Partnering with Schools to Implement Physical Activity Interventions

INTRODUCTION Physical activity plays a key role in the development of children’s sensory system and brain functions that create neural connections necessary for learning, memory and coordination, and, consequently, academic performance (1). Children who regularly engage in physical activity perform better in tasks that include motor control, problem solving, and attention. The U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans ages 6 and older, based on scientific research, recommends that children engage in a variety of age-appropriate and enjoyable physical activities for 60 minutes (1 hour) or more daily (2). Specific guidelines also suggest: Aerobic Activities: Most of the 60 or more minutes per day should be either moderate- or vigorous-intensity aerobic physical activity. Vigorous-intensity physical activity should be included at least 3 days per week. Muscle-strengthening activities: Include muscle-strengthening physical activity on at least 3 days of the week as part of the 60 or more minutes. Bone-strengthening activities: Include bone-strengthening physical activity on at least 3 days of the week as part of the 60 or more minutes. Although the benefits of physical activity are well documented, almost 80% of children are not engaging in enough physical activity to promote positive health outcomes (3). The prevalence of those meeting physical activity recommendations is not equitable among demographic sectors. Social and environmental circumstances can deter children’s ability to be physically active. For many children, participation in physical activity outside the school may be limited because of logistic or financial reasons, especially among minority or low socioeconomically disadvantaged communities (4). For example, not having access to safe after-school activities or sidewalks for playing or walking to parks may negatively impact physical activity engagement. During these formative years, it is essential for children to learn the skills necessary to participate in a variety of physical activities, thus aiding in their development and achieving physical literacy that nurtures long-lasting healthy behavior changes for future generations (5). Daily physical activity is associated with many health benefits, including, but not limited to, risk of obesity, cardiovascular disease, type 2 diabetes (non–insulin-dependent), and metabolic syndrome (2,6–9). Furthermore, several research syntheses regarding school-based physical activity and academic performance (e.g., cognitive skills and attitudes), academic behaviors (e.g., concentration, attentiveness, time on task), and academic achievement (e.g., GPA, test scores) concluded that maintaining or increasing time dedicated for physical activity during the school day does not negatively impact, but rather, may positively impact students’ academic performance, behaviors, and achievement (1,10,11). In fact, a review of associations among physical activity, fitness, cognition, and academic achievement concluded that physical activity does not negatively affect cognition or academic achievement, and results are disseminated as an American College of Sports Medicine (ACSM) Position Stand “Physical Activity, Fitness, Cognitive Function, and Academic Achievement in Children: A Systematic Review” (12).PURPOSE The purpose of this Clinical Applications column is to provide health and fitness professionals with strategies to partner with schools to achieve their mission of developing healthy children. COMPREHENSIVE SCHOOL PHYSICAL ACTIVITY PROGRAM Because schools serve nearly 56 million children, they are the ideal setting for promoting and improving physical activity, with scientific evidence strongest for implementing multicomponent programs (1,13). The Society of Health and Physical Educators (SHAPE America) and the U.S. Centers for Disease Control and Prevention recommend that all schools implement a comprehensive school physical activity program (CSPAP), a multicomponent approach by which schools use all opportunities for students to be physically active, meet the nationally recommended 60 minutes of physical activity each day, and develop the knowledge, skills, and confidence to be physically active for a lifetime (14,15). See the Figure and the Table for the components and descriptions of a CSPAP.Figure: Comprehensive Physical Activity Program (CSPAP) (14,15).TABLE: Components and Descriptions of a Comprehensive School Physical Activity Program (CSPAP) (14,15)PHYSICAL EDUCATION PARTNERSHIP The national recommendations for quality physical education (PE) of 150 minutes/week in elementary and 225 minutes/week in middle school and high school students (16) are barely met because many schools do not have PE in their curriculum and have limited time for free play during recess. PE should be taught by physical educators who have been properly trained from accredited teacher preparation programs and adhere to national standards (17). A quality PE program allows children sufficient opportunities to learn meaningful PE content with appropriate instruction and is the foundation on which children develop skills to become and stay physically active. Health and fitness professionals can partner with physical educators to administer fitness tests; develop, implement, and evaluate fitness programming; and collaborate in professional development opportunities in PE, fitness workshops, and conferences. BEFORE- AND AFTER-SCHOOL PARTNERSHIPS Having convenient, reliable access to open space and recreational areas can be challenging for communities. Research findings indicate that there is a positive association between proximity to recreational facilities and increased physical activity levels (18). The American Heart Association and the National Physical Activity Plan encourage the use of school recreational spaces for communities (19,20). Health and fitness professionals can partner with schools to improve physical activity opportunities for children by encouraging after-school organizations, clubs, student groups, and parent groups to incorporate physical activities into their programs and events (1). These programs offer students opportunities to be physically active and learn sport and fitness skills. Programs may include a walking club or intramural programs, a supervised open gym or open playground, integrating physical activity in homework during out-of-school hours, and interscholastic sports. Finally, before- and after-school physical activity programs can be coordinated with community-based organizations (e.g., YMCAs, community parks and recreation) and delivered in school settings, providing benefits to the students, families, and community members. FAMILY AND COMMUNITY ENGAGEMENT PARTNERSHIPS Improving children’s physical activity levels requires multisectorial attention — including collaboration among schools, businesses, policy, advocacy, nutrition, recreation, planning, transport agencies, and health care organizations (20,21). The communities’ capacity to develop and support physical activity programming so that it is sustainable is an important aspect of health promotion interventions (22). Health and fitness professionals can borrow school facilities that offer clean, protected, and often underused space that community members can use for physical activity. Another example of a partnership would be Parent Teachers Associations/Organizations (PTAs/PTOs) or parent-teacher-student associations (PTSAs). These formal organizations are composed of parents, teachers, and staff who are intended to facilitate parental participation in a school (23). PTAs/PTOs are organized bodies with individual bylaws in agreement to national standards. The common goal of the PTAs/PTOs is to advocate for children’s well-being. In most of the schools, PTAs/PTOs organize before- and after-school activities, fundraising, and sport club activities. Health and fitness professionals can contact members of PTAs/PTOs to start a fitness club. Sometimes, PTAs/PTOs already have money set aside for activities, or they can create fundraising opportunities and even apply for several grants. Sport-specific clubs also are very popular and affordable, and allow children to be active while their parents are at work. PHYSICAL ACTIVITY DURING SCHOOL As described earlier, research shows that schools help students meet national physical activity recommendations without detracting from academic performance (11). Health and fitness professionals can serve as consultants for schools or simply train teachers in strategies to incorporate physical activity during school hours by increasing the number of active breaks in the classroom with activities that are of short duration, high intensity, and enjoyable for students in a reduced space. STAFF INVOLVEMENT Staff involvement in a CSPAP can enhance the overall culture of physical activity at a school as well as improve staff health. Administrators, teachers, aides, and other school staff members can integrate physical activity into classroom academic instruction and breaks, and support recess, intramurals, and other physical activity offerings. Health and fitness professionals can host an information session describing physical activity recommendations for adults and children, physical activity prevalence, national standards, and assessment. Furthermore, providing data about school fitness levels compared with state and national benchmarks is an excellent strategy to elicit partnership support from school administrators, teachers, parents, children, decision- and policy-makers, and other key stakeholders. CONCLUSIONS In conclusion, the health and fitness professional is positioned to aid schools in achieving their mission of developing and supporting children’s well-being and academic success. The most important aspect of developing a partnership is to clearly ask for what is needed for a quality, physical activity partnership. It is recommended, and research indicates, that the establishment of a shared use agreement that clearly delineates the roles and responsibilities of schools and organizations can help to ease potential concerns that schools may have regarding liabilities. Specific agreements have been found to be more successful in building mutually beneficial partnerships than if shared use agreements were more vague or informal (24). Health and fitness professionals and school administrators have shared goals. A health and fitness professional can clearly outline to administrators strategies to build a mutually beneficial, quality, physical activity partnership.

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