Resource Type: Tools & Guides

Strategy Profile: Active Physical Education (Active PE)

A diverse group of children playing basketball.

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Active PE is a policy that requires that 50% of time provided in physical education classes for grades K-8 be spent in moderate-to-vigorous physical activity. Physical education teachers are trained to promote physical activity during PE classes using the SPARK or CATCH curricula.

What population benefits?

Children in grades K-8 (5-14 years old).

What are the estimated benefits?

Relative to not implementing the strategy
Increase students’ moderate-to-vigorous physical activity levels and, in turn, promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Oversee training and implementation of Active PE in schools • Time for state PE coordinator to oversee implementation and training State PE coordinator
Monitor compliance with moderate-to-vigorous physical activity policy • Time for state PE coordinator to monitor compliance with policy State PE coordinator
Train PE teachers through state trainings • Time for SPARK/CATCH training consultant to lead trainings
• Time for PE teachers to attend trainings
• Travel costs for PE teachers and SPARK/CATCH training consultants to attend trainings
SPARK/CATCH training consultant
Purchase PE equipment and curricula • PE equipment costs
• SPARK or CATCH curricula costs
Schools
Train principals in assessing moderate-to-vigorous physical activity in PE classes at a state principals association event • Time for training consultant to lead trainings
• Incremental time increase for principals to attend trainings on evaluating PE
• Travel costs for training consultants
Training consultant
Strategy Modification

State and local health agencies modified this strategy in the following ways. 1) Some health agencies modified this strategy to be a best practice or implementation guideline instead of a policy. With this modification, the strategy would cost less because activities to monitor compliance, including training principals, would not occur. Additionally, a percentage – instead of all PE teachers – might be trained using this modification, which would mean reaching fewer children. 2) Some health agencies modified this strategy to use a train-the-trainer model. This modifies the training model so that the training consultants train school district master trainers and the master trainers lead trainings for the PE teachers. Modifying the strategy this way could cost less.


FOR ADDITIONAL INFORMATION

Cradock AL, Barrett JL, Kenney EL, Giles CM, Ward ZJ, Long MW, Resch SC, Pipito AA, Wei ER, Gortmaker SL. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med. 2017 Feb;95 Suppl: S17-S27. doi: 10.1016/j.ypmed.2016.10.017. Supplemental Appendix with strategy details available at: https://ars.els-cdn.com/ content/image/1-s2.0-S0091743516303395-mmc1.docx

Selected CHOICES research brief including cost-effectiveness metrics:
Hopkins H, Lange J, Olson E, Taylor-Watts S, Jenkins L, McCulloch S, Barrett J, Reiner J, and Cradock AL. Iowa: Active Physical Education (PE) {Issue Brief}. Iowa Department of Public Health, Iowa Department of Education, Des Moines, IA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2021. Available at: https://choicesproject.org/publications/brief-active-pe-iowa


Suggested Citation

CHOICES Strategy Profile: Active Physical Education (Active PE). CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2022.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Strategy Profile: Active Recess

Three kids at the playground

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Active Recess is a program to increase physical activity during elementary school recess with structured activities, playground markings, and/or portable play equipment. This program is implemented in elementary schools to promote physical activity during recess.

What population benefits?

Children in grades K-5 (5-11 years old).

What are the estimated benefits?

Relative to not implementing the strategy
Increase students’ moderate-to-vigorous physical activity levels and, in turn, promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Train teachers and recess monitors on recess supervision strategies to increase physical activity • Time for trainer to lead trainings on supervision strategies to increase physical activity
• Time for teachers and recess monitors to attend trainings
• Travel costs for the trainers, teachers, and recess monitors
School district coordinator
Paint markings onto outdoor play spaces • Time for volunteers to paint markings
• Time for school staff member to supervise painting
• Painting material costs
School staff member
Purchase portable playground equipment • Playground equipment costs Schools
Strategy Modification

Some state and local health agencies have added to this strategy the costs of coordinating a broader state-level program when envisioning it being implemented in more than one district. This would add time for a state-level coordinator in the Department of Education to oversee the program and provide training to participating district-level coordinators. With this modification, this strategy could reach more children.


FOR ADDITIONAL INFORMATION

Cradock AL, Barrett JL, Kenney EL, Giles CM, Ward ZJ, Long MW, Resch SC, Pipito AA, Wei ER, Gortmaker SL. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med. 2017 Feb;95 Suppl: S17-S27. doi: 10.1016/j.ypmed.2016.10.017. Supplemental Appendix with strategy details available at: https://ars.els-cdn.com/ content/image/1-s2.0-S0091743516303395-mmc1.docx

Selected CHOICES research brief including cost-effectiveness metrics:
McKinnon A, Barrett J, Cradock AL, Flax C. Salt Lake County: Active Recess {Issue Brief}. Salt Lake County Health Department, Salt Lake City, UT, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2019. Available at: https://choicesproject.org/publications/brief-active-recess-salt-lake-county/


Suggested Citation

CHOICES Strategy Profile: Active Recess. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2022.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Investing in Prevention: A Messaging Guide

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

The COVID-19 pandemic has emphasized the importance of prevention and prioritizing public health efforts that can ensure a healthier future for everyone. The purpose of this messaging guide is to help you communicate about keeping the focus on prevention and making responsible and equitable investments in policies and programs, particularly those focused on healthy eating and active living.

Things to Keep in Mind

  • The COVID-19 pandemic has underscored the importance of prevention. Vaccination,1 mask-wearing,2 social distancing,3 and handwashing4 are all key prevention strategies to limit the spread of the SARS-CoV-2 virus.
  • As state and local health departments strive to foster greater resiliency in local communities, making smart investments in preventive strategies that promote greater health equity matters more than ever.
  • Cost-effectiveness analysis is a powerful tool that can assess which strategies will offer the best value for the money invested and can provide economic justification for investing appropriately. These data points can inform strategic decision-making.
  • Investing in efforts to promote healthy eating and active living can help prevent chronic disease and avoid costly health and economic challenges related to poorer health outcomes in the years to come.
  • Structural racism has contributed to economic disadvantages, healthcare inequities, and lack of access to healthy foods and beverages, resulting in higher rates of obesity and obesity-related diseases among communities of color – including Black, Latinx, and Native American populations.5
  • Incorporating cost-effectiveness analysis methods and focusing on health equity when choosing strategies to promote healthy eating and active living can help reduce obesity and obesity-related disparities. CHOICES Project research documents strategies that are projected to improve overall population health and improve health equity. These strategies should be high on the list of priority actions for state/local governments.

Examples of Strategies that Can Improve Overall Population Health & Improve Health Equity

Excise tax on sugary drinks in California
Incorporating screen time counseling into the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Oklahoma
Electronic decision support for pediatric medical providers in Denver, Colorado

CHOICES Tools & Resources

CHOICES Childhood Obesity National Action Kit
CHOICES Community of Practice
CHOICES Research

Additional Tools & Resources

FrameWorks Guidance: Framing COVID-19
Voices for Healthy Kids: Resource Library

Sample Messaging

An Epidemic of Inactivity & Poor Nutrition

• Making sure kids are growing up with opportunities to be active and eat healthy from their very first days is one of the critical ways to ensure that they have a healthy weight when they reach adulthood.
• Most kids entering adolescence with obesity will still have obesity as adults. Focusing on healthy eating and moving more from an early age are essential prevention strategies.

A Range of Strategies

• Everyone – especially children – should have opportunities to eat healthy and be physically active.
• We must implement a range of strategies within multiple settings – schools, early education and care, health care, and the broader community – if we expect to slow the rise in child and adult obesity and lessen the burden on health and health care costs. No single strategy will be enough.

Prevention Works

• There are a number of strategies that have strong scientific evidence that they will benefit health: these include strategies targeted at increasing physical activity, decreasing sugary drink consumption, and improving diet quality.
• Some of these strategies are even cost-saving, meaning they save more in future health care costs than they cost to put into place.6

Improving Health Equity

• The COVID-19 pandemic has underlined the significant inequities seen throughout the United States among populations defined by race, ethnicity, and income.
• Prevention strategies with strong evidence for a cost-effective impact on health and that promote greater health equity are needed to meaningfully address the disproportionate impact that chronic disease and obesity have on low-income populations and communities of color.

Why Promoting Healthy Weight Matters

• If we don’t act now, more than half of today’s kids will have obesity when they are adults.7 Half of the adult U.S. population will have obesity and a quarter will have severe obesity by 2030.8
• These increases are accompanied by growing inequities by race/ethnicity, geography, and income.9
• Obesity increases risks for diabetes, cardiovascular disease, and cancer.
• Kids with obesity incur an extra $120 in medical costs each year; adults with obesity incur an extra $1,900 in medical costs each year.9

References

  1. Benefits of Getting a COVID-19 Vaccine. Centers for Disease Control and Prevention. Updated April 12, 2021. Accessed April 21, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/vaccines/vaccine-benefits.html
  2. Guidance for Wearing Masks. Centers for Disease Control and Prevention. Updated April 19, 2021. Accessed April 21, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/prevent-getting-sick/cloth-facecover-guidance.html
  3. Social Distancing. Centers for Disease Control and Prevention. Updated November 17, 2020. Accessed April 21, 2021. https://www.cdc.gov/coronavirus/2019-ncov/ prevent-getting-sick/social-distancing.html
  4. When and How to Wash Your Hands. Centers for Disease Control and Prevention. Updated November 24, 2020. Accessed April 21, 2021. https://www.cdc.gov/ handwashing/when-how-handwashing.html
  5. Bleich SN & Ard JD. COVID-19, Obesity, and Structural Racism: Understanding the Past and Identifying Solutions for the Future. Cell Metabolism. 2021 Feb 2;33(2):234-241. doi: 10.1016/j.cmet.2021.01.010.
  6. Gortmaker SL, Claire Wang Y, Long MW, Giles CM, Ward ZJ, Barrett JL, Kenney EL, Sonneville KR, Afzal AS, Resch SC, Cradock AL. Three Interventions That Reduce Childhood Obesity Are Projected to Save More Than They Cost to Implement. Health Affairs, 34, no. 11 (2015):1304-1311. doi/full/10.1377/hlthaff.2015.0631
  7. Ward Z, Long M, Resch S, Giles C, Cradock A, Gortmaker S. Simulation of Growth Trajectories of Childhood Obesity into Adulthood. New England Journal of Medicine. 2017 Nov 30;377(22):2145-2153. doi/full/10.1056/NEJMoa1703860
  8. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax CN, Long MW, Gortmaker SL. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. New England Journal of Medicine. 2019;381:2440-50. doi:10.1056/NEJMsa1909301
  9. Ward ZJ, Bleich SN, Long MW, Gortmaker SL. Association of body mass index with health care expenditures in the United States by age and sex. PLOS ONE. 2021 Mar;16(3): e0247307. doi:10.1371/journal.pone.0247307

Suggested Citation

Investing in Prevention: A Messaging Guide. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2021.

This work has been supported by grants from The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. This messaging guide is intended for educational use only. 

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Making CHOICES in a Health Department: Case 2 (Advanced)

People drawing on a whiteboard

In this advanced teaching case, which builds on Case 1, a fictional health department continues to work with the CHOICES Project’s Learning Collaborative Partnership to determine how to implement an evidence-based strategy that requires substantial investment, but they face a variety of additional challenges such as state politics and the complexities of health policy.

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Making CHOICES in a Health Department: Case 1 (Introductory)

In this introductory teaching case, a fictional health department engages with the CHOICES Project’s Learning Collaborative Partnership to help them narrow down a list of potential strategies to reduce childhood obesity in their county through a cost-effectiveness lens.

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