To assess the effectiveness of physical education (PE) interventions designed to foster health features among school-aged children, and to present a qualitative perspective of the different approaches that are most effective in promoting health among youth.
Design:
Systematic review.
Method:
An extensive electronic literature search was carried out of published trials on interventions targeted to alter health features using school PE. The systematic searches across PE programmes and different health features were conducted using Medline and Web of Science databases. Following screening for scope and relevance, the studies included were compared based on the type of PE programme: augmented PE programme, non-augmented PE programme and multi-component programme.
Results:
A number of positive outcomes have been reached. Improvements were reported in both self-reported and objectively measured physical activity (PA), student activity levels during PE, physical fitness, blood profile, fundamental movement skills, cardiovascular disease risk, health-knowledge and dietary profiles. A considerable number of PE-interventions failed to decrease body mass index (BMI), adiposity measures and percent body fat (% BF). Modest effects were also observed for bone mass acquisition.
Conclusion:
Evidence revealed positive and consistent results across different health features. Nevertheless, the findings regarding body composition were inconsistent and sparse. Few considerations and recommendations were raised toward the PE role in the promotion of healthy lifestyles, and a number of implications for health promotion practice have been stressed.
FaircloughSStrattonGBaldwinG. The contribution of secondary school physical education to lifetime physical activity. European Physical Education Review, 2002: 8(1): 69–84.
2.
SallisJFMcKenzieTL. Physical education’s role in public health. Res Q Exerc Sport, 1991: 62(2): 124–37.
3.
StoneEJ. Effects of physical activity interventions in youth. Review and synthesis. Am J Prev Med, 1998: 15(4): 298–315.
4.
KahnEB. The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med, 2002: 22(4 Suppl): 73–107.
5.
CampbellK. Interventions for preventing obesity in childhood. A systematic review. Obes Rev, 2001: 2(3): 149–57.
6.
StoryM. School-based approaches for preventing and treating obesity. Int J Obes Relat Metab Disord, 1999: 23Suppl 2: S43–51.
7.
GlennyAM. The treatment and prevention of obesity: A systematic review of the literature. Int J Obes Relat Metab Disord, 1997: 21(9): 715–37.
8.
ResnicowKCrossDWynderE. The know your body program: A review of evaluation studies. Bull N Y Acad Med, 1993: 70(3): 188–207.
9.
CaballeroB. Pathways: A school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr, 2003: 78(5): 1030–8.
10.
HarrisKC. Effect of school-based physical activity interventions on body mass index in children: A meta-analysis. CMAJ, 2009: 180(7): 719–26.
11.
ShayaFT. School-based obesity interventions: A literature review. J Sch Health, 2008: 78(4): 189–96.
12.
SharmaM. School-based interventions for childhood and adolescent obesity. Obes Rev, 2006: 7(3): 261–9.
13.
ThomasH. Obesity prevention programs for children and youth: Why are their results so modest?Health Educ Res, 2006: 21(6): 783–95.
14.
HaymanLL. Cardiovascular health promotion in the schools: A statement for health and education professionals and child health advocates from the Committee on Atherosclerosis, Hypertension, and Obesity in Youth (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation, 2004: 110(15): 2266–75.
15.
HarrisJCaleL. How healthy is school PE? A review of the effectiveness of health-related physical education programmes in schools. Health Education Journal, 1997: 56: 84–104.
16.
PenneyDEJessM. Physical education and physically active lives: A lifelong approach to curriculum development. Sport, Education and Society, 2004: 9(2): 269–87.
17.
SteinbeckKS. The importance of physical activity in the prevention of overweight and obesity in childhood: A review and an opinion. Obes Rev, 2001: 2(2): 117–30.
18.
ConeS. Pay me now or pay me later: 10 years later and have we seen any change?Journal of Teaching in Physical Education, 2004: 23: 271–80.
19.
ValdimarssonO. Daily physical education in the school curriculum in prepubertal girls during 1 year is followed by an increase in bone mineral accrual and bone width – data from the prospective controlled Malmo pediatric osteoporosis prevention study. Calcif Tissue Int, 2006: 78(2): 65–71.
20.
AlwisG. A 2-year school-based exercise programme in pre-pubertal boys induces skeletal benefits in lumbar spine. Acta Paediatr, 2008: 97(11): 1564–71.
21.
AlwisG. A one-year exercise intervention program in pre-pubertal girls does not influence hip structure. BMC Musculoskelet Disord, 2008: 9: 9.
22.
AlwisG. A school-curriculum-based exercise intervention program for two years in pre-pubertal girls does not influence hip structure. Dyn Med, 2008: 7: 8.
23.
Stenevi-LundgrenS. Effects of a daily school based physical activity intervention program on muscle development in prepubertal girls. Eur J Appl Physiol, 2009: 105(4): 533–41.
24.
Stenevi-LundgrenSDalyRMKarlssonMK. A school-based exercise intervention program increases muscle strength in prepubertal boys. Int J Pediatr, 2010: 105(4): 1–9.
25.
SollerhedACEjlertssonG. Physical benefits of expanded physical education in primary school: Findings from a 3-year intervention study in Sweden. Scand J Med Sci Sports, 2008: 18(1): 102–7.
26.
WaltherC. Increasing physical education in high school students: Effects on concentration of circulating endothelial progenitor cells. Eur J Cardiovasc Prev Rehabil, 2008: 15(4): 416–22.
27.
HasselstromHA. A 3-year physical activity intervention program increases the gain in bone mineral and bone width in prepubertal girls but not boys: The prospective copenhagen school child interventions study (CoSCIS). Calcif Tissue Int, 2008: 83(4): 243–50.
28.
ResalandGK. Effects of a 2-year school-based daily physical activity intervention on cardiorespiratory fitness: The Sogndal school-intervention study. Scand J Med Sci Sports, 2009: 21: 302–9.
29.
ResalandGK. Effects of a 2-year school-based daily physical activity intervention on cardiovascular disease risk factors: The Sogndal school-intervention study. Scand J Med Sci Sports, 2011: 21(6): e122–31.
30.
KriemlerS. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ, 2010: 340: 1–8.
31.
MeyerU. Effect of a general school-based physical activity intervention on bone mineral content and density: A cluster-randomized controlled trial. Bone, 2011: 48(4): 792–7.
32.
SallisJF. The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, play and active recreation for kids. Am J Public Health, 1997: 87(8): 1328–34.
33.
VerstraeteSJ. A comprehensive physical activity promotion programme at elementary school: The effects on physical activity, physical fitness and psychosocial correlates of physical activity. Public Health Nutr, 2007: 10(5): 477–84.
34.
EwartCKYoungDRHagbergJM. Effects of school-based aerobic exercise on blood pressure in adolescent girls at risk for hypertension. Am J Public Health, 1998: 88(6): 949–51.
35.
PetitMA. A randomized school-based jumping intervention confers site and maturity-specific benefits on bone structural properties in girls: A hip structural analysis study. J Bone Miner Res, 2002: 17(3): 363–72.
36.
McKayHA. Augmented trochanteric bone mineral density after modified physical education classes: A randomized school-based exercise intervention study in prepubescent and early pubescent children. J Pediatr, 2000: 136(2): 156–62.
37.
MacKelvieKJ. A school-based exercise intervention elicits substantial bone health benefits: A 2-year randomized controlled trial in girls. Pediatrics, 2003: 112(6): e447–52.
38.
BaquetGBerthoinSVan PraaghE. Are intensified physical education sessions able to elicit heart rate at a sufficient level to promote aerobic fitness in adolescents?Res Q Exerc Sport, 2002: 73(3): 282–8.
39.
van BeurdenE. Can we skill and activate children through primary school physical education lessons? ‘Move it Groove it’ – a collaborative health promotion intervention. Prev Med, 2003: 36(4): 493–501.
40.
JamnerMS. A controlled evaluation of a school-based intervention to promote physical activity among sedentary adolescent females: Project FAB. J Adolesc Health, 2004: 34(4): 279–89.
41.
FaircloughSStrattonG. Improving health-enhancing physical activity in girls’ physical education. Health Educ Res, 2005: 20(4): 448–57.
42.
FaircloughSStrattonG. Effects of a physical education intervention to improve student sctivity levels. Physical Education and Sport Pedagogy, 2006: 11(1): 20–44.
43.
HortzBPetosaR. Impact of the ‘planning to be active’ leisure time physical exercise program on rural high school students. J Adolesc Health, 2006: 39(4): 530–5
44.
WeeksBKYoungCMBeckBR. Eight months of regular in-school jumping improves indices of bone strength in adolescent boys and girls: The POWER PE study. Miner Res, 2008: 23(7): 1002–11.
45.
Boyle-HolmesT. Promoting elementary physical education: Results of a school-based evaluation study. Health Educ Behav, 2009: 10: 1–13.
46.
HarrellJS.Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the cardiovascular health in children (CHIC) study. J Pediatr, 1996: 128(6): 797–805.
47.
HarrellJS. A public health vs a risk-based intervention to improve cardiovascular health in elementary school children: The cardiovascular health in children study. Am J Public Health, 1999: 89(10): 1529–35.
48.
McMurrayRG. A school-based intervention can reduce body fat and blood pressure in young adolescents. J Adolesc Health, 2002: 31(2): 125–32.
49.
FardyPS. Coronary disease risk factor reduction and behavior modification in minority adolescents: the PATH program. J Adolesc Health, 1996: 18(4): 247–53.
50.
LuepkerRV. Outcomes of a field trial to improve children’s dietary patterns and physical activity. The child and adolescent trial for cardiovascular health. CATCH collaborative group. Jama, 1996: 275(10): 768–76.
51.
McKenzieTL. School physical education: Effect of the child and adolescent trial for cardiovascular health. Prev Med, 1996: 25(4): 423–31.
52.
McKenzieTL. Effects of the CATCH physical education intervention: Teacher type and lesson location. Am J Prev Med, 2001: 21(2): 101–9.
53.
WebberLS. Cardiovascular risk factors among children after a 2 1/2-year intervention – the CATCH study. Prev Med, 1996: 25(4): 432–41.
54.
ManiosYKafatosA. Health and nutrition education in elementary schools: Changes in health knowledge, nutrient intakes and physical activity over a six year period. Public Health Nutr, 1999: 2(3): 445–8.
55.
ManiosYKafatosAMamalakisG. The effects of a health education intervention initiated at first grade over a 3 year period: Physical activity and fitness indices. Health Educ Res, 1998: 13(4): 593–606.
56.
ManiosY. Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period. Prev Med, 1999: 28(2): 149–59.
57.
ManiosY. Health and nutrition education in primary schools of Crete: Changes in chronic disease risk factors following a 6-year intervention programme. Br J Nutr, 2002: 88(3): 315–24.
58.
GortmakerSL. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet health. Arch Pediatr Adolesc Med, 1999: 153(4): 409–18.
59.
GoingS. The effects of the pathways obesity prevention program on physical activity in American Indian children. Prev Med, 2003: 37(6 Pt 2): S62–9.
60.
McKenzieTL. Evaluation of a two-year middle-school physical education intervention: M-SPAN. Med Sci Sports Exerc, 2004: 36(8): 1382–8.
61.
SallisJF. Environmental interventions for eating and physical activity: A randomized controlled trial in middle schools. Am J Prev Med, 2003: 24(3): 209–17.
62.
TrevinoRP. Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: A randomized controlled trial. Arch Pediatr Adolesc Med, 2004: 158(9): 911–17.
63.
KainJ. School-based obesity prevention in Chilean primary school children: Methodology and evaluation of a controlled study. Int J Obes Relat Metab Disord, 2004: 28(4): 483–93.
64.
KainJ. Two-year controlled effectiveness trial of a school-based intervention to prevent obesity in Chilean children. Public Health Nutr, 2009: 12(9): 1451–61.
65.
CarrelAL. Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study. Arch Pediatr Adolesc Med, 2005: 159(10): 963–8.
66.
Neumark-SztainerD. New moves: A school-based obesity prevention program for adolescent girls. Prev Med, 2003: 37(1): 41–51.
67.
PateRR. Promotion of physical activity among high-school girls: A randomized controlled trial. Am J Public Health, 2005: 95(9): 1582–7.
68.
ChristodoulosAD. Attitudes towards exercise and physical activity behaviours in Greek schoolchildren after a year long health education intervention. Br J Sports Med, 2006: 40(4): 367–71.
69.
JiangJ. The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child Care Health Dev, 2007: 33(5): 641–6.
70.
WebberLS. Promoting physical activity in middle school girls: Trial of activity for adolescent girls. Am J Prev Med, 2008: 34(3): 173–84.
71.
SinghAS. Dutch obesity intervention in teenagers: Effectiveness of a school-based program on body composition and behavior. Arch Pediatr Adolesc Med, 2009: 163(4): 309–17.
72.
SlawtaJNDeneuiD. Be a fit kid: Nutrition and physical activity for the fourth grade. Health Promot Pract, 2010: 11(4): 522–9.
73.
PeraltaLRJonesRAOkelyAD. Promoting healthy lifestyles among adolescent boys: The fitness improvement and lifestyle awareness program RCT. Prev Med, 2009: 48(6): 537–42.
74.
BenjaminsMRWhitmanS. A culturally appropriate school wellness initiative: Results of a 2-year pilot intervention in 2 Jewish schools. J Sch Health, 2010: 80(8): 378–86.
75.
FosterGD. A school-based intervention for diabetes risk reduction. N Engl J Med, 2010: 363(5): 443–53.
76.
RiddochCJ. Physical activity levels and patterns of 9- and 15-yr-old European children. Med Sci Sports Exerc, 2004: 36(1): 86–92.
77.
MeyerU. Contribution of physical education to overall physical activity. Scand J Med Sci Sports: 2011. doi: 10.1111/j.1600-0838.2011.01425.x.
78.
McKenzieTLSallisJFNaderPR. SOFIT: System for observing fitness instruction time. Journal of Teaching in Physical Education, 1991: 11: 195–205.
79.
RoweP. Measuring students’ physical activity levels: Validating SOFIT for use with high school students. Journal of Teaching in Physical Education, 2004: 23: 235–51.
80.
StrattonG. Children’s heart rates during physical education lessons: A review. Pediatr Exerc Sci, 1996: 8: 215–33.
81.
MacdonaldHM. Is a school-based physical activity intervention effective for increasing tibial bone strength in boys and girls?J Bone Miner Res, 2007: 22(3): 434–46.
LohmanTGChenZ. Dual-energy x-ray absorptiometry. In: HeymsfieldSB. (eds) Human body composition (pp. 134–5). Champaign, IL: Human Kinetics, 2005.
84.
CaleLHarrisJ. Fitness testing in physical education – a misdirected effort in promoting healthy lifestyles and physical activity?Physical Education & Sport Pedagogy, 2009: 14(1): 89–108.
85.
TinningRKirkD. Daily physical education. Collected Papers on Health Based Physical Education in Australia. Geelong, Australia: Deakin University Press, 1991.
86.
BulgerSHousnerL. Relocating from easy street: Strategies for moving physical education forward. Res Q Exerc Sport, 2011: 82(1): A-4(1).
87.
EvansJ. Physical education and health: A polemic or ‘let them eat the cake!’. European Physical Education Review, 2003: 9(1): 87–101.
88.
CrumB. Conventional thought and practice in physical education: Problems of teaching and implications for change. Quest, 1993: 45: 339–56.
89.
BaileyRDismoreH. A review of research on the nature and function of sport pedagogy 2004–2005. International Journal of Physical Education, 2006: 4: 144–8.
90.
Greenwood-ParrMOslinJ. Promoting lifelong involvement through physical activity. Journal of Physical Education, Recreation and Dance, 1998: 69(2): 72–6.
91.
WeissMR. Motivating kids in physical activity. President’s council on physical fitness and sports. Research Digest, 2000: 3(11): 1–8.
