School Physical Activity Policy

This article provides a general summary of school physical activity policies, addresses the appeal of policy as means to increase school physical activity, identifies general policy research approaches and findings, and outlines perspectives on future policy research in schools. It begins with an overview of the elementary school physical activity environment, distinguishes policies from practices, and outlines why school physical activity policy can be considered as a viable solution for improving population-level physical activity and health. Next, it describes relevant aspects of policy and provides an overview of policy-related research aims and findings. Lastly, it provides perspectives on policy research efforts that are needed to support evidence-based advocacy efforts. INTRODUCTION Articles throughout this special issue have highlighted decades of physical activity research and the substantial contributions it has made on improving our understanding of its relationship to both physical and mental health. Yet despite our current and growing understanding of the vital importance of physical activity, most of the population, including children, do not meet physical activity guidelines (1). Over the past three decades, many social, technological, occupational, and environmental advances have fundamentally shifted the way we live, work, and play. Although these advances have addressed and solvedmany problems, they simultaneously intensified the problem of physical inactivity. With so many modern touchof-the-button conveniences, we have engineered physical activity out of everyday living. Therefore, perhaps themost extraordinary public health challenge of our time is how to make physical activity an easy choice, especially in environments where members of the population spend their greatest proportions of time—homes, communities, workplaces, and schools. We have spent our careers addressing the challenge of increasing children’s accrual of moderate to vigorous physical activity (MVPA) in school environments. Collectively, we have California State University Long Beach, Long Beach, CA; San Diego State University, San Diego, CA; and California State University Fresno, Fresno, CA Address for correspondence: Monica A.F. Lounsbery, Ph.D., College of Health and Human Services, California State University Long Beach, 1250 Bellflower Blvd, Long Beach, CA 90840-5805 (E-mail: monica.lounsbery@csulb.edu). The views reflected in this article do not constitute endorsement by the American College of Sports Medicine. 2379-2868/0417/0173–0178 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 published well over 300 articles on schoolrelated physical activity with most aimed at improving children’s MVPA in physical education (PE), at recess, and through before, during, and after school programs. A significant proportion of our recent work has focused on school physical activity policy—the topic of this article. In this article, we provide background on school physical activity policy and its appeal for addressing physical inactivity. In addition, we present general research approaches and findings and outline our perspectives on future research needs. We begin by providing an overview of the school physical activity environment, distinguishing policies from practices, and outlining why school physical activity policy is widely viewed as a viable solution to improving population-level physical activity and health. Next, we describe relevant aspects of policy and provide an overview of related research aims and findings. Lastly, we provide our perspectives on research approach needs, andwemake the case for more calculated research efforts to support evidencebased advocacy. ELEMENTARY SCHOOL PHYSICAL ACTIVITY ENVIRONMENT Regular physical activity engagement is important for children’s growth, development, and health. The revised 2018 National Physical Activity Guidelines recommend that children engage in MVPA for at least 60 min daily (2). Most do not meet guidelines, and some are at increased health risk—girls and childrenwith disabilities, living in unsafe neighborhoods, and/or being part of an ethnic minority group (3,4). From a public health perspective, there has never been a greater need for schools to provide and promote physical activity, especially because they reach all children, regardless of race/ethnicity, disability, and socioeconomic status. Further, more than 35 million children attend elementary schools for approximately 175 d·yr, making it an ideal setting not only for providing and promoting physical activity but also for increasing and sustaining it at the population level (5). PE and recess provide opportunities for children to be physically active. They are institutionalized as part of the school day in most elementary school settings. As well, recent efforts have been made to expand school physical activity opportunities to include classroom activity breaks, before and after school programs, and active transport (walking/biking) to and from school. Meanwhile, the federal reauthorization of Translational Journal of the ACSM 173 duction of this article is prohibited. the Elementary and Secondary Education Act of 2001, known as “No Child Left Behind,” has led to reductions in physical activity programs and resources (6), and today, fewer than 3% of elementary schoolchildren receive physical education every day (7,8). SCHOOL PHYSICAL ACTIVITY POLICIES AND PRACTICES Lack of progress in improving school physical activity programs has motivated interest in school physical activity policy. From an ecological perspective, policies change the guiding principles and procedural structures that relate to target behaviors (9) and therefore, in the school environment, have the potential to shape the function (e.g., aims, scope, and expected outcomes) and structure (e.g., how much, how often, and delivery personnel) of programs. For interventionists, policies hold wide appeal because once they are established, they remain part of the environment and affect target behaviors in a sustained manner. School physical activity policies aim to change aspects of the prevalence and delivery of school physical activity program practices. Practices include not only the frequency and the duration of programs (e.g., PE, recess, before, during and after school programs, and classroom physical activity breaks) but also the aspects of the program content, how it is delivered, and by whom. Practices also relate to more indirect aspects of programs like staff training, program funding, and design, use, and maintenance of school facilities. Numerous studies of school-based physical activity have been conducted, and this research has identified multiple evidence-based school practices that more fully optimize children’s activity. This research has guided the development and promotion of school physical activity policy recommendations (10). The relationship between policies, children’s access to physical activity programs (including program minutes), and children’s actual engagement in physical activity is complex, and research in this area is relatively new. Although there are some studies (11,12), including those examining the effects of state policies (13,14), research on school policy and its direct relationship to children’s physical activity is limited. In particular, there is little clarity on how specific policies contribute to children’s objectively measured physical activity in schools. Although there is a paucity of research with this focus, there are multiple factors that moderate the impact policy can have on children’s physical activity. For example, even when enacted, we know many schools do not fully comply with policies (15). Further, research has shown that school physical activity programs are commonly provided in ways that do not fully Figure 1: Ecological model of school physical activity policy and children’s ph 174 Volume 4 • Number 17 • September 1 2019 Copyright © 2019 by the American College of Sports Medicin optimize the accrual of MVPA (16). Therefore, even when schools were in full compliance with a policy, the nature of the programs and their deliverymay hamper children’sMVPA accrual. Thus, in addition to having a policy in place (policy enactment) and school adherence to the policy, it is imperative that the program be a quality one that incorporates evidencebased practices. Studying school policies and their direct effect on children’s physical activity is multifaceted and complex because of the nested nature of physical activity, practices, and policy and classes within schools, schools within districts, and districts within states. Figure 1 demonstrates this complexity by illustrating the different levels of policy (e.g., state, district, and school) and how policies at these levels may influence children’s physical activity directly or indirectly. These different levels of enactment, adoption, and implementation result in substantial variation at subsequent levels and in individual children’s physical activity—all of which have not been examined empirically. Level of policy enactment, school compliance, and school practice are all important contextual aspects to consider when formulating physical activity policy research questions. Next, we describe these and other aspects of policy as essential considerations for school physical activity policy research efforts. For each area, we generally describe research approaches, findings, and gaps. ASPECTS OF POLICY Policy Enactment and Advocacy Surveillance studies, particularly those conducted systematically over time, help to identify the prevalence of and changes in school physical activity policies and practices. For example, the School Health Policies and Practices Study is an effort undertaken by the Division of Ad