Partnerships for active elementary schools: Physical education outcomes after 4 months of a 2-year pilot study

Abstract

Objective:

This study assessed the impact of Partnerships for Active Children in Elementary Schools (PACES) on children’s moderate-to-vigorous physical activity (MVPA) during physical education (PE) and teachers’ incorporation of physical activity promotion strategies after one academic semester (i.e. 4 months) of the intervention.

Design:

Single group pre–post pilot study.

Setting:

Three elementary schools in one southeastern metropolitan city in the USA.

Methods:

Using principles of community-based participatory-research, researchers worked with teachers to identify contextually appropriate physical activity promotion strategies aligned with prevailing recommendations, principles and theories. Outcome measures included accelerometer-derived percent of time children (N = 150) engaged in MVPA. The System for Observing Fitness Instruction Time+ assessed changes in teachers’ incorporation of physical activity promotion strategies. Multi-level mixed-effects linear regression estimated differences over time.

Results:

MVPA increased for girls (22.7%–26.6%) and boys (33.2%–39.0%). Small-sided games (1.0%–9.0%) and teachers’ verbal promotion of physical activity (6.4%–13.5%) increased while student’s off-task behaviour (6.0%–2.0%) decreased. Lines (20.2%–8.4%) and elimination games (21.6%–13.3%) decreased, but these changes were not statistically significant.

Conclusion:

PACES shows promise for increasing the percent of time children spend in MVPA during PE but requires further evaluation.

Keywords

Intervention obesity PACES physical education policy youth

Physical education (PE) is at the core of school-based physical activity promotion efforts (Alliance for a Healthier Generation, 2012; Fairclough and Stratton, 2006; Institute of Medicine, 2013; Pate, 2009; Society of Health and Physical Educators (SHAPE), America, 2013a; US Department of Health and Human Services, 2000). However, children’s moderate-to-vigorous physical activity (MVPA) during PE consistently falls below recommended benchmarks (Lonsdale et al., 2013; Pate et al., 2011). Novel approaches for increasing children’s MVPA during PE are therefore needed.

Past efforts to increase children’s MVPA during PE have focused on providing teachers with specially designed active curricula (McKenzie et al., 1996; Simons-Morton et al., 1991; Verstraete et al., 2007; Young et al., 2006), replacing content during PE lessons with fitness activities (Ignico et al., 2006; Quinn and Strand, 1995; Scantling et al., 1998) and providing teachers with skill-based professional development training (McKenzie et al., 2004; Webber et al., 2008). However, these approaches have limitations. Curriculum-based interventions can cost up to US$10K for equipment, training and other resources (Flag House, 2012; School Specialty, 2012). Investing in these curricula represents a substantial investment that not all schools are willing or able to make. Furthermore, while developing and maintaining health-enhancing levels of fitness is an important objective of PE, it is not the only objective. Focusing solely on fitness activities during PE neglects other important PE objectives in the psychomotor, cognitive and affective domains (Society of Health and Physical Educators [SHAPE] America, 2013). Thus, novel approaches for increasing students’ MVPA during PE lessons are needed.

The final approach used in previous interventions for increasing students’ MVPA during PE is to provide teachers with skill-based training. Interventions using this approach have produced minimal increases in children’s MVPA (McKenzie et al., 2004; Webber et al., 2008). These minimal increases may be due to the fact that past training has mainly focused on training teachers to streamline management time in order to increase time in motor content. However, a key missing component is training teachers to structure activities during motor content to elicit the maximum amount of MVPA. This study employed professional development training that focused on providing teachers with contextually appropriate skills aligned with an established framework of best practices for maximising children’s MVPA during motor skill content (Weaver et al., 2013). This framework was chosen because it has been successfully used in summer day camps and afterschool programmes to increase children’s MVPA (Beets et al., 2014, 2015; Weaver et al., 2014b).

This study is part of a 2-year pilot intervention, called Partnerships for Active Children in Elementary Schools (PACES), which is designed to increase children’s physical activity during PE and regular classroom time. PACES capitalised on school-university partnerships to assist teachers with promoting children’s physical activity (Webster et al., 2015). Partnership approaches that are used include community-based participatory research (CBPR), communities of practice and university service learning. The purpose of this study was to test the effectiveness of PACES following one academic semester (4 months) of implementation. Specifically, this study assessed the effectiveness of CBPR-derived PA promotion strategies on increasing (a) the percent of time boys and girls spend in MVPA during PE and (b) teachers’ incorporation of the physical activity promotion strategies into their lessons.

Methods

Participants and setting

A state-level professional network of educators helped the project team identify and recruit a convenience sample of three local elementary schools who were dedicated to increasing children’s physical activity as part of the schools’ strategic plans. Three intact classes of students (first to third grades) from each school were selected to participate in the study. These classes were purposively selected in line with one of the aims of the classroom physical activity component of the PACES project, which was to tailor the intervention for classroom teachers who promoted physical activity less than other classroom teachers at their school. Teachers who integrated physical activity into their lessons the least frequently were identified using a self-report survey adapted from previous research (Elmakis, 2010; Webster, et al., 2013). Students in each of the selected classes whose parents provided informed consent were eligible to participate in all aspects of the PACES project.

Two PE teachers, both women, participated in this study. One of the PE teachers worked at two of the participant schools, which operated as companion campuses under the same administration. Both PE teachers were the sole employees in the subject at their schools. The PE teachers provided informed consent prior to the start of data collection. Further details about each of the participating schools, children and PE teachers are presented in Table 1. All procedures were approved by the lead author’s institutional review board prior to the start of the study.

Table 1.

Characteristics of participant schools and students.

School	A	B	C
School characteristics
Total students	264	176	563
Grades	K–5	K–3	K–5
Ethnicity
Percent Caucasian	43.9	44.9	31.3
Percent Black	36.4	36.9	57.5
Percent Other	19.7	17.0	11.2
Percent Free and reduced lunch	12.0	9.0	48.6
Number of staff and teachers	33	20	109
Participant characteristics
Total participants	54	36	42
Percent Boys	51.9	58.3	50.0
Age (SD)	7.2 (0.9)	8.0 (0.5)	7.5 (0.8)
Ethnicity
Percent Caucasian	63.0	33.3	21.4
Percent Black	18.5	50.0	64.3
Percent Other	18.5	16.7	14.3

SD: standard deviation.

The PACES PE intervention

The PE intervention component of PACES draws upon the participatory principle of CBPR (Israel et al., 1998, 2010), the LET US Play Principles (Weaver et al., 2013), behaviour change theory (Kealey et al., 2000) and goal setting theory (Locke and Latham, 2002). Consistent with CBPR principle of meaningfully engaging community partners in the design and implementation of interventions, the lead author (R.G.W.) met with both intervention PE teachers separately to orient them to the intervention, review results from baseline data collection and set contextually appropriate goals for increasing children’s MVPA during their lessons in January 2015.

Goal setting was informed by the LET US Play principles for promoting children’s physical activity. LET US is an acronym for lines, elimination, team size, uninvolved children and space, equipment and rules. LET US Play was used as a reflective tool for the teachers to identify components of activities and games that limit children’s ability to accumulate physical activity. A key aspect of the LET US Play principles is their ability to be incorporated into existing curricula and content at no cost. Moreover, these principles are consistent with best practice teaching strategies in elementary PE (Rink and Hall, 2008), allowing teachers to increase children’s MVPA while teaching towards educational standards.

During these initial meetings, PE teachers were shown data related to their incorporation of the LET US Play principles and management strategies. Then, with the help of the lead author, they identified strategies to incorporate into their lessons. Finally, the lead author and teacher created SMART (specific, measurable, achievable, results-focused and time-bound) goals related to incorporating existing strategies. Following the initial meeting, each teacher was visited two additional times prior to outcome data collection in the Spring 2015. On each visit, the lead author observed one class taught by the teacher while taking notes and completing a checklist consistent with teacher’s identified strategies (based on the LET US Play Principles). Following the observation of the class, the teachers and lead author met for approximately 30 minutes to (a) review the results of the observation with respect to the teacher’s goals, (b) troubleshoot barriers to implementing the strategies and (c) set new SMART goals as appropriate.

Instrumentation and protocols

Observation schedule and physical activity measurement

All observations occurred in the 2014–2015 academic school year. Children’s MVPA was measured via accelerometer (ActiGraph GT3X+ Shalimar, FL). Participant classes were visited on days when PE was scheduled at both baseline (Fall 2014) and post-intervention (Spring 2015). On observation days, children received an accelerometer upon arrival to school before the start of the school day. Children would then participate in their normally scheduled activities, including PE, until the end of the school day, at which time accelerometers were returned to research staff. Accelerometers were affixed to children’s waist via an elastic belt. For this study, only accelerometer data during PE were included. Data were distilled using cutpoint thresholds related to MVPA (Evenson et al., 2008). A trained research assistant would arrive prior to the start of each PE lesson and note the time the lesson began and ended. All PE lessons were video recorded and coded using the System for Observing Fitness Instruction Time+ (SOFIT+) instrument (Weaver et al., 2016). Height and weight were measured on all participating children. Body mass index (BMI) was then calculated and transformed into age- and sex-specific percentiles (Kuczmarski et al., 2002). Age, sex and ethnicity were collected via school records.

SOFIT+

PE teachers’ incorporation of the physical activity promotion strategies aligned with the LET US Play principles was collected via the SOFIT+ instrument (Weaver et al., 2016). SOFIT+ is a systematic observation instrument designed to capture teacher practices that contribute to or restrict children’s MVPA during PE exclusively (i.e. SOFIT+ does not collect child activity data) and has been found to be valid and reliable (Weaver et al., 2016). The instrument uses a series of 10-second observe and record intervals and is divided into two phases. During Phase 1, observers code variables related to the context of the lesson and the activities in which students are engaged. During Phase 2, observers code variables related to teacher behaviours and activity management.

Training was conducted by the lead author and consisted of classroom training and video analysis. Classroom training lasted 3 days (i.e. 3 hours each day) and included reviewing study protocols, familiarising observers with the instrument and committing observational categories and codes to memory. Consistent with previous research, the criterion for inter-rater agreement was set at >80% using interval-by-interval agreement for each category (Ridgers et al., 2010). To establish initial reliability, all observers coded four video recorded PE lessons not included in the study before starting data collection. Additionally, two observers coded nine PE lessons, included in the study, simultaneously to ensure that there was no observer drift during data collection (Ridgers et al., 2010). Percent agreement between observers ranged from 81.0% to 99.7%.

Data analysis

All analyses were performed using Stata (v.13.0; College Station TX) and included all children with at least one valid day of accelerometer wear at baseline or outcome (Quené and Van den Bergh, 2004). Mean, standard deviations and percentages were computed for schools and child characteristics. Mixed-effects linear regression models nesting measurement days, within, children, within class were estimated using the percent of time children spent in MVPA during PE as the dependent variable. Furthermore, changes in the distribution of children at the 25th, 50th and 75th quantile for the percent of time children spent in MVPA during PE were modelled using random effects quantile regression. Separate models were estimated for boys and girls for both linear and quantile regression. Full information maximum likelihood estimators accounted for missing data at baseline and post-intervention measurements. Age, race, BMI percentile and primary lesson content (i.e. fitness, team sports, dance, locomotor, manipulative, educational games) were included in all models as covariates.

Changes in teachers’ incorporation of the physical activity promotion strategies were examined using mixed-effects linear regression models (i.e. LET US Play variables expressed as a percentage of SOFIT+ scans observed) nesting days within class. Changes in LET US Play variables were estimated during motor content only, as that is when the LET US Play variables are intended to be implemented.

Results

Change in activity levels

A total of 41 PE lessons were observed during baseline (n = 18) and post-assessment (n = 23). Descriptive characteristics of school and demographic characteristics of children are presented in Table 1. The number of children enrolled across schools and the number of children meeting the valid accelerometer wear day inclusion criteria are presented in Figure 1, along with the flow chart for participant recruitment, data collection and analyses. Changes in the percent of time children spent in MVPA during PE from baseline to post-assessment are presented in Table 2 and Figure 2. Statistically significant increases were observed for boys’ (5.8%) and girls’ (3.9%) MVPA.

Table 2.

Model estimated change in percent moderate-to-vigorous physical activity (MVPA) during physical education from Fall 2014 to Spring 2015.

	Base	Outcome	∆	95 CI	Cohen’s d	95 CI
Boys
Mean % MVPA	33.2	39.0	5.8	(3.0, 8.8)	.37	(0.14, 0.62)
25th quantile	18.0	27.0	9.0	(3.6, 14.4)
50th quantile	32.4	40.4	7.9	(2.5, 13.4)
75th quantile	44.8	49.1	4.3	(−0.6, 9.2)
Girls
Mean % MVPA	22.7	26.6	3.9	(0.6, 7.3)	.16	(−0.07, 0.41)
25th quantile	12.8	15.8	2.9	(−1.5, 7.4)
50th quantile	20.0	25.7	5.7	(1.0, 10.4)
75th quantile	30.1	35.2	5.1	(1.3, 9.0)

CI: confidence interval.

Statistically significant changes at p ⩽ .05 are bolded.

Figure 1.

Participant flow diagram.

Figure 2.

Changes in percent of time boys and girls spend in moderate-to-vigorous physical activity during physical education.

The results of the random effects quantile regressions on the 25th, 50th and 75th quantiles of minutes of MVPA are also presented in Table 2 and Figure 2. Statistically significant increases were observed for boys at the 25th and 50th quantile, while statistically significant increases were observed for girls at the 50th and 75th quantile.

Change in SOFIT+ variables

A total of 2,740 SOFIT+ scans were completed with 1,280 scans occurring during motor content. Changes in teachers’ incorporation of the LET US Play principles are presented in Table 3. All five teacher practices targeted in this study changed in the desired direction with three of the changes reaching statistical significance (i.e. team size, teacher promotion of physical activity and students off task or uninvolved). Changes ranged from an 11.8% reduction in the presence of lines to an 8.2% increase in the presence of small sided games (i.e. team size).

Table 3.

Changes in LET US Play principles from baseline to post-assessment.

Principle	Percent of time observed during physical education
Principle	Baseline	Outcome	∆	95% CI	Cohen’s d	95% CI
Lines (presence of lines)	20.2	8.4	−11.8	(−24.7, 1.2)	.02	(−0.06, 0.09)
Elimination (playing games where children are eliminated)	21.6	13.3	−8.4	(−25.9, 9.1)	.23	(0.14, 0.29)
Team size (games are small-sided, 5-v-5 or smaller)	1.0	9.3	8.2	(0.2, 16.2)	.31	(0.24, 0.39)
Uninvolved teachers and children
Teacher verbally promotes/encourages physical activity	6.4	13.5	7.2	(1.5, 12.9)	.18	(0.11, 0.26)
Students are off task or uninvolved	6.0	2.0	−4.0	(−7.8, −0.1)	.06	(−0.02, 0.13)

CI: confidence interval.

Based on 1,280 SOFIT+ scans during motor content, statistically significant changes are bolded.

Discussion

This study examined the effect of a novel CBPR-based professional development training programme on PE teachers’ incorporation physical activity promotion strategies aligned with the LET US Play principles and subsequent changes in the percent of time children spent in MVPA during PE. Teachers’ incorporation of all the LET US Play principles changed in the desired direction with three of the five changes reaching statistical significance. Correspondingly, the percent of time boys and girls spent in MVPA during PE increased by 5.8% and 3.9%, respectively.

Changes in children’s activity

The PACES intervention successfully increased the percent of time both boys and girls spent in MVPA during PE lessons. The intervention led to a 3.9% increase (baseline: 22.7% vs post-assessment: 26.6%) for girls in the percent of time in MVPA and a greater increase for boys (5.8%, baseline: 33.2% vs post-assessment: 39.0%). These increases are similar to previous interventions targeting increases in MVPA during PE. Van Beurden et al. (2003) produced a 4.5% increase in percent of time in MVPA during PE, while Fairclough and Stratton (2005) produced a 5.6% increase in girls MVPA during PE. It is impossible to compare these results to those reported from the SPARK intervention (one of the most prominent and widely disseminated elementary PE interventions to date), as data are only presented as differences between control and intervention groups at outcome (Sallis et al., 1997). Furthermore, most SPARK research has assessed students’ physical activity during PE using the System for Observing Fitness Instruction Time as opposed to accelerometers. This makes direct comparisons problematic as the activity codes included in SOFIT have been shown to overestimate MVPA when compared to accelerometers (Saint-Maurice et al., 2011). One previous study evaluated SPARK physical activity outcomes with accelerometers and SOFIT but the results were mixed. Accelerometers showed a 7.1% reduction in MVPA and SOFIT showed a 14.0% increase in MVPA from baseline to post-assessment. Thus, interpreting the effectiveness of the intervention approach used in this study to other PE interventions is challenging because of the differing, sometimes conflicting and incomplete estimates of changes in MVPA from past interventions. However, the LET US Play training did increase MVPA for both boys and girls over a relatively short time-frame (January–April 2015) and appears to be a promising approach.

One particularly important finding is that PACES increased MVPA the most for the least active boys. Boys at the 25th quantile increased MVPA by 9.0% from baseline to outcome (baseline: 18.0% vs outcome: 27.0%). This is a 3.2% greater increase than the mean increase in MVPA of 5.8%. Strategies that target the lowest active students are important because the least active children are at most risk of negative health consequences related to low levels of MVPA. This is a unique finding of the PACES PE intervention. To the best of the authors’ knowledge, no other PE interventions have examined increases in low active students’ MVPA as a result of intervention. While this finding is novel, it is not surprising. Previous experimental work that modified common games via the LET US Play principles not only produced increased MVPA, but also reduced the variation in children’s accumulated MVPA during these modified games when compared to games played with traditional rules (Brazendale et al., 2015). This finding is likely because the LET US Play principles focus on identifying uninvolved children, encouraging those children to get involved and providing activities that involve all children.

However, this same finding was not true for girls. While girls at the 50th and 75th quantile increased MVPA by 5.7% and 5.1%, respectively, girls at the 25th only increased by 2.9% from baseline to outcome. The mean percent increase in MVPA for girls was also relatively smaller than that for boys (i.e. 3.9% vs 5.9% vs 3.9% increase for girls and boys, respectively). While it is unclear why this is the case in this study, it is not inconsistent with other large-scale interventions targeting increases in girls’ physical activity (Ignico et al., 2006; Klesges et al., 2010; Pate et al., 2005; Webber et al., 2008). Effects on girls’ activity levels in most interventions have been minimal and girls continue to be less active than boys during PE (Hollis et al., 2015; Riddoch et al., 2004) and throughout the day (Troiano et al., 2008). Thus, understanding why this is a consistent finding is a pressing public health issue and strategies to increase girls’ physical activity, and especially strategies to increase the least active girls physical activity, should be considered in future iterations of this intervention and other interventions targeting increases in children’s physical activity.

Changes in LET US Play incorporation

Similar to previous studies in afterschool programmes (Weaver et al., 2014a), and summer camps (Weaver et al., 2014b), working with the PE teachers to identify contextually appropriate physical activity promotion strategies aligned with the LET US Play principles was able to change the behaviours of teachers. In addition, the LET US Play training was much less resource intensive than many previous PE interventions. For example, SPARK PE requires the purchase of curricula, equipment and trainings. In the original evaluation of SPARK, teachers received up to 32 hours of initial training and bi-weekly to bi-monthly follow-up training visits (Sallis et al., 1997). Similarly, another intervention included five professional development workshops each lasting 3 hours to enhance PE teacher’s instructional skills and create action plans for promoting physical activity (Sallis et al., 2003). This was in addition to providing new curriculum and materials and bi-monthly school site consultations for PE teachers. By contrast, the study described herein included an initial 1-hour training, along with 2 90 minute follow-up technical support sessions, and produced comparable increases to other interventions with substantially reduced input of resources.

An important component of this intervention is that the LET US Play principles are aligned with quality teaching principles (Rink, 2010). Therefore, the LET US Play principles are accommodating for teachers who are already using effective teaching behaviours and can be easily incorporated into teachers’ routine practices. A key advantage of using the LET US Play principles is that their alignment with effective teaching ensures that teachers can promote MVPA while also maintaining a strong focus on important educational goals of PE, such as motor skill acquisition (Society of Health and Physical Educators [SHAPE] America, 2013).

This study has several strengths. First, the use of accelerometers as an objective activity monitor and a simple easily transferable intervention are strengths. Limitations include the lack of a control group and the limited number of participant teachers and schools. Further research is needed to confirm the preliminary findings from this pilot study.

Conclusion

Initial indications are that professional development trainings targeting the LET US Play principles can change teacher behaviours and the percent of time children spend in MVPA during PE. However, these results are preliminary with further development of the professional development training and more rigorous scientific testing needed.

Footnotes

Acknowledgements

We would like to acknowledge the teachers and administrators at our participant schools for their support of the PACES project.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

References

Alliance for a Healthier Generation (2012) Facts on physical education. Available at: https://www.healthiergeneration.org/_asset/02bbrr/08–727_PEFactSheet.pdf

Beets

Weaver

Moore

et al . (2014) From policy to practice: Strategies to meet physical activity standards in YMCA afterschool programs. American Journal of Preventive Medicine 46: 281–288.

Beets

Weaver

Turner-McGrievy

et al . (2015) Making physical activity policy practice: A group randomized controlled trial on changes in moderate-to-vigorous physical activity in afterschool programs. American Journal of Preventive Medicine 48: 694–706.

Brazendale

Chandler

Beets

et al . (2015) Breaking tradition: Maximizing children’s physical activity by modifying traditional games with the LET US Play principles. Preventive Medicine 76: 14–19.

Elmakis

(2010) Survey of Physical Activity in Elementary School Classrooms in the State of Virginia. ProQuest LLC. 789 East Eisenhower Parkway, PO Box 1346, Ann Arbor, MI 48106.

Evenson

Catellier

Gill

et al . (2008) Calibration of two objective measures of physical activity for children. Journal of Sports Sciences 26: 1557–1565.

Fairclough

Stratton

(2005) Improving health-enhancing physical activity in girls’ physical education. Health Education Research 20: 448–457.

Fairclough

Stratton

(2006) A review of physical activity levels during elementary school physical education. Journal of Teaching in Physical Education 25: 239–257.

Flag House (2012) CATCH: Coordinated approach to child health. Available at: http://www.flaghouse.com/Catch.asp?Category=Athletic&AltTab=Catch&srccode=902080

10.

Hollis

Williams

Sutherland

et al . (2015) A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in elementary school physical education lessons. Preventive Medicine 86: 34–54.

11.

Ignico

Corson

Vidoni

(2006) The effects of an intervention strategy on children’s heart rates and skill performance. Early Child Development and Care 176: 753–761.

12.

Institute of Medicine (2013) Educating the student body: Taking physical activity and physical education to school. Available at: http://www.nationalacademies.org/hmd/Reports/2013/Educating-the-Student-Body-Taking-Physical-Activity-and-Physical-Education-to-School.aspx

13.

Israel

Coombe

Cheezum

et al . (2010) Community-based participatory research: A capacity-building approach for policy advocacy aimed at eliminating health disparities. American Journal of Public Health 100: 2094–2102.

14.

Israel

Schulz

Parker

et al . (1998) Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health 19: 173–202.

15.

Kealey

Peterson

Gaul

et al . (2000) Teacher training as a behavior change process: Principles and results from a longitudinal study. Health Education & Behavior 27: 64–81.

16.

Klesges

Obarzanek

Kumanyika

et al . (2010) The Memphis Girls’ health Enrichment Multi-site Studies (GEMS): An evaluation of the efficacy of a 2-year obesity prevention program in African American girls. Archives of Pediatrics & Adolescent Medicine 164: 1007–1014.

17.

Kuczmarski

Ogden

Guo

et al . (2002) CDC growth charts for the US: Methods and development. Vital and Health Statistics Series 11 246: 1–190.

18.

Locke

Latham

(2002) Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American Psychologist 57: 705–717.

19.

Lonsdale

Rosenkranz

Peralta

et al . (2013) A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons. Preventive Medicine 56: 152–161.

20.

McKenzie

Nader

Strikmiller

et al . (1996) School physical education: Effect of the child and adolescent trial for cardiovascular health. Preventive Medicine 25: 423–431.

21.

McKenzie

Sallis

Prochaska

et al . (2004) Evaluation of a Two-Year Middle-School Physical Education Intervention: M-SPAN. Medicine and Science in Sports and Exercise 36: 1382–1388.

22.

Pate

(2009) A national physical activity plan for the United States. Journal of Physical Activity and Health 6: S157.

23.

Pate

O’Neill

McIver

(2011) Physical activity and health: Does physical education matter? Quest 63: 19–35.

24.

Pate

Ward

Saunders

et al . (2005) Promotion of physical activity among high-school girls: A randomized controlled trial. American Journal of Public Health 95: 1582–1587.

25.

Quené

Van den Bergh

(2004) On multi-level modeling of data from repeated measures designs: A tutorial. Speech Communication 43: 103–121.

26.

Quinn

Strand

(1995) A comparison of two instructional formats on heart rate intensity and skill development. Physical Educator 52: 62–69.

27.

Riddoch

Andersen

Wedderkopp

et al . (2004) Physical activity levels and patterns of 9-and 15-yr-old European children. Medicine and Science in Sports and Exercise 36: 86–92.

28.

Ridgers

Stratton

McKenzie

(2010) Reliability and validity of the system for observing children’s activity and relationships during play (SOCARP). Journal of Physical Activity and Health 7: 17–25.

29.

Rink

Tina

(2008) “Research on effective teaching in elementary school physical education.” The Elementary School Journal 108(3): 207–218.

30.

Rink

(2010) Teaching Physical Education for Learning. New York: McGraw-Hill.

31.

Saint-Maurice

Welk

Ihmels

et al . (2011) Validation of the SOPLAY direct observation tool with an accelerometry-based physical activity monitor. Journal of Physical Activity and Health 8: 1108–1116.

32.

Sallis

McKenzie

Alcaraz

et al . (1997) The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. American Journal of Public Health 87: 1328–1334.

33.

Sallis

McKenzie

Conway

et al . (2003) Environmental interventions for eating and physical activity: A randomized controlled trial in middle schools. American Journal of Preventive Medicine 24: 209–217.

34.

Scantling

Dugdale

Bishop

et al . (1998) The effects of two instructional formats on the heart rate intensity and skill development of physical education students. The Physical Educator 55: 138–143.

35.

School Specialty (2012) SPARK PE K-2. Available at: http://www.sparkpe.org/

36.

Simons-Morton

Parcel

Baranowski

et al . (1991) Promoting physical activity and a healthful diet among children: Results of a school-based intervention study. American Journal of Public Health 81: 986–991.

37.

Society of Health and Physical Educators (SHAPE) America (2013a) Comprehensive school physical activity programs: helping all students achieve 60 minutes of physical activity each day. Available at: http://www.shapeamerica.org/advocacy/positionstatements/pa/upload/Comprehensive-School-Physical-Activity-programs-2013.pdf

38.

Society of Health and Physical Educators (SHAPE) America (2013b) National standards & grade-level outcomes for K-12 physical education. Available at: http://www.shapeamerica.org/standards/pe/upload/Grade-Level-Outcomes-for-K-12-Physical-Education.pdf

39.

Troiano

Berrigan

Dodd

et al . (2008) Physical activity in the United States measured by accelerometer. Medicine and Science in Sports and Exercise 40: 181–188.

40.

US Department of Health and Human Services (2000) Healthy people 2010. Available at: http://www.healthypeople.gov/2010/?visit=1

41.

Van Beurden

Barnett

Zask

et al . (2003) Can we skill and activate children through primary school physical education lessons? ‘move it groove it’ – A collaborative health promotion intervention. Preventive Medicine 36: 493–501.

42.

Verstraete

Cardon

De Clercq

et al . (2007) Effectiveness of a 2 year health-related physical education intervention in elementary schools. Journal of Teaching in Physical Education 26: 20–34.

43.

Weaver

Beets

Webster

(2013) LET US Play: Maximizing children’s physical activity in physical education. Strategies 26: 33–37.

44.

Weaver

Beets

Saunders

et al . (2014a) A comprehensive professional development training’s effect on afterschool program staff behaviors to promote healthy eating and physical activity. Journal of Public Health Management and Practice 20: E6–E14.

45.

Weaver

Beets

Saunders

et al . (2014b) A coordinated comprehensive professional development training’s effect on summer day camp staff healthy eating and physical activity promoting behaviors. Journal of Physical Activity and Health 11: 1170–1178.

46.

Weaver

Webster

Erwin

et al . (2016) Modifying the system for observing fitness instruction time to measure teacher competencies related to physical activity promotion: SOFIT+. Journal of Physical Activity and Health 20: 121–130.

47.

Webber

Catellier

Lytle

et al . (2008) Promoting physical activity in middle school girls: Trial of activity for adolescent girls. American Journal of Preventive Medicine 34: 173–184.

48.

Webster

Caputi

Perreault

et al . (2013) Elementary classroom teachers’ adoption of physical activity promotion in the context of a statewide policy: An innovation diffusion and socio-ecologic perspective. Journal of Teaching in Physical Education 32(4): 419–440.

49.

Webster

Beets

Weaver

et al . (2015) Rethinking Recommendations for Implementing Comprehensive School Physical Activity Programs: A Partnership Model. Quest 67(2): 185–202.

50.

Young

Phillips

et al . (2006) Effects of a life skills intervention for increasing physical activity in adolescent girls. Archives of Pediatrics & Adolescent Medicine 160: 1255–1261.