Childhood obesity is a serious national health problem. Approximately 17% of children ages 2 to 19 are obese, and this number is rising.1 Today's children are more sedentary and are faced with poor nutritional choices compared to the generations before them. The relationship between sedentary behaviors and obesity is well documented,2,3 and the amount of physical activity performed in schools continues to decline.4
Childhood obesity is now a priority for the nation. The "Let's Move" campaign, developed with federal guidance and led by Michelle Obama, seeks to provide healthy foods in schools, improve access to healthy, affordable foods, and to increase physical activity by children of all ages.5 The goal of the program is laudable: returning the childhood obesity rate to 5% by 2030. Two key indicators will monitor progress toward this goal: the number of children eating a healthy diet and the number of children meeting recommended activity guidelines.5
Children should engage in moderate activity on most days of the week for 60 minutes.1,5 But U.S. children continue to fall short of this goal.6 Schools are a venue that can provide opportunities to meet this goal, but most children get little physical activity in school. Despite the many documented benefits of exercise, funding to schools is based on academic success alone. Therefore, schools often increase classroom time at the expense of school-based physical activity programs.
Being physically active and maintaining a healthy body weight are essential to the overall well-being of children. Increased physical activity and the development of fundamental movement skills have a beneficial effect on preventing childhood obesity.7 The American Academy of Pediatrics (AAP) recommends that children engage in at least 60 minutes of physical activity daily and that sedentary behavior be limited to less than 2 hours per day.8
Activity tends to decline from elementary to middle school, and this trend continues through high school. Recent data show that black and Hispanic youth are less physically active than their white counterparts, particularly black and Hispanic girls.4
The National Association for Sport and Physical Education (NASPE) states that physical education at school provides students with instruction in physical activity, health-related fitness, physical competence and cognitive understanding about physical activity. The long-term goal of physical education is for students to adopt healthy, physically active lifestyles that will continue into adulthood. A quality physical education program includes daily physical education, a curriculum that meets the National Standards for Physical Education Student assessment, a certified physical education teacher providing meaningful content through standards-based instruction, a pupil-to-teacher ratio equivalent to the classroom, and adequate equipment to promote maximum practice time.9
During the school day, recess provides children with an opportunity for unstructured or structured active, free play. According to NASPE's position statement on Recess for Elementary School Students, all elementary school children should have at least one period of recess daily for a minimum of 20 minutes. The position statement also provides information about the importance of recess for a child's physical, social and academic development.9
Extracurricular physical activities occur outside the regular school day. They include physical activity clubs, intramural sports and interscholastic sports. Physical activity clubs and intramural sports provide enjoyable participation in physical activity and enable students who do not compete in interscholastic sports to be physically active with their peers. Sports can be within the school (intramural) or between schools (extramural).
Health Benefits of Physical Activity
Physical activity reduces the risk for childhood obesity and the risk for diabetes.10 It improves psychological well-being and contributes to self-confidence.11 Recent studies have documented beneficial effects of exercise in older adults, including improvement in brain function.12-14 Less research has examined the effects of exercise on the development of brain functioning in children, but new evidence shows that physical activity and exercise can improve students' concentration and cognitive functioning.15 Studies have also shown that children who are more physically active tend to perform better academically.16-18
A physically active lifestyle is integral to ensuring that children and adolescents are reaching their full potential. The development of a physically active lifestyle is an attainable goal for all children. Assisting children and adolescents in adopting a physically active lifestyle is integral to the health education and promotion services delivered by healthcare providers in a variety of settings. Physical activity must be promoted at home, in the community and at school, but school is perhaps the most encompassing way for all children to benefit. Since children spend more than half their day in school, it is reasonable to expect that this environment be used to promote a healthy lifestyle. To effectively engage in physical activity promotion in the school setting, exploring the relationship between physical activity and academic performance is necessary.
A child's self-efficacy, as well as social influences, are positively correlated with more intense physical activity.19 Peer and family social support also contribute to a child's physical activity levels. Parents exert a significant influence on the physical activity levels of their children by modeling behaviors that can influence it.20 In the case of adolescents, peer influence and social support can influence physical activity and sedentary behaviors.21 These social norms are a powerful influence on their involvement with physical activity.
Lack of opportunities to engage in physical activity is thought to contribute to the low levels of physical activity in children. Access to greater recreational opportunities is vital to encouraging and maintaining children's physical activity. This includes safe parks and recreational areas.22 Safety is a requirement for children to play outside. Living in a neighborhood with a high crime rate is significantly associated with a decrease in physical activity.23 Additionally, the influence of physical environment is also an important determinant of physical activity levels. Certain factors in the environment, such as a lack of sidewalks, long distances to schools, and the need to cross busy streets, discourage walking and biking to school. Eliminating and modifying these obstacles can promote more physical activity.
Physical Activity in Schools
The school environment is an important influence on the physical activity of children and adolescents. Schools offer many opportunities for young people to engage in physical activities.
The National Association of State Boards of Education (NASBE) recommends 150 minutes per week of physical education for elementary school children and 225 minutes per week in middle and high school students.24 A 2006 survey of private and public schools found that 63% of elementary schools, 83.9% of middle schools and 95.2% of high schools required physical education. However, only 3.8% of elementary schools, 7.9% of middle schools and 2.1% of high schools with existing requirements provided daily physical education classes for all grades for the entire year.6 A survey conducted in 2012 found that a majority of states mandate physical education classes for public schools, but only six require physical education in every grade.25
Opportunities for children to become physically active are decreasing. Despite goals and recommended standards for school time spent on physical education and activity, few states have legislative policies that increase time or opportunities in school.
Physical Activity and the Brain
An emerging body of evidence has documented the beneficial effects of aerobic activity on various aspects of brain function. Cognitive functioning is usually assessed through paper-and-pencil or computerized testing. New technology in the field of neuroimaging is also being used to examine the link between exercise and cognition.15
The impact of physical activity on learning, cognition and academic achievement in children can be maximized through school-based physical activity. The Centers for Disease Control and Prevention (CDC) recently looked at academic-related outcomes of school-based physical education, recess, classroom-based physical activity and extracurricular activities. The analysis concluded that school-based physical activity had either a positive effect on academic achievement or did not detract from academic outcomes.26
Making an Impact
NPs and PAs play an important role in promoting health and wellness. Through a holistic approach that cultivates the growth of the child and sets him or her up for healthy development, increased physical activity can be a key weapon in the fight against childhood obesity. An essential component of healthy living is performing recommended amounts of physical activity. In the face of a growing obesity epidemic, there is a nationwide need for preventive action to fight childhood obesity. NPs and PAs are in a unique position to provide direction to families, schools and communities.
1. Centers for Disease Control and Prevention. Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 through 2007-2008. 2010. http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm#figure1
2. Sundquist K, et al. Increasing trends of obesity in Sweden between 1996/97 and 2000/01. Int J Obes Relat Metab Disord. 2004;28(2):254-261.
3. Rey-López JP, et al. Sedentary behaviour and obesity development in children and adolescents. Nutr Metab Cardiovasc Dis. 2008;18(3):242-251.
4. Eaton DK, et al. Youth risk behavior surveillance United States, 2011. MMWR Surveill Summ. 2011;61(4):1-162.
5. White House Task Force on Childhood Obesity. Solving the Problem of Childhood Obesity Within a Generation. 2010. http://www.letsmove.gov/white-house-task-force-childhood-obesity-report-president
6. Lee SM, et al. Physical education and physical activity: results from the School Health Policies and Programs Study 2006. J Sch Health. 2007;77(8):435-463.
7. Waters E, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD001871.
8. American Academy of Pediatrics, Council on Sports Medicine and Fitness and Council on School Health. Active healthy living: prevention of childhood obesity through increased physical activity. Pediatrics. 2006;117:1834-1842.
9. National Association for Sport and Physical Education. Comprehensive School Physical Activity Programs. 2008. http://www.aahperd.org/naspe/standards/upload/CSPAP-Final-7-22-13-2.pdf
10. Callahan ST, Mansfield MJ. Type 2 diabetes mellitus in adolescents. Curr Opin Pediatr. 2000;12(4):310-315.
11. Ussher MH, et al. The relationship between physical activity, sedentary behaviour and psychological wellbeing among adolescents. Soc Psychiatry Psychiatr Epidemiol. 2007;42(10):851-856.
12. Ahlskog JE, et al. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc. 2011;86(9):876-884.
13. Churchill JD, et al. Exercise, experience and the aging brain. Neurobiol Aging. 2002;23(5):941-955.
14. Voss MW, et al. Exercise, brain, and cognition across the life span. J Appl Physiol. 2011;111(5):1505-1513.
15. Hillman CH, et al. Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev Neurosci. 2008;9(1):58-65.
16. Chomitz VR, et al. Is there a relationship between physical fitness and academic achievement? Positive results from public school children in the northeastern United States. J Sch Health. 2009;79(1):30-37.
17. Fedewa AL, Ahn S. The effects of physical activity and physical fitness on children's achievement and cognitive outcomes: a meta-analysis. Res Q Exerc Sport. 2011;82(3):521-535.
18. Trudeau F, Shephard RJ. Physical education, school physical activity, school sports and academic performance. Int J Behav Nutr Phys Act. 2008;5:10.
19. Strauss RS, et al. Psychosocial correlates of physical activity in healthy children. Arch Pediatr Adolesc Med. 2001;155(8):897-902.
20. Wright MS, et al. A qualitative study of parental modeling and social support for physical activity in underserved adolescents. Health Educ Res. 2010;25(2):224-232.
21. Springer AE, et al. Social support, physical activity and sedentary behavior among 6th-grade girls: a cross-sectional study. Int J Behav Nutr Phys Act. 2006;3:8.
22. Tucker P, et al. Environmental influences on physical activity levels in youth. Health Place. 2009;15(1):357-363.
23. Popkin BM, et al. Environmental influences on food choice, physical activity and energy balance. Physiol Behav. 2005;86(5):603-613.
24. National Association of State Boards of Education. Fit, Healthy, and Ready to Learn: A School Health Policy Guide. Arlington, VA: National Association of State Boards of Education; 2000: 27-31.
25. National Association for Sport and Physical Education, American Heart Association. 2012 Shape of the Nation Report: Status of Physical Education in the USA. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance; 2012: 15-66.
26. Rasberry CN, et al. The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature. Prev Med. 2011;52(Suppl 1):S10-20.
Theresa Jill Fryer is a family nurse practitioner who lives in Jacksonville, Fla. She has completed a disclosure statement and reports no relationships related to this article.