Physical Environments for Active Schools: Future Directions for Transdisciplinary Research

The rise in childhood obesity coincides with children spending more of their formative years in child care or school environments, settings found to be strong predictors of children’s physical activity. Although most efforts focus on the social environment of the school, studies show there is potential to develop better evidence-based design guidelines for interventions in the physical environment that can afford more physical activity and support or complement other initiatives. In the context of the school, multiple studies long established that physical activity is correlated with time spent outside, but more recent studies found that the intentional design of outdoor spaces to have certain characteristics results in more participation of different groups and higher physical activity generally. However, there are many documented physical and social barriers to going outside, some of which could potentially be overcome through better design of the relationship between inside and outside, but there has been far less research into how the physical environment of the school building enables or hinders going outside in the first place. This article reviews and summarizes important findings in the literature that provide evidence of the effects that the physical environment of the school has on children’s health and resilience generally, andon their physical activitymore specifically; presents field observations from research on the design of schools in Finland—one of the best school systems in the world in one of themost challenging climateswith a strong tradition of outdoor learning and frequent time outside; and identifies gaps in knowledge and future directions for transdisciplinary research specifically focused on the design of active schools. INTRODUCTION: PHYSICAL ENVIRONMENT AND HEALTH Understanding the effects of the physical environment on children’s health is important to make better policy, guidelines for design, and decisions on capital investments. This is critical because medical researchers have found that children’s less mature systems are more susceptible to environmental hazards and that they have manymore years of life to develop problems (1). In turn, the opportunity for early life interventions can potentially influence healthy habits and behaviors that can positively shape their adult lives. Notably, the increasing rate and earlier onset of childhood obesity, which can have long-term Northeastern University, Boston, MA Address for correspondence: Michelle Laboy, P.E., M.Arch., M.U.P., School of Architecture, Northeastern University, 151 Ryder Hall, 360 Huntington Avenue, Boston, MA 02118 (E-mail: m.laboy@northeastern.edu). 2379-2868/0417/0155–0164 Translational Journal of the ACSM Copyright © 2019 by the American College of Sports Medicine http://www.acsm-tj.org Copyright © 2019 by the American College of Sports Medicine. Unauthorized repro effects on health, coincides with children spending increasingly longer portions of their most formative years in child care or school environments, places often considered an untapped opportunity to intervene early and effectively to learn healthier habits (2,3). Ecologicalmodels in public health suggest that the physical and sociocultural surroundings affect the health and wellness of people and that effective interventions operate at multiple levels, from physical environments to policies and educational programs,which promote physical activity (4). While recognizing the need for multilevel strategies, this article is focusedmore narrowlyon the physical environment: the physical space outside the person’s body, both its natural and constructed characteristics, which may be modified to influence health positively or negatively. Evaluating the available evidence of the physical environment’s effects on health generally, and through physical activity more specifically, suggests that the way the built environment affects children is not always similar to the way it influences adults. A goal of this research is to understand the current state of research on the physical environment for all age-groups, identify the similarities and differences specific to children, and find potential for new evidence in the school environment that may guide future transdisciplinary research directions. Studies have found the child care center or preschool that a child attends to be one of the strongest predictors of physical activity (5,6), which in turn affects obesity, and yet studies on the influence of specific attributes of the environment are considered lacking (2)—especially ones that isolate or comprehensively examine many attributes of the school’s physical environment. A recent review of the literature on the effect of the built environment on people’s physical activity concluded that future studies should examine context-specific physical activity and develop context-specific models and frameworks (7). Although context-specific studies of schools are beginning to guide policy and program interventions, there is an opportunity to develop transdisciplinary research that could also guide better evidence-based design, regulations, and investments in a physical environment that supports the success of other efforts to ensure better outcomes. Translational Journal of the ACSM 155 duction of this article is prohibited. This article summarizes the most important findings in the literature that provide evidence of the effects that the physical environment of the school has on children’s health and resilience generally, and on their physical activitymore specifically; presents field observations from research on the design of schools in Finland—one of the best school systems in theworld in one of the most challenging climates with a strong tradition of outdoor learning and frequent time outside; and identifies potential gaps in knowledge and future directions for research specifically focused on the design of the physical environment of active schools, which can support physical activity, social competence, and better learning in children. THE STATE OF RESEARCH ON PHYSICAL ENVIRONMENT AND PHYSICAL ACTIVITY OF ALL AGE-GROUPS Increased urbanization, growing population, digital technology, food systems, pollution, climate change, and other factors transforming the natural and built environment—which may hinder or support healthy habits and outcomes including physical activity—are areas of increasing interest to researchers, policy makers, and designers, thanks to several important studies in recent decades, which were reviewed for this article and will be mentioned in this and the following sections. A broad review of the literature indicates that these studies generally take on two forms: (a) determination of correlates, where researchers make observations of attributes of the social or physical environment and measure health outcomes to find if there is strong correlation, and (b) designing interventions in environments that are suspected to have a certain deficiency or barrier and measuring the effect of those interventions in a particular health outcome or behavior. In both types of studies, it is important to be able to make effective observations and accurate measurements of, and creative interventions in, the physical environment. However, often research teams do not include physical–spatial design expertise. A recent study explicitly mentioned architectural coherence as a potentially important contributor to physical activity, but self-admittedly had to leave this characteristic unexplored because of the lack of expertise of researchers in design considerations (8). Better studies may be more comprehensive and better supported by expertise in spatial–environmental design combined with research experience designing valid and appropriate methods to measure effects and outcomes. Studies examining correlates of the physical environment and physical activity, and its related health outcomes, cover a broad range of ages and characteristics of the physical environment. For example, historical changes in clothing, the closest component of the physical environment to our bodies, are hypothesized to have decreased our energy expenditures (caring for them) and increased our ability to withstand various environments (making exercise more comfortable) (9). Buildings, as extensions of our clothing to provide shelter, are where people spend a significant portion of their lives to be protected from the weather. Attention to the interior configuration of space, especially building circulation systems where people move from one place to another, is theorized to have effects on people’s desire and motivation for physical activity. For example, building elements like stairs, which are often hard to find or unattractive, can be designed to encourage people to choose them over elevators, from simple signage strategies to improvements that make them more open, accessible, and attractive (10). The design of the office environment, specifically the amount of natural light, 156 Volume 4 • Number 17 • September 1 2019 Copyright © 2019 by the American College of Sports Medicin shows correlations with a person’s sleep and vitality, which show a tendency towardmore physical activity when compared with artificial light—albeit it remains unclear if it is the cause or the effect (11). The design of the urban context also affects health, and especially on physical activity. Whether it is improved accessibility (8), the convenience of accessing building and park facilities (12,13), their physical location, and the time of year (14), these factors appear to influence whether a person is more likely to engage in physical activity. Transportation, land use planners, and community designers have an especially strong record of research on correlates, specifically between physical activity and land use; what has been called the triple D of “density, diversity, and design” (8); and other qualities of communi