Topic: Active Living

Strategy Profile: Active Recess

Posted on April 28, 2022

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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February 2022 Coffee Chat Resource Round-Up

Posted on March 8, 2022

This document compiles resources and information shared during the February 24, 2022 coffee chat, which featured partners who shared creative ways they have brought attention to prevention and health promotion priorities in their communities.

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Brief: More Movement Program in Early Child Care Settings in Boston, MA

Posted on September 20, 2021

Young boy getting physical activity

The information in this brief is intended only to provide educational information.

Versions of this brief were published in September 2021 and January 2023. The January 2023 update was to reflect revised projections for Boston’s population. This brief was updated again in October 2023 to more accurately represent the model period.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining the More Movement program in early child care settings in Boston. This strategy provides training opportunities and resources for early child care educators to implement actions in their programs to encourage physical activity.

The Issue

Every child should have opportunities to grow up at a healthy weight. Early child care programs are key settings that can provide physical activity opportunities that support child development and lay the foundation for a healthy lifestyle. National guidelines recommend preschool-aged children engage daily in 60 to 90 minutes of moderate-to-vigorous physical activity while in early child care settings.1 However, many children do not meet these recommended levels of activity.2

In 2017, about three in 10 first graders in Boston had overweight or obesity.3 If trends continue, over half of today’s children will have obesity as adults.4 Increasing physical activity in child care settings is a national health priority.5 Therefore, identifying strategies that help young children move more is important for ensuring children develop healthy habits and grow up at a healthy weight.

About the More Movement Program in Early Child Care Settings

The More Movement program could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators in physical activity curricula, provide resources and instructional materials, and support technical assistance opportunities that may lead to higher physical activity levels among young children.6,7 Helping educators implement practices shown to be effective in increasing physical activity can help the children in Boston’s early education and care settings to move more.

NOTE: The data that informed these estimates were collected after the program closures prompted by the COVID-19 pandemic. As programs reopen and demand continues to increase, this strategy could reach more children.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of implementing the More Movement program in Boston early child care settings with the costs and outcomes associated with not implementing the strategy over 10 years (2020-2029).

Implementing the More Movement program in early child care settings is an investment in the future. By the end of 2029:

18,200 children would be reached over 10 years; 94 cases of childhood obesity would be prevented in 2029; this strategy would cost $30 per child to implement; children reached would get 7.4 additional minutes of moderate-to-vigorous physical activity per child per day

Conclusions and Implications

If the More Movement program were implemented, we project that over 10 years, 18,200 children ages 3-5 would attend early child care programs that promote and encourage more physical activity (based on the number of programs open during the COVID-19 pandemic). This strategy would prevent 94 cases of obesity in 2029 alone, saving $104,000 in obesity-related health care costs over 10 years. The average annual cost to implement these activities would be $293 per program, or $30 per child.

Expanding training opportunities for early child care educators will also help support quality care. Ensuring access to quality care is essential for families and employers.8 In the initial training series, the More Movement program would provide additional skills training and professional development for 1,380 educators and more physical activity promotion opportunities in 570 (100%) child care programs serving 3-5 year olds.

Besides promoting a healthy weight, engaging in physical activity benefits children in other ways. Increased physical activity is linked to improved bone and muscular health and better gross motor skills in young children.9-11 We estimate that, on average, each child attending a More Movement program would increase daily moderate-to-vigorous physical activity by seven minutes. This can help to form a strong foundation for overall health and well-being.

The More Movement program is a strategy for training and providing technical assistance in early child care. As programs reopen post-pandemic and demand for child care continues to increase, the strategy could reach even more children. The More Movement program would enable early child care programs in Boston to support healthy growth because every child deserves a healthy start.

References

  1. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs. 2019. https://nrckids.org/files/CFOC4%20pdf-%20FINAL.pdf

  2. Tassitano RM, Weaver RG, Tenório MCM, Brazendale K, Beets MW. Physical activity and sedentary time of youth in structured settings: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2020;17(1):160. Published 2020 Dec 4. doi:10.1186/s12966-020-01054-y

  3. School Health Services, Dept of Public Health. Results from the Body Mass Index Screening in Massachusetts Public School Districts, 2017. School Health Services, Dept of Public Health; 2020. Accessed July 23, 2021. https://www.mass.gov/doc/the-status-of-childhood-weight-in-massachusetts-2017  

  4. 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; 377(22): 2145-2153. 

  5. Healthy People 2030. Increase the proportion of child care centers where children aged 3 to 5 years do at least 60 minutes of physical activity a day — PA-R01. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health. Accessed Nov 16, 2020. https://health.gov/healthypeople/objectives-and-data/browse-objectives/physical-activity/increase-proportion-child-care-centers-where-children-aged-3-5-years-do-least-60-minutes-physical-activity-day-pa-r01

  6. Fitzgibbon ML, Stolley MR, Schiffer LA, et al. Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: Postintervention Results. Obesity (Silver Spring). 2011;19(5):994-1003. 

  7. Kong A, Buscemi J, Stolley MR, Schiffer LA, Kim Y, Braunschweig CL, Gomez-Perez SL, Blumstein LB, Van Horn L, Dyer AR, Fitzgibbon ML. Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results. American Journal of Preventive Medicine. 2016 Feb;50(2):136-44.

  8. Campbell F, Patil P, McSwain K. Boston’s Child-Care Supply Crisis: What a Pandemic Reveals. Boston Opportunity Agenda; 2020. Accessed July 23, 2021. https://www.bostonopportunityagenda.org/-/media/boa/early-ed-census-2020-pt-1-202011.pdf

  9. U.S. Dept of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. U.S. Dept of Health and Human Services; 2018. Accessed Jul 23, 2021. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

  10. Pate RR, Hillman CH, Janz KF, et al. Physical Activity and Health in Children Younger than 6 Years: A Systematic Review. Medicine & Science in Sports & Exercise. 06 2019;51(6):1282-1291.

  11. Timmons BW, Leblanc AG, Carson V, et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Applied Physiology, Nutrition, and Metabolism. Aug 2012;37(4):773-92.

Suggested Citation:

Bovenzi M, Carter S, Sabir M, Bolton AA, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Boston, MA: More Movement Program in Early Child Care Settings {Issue Brief}. Boston Public Health Commission and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023. For more information, please visit www.choicesproject.org 

Versions of this brief were published in September 2021 and January 2023. The January 2023 update was to reflect revised projections for Boston’s population. This brief was updated again in October 2023 to more accurately represent the model period.

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Boston Public Health Commission through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by 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.

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Brief: Creating Healthier Child Care Environments: NAPSACC in the Quality Rating Improvement System in Arkansas

Posted on May 17, 2021

Young kids playing in an early care setting

The information in this brief is intended only to provide educational information.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy incorporating the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) assessment tools into Better Beginnings, Arkansas’ Quality Rating and Improvement System, to support quality early child care program opportunities and promote child health. 

The Issue

In Arkansas, three out of 10 kindergarteners entering school in 2018 had overweight or obesity.1 The majority of today’s children will have obesity at age 35 if we don’t act.2 Making sure children are growing up at a healthy weight from their very first days is a critical way to prevent obesity and future risk for obesity-related diseases like diabetes as adults. Conditions linked to obesity, previously only seen in adults, are appearing in Arkansas’ Medicaid-enrolled children.3 Early child care programs that support healthy nutrition and physical activity habits show great promise in promoting healthy weight.4

In Arkansas, more than half of children ages 2-5 attend a licensed child care program.5 Providing licensed child care programs with training opportunities and resources through Better Beginnings may be an effective strategy to improve the quality of child care programs and to ensure that the majority of children in Arkansas are off to a healthy start.

About NAP SACC

NAP SACC is an evidence-based, trusted strategy enabling child care centers to attain best practices regarding nutrition, active play, and screen time.4 To date, NAP SACC shows the best evidence for reducing childhood obesity risk in children under age 5.6 Early education program directors and staff complete self-assessments and receive training and technical assistance to implement practices, policies, and changes supporting healthy outcomes. Better Beginnings is designed to improve child care environments to support child health and development. Integrating NAP SACC into Better Beginnings can improve the quality of child care programs and ensure more children grow up healthy in Arkansas.

Comparing Costs and Outcomes

A CHOICES cost-effectiveness analysis compared the costs and outcomes over a 10-year time horizon (2020-2030) of implementing NAP SACC with the costs and outcomes of not implementing the program.

Implementing NAP SACC into Better Beginnings in Arkansas is an investment in child health. By the end of 2030:

If NAP SACC was incorporated into Better Beginnings in Arkansas, then 116,000 children would be reached over 10 years with more active play, less screen time, and healthier food and drinks. 1,320 early care directors and staff would be trained in the first year. It would cost $18 per child per year to implement. 8,720 years with obesity would be prevented over 10 years.

Conclusions and Implications

Every child should have opportunities for a healthy start. A state-level initiative integrating NAP SACC into training and quality improvement through Better Beginnings could create healthier nutrition and physical activity environments in child care programs for 116,000 children over 10 years. This strategy would benefit 1,320 early care directors and staff with training and technical assistance to support using nutrition, active play, and screen time best practices at 659 child care programs. Over 10 years, children in Arkansas would have 8,720 more years lived at a healthy weight and 1,130 fewer children would have obesity in 2030 alone.

Many prevention strategies targeting children require an upfront investment because costly obesity-related health conditions generally present later in adulthood.7 While we project this strategy would cost $18 per child per year, shortchanging early prevention efforts may lead to costly and complicated treatment in the future. Already, the total annual costs of having obesity are estimated to be $6 million for the 30,000 25- to 29-year-olds enrolled in Medicaid—inclusive of Arkansas’ expansion population. This represents an excess annual cost of $200 per person due to obesity.3

Early child care programs also play a critical role in supporting healthy child development and children’s academic readiness.8 Investing in a strategy for quality improvement that provides the necessary training, technical assistance, and resources supports early educators in providing high-quality child care that nurtures healthy habits. Enabling early education leaders in Arkansas to use the best available evidence to prevent excess weight gain in children will support children’s healthy growth and development.

References

  1. ACHI. (2019). Assessment of Childhood and Adolescent Obesity in Arkansas: Year 16 (Fall 2018–Spring 2019). Arkansas Center for Health Improvement. Little Rock, AR.

  2. 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; 377(22): 2145-2153.

  3. ACHI, Arkansas Medicaid. Comorbid Conditions and Medicaid Costs Associated with Childhood Obesity in Arkansas. 2019.

  4. Alkon A, Crowley AA, Neelon SE, Hill S, Pan Y, Nguyen V, Rose R, Savage E, Forestieri N, Shipman L, Kotch JB. Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children’s body mass index. BMC Public Health. 2014;14:215.

  5. Arkansas Department of Human Services, Division of Child Care and Early Childhood Education, Child Care Facilities Database. Unpublished data. 2020.

  6. Kenney E, Cradock A, Resch S, Giles C, Gortmaker S. The Cost-Effectiveness of Interventions for Reducing Obesity among Young Children through Healthy Eating, Physical Activity, and Screen Time. Durham, NC: Healthy Eating Research; 2019. Available at: http://healthyeatingresearch.org

  7. Gortmaker SL, Wang YC, Long MW, Giles CM, Ward ZJ, Barrett JL, …Cradock, AL. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Affairs. 2015; 34(11), 1932–1939.

  8. Morrisey T. The Effects of Early Care And Education on Children’s Health. Health Affairs Health Policy Brief. 2019

Suggested Citation:

Adams B, Sutphin B, Betancourt K, Balamurugan A, Kim H, Bolton A, Barrett J, Reiner J, Cradock AL. Arkansas: Creating Healthier Child Care Environments: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) in the Quality Rating Improvement System (QRIS) {Issue Brief}. Arkansas Department of Health, Little Rock, AR, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2021. For more information, please visit www.choicesproject.org

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Arkansas Department of Health through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by 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.

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

Posted on May 13, 2021

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)

Posted on May 13, 2021

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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Brief: Safe Routes to School in Wisconsin

Posted on May 5, 2021

Young girl riding bike at the Safe Routes to School Family Fun Night Event in Neenah, Wisconsin in May 2018; orange cone in the background

The information in this brief is intended only to provide educational information.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining the expansion of a regional Safe Routes to School program in K-8 public and private schools in Wisconsin. Safe Routes to School Programs help children safely walk and bike to school by incorporating principles of the six E’s: engagement, encouragement, equity, engineering, education, and evaluation.

The Issue

In Wisconsin, just three out of every 10 children achieve the 60 minutes of physical activity recommended daily for health.1 Over recent decades, the number of students walking and bicycling to school has declined,2 eliminating an important physical activity opportunity. Adopting programs that make it safer and easier to walk or bike to school can increase the number of students using these physically active travel modes and can also allow students to incorporate physical activity into a daily routine.3 Every child should have the opportunity to be healthy, and all kids need opportunities to be physically active, no matter where they live or where they go to school. This study estimates the cost-effectiveness of increasing funding and diversifying funding sources to expand a regional model for Safe Routes to School programs for those schools that have not yet implemented comprehensive Safe Routes to School programs in Wisconsin.

About Safe Routes to School

Safe Routes to School programs that adopt the six E’s, including improvements to local sidewalks and roads around schools, providing pedestrian and bike safety education, and offering encouragement and promotion activities, can increase the number of students walking and bicycling to school.2 This study looked at the scaled expansion of East Central Wisconsin Regional Planning Commission’s Safe Routes to School program to other regional planning commissions across Wisconsin. A state-wide Safe Routes to School Program Coordinator would work with regional SRTS Coordinators and advisory committees, providing oversight and administration of the allocated funding to support projects in their region. Each regional planning commission would coordinate education, encouragement, and promotion activities across funded schools in their region. Local municipalities would lead projects to improve the safety of sidewalks and road infrastructure.

Comparing Costs and Outcomes

A CHOICES cost-effectiveness analysis compared the costs and outcomes of expanding Safe Routes to School in Wisconsin with the costs and outcomes associated with not implementing the program over 10 years (2020-2030).

Implementing Safe Routes to School in Wisconsin is an investment in child health. By the end of 2030:

If Safe Routes to School was expanded in Wisconsin, then by the end of 2030, 151,000 children would attend schools with safer transportation environments, and children who start walking or biking to school would get 48 more active minutes per week. This program would cost $58 per child annually to implement, for those children attending schools that adopt Safe Routes to School programs.

Conclusions and Implications

Every student should be able to walk or bike to school safely. Expanding East Central’s regional Safe Routes to School model in Wisconsin could support safer walking and biking environments and provide programmatic education and encouragement initiatives for 151,000 elementary and middle school students over 10 years. We estimate that the Safe Routes to School program, which includes education and promotion activities, improvements to sidewalks and road infrastructure, and coordination support, would cost $58 per student per year. Over 10 years, these activities to expand the regional SRTS model in Wisconsin would cost about $215,000 per school. At the same time, more than 8,000 students would start walking and biking to school, and they would get 48 more minutes of physical activity per week. This translates to better health outcomes and more kids at a healthy weight in Wisconsin, with 16 fewer cases of obesity in the year 2030 alone.

In addition to getting students more active,4,5 SRTS initiatives may also reduce the risk of pedestrian and bicycle injury, exposure to unsafe traffic, and air pollution.3,6,7 Greater safety, improved health from increased physical activity, and lesser environmental impact from decreased automobile use provide economic benefits to the community.8 In Wisconsin, the costs of implementing SRTS projects could be offset by savings associated with reduced vehicle travel, potentially amounting to $2.19 million in environment-related cost savings over 10 years. Further, families whose students start walking or bicycling would also drive less and could save an average of $1,120 by not driving their students to school. Walking and biking are great ways for kids to be active, and this program invests in ways to ensure that more students can do so safely while developing healthy lifestyle habits that would continue into adulthood.

References

  1. Child and Adolescent Health Measurement Initiative. 2018-2019 National Survey of Children’s Health (NSCH) data query. https://www.nschdata.org/browse/survey/results?q=7700&r=51. Accessed October 29, 2020.

  2. McDonald, NC. Active transportation to school: trends among US schoolchildren, 1969–2001. American Journal of Preventive Medicine. 2007; 32(6), 509-516.

  3. Stewart O, Vernez Moudon A, Claybrooke C. Multistate Evaluation of Safe Routes to School Programs. American Journal of Health Promotion. 2014;28(3);S89-S96.

  4. Cooper, Jago, Southard, Page. Active Travel and Physical Activity across the School Transition: The PEACH Project. Medicine & Science in Sports & Exercise. 2012; 44(13); 1890–1897.

  5. Huang WY, Wong SH, He G. Is change to active travel to school an important source of physical activity for Chinese children? Pediatric Exercise Science. 2017; 29(1):161-168.

  6. DiMaggio, C, & Li, G. Effectiveness of a safe routes to school program in preventing school-aged pedestrian injury. Pediatrics. 2013;131(2);290-296.

  7. DiMaggio C, Chen Q, Muennig PA, Li G. Timing and effect of a safe routes to school program on child pedestrian injury risk during school travel hours: Bayesian changepoint and difference-in-difference analysis. Injury Epidemiol. 2014;1:17.

  8. Jacob V, Chattopadhyay SK, Reynolds JA, et al. Economics of Interventions to Increase Active Travel to School: A Community Guide Systematic Review. American Journal of Preventive Medicine. 2021;60(1):e27-e40.

Suggested Citation:

McCulloch SM, Barrett JL, Reiner JF, Cradock AL. Wisconsin: Safe Routes to School {Issue Brief}. Wisconsin Department of Health Services, Division of Public Health, Madison, WI, & East Central Wisconsin Regional Planning Commission, Menasha, WI and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2021. For more information, please visit www.choicesproject.org

Funding for the Survey of the Health of Wisconsin (SHOW) was provided by the Wisconsin Partnership Program PERC Award (233 AAG9971). The authors would also like to thank the University of Wisconsin Survey Center, SHOW administrative, field, and scientific staff, as well as all the SHOW participants for their contributions to this study.

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Wisconsin Department of Health Services through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by 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.

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Brief: Active Physical Education (PE) in Iowa

Posted on April 12, 2021

PE class at Carver Elementary, Des Moines Public School System

The information in this brief is intended only to provide educational information.

This brief summarizes the findings from a CHOICES Learning Collaborative Partnership model examining a strategy supporting the implementation of a guideline that 50% of physical education (PE) class time be spent in moderate-to-vigorous physical activity, consistent with best practice guidelines in quality physical education programs.

The Issue

In Iowa, only three out of every 10 children meet the national recommendation for participating in 60 minutes or more of moderate-to-vigorous physical activity each day.1 Evidence shows that physical activity helps kids grow up at a healthy weight, preventing diseases like diabetes and heart disease. Physical activity also has important brain health benefits for students, such as promoting cognition and reducing symptoms of depression.2 High-quality physical education programs in schools can help students get the recommended amount of daily physical activity.2 However, research shows that some children may spend less than half of the PE class being physically active.3

About Active PE

Active PE would support educators’ equipment, curricular, and training needs to ensure that their students can participate in high-quality physical education. Curriculum training specialists would train physical education teachers in Iowa schools in an evidence-based, standards-aligned curriculum and training program that can increase the quality of the existing physical education program and the proportion of time students are active while in PE class.4 This strategy would support the implementation of Iowa’s Physical Education standards and aligns with Iowa Department of Public Health’s goal to ensure students have the opportunity to engage in one hour of physical activity each day.5 Implementation of Active PE would include a two-day training workshop for PE teachers, providing the necessary curriculum and equipment materials for schools, and include state-level coordination.6,7

Comparing Costs and Outcomes

A CHOICES cost-effectiveness analysis compared the costs and outcomes over 10 years (2020-2030) of implementing Active PE with the costs and outcomes associated with not implementing the strategy.

Implementing Active PE in Iowa is an investment in the future. By the end of 2030:
If Active PE was implemented in Iowa, then by the end of 2030, 495,000 children would be reach over 10 years. It would cost $8 per child to implement Active PE. Each child would get 7 more active minutes per week.

Conclusions and Implications

Implementation of Active PE strategies is projected to increase physical activity and improve the health of 495,000 elementary and middle school students in Iowa over 10 years. On average, each student would participate in seven more minutes of moderate-to-vigorous physical activity during each school week. We also estimate there will be 137 fewer cases of obesity in Iowa in 2030 alone just by implementing these strategies to increase the active time during existing physical education classes.

This strategy also provides professional development opportunities for 912 teachers annually at 1,033 schools, enabling them to learn new instructional strategies to foster a fun and enjoyable environment where children can gain standards-based skills that support lifelong physical activity.4 Implementing the Active PE best practice guideline would ensure that most students in Iowa could benefit from high-quality PE time without requiring changes to staffing or school schedules. This could be incorporated into a comprehensive plan to help support healthy growth and development at an average cost of under $8 per student per year.

Strategies to ensure that students have access to high-quality physical education classes where more time is spent in active movement can help children get more physical activity.2 In addition to promoting a healthy weight, physical activity benefits students in other ways. Regular physical activity builds strong bones and muscles, reduces symptoms of anxiety and depression, and improves cognition.2 Additionally, evidence shows that when children are physically active, they tend to perform better in the classroom, have higher school attendance, and have fewer disciplinary problems.8 These other benefits are not quantified in this analysis but are key for children’s education and well-being.

References

  1. Child and Adolescent Health Measurement Initiative. 2018-2019 National Survey of Children’s Health (NSCH) data query. https://www.nschdata.org/browse/survey/results?q=7700&r=17. Accessed October 29, 2020.

  2. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services, 2018.

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

  4. Lonsdale C, Rosenkranz RR, Peralta LR, Bennie A, Fahey P, Lubans DR. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons. Preventive Medicine. 2013;56(2):152-161.

  5. Iowa Department of Public Health. Play Your Way. https://idph.iowa.gov/inn/play-your-way. Accessed November 30, 2020.

  6. Barrett JL, Gortmaker SL, Long MW, et al. Cost Effectiveness of an Elementary School Active Physical Education Policy. American Journal of Preventive Medicine. 2015;49(1);148-159.

  7. Cradock AL, Barrett JL, Kenney EL, et al. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Preventive Medicine. 2017; 95;S17-S27.

  8. Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion. Physical Education. April 21, 2020. https://www.cdc.gov/healthyschools/physicalactivity/physical-education.htm. Accessed December 15, 2020.

Suggested Citation:

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. For more information, please visit www.choicesproject.org

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Iowa Department of Public Health through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by 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.

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