Topic: Active Living

Strategy Profile: Creating Healthier Afterschool Environments

Posted on October 6, 2022

Young boy eating a green apple

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.

  • Creating healthier afterschool environments is a strategy to improve nutrition and physical activity policies & practices through the Out of School Nutrition and Physical Activity (OSNAP) initiative for children in grades K-5 attending state-administered 21st Century Learning afterschool programs.

What population benefits?

Children in grades K-5 attending state-administered 21st Century Learning afterschool programs.

What are the estimated benefits?

Relative to not implementing the strategy
Increase vigorous physical activity and improve nutritional quality of snacks and beverages offered in afterschool programs, and, in turn, promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Issue regulations to improve nutrition and physical activity policies and practices in afterschool programs • Time to issue and communicate regulations State government
Provide training and technical assistance to regional Healthy Afterschool trainers on how to lead learning collaborative sessions • Time for state Healthy Afterschool coordinator to lead trainings
• Time for regional Healthy Afterschool trainers to be trained and receive technical assistance
• Travel costs
• Training material costs		 State healthy afterschool coordinator
Conduct regional learning collaboratives with afterschool program staff including training and technical assistance on goals and implementation activities • Time for regional Healthy Afterschool trainers to lead learning collaboratives and provide technical assistance
• Time for afterschool program staff to attend learning collaboratives and receive technical assistance
• Training material costs
• Travel costs		 Regional healthy afterschool trainer
Assess and implement actions to change program practices to meet Healthy Afterschool standards • Time for afterschool program staff to conduct program practice self-assessments and implement changes at their program
• Increase in food costs to provide snacks in compliance with nutrition standards to children attending Healthy Afterschool programs		 Afterschool program director
Develop CEU-accredited course for local program staff • Cost to create a CEU-accredited course State healthy afterschool coordinator
Provide educational materials and incentives to local program staff • Material and incentive costs State government
Monitor compliance to ensure afterschool programs are following programmatic requirements • Time for state monitoring and compliance staff to monitor compliance
• Travel costs		 State government monitoring and compliance staff
Establish a Healthy Afterschool recognition and monitoring website • Time to create and maintain website State government website developer
Strategy Modification

This strategy could be modified to benefit children who participate in out-of-school programs administered by other organizations (e.g., YMCA or Boys and Girls Club of America). With this modification, the activities necessary to carry out the voluntary recognition program may not be included (e.g., issuing regulations, creating a healthy afterschool nutrition website, and monitoring compliance). With this modification, the impact on health is expected to be similar, and the impact on reach and cost may vary.

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

Suggested Citation

CHOICES Strategy Profile: Creating Healthier Afterschool Environments. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2023.

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: Movement Breaks in the Classroom

Posted on October 6, 2022

Teacher leading a movement break in the classroom with young kids

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.

  • Movement Breaks in the Classroom is a strategy to promote physical activity during the school day by incorporating five-to-10-minute movement breaks in K-5 public elementary school classrooms. 

What population benefits?

 Children in grades K-5 attending public elementary schools. 

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?
Identify and compile materials and content for training and implementation • Time for physical activity coordinator to identify and compile materials/content to train teachers
• Time for physical activity coordinator to develop a movement break library to support teachers with implementation		 Physical activity coordinator
Recruit schools and coordinate training • Time for physical activity coordinator to communicate and plan training activities with schools Physical activity coordinator
Train classroom teachers in movement breaks • Time for physical activity coordinator to provide training
• Time for classroom teachers to attend trainings		 Physical activity coordinator
Materials and equipment provided to teachers to implement movement breaks • Material costs School districts or local government

FOR ADDITIONAL INFORMATION

The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide. 2021:8. Available at: https://www.thecommunityguide.org/findings/physical-activity-classroom-based-physical-activity-break-interventions

Selected CHOICES research brief including cost-effectiveness metrics:

Carter J, Greene J, Neeraja S, Bovenzi, M, Sabir M, Carter S, Bolton AA, Barrett JL, Reiner JR, Cradock AL. Boston, MA: Movement Breaks in the Classroom {Issue Brief}. Boston Public Schools, Boston Public Health Commission, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; August 2022. Available at: https://choicesproject.org/publications/brief-movement-breaks-boston

Good N, Bolton AA, Barrett JL, Reiner JF, Cradock AL. Massachusetts: Movement Breaks in the Classroom {Issue Brief}. The CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; June 2023. Available at: https://choicesproject.org/publications/brief-movement-breaks-ma

Suggested Citation

CHOICES Strategy Profile: Movement Breaks in the Classroom. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; October 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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Brief: Movement Breaks in the Classroom in Boston, MA

Posted on August 9, 2022

Teacher leading a movement break in the classroom with young kids

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

A version of this brief was published in May 2022. This brief was updated in August 2022 to reflect revised projections for Boston’s population.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy to integrate movement breaks into school classrooms in Boston, MA. This strategy incorporates five-to-10-minute classroom physical activity breaks during class time in kindergarten to fifth grade classrooms. 

The Issue

One in three first-graders in Boston has overweight or obesity.1 Being physically active can support children in growing up at a healthy weight, though not all schools provide students with the recommended 150 minutes of physical activity per week or 30 minutes per day.2,3 Regular physical activity can boost brain health, including improved cognition and reduced symptoms of depression.4 Students who are physically active also tend to have better grades, attendance at school, and stronger muscles and bones.4

Experts suggest that schools provide opportunities for classroom physical activity,5 but few schools offer it.6 Movement breaks supplement other critical school physical activity opportunities, like recess and physical education, and help children meet recommendations for physical activity.5 Providing all students with opportunities to be physically active will ensure more students are growing up at a healthy weight and ready to learn.

About the Movement Breaks in the Classroom Strategy

We can provide healthier opportunities for all children by initiating strategies with strong evidence for effectiveness. To implement the Movement Breaks strategy, teachers, Wellness Champions, and staff would receive training, equipment, and materials to incorporate short activity breaks in the classroom to help children move more.7,8 Initiating strategies with strong evidence for effectiveness like Movement Breaks in the Classroom helps fulfill Boston Public School’s (BPS) Physical Education and Physical Activity Policy requirements for schools to offer physical activity opportunities during the school day.3 This strategy also aligns with BPS’ Whole School, Whole Community, Whole Child approach, which supports students’ holistic health by promoting positive classroom environments that foster physical activity and learning.

Comparing Costs and Outcomes

A CHOICES cost-effectiveness analysis compared the costs and outcomes over a 10-year time horizon (2020-2030) of implementing movement breaks with the costs and outcomes associated with not implementing them. We assumed that elementary schools in Boston Public Schools serving grades K-5 would receive training, equipment, and materials to implement movement breaks. The model assumes that 56% of those trained would implement the movement breaks in classrooms.

Implementing movement breaks in the classroom is an investment in the future. By the end of 2030:
If movement breaks in the classroom was implemented in Boston, 29,400 students would be reached over 10 years, it would cost $1.74 per child to implement, and per school week, each student would engage in 25 additional minutes of moderate-to-vigorous physical activity.

Conclusions and Implications

If movement breaks were incorporated into classrooms, we project that over 10 years, 29,400 students would benefit. The students would increase their moderate-to-vigorous-physical activity levels by 25 minutes per school week, helping them meet wellness goals of 150 minutes of physical activity per week.3 This strategy would also prevent 37 cases of childhood obesity (in 2030) and save $35,300 in health care costs related to excess weight over 10 years. The average annual cost to implement this program in every public elementary school (Grades K-5) in Boston would be $1.74 per student, or just over $1,000 per school per year.

In addition to promoting a healthy weight, classroom physical activity benefits students in other important ways. By training and equipping over 600 teachers and other school staff yearly to incorporate movement breaks in the classroom, this strategy could help all Boston Public Schools cultivate a positive school climate and improve social emotional learning.9 Participation in movement breaks are associated with students spending more time on task,5 and teachers report that students are more engaged, supportive of each other, and responsive to teacher instructions after participating in a movement break.10

Childhood is a crucial period for developing healthy habits. Many preventive strategies can play a critical role in helping children establish healthy behaviors early on in life. Providing movement breaks in the classroom is an easy and relatively low-cost way to increase physical activity and support the overall health and wellness of all Boston students. 

References

  1. School Health Services, Department of Public Health. Results from the Body Mass Index Screening in Massachusetts Public School Districts, 2017. 2020:88. https://www.mass.gov/doc/the-status-of-childhood-weight-in-massachusetts-2017

  2. Boston Public Schools, Health and Wellness Department. School Health Profiles [2018]: Boston, MA.

  3. Boston Public Schools. Physical Education & Physical Activity Policy. 2020:8. Superintendent’s Circular. https://drive.google.com/file/d/1rSGwpFaa4LsPKxjhdsHxz2IaXg3ZFVtE/view?usp=embed_facebook

  4. 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; 2020-04-21T09:02:35Z 2010.

  5. The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide. 2021:8.

  6. Classroom Physical Activity. Centers for Disease Control and Prevention. Accessed Oct 8, 2021. https://www.cdc.gov/healthyschools/physicalactivity/classroom-pa.htm

  7. Erwin HE, Beighle A, Morgan CF, Noland M. Effect of a low-cost, teacher-directed classroom intervention on elementary students’ physical activity. J Sch Health. 2011;81(8):455-461.

  8. Murtagh E, Mulvihill M, Markey O. Bizzy Break! The effect of a classroom-based activity break on in-school physical activity levels of primary school children. Pediatr Exerc Sci. 2013;25(2):300-307.

  9. School-Based Physical Activity Improves the Social and Emotional Climate for Learning. Centers for Disease Control and Prevention,. Accessed March 9, 2022. https://www.cdc.gov/healthyschools/school_based_pa_se_sel.htm

  10. Campbell AL, Lassiter JW. Teacher perceptions of facilitators and barriers to implementing classroom physical activity breaks. J Educ Res. 2020;113(2):108-119

Suggested Citation:

Carter J, Greene J, Neeraja S, Bovenzi M, Sabir M, Carter S, Bolton AA, Barrett JL, Reiner JR, Cradock AL, Gortmaker SL. Boston, MA: Movement Breaks in the Classroom {Issue Brief}. Boston Public Schools, Boston Public Health Commission, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; August 2022. For more information, please visit www.choicesproject.org

A version of this brief was published in May 2022. This brief was updated in August 2022 to reflect revised projections for Boston’s population.

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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Fact Sheet: Physical Activity is Key for Young Kids’ Health (Ages 3 through 5)

Posted on May 3, 2022

Preschool students jumping and dancing around having fun

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.

Early childhood is a critical time to establish movement skills and learn healthy habits. Regular physical activity is vital for healthy growth and development.

  • Being active improves bone health,1–3 helps maintain a healthy weight,2,3 and strengthens important muscles in the bodies of young children.

Young kids should get at least three hours each day of total physical activity to enhance their growth and development.3,5

  • Many (but not all) young children get recommended levels of physical activity.4,5
  • Participating in a variety of activities like playing dress up, or more moderate intensity activities like riding tricycles, and more vigorous intensity activities like skipping and jumping helps young children grow up healthy
  • However, only about one-third of kids’ physical activity during child care hours is done at moderate-to-vigorous intensity levels.6

Increasing physical activity in early care and education settings is a national health priority.7

  • Only about one-third of physical activity that happens during a child’s time in an early care and education setting is done at moderate-to-vigorous intensity levels.6 Most opportunities should allow for moderate-to-vigorous intensity movements, like running.8
  • Every day, early educators can offer multiple active play opportunities, like playing on a playground, in addition to structured activities, like playing tag.
    • ✓Planning safe, fun outdoor activities that can occur in imperfect weather7,8,9and integrating physical activity into educational lessons can help children move more.4,10
  • Young kids are generally physically active in short bursts,8,11 so offering a variety of activities and opportunities throughout the day can help young kids accumulate enough movement.
  • While in early care and education settings, all young children should have about 15 minutes per hour of active and outdoor play opportunities (or about two hours per eight-hour day in care).4,8

Early care and education settings are important places for helping the children who spend time there to move more.11

  • Having open spaces and accessible portable play equipment, like balls or soft building blocks, can promote physical activity for all children,4,12–14 even in smaller early care spaces. 
  • Children should have daily opportunities to play outside.4,8,13 
  • Early care educators can support physical activity through:
    • ✓Modifying games and activities to help all children stay moving throughout the duration of the activity, including children with disabilities or lower fitness levels.15,16
    • ✓Participating in physical activity with the children.* This motivates children to move,10,17 especially those who are less active.17
    • ✓Sharing ideas for games to play or suggesting ways to go back into games to help children stay moving.17
    • ✓Not taking physical activity opportunities away from children as a punishment.4,8 

*Added benefit!: Initiating and engaging in physical activity with children can help educators be more physically active too. Being physically active reduces the risk of heart disease, type 2 diabetes, and depression and also leads to better sleep and less anxiety.3

 

Additional Resources

The following additional resources may be useful to:

✓Help children move more

✓Provide more guidance on physical activity and young children

References

  1. Carson V, Lee EY, Hewitt L, et al. Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years). BMC Public Health. 2017;17(5):854. doi:10.1186/s12889-017-4860-0
  2. Pate RR, Hillman CH, Janz KF, et al. Physical Activity and Health in Children Younger than 6 Years: A Systematic Review. Med Sci Sports Exerc. 2019;51(6):1282-1291. doi:10.1249/MSS.0000000000001940
  3. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd Edition. U.S. Department of Health and Human Services; 2018:118. Accessed November 29, 2021. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
  4. Institute of Medicine. Early Childhood Obesity Prevention Policies. (Birch LL, Parker L, Burns A, eds.). The National Academies Press; 2011. doi:10.17226/13124
  5. Bruijns BA, Truelove S, Johnson AM, Gilliland J, Tucker P. Infants’ and toddlers’ physical activity and sedentary time as measured by accelerometry: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2020;17(1):14. doi:10.1186/s12966-020-0912-4
  6. 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. Int J Behav Nutr Phys Act. 2020;17(1):160. doi:10.1186/s12966-020-01054-y
  7. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health. 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. Accessed December 6, 2021. 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
  8. American Academy of Pediatrics, National Resource Center for Health and Safety in Child Care (U.S.), American Public Health Association, United States, eds. Caring for Our Children: National Health and Safety Performance Standards, Guidelines for Early Care, and Education Programs. Fourth edition. American Academy of Pediatrics; 2019.
  9. Timmons BW, Leblanc AG, Carson V, et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab Physiol Appl Nutr Metab. 2012;37(4):773-792. doi:10.1139/h2012-070
  10. Physical Activity Alliance. Physical Activity for Preschoolers during the COVID Pandemic. Published online April 2021. Accessed December 6, 2021. https://paamovewithus.org/wp-content/uploads/2021/04/PAA-Preschool-Covid-FINAL-04-13-2021.pdf
  11. Ruiz RM, Tracy D, Sommer EC, Barkin SL. A novel approach to characterize physical activity patterns in preschool-aged children. Obesity. 2013;21(11):2197-2203. doi:10.1002/oby.20560
  12. Hoyos-Quintero AM, García-Perdomo HA. Factors Related to Physical Activity in Early Childhood: A Systematic Review. J Phys Act Health. 2019;16(10):925-936. doi:10.1123/jpah.2018-0715
  13. Tonge KL, Jones RA, Okely AD. Correlates of children’s objectively measured physical activity and sedentary behavior in early childhood education and care services: A systematic review. Prev Med. 2016;89:129-139. doi:10.1016/j.ypmed.2016.05.019
  14. Terrón-Pérez M, Molina-García J, Martínez-Bello VE, Queralt A. Relationship Between the Physical Environment and Physical Activity Levels in Preschool Children: A Systematic Review. Curr Environ Health Rep. 2021;8(2):177-195. doi:10.1007/s40572-021-00318-4
  15. Physical Activity for Students With Special Needs. Action for Healthy Kids. Published September 6, 2018. Accessed December 6, 2021. https://www.actionforhealthykids.org/physical-activity-for-students-with-special-needs/
  16. Including All Children: Health for Kids With Disabilities. Action for Healthy Kids. Published September 4, 2018. Accessed December 6, 2021. https://www.actionforhealthykids.org/including-all-children-health-for-kids-with-disabilities/
  17. Kippe KO, Fossdal TS, Lagestad PA. An Exploration of Child–Staff Interactions That Promote Physical Activity in Pre-School. Front Public Health. 2021;9:998. doi:10.3389/fpubh.2021.607012

Suggested Citation

Get the Facts: Physical Activity is Key for Young Kids’ Health (Ages 3 through 5). Prevention Research Center on Nutrition and Physical Activity Team at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2022. 

Funding

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. 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. 

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Strategy Profile: Safe Routes to School

Posted on April 28, 2022

Kids crossing street with crossing guard

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.

  • Safe Routes to School is a program that supports the use of physically active modes of transportation to and from school, and aims to help children in grades K-8 safely walk and bicycle to school through infrastructure improvements, education, enforcement, and promotional activities.

What population benefits?

Children in grades K-8 who switch from passive to active travel to school after their school adopts an active transport program.

What are the estimated benefits?

Relative to not implementing the strategy
Increase physical activity and, in turn, promote healthy child weight.

What are the additional benefits?

Relative to not implementing the strategy
The costs of implementing this strategy could be offset by savings from…
↓ Decrease in driving, parking, and vehicle ownership and operation costs
↓ Decrease in travel time for families using their own vehicles for transportation
↓ Decrease in pedestrian and bicycle injuries and vehicle crash costs
↓ Decrease in air, greenhouse gas, water, and noise pollution costs

What activities and resources are needed?

Activities Resources Who Leads?
Oversee implementation of Safe Routes to School program • Time for Safe Routes to School coordinator(s) to oversee and manage implementation of the program
• Time for Safe Routes to School committee to select and provide guidance on projects, including advise and award grants, provide technical assistance to programs, communicate between Safe Routes to School programs and partners, and advocate for programs		 Safe Routes to School coordinator(s) and committee members
Attend Safe Routes to School committee meetings • Time for Safe Routes to School committee members to attend meetings
• Travel costs for Safe Routes to School committee members		 Safe Routes to School committee members
Improve infrastructure around schools • Infrastructure project costs Local government or other organization and schools
Adopt key components of Safe Routes to School Framework (e.g., education, encouragement, equity, enforcement, and evaluation) • Non-infrastructure project costs Local government or other organization and schools

FOR ADDITIONAL INFORMATION

Selected CHOICES research brief including cost-effectiveness metrics:
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. Available at: https://choicesproject.org/publications/brief-safe-routes-to-school-wisconsin/

Reiner J, Barrett J, Giles C, Cradock AL. Houston: Safe Routes to School {Issue Brief}. Houston Health Department, Houston, TX 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-srts-houston-tx

Pelletier J, Reiner J, Barrett J, Cradock AL, Giles C. Minnesota: Safe Routes to School (SRTS) {Issue Brief}. Minnesota Department of Health (MDH), St. Paul, MN, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; March 2019. Available at: https://choicesproject.org/publications/brief-srts-minnesota/

Suggested Citation

CHOICES Strategy Profile: Safe Routes to School. 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 Physical Education (Active PE)

Posted on April 28, 2022

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

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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