was provided to each participant (juice and a pack of candies or gum). At the end of each week, an extra gift was given (a small toy, a game, stickers, etc.) to reward efforts and increase motivation.

Primary Outcomes

The CDI is a 27-item self-report instrument ( Kovacs and Beck, 1979) that provides a score based on the child's statement describing how she or he felt during the two previous weeks. The average score in the general population is 9 points ( Kovacs and Beck, 1979), and a score of 19 or more is considered pathological ( Smucker et al., 1986). The CDI showed good internal reliability (Cronbach's alpha = 0.86), sensitivity, specificity and a low level of bias ( Stockings et al., 2015). The pooled estimate for internal reliability is considered as high. This scale is mainly used in research to assess mood and depression (ICD-10-CM F32.9) in a longitudinal follow-up.

The STAI ( Spielberg et al., 1983) consists of two subscales with twenty items, the STAI, form Y-A, which assesses the recent state (i.e., what the participants felt during the week of testing), and the STAI, form Y-B, which assesses the long-term anxiety trait (i.e., what the participants felt during the past year). Each part (A or B) of the STAI provides a state score or an anxiety trait score ranging from 20 to 80. The pathological threshold is 39-40 ( Knight et al., 1983). This test has a high degree of reliability (Cronbach's alpha = 0.86) and validity. This is widely used to detect anxiety (ICD-10-CM F41.9).

In this study, the abbreviated BDI-13 ( Beck et al., 1988), the Hospital Anxiety and Depression Scale (HADS) ( Zigmond and Snaith, 1983), the Zung Self-Rating Depression Scale (SDS) ( Zung, 1965), and the Self Perception profile for Children ( Bouffard et al., 2002) were also used to determine their relevance and reliability in testing pre-adolescents.

The Beck Depression Inventory (BDI) ( Beck et al., 1988) consists of 13 questions with multiple-choice answers evaluating depression severity. A Likert scale from 0 to 3 is assigned for each answer and the item scores are summed to give a total score ranging from 0 to 39. The higher the score is, the higher the severity of depression is. The BDI has a high internal consistency (alpha coefficients = 0.86 for non-clinical population).

The HADS is a reliable questionnaire ( Zigmond and Snaith, 1983) that allows detecting anxiety and depressive disorders. It has 14 items rated from 0 to 3. There are 7 questions related to anxiety (subscale A) and 7 others to the depressive dimension (subscale D) providing 2 scores. Maximal scores for anxiety and for depression range from 0 to 21. A score of 0 to 7 for either subscale indicates an absence of symptoms while a score of 11 or more is probably pathological. The internal reliability is correct (Cronbach's alpha = 0.79 to 0.86).

The Zung Self-Rating Depression Scale questionnaire ( Zung, 1965) is used to assess depression severity. There are 20 items in the scale. Each question is scored on a Likert scale ranging from 1 (rarely) to 4 (nearly always). The sum of item scores is multiplied by 1.25 and divided by 100 to provide the depression score in percentage. Most people with depression have a score between 0.50 and 0.69 while a score of 0.70 and above indicates severe depression. According to the World Health Organization, the SDS score may give an indicative range for the severity of depression but is not sufficient to confirm the pathology. The internal consistency is correct (Cronbach's alpha = 0.79).

To assess self-esteem, the Self Perception profile for Children ( Harter, 1985) has been used in its French version, the "Questionnaire de perception de soi pour jeunes, QPSJ." There are six categories including six questions, for a total of 36 questions. Each category refers to a competence (social, athletic, scholastic, physical, behavioral, and global self-worth). The internal consistency is acceptable to good (Cronbach's alphas of the six categories are ranged 0.71 to 0.86).

Secondary Outcomes

A body composition mass monitor (OMRON BF 511 ®), used in humans aged 6 to 80 years, was used to measure body mass, body fat, muscle percentage and skeletal muscle percentage. A medical device was also used to measure height.

The Leger shuttle test is a 20-meter multi-steps shuttle run test, providing an extrapolated assessment of maximal oxygen uptake (VO2max) ( Leger et al., 1988). A meta-analysis showed that " the 20 m shuttle test seems to be a useful alternative to estimate cardiorespiratory fitness" and this test has a high validity in young people ( Mayorga-Vega et al., 2015). We used POLAR FT2 ® heart-rate monitors with a transmitter belt at the sternum level to record maximum heart rate, average heart rate, and session time.

Pre-assessment and post-assessment tests took place, respectively, the week before and the week after the intervention.

Statistical Analysis

A sample size was defined from a previous study, whereby CDI II was used to measure variance in depression among adolescents receiving physical exercise as treatment (10). Accordingly, with a detected change of −9, a detected change in SD of 10.2, a desired power of 0.8 and a p = 0.05, 12 children per group were needed to obtain significant results.

Since some measures were based on Likert scores, a graphical tool (quantile-quantile plot) and a Kolmogorov Smirnov test were used to assess the distribution of normality. If the data were not normal, a logarithmic transformation was performed to obtain normal data (if it were possible). The General Linear Model (GLM), with two criteria, or the Mann-Whitney test was performed to determine the difference between the two groups and two tests sessions. Due to a prior assumption of greater changes in depression/anxiety scores for HIG, two dependent tests ( t-test or Wilcoxon test) were used to determine the change in a variable (STAI, CDI, etc.) over time in each experimental group (HIG or LMIG). The effect size based on the partial eta squared (η ²) was performed to calculate the number of participants required for future research. A Pearson correlation test was used to evaluate the potential correlation between the variables in the two groups. All statistical procedures were performed using the SPSS software. The data were anonymized for the statistical analysis so that the two groups could not be identified.

Results

Participation Analysis

Among the recruited 27 pre-adolescents in pre-test, four participants, two in each group, were lost during the experimentation. The statistical analysis of pre- and post-test measures was restricted to the remaining 23 participants who were involved in the whole study (see Figure 1 for details). The mean age at assessment was 10.7 ± 0.7 with 6 girls and 6 boys in HIG and 10.6 ± 0.7 with 5 girls and 6 boys in LMIG ( p = 0.690, Student t-test).

The mean attendance rate was 93.11% in HIG and 96.65% in LMIG ( p = 0.290, Mann-Whitney test). The mean individual "tiredness score" (0-3, 0 = not tired at all; 1 = a little bit tired; 2 = moderately tired; 3 = exhaustively tired), averaged for all sessions, was slightly higher in HIG than LMIG (0.64 versus 0.43) without significant difference between groups ( p = 0.600, Mann-Whitney test). The participants enjoyed the interventions, as reported in a mean "fun index" (0-3, 0 = very fun; 1 = quite fun; 2 = moderately boring; 3 = very boring), averaged for all sessions, which revealed no difference between groups (0.45 in HIG and 0.52 in LMIG, p = 0.710, Mann-Whitney test).

A HIG intervention session lasted an average of 43 min, combining 15 min of jogging and interactive games, 15 min of muscle building and 8 min of warm-up and stretching. Each LMIG intervention lasted also an average of 43 min, combining 16 min of seated play, postural control and very gentle movements, 23 min of games exerting the sensation of movement (proprioception), with gentle and slow movements, and a warm-up (2 min).

Primary Outcome

Self-reported data from primary questionnaires are summarized in Table 1 . The Likert score variables, with a non-normal distribution, were the CDI and the BDI-13. However, a transformation was made on the CDI and BDI scores with this formula "Ln(variable)" to obtain a normal distribution. Only CDI score variables became normal after this procedure.

TABLE 1

High intensity group Low-to-moderate intensity group

Self-reports Time Mean (SEM) p-value (T2-T1)° Mean (SEM) P-value (T2-T1)° Group × time effect* Group effect* Time effect*

STAI B

T1

36.58 (2.75)

0.911

38.82 (2.20)
0.004 0.050
0.912
0.030

CDI

T1

11.00 (2.75)

0.447

10.36 (2.83)
0.006
0.250

0.480
0.007

It should be noted that, although participants were randomly assigned, STAI-B scores at baseline (T1) were slightly higher in LMIG than in HIG. However, the group difference was not significant ( p = 0.52, unpaired t-test). A GLM performed on the STAI-B scores revealed a significant group × time interaction ( p = 0.050) and a time effect ( p = 0.030). With respect to the LMIG, we found that this program induced lower anxiety symptoms over time with a significant and reproducible effect in small samples [ F(1,21) = 4.17, p = 0.050, η ² = 0.17]. The eta-squared (η ²) measure from independent t-test ranges between 0 and 1. Following the Cohen guidelines ( Cohen, 1988) for the eta-squared (small effect = 0.01, moderate effect = 0.06, and large effect = 0.14), the outcome of η ² = 0.17 showed a large effect size.

It was only in the LMIG that the STAI B scores, on average, decreased from 38.82 (SEM (Standard Error of Mean) 2.20) at T1 to 33.36 (SEM 2.83) at T2 ( p = 0.004, Student paired t-test, see Figure 2 and Table 1 ). On average, the scores remained stable in HIG, evolving from 36.58 (SEM 2.75) to 36.33 (SEM 2.30).

Moreover, analysis of data from the children with "pathological" scores (39 and higher), with a GLM performed on their STAI-B scores, revealed no group × time interaction effect ( p = 0.270). Among children with "pathological" scores, only those who attended LMIG sessions improved their STAI-B scores at post-test [36.17 ± (SEM 1.65)] relative to the pre-test [44.00 ± (SEM 2.89)] ( p = 0.019, Student paired t-test).

The analysis of STAI-A scores did not reveal any group difference nor time-dependent changes (all p-Values > 0.05, see Table 1 ).

A GLM performed on the CDI scores did not reveal a group × time interaction ( p-Value = 0.25) but a time effect ( p-Value = 0.007). Concerning the LMIG, we observed that this program induced a moderate size effect, resulting from the eta squared, to lower depressive symptoms, although the results did not reach the level of significance [ F(1,21) = 1.60, p = 0.25, η ² = 0.071]. It was only in the LMIG that a significant improvement in CDI scores was observed; the CDI scores decreased, on average, from 10.36 (SEM 2.83) at T1 to 6.73 (SEM 1.88) at T2 ( p = 0.006, Student's paired t-test, see Figure 3 and Table 1 ). The average scores remained stable in HIG, evolving from 11.00 (SEM 2.75) to 10.08 (SEM 2.98) ( p > 0.05, Student t-test).

The GLM analysis of pathological CDI scores (19 and higher) was not considered since only four patients (2 in each group) had pathological scores.

The STAI A, the abbreviated BDI-13, the HADS, the SDS and the Self Perception profile for Children did not reveal any group difference for depression or for anxiety (all p-Value > 0.05).

Secondary Outcome

These data are summarized in Table 2 . The Likert score variables, with a non-normal distribution, were the BMI and the body fat. A transformation was made on these two variables scores with the formula "Ln(variable)" to obtain a normal distribution. However, the two variable scores remained non-normal after the procedure.

TABLE 2

High intensity group Low-to-moderate intensity group

Physical measures Time Mean (SEM) p-value (T2-T1)° Mean (SEM) P-value (T2-T1)° Group × time effect* Group effect* Time effect*

Size (cm)

T1

143.88 (2.63)
0.010
139.72 (3.05)
0.001
0.36

0.30
0.00

Body mass (kg)

T1

37.19 (3.26)
0.003
34.28 (1.74)
0.004
0.54

0.43
0.00

Body mass index (Kg/m ²)

T1

17.68 (0.95)
0.040
17.49 (0.54)

0.075

0.97
/ /

Body fat (% of body mass)

T1

17.69 (2.11)
0.003
19.1 (1.74)
0.033
0.47
/ /

Muscular mass (% of body mass)

T1

33.5 (0.79)

0.464

33.43 (1.13)
0.033
0.25

0.75
0.03

Resting metabolic rate (cal)

T1

1238 (46.15)

0.069

1213.45 (32.22)

0.387

0.44

0.63
0.05

VO2peak (ml/min/kg)

T1

42.21 (1.53)
0.014
42.45 (1.77)

0.740

0.174

0.60

0.06

When a GLM was used to analyze physical measures, it did not reveal a group × time interaction ( p > 0.05). The children's weight and size increased similarly in each group at the end of the 5-week program. There was no difference between groups regarding weight, height, body mass index, muscle or body fat percentages, nor at T1, nor at T2 (all p-Values > 0.05).

A GLM performed on the VO2max estimations, as evaluated using the Léger shuttle test, did not reveal any group × time interaction ( p = 0.174). Although there was a trend for improvement in both groups (time effect: p = 0.060), it was only in HIG that a significant improvement of VO2max estimation was observed at T2 [44.88 (SEM 1.46) ml/min/kg] relative to T1 [42.21 (SEM 1.53) ml/min/kg] ( p = 0.014, paired t-test, see Figure 4 ). The scores remained generally stable in LMIG, evolving from 42.45 (SEM 1.34) ml/min/kg at T1 to 42.89 ± (SEM 1.77) ml/min/kg at T2.

Additional Pearson correlation analyses were performed to test the relationship between the changes in CDI/STAI-B/Léger shuttle test over time (T2-T1). Only the variables that showed a significant time-related change in paired t-tests were analyzed according to the Pearson correlation. The pre-test scores were, first, subtracted from the post-test scores for each variable (CDI, STAI-B, and VO2max) and the obtained indexes of time-related change were further correlated with each other. This analysis did not reveal any correlation between variables.

Discussion

This study sought to compare high-intensity and low- to moderate-intensity physical exercise programs, as per their impact on self-reported depression and/or anxiety scores among a non-clinical sample of 5th-6th grade pupils. The results of the participants from both groups were examined separately, and we found that CDI (self-report scale for depression) and STAI-B (self-report scale for trait anxiety) scores significantly improved, over time, in the LMIG. The HIG did not show this improvement, but there was an upward trend in improving the VO2max indices compared to the LMIG group.

Main Results

Trials investigating the influence of PA on anxiety/depression symptoms in children and adolescents are few. They have yielded different results in terms of duration and intensity despite usually indicating that PA should have a beneficial effect on depressive symptoms ( Korczak et al., 2017a). For instance, a study involving 43 adolescents with depression, where the intervention was a 6-week circuit-training made of 12 separate sessions done twice weekly at preferred intensity ( Carter et al., 2015), saw significant beneficial effects on CDI 2 version scores. However, these improvements were only statistically significant at a 6 month follow up post-intervention and were not apparent immediately after its duration. When the sample size was measured from this previous study alongside the significant follow-up results, 12 children could be said to have markedly reduced levels of depressive symptoms because of the exercise therapy. The follow-up results were used to obtain the necessary sample size for our post-intervention because our program contained more sessions (20 sessions). Without lost participants, we would have been able to perform a significant change. Eventually, we performed a 5-week program, which is a short time period in comparison with another randomized clinical trial ( Hughes et al., 2013). An intervention of 6 to 12 weeks was used and effective in alleviating depression in adolescents aged 12 to 18. Although we intended to do 50-min sessions, the average duration was 43 min approximately in each group. However, this duration was sufficient in demonstrating effective change, and average attendance was very good (92.21%) in both groups. A precise monitoring of the interventions, with continuous supervision on site, ensured that participants correctly performed the requested exercises with little deviation.

Thus, twenty sessions in 5 weeks seems adapted to decrease depression symptoms at post-intervention. According to a systematic review based on a meta-analysis mixing children and adolescents ( Brown et al., 2013), PA could have a significant but small effect in the prevention and treatment of depression. A recent study in a large community-based sample of participants indicated that PA, objectively measured as moderate to vigorous, at 6 and 8 years of age lowered the average level of depressive symptoms 2 years later ( Zahl et al., 2017). Our observations indicate that a high-intensity exercise intervention would not be the optimum to improve anxiety and depression symptoms in pre-adolescents, despite a better increase of physical condition. Even with positive coaching, high-intensity training can be restricting for some participants who feel unable to achieve their goals due to poor physical condition caused by a lack of prior exercise. In independent t-test in STAI-B, the eta squared value (η ² = 0.17) demonstrated a large effect size and can thus suggest that the children in our study benefited from the low-to-moderate program to reduce their anxiety symptoms compared to the high intensity program. Accordingly, combining low- to moderate-intensity exercise with interaction and play should better reduce the anxiety/depression symptoms. Additional studies are clearly needed to test this hypothesis in adolescents with a medical diagnosis of depression and/or anxiety.

Limitations

A first limitation concerns our population who was highly heterogeneous with regards to depression/anxiety symptoms; it was not a clinical population, which also explains why somevariables did not have a normal distribution. The self-rated questionnaires used in this study are regarded as highly validand reliable ( Stockings et al., 2015), although CDI and STAI cannot be considered substitutes for a medical diagnosis made by a psychiatrist ( Rush et al., 2006). Thus, the results may not be inferred to patients since participants, even those who had scores above the cut-offs at pre-test, were not submitted to a neuropsychiatric interview. Secondly, with a small sample size (23 participants in the both groups), caution must be applied, as the findings for a reduction of anxiety in LMIG might not be for the reduction of anxiety score. Furthermore, the small sample size might be a contributing factor to the non-significance group × time effect in independent t-test for depression symptoms. It is therefore likely that more participants should be included in studies to evaluate the efficiency of the low-to-moderate intensity among pre-adolescents to reduce the psychological symptoms. Another potential problem is that we cannot exclude the possibility that participants of each group knew what their peers in the other group were doing. We attempted every effort to avoid mutual influence; the different questionnaires were used in random order to minimize outside influence. Then the inferred results were obtained from tests performed twice, once before and once after the 5-week period. This gives us a limited scope of data and knowledge, especially concerning any long-term effects of the intervention; a 6-month follow up examination would be required to rectify this problem but could not be achieved due to practicalities. In addition, when we tried to correlate changes in physical condition with changes in depression/anxiety scores there was no significant correlation, although poor physical condition may promote increased scores of depression due to the prevention effect of PA described in the literature ( Hughes et al., 2013; Korczak et al., 2017a). It should be noted, however, that any correlation should not allow disentangling between the two hypotheses in terms of cause and effect (lack of PA favoring depression, depression favoring lack of PA).

Ethics Statement

The ethical committee of the School of Medicine of the Université catholique de Louvain approved this study (No. CEHF-FORM-003/REV005-B403201627586).

Author Contributions

AP contributed to the study design, was involved in the two arms of the trial, made the statistical analysis of data, and wrote the first draft of the manuscript. AM, LD, and GS were involved in the two arms of the trial and contributed to the statistical analysis. YB contributed to the study design and manuscript draft. ADV made the study design, verified the exercise and control arms, made all scoring, provided results on an anonymous basis, and wrote the manuscript. All authors had access to the study data that support the publication.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank Mr. Olivier Parmentier for his sponsorship and support to our project by graciously providing the summer equipment of Park Parmentier, Mr. Olivier Huaux, director of the "Section Fondamentale Parmentier du Collège Jean XXIII" in Brussels, Belgium and his staff for the great welcome, Prof. Annie Robert and SMCS from the UCL for statistic supervision, Prof. Vincent Dubois for the financial support, Ms. Kate Lambrechts for the help with informatics, and the members of the MSL-In lab for advice and support. We would also like to thank the participants and their families.

Abbreviations

CDI

Child Depression Inventory

HIG

high intensity group

LMIG

low-to-moderate intensity group

STAI

State-Trait Anxiety inventory.

Footnotes

Funding. AP was funded by the Funds Baillet Latour in partnership with the Prof. Vincent Dubois. ADV is a Senior Research Associate at the Belgian National Fund for Scientific Research and was supported by the FNRS grant # J.0205.17 (Belgium).

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Articles from Frontiers in Psychology are provided here courtesy of Frontiers Media SA

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Impact of Physical Exercise on Symptoms of Depression and Anxiety in Pre-adolescents: A Pilot Randomized Trial

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The intensity of the most appropriate exercise to use in depressed youth is unclear due to differences in methodology and the lack of evidence documenting the effect of physical activity in children. Therefore, the authors of this study attempted to document ...

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Get Moving: The Benefits of Exercise for Teen Mental Health 

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Get Moving: The Benefits of Exercise for Teen Mental Health 

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One of the best things that parents can do for their kids is help them build an exercise habit. That might mean dance, yoga, hiking or high school athletics. It should be something they really enjoy, so they're inspired to keep doing it.

Why is exercise so essential for teens? Because physical activity has significant benefits for teen mental health, according to a large body of research. In fact, exercise can even be as effective as antidepressants. And, on the flip side, physical inactivity is associated with the development of psychological disorders.
Studies show that exercise has the following benefits for teen mental health:

Positively impacts levels of serotonin, a chemical that helps regulate mental health.

Releases endorphins, the body's natural "happy chemicals."

Lowers levels of the stress hormone cortisol .

Stimulates the neurotransmitter norepinephrine, which improves mood.

Increases self-esteem and body positivity.

Helps teens sleep better.

Evidence shows that teen athletics are particularly supportive, on a number of levels.

According to a Canadian study published in the Journal of Adolescent Health, students who play team sports in grades eight through 12 have less stress and depression as young adults. Teens who play sports also gain confidence, critical-thinking and judgment skills, as well as increased cognitive function.

However, just about any type of physical exercise is beneficial. In a small study of a dozen young adults at the University of Newcastle in Australia, participants with major depressive disorder exercised regularly; after 12 weeks of exercise, 10 of the participants were no longer categorized as depressed. Regular exercise has also been shown to decrease symptoms of anxiety.

And the effects are long-lasting: In one study, researchers found that people who got regular vigorous exercise were 25 percent less likely to develop depression or an anxiety disorder over the next five years.

According to James S. Gordon, author of"Unstuck: Your Guide to the Seven-Stage Journey Out of Depression,""Physical exercise has direct effects on the biology and psychology of depression. ... Exercising, we discover that feelings of helplessness and hopelessness begin to fade."
Another important benefit for teens: Exercise prevents substance use disorder.
As well as keeping anxiety and depression at bay, physical activity helps fight addiction. Research on lab rats and mice shows that regular exercise reduces the inclination to use drugs and alcohol. In essence, physical activity provides a healthy alternative reward for the brain, catalyzing a powerful surge of dopamine. And finding healthy ways to increase dopamine is key to successful recovery, especially in the early stages.

Additionally, exercise combats addiction because it addresses two of the major motivators for substance and alcohol abuse: depression and anxiety. According to the National Institute on Drug Abuse, teens who have substance use disorder are roughly twice as likely to have mood and anxiety disorders compared with the general population, and those with mood and anxiety disorders are more likely to use drugs. State of mind is intimately linked with substance use.
However, there are risks associated with teen sports.
When teen athletes feel pressured to overachieve in sports, they sometimes turn to performance-enhancing drugs. In the federal government's annual Monitoring the Future study, researchers examined the use of performance-enhancing substances among 67,000 high school students. Overall, close to 7 percent of students reported trying anabolic steroids at least once - an increase from 2012, when it was 5 percent.

In addition, doctors often prescribe medication for sports injuries, which can lead to addiction, causing serious health problems and even death. Therefore, coaches, doctors and parents need to monitor teen athletes closely, and be vigilant about avoiding addictive methods of pain relief for injured teens.
Researchers say that how often we exercise is more important for mental health than how vigorously we exercise.
"Data regarding the positive mood effects of exercise involvement, independent of fitness gains, suggest that the focus should be on frequency of exercise rather than duration or intensity," say Lynette Craft and Frank Perna, authors of a review of research on the benefits of exercise for clinical depression. According to experts, teens who do some sort of physical activity three to five times a week, for at least 30 minutes, can reap mental health benefits.

Bottom line: Encouraging teens to get moving is worth the extra time, money or driving that teen exercise or athletics might require from parents. Ultimately, it will give them a strong foundation for physical and mental well-being for the rest of their lives.

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Get Moving: The Benefits of Exercise for Teen Mental Health

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Physical activity has significant benefits, like increasing self-esteem and body positivity.

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Can Exercise Help Relieve Teen Depression?

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Can Exercise Help Relieve Teen Depression?

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In recent years, the media has been awash with information on the health benefits of exercise. Exercise is known to boost mood in adults. But what about younger members of society? Based on recent, high quality survey data, we can estimate that about 11% of adolescents are depressed. Sadly, this means that one in 10 adolescents between the ages of 12 and 17 experienced a major depressive episode during the year of the survey. These numbers should raise alarm bells for both parents and doctors.

Depression makes teens feel awful, but being depressed as a teen may also have life-long consequences, including being depressed as an adult. Depressive episodes in teens can contribute to poor grades, poor interpersonal relationships, and worse physical health. Depression can also increase the burden of care for parents. In a recent post, I discussed how a teen's social network can impact his or her chances of becoming depressed. There, we explored how having friends with good spirits could exert a positive influence on a teen's mood. We have also previously touched on some of the concerns with giving teens antidepressant medication. Today we will tackle the hot topic of exercise and depression in adolescents.

A carefully conducted analysis of exercise and depression in teens

A recent study attempted to delve into the data behind exercise as a treatment for depression in teens. The authors initially screened 543 studies and found 11 to include in their analysis. Of those 11, only eight yielded good data to use for more specific calculations. In general, although not always, these types of analyses are particularly powerful because the authors use rigorous criteria when deciding which studies to include.

The teens included in this analysis were 13 to 17 year olds, who did not have any major physical health problems, such as obesity. The data from the studies compared the use of exercise as treatment for depression against a psychosocial intervention, an educational intervention, treatment "as usual", or no treatment at all. After combining data, the authors eventually concluded that exercise appears to lead to moderately improve depression in adolescents, particularly in those already receiving some formal treatment. But, treatment "as usual" was not well defined, and we don't know, for example, how many of these teens were taking antidepressant medication.

Will exercise really help teens suffering with depression?

So, should we conclude from this study that all teens with depression should be treated, to some extent, with exercise? It is tempting to say yes. However, concluding that all teens with depression should be treated with exercise would over-simplify the results of this study. A person (adult or teen) with depression will likely find that exercise helps improve symptoms to some degree. However, this study doesn't support the statement that exercise is the best cure for depression. Instead, it would be more accurate to say that in teens who are already undergoing treatment for depression, exercise appears to be a strategy with modest benefits and little downside. This particular study is a wonderful addition to our knowledge base, in that it puts another tool into a doctor's toolkit to help treat patients with depression in clinical settings.

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Can exercise help relieve teen depression? - Harvard Health

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Depression and Anxiety: Exercise Eases Symptoms

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Depression and Anxiety: Exercise Eases Symptoms

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Depression and anxiety: Exercise eases symptoms

Depression and anxiety symptoms often improve with exercise. Here are some realistic tips to help you get started and stay motivated.
By Mayo Clinic Staff
When you have depression or anxiety, exercise often seems like the last thing you want to do. But once you get motivated, exercise can make a big difference.

Exercise helps prevent and improve a number of health problems, including high blood pressure, diabetes and arthritis. Research on depression, anxiety and exercise shows that the psychological and physical benefits of exercise can also help improve mood and reduce anxiety.

The links between depression, anxiety and exercise aren't entirely clear - but working out and other forms of physical activity can definitely ease symptoms of depression or anxiety and make you feel better. Exercise may also help keep depression and anxiety from coming back once you're feeling better.

How does exercise help depression and anxiety?

Regular exercise may help ease depression and anxiety by:

Releasing feel-good endorphins, natural cannabis-like brain chemicals (endogenous cannabinoids) and other natural brain chemicals that can enhance your sense of well-being

Taking your mind off worries so you can get away from the cycle of negative thoughts that feed depression and anxiety

Regular exercise has many psychological and emotional benefits, too. It can help you:

Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence. Getting in shape can also make you feel better about your appearance.

Get more social interaction. Exercise and physical activity may give you the chance to meet or socialize with others. Just exchanging a friendly smile or greeting as you walk around your neighborhood can help your mood.

Cope in a healthy way. Doing something positive to manage depression or anxiety is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how you feel, or hoping depression or anxiety will go away on its own can lead to worsening symptoms.

Is a structured exercise program the only option?

Some research shows that physical activity such as regular walking - not just formal exercise programs - may help improve mood. Physical activity and exercise are not the same thing, but both are beneficial to your health.

Physical activity is any activity that works your muscles and requires energy and can include work or household or leisure activities.

Exercise is a planned, structured and repetitive body movement done to improve or maintain physical fitness.

The word "exercise" may make you think of running laps around the gym. But exercise includes a wide range of activities that boost your activity level to help you feel better.

Certainly running, lifting weights, playing basketball and other fitness activities that get your heart pumping can help. But so can physical activity such as gardening, washing your car, walking around the block or engaging in other less intense activities. Any physical activity that gets you off the couch and moving can help improve your mood.

You don't have to do all your exercise or other physical activity at once. Broaden how you think of exercise and find ways to add small amounts of physical activity throughout your day. For example, take the stairs instead of the elevator. Park a little farther away from work to fit in a short walk. Or, if you live close to your job, consider biking to work.

How much is enough?

Doing 30 minutes or more of exercise a day for three to five days a week may significantly improve depression or anxiety symptoms. But smaller amounts of physical activity - as little as 10 to 15 minutes at a time - may make a difference. It may take less time exercising to improve your mood when you do more-vigorous activities, such as running or bicycling.

The mental health benefits of exercise and physical activity may last only if you stick with it over the long term - another good reason to focus on finding activities that you enjoy.

How do I get started - and stay motivated?

Starting and sticking with an exercise routine or regular physical activity can be a challenge. These steps can help:

Identify what you enjoy doing. Figure out what type of physical activities you're most likely to do, and think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening, start your day with a jog, or go for a bike ride or play basketball with your children after school? Do what you enjoy to help you stick with it.

Get your mental health professional's support. Talk to your doctor or mental health professional for guidance and support. Discuss an exercise program or physical activity routine and how it fits into your overall treatment plan.

Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think realistically about what you may be able to do and begin gradually. Tailor your plan to your own needs and abilities rather than setting unrealistic guidelines that you're unlikely to meet.

Don't think of exercise or physical activity as a chore. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise or physical activity schedule the same way you look at your therapy sessions or medication - as one of the tools to help you get better.

Analyze your barriers. Figure out what's stopping you from being physically active or exercising. If you feel self-conscious, for instance, you may want to exercise at home. If you stick to goals better with a partner, find a friend to work out with or who enjoys the same physical activities that you do. If you don't have money to spend on exercise gear, do something that's cost-free, such as regular walking. If you think about what's stopping you from being physically active or exercising, you can probably find an alternative solution.

Prepare for setbacks and obstacles. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you can't maintain an exercise routine and might as well quit. Just try again the next day. Stick with it.

Do I need to see my doctor?

Check with your doctor before starting a new exercise program to make sure it's safe for you. Talk to your doctor to find out which activities, how much exercise and what intensity level is OK for you. Your doctor will consider any medications you take and your health conditions. He or she may also have helpful advice about getting started and staying motivated.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, see your doctor or mental health professional. Exercise and physical activity are great ways to ease symptoms of depression or anxiety, but they aren't a substitute for talk therapy (psychotherapy) or medications.

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Show references

1. Cooney GM, et al. Exercise for depression. JAMA. 2014;311:2432.

2. Peterson DM. The benefits and risks of exercise. https://www.uptodate.com/contents/search. Accessed Sept. 15, 2017.

3. Greer TL, et al. Improvements in psychosocial functioning and health-related quality of life following exercise augmentation in patients with treatment response but nonremitted major depressive disorder: Results from the TREAD study. Depression and Anxiety. 2016;33:870.

4. Schuch FB, et al. Exercise as treatment for depression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research. 2016;77:42.

5. Understand physical activity, exercise and your heart. Society for Cardiovascular Angiography and Interventions. http://www.secondscount.org/healthy-living/physical-activity-exercise#.WbGhPWeWzRF. Accessed Sept. 7, 2017.

6. Physical activity and health. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Accessed Sept. 7, 2017.

7. Exercise for mental health: 8 keys to get and stay moving. National Alliance on Mental Illness. https://www.nami.org/Blogs/NAMI-Blog/May-2016/Exercise-for-Mental-Health-8-Keys-to-Get-and-Stay. Accessed Sept. 7, 2017.

8. Exercise for stress and anxiety. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety. Accessed Sept. 7, 2017.

9. Zschucke E, et al. Exercise and physical activity in mental disorders: Clinical and experimental evidence. Journal of Preventive Medicine and Public Health. 2013;46:512.

10. Anderson E, et al. Effects of exercise and physical activity on anxiety. Frontiers in Psychiatry. 2013;4:1.

11. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 19, 2017.

See more In-depth

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Depression and anxiety: Exercise eases symptoms

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Research on depression and anxiety shows that exercise and other physical activity can help improve mood, reduce anxiety and improve other health problems.

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Leveraging Physical Activity in Schools to Address Pandemic-Related Health Disparities

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Leveraging Physical Activity in Schools to Address Pandemic-Related Health Disparities

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The COVID-19 pandemic disrupted all aspects of daily life, including school operations and the capacity for schools to meet students' physical and emotional needs. CDC aims to gain a better understanding of the pandemic's impact on student health and to leverage evidence-based strategies to reduce that impact.

Since the widespread school closures to prevent COVID-19 transmission in March 2020, CDC has created new channels for collecting data to monitor the pandemic's impact. The COVID Experiences (CovEx) study and the Adolescent Behaviors and Experiences Study (ABES) have both been useful sources of data that provide pandemic-related insight directly from students and parents.

The CovEx study focused on child well-being, including physical health, mental health, and emotional health, as well as stress and anxiety indicators. Baseline data were collected from October through November 2020, with follow-up data collection in March and April 2021. Survey responses were collected from about 1,500 parents of children ages 5-12 and from about 700 adolescents ages 13-19.

CovEx results showed that during the pandemic, many parents experienced loss of work, were concerned about job stability, and had childcare challenges. Many parents also reported that their well-being had been impacted by emotional distress, difficulty managing emotions, and difficulty sleeping. Similar challenges were reported among the indicators of child well-being: a large proportion of parents reported that their children experienced decreases in physical activity, decreased time spent outside, and decreased time spent with friends. The results for most well-being indicators for both children and their parents were better for students who were attending school in person than for those receiving virtual instruction only or combined virtual/in-person instruction.

The ABES study, assessed the pandemic's impact on student health, including emotional well-being. Access to the online survey was provided by teachers in the spring of 2020 to a nationally representative sample of students in 9 th through 12 th grade at both public and private schools. The survey included questions from the Youth Risk Behavior Survey (YRBS) on various health-related topics, such as substance abuse and violence victimization (defined by the US Department of Justice as rape, sexual assault, robbery, aggravated assault, or simple assault). Newly added questions assessed students' experience with racism, discrimination, and mental health during the pandemic.

Results recently published from the study found that 37% of students experienced poor mental health during the pandemic, 44% experienced feelings of sadness or hopelessness, and 20% had seriously considered attempting suicide. However, students who felt close to people at school - such as teachers, coaches, and school nurses - had a significantly lower prevalence of poor mental health during the pandemic.
So what do the CovEx and ABES results mean for physical education and physical activity professionals who want to support the mental and physical health of our students?
School-based physical activity programs are critically needed, and there is an even greater need for policies that increase the amount of time for physical activity during the school day. Physical education teachers and physical activity leaders within schools can play a pivotal role in proposing regularly scheduled time for recess, classroom-based physical activity, daily physical education, and out-of-school time programs.

Physical health educators can support social, emotional, and mental health programs and services through instructional strategies that engage students, help them express their emotional needs, and create more social interactions with peers. Educators should continue asking students about their needs, experiences, and feelings, as well as recognize that both parents and teachers may need support through school-based wellness programs.

The findings from CovEx and ABES show us that decreased physical activity and isolation can adversely affect children, both physically and emotionally, and that chronic stress can affect the well-being of both parents and their children. These findings underline the need for public health professionals, community partners, and school leaders to act locally to increase opportunities for physical activity, provide culturally appropriate physical activity programs and resources, support pandemic-related prevention efforts, and collaborate more with social and mental health services.

In CDC's National Center for Chronic Disease Prevention and Health Promotion, we envision vibrant, thriving, active communities where people live, work, and play. Schools are in a unique position to be champions in the community and can lead by example through implementing Comprehensive School Physical Activity Programs that increase physical activity opportunities before, during, and after school. School-based physical activity and physical education play a major role in fostering an activity-friendly community and helping students get the recommended amount of daily physical activity that promotes lifelong health and well-being.

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Kelly Cornett, MS, is a Health Scientist on the Research Application and Evaluation Team of the Healthy Schools Branch in CDC's Division of Population Health.

The views expressed in written training materials, publications, or presentations by CDC speakers and moderators do not necessarily reflect the official position of CDC or the US Department of Health and Human Services.

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Leveraging Physical Activity in Schools to Address Pandemic-Related Health Disparities | Active Schools

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By: Kelly Cornett, MS Centers for Disease Control & Prevention The COVID-19 pandemic disrupted all aspects of daily life, including school operations and the capacity for schools to meet students' physical and emotional needs. CDC aims to gain a betterRead More ›

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Sedentary Time and Behavior During School

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Sedentary Time and Behavior During School

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CDC - Physical Activity and Sedentary Behaviors and Academic Grades

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CDC - Physical Activity and Sedentary Behaviors and Academic Grades

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Physical Activity and Sedentary Behaviors and Academic Grades | Healthy Schools | CDC

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Healthy Schools, CDC, Centers for Disease Control and Prevention

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Of the many subjects children study in school, there may be none more important than physical education. However it must be of high quality and aligned with state/national standards and guidelines. A high quality physical education program offers children opportunities to develop the skills, concepts, and dispositions needed to be physically active for life. Sufficient, regular physical activity not only helps prevent major diseases but it also: promotes learning; reduces stress, anxiety, and depression; and improves overall student wellness. It doesn't matter if the child excels in every other subject in school and grows up to become a successful professional, with poor health any professional achievement becomes secondary.

There are many factors that contribute to the ease of implementing and sustaining a quality program, including the involvement of the administration, parents, and community. However it ultimately comes down to the willingness of the physical education teacher(s) to do their best no matter the situation.

​That being said, REAL teachers still need our support and appreciation. This can be in the form of equipment (every jump-rope, pedometer, heart-rate monitor, and home-made scoop catcher counts), classroom assistance, time and funding for professional development, and by advocating for quality physical education at the local, state, and national level.

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Information and resources on the importance of quality physical education (research, articles, position statements, etc).

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Physical education is the foundation of a Comprehensive School Physical Activity Program. 1, 2 It is an academic subject characterized by a planned, sequential K-12 curriculum (course of study) that is based on the national standards for physical education. ²⁻⁴ Physical education provides cognitive content and instruction designed to develop motor skills, knowledge, and behaviors for physical activity and physical fitness. ²⁻⁴ Supporting schools to establish physical education daily can provide students with the ability and confidence to be physically active for a lifetime. ²⁻⁴

There are many benefits of physical education in schools. When students get physical education, they can ⁵⁻⁷:

Increase their level of physical activity.

Improve their grades and standardized test scores.

Stay on-task in the classroom.

Increased time spent in physical education does not negatively affect students' academic achievement.

Strengthen Physical Education in Schools [PDF - 437 KB] -This data brief defines physical education, provides a snapshot of current physical education practices in the United States, and highlights ways to improve physical education through national guidance and practical strategies and resources. This was developed by Springboard to Active Schools in collaboration with CDC.

Secular Changes in Physical Education Attendance Among U.S. High School Students, YRBS 1991-2013

The Secular Changes in Physical Education Attendance Among U.S. High School Students report [PDF - 3 MB] explains the secular changes (long-term trends) in physical education attendance among US high school students over the past two decades. Between 1991 and 2013, US high school students' participation in school-based physical education classes remained stable, but at a level much lower than the national recommendation of daily physical education. In order to maximize the benefits of physical education, the adoption of policies and programs aimed at increasing participation in physical education among all US students should be prioritized. Download the report for detailed, nationwide findings.

Physical Education Analysis Tool (PECAT)

The Physical Education Curriculum Analysis Tool (PECAT) [PDF - 6 MB] is a self-assessment and planning guide developed by CDC. It is designed to help school districts and schools conduct clear, complete, and consistent analyses of physical education curricula, based upon national physical education standards.

Visit our PECAT page to learn more about how schools can use this tool.

1. Centers for Disease Control and Prevention. A Guide for Developing Comprehensive School Physical Activity Programs. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013.

2. Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and physical activity. MMWR. 2011;60(RR05):1-76.

3. Institute of Medicine. Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington, DC: The National Academies Press; 2013. Retrieved from http://books.nap.edu/openbook.php?record_id=18314&page=R1.

4. SHAPE America. The Essential Components of Physical Education. Reston, VA: SHAPE America; 2015. Retrieved from http://www.shapeamerica.org/upload/TheEssentialComponentsOfPhysicalEducation.pdf [PDF - 392 KB].

5. Centers for Disease Control and Prevention. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA; Centers for Disease Control and Prevention, US Department of Health and Human Services; 2010.

6. Centers for Disease Control and Prevention. Health and Academic Achievement. Atlanta: US Department of Health and Human Services; 2014.

7. Michael SL, Merlo C, Basch C, et al. Critical connections: health and academics. Journal of School Health. 2015;85(11):740-758.

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centers for disease control and prevention

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regular physical activity in adolescents

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comprehensive school physical activity program

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physical education curriculum analysis tool

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Physical education benefits students by increasing their level of physical activity, improving their grades and standardized test scores, and helping them stay on-task in the classroom.

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The Physical Activity Guidelines for Americans, 2nd edition recommend that children and adolescents ages 6 to 17 years do 60 minutes or more of moderate-to-vigorous physical activity daily. ²

Regular physical activity can help children and adolescents improve cardiorespiratory fitness, build strong bones and muscles, control weight, reduce symptoms of anxiety and depression, and reduce the risk of developing health conditions such as: ¹

Physical inactivity can

Lead to energy imbalance (e.g., expend less energy through physical activity than consumed through diet) and can increase the risk of becoming overweight or obese.¹⁴

Increase the risk of factors for cardiovascular disease, including hyperlipidemia (e.g., high cholesterol and triglyceride levels), high blood pressure, obesity, and insulin resistance and glucose intolerance.1,5,6

Increase the risk for developing type 2 diabetes.1,7

Increase the risk for developing breast, colon, endometrial, and lung cancers.¹

Lead to low bone density, which in turn, leads to osteoporosis.¹

Less than one-quarter (24%) of children 6 to 17 years of age participate in 60 minutes of physical activity every day. ⁸

In 2017, only 26.1% of high school students participate in at least 60 minutes per day of physical activity on all 7 days of the previous week.⁹

In 2017, 51.1% of high school students participated in muscle strengthening exercises (e.g., push-ups, sit-ups, weight lifting) on 3 or more days during the previous week.⁹

In 2017, 51.7% of high school students attended physical education classes in an average week, and only 29.9% of high school students attended physical education classes daily.⁹

Aerobic: Most of the 60 minutes or more per day should be either moderate- or vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity on at least 3 days a week.

Muscle-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days a week.

Bone-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days a week.

These guidelines state that children and adolescents be provided opportunities and encouragement to participate in physical activities that are appropriate for their age, that are enjoyable, and that offer variety. ³

The national recommendation for schools is to have a comprehensive approach for addressing physical education and physical activity in schools. ¹⁰⁻¹² This approach is called Comprehensive School Physical Activity Programs. ¹³

Students who are physically active tend to have better grades, school attendance, cognitive performance (e.g., memory), and classroom behaviors (e.g., on-task behavior).14, 15

Higher physical activity and physical fitness levels are associated with improved cognitive performance (e.g., concentration, memory) among students.14, 15

1. Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Dept of Health and Human Services; 2018.

2. US Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: US Department of Health and Human Services; 2018.

3. National Physical Activity Plan Alliance. The 2018 United States Report Card on Physical Activity for Children and Youth. Washington, DC: National Physical Activity Plan Alliance, 2018.

4. Loprinzi PD, Lee I, Andersen RE, Crespo CJ, Smit E. Association of concurrent healthy eating and regular physical activity with cardiovascular disease risk factors in US youth. American Journal of Health Promotion. 2015; 30(1):2-8.

5. Cuenca-Garcia M; Ortega FB; Ruiz JR; et al. Combined influence of healthy diet and active lifestyle on cardiovascular disease risk factors in adolescents. Scandinavian Journal of Medicine & Science in Sports. 2014;24(3):553-562.

6. Kriska A; Delahanty L; Edelstein S; et al. Sedentary behavior and physical activity in youth with recent onset of type 2 diabetes. Pediatrics. 2013;131(3): e850-e856.

7. The Child & Adolescent Health Measurement Initiative (CAHMI). 2016 National Survey of Childrens Health. Data Resource Center for Child and Adolescent Health;2016.

8. Merlo CL, Jones SE, Michael SL, et al. Dietary and Physical Activity Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019. MMWR Suppl 2020;69(Suppl-1):64-76.

9. Centers for Disease Control and Prevention. School Health Guidelines to Promote Healthy Eating and Physical Activity. MMWR. 2011;60(No. RR-5).

10. US Department of Health and Human Services. Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth. Washington, DC: US Department of Health and Human Services: 2012.

11. Institute of Medicine. Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington, DC: The National Academies Press; 2013.

12. Centers for Disease Control and Prevention. A Guide for Developing Comprehensive School Physical Activity Programs. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013.

13. Centers for Disease Control and Prevention. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA; Centers for Disease Control and Prevention, US Department of Health and Human Services; 2010.

14. Michael SL, Merlo C, Basch C, et al. Critical connections: health and academics. Journal of School Health. 2015;85(11):740-758.

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centers for disease control and prevention

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regular physical activity in adolescents

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comprehensive school physical activity program

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Regular physical activity can help children and adolescents improve cardiorespiratory fitness, build strong bones and muscles, control weight, reduce symptoms of anxiety and depression, and reduce the risk of developing health conditions such as heart disease, cancer, type 2 diabetes, high blood pressure, osteoporosis, obesity.

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Physical Activity, Fitness, and Physical Education: Effects on Academic Performance

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Physical Activity, Fitness, and Physical Education: Effects on Academic Performance

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Evidence suggests that increasing physical activity and physical fitness may improve academic performance and that time in the school day dedicated to recess, physical education class, and physical activity in the classroom may also facilitate academic performance.

Available evidence suggests that mathematics and reading are the academic topics that are most influenced by physical activity. These topics depend on efficient and effective executive function, which has been linked to physical activity and physical fitness.

Executive function and brain health underlie academic performance. Basic cognitive functions related to attention and memory facilitate learning, and these functions are enhanced by physical activity and higher aerobic fitness.

Single sessions of and long-term participation in physical activity improve cognitive performance and brain health. Children who participate in vigorous- or moderate-intensity physical activity benefit the most.

Given the importance of time on task to learning, students should be provided with frequent physical activity breaks that are developmentally appropriate.

Although presently understudied, physically active lessons offered in the classroom may increase time on task and attention to task in the classroom setting.

PHYSICAL FITNESS AND PHYSICAL ACTIVITY: RELATION TO ACADEMIC PERFORMANCE

State-mandated academic achievement testing has had the unintended consequence of reducing opportunities for children to be physically active during the school day and beyond. In addition to a general shifting of time in school away from physical education to allow for more time on academic subjects, some children are withheld from physical education classes or recess to participate in remedial or enriched learning experiences designed to increase academic performance ( Pellegrini and Bohn, 2005; see Chapter 5). Yet little evidence supports the notion that more time allocated to subject matter will translate into better test scores. Indeed, 11 of 14 correlational studies of physical activity during the school day demonstrate a positive relationship to academic performance ( Rasberry et al., 2011). Overall, a rapidly growing body of work suggests that time spent engaged in physical activity is related not only to a healthier body but also to a healthier mind ( Hillman et al., 2008).

Children respond faster and with greater accuracy to a variety of cognitive tasks after participating in a session of physical activity ( Tomporowski, 2003; Budde et al., 2008; Hillman et al., 2009; Pesce et al., 2009; Ellemberg and St-Louis-Deschênes, 2010). A single bout of moderate-intensity physical activity has been found to increase neural and behavioral concomitants associated with the allocation of attention to a specific cognitive task ( Hillman et al., 2009; Pontifex et al., 2012). And when children who participated in 30 minutes of aerobic physical activity were compared with children who watched television for the same amount of time, the former children cognitively outperformed the latter ( Ellemberg and St-Louis-Desêhenes, 2010). Visual task switching data among 69 overweight and inactive children did not show differences between cognitive performance after treadmill walking and sitting ( Tomporowski et al., 2008b).

When physical activity is used as a break from academic learning time, postengagement effects include better attention ( Grieco et al., 2009; Bartholomew and Jowers, 2011), increased on-task behaviors ( Mahar et al., 2006), and improved academic performance ( Donnelly and Lambourne, 2011). Comparisons between 1st-grade students housed in a classroom with stand-sit desks where the child could stand at his/her discretion and in classrooms containing traditional furniture showed that the former children were highly likely to stand, thus expending significantly more energy than those who were seated ( Benden et al., 2011). More important, teachers can offer physical activity breaks as part of a supplemental curriculum or simply as a way to reset student attention during a lesson ( Kibbe et al., 2011; see Chapter 6) and when provided with minimal training can efficaciously produce vigorous or moderate energy expenditure in students ( Stewart et al., 2004). Further, after-school physical activity programs have demonstrated the ability to improve cardiovascular endurance, and this increase in aerobic fitness has been shown to mediate improvements in academic performance ( Fredericks et al., 2006), as well as the allocation of neural resources underlying performance on a working memory task ( Kamijo et al., 2011).

Over the past three decades, several reviews and meta-analyses have described the relationship among physical fitness, physical activity, and cognition (broadly defined as all mental processes). The majority of these reviews have focused on the relationship between academic performance and physical fitness-a physiological trait commonly defined in terms of cardiorespiratory capacity (e.g., maximal oxygen consumption; see Chapter 3). More recently, reviews have attempted to describe the effects of an acute or single bout of physical activity, as a behavior, on academic performance. These reviews have focused on brain health in older adults ( Colcombe and Kramer, 2003), as well as the effects of acute physical activity on cognition in adults ( Tomporowski, 2003). Some have considered age as part of the analysis ( Etnier et al., 1997, 2006). Reviews focusing on research conducted in children ( Sibley and Etnier, 2003) have examined the relationship among physical activity, participation in sports, and academic performance ( Trudeau and Shephard, 2008, 2010; Singh et al., 2012); physical activity and mental and cognitive health ( Biddle and Asare, 2011); and physical activity, nutrition, and academic performance ( Burkhalter and Hillman, 2011). The findings of most of these reviews align with the conclusions presented in a meta-analytic review conducted by Fedewa and Ahn (2011). The studies reviewed by Fedewa and Ahn include experimental/quasi-experimental as well as cross-sectional and correlational designs, with the experimental designs yielding the highest effect sizes. The strongest relationships were found between aerobic fitness and achievement in mathematics, followed by IQ and reading performance. The range of cognitive performance measures, participant characteristics, and types of research design all mediated the relationship among physical activity, fitness, and academic performance. With regard to physical activity interventions, which were carried out both within and beyond the school day, those involving small groups of peers (around 10 youth of a similar age) were associated with the greatest gains in academic performance.

The number of peer-reviewed publications on this topic is growing exponentially. Further evidence of the growth of this line of inquiry is its increased global presence. Positive relationships among physical activity, physical fitness, and academic performance have been found among students from the Netherlands ( Singh et al., 2012) and Taiwan ( Chih and Chen, 2011). Broadly speaking, however, many of these studies show small to moderate effects and suffer from poor research designs ( Biddle and Asare, 2011; Singh et al., 2012).

Basch (2010) conducted a comprehensive review of how children's health and health disparities influence academic performance and learning. The author's report draws on empirical evidence suggesting that education reform will be ineffective unless children's health is made a priority. Basch concludes that schools may be the only place where health inequities can be addressed and that, if children's basic health needs are not met, they will struggle to learn regardless of the effectiveness of the instructional materials used. More recently, Efrat (2011) conducted a review of physical activity, fitness, and academic performance to examine the achievement gap. He discovered that only seven studies had included socioeconomic status as a variable, despite its known relationship to education ( Sirin, 2005).

Physical Fitness as a Learning Outcome of Physical Education and Its Relation to Academic Performance

Achieving and maintaining a healthy level of aerobic fitness, as defined using criterion-referenced standards from the National Health and Nutrition Examination Survey (NHANES; Welk et al., 2011), is a desired learning outcome of physical education programming. Regular participation in physical activity also is a national learning standard for physical education, a standard intended to facilitate the establishment of habitual and meaningful engagement in physical activity ( NASPE, 2004). Yet although physical fitness and participation in physical activity are established as learning outcomes in all 50 states, there is little evidence to suggest that children actually achieve and maintain these standards (see Chapter 2).

Statewide and national datasets containing data on youth physical fitness and academic performance have increased access to student-level data on this subject ( Grissom, 2005; Cottrell et al., 2007; Carlson et al., 2008; Chomitz et al., 2008; Wittberg et al., 2010; Van Dusen et al., 2011). Early research in South Australia focused on quantifying the benefits of physical activity and physical education during the school day; the benefits noted included increased physical fitness, decreased body fat, and reduced risk for cardiovascular disease ( Dwyer et al., 1979, 1983). Even today, Dwyer and colleagues are among the few scholars who regularly include in their research measures of physical activity intensity in the school environment, which is believed to be a key reason why they are able to report differentiated effects of different intensities. A longitudinal study in Trois-Rivières, Québec, Canada, tracked how the academic performance of children from grades 1 through 6 was related to student health, motor skills, and time spent in physical education. The researchers concluded that additional time dedicated to physical education did not inhibit academic performance ( Shephard et al., 1984; Shephard, 1986; Trudeau and Shephard, 2008).

Longitudinal follow-up investigating the long-term benefits of enhanced physical education experiences is encouraging but largely inconclusive. In a study examining the effects of daily physical education during elementary school on physical activity during adulthood, 720 men and women completed the Québec Health Survey ( Trudeau et al., 1999). Findings suggest that physical education was associated with physical activity in later life for females but not males ( Trudeau et al., 1999); most of the associations were significant but weak ( Trudeau et al., 2004). Adult body mass index (BMI) at age 34 was related to childhood BMI at ages 10-12 in females but not males ( Trudeau et al., 2001). Longitudinal studies such as those conducted in Sweden and Finland also suggest that physical education experiences may be related to adult engagement in physical activity ( Glenmark, 1994; Telama et al., 1997). From an academic performance perspective, longitudinal data on men who enlisted for military service imply that cardiovascular fitness at age 18 predicted cognitive performance in later life (Aberg et al., 2009), thereby supporting the idea of offering physical education and physical activity opportunities well into emerging adulthood through secondary and postsecondary education.

Castelli and colleagues (2007) investigated younger children (in 3rd and 5th grades) and the differential contributions of the various subcomponents of the Fitnessgram ®. Specifically, they examined the individual contributions of aerobic capacity, muscle strength, muscle flexibility, and body composition to performance in mathematics and reading on the Illinois Standardized Achievement Test among a sample of 259 children. Their findings corroborate those of the California Department of Education ( Grissom, 2005), indicating a general relationship between fitness and achievement test performance. When the individual components of the Fitnessgram were decomposed, the researchers determined that only aerobic capacity was related to test performance. Muscle strength and flexibility showed no relationship, while an inverse association of BMI with test performance was observed, such that higher BMI was associated with lower test performance. Although Baxter and colleagues (2011) confirmed the importance of attending school in relation to academic performance through the use of 4th-grade student recall, correlations with BMI were not significant.

State-mandated implementation of the coordinated school health model requires all schools in Texas to conduct annual fitness testing using the Fitnessgram among students in grades 3-12. In a special issue of Research Quarterly for Exercise and Sport (2010), multiple articles describe the current state of physical fitness among children in Texas; confirm the associations among school performance levels, academic achievement, and physical fitness ( Welk et al., 2010; Zhu et al., 2010); and demonstrate the ability of qualified physical education teachers to administer physical fitness tests ( Zhu et al., 2010). Also using data from Texas schools, Van Dusen and colleagues (2011) found that cardiovascular fitness had the strongest association with academic performance, particularly in mathematics over reading. Unlike previous research, which demonstrated a steady decline in fitness by developmental stage ( Duncan et al., 2007), this study found that cardiovascular fitness did decrease but not significantly ( Van Dusen et al., 2011). Aerobic fitness, then, may be important to academic performance, as there may be a dose-response relationship ( Van Dusen et al., 2011).

Using a large sample of students in grades 4-8, Chomitz and colleagues (2008) found that the likelihood of passing both mathematics and English achievement tests increased with the number of fitness tests passed during physical education class, and the odds of passing the mathematics achievement tests were inversely related to higher body weight. Similar to the findings of Castelli and colleagues (2007), socioeconomic status and demographic factors explained little of the relationship between aerobic fitness and academic performance; however, socioeconomic status may be an explanatory variable for students of low fitness ( London and Castrechini, 2011).

In sum, numerous cross-sectional and correlational studies demonstrate small-to-moderate positive or null associations between physical fitness ( Grissom, 2005; Cottrell et al., 2007; Edwards et al., 2009; Eveland-Sayers et al., 2009; Cooper et al., 2010; Welk et al., 2010; Wittberg et al., 2010; Zhu et al., 2010; Van Dusen et al., 2011), particularly aerobic fitness, and academic performance ( Castelli et al, 2007; Chomitz et al., 2008; Roberts et al., 2010; Welk et al., 2010; Chih and Chen, 2011; London and Castrechini, 2011; Van Dusen et al., 2011). Moreover, the findings may support a dose-response association, suggesting that the more components of physical fitness (e.g., cardiovascular endurance, strength, muscle endurance) considered acceptable for the specific age and gender that are present, the greater the likelihood of successful academic performance. From a public health and policy standpoint, the conclusions these findings support are limited by few causal inferences, a lack of data confirmation, and inadequate reliability because the data were often collected by nonresearchers or through self-report methods. It may also be noted that this research includes no known longitudinal studies and few randomized controlled trials (examples are included later in this chapter in the discussion of the developing brain).

Physical Activity, Physical Education, and Academic Performance

In contrast with the correlational data presented above for physical fitness, more information is needed on the direct effects of participation in physical activity programming and physical education classes on academic performance.

The regular engagement in physical activity achieved during physical education programming can also be related to academic performance, especially when the class is taught by a physical education teacher. The Sports, Play, and Active Recreation for Kids (SPARK) study examined the effects of a 2-year health-related physical education program on academic performance in children ( Sallis et al., 1999). In an experimental design, seven elementary schools were randomly assigned to one of three conditions: (1) a specialist condition in which certified physical education teachers delivered the SPARK curriculum, (2) a trained-teacher condition in which classroom teachers implemented the curriculum, and (3) a control condition in which classroom teachers implemented the local physical education curriculum. No significant differences by condition were found for mathematics testing; however, reading scores were significantly higher in the specialist condition relative to the control condition ( Sallis et al., 1999), while language scores were significantly lower in the specialist condition than in the other two conditions. The authors conclude that spending time in physical education with a specialist did not have a negative effect on academic performance. Shortcomings of this research include the amount of data loss from pre- to posttest, the use of results of 2nd-grade testing that exceeded the national average in performance as baseline data, and the use of norm-referenced rather than criterion-based testing.

In seminal research conducted by Gabbard and Barton (1979), six different conditions of physical activity (no activity; 20, 30, 40, and 50 minutes; and posttest no activity) were completed by 106 2nd graders during physical education. Each physical activity session was followed by 5 minutes of rest and the completion of 36 math problems. The authors found a potential threshold effect whereby only the 50-minute condition improved mathematical performance, with no differences by gender.

A longitudinal study of the kindergarten class of 1998-1999, using data from the Early Childhood Longitudinal Study, investigated the association between enrollment in physical education and academic achievement ( Carlson et al., 2008). Higher amounts of physical education were correlated with better academic performance in mathematics among females, but this finding did not hold true for males.

Ahamed and colleagues (2007) found in a cluster randomized trial that, after 16 months of a classroom-based physical activity intervention, there was no significant difference between the treatment and control groups in performance on the standardized Cognitive Abilities Test, Third Edition (CAT-3). Others have found, however, that coordinative exercise ( Budde et al., 2008) or bouts of vigorous physical activity during free time ( Coe et al., 2006) contribute to higher levels of academic performance. Specifically, Coe and colleagues examined the association of enrollment in physical education and self-reported vigorous- or moderate-intensity physical activity outside school with performance in core academic courses and on the Terra Nova Standardized Achievement Test among more than 200 6th-grade students. Their findings indicate that academic performance was unaffected by enrollment in physical education classes, which were found to average only 19 minutes of vigorous- or moderate-intensity physical activity. When time spent engaged in vigorous- or moderate-intensity physical activity outside of school was considered, however, a significant positive relation to academic performance emerged, with more time engaged in vigorous- or moderate-intensity physical activity being related to better grades but not test scores ( Coe et al., 2006).

Studies of participation in sports and academic achievement have found positive associations ( Mechanic and Hansell, 1987; Dexter, 1999; Crosnoe, 2002; Eitle and Eitle, 2002; Stephens and Schaben, 2002; Eitle, 2005; Miller et al., 2005; Fox et al., 2010; Ruiz et al., 2010); higher grade point averages (GPAs) in season than out of season ( Silliker and Quirk, 1997); a negative association between cheerleading and science performance ( Hanson and Kraus, 1998); and weak and negative associations between the amount of time spent participating in sports and performance in English-language class among 13-, 14-, and 16-year-old students ( Daley and Ryan, 2000). Other studies, however, have found no association between participation in sports and academic performance ( Fisher et al., 1996). The findings of these studies need to be interpreted with caution as many of their designs failed to account for the level of participation by individuals in the sport (e.g., amount of playing time, type and intensity of physical activity engagement by sport). Further, it is unclear whether policies required students to have higher GPAs to be eligible for participation. Offering sports opportunities is well justified regardless of the cognitive benefits, however, given that adolescents may be less likely to engage in risky behaviors when involved in sports or other extracurricular activities ( Page et al., 1998; Elder et al., 2000; Taliaferro et al., 2010), that participation in sports increases physical fitness, and that affiliation with sports enhances school connectedness.

Although a consensus on the relationship of physical activity to academic achievement has not been reached, the vast majority of available evidence suggests the relationship is either positive or neutral. The meta-analytic review by Fedewa and Ahn (2011) suggests that interventions entailing aerobic physical activity have the greatest impact on academic performance; however, all types of physical activity, except those involving flexibility alone, contribute to enhanced academic performance, as do interventions that use small groups (about 10 students) rather than individuals or large groups. Regardless of the strength of the findings, the literature indicates that time spent engaged in physical activity is beneficial to children because it has not been found to detract from academic performance, and in fact can improve overall health and function ( Sallis et al., 1999; Hillman et al., 2008; Tomporowski et al., 2008a; Trudeau and Shephard, 2008; Rasberry et al., 2011).

Single Bouts of Physical Activity

Beyond formal physical education, evidence suggests that multi-component approaches are a viable means of providing physical activity opportunities for children across the school curriculum (see also Chapter 6). Although health-related fitness lessons taught by certified physical education teachers result in greater student fitness gains relative to such lessons taught by other teachers ( Sallis et al., 1999), non-physical education teachers are capable of providing opportunities to be physically active within the classroom ( Kibbe et al., 2011). Single sessions or bouts of physical activity have independent merit, offering immediate benefits that can enhance the learning experience. Studies have found that single bouts of physical activity result in improved attention ( Hillman et al., 2003, 2009; Pontifex et al., 2012), better working memory ( Pontifex et al., 2009), and increased academic learning time and reduced off-task behaviors ( Mahar et al., 2006; Bartholomew and Jowers, 2011). Yet single bouts of physical activity have differential effects, as very vigorous exercise has been associated with cognitive fatigue and even cognitive decline in adults ( Tomporowski, 2003). As seen in Figure 4-1, high levels of effort, arousal, or activation can influence perception, decision making, response preparation, and actual response. For discussion of the underlying constructs and differential effects of single bouts of physical activity on cognitive performance, see Tomporowski (2003).

A randomized controlled trial entitled Physical Activity Across the Curriculum (PAAC) used cluster randomization among 24 schools to examine the effects of physically active classroom lessons on BMI and academic achievement ( Donnelly et al., 2009). The academically oriented physical activities were intended to be of vigorous or moderate intensity (3-6 metabolic equivalents [METs]) and to last approximately 10 minutes and were specifically designed to supplement content in mathematics, language arts, geography, history, spelling, science, and health. The study followed 665 boys and 677 girls for 3 years as they rose from 2nd or 3rd to 4th or 5th grades. Changes in academic achievement, fitness, and blood screening were considered secondary outcomes. During a 3-year period, students who engaged in physically active lessons, on average, improved their academic achievement by 6 percent, while the control groups exhibited a 1 percent decrease. In students who experienced at least 75 minutes of PAAC lessons per week, BMI remained stable (see Figure 4-3).

It is important to note that cognitive tasks completed before, during, and after physical activity show varying effects, but the effects were always positive compared with sedentary behavior. In a study carried out by Drollette and colleagues (2012), 36 preadolescent children completed two cognitive tasks-a flanker task to assess attention and inhibition and a spatial nback task to assess working memory-before, during, and after seated rest and treadmill walking conditions. The children sat or walked on different days for an average of 19 minutes. The results suggest that the physical activity enhanced cognitive performance for the attention task but not for the task requiring working memory. Accordingly, although more research is needed, the authors suggest that the acute effects of exercise may be selective to certain cognitive processes (i.e., attentional inhibition) while unrelated to others (e.g., working memory). Indeed, data collected using a task-switching paradigm (i.e., a task designed to assess multitasking and requiring the scheduling of attention to multiple aspects of the environment) among 69 overweight and inactive children did not show differences in cognitive performance following acute bouts of treadmill walking or sitting ( Tomporowski et al., 2008b). Thus, findings to date indicate a robust relationship of acute exercise to transient improvements in attention but appear inconsistent for other aspects of cognition.

Academic Learning Time and On- and Off-Task Behaviors

Excessive time on task, inattention to task, off-task behavior, and delinquency are important considerations in the learning environment given the importance of academic learning time to academic performance. These behaviors are observable and of concern to teachers as they detract from the learning environment. Systematic observation by trained observers may yield important insight regarding the effects of short physical activity breaks on these behaviors. Indeed, systematic observations of student behavior have been used as an alternative means of measuring academic performance ( Mahar et al., 2006; Grieco et al., 2009).

After the development of classroom-based physical activities, called Energizers, teachers were trained in how to implement such activities in their lessons at least twice per week ( Mahar et al., 2006). Measurements of baseline physical activity and on-task behaviors were collected in two 3rd-grade and two 4th-grade classes, using pedometers and direct observation. The intervention included 243 students, while 108 served as controls by not engaging in the activities. A subgroup of 62 3rd and 4th graders was observed for on-task behavior in the classroom following the physical activity. Children who participated in Energizers took more steps during the school day than those who did not; they also increased their on-task behaviors by more than 20 percent over baseline measures.

A systematic review of a similar in-class, academically oriented, physical activity plan-Take 10!-was conducted to identify the effects of its implementation after it had been in use for 10 years ( Kibbe et al., 2011). The findings suggest that children who experienced Take 10! in the classroom engaged in moderate to vigorous physical activity (6.16 to 6.42 METs) and had lower BMIs than those who did not. Further, children in the Take 10! classrooms had better fluid intelligence ( Reed et al., 2010) and higher academic achievement scores ( Donnelly et al., 2009).

Some have expressed concern that introducing physical activity into the classroom setting may be distracting to students. Yet in one study it was sedentary students who demonstrated a decrease in time on task, while active students returned to the same level of on-task behavior after an active learning task ( Grieco et al., 2009). Among the 97 3rd-grade students in this study, a small but nonsignificant increase in on-task behaviors was seen immediately following these active lessons. Additionally, these improvements were not mediated by BMI.

In sum, although presently understudied, physically active lessons may increase time on task and attention to task in the classroom setting. Given the complexity of the typical classroom, the strategy of including content-specific lessons that incorporate physical activity may be justified.

Recess

To examine the effects of engagement in physical activity during recess on classroom behavior, Barros and colleagues (2009) examined data from the Early Childhood Longitudinal Study on 10,000 8- to 9-year-old children. Teachers provided the number of minutes of recess as well as a ranking of classroom behavior (ranging from "misbehaves frequently" to "behaves exceptionally well"). Results indicate that children who had at least 15 minutes of recess were more likely to exhibit appropriate behavior in the classroom ( Barros et al., 2009). In another study, 43 4th-grade students were randomly assigned to 1 or no days of recess to examine the effects on classroom behavior ( Jarrett et al., 1998). The researchers concluded that on-task behavior was better among the children who had recess. A moderate effect size (= 0.51) was observed. In a series of studies examining kindergartners' attention to task following a 20-minute recess, increased time on task was observed during learning centers and story reading ( Pellegrini et al., 1995). Despite these positive findings centered on improved attention, it is important to note that few of these studies actually measured the intensity of the physical activity during recess.

From a slightly different perspective, survey data from 547 Virginia elementary school principals suggest that time dedicated to student participation in physical education, art, and music did not negatively influence academic performance ( Wilkins et al., 2003). Thus, the strategy of reducing time spent in physical education to increase academic performance may not have the desired effect. The evidence on in-school physical activity supports the provision of physical activity breaks during the school day as a way to increase fluid intelligence, time on task, and attention. However, it remains unclear what portion of these effects can be attributed to a break from academic time and what portion is a direct result of the specific demands/characteristics of the physical activity.

THE DEVELOPING bRAIN, PHYSICAL ACTIVITY, AND BRAIN HEALTH

The study of brain health has grown beyond simply measuring behavioral outcomes such as task performance and reaction time (e.g., cognitive processing speed). New technology has emerged that has allowed scientists to understand the impact of lifestyle factors on the brain from the body systems level down to the molecular level. A greater understanding of the cognitive components that subserve academic performance and may be amenable to intervention has thereby been gained. Research conducted in both laboratory and field settings has helped define this line of inquiry and identify some preliminary underlying mechanisms.

The Evidence Base on the Relationship of Physical Activity to Brain Health and Cognition in Older Adults

Despite the current focus on the relationship of physical activity to cognitive development, the evidence base is larger on the association of physical activity with brain health and cognition during aging. Much can be learned about how physical activity affects childhood cognition and scholastic achievement through this work. Despite earlier investigations into the relationship of physical activity to cognitive aging (see Etnier et al., 1997, for a review), the field was shaped by the findings of Kramer and colleagues (1999), who examined the effects of aerobic fitness training on older adults using a randomized controlled design. Specifically, 124 older adults aged 60 and 75 were randomly assigned to a 6-month intervention of either walking (i.e., aerobic training) or flexibility (i.e., nonaerobic) training. The walking group but not the flexibility group showed improved cognitive performance, measured as a shorter response time to the presented stimulus. Results from a series of tasks that tapped different aspects of cognitive control indicated that engagement in physical activity is a beneficial means of combating cognitive aging ( Kramer et al., 1999).

Cognitive control, or executive control, is involved in the selection, scheduling, and coordination of computational processes underlying perception, memory, and goal-directed action. These processes allow for the optimization of behavioral interactions within the environment through flexible modulation of the ability to control attention ( MacDonald et al., 2000; Botvinick et al., 2001). Core cognitive processes that make up cognitive control or executive control include inhibition, working memory, and cognitive flexibility ( Diamond, 2006), processes mediated by networks that involve the prefrontal cortex. Inhibition (or inhibitory control) refers to the ability to override a strong internal or external pull so as to act appropriately within the demands imposed by the environment ( Davidson et al., 2006). For example, one exerts inhibitory control when one stops speaking when the teacher begins lecturing. Working memory refers to the ability to represent information mentally, manipulate stored information, and act on the information ( Davidson et al., 2006). In solving a difficult mathematical problem, for example, one must often remember the remainder. Finally, cognitive flexibility refers to the ability to switch perspectives, focus attention, and adapt behavior quickly and flexibly for the purposes of goal-directed action ( Blair et al., 2005; Davidson et al., 2006; Diamond, 2006). For example, one must shift attention from the teacher who is teaching a lesson to one's notes to write down information for later study.

Based on their earlier findings on changes in cognitive control induced by aerobic training, Colcombe and Kramer (2003) conducted a meta-analysis to examine the relationship between aerobic training and cognition in older adults aged 55-80 using data from 18 randomized controlled exercise interventions. Their findings suggest that aerobic training is associated with general cognitive benefits that are selectively and disproportionately greater for tasks or task components requiring greater amounts of cognitive control. A second and more recent meta-analysis ( Smith et al., 2010) corroborates the findings of Colcombe and Kramer, indicating that aerobic exercise is related to attention, processing speed, memory, and cognitive control; however, it should be noted that smaller effect sizes were observed, likely a result of the studies included in the respective meta-analyses. In older adults, then, aerobic training selectively improves cognition.

Hillman and colleagues (2006) examined the relationship between physical activity and inhibition (one aspect of cognitive control) using a computer-based stimulus-response protocol in 241 individuals aged 15-71. Their results indicate that greater amounts of physical activity are related to decreased response speed across task conditions requiring variable amounts of inhibition, suggesting a generalized relationship between physical activity and response speed. In addition, the authors found physical activity to be related to better accuracy across conditions in older adults, while no such relationship was observed for younger adults. Of interest, this relationship was disproportionately larger for the condition requiring greater amounts of inhibition in the older adults, suggesting that physical activity has both a general and selective association with task performance ( Hillman et al., 2006).

Colcombe and colleagues (2003) investigated the relationship of aerobic fitness to gray and white matter tissue loss using magnetic resonance imaging (MRI) in 55 healthy older adults aged 55-79. They observed robust age-related decreases in tissue density in the frontal, temporal, and parietal regions using voxel-based morphometry, a technique used to assess brain volume. Reductions in the amount of tissue loss in these regions were observed as a function of fitness. Given that the brain structures most affected by aging also demonstrated the greatest fitness-related sparing, these initial findings provide a biological basis for fitness-related benefits to brain health during aging.

In a second study, Colcombe and colleagues (2006) examined the effects of aerobic fitness training on brain structure using a randomized controlled design with 59 sedentary healthy adults aged 60-79. The treatment group received a 6-month aerobic exercise (i.e., walking) intervention, while the control group received a stretching and toning intervention that did not include aerobic exercise. Results indicated that gray and white matter brain volume increased for those who received the aerobic fitness training intervention. No such results were observed for those assigned to the stretching and toning group. Specifically, those assigned to the aerobic training intervention demonstrated increased gray matter in the frontal lobes, including the dorsal anterior cingulate cortex, the supplementary motor area, the middle frontal gyrus, the dorsolateral region of the right inferior frontal gyrus, and the left superior temporal lobe. White matter volume changes also were evidenced following the aerobic fitness intervention, with increases in white matter tracts being observed within the anterior third of the corpus callosum. These brain regions are important for cognition, as they have been implicated in the cognitive control of attention and memory processes. These findings suggest that aerobic training not only spares age-related loss of brain structures but also may in fact enhance the structural health of specific brain regions.

In addition to the structural changes noted above, research has investigated the relationship between aerobic fitness and changes in brain function. That is, aerobic fitness training has also been observed to induce changes in patterns of functional activation. Functional MRI (fMRI) measures, which make it possible to image activity in the brain while an individual is performing a cognitive task, have revealed that aerobic training induces changes in patterns of functional activation. This approach involves inferring changes in neuronal activity from alteration in blood flow or metabolic activity in the brain. In a seminal paper, Colcombe and colleagues (2004) examined the relationship of aerobic fitness to brain function and cognition across two studies with older adults. In the first study, 41 older adult participants (mean age ~66) were divided into higher- and lower-fit groups based on their performance on a maximal exercise test. In the second study, 29 participants (aged 58-77) were recruited and randomly assigned to either a fitness training (i.e., walking) or control (i.e., stretching and toning) intervention. In both studies, participants were given a task requiring variable amounts of attention and inhibition. Results indicated that fitness (study 1) and fitness training (study 2) were related to greater activation in the middle frontal gyrus and superior parietal cortex; these regions of the brain are involved in attentional control and inhibitory functioning, processes entailed in the regulation of attention and action. These changes in neural activation were related to significant improvements in performance on the cognitive control task of attention and inhibition.

Child Development, Brain Structure, and Function

Effects of Regular Engagement in Physical Activity and Physical Fitness on Brain Structure

Recent advances in neuroimaging techniques have rapidly advanced understanding of the role physical activity and aerobic fitness may have in brain structure. In children a growing body of correlational research suggests differential brain structure related to aerobic fitness. Chaddock and colleagues (2010a, b) showed a relationship among aerobic fitness, brain volume, and aspects of cognition and memory. Specifically, Chaddock and colleagues (2010a) assigned 9- to 10-year-old preadolescent children to lower- and higher-fitness groups as a function of their scores on a maximal oxygen uptake (VO ₂max) test, which is considered the gold-standard measure of aerobic fitness. They observed larger bilateral hippocampal volume in higher-fit children using MRI, as well as better performance on a task of relational memory. It is important to note that relational memory has been shown to be mediated by the hippocampus ( Cohen and Eichenbaum, 1993; Cohen et al., 1999). Further, no differences emerged for a task condition requiring item memory, which is supported by structures outside the hippocampus, suggesting selectivity among the aspects of memory that benefit from higher amounts of fitness. Lastly, hippocampal volume was positively related to performance on the relational memory task but not the item memory task, and bilateral hippocampal volume was observed to mediate the relationship between fitness and relational memory ( Chaddock et al., 2010a). Such findings are consistent with behavioral measures of relational memory in children ( Chaddock et al., 2011) and neuroimaging findings in older adults ( Erickson et al., 2009, 2011) and support the robust nonhuman animal literature demonstrating the effects of exercise on cell proliferation ( Van Praag et al., 1999) and survival ( Neeper et al., 1995) in the hippocampus.

Effects of Regular Engagement in Physical Activity and Physical Fitness on Brain Function

Other imaging research has examined the neuroelectric system (i.e., ERPs) to investigate which cognitive processes occurring between stimulus engagement and response execution are influenced by fitness. Several studies ( Hillman et al., 2005, 2009; Pontifex et al., 2011) have examined the P3 component of the stimulus-locked ERP and demonstrated that higher-fit children have larger-amplitude and shorter-latency ERPs relative to their lower-fit peers. Classical theory suggests that P3 relates to neuronal activity associated with revision of the mental representation of the previous event within the stimulus environment ( Donchin, 1981). P3 amplitude reflects the allocation of attentional resources when working memory is updated ( Donchin and Coles, 1988) such that P3 is sensitive to the amount of attentional resources allocated to a stimulus ( Polich, 1997; Polich and Heine, 2007). P3 latency generally is considered to represent stimulus evaluation and classification speed ( Kutas et al., 1977; Duncan-Johnson, 1981) and thus may be considered a measure of stimulus detection and evaluation time ( Magliero et al., 1984; Ila and Polich, 1999). Therefore the above findings suggest that higher-fit children allocate greater attentional resources and have faster cognitive processing speed relative to lower-fit children ( Hillman et al., 2005, 2009), with additional research suggesting that higher-fit children also exhibit greater flexibility in the allocation of attentional resources, as indexed by greater modulation of P3 amplitude across tasks that vary in the amount of cognitive control required ( Pontifex et al., 2011). Given that higher-fit children also demonstrate better performance on cognitive control tasks, the P3 component appears to reflect the effectiveness of a subset of cognitive systems that support willed action ( Hillman et al., 2009; Pontifex et al., 2011).

Two ERP studies ( Hillman et al., 2009; Pontifex et al., 2011) have focused on aspects of cognition involved in action monitoring. That is, the error-related negativity (ERN) component was investigated in higher- and lower-fit children to determine whether differences in evaluation and regulation of cognitive control operations were influenced by fitness level. The ERN component is observed in response-locked ERP averages. It is often elicited by errors of commission during task performance and is believed to represent either the detection of errors during task performance ( Gehring et al., 1993; Holroyd and Coles, 2002) or more generally the detection of response conflict ( Botvinick et al., 2001; Yeung et al., 2004), which may be engendered by errors in response production. Several studies have reported that higher-fit children exhibit smaller ERN amplitude during rapid-response tasks (i.e., instructions emphasizing speed of responding; Hillman et al., 2009) and more flexibility in the allocation of these resources during tasks entailing variable cognitive control demands, as evidenced by changes in ERN amplitude for higher-fit children and no modulation of ERN in lower-fit children ( Pontifex et al., 2011). Collectively, this pattern of results suggests that children with lower levels of fitness allocate fewer attentional resources during stimulus engagement (P3 amplitude) and exhibit slower cognitive processing speed (P3 latency) but increased activation of neural resources involved in the monitoring of their actions (ERN amplitude). Alternatively, higher-fit children allocate greater resources to environmental stimuli and demonstrate less reliance on action monitoring (increasing resource allocation only to meet the demands of the task). Under more demanding task conditions, the strategy of lower-fit children appears to fail since they perform more poorly under conditions requiring the upregulation of cognitive control.

Finally, only one randomized controlled trial published to date has used ERPs to assess neurocognitive function in children. Kamijo and colleagues (2011) studied performance on a working memory task before and after a 9-month physical activity intervention compared with a wait-list control group. They observed better performance following the physical activity intervention during task conditions that required the upregulation of working memory relative to the task condition requiring lesser amounts of working memory. Further, increased activation of the contingent negative variation (CNV), an ERP component reflecting cognitive and motor preparation, was observed at posttest over frontal scalp sites in the physical activity intervention group. No differences in performance or brain activation were noted for the wait-list control group. These findings suggest an increase in cognitive preparation processes in support of a more effective working memory network resulting from prolonged participation in physical activity. For children in a school setting, regular participation in physical activity as part of an after-school program is particularly beneficial for tasks that require the use of working memory.

Adiposity and Risk for Metabolic Syndrome as It Relates to Cognitive Health

Recently published reports describe the relationship between adiposity and cognitive and brain health to advance understanding of the basic cognitive processes and neural substrates that may underlie the adiposity-achievement relationship. Bolstered by findings in adult populations (e.g., Debette et al., 2010; Raji et al., 2010; Carnell et al., 2011), researchers have begun to publish data on preadolescent populations indicating differences in brain function and cognitive performance related to adiposity (however, see Gunstad et al., 2008, for an instance in which adiposity was unrelated to cognitive outcomes). Specifically, Kamijo and colleagues (2012a) examined the relationship of weight status to cognitive control and academic achievement in 126 children aged 7-9. The children completed a battery of cognitive control tasks, and their body composition was assessed using dual X-ray absorptiometry (DXA). The authors found that higher BMI and greater amounts of fat mass (particularly in the midsection) were related to poorer performance on cognitive control tasks involving inhibition, as well as lower academic achievement. In follow-up studies, Kamijo and colleagues (2012b) investigated whether neural markers of the relationship between adiposity and cognition may be found through examination of ERP data. These studies compared healthy-weight and obese children and found a differential distribution of the P3 potential (i.e., less frontally distributed) and larger N2 amplitude, as well as smaller ERN magnitude, in obese children during task conditions that required greater amounts of inhibitory control ( Kamijo et al., 2012c). Taken together, the above results suggest that obesity is associated with less effective neural processes during stimulus capture and response execution. As a result, obese children perform tasks more slowly ( Kamijo et al., 2012a) and are less accurate ( Kamijo et al., 2012b, c) in response to tasks requiring variable amounts of cognitive control. Although these data are correlational, they provide a basis for further study using other neuroimaging tools (e.g., MRI, fMRI), as well as a rationale for the design and implementation of randomized controlled studies that would allow for causal interpretation of the relationship of adiposity to cognitive and brain health. The next decade should provide a great deal of information on this relationship.

LIMITATIONS

Despite the promising findings described in this chapter, it should be noted that the study of the relationship of childhood physical activity, aerobic fitness, and adiposity to cognitive and brain health and academic performance is in its early stages. Accordingly, most studies have used designs that afford correlation rather than causation. To date, in fact, only two randomized controlled trials ( Davis et al., 2011; Kamijo et al., 2011) on this relationship have been published. However, several others are currently ongoing, and it was necessary to provide evidence through correlational studies before investing the effort, time, and funding required for more demanding causal studies. Given that the evidence base in this area has grown exponentially in the past 10 years through correlational studies and that causal evidence has accumulated through adult and nonhuman animal studies, the next step will be to increase the amount of causal evidence available on school-age children.

Accomplishing this will require further consideration of demographic factors that may moderate the physical activity-cognition relationship. For instance, socioeconomic status has a unique relationship with physical activity ( Estabrooks et al., 2003) and cognitive control ( Mezzacappa, 2004). Although many studies have attempted to control for socioeconomic status (see Hillman et al., 2009; Kamijo et al., 2011, 2012a, b, c; Pontifex et al., 2011), further inquiry into its relationship with physical activity, adiposity, and cognition is warranted to determine whether it may serve as a potential mediator or moderator for the observed relationships. A second demographic factor that warrants further consideration is gender. Most authors have failed to describe gender differences when reporting on the physical activity-cognition literature. However, studies of adiposity and cognition have suggested that such a relationship may exist (see Datar and Sturm, 2006). Additionally, further consideration of age is warranted. Most studies have examined a relatively narrow age range, consisting of a few years. Such an approach often is necessary because of maturation and the need to develop comprehensive assessment tools that suit the various stages of development. However, this approach has yielded little understanding of how the physical activity-cognition relationship may change throughout the course of maturation.

Finally, although a number of studies have described the relationship of physical activity, fitness, and adiposity to standardized measures of academic performance, few attempts have been made to observe the relationship within the context of the educational environment. Standardized tests, although necessary to gauge knowledge, may not be the most sensitive measures for (the process of) learning. Future research will need to do a better job of translating promising laboratory findings to the real world to determine the value of this relationship in ecologically valid settings.

SUMMARY

From an authentic and practical to a mechanistic perspective, physically active and aerobically fit children consistently outperform their inactive and unfit peers academically on both a short- and a long-term basis. Time spent engaged in physical activity is related not only to a healthier body but also to enriched cognitive development and lifelong brain health. Collectively, the findings across the body of literature in this area suggest that increases in aerobic fitness, derived from physical activity, are related to improvements in the integrity of brain structure and function that underlie academic performance. The strongest relationships have been found between aerobic fitness and performance in mathematics, reading, and English. For children in a school setting, regular participation in physical activity is particularly beneficial with respect to tasks that require working memory and problem solving. These findings are corroborated by the results of both authentic correlational studies and experimental randomized controlled trials. Overall, the benefits of additional time dedicated to physical education and other physical activity opportunities before, during, and after school outweigh the benefits of exclusive utilization of school time for academic learning, as physical activity opportunities offered across the curriculum do not inhibit academic performance.

Both habitual and single bouts of physical activity contribute to enhanced academic performance. Findings indicate a robust relationship of acute exercise to increased attention, with evidence emerging for a relationship between participation in physical activity and disciplinary behaviors, time on task, and academic performance. Specifically, higher-fit children allocate greater resources to a given task and demonstrate less reliance on environmental cues or teacher prompting.

REFERENCES

Cohen NJ, Eichenbaum H. Memory, amnesia, and the hippocampal system. Cambridge, MA: MIT Press; 1993.

Dawson P, Guare R. Executive skills in children and adolescents: A practical guide to assessment and intervention. New York: Guilford Press; 2004. pp. 2-8.

Diamond A. The early development of executive functions. In: Bialystok E, Craik FIM, editors. In Lifespan cognition: Mechanisms of change. New York: Oxford University Press; 2006. pp. 70-95.

Eitle TM, Eitle DJ. Sociology of Education. 2002. Race, cultural capital, and the educational effects of participation in sports; pp. 123-146.

Hatfield BD, Hillman CH. The psychophysiology of sport: A mechanistic understanding of the psychology of superior performance. In: Singer RN, Hausenblas HA, Janelle C, editors. In The handbook of research on sport psychology. 2nd. New York: John Wiley; 2001. pp. 362-386.

Kamijo K, Pontifex MB, Khan NA, Raine LB, Scudder MR, Drollette ES, Evans EM, Castelli DM, Hillman CH. Cerebral Cortex. 2012c. [October 4, 2013]. The negative association of childhood obesity to the cognitive control of action monitoring. Epub ahead of print, November 11. cercor​.oxfordjournals​.org/content/early/2012/11/09/cercor​.bhs349.long. [ PMC free article: PMC3920765 ] [ PubMed: 23146965 ]

Kibbe DL, Hackett J, Hurley M, McFarland A, Schubert KG, Schultz A, Harris S. Ten years of TAKE 10! ®: Integrating physical activity with academic concepts in elementary school classrooms. Preventive Medicine. 2011;52(Suppl):S43-S50. [ PubMed: 21281670 ]

NASPE (National Association for Sport and Physical Education). Moving into the future: National Physical Education Content Standards. 2nd. Reston, VA: NASPE; 2004.

NRC (National Research Council)/IOM (Institute of Medicine). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press; 2000. [ PubMed: 25077268 ]

Raz N. Aging of the brain and its impact on cognitive performance: Integration of structural and functional findings. In: Craik FM, Salthouse TA, editors. In The handbook of aging and cognition. Vol. 2. Mahweh, NJ: Lawrence Erlbaum Associates; 2000. pp. 1-90.

Shephard RJ, Volle M, Lavallee H, LaBarre R, Jequier J, Rajic M. In Children and Sport. Berlin, Germany: Springer-Verlag; 1984. Required physical activity and academic grades: A controlled study; pp. 58-63.

Stewart JA, Dennison DA, Kohl HW III, Doyle JA. Exercise level and energy expenditure in the TAKE 10! ® in-class physical activity program. Journal of School Health. 2004;74(10):397-400. [ PubMed: 15724566 ]

Taylor MJ. Neural bases of cognitive development. In: Bialystok E, Craik FIM, editors. In Lifespan cognition: Mechanisms of change. Oxford, UK: Oxford University Press; 2006. pp. 15-26.

Welk GJ, Going SB, Morrow JR, Meredith MD. Development of new criterion-referenced fitness standards in the Fitnessgram ® program. American Journal of Preventive Medicine. 2011;41(2):6. [ PubMed: 21961614 ]

# data[].attributes.attachment_link.title
Physical Activity, Fitness, and Physical Education: Effects on Academic Performance

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Although academic performance stems from a complex interaction between intellect and contextual variables, health is a vital moderating factor in a child's ability to learn. The idea that healthy children learn better is empirically supported and well accepted (Basch, 2010), and multiple studies have confirmed that health benefits are associated with physical activity, including cardiovascular and muscular fitness, bone health, psychosocial outcomes, and cognitive and brain health (Strong et al., 2005; see Chapter 3).

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PE Classes Vital to Children's Physical and Mental Health

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PE Classes Vital to Children's Physical and Mental Health

# data[].attributes.attachment_link.readable_text
Childhood obesity is prevalent in the United States - more than 14 million children are considered obese - and that national health problem has gotten even worse over the past two years.

Data from the Centers for Disease Control and Prevention show that childhood obesity rose significantly around the nation during the pandemic. Experts say much of that increase can be attributed to schools being closed and children not having access to PE classes and the equipment and areas of play they ordinarily would.

Rebecca Dudovitz, MD, associate professor of general pediatrics, says physical education classes are key for helping children maintain their overall health.

"It's fair to say that more physical education time could help fight the obesity epidemic. The need for that became greater after the pandemic," Dr. Dudovitz said.

"Two things got universally worse for many children and families during the pandemic and that was obesity and mental health," she said. "Exercise is a key component for recovering from and preventing obesity and it's a key part of coping with and preventing mental health problems."

Mental health benefits

Dr. Dudovitz, a parent herself, said working with physical education teachers showed her the importance of PE beyond just exercise.

"It's truly an area of learning where there are core educational standards and many of those PE standards are around developing social-emotional skills," she said. "Data and research shows that exercise improves school performance and, in fact, children have an easier time focusing and learning after they have exercised.

"As parents, we need to think about the role that PE plays in our child's education and lives," she said. "We need to make sure we're advocating for enough PE minutes. Sometimes, I think PE gets de-emphasized and parents are often advocating for other educational opportunities. Meanwhile, our PE resources are kind of fading away."

Changing the PE format

Ancient are the days when the gym teacher strolled into class sporting short-shorts and a polo shirt with the school colors and a sack full of dodge balls. Programs such as UCLA Health Sound Body Sound Mind have helped shape a new era of physical education.

Providing state-of-the-art fitness equipment and fitness resources to more than 140 middle schools and high schools across Los Angeles, Sound Body Sound Mind has raised the bar on what gym class can look like.

From stationary indoor cycling bikes, to cable machines, row machines, and many other pieces of fitness equipment, Sound Body Sound Mind has transformed PE programs at certain schools with resources that provide access for students and support a more holistic approach to health and wellness.

Matt Flesock, executive director of Sound Body Sound Mind, says movement and exercise are essential for a child's overall development.

"Physical activity has been shown to improve students' academic performance, social-emotional learning and mental health," Flesock said. "The benefits are incredible."

Sound Body Sound Mind, which is dedicated to promoting self-confidence and healthy lifestyle choices among youth, continued to assist families and communities during the pandemic by ensuring students could incorporate movement into their daily academic programs despite distanced learning.

"I think Sound Body Sound Mind has done an amazing job on two fronts," Dr. Dudovitz said.

"One, it's giving schools and families the resources they need to exercise and that included fitness kits when families were stuck at home and schools were closed," she said. "Secondly, Sound Body Sound Mind helps to decrease the barriers to working out, especially for kids who don't view themselves as athletes by creating a safe place and safe space for students who are less experienced at working out."

For children who are exempt from physical education classes due to health conditions, parents can still find ways to make sure their children are getting the exercise they need.

Parents can ask for a 504 plan, which provides students with disabilities extra support or accommodations they need in school. Schools can then provide students with an individualized exercise plan or an adaptive PE program.

"As pediatricians, we often work with schools and parents to support them in developing and executing those plans. We also make sure children with medical problems still get their exercise," Dr. Dudovitz explained. "For example, children in wheelchairs or with physical disabilities need to move their muscles and they need that physical movement because it's vital to their overall health."

Is physical education enough to keep students healthy?

The California Department of Education requires 400 minutes of physical education every 10 days for students in grades 7-12 and 200 minutes for students in grades 1-6. Yet, California ranks No. 28 out of 50 states when it comes to childhood obesity.

Flesock noted that the mandates for physical education are not enough to keep children healthy.

"Children need to move 60 minutes a day, every day," Flesock said. "That is the recommendation. When you look at the California school mandate, that's not enough time: 400 minutes every 10 days or 200 minutes every five days. That is not equivalent to 60 minutes a day."

However, some people question whether schools should bear all the responsibility of making sure students meet the suggested 60 minutes of physical activity daily. If not, this would mean that parents, or students themselves, would need to make sure they are getting enough physical activity throughout the day.

That is easier said than done for many families. Dr. Dudovitz and Flesock acknowledge that for many children, PE class is the only time exclusively set aside for exercise. That's particularly true for children who do not have access to safe places to play outside of school. Families of students in underserved communities may not have the same resources or privileges of a safe environment for exercise in their neighborhood.

Flesock and his staff at UCLA Sound Body Sound Mind are continuously working on solutions to help schools, families and students in underrepresented communities get the resources they need to promote a healthy lifestyle.

Role of the parent

Dr. Dudovitz said parents have always had the important duty of making sure their child's health was a priority. What's changed over the generations, she said, is that the forces working against a healthy lifestyle have become so strong that it takes a concerted effort to fight against them.

"We see that there is a McDonald's or Starbucks on every corner and instead of getting out, we have Zoom calls and video games. It makes it so easy to fall into an unhealthy routine," she said. "All of these push against a healthy lifestyle and it takes more of an effort to maintain healthy practices."

Making sure your child focuses on fitness outside of physical education classes is possible, but requires commitment and follow-through from parent and child. Here are some steps parents can take:

Carve out daily time for physical activity

Use fun competition as a motivator

Incorporate nutrition (a healthy diet reinforces performance and ambition to stay fit)

Encourage your child to join a sports program or organized after-school fitness activity

Limit time on video games and cell phones

Dr. Dudovitz says parents have a responsibility to instill the importance of being healthy within their child, but the onus can't be totally on them.

"We need to advocate for healthier systems within the schools, for funding and structures to be in place equitably if we want to have a healthy generation," she said.
If you want more information about creating a healthy lifestyle for your child, please visit the Sound Body Sound Mind page.

# data[].attributes.attachment_link.title
PE classes vital to children's physical and mental health

# data[].attributes.attachment_link.description
Childhood obesity is prevalent in the United States - more than 14 million children are considered obese - and that national health problem has gotten even worse over the past two years. Data from the Centers for Disease Control and Prevention show that childhood obesity rose significantly around the nation during the pandemic.

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Supporting Physical Education in Schools for All Youth

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Supporting Physical Education in Schools for All Youth

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Abstract
This policy statement provides scientific evidence that schools are unique places where children should be engaged in physical activity. However, most school policies and programs are not supportive of physical activity in the school day, specifically physical education. Considering that 30.4% of youth are overweight or obese and that 76.8% do not meet the daily physical activity recommendations, and considering the benefits of physical activity with respect to increased ability to concentrate and learn, it is of the utmost importance to incorporate policies and programs that facilitate healthy engagement in physical activity in schools. Marginalized youth from low-income families, communities of color, immigrant communities, and others are disproportionately impacted by lack of supportive policies and programming. This policy statement calls for comprehensive and cooperative actions from the public health community, schools, administrators, researchers, and community members to increase physical activity opportunities through physical education in order to engage youth in at least 60 minutes of physical activity daily.
Relationship to Existing Policy Statements

APHA Policy Statement 20137: Improving Health and Wellness through Access to Nature

APHA Policy Statement 20172: Supporting the Updated National Physical Activity Plan

APHA Policy Statement 201515: The Role of Health Education Specialists in a Post-Health Reform Environment

APHA Policy Statement 20079: Building a Public Health Infrastructure for Physical Activity Promotion

APHA Policy Statement 9709: Promoting Public Health Through Physical Activity

APHA Policy Statement 20044: Creating Policies on Land Use and Transportation Systems that Promote Public Health

APHA Policy Statement 20058: Supporting the WHO Global Strategy on Diet, Physical Activity and Health

APHA Policy Statement 200619: Urgent Call for a Nationwide Public Health Infrastructure and Action to Reverse the Obesity Epidemic

APHA Policy Statement 20079: Building a Public Health Infrastructure for Physical Activity Promotion

APHA Policy Statement 201514: Building Environments and a Public Health Workforce to Support Physical Activity Among Older Adults

APHA Policy Statement 20121: Supporting the National Physical Activity Plan

APHA Policy Statement 201415: Support for Social Determinants of Behavioral Health and Pathways for Integrated and Better Public Health

Problem Statement
Obesity is an important health issue among children in the United States. According to the 2019 National Health and Nutrition Examination Survey, 16.1% of U.S. youth are overweight and 19.3% are obese.[1] Moreover, racial, socioeconomic, and gender disparities exist in terms of risk factors associated with being overweight or obese. The chronic disease burden is consistent with the disproportionately high percentages of overweight and obese youth in racial minority and socioeconomically disadvantaged populations. According to data from the 2019 Youth Risk Behavior Surveillance System (YRBSS), 37.7% of Black youth and 38.8% of Hispanic youth are overweight or obese, as compared with just 27.7% of White youth.[2]

P hysical inactivity is a significant risk factor for obesity and other chronic conditions.[3]As the proportion of students who are overweight or obese has increased, so has inactivity. Empirical evidence suggests that physical activity may be used as a standalone strategy to decrease adiposity among children.[4] It is recommended that school-aged children and adolescents (6-17 years of age) engage in 60 minutes of physical activity seven days per week.[5] According to data from the 2019 YRBSS, 76.8% of youth do not meet the recommended amounts of physical activity.[2] The same data set indicates that adolescent girls, in particular, are at a higher risk for being inactive as they age; 84.6% of girls do not meet the physical activity guideline of 60 minutes per day seven days a week, as compared with 69.1% of boys.[2] In addition, inactive youth are more likely to be inactive as adults.[6] Starting physical activity early is essential to prevent inactivity in adulthood and older adulthood.

Physical activity provides benefits beyond physical health. For example, it is associated with a reduced risk for depression.[7] Trends for contemplating and making a plan for suicide are increasing among White, Hispanic, and Black youth, and there are racial and ethnic disparities in terms of mental health challenges among youth.[5] In 2019, 40.0% of Hispanic youth reported persistent feelings of sadness or hopelessness, as compared with 36.0% of White youth and 31.5% of Black youth.[5]

In addition to the long-term health benefits of child physical activity, there are numerous academic-related benefits, which the body of evidence continues to expand.[8] Extensive research has demonstrated strong positive correlations between physical activity and higher levels of physical fitness and academic achievement, educational attainment, academic performance, and brain functioning.[8-10] In fact, physical activity participation has both intermediate and long-term benefits with respect to academic performance. Research has shown that, immediately following engagement in physical activity, children have improved concentration on classroom tasks, which may potentially enhance learning.[8]

It is recommended that schools provide 150 minutes of instructional physical education for elementary school children and 225 minutes for middle and high school students per week for the entire school year.[11] However, only Oregon and the District of Columbia have requirements that meet the recommendations for minutes of physical education.[12] Physical education requirements notably decrease after the fifth grade, which aligns with significant decreases in physical activity in youth. Only 8.7% of schools require physical education for 12th grade, as compared with 45.1% of schools for fifth grade.[13]

The lack of universal physical education requirements at all grade levels and the lack of funding dedicated to physical education facilitate inactivity. The median school physical education budget in the United States is just $764 per year,[12] which may further hinder schools from meeting physical education recommendations. Ohinmaa and colleagues suggested that grants, donations, and fundraising account for about half of all funding for school health.[14] Improving physical education policies nationwide has the potential to reduce overall health care costs by $60.5 million within 10 years.[15]

Students who attend physical education in school are two to three times more likely to be physically active outside of school and nearly twice as likely to be active in adulthood.[16] Furthermore, physical education has been shown to be an opportunity for students to gain many of their recommended minutes of physical activity, but many students do not attend or participate in these classes.[13] According to 2019 YRBSS data, about half of high school students attend physical education classes one or more days per week.[2] Therefore, targeting middle and high schools is uniquely important because a significant drop in physical education attendance and physical activity participation occurs between the seventh and 12th grades.[11]

Evidence-Based Strategies to Address the Problem
Youth spend a significant portion of their time at school[17]; therefore, schools are one of the most important places for physical activity interventions.[18] According to the Society of Health and Physical Educators, schools should require physical education for students in kindergarten through grade 12.[19] Specifically, all students within secondary school (which includes middle school and high school) should achieve 225 minutes of physical activity per week, while students in primary school (which includes elementary school) should achieve 150 minutes per week.[19]

Current evidence-based strategies to increase physical activity among youth are described below.

Improving school-based physical education: According to the Community Preventive Services Task Force (CPSTF),[20] enhanced school-based physical education involves changing the curriculum and coursework for K-12th-grade students to increase the amount of time students spend engaging in moderate to vigorous physical activity (MVPA) during physical education classes. Enhanced school-based physical education is defined as increasing the amount of time students spend completing MVPA during physical education classes to at least 50% of class time.[20] The CPSTF specifically recommended improving physical education teaching strategies by (1) incorporating modified games and substituting sedentary games with active games and (2) including physical education lesson plans that incorporate fitness and circuit training activities.[20]

Lonsdale and colleagues highlighted effective strategies to increase MVPA, which included teacher professional learning focusing on class organization, management, and instruction and supplementing the usual physical education lessons with high-intensity activity (i.e., fitness infusion).[21] A systematic review of 14 studies showed that students who participated in enhanced school-based physical education classes engaged in 24% more MVPA.[21] Also, groups that received enhanced school-based physical education spent on average 53% of their time engaged in MVPA.[21] In addition, Zhou and Wang found that team games were reported to accumulate the most MVPA time, with movement-based activities (such as gymnastics and dance) having the highest amounts of MVPA and knowledge-based activities (i.e., lesson-based instruction) having the lowest amounts.[22] Implementation of enhanced school-based physical education aligns with the Healthy People 2030 objectives, which aim to increase the proportion of adolescents who meet current federal physical activity guidelines for aerobic physical activity and muscle-strengthening activity.[23]

It is important that physical education classes be taught by state‐licensed or state‐certified teachers who are endorsed to teach physical education. In a meta-analytic review, Hollis and colleagues found that youth were engaged in MVPA for an average of 44.8% of lesson time.[24] Low MVPA levels in physical education lessons could be the result of pedagogical characteristics often observed in typical lessons, such as stopping physical activity to provide instruction, observing demonstrations related to the activity, or organizing equipment or student groups.[25] An examination of time allotment in terms of lesson context revealed that 30% of lesson time was spent in game play, 29% in fitness, 20% in classroom management, 9% in knowledge-related activities, and 5% in skill-related activities.[15] Similar results were found in a study by Powell and colleagues in which the average length of physical education lessons was 35.3 minutes, with only 15 minutes of MVPA during physical education.[26] Results further demonstrated that 34% of the lesson was spent standing and 21.7% was spent sitting, with time sitting being directly linked to knowledge attainment.[26]

In conclusion, a significant proportion of physical education instruction time is spent on classroom management, instruction, and transitional periods. While these periods are necessary, they detract from the overall time youth spend participating in MVPA. It is, therefore, recommended that all physical education courses be taught by qualified individuals who have received formal training in physical education pedagogy. SHAPE America has specifically recommended that physical education be taught by an endorsed state‐licensed or state‐certified teacher.[11] This educational licensure or certification requirement would ensure that the physical education curriculum used in schools is appropriate and maximizes the time students spend engaging in MVPA while also aligning with national and/or state physical education standards for K-12 physical education.[11]

Increasing the frequency of physical education: Scientific evidence has shown that increasing the frequency of physical education can improve overall physical activity among youth. Research indicates that only 25.9% of high school students attend physical education classes five days per week.[5] Findings from the School Health Policies and Practices Study showed that less than 4% of elementary and middle schools require physical education or similar activity every day throughout the school year.[18] Moreover, less than 9% of middle schools require physical education at least three days per week.[18] Physical education instruction for high school students decreased from 29.9% in 2017 to 25.9% in 2019.[5]

The benefits of regular physical activity are well documented and include improvements in bone and muscle development, cardiorespiratory fitness, and weight control; reduced symptoms of depression and anxiety; and reduced risks of heart disease, cancer, type 2 diabetes, and hypertension.[3] Research has demonstrated that physical activity throughout the school day is associated with better school performance.[8] Healthy People 2030 objectives highlight the importance of increased physical activity through improved physical education in both public and private school systems. Specifically, the Educational and Community-Based Programs workgroup aims to increase the proportion of adolescents who participate in daily school-based physical education.[7]

Reduction or removal of waivers, substitutions, and exemptions for physical education: Another important strategy to increase school-based MVPA is the reduction or removal of waivers, substitutions, and exemptions for physical education. According to the Shape of the Nation 2016 report, 30 U.S. states allow student exemptions from physical education classes, and 31 states allow students to substitute activities such as marching band, cheerleading, drill team, or intramural sports for physical education credit.[12] SHAPE America issued a position statement according to which school districts and schools should not allow waivers or exemptions from physical education class time or credit requirements.[11] Specifically, SHAPE firmly asserted that all students should be required to complete physical education courses and that state, district, and school policies should not allow substitutions, waivers, or exemptions for physical education courses, class time, or credit requirements. By allowing waivers, substitutions, and exemptions for physical education, schools and districts eliminate opportunities for students to be active at a time when physical activity levels are at an all-time low among youth.[11] As mentioned, schools offer a unique setting to teach children the value of physical activity as well as a structured, supervised environment in which children can learn the necessary skills to encourage lifelong physical activity.[11]

Culturally tailored physical education: Multiple organizations have reported the need to ensure culturally tailored physical education for all populations, especially marginalized populations such as minority racial, ethnic, and cultural groups; girls and women; refugees; people experiencing homelessness; LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning) populations; and others.[27,28] The United Nations Educational, Scientific and Cultural Organization's Guidelines for Policy-Makers on Quality Physical Education stated the need for and importance of providing physical education for minority groups. According to the guidelines, (1) curricula should be flexible and adaptable for all groups, (2) teachers should be professionally qualified and capable of providing physical education for all students, and (3) school policies and practices should provide appropriate infrastructure, faculties, equipment, and teaching material for all students.[28]

Lastly, it is recommended that teachers have access to resources such as community health workers who can provide culturally specific guidance on physical education. Community health workers are particularly effective because of the cultural and linguistic connections they have with the communities they serve.[29] Providing culturally appropriate physical education may increase physical activity,[30] decrease obesity,[31] and improve the overall health of minority groups by increasing social support, promoting healthy lifestyles, and increasing knowledge of disease prevention.[32]

Adaptive physical education: According to the Physical Activity Guidelines for Americans, children and adolescents with disabilities are more likely to be inactive than those without disabilities.[7] It is recommended that children and adolescents with disabilities still aim to meet the key guideline of 60 minutes of physical activity every day when possible. If youth are unable to participate in the physical activities or durations needed to meet the key guidelines, it is recommended that they be as active as possible and avoid being inactive.[7]

Youth with disabilities should work with health care professionals or physical activity specialists to learn about the types and amounts of physical activity appropriate for them.[7] The Adapted Physical Education National Standards were developed to ensure that physical education for children with disabilities be delivered by a qualified adapted physical educator. According to these standards, physical education teachers should use sound teaching practices to ensure the inclusion and representation of all skill and ability levels.[33] Specifically, master physical educators should be well prepared to provide knowledge acquisition as well as physical activity opportunities for all abilities to create active and healthy lifestyles for all students. In addition, the standards outline high expectations for a physically active lifestyle. Lastly, it is expected that master physical educators will maintain a stimulating, productive learning environment that holds all students to the highest expectations for a physically active lifestyle.[33]

Conclusion: In conclusion, schools are the ideal and recommended setting for the promotion of physical activity among youth, and physical education is the primary vehicle through which to achieve this objective in schools.[34] Improving the quality and quantity of physical education courses will give youth more opportunities to attain the recommended amount of physical activity each day. Reducing physical education waivers would ensure that youth are not exploiting a loophole in the system. Advocating for culturally tailored physical education and adaptive physical education would foster an inclusive environment in which all children are able to be physically active and healthy.

Opposing Arguments/Evidence
Few would disagree that physical activity and time spent engaged in physical education are important for youth development and overall health. The primary opposing arguments tend to stem from the poorly designed physical education curriculum and the time taken away from other subjects amid increased pressure to raise standards and scores in subjects such as math, science, and English. As a result, time allocated to physical education and the perceived importance of physical education lessons have been reduced.

However, there is a substantial amount of evidence that physical activity can help improve academic achievement, including overall grades and standardized test scores.[34] In a systematic review of 43 articles and 50 studies, the Centers for Disease Control and Prevention (CDC) determined that physical activity has a positive impact on cognitive skills, attitudes, and academic achievement.[34] Specifically, physical activity enhanced concentration and attention and improved classroom behavior.[34] The review also showed that increasing time during the school day for physical activity does not appear to take away from overall academic performance.[34] Therefore, the CDC recommended that schools increase the amount of time students spend in physical education or consider adding components to increase the quality of physical education classes.[34] As highlighted in the evidence-based strategies to improve school-based MVPA, the CPSTF recommended use of enhanced physical education, including improved physical education teaching strategies, by incorporating modified, more active games and physical education lesson plans that involve fitness and circuit training activities.[20]

Alternative Strategies
Enhancing, encouraging, and maintaining physical education class duration and quality are vital to the health and well-being of children, particularly in terms of their physical activity behaviors. However, there are several alternative strategies to increase the physical activity of youth that should be considered in conjunction with retaining the importance of physical education.

Before- and after-school physical activity programs: According to the World Health Organization, after-school activities are a key avenue to supplement youth MVPA levels.[35] After-school physical activity could include physical activity clubs, intramural programs, informal play on school grounds, physical activity in school-based before- and after-care programs, and interscholastic sports.[18] Mayorga-Vega and colleagues found that physical activity that took place after school hours achieved 36% of the recommended 60 minutes of MVPA per day.[36] However, adolescents still reported a higher level of MVPA during physical education classes than during school recess and after-school programs.[36]

Only about 26% of the nation's public and private schools provide access to their physical activity spaces and facilities for all individuals outside of normal school hours. In addition, a steady decline has been observed in provision of access to physical activity facilities during nonschool hours.[37] Therefore, schools can further encourage physical activity by opening up their facilities for community use.[18]

Increasing active transportation to and from school: According to the CPSTF, walking or bicycling to and from school provides children and adolescents with an opportunity to be physically active most days of the week.[38] Interventions such as the Safe Routes to School program could increase active transportation to and from school and reduce pedestrian and bicycle injury rates. However, there is not enough evidence to show that school travel leads to increases in students' overall daily physical activity.[38]

Recess: Recess is defined as a regularly scheduled period during the school day for physical activity and play that are monitored by trained staff or volunteers.[13] Recess has been directly related to increased physical activity, improved memory, improved attention, improved concentration, decreased classroom disruptive behavior, improved social and emotional development, and academic achievement.[8,39-41] It is recommended that elementary, middle, and high school students have a minimum of 20 minutes of daily recess.[39] The CDC has further recommended that recess and physical education be separate, distinct physical activity opportunities, which creates separate times for skill acquisition (physical education) and active play (recess).[39] Also, the CDC has recommended that schools provide students with adequate, designated, and safe spaces, facilities, equipment, and supplies for both indoor and outdoor recess (e.g., playground markings, physical activity zones, activity cards).[39] Lastly, students should not be excluded from recess for disciplinary reasons or academic performance because such practices promote negative reinforcement.[39]

Classroom-based physical activity: Classroom-based physical activity, including single physical activity sessions, may increase student attention, concentration, and memory; increase motivation and enjoyment of learning; and reduce behavior issues.[8,40] Classroom-based physical activity integration may include physically active lessons, physical activity before a test, physical activity breaks, energizers, brain boosters, and active classrooms (a teaching technique that intentionally blends physical activity into academic lessons to satisfy the learning outcomes of the classroom without sacrificing time spent engaging in physical activity).[8,40,42] Further guidance by the CDC and other national organizations includes providing teachers with ongoing professional development to integrate physical activity into planned academic instruction as a means of reinforcing academic concepts.[40]

Action Steps
Increasing physical activity among school-aged children is a vital investment in the health and well-being of youth in the United States. Increasing physical activity at this critical age has the potential to build healthier, happier young adults. Schools should support physical activity through culturally appropriate, high-quality physical education. Schools; local, state, and federal education agencies; public health departments; policymakers; and researchers should address the following objectives relevant to public health priority setting in order to advance school-based physical activity programming and activities:

1. Federal agencies should develop national policies on physical education that are consistent with the larger national strategies to increase physical activity among youth.

2. Federal and state governments should increase funding for schools to implement high-quality physical education programming

3. State and local education departments should improve physical education requirements to provide the opportunity for 60 minutes of MVPA each school day.

4. Policymakers at state and local education departments should be made aware of the importance of physical education provided by schools.

5. Schools should require that all physical education teachers be appropriately credentialed to deliver culturally appropriate, high-quality physical education.

6. Schools should solicit involvement and expertise from state and local public health departments and physical activity researchers on culturally specific, evidence-based strategies to improve school-based physical education.

7. Principals and superintendents of schools should develop action plans to improve physical education for all of their students. Youth should have the opportunity to engage in 60 minutes of physical activity during the school day.

8. Principals and superintendents should reduce or eliminate policies allowing waivers for physical education. Waivers should be considered on a case-by-case basis.

9. Schools and school districts should engage in collaborative efforts to share the results of successfully implemented physical education programs.

10. Schools and researchers should collaborate in studying physical activity among diverse youth who have been traditionally understudied and systematically underserved. Furthermore, researchers should be encouraged to develop innovative programs for youth in school settings that promote physical activity for all.

11. Greater diversity in programming should be implemented in schools so that youth can be exposed to a variety of activities that those of all abilities and cultures might enjoy.

12. Youth, families, community members, and local organizations should advocate to their school districts and legislative bodies for culturally appropriate, high-quality physical education in their local schools.

13. Public health departments should partner with and support physical education teachers and programs. This support should include school-based physical activity in community health assessments and community health improvement plans highlighting the importance of physical activity in preventing chronic disease and providing mental and cognitive benefits.

References
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9. Kari JT, Pehkonen J, Hutri-Kähönen N, Raitakari OT, Tammelin TH. Longitudinal associations between physical activity and educational outcomes. Med Sci Sports Exerc. 2017;49(11):2158-2166.
10. Kohl HW, Cook HD. Physical activity, fitness, and physical education: effects on academic performance. Available at: https://www.ncbi.nlm.nih.gov/books/NBK201501/. Accessed October 20, 2021.
11. Society of Health and Physical Educators. The essential components of physical education. Available at: https://www.shapeamerica.org/uploads/pdfs/TheEssentialComponentsOfPhysicalEducation.pdf. Accessed October 20, 2021.
12. Society of Health and Physical Educators (2016). 2016 shape of the nation: status of physical education in the U.S. Available at: https://www.shapeamerica.org//advocacy/son/2016/upload/Shape-of-the-Nation-2016_web.pdf. Accessed October 20, 2021.
13. Springboard to Active Schools. Keep recess in schools. Available at: https://www.cdc.gov/healthyschools/physicalactivity/pdf/Recess_Data_Brief_CDC_Logo_FINAL_191106.pdf. Accessed October 20, 2021.
14. Ohinmaa A, Langille JL, Jamieson S, Whitby C, Veugelers PJ. Costs of implementing and maintaining comprehensive school health: the case of the Annapolis Valley Health Promoting Schools program. Can J Public Health. 2011;102(6):451-454.
15. Barrett JL, Gortmaker SL, Long MW, et al. Cost effectiveness of an elementary school active physical education policy. Am J Prev Med. 2015;49(1):148-159.
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17. Synder TD, de Brey C, Dillow SA. Digest of education statistics. Available at: https://files.eric.ed.gov/fulltext/ED580954.pdf. Accessed October 20, 2021.
18. Centers for Disease Control and Prevention. School Health Policies and Practices Study, 2014. Available at: https://www.cdc.gov/healthyyouth/data/shpps/pdf/shpps-results_2016.pdf. Accessed October 20, 2021.
19. Society of Health and Physical Educators. A-Z of social justice physical education. Available at: https://www.shapeamerica.org/uploads/pdfs/2020/publications/joperd/The-A%E2%80%93Z-of-Social%20Justice-Physical-Education-P1.pdf. Accessed October 20, 2021.
20. Community Preventive Services Task Force. Annual report to Congress: 2013. Available at: https://www.thecommunityguide.org/content/tffrs-physical-activity-interventions-increase-active-travel-school. Accessed October 20, 2021.
21. Lonsdale C, Rosenkranz R, Peralta L, et al. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical activity lessons. Prev Med. 2013;56:152-161.
22. Zhou Y, Wang L. (2019). Correlates of physical activity of students in secondary school physical education: a systematic review of literature. BioMed Res Int. 2019;2019:4563484.
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31. Falbe J, Cadiz AA, Tantoco NK, Thompson HR, Madsen KA. Active and healthy families: a randomized controlled trial of a culturally tailored obesity intervention for Latino children. Acad Pediatr. 2015;15(4):386-395.
32. Joo JY, Liu MF. Culturally tailored interventions for ethnic minorities: A scoping review. Nurs Open. 2021;8(5):2078-2090.
33. APENS. Adapted Physical Education National Standards. Available at: https://apens.org/national_standard.html. Accessed October 20, 2021.
34. Centers for Disease Control and Prevention. The association between school based physical activity, including physical education, and academic performance. Available at: https://www.cdc.gov/healthyyouth/health_and_academics/pdf/pa-pe_paper.pdf. Accessed October 20, 2021.
35. World Health Organization. School policy framework: implementation of the WHO global strategy on diet, physical activity and health. Available at: https://www.who.int/dietphysicalactivity/SPF-en-2008.pdf. Accessed October 20, 2021.
36. Mayorga-Vega D, Saldias MP, Viciana J. Comparison of moderate-to-vigorous physical activity levels between physical education, school recess and after-school time in secondary school students: an accelerometer-based study. Kinesiology. 2017;49(2):242-251.
37. U.S. Department of Health and Human Services. Healthy People 2020. Physical activity objectives. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity/objectives. Accessed October 20, 2021.
38. Community Guide. Physical activity: interventions to increase active travel to school. Available at: https://www.thecommunityguide.org/content/tffrs-physical-activity-interventions-increase-active-travel-school. Accessed October 20, 2021.
39. Centers for Disease Control and Prevention and Society of Health and Physical Educators. Strategies for recess in schools. Available at: https://www.shapeamerica.org/uploads/pdfs/recess/SchoolRecessStrategies.pdf. Accessed October 20, 2021.
40. Centers for Disease Control and Prevention. Strategies for classroom physical activity in schools. Available at: https://www.cdc.gov/healthyschools/physicalactivity/pdf/classroompastrategies_508.pdf. Accessed October 20, 2021.
41. Zavacky F, Michael SL. Keeping recess in schools. J Phys Educ Recreation Dance. 2017;88(5):46-53.
42. Bedard C, St. John L, Bremer E, Graham JD, Cairney J. A systematic review and meta-analysis on the effects of physically active classrooms on educational and enjoyment outcomes in school age children. PLoS One. 2019;14(6):1-19.

# data[].attributes.attachment_link.title
Supporting Physical Education in Schools for All Youth

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Abstract This policy statement provides scientific evidence that schools are unique places where children should be engaged in physical activity. However, most school policies and programs are not supportive of physical activity in the school day, specifically physical education.

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Physical education is the foundation of a Comprehensive School Physical Activity Program. 1, 2 It is an academic subject characterized by a planned, sequential K-12 curriculum (course of study) that is based on the national standards for physical education. ²⁻⁴ Physical education provides cognitive content and instruction designed to develop motor skills, knowledge, and behaviors for physical activity and physical fitness. ²⁻⁴ Supporting schools to establish physical education daily can provide students with the ability and confidence to be physically active for a lifetime. ²⁻⁴

There are many benefits of physical education in schools. When students get physical education, they can ⁵⁻⁷:

Increase their level of physical activity.

Improve their grades and standardized test scores.

Stay on-task in the classroom.

Increased time spent in physical education does not negatively affect students' academic achievement.

Strengthen Physical Education in Schools [PDF - 437 KB] -This data brief defines physical education, provides a snapshot of current physical education practices in the United States, and highlights ways to improve physical education through national guidance and practical strategies and resources. This was developed by Springboard to Active Schools in collaboration with CDC.

Secular Changes in Physical Education Attendance Among U.S. High School Students, YRBS 1991-2013

The Secular Changes in Physical Education Attendance Among U.S. High School Students report [PDF - 3 MB] explains the secular changes (long-term trends) in physical education attendance among US high school students over the past two decades. Between 1991 and 2013, US high school students' participation in school-based physical education classes remained stable, but at a level much lower than the national recommendation of daily physical education. In order to maximize the benefits of physical education, the adoption of policies and programs aimed at increasing participation in physical education among all US students should be prioritized. Download the report for detailed, nationwide findings.

Physical Education Analysis Tool (PECAT)

The Physical Education Curriculum Analysis Tool (PECAT) [PDF - 6 MB] is a self-assessment and planning guide developed by CDC. It is designed to help school districts and schools conduct clear, complete, and consistent analyses of physical education curricula, based upon national physical education standards.

Visit our PECAT page to learn more about how schools can use this tool.

1. Centers for Disease Control and Prevention. A Guide for Developing Comprehensive School Physical Activity Programs. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013.

2. Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and physical activity. MMWR. 2011;60(RR05):1-76.

3. Institute of Medicine. Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington, DC: The National Academies Press; 2013. Retrieved from http://books.nap.edu/openbook.php?record_id=18314&page=R1.

4. SHAPE America. The Essential Components of Physical Education. Reston, VA: SHAPE America; 2015. Retrieved from http://www.shapeamerica.org/upload/TheEssentialComponentsOfPhysicalEducation.pdf [PDF - 392 KB].

5. Centers for Disease Control and Prevention. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA; Centers for Disease Control and Prevention, US Department of Health and Human Services; 2010.

6. Centers for Disease Control and Prevention. Health and Academic Achievement. Atlanta: US Department of Health and Human Services; 2014.

7. Michael SL, Merlo C, Basch C, et al. Critical connections: health and academics. Journal of School Health. 2015;85(11):740-758.

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centers for disease control and prevention

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regular physical activity in adolescents

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comprehensive school physical activity program

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physical education curriculum analysis tool

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Physical education benefits students by increasing their level of physical activity, improving their grades and standardized test scores, and helping them stay on-task in the classroom.

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National Library of Medicine - Effects on Academic Performance

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National Library of Medicine - Effects on Academic Performance

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Evidence suggests that increasing physical activity and physical fitness may improve academic performance and that time in the school day dedicated to recess, physical education class, and physical activity in the classroom may also facilitate academic performance.

Available evidence suggests that mathematics and reading are the academic topics that are most influenced by physical activity. These topics depend on efficient and effective executive function, which has been linked to physical activity and physical fitness.

Executive function and brain health underlie academic performance. Basic cognitive functions related to attention and memory facilitate learning, and these functions are enhanced by physical activity and higher aerobic fitness.

Single sessions of and long-term participation in physical activity improve cognitive performance and brain health. Children who participate in vigorous- or moderate-intensity physical activity benefit the most.

Given the importance of time on task to learning, students should be provided with frequent physical activity breaks that are developmentally appropriate.

Although presently understudied, physically active lessons offered in the classroom may increase time on task and attention to task in the classroom setting.

PHYSICAL FITNESS AND PHYSICAL ACTIVITY: RELATION TO ACADEMIC PERFORMANCE

State-mandated academic achievement testing has had the unintended consequence of reducing opportunities for children to be physically active during the school day and beyond. In addition to a general shifting of time in school away from physical education to allow for more time on academic subjects, some children are withheld from physical education classes or recess to participate in remedial or enriched learning experiences designed to increase academic performance ( Pellegrini and Bohn, 2005; see Chapter 5). Yet little evidence supports the notion that more time allocated to subject matter will translate into better test scores. Indeed, 11 of 14 correlational studies of physical activity during the school day demonstrate a positive relationship to academic performance ( Rasberry et al., 2011). Overall, a rapidly growing body of work suggests that time spent engaged in physical activity is related not only to a healthier body but also to a healthier mind ( Hillman et al., 2008).

Children respond faster and with greater accuracy to a variety of cognitive tasks after participating in a session of physical activity ( Tomporowski, 2003; Budde et al., 2008; Hillman et al., 2009; Pesce et al., 2009; Ellemberg and St-Louis-Deschênes, 2010). A single bout of moderate-intensity physical activity has been found to increase neural and behavioral concomitants associated with the allocation of attention to a specific cognitive task ( Hillman et al., 2009; Pontifex et al., 2012). And when children who participated in 30 minutes of aerobic physical activity were compared with children who watched television for the same amount of time, the former children cognitively outperformed the latter ( Ellemberg and St-Louis-Desêhenes, 2010). Visual task switching data among 69 overweight and inactive children did not show differences between cognitive performance after treadmill walking and sitting ( Tomporowski et al., 2008b).

When physical activity is used as a break from academic learning time, postengagement effects include better attention ( Grieco et al., 2009; Bartholomew and Jowers, 2011), increased on-task behaviors ( Mahar et al., 2006), and improved academic performance ( Donnelly and Lambourne, 2011). Comparisons between 1st-grade students housed in a classroom with stand-sit desks where the child could stand at his/her discretion and in classrooms containing traditional furniture showed that the former children were highly likely to stand, thus expending significantly more energy than those who were seated ( Benden et al., 2011). More important, teachers can offer physical activity breaks as part of a supplemental curriculum or simply as a way to reset student attention during a lesson ( Kibbe et al., 2011; see Chapter 6) and when provided with minimal training can efficaciously produce vigorous or moderate energy expenditure in students ( Stewart et al., 2004). Further, after-school physical activity programs have demonstrated the ability to improve cardiovascular endurance, and this increase in aerobic fitness has been shown to mediate improvements in academic performance ( Fredericks et al., 2006), as well as the allocation of neural resources underlying performance on a working memory task ( Kamijo et al., 2011).

Over the past three decades, several reviews and meta-analyses have described the relationship among physical fitness, physical activity, and cognition (broadly defined as all mental processes). The majority of these reviews have focused on the relationship between academic performance and physical fitness-a physiological trait commonly defined in terms of cardiorespiratory capacity (e.g., maximal oxygen consumption; see Chapter 3). More recently, reviews have attempted to describe the effects of an acute or single bout of physical activity, as a behavior, on academic performance. These reviews have focused on brain health in older adults ( Colcombe and Kramer, 2003), as well as the effects of acute physical activity on cognition in adults ( Tomporowski, 2003). Some have considered age as part of the analysis ( Etnier et al., 1997, 2006). Reviews focusing on research conducted in children ( Sibley and Etnier, 2003) have examined the relationship among physical activity, participation in sports, and academic performance ( Trudeau and Shephard, 2008, 2010; Singh et al., 2012); physical activity and mental and cognitive health ( Biddle and Asare, 2011); and physical activity, nutrition, and academic performance ( Burkhalter and Hillman, 2011). The findings of most of these reviews align with the conclusions presented in a meta-analytic review conducted by Fedewa and Ahn (2011). The studies reviewed by Fedewa and Ahn include experimental/quasi-experimental as well as cross-sectional and correlational designs, with the experimental designs yielding the highest effect sizes. The strongest relationships were found between aerobic fitness and achievement in mathematics, followed by IQ and reading performance. The range of cognitive performance measures, participant characteristics, and types of research design all mediated the relationship among physical activity, fitness, and academic performance. With regard to physical activity interventions, which were carried out both within and beyond the school day, those involving small groups of peers (around 10 youth of a similar age) were associated with the greatest gains in academic performance.

The number of peer-reviewed publications on this topic is growing exponentially. Further evidence of the growth of this line of inquiry is its increased global presence. Positive relationships among physical activity, physical fitness, and academic performance have been found among students from the Netherlands ( Singh et al., 2012) and Taiwan ( Chih and Chen, 2011). Broadly speaking, however, many of these studies show small to moderate effects and suffer from poor research designs ( Biddle and Asare, 2011; Singh et al., 2012).

Basch (2010) conducted a comprehensive review of how children's health and health disparities influence academic performance and learning. The author's report draws on empirical evidence suggesting that education reform will be ineffective unless children's health is made a priority. Basch concludes that schools may be the only place where health inequities can be addressed and that, if children's basic health needs are not met, they will struggle to learn regardless of the effectiveness of the instructional materials used. More recently, Efrat (2011) conducted a review of physical activity, fitness, and academic performance to examine the achievement gap. He discovered that only seven studies had included socioeconomic status as a variable, despite its known relationship to education ( Sirin, 2005).

Physical Fitness as a Learning Outcome of Physical Education and Its Relation to Academic Performance

Achieving and maintaining a healthy level of aerobic fitness, as defined using criterion-referenced standards from the National Health and Nutrition Examination Survey (NHANES; Welk et al., 2011), is a desired learning outcome of physical education programming. Regular participation in physical activity also is a national learning standard for physical education, a standard intended to facilitate the establishment of habitual and meaningful engagement in physical activity ( NASPE, 2004). Yet although physical fitness and participation in physical activity are established as learning outcomes in all 50 states, there is little evidence to suggest that children actually achieve and maintain these standards (see Chapter 2).

Statewide and national datasets containing data on youth physical fitness and academic performance have increased access to student-level data on this subject ( Grissom, 2005; Cottrell et al., 2007; Carlson et al., 2008; Chomitz et al., 2008; Wittberg et al., 2010; Van Dusen et al., 2011). Early research in South Australia focused on quantifying the benefits of physical activity and physical education during the school day; the benefits noted included increased physical fitness, decreased body fat, and reduced risk for cardiovascular disease ( Dwyer et al., 1979, 1983). Even today, Dwyer and colleagues are among the few scholars who regularly include in their research measures of physical activity intensity in the school environment, which is believed to be a key reason why they are able to report differentiated effects of different intensities. A longitudinal study in Trois-Rivières, Québec, Canada, tracked how the academic performance of children from grades 1 through 6 was related to student health, motor skills, and time spent in physical education. The researchers concluded that additional time dedicated to physical education did not inhibit academic performance ( Shephard et al., 1984; Shephard, 1986; Trudeau and Shephard, 2008).

Longitudinal follow-up investigating the long-term benefits of enhanced physical education experiences is encouraging but largely inconclusive. In a study examining the effects of daily physical education during elementary school on physical activity during adulthood, 720 men and women completed the Québec Health Survey ( Trudeau et al., 1999). Findings suggest that physical education was associated with physical activity in later life for females but not males ( Trudeau et al., 1999); most of the associations were significant but weak ( Trudeau et al., 2004). Adult body mass index (BMI) at age 34 was related to childhood BMI at ages 10-12 in females but not males ( Trudeau et al., 2001). Longitudinal studies such as those conducted in Sweden and Finland also suggest that physical education experiences may be related to adult engagement in physical activity ( Glenmark, 1994; Telama et al., 1997). From an academic performance perspective, longitudinal data on men who enlisted for military service imply that cardiovascular fitness at age 18 predicted cognitive performance in later life (Aberg et al., 2009), thereby supporting the idea of offering physical education and physical activity opportunities well into emerging adulthood through secondary and postsecondary education.

Castelli and colleagues (2007) investigated younger children (in 3rd and 5th grades) and the differential contributions of the various subcomponents of the Fitnessgram ®. Specifically, they examined the individual contributions of aerobic capacity, muscle strength, muscle flexibility, and body composition to performance in mathematics and reading on the Illinois Standardized Achievement Test among a sample of 259 children. Their findings corroborate those of the California Department of Education ( Grissom, 2005), indicating a general relationship between fitness and achievement test performance. When the individual components of the Fitnessgram were decomposed, the researchers determined that only aerobic capacity was related to test performance. Muscle strength and flexibility showed no relationship, while an inverse association of BMI with test performance was observed, such that higher BMI was associated with lower test performance. Although Baxter and colleagues (2011) confirmed the importance of attending school in relation to academic performance through the use of 4th-grade student recall, correlations with BMI were not significant.

State-mandated implementation of the coordinated school health model requires all schools in Texas to conduct annual fitness testing using the Fitnessgram among students in grades 3-12. In a special issue of Research Quarterly for Exercise and Sport (2010), multiple articles describe the current state of physical fitness among children in Texas; confirm the associations among school performance levels, academic achievement, and physical fitness ( Welk et al., 2010; Zhu et al., 2010); and demonstrate the ability of qualified physical education teachers to administer physical fitness tests ( Zhu et al., 2010). Also using data from Texas schools, Van Dusen and colleagues (2011) found that cardiovascular fitness had the strongest association with academic performance, particularly in mathematics over reading. Unlike previous research, which demonstrated a steady decline in fitness by developmental stage ( Duncan et al., 2007), this study found that cardiovascular fitness did decrease but not significantly ( Van Dusen et al., 2011). Aerobic fitness, then, may be important to academic performance, as there may be a dose-response relationship ( Van Dusen et al., 2011).

Using a large sample of students in grades 4-8, Chomitz and colleagues (2008) found that the likelihood of passing both mathematics and English achievement tests increased with the number of fitness tests passed during physical education class, and the odds of passing the mathematics achievement tests were inversely related to higher body weight. Similar to the findings of Castelli and colleagues (2007), socioeconomic status and demographic factors explained little of the relationship between aerobic fitness and academic performance; however, socioeconomic status may be an explanatory variable for students of low fitness ( London and Castrechini, 2011).

In sum, numerous cross-sectional and correlational studies demonstrate small-to-moderate positive or null associations between physical fitness ( Grissom, 2005; Cottrell et al., 2007; Edwards et al., 2009; Eveland-Sayers et al., 2009; Cooper et al., 2010; Welk et al., 2010; Wittberg et al., 2010; Zhu et al., 2010; Van Dusen et al., 2011), particularly aerobic fitness, and academic performance ( Castelli et al, 2007; Chomitz et al., 2008; Roberts et al., 2010; Welk et al., 2010; Chih and Chen, 2011; London and Castrechini, 2011; Van Dusen et al., 2011). Moreover, the findings may support a dose-response association, suggesting that the more components of physical fitness (e.g., cardiovascular endurance, strength, muscle endurance) considered acceptable for the specific age and gender that are present, the greater the likelihood of successful academic performance. From a public health and policy standpoint, the conclusions these findings support are limited by few causal inferences, a lack of data confirmation, and inadequate reliability because the data were often collected by nonresearchers or through self-report methods. It may also be noted that this research includes no known longitudinal studies and few randomized controlled trials (examples are included later in this chapter in the discussion of the developing brain).

Physical Activity, Physical Education, and Academic Performance

In contrast with the correlational data presented above for physical fitness, more information is needed on the direct effects of participation in physical activity programming and physical education classes on academic performance.

The regular engagement in physical activity achieved during physical education programming can also be related to academic performance, especially when the class is taught by a physical education teacher. The Sports, Play, and Active Recreation for Kids (SPARK) study examined the effects of a 2-year health-related physical education program on academic performance in children ( Sallis et al., 1999). In an experimental design, seven elementary schools were randomly assigned to one of three conditions: (1) a specialist condition in which certified physical education teachers delivered the SPARK curriculum, (2) a trained-teacher condition in which classroom teachers implemented the curriculum, and (3) a control condition in which classroom teachers implemented the local physical education curriculum. No significant differences by condition were found for mathematics testing; however, reading scores were significantly higher in the specialist condition relative to the control condition ( Sallis et al., 1999), while language scores were significantly lower in the specialist condition than in the other two conditions. The authors conclude that spending time in physical education with a specialist did not have a negative effect on academic performance. Shortcomings of this research include the amount of data loss from pre- to posttest, the use of results of 2nd-grade testing that exceeded the national average in performance as baseline data, and the use of norm-referenced rather than criterion-based testing.

In seminal research conducted by Gabbard and Barton (1979), six different conditions of physical activity (no activity; 20, 30, 40, and 50 minutes; and posttest no activity) were completed by 106 2nd graders during physical education. Each physical activity session was followed by 5 minutes of rest and the completion of 36 math problems. The authors found a potential threshold effect whereby only the 50-minute condition improved mathematical performance, with no differences by gender.

A longitudinal study of the kindergarten class of 1998-1999, using data from the Early Childhood Longitudinal Study, investigated the association between enrollment in physical education and academic achievement ( Carlson et al., 2008). Higher amounts of physical education were correlated with better academic performance in mathematics among females, but this finding did not hold true for males.

Ahamed and colleagues (2007) found in a cluster randomized trial that, after 16 months of a classroom-based physical activity intervention, there was no significant difference between the treatment and control groups in performance on the standardized Cognitive Abilities Test, Third Edition (CAT-3). Others have found, however, that coordinative exercise ( Budde et al., 2008) or bouts of vigorous physical activity during free time ( Coe et al., 2006) contribute to higher levels of academic performance. Specifically, Coe and colleagues examined the association of enrollment in physical education and self-reported vigorous- or moderate-intensity physical activity outside school with performance in core academic courses and on the Terra Nova Standardized Achievement Test among more than 200 6th-grade students. Their findings indicate that academic performance was unaffected by enrollment in physical education classes, which were found to average only 19 minutes of vigorous- or moderate-intensity physical activity. When time spent engaged in vigorous- or moderate-intensity physical activity outside of school was considered, however, a significant positive relation to academic performance emerged, with more time engaged in vigorous- or moderate-intensity physical activity being related to better grades but not test scores ( Coe et al., 2006).

Studies of participation in sports and academic achievement have found positive associations ( Mechanic and Hansell, 1987; Dexter, 1999; Crosnoe, 2002; Eitle and Eitle, 2002; Stephens and Schaben, 2002; Eitle, 2005; Miller et al., 2005; Fox et al., 2010; Ruiz et al., 2010); higher grade point averages (GPAs) in season than out of season ( Silliker and Quirk, 1997); a negative association between cheerleading and science performance ( Hanson and Kraus, 1998); and weak and negative associations between the amount of time spent participating in sports and performance in English-language class among 13-, 14-, and 16-year-old students ( Daley and Ryan, 2000). Other studies, however, have found no association between participation in sports and academic performance ( Fisher et al., 1996). The findings of these studies need to be interpreted with caution as many of their designs failed to account for the level of participation by individuals in the sport (e.g., amount of playing time, type and intensity of physical activity engagement by sport). Further, it is unclear whether policies required students to have higher GPAs to be eligible for participation. Offering sports opportunities is well justified regardless of the cognitive benefits, however, given that adolescents may be less likely to engage in risky behaviors when involved in sports or other extracurricular activities ( Page et al., 1998; Elder et al., 2000; Taliaferro et al., 2010), that participation in sports increases physical fitness, and that affiliation with sports enhances school connectedness.

Although a consensus on the relationship of physical activity to academic achievement has not been reached, the vast majority of available evidence suggests the relationship is either positive or neutral. The meta-analytic review by Fedewa and Ahn (2011) suggests that interventions entailing aerobic physical activity have the greatest impact on academic performance; however, all types of physical activity, except those involving flexibility alone, contribute to enhanced academic performance, as do interventions that use small groups (about 10 students) rather than individuals or large groups. Regardless of the strength of the findings, the literature indicates that time spent engaged in physical activity is beneficial to children because it has not been found to detract from academic performance, and in fact can improve overall health and function ( Sallis et al., 1999; Hillman et al., 2008; Tomporowski et al., 2008a; Trudeau and Shephard, 2008; Rasberry et al., 2011).

Single Bouts of Physical Activity

Beyond formal physical education, evidence suggests that multi-component approaches are a viable means of providing physical activity opportunities for children across the school curriculum (see also Chapter 6). Although health-related fitness lessons taught by certified physical education teachers result in greater student fitness gains relative to such lessons taught by other teachers ( Sallis et al., 1999), non-physical education teachers are capable of providing opportunities to be physically active within the classroom ( Kibbe et al., 2011). Single sessions or bouts of physical activity have independent merit, offering immediate benefits that can enhance the learning experience. Studies have found that single bouts of physical activity result in improved attention ( Hillman et al., 2003, 2009; Pontifex et al., 2012), better working memory ( Pontifex et al., 2009), and increased academic learning time and reduced off-task behaviors ( Mahar et al., 2006; Bartholomew and Jowers, 2011). Yet single bouts of physical activity have differential effects, as very vigorous exercise has been associated with cognitive fatigue and even cognitive decline in adults ( Tomporowski, 2003). As seen in Figure 4-1, high levels of effort, arousal, or activation can influence perception, decision making, response preparation, and actual response. For discussion of the underlying constructs and differential effects of single bouts of physical activity on cognitive performance, see Tomporowski (2003).

A randomized controlled trial entitled Physical Activity Across the Curriculum (PAAC) used cluster randomization among 24 schools to examine the effects of physically active classroom lessons on BMI and academic achievement ( Donnelly et al., 2009). The academically oriented physical activities were intended to be of vigorous or moderate intensity (3-6 metabolic equivalents [METs]) and to last approximately 10 minutes and were specifically designed to supplement content in mathematics, language arts, geography, history, spelling, science, and health. The study followed 665 boys and 677 girls for 3 years as they rose from 2nd or 3rd to 4th or 5th grades. Changes in academic achievement, fitness, and blood screening were considered secondary outcomes. During a 3-year period, students who engaged in physically active lessons, on average, improved their academic achievement by 6 percent, while the control groups exhibited a 1 percent decrease. In students who experienced at least 75 minutes of PAAC lessons per week, BMI remained stable (see Figure 4-3).

It is important to note that cognitive tasks completed before, during, and after physical activity show varying effects, but the effects were always positive compared with sedentary behavior. In a study carried out by Drollette and colleagues (2012), 36 preadolescent children completed two cognitive tasks-a flanker task to assess attention and inhibition and a spatial nback task to assess working memory-before, during, and after seated rest and treadmill walking conditions. The children sat or walked on different days for an average of 19 minutes. The results suggest that the physical activity enhanced cognitive performance for the attention task but not for the task requiring working memory. Accordingly, although more research is needed, the authors suggest that the acute effects of exercise may be selective to certain cognitive processes (i.e., attentional inhibition) while unrelated to others (e.g., working memory). Indeed, data collected using a task-switching paradigm (i.e., a task designed to assess multitasking and requiring the scheduling of attention to multiple aspects of the environment) among 69 overweight and inactive children did not show differences in cognitive performance following acute bouts of treadmill walking or sitting ( Tomporowski et al., 2008b). Thus, findings to date indicate a robust relationship of acute exercise to transient improvements in attention but appear inconsistent for other aspects of cognition.

Academic Learning Time and On- and Off-Task Behaviors

Excessive time on task, inattention to task, off-task behavior, and delinquency are important considerations in the learning environment given the importance of academic learning time to academic performance. These behaviors are observable and of concern to teachers as they detract from the learning environment. Systematic observation by trained observers may yield important insight regarding the effects of short physical activity breaks on these behaviors. Indeed, systematic observations of student behavior have been used as an alternative means of measuring academic performance ( Mahar et al., 2006; Grieco et al., 2009).

After the development of classroom-based physical activities, called Energizers, teachers were trained in how to implement such activities in their lessons at least twice per week ( Mahar et al., 2006). Measurements of baseline physical activity and on-task behaviors were collected in two 3rd-grade and two 4th-grade classes, using pedometers and direct observation. The intervention included 243 students, while 108 served as controls by not engaging in the activities. A subgroup of 62 3rd and 4th graders was observed for on-task behavior in the classroom following the physical activity. Children who participated in Energizers took more steps during the school day than those who did not; they also increased their on-task behaviors by more than 20 percent over baseline measures.

A systematic review of a similar in-class, academically oriented, physical activity plan-Take 10!-was conducted to identify the effects of its implementation after it had been in use for 10 years ( Kibbe et al., 2011). The findings suggest that children who experienced Take 10! in the classroom engaged in moderate to vigorous physical activity (6.16 to 6.42 METs) and had lower BMIs than those who did not. Further, children in the Take 10! classrooms had better fluid intelligence ( Reed et al., 2010) and higher academic achievement scores ( Donnelly et al., 2009).

Some have expressed concern that introducing physical activity into the classroom setting may be distracting to students. Yet in one study it was sedentary students who demonstrated a decrease in time on task, while active students returned to the same level of on-task behavior after an active learning task ( Grieco et al., 2009). Among the 97 3rd-grade students in this study, a small but nonsignificant increase in on-task behaviors was seen immediately following these active lessons. Additionally, these improvements were not mediated by BMI.

In sum, although presently understudied, physically active lessons may increase time on task and attention to task in the classroom setting. Given the complexity of the typical classroom, the strategy of including content-specific lessons that incorporate physical activity may be justified.

Recess

To examine the effects of engagement in physical activity during recess on classroom behavior, Barros and colleagues (2009) examined data from the Early Childhood Longitudinal Study on 10,000 8- to 9-year-old children. Teachers provided the number of minutes of recess as well as a ranking of classroom behavior (ranging from "misbehaves frequently" to "behaves exceptionally well"). Results indicate that children who had at least 15 minutes of recess were more likely to exhibit appropriate behavior in the classroom ( Barros et al., 2009). In another study, 43 4th-grade students were randomly assigned to 1 or no days of recess to examine the effects on classroom behavior ( Jarrett et al., 1998). The researchers concluded that on-task behavior was better among the children who had recess. A moderate effect size (= 0.51) was observed. In a series of studies examining kindergartners' attention to task following a 20-minute recess, increased time on task was observed during learning centers and story reading ( Pellegrini et al., 1995). Despite these positive findings centered on improved attention, it is important to note that few of these studies actually measured the intensity of the physical activity during recess.

From a slightly different perspective, survey data from 547 Virginia elementary school principals suggest that time dedicated to student participation in physical education, art, and music did not negatively influence academic performance ( Wilkins et al., 2003). Thus, the strategy of reducing time spent in physical education to increase academic performance may not have the desired effect. The evidence on in-school physical activity supports the provision of physical activity breaks during the school day as a way to increase fluid intelligence, time on task, and attention. However, it remains unclear what portion of these effects can be attributed to a break from academic time and what portion is a direct result of the specific demands/characteristics of the physical activity.

THE DEVELOPING bRAIN, PHYSICAL ACTIVITY, AND BRAIN HEALTH

The study of brain health has grown beyond simply measuring behavioral outcomes such as task performance and reaction time (e.g., cognitive processing speed). New technology has emerged that has allowed scientists to understand the impact of lifestyle factors on the brain from the body systems level down to the molecular level. A greater understanding of the cognitive components that subserve academic performance and may be amenable to intervention has thereby been gained. Research conducted in both laboratory and field settings has helped define this line of inquiry and identify some preliminary underlying mechanisms.

The Evidence Base on the Relationship of Physical Activity to Brain Health and Cognition in Older Adults

Despite the current focus on the relationship of physical activity to cognitive development, the evidence base is larger on the association of physical activity with brain health and cognition during aging. Much can be learned about how physical activity affects childhood cognition and scholastic achievement through this work. Despite earlier investigations into the relationship of physical activity to cognitive aging (see Etnier et al., 1997, for a review), the field was shaped by the findings of Kramer and colleagues (1999), who examined the effects of aerobic fitness training on older adults using a randomized controlled design. Specifically, 124 older adults aged 60 and 75 were randomly assigned to a 6-month intervention of either walking (i.e., aerobic training) or flexibility (i.e., nonaerobic) training. The walking group but not the flexibility group showed improved cognitive performance, measured as a shorter response time to the presented stimulus. Results from a series of tasks that tapped different aspects of cognitive control indicated that engagement in physical activity is a beneficial means of combating cognitive aging ( Kramer et al., 1999).

Cognitive control, or executive control, is involved in the selection, scheduling, and coordination of computational processes underlying perception, memory, and goal-directed action. These processes allow for the optimization of behavioral interactions within the environment through flexible modulation of the ability to control attention ( MacDonald et al., 2000; Botvinick et al., 2001). Core cognitive processes that make up cognitive control or executive control include inhibition, working memory, and cognitive flexibility ( Diamond, 2006), processes mediated by networks that involve the prefrontal cortex. Inhibition (or inhibitory control) refers to the ability to override a strong internal or external pull so as to act appropriately within the demands imposed by the environment ( Davidson et al., 2006). For example, one exerts inhibitory control when one stops speaking when the teacher begins lecturing. Working memory refers to the ability to represent information mentally, manipulate stored information, and act on the information ( Davidson et al., 2006). In solving a difficult mathematical problem, for example, one must often remember the remainder. Finally, cognitive flexibility refers to the ability to switch perspectives, focus attention, and adapt behavior quickly and flexibly for the purposes of goal-directed action ( Blair et al., 2005; Davidson et al., 2006; Diamond, 2006). For example, one must shift attention from the teacher who is teaching a lesson to one's notes to write down information for later study.

Based on their earlier findings on changes in cognitive control induced by aerobic training, Colcombe and Kramer (2003) conducted a meta-analysis to examine the relationship between aerobic training and cognition in older adults aged 55-80 using data from 18 randomized controlled exercise interventions. Their findings suggest that aerobic training is associated with general cognitive benefits that are selectively and disproportionately greater for tasks or task components requiring greater amounts of cognitive control. A second and more recent meta-analysis ( Smith et al., 2010) corroborates the findings of Colcombe and Kramer, indicating that aerobic exercise is related to attention, processing speed, memory, and cognitive control; however, it should be noted that smaller effect sizes were observed, likely a result of the studies included in the respective meta-analyses. In older adults, then, aerobic training selectively improves cognition.

Hillman and colleagues (2006) examined the relationship between physical activity and inhibition (one aspect of cognitive control) using a computer-based stimulus-response protocol in 241 individuals aged 15-71. Their results indicate that greater amounts of physical activity are related to decreased response speed across task conditions requiring variable amounts of inhibition, suggesting a generalized relationship between physical activity and response speed. In addition, the authors found physical activity to be related to better accuracy across conditions in older adults, while no such relationship was observed for younger adults. Of interest, this relationship was disproportionately larger for the condition requiring greater amounts of inhibition in the older adults, suggesting that physical activity has both a general and selective association with task performance ( Hillman et al., 2006).

Colcombe and colleagues (2003) investigated the relationship of aerobic fitness to gray and white matter tissue loss using magnetic resonance imaging (MRI) in 55 healthy older adults aged 55-79. They observed robust age-related decreases in tissue density in the frontal, temporal, and parietal regions using voxel-based morphometry, a technique used to assess brain volume. Reductions in the amount of tissue loss in these regions were observed as a function of fitness. Given that the brain structures most affected by aging also demonstrated the greatest fitness-related sparing, these initial findings provide a biological basis for fitness-related benefits to brain health during aging.

In a second study, Colcombe and colleagues (2006) examined the effects of aerobic fitness training on brain structure using a randomized controlled design with 59 sedentary healthy adults aged 60-79. The treatment group received a 6-month aerobic exercise (i.e., walking) intervention, while the control group received a stretching and toning intervention that did not include aerobic exercise. Results indicated that gray and white matter brain volume increased for those who received the aerobic fitness training intervention. No such results were observed for those assigned to the stretching and toning group. Specifically, those assigned to the aerobic training intervention demonstrated increased gray matter in the frontal lobes, including the dorsal anterior cingulate cortex, the supplementary motor area, the middle frontal gyrus, the dorsolateral region of the right inferior frontal gyrus, and the left superior temporal lobe. White matter volume changes also were evidenced following the aerobic fitness intervention, with increases in white matter tracts being observed within the anterior third of the corpus callosum. These brain regions are important for cognition, as they have been implicated in the cognitive control of attention and memory processes. These findings suggest that aerobic training not only spares age-related loss of brain structures but also may in fact enhance the structural health of specific brain regions.

In addition to the structural changes noted above, research has investigated the relationship between aerobic fitness and changes in brain function. That is, aerobic fitness training has also been observed to induce changes in patterns of functional activation. Functional MRI (fMRI) measures, which make it possible to image activity in the brain while an individual is performing a cognitive task, have revealed that aerobic training induces changes in patterns of functional activation. This approach involves inferring changes in neuronal activity from alteration in blood flow or metabolic activity in the brain. In a seminal paper, Colcombe and colleagues (2004) examined the relationship of aerobic fitness to brain function and cognition across two studies with older adults. In the first study, 41 older adult participants (mean age ~66) were divided into higher- and lower-fit groups based on their performance on a maximal exercise test. In the second study, 29 participants (aged 58-77) were recruited and randomly assigned to either a fitness training (i.e., walking) or control (i.e., stretching and toning) intervention. In both studies, participants were given a task requiring variable amounts of attention and inhibition. Results indicated that fitness (study 1) and fitness training (study 2) were related to greater activation in the middle frontal gyrus and superior parietal cortex; these regions of the brain are involved in attentional control and inhibitory functioning, processes entailed in the regulation of attention and action. These changes in neural activation were related to significant improvements in performance on the cognitive control task of attention and inhibition.

Child Development, Brain Structure, and Function

Effects of Regular Engagement in Physical Activity and Physical Fitness on Brain Structure

Recent advances in neuroimaging techniques have rapidly advanced understanding of the role physical activity and aerobic fitness may have in brain structure. In children a growing body of correlational research suggests differential brain structure related to aerobic fitness. Chaddock and colleagues (2010a, b) showed a relationship among aerobic fitness, brain volume, and aspects of cognition and memory. Specifically, Chaddock and colleagues (2010a) assigned 9- to 10-year-old preadolescent children to lower- and higher-fitness groups as a function of their scores on a maximal oxygen uptake (VO ₂max) test, which is considered the gold-standard measure of aerobic fitness. They observed larger bilateral hippocampal volume in higher-fit children using MRI, as well as better performance on a task of relational memory. It is important to note that relational memory has been shown to be mediated by the hippocampus ( Cohen and Eichenbaum, 1993; Cohen et al., 1999). Further, no differences emerged for a task condition requiring item memory, which is supported by structures outside the hippocampus, suggesting selectivity among the aspects of memory that benefit from higher amounts of fitness. Lastly, hippocampal volume was positively related to performance on the relational memory task but not the item memory task, and bilateral hippocampal volume was observed to mediate the relationship between fitness and relational memory ( Chaddock et al., 2010a). Such findings are consistent with behavioral measures of relational memory in children ( Chaddock et al., 2011) and neuroimaging findings in older adults ( Erickson et al., 2009, 2011) and support the robust nonhuman animal literature demonstrating the effects of exercise on cell proliferation ( Van Praag et al., 1999) and survival ( Neeper et al., 1995) in the hippocampus.

Effects of Regular Engagement in Physical Activity and Physical Fitness on Brain Function

Other imaging research has examined the neuroelectric system (i.e., ERPs) to investigate which cognitive processes occurring between stimulus engagement and response execution are influenced by fitness. Several studies ( Hillman et al., 2005, 2009; Pontifex et al., 2011) have examined the P3 component of the stimulus-locked ERP and demonstrated that higher-fit children have larger-amplitude and shorter-latency ERPs relative to their lower-fit peers. Classical theory suggests that P3 relates to neuronal activity associated with revision of the mental representation of the previous event within the stimulus environment ( Donchin, 1981). P3 amplitude reflects the allocation of attentional resources when working memory is updated ( Donchin and Coles, 1988) such that P3 is sensitive to the amount of attentional resources allocated to a stimulus ( Polich, 1997; Polich and Heine, 2007). P3 latency generally is considered to represent stimulus evaluation and classification speed ( Kutas et al., 1977; Duncan-Johnson, 1981) and thus may be considered a measure of stimulus detection and evaluation time ( Magliero et al., 1984; Ila and Polich, 1999). Therefore the above findings suggest that higher-fit children allocate greater attentional resources and have faster cognitive processing speed relative to lower-fit children ( Hillman et al., 2005, 2009), with additional research suggesting that higher-fit children also exhibit greater flexibility in the allocation of attentional resources, as indexed by greater modulation of P3 amplitude across tasks that vary in the amount of cognitive control required ( Pontifex et al., 2011). Given that higher-fit children also demonstrate better performance on cognitive control tasks, the P3 component appears to reflect the effectiveness of a subset of cognitive systems that support willed action ( Hillman et al., 2009; Pontifex et al., 2011).

Two ERP studies ( Hillman et al., 2009; Pontifex et al., 2011) have focused on aspects of cognition involved in action monitoring. That is, the error-related negativity (ERN) component was investigated in higher- and lower-fit children to determine whether differences in evaluation and regulation of cognitive control operations were influenced by fitness level. The ERN component is observed in response-locked ERP averages. It is often elicited by errors of commission during task performance and is believed to represent either the detection of errors during task performance ( Gehring et al., 1993; Holroyd and Coles, 2002) or more generally the detection of response conflict ( Botvinick et al., 2001; Yeung et al., 2004), which may be engendered by errors in response production. Several studies have reported that higher-fit children exhibit smaller ERN amplitude during rapid-response tasks (i.e., instructions emphasizing speed of responding; Hillman et al., 2009) and more flexibility in the allocation of these resources during tasks entailing variable cognitive control demands, as evidenced by changes in ERN amplitude for higher-fit children and no modulation of ERN in lower-fit children ( Pontifex et al., 2011). Collectively, this pattern of results suggests that children with lower levels of fitness allocate fewer attentional resources during stimulus engagement (P3 amplitude) and exhibit slower cognitive processing speed (P3 latency) but increased activation of neural resources involved in the monitoring of their actions (ERN amplitude). Alternatively, higher-fit children allocate greater resources to environmental stimuli and demonstrate less reliance on action monitoring (increasing resource allocation only to meet the demands of the task). Under more demanding task conditions, the strategy of lower-fit children appears to fail since they perform more poorly under conditions requiring the upregulation of cognitive control.

Finally, only one randomized controlled trial published to date has used ERPs to assess neurocognitive function in children. Kamijo and colleagues (2011) studied performance on a working memory task before and after a 9-month physical activity intervention compared with a wait-list control group. They observed better performance following the physical activity intervention during task conditions that required the upregulation of working memory relative to the task condition requiring lesser amounts of working memory. Further, increased activation of the contingent negative variation (CNV), an ERP component reflecting cognitive and motor preparation, was observed at posttest over frontal scalp sites in the physical activity intervention group. No differences in performance or brain activation were noted for the wait-list control group. These findings suggest an increase in cognitive preparation processes in support of a more effective working memory network resulting from prolonged participation in physical activity. For children in a school setting, regular participation in physical activity as part of an after-school program is particularly beneficial for tasks that require the use of working memory.

Adiposity and Risk for Metabolic Syndrome as It Relates to Cognitive Health

Recently published reports describe the relationship between adiposity and cognitive and brain health to advance understanding of the basic cognitive processes and neural substrates that may underlie the adiposity-achievement relationship. Bolstered by findings in adult populations (e.g., Debette et al., 2010; Raji et al., 2010; Carnell et al., 2011), researchers have begun to publish data on preadolescent populations indicating differences in brain function and cognitive performance related to adiposity (however, see Gunstad et al., 2008, for an instance in which adiposity was unrelated to cognitive outcomes). Specifically, Kamijo and colleagues (2012a) examined the relationship of weight status to cognitive control and academic achievement in 126 children aged 7-9. The children completed a battery of cognitive control tasks, and their body composition was assessed using dual X-ray absorptiometry (DXA). The authors found that higher BMI and greater amounts of fat mass (particularly in the midsection) were related to poorer performance on cognitive control tasks involving inhibition, as well as lower academic achievement. In follow-up studies, Kamijo and colleagues (2012b) investigated whether neural markers of the relationship between adiposity and cognition may be found through examination of ERP data. These studies compared healthy-weight and obese children and found a differential distribution of the P3 potential (i.e., less frontally distributed) and larger N2 amplitude, as well as smaller ERN magnitude, in obese children during task conditions that required greater amounts of inhibitory control ( Kamijo et al., 2012c). Taken together, the above results suggest that obesity is associated with less effective neural processes during stimulus capture and response execution. As a result, obese children perform tasks more slowly ( Kamijo et al., 2012a) and are less accurate ( Kamijo et al., 2012b, c) in response to tasks requiring variable amounts of cognitive control. Although these data are correlational, they provide a basis for further study using other neuroimaging tools (e.g., MRI, fMRI), as well as a rationale for the design and implementation of randomized controlled studies that would allow for causal interpretation of the relationship of adiposity to cognitive and brain health. The next decade should provide a great deal of information on this relationship.

LIMITATIONS

Despite the promising findings described in this chapter, it should be noted that the study of the relationship of childhood physical activity, aerobic fitness, and adiposity to cognitive and brain health and academic performance is in its early stages. Accordingly, most studies have used designs that afford correlation rather than causation. To date, in fact, only two randomized controlled trials ( Davis et al., 2011; Kamijo et al., 2011) on this relationship have been published. However, several others are currently ongoing, and it was necessary to provide evidence through correlational studies before investing the effort, time, and funding required for more demanding causal studies. Given that the evidence base in this area has grown exponentially in the past 10 years through correlational studies and that causal evidence has accumulated through adult and nonhuman animal studies, the next step will be to increase the amount of causal evidence available on school-age children.

Accomplishing this will require further consideration of demographic factors that may moderate the physical activity-cognition relationship. For instance, socioeconomic status has a unique relationship with physical activity ( Estabrooks et al., 2003) and cognitive control ( Mezzacappa, 2004). Although many studies have attempted to control for socioeconomic status (see Hillman et al., 2009; Kamijo et al., 2011, 2012a, b, c; Pontifex et al., 2011), further inquiry into its relationship with physical activity, adiposity, and cognition is warranted to determine whether it may serve as a potential mediator or moderator for the observed relationships. A second demographic factor that warrants further consideration is gender. Most authors have failed to describe gender differences when reporting on the physical activity-cognition literature. However, studies of adiposity and cognition have suggested that such a relationship may exist (see Datar and Sturm, 2006). Additionally, further consideration of age is warranted. Most studies have examined a relatively narrow age range, consisting of a few years. Such an approach often is necessary because of maturation and the need to develop comprehensive assessment tools that suit the various stages of development. However, this approach has yielded little understanding of how the physical activity-cognition relationship may change throughout the course of maturation.

Finally, although a number of studies have described the relationship of physical activity, fitness, and adiposity to standardized measures of academic performance, few attempts have been made to observe the relationship within the context of the educational environment. Standardized tests, although necessary to gauge knowledge, may not be the most sensitive measures for (the process of) learning. Future research will need to do a better job of translating promising laboratory findings to the real world to determine the value of this relationship in ecologically valid settings.

SUMMARY

From an authentic and practical to a mechanistic perspective, physically active and aerobically fit children consistently outperform their inactive and unfit peers academically on both a short- and a long-term basis. Time spent engaged in physical activity is related not only to a healthier body but also to enriched cognitive development and lifelong brain health. Collectively, the findings across the body of literature in this area suggest that increases in aerobic fitness, derived from physical activity, are related to improvements in the integrity of brain structure and function that underlie academic performance. The strongest relationships have been found between aerobic fitness and performance in mathematics, reading, and English. For children in a school setting, regular participation in physical activity is particularly beneficial with respect to tasks that require working memory and problem solving. These findings are corroborated by the results of both authentic correlational studies and experimental randomized controlled trials. Overall, the benefits of additional time dedicated to physical education and other physical activity opportunities before, during, and after school outweigh the benefits of exclusive utilization of school time for academic learning, as physical activity opportunities offered across the curriculum do not inhibit academic performance.

Both habitual and single bouts of physical activity contribute to enhanced academic performance. Findings indicate a robust relationship of acute exercise to increased attention, with evidence emerging for a relationship between participation in physical activity and disciplinary behaviors, time on task, and academic performance. Specifically, higher-fit children allocate greater resources to a given task and demonstrate less reliance on environmental cues or teacher prompting.

REFERENCES

Cohen NJ, Eichenbaum H. Memory, amnesia, and the hippocampal system. Cambridge, MA: MIT Press; 1993.

Dawson P, Guare R. Executive skills in children and adolescents: A practical guide to assessment and intervention. New York: Guilford Press; 2004. pp. 2-8.

Diamond A. The early development of executive functions. In: Bialystok E, Craik FIM, editors. In Lifespan cognition: Mechanisms of change. New York: Oxford University Press; 2006. pp. 70-95.

Eitle TM, Eitle DJ. Sociology of Education. 2002. Race, cultural capital, and the educational effects of participation in sports; pp. 123-146.

Hatfield BD, Hillman CH. The psychophysiology of sport: A mechanistic understanding of the psychology of superior performance. In: Singer RN, Hausenblas HA, Janelle C, editors. In The handbook of research on sport psychology. 2nd. New York: John Wiley; 2001. pp. 362-386.

Kamijo K, Pontifex MB, Khan NA, Raine LB, Scudder MR, Drollette ES, Evans EM, Castelli DM, Hillman CH. Cerebral Cortex. 2012c. [October 4, 2013]. The negative association of childhood obesity to the cognitive control of action monitoring. Epub ahead of print, November 11. cercor​.oxfordjournals​.org/content/early/2012/11/09/cercor​.bhs349.long. [ PMC free article: PMC3920765 ] [ PubMed: 23146965 ]

Kibbe DL, Hackett J, Hurley M, McFarland A, Schubert KG, Schultz A, Harris S. Ten years of TAKE 10! ®: Integrating physical activity with academic concepts in elementary school classrooms. Preventive Medicine. 2011;52(Suppl):S43-S50. [ PubMed: 21281670 ]

NASPE (National Association for Sport and Physical Education). Moving into the future: National Physical Education Content Standards. 2nd. Reston, VA: NASPE; 2004.

NRC (National Research Council)/IOM (Institute of Medicine). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press; 2000. [ PubMed: 25077268 ]

Raz N. Aging of the brain and its impact on cognitive performance: Integration of structural and functional findings. In: Craik FM, Salthouse TA, editors. In The handbook of aging and cognition. Vol. 2. Mahweh, NJ: Lawrence Erlbaum Associates; 2000. pp. 1-90.

Shephard RJ, Volle M, Lavallee H, LaBarre R, Jequier J, Rajic M. In Children and Sport. Berlin, Germany: Springer-Verlag; 1984. Required physical activity and academic grades: A controlled study; pp. 58-63.

Stewart JA, Dennison DA, Kohl HW III, Doyle JA. Exercise level and energy expenditure in the TAKE 10! ® in-class physical activity program. Journal of School Health. 2004;74(10):397-400. [ PubMed: 15724566 ]

Taylor MJ. Neural bases of cognitive development. In: Bialystok E, Craik FIM, editors. In Lifespan cognition: Mechanisms of change. Oxford, UK: Oxford University Press; 2006. pp. 15-26.

Welk GJ, Going SB, Morrow JR, Meredith MD. Development of new criterion-referenced fitness standards in the Fitnessgram ® program. American Journal of Preventive Medicine. 2011;41(2):6. [ PubMed: 21961614 ]

# data[].attributes.attachment_link.title
Physical Activity, Fitness, and Physical Education: Effects on Academic Performance

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Although academic performance stems from a complex interaction between intellect and contextual variables, health is a vital moderating factor in a child's ability to learn. The idea that healthy children learn better is empirically supported and well accepted (Basch, 2010), and multiple studies have confirmed that health benefits are associated with physical activity, including cardiovascular and muscular fitness, bone health, psychosocial outcomes, and cognitive and brain health (Strong et al., 2005; see Chapter 3).

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UCLA - PE Classes Vital to Children's Physical and Mental Health

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UCLA - PE Classes Vital to Children's Physical and Mental Health

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Childhood obesity is prevalent in the United States - more than 14 million children are considered obese - and that national health problem has gotten even worse over the past two years.

Data from the Centers for Disease Control and Prevention show that childhood obesity rose significantly around the nation during the pandemic. Experts say much of that increase can be attributed to schools being closed and children not having access to PE classes and the equipment and areas of play they ordinarily would.

Rebecca Dudovitz, MD, associate professor of general pediatrics, says physical education classes are key for helping children maintain their overall health.

"It's fair to say that more physical education time could help fight the obesity epidemic. The need for that became greater after the pandemic," Dr. Dudovitz said.

"Two things got universally worse for many children and families during the pandemic and that was obesity and mental health," she said. "Exercise is a key component for recovering from and preventing obesity and it's a key part of coping with and preventing mental health problems."

Mental health benefits

Dr. Dudovitz, a parent herself, said working with physical education teachers showed her the importance of PE beyond just exercise.

"It's truly an area of learning where there are core educational standards and many of those PE standards are around developing social-emotional skills," she said. "Data and research shows that exercise improves school performance and, in fact, children have an easier time focusing and learning after they have exercised.

"As parents, we need to think about the role that PE plays in our child's education and lives," she said. "We need to make sure we're advocating for enough PE minutes. Sometimes, I think PE gets de-emphasized and parents are often advocating for other educational opportunities. Meanwhile, our PE resources are kind of fading away."

Changing the PE format

Ancient are the days when the gym teacher strolled into class sporting short-shorts and a polo shirt with the school colors and a sack full of dodge balls. Programs such as UCLA Health Sound Body Sound Mind have helped shape a new era of physical education.

Providing state-of-the-art fitness equipment and fitness resources to more than 140 middle schools and high schools across Los Angeles, Sound Body Sound Mind has raised the bar on what gym class can look like.

From stationary indoor cycling bikes, to cable machines, row machines, and many other pieces of fitness equipment, Sound Body Sound Mind has transformed PE programs at certain schools with resources that provide access for students and support a more holistic approach to health and wellness.

Matt Flesock, executive director of Sound Body Sound Mind, says movement and exercise are essential for a child's overall development.

"Physical activity has been shown to improve students' academic performance, social-emotional learning and mental health," Flesock said. "The benefits are incredible."

Sound Body Sound Mind, which is dedicated to promoting self-confidence and healthy lifestyle choices among youth, continued to assist families and communities during the pandemic by ensuring students could incorporate movement into their daily academic programs despite distanced learning.

"I think Sound Body Sound Mind has done an amazing job on two fronts," Dr. Dudovitz said.

"One, it's giving schools and families the resources they need to exercise and that included fitness kits when families were stuck at home and schools were closed," she said. "Secondly, Sound Body Sound Mind helps to decrease the barriers to working out, especially for kids who don't view themselves as athletes by creating a safe place and safe space for students who are less experienced at working out."

For children who are exempt from physical education classes due to health conditions, parents can still find ways to make sure their children are getting the exercise they need.

Parents can ask for a 504 plan, which provides students with disabilities extra support or accommodations they need in school. Schools can then provide students with an individualized exercise plan or an adaptive PE program.

"As pediatricians, we often work with schools and parents to support them in developing and executing those plans. We also make sure children with medical problems still get their exercise," Dr. Dudovitz explained. "For example, children in wheelchairs or with physical disabilities need to move their muscles and they need that physical movement because it's vital to their overall health."

Is physical education enough to keep students healthy?

The California Department of Education requires 400 minutes of physical education every 10 days for students in grades 7-12 and 200 minutes for students in grades 1-6. Yet, California ranks No. 28 out of 50 states when it comes to childhood obesity.

Flesock noted that the mandates for physical education are not enough to keep children healthy.

"Children need to move 60 minutes a day, every day," Flesock said. "That is the recommendation. When you look at the California school mandate, that's not enough time: 400 minutes every 10 days or 200 minutes every five days. That is not equivalent to 60 minutes a day."

However, some people question whether schools should bear all the responsibility of making sure students meet the suggested 60 minutes of physical activity daily. If not, this would mean that parents, or students themselves, would need to make sure they are getting enough physical activity throughout the day.

That is easier said than done for many families. Dr. Dudovitz and Flesock acknowledge that for many children, PE class is the only time exclusively set aside for exercise. That's particularly true for children who do not have access to safe places to play outside of school. Families of students in underserved communities may not have the same resources or privileges of a safe environment for exercise in their neighborhood.

Flesock and his staff at UCLA Sound Body Sound Mind are continuously working on solutions to help schools, families and students in underrepresented communities get the resources they need to promote a healthy lifestyle.

Role of the parent

Dr. Dudovitz said parents have always had the important duty of making sure their child's health was a priority. What's changed over the generations, she said, is that the forces working against a healthy lifestyle have become so strong that it takes a concerted effort to fight against them.

"We see that there is a McDonald's or Starbucks on every corner and instead of getting out, we have Zoom calls and video games. It makes it so easy to fall into an unhealthy routine," she said. "All of these push against a healthy lifestyle and it takes more of an effort to maintain healthy practices."

Making sure your child focuses on fitness outside of physical education classes is possible, but requires commitment and follow-through from parent and child. Here are some steps parents can take:

Carve out daily time for physical activity

Use fun competition as a motivator

Incorporate nutrition (a healthy diet reinforces performance and ambition to stay fit)

Encourage your child to join a sports program or organized after-school fitness activity

Limit time on video games and cell phones

Dr. Dudovitz says parents have a responsibility to instill the importance of being healthy within their child, but the onus can't be totally on them.

"We need to advocate for healthier systems within the schools, for funding and structures to be in place equitably if we want to have a healthy generation," she said.
If you want more information about creating a healthy lifestyle for your child, please visit the Sound Body Sound Mind page.

# data[].attributes.attachment_link.title
PE classes vital to children's physical and mental health

# data[].attributes.attachment_link.description
Childhood obesity is prevalent in the United States - more than 14 million children are considered obese - and that national health problem has gotten even worse over the past two years. Data from the Centers for Disease Control and Prevention show that childhood obesity rose significantly around the nation during the pandemic.

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APHA - Supporting Physical Education in Schools for All Youth

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APHA - Supporting Physical Education in Schools for All Youth

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Abstract
This policy statement provides scientific evidence that schools are unique places where children should be engaged in physical activity. However, most school policies and programs are not supportive of physical activity in the school day, specifically physical education. Considering that 30.4% of youth are overweight or obese and that 76.8% do not meet the daily physical activity recommendations, and considering the benefits of physical activity with respect to increased ability to concentrate and learn, it is of the utmost importance to incorporate policies and programs that facilitate healthy engagement in physical activity in schools. Marginalized youth from low-income families, communities of color, immigrant communities, and others are disproportionately impacted by lack of supportive policies and programming. This policy statement calls for comprehensive and cooperative actions from the public health community, schools, administrators, researchers, and community members to increase physical activity opportunities through physical education in order to engage youth in at least 60 minutes of physical activity daily.
Relationship to Existing Policy Statements

APHA Policy Statement 20137: Improving Health and Wellness through Access to Nature

APHA Policy Statement 20172: Supporting the Updated National Physical Activity Plan

APHA Policy Statement 201515: The Role of Health Education Specialists in a Post-Health Reform Environment

APHA Policy Statement 20079: Building a Public Health Infrastructure for Physical Activity Promotion

APHA Policy Statement 9709: Promoting Public Health Through Physical Activity

APHA Policy Statement 20044: Creating Policies on Land Use and Transportation Systems that Promote Public Health

APHA Policy Statement 20058: Supporting the WHO Global Strategy on Diet, Physical Activity and Health

APHA Policy Statement 200619: Urgent Call for a Nationwide Public Health Infrastructure and Action to Reverse the Obesity Epidemic

APHA Policy Statement 20079: Building a Public Health Infrastructure for Physical Activity Promotion

APHA Policy Statement 201514: Building Environments and a Public Health Workforce to Support Physical Activity Among Older Adults

APHA Policy Statement 20121: Supporting the National Physical Activity Plan

APHA Policy Statement 201415: Support for Social Determinants of Behavioral Health and Pathways for Integrated and Better Public Health

Problem Statement
Obesity is an important health issue among children in the United States. According to the 2019 National Health and Nutrition Examination Survey, 16.1% of U.S. youth are overweight and 19.3% are obese.[1] Moreover, racial, socioeconomic, and gender disparities exist in terms of risk factors associated with being overweight or obese. The chronic disease burden is consistent with the disproportionately high percentages of overweight and obese youth in racial minority and socioeconomically disadvantaged populations. According to data from the 2019 Youth Risk Behavior Surveillance System (YRBSS), 37.7% of Black youth and 38.8% of Hispanic youth are overweight or obese, as compared with just 27.7% of White youth.[2]

P hysical inactivity is a significant risk factor for obesity and other chronic conditions.[3]As the proportion of students who are overweight or obese has increased, so has inactivity. Empirical evidence suggests that physical activity may be used as a standalone strategy to decrease adiposity among children.[4] It is recommended that school-aged children and adolescents (6-17 years of age) engage in 60 minutes of physical activity seven days per week.[5] According to data from the 2019 YRBSS, 76.8% of youth do not meet the recommended amounts of physical activity.[2] The same data set indicates that adolescent girls, in particular, are at a higher risk for being inactive as they age; 84.6% of girls do not meet the physical activity guideline of 60 minutes per day seven days a week, as compared with 69.1% of boys.[2] In addition, inactive youth are more likely to be inactive as adults.[6] Starting physical activity early is essential to prevent inactivity in adulthood and older adulthood.

Physical activity provides benefits beyond physical health. For example, it is associated with a reduced risk for depression.[7] Trends for contemplating and making a plan for suicide are increasing among White, Hispanic, and Black youth, and there are racial and ethnic disparities in terms of mental health challenges among youth.[5] In 2019, 40.0% of Hispanic youth reported persistent feelings of sadness or hopelessness, as compared with 36.0% of White youth and 31.5% of Black youth.[5]

In addition to the long-term health benefits of child physical activity, there are numerous academic-related benefits, which the body of evidence continues to expand.[8] Extensive research has demonstrated strong positive correlations between physical activity and higher levels of physical fitness and academic achievement, educational attainment, academic performance, and brain functioning.[8-10] In fact, physical activity participation has both intermediate and long-term benefits with respect to academic performance. Research has shown that, immediately following engagement in physical activity, children have improved concentration on classroom tasks, which may potentially enhance learning.[8]

It is recommended that schools provide 150 minutes of instructional physical education for elementary school children and 225 minutes for middle and high school students per week for the entire school year.[11] However, only Oregon and the District of Columbia have requirements that meet the recommendations for minutes of physical education.[12] Physical education requirements notably decrease after the fifth grade, which aligns with significant decreases in physical activity in youth. Only 8.7% of schools require physical education for 12th grade, as compared with 45.1% of schools for fifth grade.[13]

The lack of universal physical education requirements at all grade levels and the lack of funding dedicated to physical education facilitate inactivity. The median school physical education budget in the United States is just $764 per year,[12] which may further hinder schools from meeting physical education recommendations. Ohinmaa and colleagues suggested that grants, donations, and fundraising account for about half of all funding for school health.[14] Improving physical education policies nationwide has the potential to reduce overall health care costs by $60.5 million within 10 years.[15]

Students who attend physical education in school are two to three times more likely to be physically active outside of school and nearly twice as likely to be active in adulthood.[16] Furthermore, physical education has been shown to be an opportunity for students to gain many of their recommended minutes of physical activity, but many students do not attend or participate in these classes.[13] According to 2019 YRBSS data, about half of high school students attend physical education classes one or more days per week.[2] Therefore, targeting middle and high schools is uniquely important because a significant drop in physical education attendance and physical activity participation occurs between the seventh and 12th grades.[11]

Evidence-Based Strategies to Address the Problem
Youth spend a significant portion of their time at school[17]; therefore, schools are one of the most important places for physical activity interventions.[18] According to the Society of Health and Physical Educators, schools should require physical education for students in kindergarten through grade 12.[19] Specifically, all students within secondary school (which includes middle school and high school) should achieve 225 minutes of physical activity per week, while students in primary school (which includes elementary school) should achieve 150 minutes per week.[19]

Current evidence-based strategies to increase physical activity among youth are described below.

Improving school-based physical education: According to the Community Preventive Services Task Force (CPSTF),[20] enhanced school-based physical education involves changing the curriculum and coursework for K-12th-grade students to increase the amount of time students spend engaging in moderate to vigorous physical activity (MVPA) during physical education classes. Enhanced school-based physical education is defined as increasing the amount of time students spend completing MVPA during physical education classes to at least 50% of class time.[20] The CPSTF specifically recommended improving physical education teaching strategies by (1) incorporating modified games and substituting sedentary games with active games and (2) including physical education lesson plans that incorporate fitness and circuit training activities.[20]

Lonsdale and colleagues highlighted effective strategies to increase MVPA, which included teacher professional learning focusing on class organization, management, and instruction and supplementing the usual physical education lessons with high-intensity activity (i.e., fitness infusion).[21] A systematic review of 14 studies showed that students who participated in enhanced school-based physical education classes engaged in 24% more MVPA.[21] Also, groups that received enhanced school-based physical education spent on average 53% of their time engaged in MVPA.[21] In addition, Zhou and Wang found that team games were reported to accumulate the most MVPA time, with movement-based activities (such as gymnastics and dance) having the highest amounts of MVPA and knowledge-based activities (i.e., lesson-based instruction) having the lowest amounts.[22] Implementation of enhanced school-based physical education aligns with the Healthy People 2030 objectives, which aim to increase the proportion of adolescents who meet current federal physical activity guidelines for aerobic physical activity and muscle-strengthening activity.[23]

It is important that physical education classes be taught by state‐licensed or state‐certified teachers who are endorsed to teach physical education. In a meta-analytic review, Hollis and colleagues found that youth were engaged in MVPA for an average of 44.8% of lesson time.[24] Low MVPA levels in physical education lessons could be the result of pedagogical characteristics often observed in typical lessons, such as stopping physical activity to provide instruction, observing demonstrations related to the activity, or organizing equipment or student groups.[25] An examination of time allotment in terms of lesson context revealed that 30% of lesson time was spent in game play, 29% in fitness, 20% in classroom management, 9% in knowledge-related activities, and 5% in skill-related activities.[15] Similar results were found in a study by Powell and colleagues in which the average length of physical education lessons was 35.3 minutes, with only 15 minutes of MVPA during physical education.[26] Results further demonstrated that 34% of the lesson was spent standing and 21.7% was spent sitting, with time sitting being directly linked to knowledge attainment.[26]

In conclusion, a significant proportion of physical education instruction time is spent on classroom management, instruction, and transitional periods. While these periods are necessary, they detract from the overall time youth spend participating in MVPA. It is, therefore, recommended that all physical education courses be taught by qualified individuals who have received formal training in physical education pedagogy. SHAPE America has specifically recommended that physical education be taught by an endorsed state‐licensed or state‐certified teacher.[11] This educational licensure or certification requirement would ensure that the physical education curriculum used in schools is appropriate and maximizes the time students spend engaging in MVPA while also aligning with national and/or state physical education standards for K-12 physical education.[11]

Increasing the frequency of physical education: Scientific evidence has shown that increasing the frequency of physical education can improve overall physical activity among youth. Research indicates that only 25.9% of high school students attend physical education classes five days per week.[5] Findings from the School Health Policies and Practices Study showed that less than 4% of elementary and middle schools require physical education or similar activity every day throughout the school year.[18] Moreover, less than 9% of middle schools require physical education at least three days per week.[18] Physical education instruction for high school students decreased from 29.9% in 2017 to 25.9% in 2019.[5]

The benefits of regular physical activity are well documented and include improvements in bone and muscle development, cardiorespiratory fitness, and weight control; reduced symptoms of depression and anxiety; and reduced risks of heart disease, cancer, type 2 diabetes, and hypertension.[3] Research has demonstrated that physical activity throughout the school day is associated with better school performance.[8] Healthy People 2030 objectives highlight the importance of increased physical activity through improved physical education in both public and private school systems. Specifically, the Educational and Community-Based Programs workgroup aims to increase the proportion of adolescents who participate in daily school-based physical education.[7]

Reduction or removal of waivers, substitutions, and exemptions for physical education: Another important strategy to increase school-based MVPA is the reduction or removal of waivers, substitutions, and exemptions for physical education. According to the Shape of the Nation 2016 report, 30 U.S. states allow student exemptions from physical education classes, and 31 states allow students to substitute activities such as marching band, cheerleading, drill team, or intramural sports for physical education credit.[12] SHAPE America issued a position statement according to which school districts and schools should not allow waivers or exemptions from physical education class time or credit requirements.[11] Specifically, SHAPE firmly asserted that all students should be required to complete physical education courses and that state, district, and school policies should not allow substitutions, waivers, or exemptions for physical education courses, class time, or credit requirements. By allowing waivers, substitutions, and exemptions for physical education, schools and districts eliminate opportunities for students to be active at a time when physical activity levels are at an all-time low among youth.[11] As mentioned, schools offer a unique setting to teach children the value of physical activity as well as a structured, supervised environment in which children can learn the necessary skills to encourage lifelong physical activity.[11]

Culturally tailored physical education: Multiple organizations have reported the need to ensure culturally tailored physical education for all populations, especially marginalized populations such as minority racial, ethnic, and cultural groups; girls and women; refugees; people experiencing homelessness; LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning) populations; and others.[27,28] The United Nations Educational, Scientific and Cultural Organization's Guidelines for Policy-Makers on Quality Physical Education stated the need for and importance of providing physical education for minority groups. According to the guidelines, (1) curricula should be flexible and adaptable for all groups, (2) teachers should be professionally qualified and capable of providing physical education for all students, and (3) school policies and practices should provide appropriate infrastructure, faculties, equipment, and teaching material for all students.[28]

Lastly, it is recommended that teachers have access to resources such as community health workers who can provide culturally specific guidance on physical education. Community health workers are particularly effective because of the cultural and linguistic connections they have with the communities they serve.[29] Providing culturally appropriate physical education may increase physical activity,[30] decrease obesity,[31] and improve the overall health of minority groups by increasing social support, promoting healthy lifestyles, and increasing knowledge of disease prevention.[32]

Adaptive physical education: According to the Physical Activity Guidelines for Americans, children and adolescents with disabilities are more likely to be inactive than those without disabilities.[7] It is recommended that children and adolescents with disabilities still aim to meet the key guideline of 60 minutes of physical activity every day when possible. If youth are unable to participate in the physical activities or durations needed to meet the key guidelines, it is recommended that they be as active as possible and avoid being inactive.[7]

Youth with disabilities should work with health care professionals or physical activity specialists to learn about the types and amounts of physical activity appropriate for them.[7] The Adapted Physical Education National Standards were developed to ensure that physical education for children with disabilities be delivered by a qualified adapted physical educator. According to these standards, physical education teachers should use sound teaching practices to ensure the inclusion and representation of all skill and ability levels.[33] Specifically, master physical educators should be well prepared to provide knowledge acquisition as well as physical activity opportunities for all abilities to create active and healthy lifestyles for all students. In addition, the standards outline high expectations for a physically active lifestyle. Lastly, it is expected that master physical educators will maintain a stimulating, productive learning environment that holds all students to the highest expectations for a physically active lifestyle.[33]

Conclusion: In conclusion, schools are the ideal and recommended setting for the promotion of physical activity among youth, and physical education is the primary vehicle through which to achieve this objective in schools.[34] Improving the quality and quantity of physical education courses will give youth more opportunities to attain the recommended amount of physical activity each day. Reducing physical education waivers would ensure that youth are not exploiting a loophole in the system. Advocating for culturally tailored physical education and adaptive physical education would foster an inclusive environment in which all children are able to be physically active and healthy.

Opposing Arguments/Evidence
Few would disagree that physical activity and time spent engaged in physical education are important for youth development and overall health. The primary opposing arguments tend to stem from the poorly designed physical education curriculum and the time taken away from other subjects amid increased pressure to raise standards and scores in subjects such as math, science, and English. As a result, time allocated to physical education and the perceived importance of physical education lessons have been reduced.

However, there is a substantial amount of evidence that physical activity can help improve academic achievement, including overall grades and standardized test scores.[34] In a systematic review of 43 articles and 50 studies, the Centers for Disease Control and Prevention (CDC) determined that physical activity has a positive impact on cognitive skills, attitudes, and academic achievement.[34] Specifically, physical activity enhanced concentration and attention and improved classroom behavior.[34] The review also showed that increasing time during the school day for physical activity does not appear to take away from overall academic performance.[34] Therefore, the CDC recommended that schools increase the amount of time students spend in physical education or consider adding components to increase the quality of physical education classes.[34] As highlighted in the evidence-based strategies to improve school-based MVPA, the CPSTF recommended use of enhanced physical education, including improved physical education teaching strategies, by incorporating modified, more active games and physical education lesson plans that involve fitness and circuit training activities.[20]

Alternative Strategies
Enhancing, encouraging, and maintaining physical education class duration and quality are vital to the health and well-being of children, particularly in terms of their physical activity behaviors. However, there are several alternative strategies to increase the physical activity of youth that should be considered in conjunction with retaining the importance of physical education.

Before- and after-school physical activity programs: According to the World Health Organization, after-school activities are a key avenue to supplement youth MVPA levels.[35] After-school physical activity could include physical activity clubs, intramural programs, informal play on school grounds, physical activity in school-based before- and after-care programs, and interscholastic sports.[18] Mayorga-Vega and colleagues found that physical activity that took place after school hours achieved 36% of the recommended 60 minutes of MVPA per day.[36] However, adolescents still reported a higher level of MVPA during physical education classes than during school recess and after-school programs.[36]

Only about 26% of the nation's public and private schools provide access to their physical activity spaces and facilities for all individuals outside of normal school hours. In addition, a steady decline has been observed in provision of access to physical activity facilities during nonschool hours.[37] Therefore, schools can further encourage physical activity by opening up their facilities for community use.[18]

Increasing active transportation to and from school: According to the CPSTF, walking or bicycling to and from school provides children and adolescents with an opportunity to be physically active most days of the week.[38] Interventions such as the Safe Routes to School program could increase active transportation to and from school and reduce pedestrian and bicycle injury rates. However, there is not enough evidence to show that school travel leads to increases in students' overall daily physical activity.[38]

Recess: Recess is defined as a regularly scheduled period during the school day for physical activity and play that are monitored by trained staff or volunteers.[13] Recess has been directly related to increased physical activity, improved memory, improved attention, improved concentration, decreased classroom disruptive behavior, improved social and emotional development, and academic achievement.[8,39-41] It is recommended that elementary, middle, and high school students have a minimum of 20 minutes of daily recess.[39] The CDC has further recommended that recess and physical education be separate, distinct physical activity opportunities, which creates separate times for skill acquisition (physical education) and active play (recess).[39] Also, the CDC has recommended that schools provide students with adequate, designated, and safe spaces, facilities, equipment, and supplies for both indoor and outdoor recess (e.g., playground markings, physical activity zones, activity cards).[39] Lastly, students should not be excluded from recess for disciplinary reasons or academic performance because such practices promote negative reinforcement.[39]

Classroom-based physical activity: Classroom-based physical activity, including single physical activity sessions, may increase student attention, concentration, and memory; increase motivation and enjoyment of learning; and reduce behavior issues.[8,40] Classroom-based physical activity integration may include physically active lessons, physical activity before a test, physical activity breaks, energizers, brain boosters, and active classrooms (a teaching technique that intentionally blends physical activity into academic lessons to satisfy the learning outcomes of the classroom without sacrificing time spent engaging in physical activity).[8,40,42] Further guidance by the CDC and other national organizations includes providing teachers with ongoing professional development to integrate physical activity into planned academic instruction as a means of reinforcing academic concepts.[40]

Action Steps
Increasing physical activity among school-aged children is a vital investment in the health and well-being of youth in the United States. Increasing physical activity at this critical age has the potential to build healthier, happier young adults. Schools should support physical activity through culturally appropriate, high-quality physical education. Schools; local, state, and federal education agencies; public health departments; policymakers; and researchers should address the following objectives relevant to public health priority setting in order to advance school-based physical activity programming and activities:

1. Federal agencies should develop national policies on physical education that are consistent with the larger national strategies to increase physical activity among youth.

2. Federal and state governments should increase funding for schools to implement high-quality physical education programming

3. State and local education departments should improve physical education requirements to provide the opportunity for 60 minutes of MVPA each school day.

4. Policymakers at state and local education departments should be made aware of the importance of physical education provided by schools.

5. Schools should require that all physical education teachers be appropriately credentialed to deliver culturally appropriate, high-quality physical education.

6. Schools should solicit involvement and expertise from state and local public health departments and physical activity researchers on culturally specific, evidence-based strategies to improve school-based physical education.

7. Principals and superintendents of schools should develop action plans to improve physical education for all of their students. Youth should have the opportunity to engage in 60 minutes of physical activity during the school day.

8. Principals and superintendents should reduce or eliminate policies allowing waivers for physical education. Waivers should be considered on a case-by-case basis.

9. Schools and school districts should engage in collaborative efforts to share the results of successfully implemented physical education programs.

10. Schools and researchers should collaborate in studying physical activity among diverse youth who have been traditionally understudied and systematically underserved. Furthermore, researchers should be encouraged to develop innovative programs for youth in school settings that promote physical activity for all.

11. Greater diversity in programming should be implemented in schools so that youth can be exposed to a variety of activities that those of all abilities and cultures might enjoy.

12. Youth, families, community members, and local organizations should advocate to their school districts and legislative bodies for culturally appropriate, high-quality physical education in their local schools.

13. Public health departments should partner with and support physical education teachers and programs. This support should include school-based physical activity in community health assessments and community health improvement plans highlighting the importance of physical activity in preventing chronic disease and providing mental and cognitive benefits.

References
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Abstract This policy statement provides scientific evidence that schools are unique places where children should be engaged in physical activity. However, most school policies and programs are not supportive of physical activity in the school day, specifically physical education.

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Playing Youth Sports Linked to Better Mental Health in Adults

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Playing youth sports linked to better mental health in adults

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Adults who continuously played organized sports through their youth have fewer symptoms of anxiety and depression than those who never played or those who dropped out, a new study finds.And those who dropped out of sports had poorer mental health than those who never played at all.But many more people drop out of youth sports than play continuou…

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Physical Activity Improves Children's Moods and Helps Reduce Idle Behavior

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PE, school sports and physical activity (PESSPA) are critical tools in fostering healthier, happier and more resilient children and young people, concluded a recent study from University of Manchester experts in collaboration with the Youth Sport Trust who have included it in their new annual report.In an article summarising their findings publi…

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Through the expansion of outdoor learning, schools are targeting mental health, academic reengagement and the ‘nature gap.’

# data[].attributes.attachment_link.title
From screen time to ‘green time’: Going outside to support student well-being

# data[].attributes.attachment_link.description
Through the expansion of outdoor learning, schools are targeting mental health, academic reengagement and the ‘nature gap.’

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Play-Based Learning in Kindergarten Is Making a Comeback

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Physical Activity During School: Providing Recess to All Students 

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How Exercise Improves Mental Health in Children 

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How Exercise Improves Mental Health in Children - AccuTrain

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Regular exercise may offer powerful support for the mental health of youth, according to new research from the University of South Australia cited in an